Healthy People Have More Fun with David Katz, MD, MPH, FACPM, FACP, FACLM

[00:00:00] Dr. David Katz: Health is not a moral imperative. Health is an opportunity. Health is a currency. The only currency you can spend on more time and more energy to do the things you love to do. Other things being equal, healthy people have more fun. I don't think we share that message. I don't think we convey the value proposition of health.

[00:00:21] Dr, Melinda Ring: This is Next Level Health. I'm your host, Dr. Melinda Ring, Director of the Osher Center for Integrative Health at Northwestern University. On this show, we explore ways to take actionable steps towards optimizing our health with leaders in the integrative, functional, and lifestyle medicine fields who believe in science backed and time tested approaches to well being. Let's take your health to the next level. Welcome.

[00:00:53] Dr. Melinda Ring: Today's guest, Dr. David Katz is a renowned leader in lifestyle medicine. With a career long mission to improve public health by preventing chronic disease and promoting health and nutrition.

 as the founding director of Yale University's Prevention Research Center, past president of the American College of

Lifestyle Medicine and founder of the non

profit True Health Initiative, Dr.

Katz has really been at the forefront of advancing evidence based strategies to combat chronic disease. He's also the founder of Diet ID, chief medical officer for Tangelo, a leading food as medicine

company, and a

senior science advisor to Blue Zones. Dr. Katz is one of the most prolific. Authors, I know, over 200 peer reviewed publications, 19 books, including a leading textbook in nutrition that I use with my own trainees. So today we'll explore one of my favorite topics, food as medicine, and dive into why lifestyle interventions are just so important. so essential for managing chronic health conditions. Welcome to the show, Dr. Katz.

[00:01:59] Dr. David Katz: what a lovely introduction. so much. So good to be

[00:02:03] Dr. Melinda Ring: Thank you.

Thanks for taking the time so let's start at the beginning of your journey in lifestyle medicine. In 1993, which was the same year that a pivotal article was published in JAMA, the Journal of the American Medical Association. And I've heard that you mentioned this paper profoundly influenced you. It's the course of your career. Can you share a little bit about what it reveals and how it inspired your focus?

[00:02:29] Dr. David Katz: I graduated medical school in 1988, and then I finished my training in internal medicine in 1991. And in 1993, I finished my second residency in preventive medicine, public health at Yale, got my MPH.

And I was pretty clear that I wanted to leverage diet and lifestyle to prevent chronic disease, to add years to lives and life to years. But I wasn't really sure what the focus of my research career would be.

 and then this paper came out that you mentioned, so this was 1993 the authors are Bill Foege and Mike McGinnis. And this paper basically said everything we think we know about causes of death is A distraction, if not a delusion, and fundamentally unhelpful.

First, death certificates are routinely filled out by sleepy medical residents in the middle of the night, and you just want to be done and go back to bed, so you're not really providing a great deal of informative detail. But second, typically what you list are the proximal causes of death. If someone dies from cardiogenic shock, secondary to congestive heart failure, secondary to myocardial infarction, that's as far as the death certificate information goes. What caused the myocardial infarction or the multiple myocardial infarctions? And even if you take it a step further and say atherosclerotic disease of the coronary arteries, what caused that? Well, McGinnis and Foege asked that question. What caused the stuff that caused the death? And in that paper, they enumerated a list of 10 factors, which collectively were the root causes of premature death in the United States and explained almost all of it, except for a rounding error. And Way back in 1993, so we're talking more than 30 years now, all of those factors were already Modifiable with information at our disposal. Now some of them, like diet and physical activity, were modifiable by individuals, at least potentially. And some of them, like exposure to toxic chemicals in the environment, or guns, or traffic accidents, were really more modifiable by actions of the body politic, policy, reforms, regulation, and so forth. But they were all modifiable. We had the knowledge to modify them. We weren't, we just weren't translating that knowledge into the power of routine action. And knowledge may be prerequisite to power, but it's clearly not commensurate with power if you don't translate what you know into what you do. So I read this paper and said, damn, that's a complete reorientation of my research career. If we could prevent 80 percent of chronic disease and premature deaths simply by addressing what we already know, I cannot justify a research career. focused on probing the unknown question. I need a research career focused on translation, turning what we know into what we do. There are a lot of questions still to ask, but they're not the what questions, they're the how questions. We, we know that the what, we don't know every last bit of the what. Preventing 80 percent of premature death and chronic disease isn't everything. There's still that 20 percent residual. But wow, it would be the single greatest advance in the history of public health if we eliminated 80 percent of heart disease, cancer, stroke, diabetes, dementia. That's what we're talking about. Imagine that world. That's an incredible advance. And for that to happen, we don't need to know new things. We need to know how to use the knowledge we already have. So, I developed a career in translational research and the rest is history. Everything I've done really has been an attempt to turn that knowledge about adding years to life, adding life to years, preventing chronic disease, preventing premature death into the power of routine action. We still have a long way to go. Forty years later, we still have a very long way to go, but that's what I've been trying to do.

