DAVID L. KATZ MD, MPH, FACPM, FACP, is the founding (1998) director of Yale University’s Prevention Research Center. He received his BA from Dartmouth College in three years (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.
Dr. Katz 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 medical director for the Integrative Medicine Center at Griffin Hospital in Derby, CT. He is the principal inventor of the NuVal nutritional guidance system, currently in roughly 1700 US supermarkets in more than 30 states, coast to coast. He holds 5 U.S. patents on other inventions, with several patents currently pending.
Dr. Katz has published nearly 200 scientific articles and textbook chapters; innumerable blogs and columns; nearly 1,000 newspaper articles; and authored or co-authored 15 books to date, including multiple editions of textbooks in both Nutrition and Preventive Medicine.
Caryn Hartglass: Hello everybody we’re back, I’m Caryn Hartglass, your listening to Its All About Food and we have another half hour about talking about my favorite subject “food” I love food and I just don’t love it because I enjoy eating food, I love what good it can do for it. If we chose the right foods now food can be good or it can be bad and we’re learning more and more about which foods are health promoting and which foods can do a little damage. So the goal as we were talking about in the last half hour is to live a long quality life, we’re all going to move on at some point, my father likes to say, nobody gets out this world alive and that’s true but we should be living joyfully, we should be feeling good, we should be able to do as much as we want until maybe 150 years later when we get a little tired and we can move on. Okay so let’s talk about doing that some more with powerful foods and I’m going to bring on my second guest Dr. David Katz. He’s the founding Director of Yale University’s Prevention Research Center. He received his B.A. from Dartmouth College, His MD from Albert Einstein College of Medicine and his MPH from Yale University School of Public Health. He’s a two-time diplomat of the American Board of Internal Medicine, Board Certified Specialist of Preventive Medicine of Public Health and a Clinical Instructor in Medicine at the Yale School of Medicine and so much more. You can go to Responsibility and Living.com and read more of all the wonderful things that Dr. David Katz has been up to, but right now we’re going to be talking about his new book Disease Proof, Welcome to It’s All About Food, Dr. Katz.
Dr. Katz: Thank you Caryn, Good to be with you.
Caryn: I’m sure you don’t remember this but a few years back I was on the Doctor Oz show, it was one of these anti-cancer prevention shows and I told my story and then you came on and were pointing out all the colorful and wonderful plant food and what to eat and that’s when I first learned about you.
Dr. Katz: Very nice.
Caryn: Live and in person. Let’s talk about your book, Disease proof, now my first question for you is how did you get so smart and make the connection between health and food because most doctors who were trained about the time you were really haven’t gotten that message.
Dr. Katz: They sort have dropped that ball. That’s really too bad. The title Disease Proof really tells the story we can, to a remarkable degree, use food as medicine, use lifestyle as medicine and the evidence is incontrovertible that we could cut our life time risk of all major chronic disease, heart stroke, cancer, stroke, diabetes, dementia by a staggering 80%. There’s nothing in all of biomedical advance to reveal that. There’s never been a noble prize for anything that could rival that potential. That’s why I’m on that space; actually I naturally gravitate toward the big picture when I was training in medicine taking care of really sick people in the hospital. I couldn’t help but notice how often hospital beds were filled with desperately sick and very unhappy people who never needed to get that sick in the first place. I did a subsequent residency in preventive medicine and focusing on disease prevention. If you’re paying attention it isn’t long before you fall in love with the transformative power of lifestyle as medicine and then the issue becomes, as you really work in that space, year after year after year. The problem isn’t that we don’t know what, we sure know what the medicine is; the trouble is we don’t seem to know how. We don’t seem how to get the medicine to go down. That’s what disease proof is about. It’s really a book about how.
Caryn: Well that’s what I love about it and I read a lot of books, a lot of diet books, and a lot of books about health. I think my favorite piece is what you call skill power.
Dr. Katz: I think it’s a critical missing piece of the puzzle, Caryn, so than you for noting that. We talk a lot about will power and clearly to get any job done, you have to care and we can call that will power. Think of something as commonplace and mundane as riding a bicycle. You can’t ride a bicycle just with will power. You have to learn how to ride a bicycle and generally somebody who knows how to ride a bicycle teaches you and once you know how, you know how forever. There’s just all sorts of things, in life, that we get started because we care and then we learn how and that’s really what skill power is. In the modern world eating well is not the path of least resistance, and if you want to get there from here you need the skill set to be able to identify more nutritious foods. Identify more nutritious food that doesn’t cost more. Identify opportunities to prepare nutritious food that are convenient and efficient and family friendly. The opportunity to love food that loves you back not trade off good taste for good health. All of this is skill dependent. Those skills can be taught. They can be learned and they can be applied but you know what Caryn, and the same is true of the physical activities types. This is why I need you and I appreciate you recognizing the importance of that because essentially I’m bringing my reader a whole different scenario. The easy way to get on the bestseller list is to promise the moon and stars, there’s a magical formula just do this.
Caryn: There’s one on the best sellers list right now that does that.