[00:06:15] Dr. Melinda Ring: And yet, since that article was published in 1993, We've had

increasing costs, increasing burden of chronic disease.

[00:06:26] Dr. David Katz: chronic disease, more obesity, more chronic disease, beginning at every younger age. Yeah. we're losing the war and, and, and, you know, when, when you work really hard in an area, you know, people recognize your work as you did with your lovely introduction and, and it's all very nice, but we also need to be brutally honest with ourselves. And so, you know, when people say nice things about me, I say, thank you very much, but I'm failing and, and everybody working alongside me is failing. We're losing the war. The things we set out to make better are Now it, it, it may be if we want to be kind to ourselves, we could say they'd be even worse if we weren't doing what we're doing.

[00:07:05] Dr. Melinda Ring: yes,

[00:07:06] Dr. David Katz: so essentially we're the good guys, we're, we're fighting the good fight, but the bottom line is we're not winning the war. To be honest about that, and we need to address the reasons why, and when we talk more about the things I've done over the course of my career, the reason for so many different roles, so many different changes, is I just keep looking for ways to make a meaningful difference.

It's incredibly hard to Do to bend those curves. There should be less obesity. We know how to fix it. We know how to prevent it. Just not doing it. There should be less chronic disease, less diabetes, less heart disease. We know how to fix it. We know how to prevent it. We're just not doing it. So yeah, it's, uh, it, it's frustrating and, it's an adjustment at this phase of my career as a young person. I believed in my ability to make a difference. , I'm now pushing 40 years of effort in medicine and public health and you're exactly right, Melinda, we, we don't, the, the things that matter most, the metrics that are crucial are not moving in the right direction and, and so there's a certain frustration there. And a certain motivation to say, okay, I need to try new things. If what I've been doing isn't making the critical, essential difference, what can I do that might?

[00:08:15] Dr. Melinda Ring: so much of healthcare is unfortunately about economics. there is this major economic toll of chronic disease, of course, but healthcare is a business like, like any other. do you feel like it's, that's a player in what's going on that that we're not investing in prevention, that the healthcare system doesn't value that, you know, What, what's it going to take if, if we had like a magic wand that would make this happen? What, what could we do to prioritize meaningful change in our country and the world?

[00:08:52] Dr. David Katz: Wow. I mean, there's so much to say on the topic. One of my books is called The Truth About Food. It's 800 pages. I, partly, I needed a good editor. I didn't have. So, so there's that. But it's 200, 000 words, 800 pages. And The Truth About Food, you know, you can easily get it down, as Michael Pollan did, to seven words. Eat food, not too much, mostly plants. That's seven words. So I had to justify the other, 199, 000, 199, 993. pretty much everything's in the way. So, you know, culture, prioritizes the status quo because, you know, essentially the prevailing culture is the way things are.

We're destroying our health, we're mortgaging the future health of our children, we are brutally harming our fellow creatures, and frankly we're destroying the climate and planetary health. The cost could not be higher. The economic costs, the human costs. But are some entities profiting massively from the status quo? Oh yeah. And it's not just big food and big pharma. It's big marketing and big publishing, right? I mean, diet books are bestsellers one after the other and fad diet books that offer, you know, quick fix

[00:10:02] Dr. Melinda Ring: Right. This

[00:10:03] Dr. David Katz: other.

Yeah, right. Until next week when everything you heard last week was wrong again. And you know, now there's a new one, but This has been going on for decades. So massive sums of money have been made by making people fat and sick. There is no question about it. So, we do need to make the economic argument for turning the Titanic around, for turning our culture around. One other thing, there's so much that could be said of This again, I've written 800 pages on the topic, but one, one other thing I think is really important, Melinda, and that is, I don't think our culture talks about health the right way. I think all too often. We convey to one another the impression that health is something at the end of an admonishing finger. That health is a moral imperative. That if you want to be a good, virtuous person, you should be healthy. And a lot of people rebel against that. You know, just the idea, you're telling me what to do. I don't want to be told what to do. But everything about that is wrong. Health is not a moral imperative. Health is an opportunity. Health is a currency. The only currency you can spend on more time and more energy to do the things you love to do. Other things being equal, healthy people have more fun. I don't think we share that message. I don't think we convey the value proposition of health. You get to do whatever it is you like to do more. Longer, better, with more gusto. Whatever it is, you'll do it with more joy. If you're healthy. If you're unhealthy, it's going to infiltrate your life. It's going to suck time away. You're going to be spending time doing unpleasant things in places you don't want to be. At the expense of doing what you want to do with the people you want to be with and where you want to be. You want to travel, but you can't. You want to dance, but you can't. You want to go for a walk and sightsee, but you can't. And on and on it goes. And with my 30 years of clinical practice, I saw that sad reality innumerable times. People who couldn't, Enjoy what ought to have been the golden years of their lives because of chronic disease. So healthy people have more fun and I think we should market that and help people appreciate that, you know, you're not giving up what you love when you talk about improving your diet, because you can, you can learn to love food that loves you back. Everybody can do. that. And we can talk about that too. Um, some of the, you know, The best cuisines on the planet are some of the healthiest. So there's an enormous opportunity there. But it's not about trading away what you care about. It's about deriving joy from how you take care of yourself. So yeah, you want to love the food that you're eating, but you also derive joy from being healthy and vital and using that as the currency to purchase the activities that you like best and to keep doing them longer. Yeah. kind of, we're all. Hoping for the blessings of the blue zones, longevity, vitality, and a gentle exit in the fullness of time. Tis a consummation devoutly to be wished. It doesn't get better. Health can get that for you. Nothing else can.

[00:13:11] Dr. Melinda Ring: as you were talking, I was thinking of the Blue Zones as an example of where they're really trying to work to change that narrative of showing the joy of being with people, eating healthy food, living a long, active life. It just also brings to mind. To me, a patient that I had seen who was like, Oh, whenever, you know, I go to a restaurant and I have to choose, like, I'm like, Oh, I really want to, I deserve to treat myself with the burger and fries. And I'm depriving myself if I choose like the green salad with the, protein on it. And, and she had a mental shift, which was, well, what am I depriving myself of by choosing to eat that unhealthy dinner instead of the healthier choice? And that was a big aha moment for her where it was like, Oh yeah, it's actually, I want to do this. This is better for me. I'm going to have more joy, more energy, you know, feel better in my body. And so I a hundred percent agree that that's. Such an important message that we have to share with people. I think there is an addictive component to these ultra processed foods that are out there in the standard American diet.

Do you have any tips that you give people in terms of how to rehab their taste buds, how to transition to a healthier diet?

[00:14:35] Dr. David Katz: do you think people take to start to actually make that change? are acting like this is all new. We're sort of discovering the harms of ultra processed food now. And a lot of the reason for all the focus is the work of Carlos Montero at the University of Sao Paulo in Brazil and colleagues who developed the NOVA classification. So we had an operational definition of ultra processed food. Cause it used to be, you knew junk food was junk food when you saw it, but we didn't really have a definition. We now have a scientific definition so it can be studied and all of that. we're acting like we, you know, Wow, we think it might be addictive. The food industry has known for decades that it could be addictive and knew how to make it addictive and made it addictive on purpose. And this has been exposed. It was exposed in 2005 2006 in a four part expose in the Chicago Tribune entitled The Oreo Obesity and Us. And the fourth entry in that four part expose was, Where There's Smoke, There May Be Food Research Too. And to make a long story short, the team of investigative journalists who wrote these pieces had three million pages of documents under subpoena from Big Tobacco during the time of the state attorney's general class action lawsuit against Big Tobacco, the so called Big Tobacco Settlement. For young people listening, this is after your time, just look up Big Tobacco Settlement, you'll find it. But anyway, what they discovered was that the big tobacco companies like Philip Morris had corporate siblings in Big Food. So, for example, Philip Morris and Kraft Food were both owned at the time by Altria, the same parent company. And so, basically, the executives at Altria could tell the executives at Philip Morris and Kraft to work together, and they did. They said, we want your scientists to work together, share the functional MRI machine, and we want the guys working on tobacco to figure out how to get young people hooked so we can have new customers, and we want the guys working on food to figure out how to make people eat endlessly, you know, how to make it impossible to stop eating our products so that they run out and buy more and we make more money. So, you know, 2005, 2006, 20 years ago, it was already exposed that Big Food was focused on developing products. People couldn't stop eating until their arm got tired from lifting it to their mouths. And then 10 years later, in case we didn't get the memo the first time, New York Times Magazine cover story by Pulitzer Prize winner Michael Moss, The Extraordinary Science of Addictive junk food, that's the title, right? Right there in the title. I mean, Yeah, read the whole thing, but there it is, the extraordinary science of addictive junk food. It's not an accident. So yes, it's addictive. It's addictive on purpose. And so, you know, in answer to your question, what are the tips? First of all, look for foods that are delivering those to you where you can trade up. One of the things that's surprising to people is that sugar is added to almost everything in the food supply because sugar triggers appetite. so it's to the advantage of the seller, to the disadvantage of the eater, but there's sugar in pasta sauces. In fact, There's more added sugar in many marinara sauces in a jar on a supermarket shelf than in just about anything in the dessert aisle. Now you don't, you don't need to sprinkle sugar over your spaghetti. So you can find a marinara sauce without added sugar, do. And what you've now done is you've reduced your daily exposure to sugar by some number of grams. Do the same thing with salad dressing. Do the same thing with bread and crackers and chips. Importantly, do the same thing with breakfast cereal. The first ingredient in a breakfast cereal should not be sugar. It often is, especially kids breakfast cereals. On and on it goes. So we're not talking about change the pattern of your diet, change all the foods you eat. No, we're talking about stick with the foods you eat, but trade up within categories. Better pasta sauce, better salad dressing, better bread, better crackers, better chips, better cereal. we should not have to work this hard. We should not be up against willfully addictive junk food. We should not have to struggle. To achieve just a reasonable level of healthy nutrition, it's, it's wrong. It's unfair. It's not a level playing field. You know, the, the average so called soccer mom should not be up against a team of PhDs who get functional MRI machines and a bonus for designing food. She and her kids can't stop eating no matter their obesity and diabetes. It's just wrong. So it shouldn't be all on the individual, but sadly folks for now. Until or unless we get an administration that wants to do something about this, uh, it's all on you. So, yes, I do have tips and, and I I coined the phrase, tastebud rehab, must be 25 years or so ago. I think it was in a column I wrote for US News and World Report, because I'd seen this with my patients. So, you know, here they were addicted to high levels of sugar and salt and so forth. and if suif we suddenly radical changes to their diet. So we went from bad stuff to good stuff. You know, one of the most potent drivers of taste preference is familiarity. But the good news is, if you get used to a junk food diet, as those of us living in America have done, and increasingly, uh, in industrialized countries all around the world, you can change your taste preferences by changing what's familiar at any stage of your life. And this has been studied in randomized controlled trials. The first one I know of was something called the Iowa Women's Health Trial, which goes back almost half a century. Study of women with breast cancer, looking at dietary changes to improve cancer survivorship and recovery. And, and what was discovered in that study was that women who had pretty junky diets at the start and craved processed foods and so forth and rich foods when they were switched to a diet of whole food, mostly plants, within about three months they had preferences for that more natural more wholesome food and started developing aversions to the really rich, really sweet, really salty food they liked at the beginning. Well, there's a huge opportunity for all of us. So tastebud rehab is the process of Identify things in your diet that you'd like to improve for most of us eating less sugar would be good, added sugar. For most of us, eating less sodium would be good, maybe less saturated fat. Just make those changes. And you've taken gram after gram after gram of sugar out of your daily diet. Well, the advantage of that is you're soaking your taste buds in less sugar every day. Your taste buds come out of their sugar induced coma, become more sensitive to sugar, and you now start to prefer less. And when we cross that threshold, usually within just a couple of weeks, I say, okay, now that your taste buds appreciate sugar at a lower threshold, Now we can start to focus on the sweet foods. Now let's talk about soda. Now let's talk about dessert and start to make some changes there. So you do this incrementally and within 6 to 12 weeks you have dramatically altered exposure to sugar. You do the same thing with sodium. You do the same thing with processing. And the end goal of this is Taste Bud Rehab, where you actually come to prefer more and more wholesome foods, which have milder flavors. And by the way, we talked just a little bit ago about the willful addiction, the engineering of addictive junk food. I refer to that because Michael Moss has written about it so compellingly as the Moss Effect. and you can reverse engineer the Moss Effect. I don't know that Michael would appreciate that. I've never asked him, but you could reverse engineer that by going to more wholesome foods, because there's no way you can manipulate. The taste profile of broccoli, because the only ingredient in it is broccoli, nor bananas or blueberries or almonds, or, you know, pick anything you like that actually comes from some part of the natural world. There's no mucking around there. There's no engineering. It's just direct from nature. So one of the many virtues of wholesome foods direct from nature is that they fill us up on fewer calories than ultra processed foods. I I weigh at this point I'm getting older. I'm starting to shrink. I actually, I think I weigh a little less than I did in high school now, but through all these years, my weight's been completely stable and I'm not a special guy and I don't have superpowers. I, you know, I'm just, I'm an expert in nutrition. I, and I practice what I preach. I've never counted calories. I've never gone on a diet. I've just eaten wholesome food until I was full and didn't want to eat anymore. And when you eat the right kind of food, that's all you really need to do. You don't, calories count for sure, but you don't need to count them. And it's tedious to do it. So shifting to wholesome food solves the problem of weight management, which in turn makes a major contribution to solving the problem of chronic disease and excess inflammation and all that bad stuff. And so, tremendous value proposition in getting to a more wholesome diet, but you don't wind up needing to eat foods that you don't like. You learn to love the foods that love you back, and everybody has that opportunity. So that's the process I favor. Everybody can do taste bud rehab. You can do it at your own pace.

[00:23:29] Dr. Melinda Ring: you know, I hear from a lot of my patients this idea of it really needing to be all or nothing for them, you know, especially when it comes to something like sugar. And so while I am absolutely not a proponent of, of like the idea of a detox diet, like actually detoxing your body of all of these things, I will say that for some of my patients Doing something that's more black and white, where it's like really two weeks of taking it all out, is, it is almost like a cleansing of the system. And for some of them, it's harder to do the thing. Smaller incremental shifts, but, but maybe, but, you know, it's hard to know which one works better in the long run.

[00:24:15] Dr. David Katz: The patient's the boss. For 30 years of patient care, I told every patient and, and if I missed anybody and you're listening, my apologies, I meant to say this to you, you are the boss. I am not the boss of you, right. I mean, a doctor's job is to empower with, with the best possible information, to be a great coach, a good teacher, but then to say, It's your life, you're in charge. So absolutely. Some people may prefer to go cold turkey. Some people. may prefer to take a plunge and then it starts getting hard and then, and then they need the ramp. So you, you could say, okay, we're going to do, and, and, you know, detox in terms of detoxifying the body per se. We don't really need to do that with special diets. We've got organs that do that far better than we possibly could. So take good care of your liver, your kidneys, your, your lymphatic system, your circulatory system. It will take good care of you. They will take good care of you. They will detoxify you. So really all you need to do is take good care of yourself. But yeah, if you. been involved in a diet that is compromising your health and you feel that making a radical change will sort of be the jolt

[00:25:19] Dr. Melinda Ring: right. It's almost like the New Year's Eve kind of thing, you know, it's sort of like I

[00:25:23] Dr. David Katz: yeah, but The problem with New Year's Eve and New Year's resolution is it tends to be go, set, not really ready. And so people Just go and they haven't made plans and they've made no preparation. And so once it starts getting hard, they fall off the wagon. Almost no New Year's resolution survives to see the crocuses come up. So I would say. Sure, if you want a jumpstart, and, and by the way, over the years with my patients, sometimes people needed extra help and the jumpstart involved pharmacotherapy. and of course, these days we would be talking about GLP 1s potentially to change your appetite, to reduce your food intake, and, and I think using those as a springboard is a far better use than saying, I'm going to need to take this medication to manage my appetite for the rest of my life. I, I have all sorts of, Problems with that, but the idea of using this as a springboard, it's hard to make a change. I want to make a brisk change because, I want to build up some momentum. And that makes sense. you think about moving a heavy object, pushing a refrigerator, for example. There's static friction and rolling friction. Status friction is trying to get a heavy object to start moving. That's really hard. And rolling friction is to keep it moving much easier. Still not easy, but much easier. I think weight loss and improving your health, improving your diet can be thought of similarly. So anything people need to do to get moving, I can get behind as long as it's consistent with their health. But then they need a long term plan too, right? So they have to land on a dietary strategy that will allow them to to maintain this for a lifetime, to share it with the people they love, and to love the food that loves them back. So all of these elements of tastebud rehab are probably still relevant. We're just talking about sequencing here. And yeah, I, I am, I am not the boss of you. You're the boss. You're life. So I can tell you, sure, let's talk strategies. Let's talk tactics. You want to talk about time restricted eating or intermittent fasting, or you tell me what tactics you think are going to best empower you. And then I can help to contextualize that so that the overall pattern of your diet winds up being healthy, shareable, sustainable, not a diet, a lifestyle.

[00:27:27] Dr. Melinda Ring: Just to go back to the ultra processed foods and public health, because, you know, there is now, uh, you had mentioned like a change in administration on the way. Right. Um, with, um, potential candidates coming in who really are arguing against the current status quo, talking about the chronic disease epidemic, saying ultra processed food should not be allowed in public schools. So you know, I think to some degree we're hearing some messages that go along with what we're talking about, which is, you know, Yeah, there are some, there's some industry at work and public health shift needs to happen. What is your take on these messages that we're hearing and, um, how do you feel about this for the upcoming years?

[00:28:16] Dr. David Katz: So, we'll leave my personal politics and ideology out of, it, and I'll certainly, just focus on pragmatic elements. I am very aware of the rich literature on social determinants of health, and we've come to recognize, as that research has accrued over the years, that your zip code is a far better predictor of your health outcomes than your genetic code. And the single biggest driver of major adverse health outcomes, chronically in the United States and acutely during the pandemic, are social disparities. And social disparities tend to widen with laissez faire administrations that, that don't want to regulate. industry or big business, typically with such administrations, social disparity gaps widen, and that drags down public health. So my concern about where we go next, leaving any personalities out of it, is simply if we have a very anti regulatory administrative focus, the probable outcome of that, based on all available historical evidence, is a widening of social disparities. And that will not be friendly to our public health objectives. The idea that big food should be regulated in some way because we are all exposed to willfully addictive junk food makes perfect sense to me. You know, what we tend to bog down in when we do get into politics is to one side, Everybody's worried about the nanny state, I don't want the government telling me what to eat for breakfast. Well, you know at the extreme I would agree with that, I don't want government telling me what to eat for breakfast, but I've always pointed out, yeah, but in the other direction is a nanny state where nothing is regulated and maybe there's arsenic in your french fries and mercury in your ice cream because it makes them creamier or crunchier or taste better. And if you want to avoid mercury and arsenic, you have to ask. It's all on you. I don't think anybody wants to be feeding their kids in a world where they have to ask every time they buy a food item, does this come with arsenic, does this come with mercury? That's just unreasonable. Well, we could extend that principle and say we should not need to defend ourselves individually against known toxins willfully put into food. Well, if we know that ultra processing is a toxin, it causes overeating as we've seen in randomized control trials by Kevin Hall at the NIH, among others. Well then, you know, we shouldn't have to defend ourselves against that either. So policy, regulation is what government does to level the playing field. It ought to do it. So I, I celebrate the, the rhetoric that is directed at those possible changes. I worry that it's going to be very hard for any member of the incoming administration to pursue that agenda in what is likely to be a very anti-regulatory administration. So hopeful. that we may see some advances we've been fighting for for a very long time, worried that we're actually going to see a lot go in the other direction, because you can't have that cake and eat it too. You can't talk about regulating big food, which by the way, even former administrations that have been more inclined to regulate industry haven't done. Suddenly we're going to have a very anti regulatory administration come in and they're going to regulate big food. Well, I'll believe it when I see it. And if they don't, then it's all just so much rhetoric and, and no real action. So proof will have to be in the proverbial pudding because

[00:31:43] Dr. Melinda Ring: I know you've done a lot with nutrition policy, but then also the training of healthcare professionals, um, because we, we've talked a lot about like the, uh, industry's role, but what about your work in, you know, your textbook, nutrition and clinical practice that I use in my teaching, um, and this idea of a vital sign? I mean, just, uh, a month or so ago, we had the publication in JAMA of 36 new nutrition, proposed nutrition competencies for medical school. You know, what's your take on the role of the health care professional, the health care industry in fostering better nutrition for people versus leaving it to, you

know, the People to figure out on their own through Instagram and TikTok, like so many of them are doing.

[00:32:38] Dr. David Katz: Well, for one thing, I, I've, I've long been an advocate of focusing on the demand side. In other words, educating and empowering. whoever this person is, the average consumer, so that they could shop for food like a nutrition expert.

And I've, I've done all kinds of things to try and make that happen. And, and the reason that I advocate for this, and, and I've done some work on the policy side. I have colleagues whose whole careers are devoted to the policy and regulatory side, but trying to get government to regulate big industry is. is quite combative, right? Because big industry pushes back, they've got all sorts of resources. So I, I've equated that to karate, kicks and punches and blood on the floor. I mean, it's, it's, it's a fairly violent exchange. Whereas if you can change the demand, It's much more like judo. You take prevailing forces, you bend them, and everything can change. You can do a complete 180, but nobody's bleeding. And we have historical examples of this. So for example, I look back at the Atkins diet, the Atkins diet craze. Long interesting history here. Atkins first wrote his books in the 1970s, the Atkins diet revolution. They sold only okay. They came out again in the 1990s when the public was ready. Everybody had forgotten. They'd seen this before. It was called the Atkins new diet revolution. Nothing was changed except here it is again. And everybody fell in love with it. Gary Taubes wrote about it in the New York Times and tens of millions of people went on the Atkins diet. Well, the net result of that was every supermarket in the United States in the span of six to 12 weeks went from having zero low carb products. They're having dozens of low carb products and eventually hundreds. No legislation, no litigation, no sweeping policy reform, just a change in the demand. Now, it was a silly change in the demand. We were eating low fat junk food, then we started eating low carb junk food, so it's not like we did anything sensible, but it proves the power of the food demand to reshape the food supply without. Legislation or policy reform. The power resides with us every time we check out of the supermarket or bodega or wherever we shop So if we can change the demand we can change everything so what I advocate for is let's let's try to win this war on all fronts Let's help people understand that healthy people have more fun. Let's help them understand the possibility of loving food that loves them back. Let's empower them to know what their diet is now, what it could be, what the value proposition of improving it would be, how to get there from here, and let's ease that journey. Let's direct education to their health professional, in particular physicians, but really all health professionals should be educated in nutrition, so wherever they touch the clinical system, there's reinforcement for the value of getting food right. Why so important? Because diet quality measured objectively is the single leading predictor variable for premature death from all causes in the United States today. It's the single leading predictor variable for the aggregate risk of all major chronic disease. Full stop. Diet quality is the leading predictor of death and disease. So it is an abdication of fundamental responsibility for any health professional to ignore it. How can You claim to be a health professional? Any kind of health professional, when you're ignoring the single leading predictor variable for health outcomes. You cannot be. And, by the way, critically important to planetary health as well. So, you know, we could make the case even more emphatically. So it's got to be addressed. So yeah, I've spent a whole career Teaching nutrition, writing about nutrition, giving talks about nutrition, four editions of a nutrition textbook, as you've mentioned kindly. And so, yes, we need to engage the clinical system. My current work there has been largely focused through the American College of Lifestyle Medicine, where we're now pushing 14, 000 dedicated health professionals who fully embrace the value proposition of getting food right, getting lifestyle right. And the growth of that college is creating new opportunities. As is the food is medicine movement. We also need private sector innovation. So there's a lot going on with food is medicine. That's the space I work in now where we can say, okay, look, we're spending, people are spending a lot of their hard earned cash on food. Mostly it's food that's Pretty dubious. So they're buying food that makes them sick. So a lot more money can be spent on treating diseases they never needed to get. Let's shift the focus to getting the food right up front. And let's take some of That money we're effectively wasting on managing chronic disease and help people stay healthy. We could spend a lot less for far better outcomes if we did food as medicine rather than food as disease and then pharmacotherapy as medicine, which is the current prevailing standard. So I, I developed a fundamentally new way to do dietary intake assessment. So we can, we can do a comprehensive assessment of your dietary intake and generate an objective measure of your diet quality. And this is all scientifically robust and fully validated and peer reviewed and published. We can do it in 60 seconds. It's effortless, easy, even fun. You don't have to remember exactly how many donuts you've eaten in the past six months or, you know, how much pasta sauce or stuff that nobody can remember. We turned it into a game, like an eye test. Which of these looks more like stuff you eat? A or B, A or B, A or B, and in 60 seconds we've got you. And then we can say, okay, and now what would you like a better diet to do for you? Do you want to lose weight, reduce inflammation, improve cognition, manage symptoms of menopause, optimize athletic performance, treat heart disease, treat diabetes, prevent diabetes, pick any. Take any box that pertains and our algorithmic filters will go through all the different potential diets and say, these are the ones that line up against your goals. And by the way, if you have an ethnic diet to begin with, Mexican or Cuban or Vietnamese or Chinese or wherever your family's from, we can optimize that diet so you get to stay in your preferred cultural lane. and still manage your blood pressure and still manage your diabetes and so forth. So we do all of that. And then that's embedded in a food as medicine. So that's diet ID. That's embedded in Tangelo, which is a food as medicine company that can say, we know where your diet is. We know where you want your diet to be. We can deliver food to your door to help you get there. And then we need to just align the incentives. So here's where the, the administration could come in and say, yeah, we want to pay for that for Medicare beneficiaries and Medicaid beneficiaries, and we want to do it for everybody because it's the economics of getting food right are so much better than getting food wrong and then paying for pharmacotherapy and surgery and coronary bypass and dialysis. So. We need to empower the individual consumer. We need to empower the health professional. We need private sector innovation to make it easier to get there from here. And then we need government policy to align the reimbursement mechanisms to support those private sector innovations. And frankly, everybody can win. Everybody could be eating better. We could be reducing the burden of chronic disease. We could be making far better use of taxpayer money. We could be improving vitality and longevity at the population level. And, consequently, improving productivity in the economic sector, saving a ton of money on chronic disease care. So health insurers, privately insured businesses, anybody dealing with capitation or value based care, all big winners. And frankly, we will invite Big Food to reform their product offerings so that they can win too. And I don't see Big Pharma going out of business anytime soon. So there'll be some shifts in, you know, where the profits are distributed, but the overall economy would thrive. On a model that says food should be the medicine to keep people vital, rather than food should be the source of disease, and then pharmacotherapy for all.

[00:40:26] Dr. Melinda Ring: So to close, I, I like to have people, my guests, give, their one step to take to get to their next level of well being.

So what, what, is this? That's one next step that people can take to, to level up

their health.

[00:40:41] Dr. David Katz: Find the fixable elements in your life that could lead to greater joy, greater pleasure, greater vitality, but not, not vitality as a health metric. Vitality is the ability to do the things you love to do. And if food is in the way, Then the reason to make changes is, you know, is not to be ascetic and give up what you love. The reason to make changes is to get to what you love. You know, basically just the, the better, more vital version of you. I would start there and then, yeah, we could talk about the specific changes. You might make sure I eat more vegetable, you know, then it starts to get pretty obvious, pretty fast, but that's the step we overlook. Why do I want to do this? Why should I do it in a way that I can do for the rest of my life? Why should I do it in a way that I can share with the people I love so I can pay it forward? Nobody's paying forward their GLP 1 prescription, but if you focus on diet and lifestyle. Absolutely. You pay it forward to the people you love. You share it with your significant other. You share it with your children. You share it with your parents. you enrich the lives of all the people around you. It's extremely gratifying. And then, they make you stronger because if you're making these changes together, remember, in unity, There is strength. We die it alone, but we live it together. And so I think that's another critical focus. The idea that this is a lifestyle change that can be shared and by sharing, fortified.

[00:42:08] Dr. Melinda Ring: Food is love. Well, thank

you so much for sharing all of your wisdom. I could talk to you for

hours and just keep absorbing your knowledge.

 and I'm sure all of the listeners will have learned many things to share with, as you said, the other people in their lives. So thank you.

[00:42:30] Dr. David Katz: been a great pleasure. Thank you for having me.

[00:42:32] Dr. Melinda Ring: Thank you for joining me on this episode of Next Level Health. I hope you found some inspiration and practical insights to enhance your wellness journey. Don't forget to leave a comment on YouTube or review on Apple Podcasts. I'd love to hear your thoughts and suggestions for future topics or speakers. Be sure to follow Next Level Health with me, Dr. Melinda Ring, as we continue exploring the path to healthier, happier lives, together.