Dr. Katz: Exactly right, and there’s always is, I’m saying haven’t we had enough? I mean, if any fad diet was ever going to work wouldn’t we had already been there? The issue is this, false promises prove false. They just don’t stand up overtime. I want to enter into a contract with you. I have the skill set for healthy living. I’m a beneficiary of it every day. My wife is, my five children are. It’s real. It’s sustainable. It’s not just about losing weight it’s about finding help. It’s not a flash in the pan, but there is no magic. I can teach it. You’ve got to learn it. You’ve got to apply it. I don’t have any pixie dust. My hope is readers are ready for that. It’s truly empowering. It’s transformational but I’m telling my readers. I can’t sprout wings and fly you there. You actually have to sign up and do the job of learning the skill set. It’s worth it.
Caryn: I’m looking at the cover of your book, Disease Proof: The Remarkable Truth About What Makes Us Well, the skills you need to slash your risk of heart disease, cancer, diabetes and more by 80%. It doesn’t mention weight loss and I was curious about that because a lot of publishers want you to put weight loss on the cover because that’s what people want to grab.
Dr. Katz: It is about weight loss.
Caryn: It is about weight loss.
Dr. Katz: Frankly, obesity is the canary in the coalmine of chronic disease. When you consider the burden of heart disease, cancer, stroke, diabetes, dementia in our society, you’re not going to fix that unless you fix obesity. So the book is absolutely about weight loss but that’s an easy sale, lose 30 pounds in 27 minutes. Enough of that nonsense. I’m really interested in finding health. Now it turns out many people need to lose weight to find health but it’s part of the bigger story. The prize isn’t a number on the scale. The prize is vitality. The prize is a better life. More years in life, yes. More life than years and the other problem with weight loss the way we do it in our culture is it’s a go at it alone thing. Parents go on diets and leave their kids behind. Disease proofing, finding health is something you absolutely want to pay forward to everybody you love. It’s one of those beautiful things were the more you share it the better you get at it because you support one another. In fact, yes Disease Proof is about losing weight if that’s what you need to do. It’s about more than that. It’s about the prize. A life well lived. A life vital, energy to do all the things you love to do. There’s no gimmickry even on the cover, you say, there’s no attempt to say you can lose a whole bunch of weight. Enough! It really is time for us to recognize the basic functional unit of our lives as a family, the people that we care about. If we need to lose weight, let’s do it with them. Let’s not leave everybody behind. Let’s find health together and share it and share the joy of it. Life is better when you’re healthy. Healthy people have more fun. I believe everybody can get there, but I believe most people lack the skills in the modern world. That’s the reader part of the contract. To read the book, learn the skills, apply the skills and accept going in that there will be no magic wand or pixie dust involved.
Caryn: I like to say you don’t know how good you can feel. You just don’t know how good you can feel until you’re on a healthier diet. Sometimes that’s a hard sell, people don’t know how good they can feel and they think you’re blowing air.
Dr. Katz: Yes. It’s amazing how good you can feel. There’s some fairly obvious sort of rock back on your heels opportunities. One of the things I point out. I always as a doctor obviously, I seen, over the years, patients with every imaginable condition and many confined to wheelchairs for various reasons. I think there is a basic human response to see somebody whose dynamism, whose vitality is limited. If we see somebody in a wheelchair and we feel sorry for them. We hope it’s temporary, but whether temporary, what happened? What’s wrong? And that’s too bad. Yet most of us, with a perfectly serviceable pair of legs don’t do very much with them. We’re constantly looking for an opportunity to avoid indulging our native animal vitality. I agree with you completely. Optimal food is not just food that’s good for you. It’s food that’s good. This is about loving food that loves you back. That’s really the emphasis … there should not be a choice between the joy of good food and the joy of good health, it should come together. Physical activity is the same. If you don’t like spandex or pumping iron… Move any way that floats your boat. You’re actually right, Caryn, you can’t imagine how good you’ll feel when you cultivate vitality and set it free. Life is better. There’s no question about it. Living is the privilege of that. You want to share it. You look around… I’m a fifty-year-old guy with five kids and a desk job but I weigh what I weighed when I graduated high school. Hike, bike, ski.
Caryn: You look pretty good.
Dr. Katz. Thanks. Most people half my age, and it’s not because I’m a better guy. It’s because I got a skill set. I’ve seen so many of my patients over the years squander their vitality and it’s so sad and it can stop. We can pay it forward to the next generation because this is just as relevant for our kids and our grandchildren. We can give them a better life and a better future if we disease proof ourselves.
Caryn: This skill power thing, I’m really liking it a lot. I like how you put that when you have a goal, something you want to do, you have to learn the skills to get there. It’s very empowering because a lot of people knock themselves when they have to lose weight or when they’re hit with a debilitating disease or something physically bothers them and it’s easy to blame themselves or easy to say, I can’t do this but web you realize everything we’ve done in life we’ve learned how to do. You have to learn. I like to say find your kitchen. I say this all the time and listeners probably hear me say it too many times. But, we don’t know how to make food. We don’t know what we’re eating. We have to learn.
Dr. Katz: Exactly, that’s a skill too. Just a quick example. Several hundred pages of the book are filled with the skills for this that and the other thing, but just a quick example of the advantage of skill power because when you rely on will power what you are trying to do is hard. You’re trying to do what you don’t want to do or trying not to do it. What you do want to do… an example would be, I got a sweet tooth, I eat too much sweets, I should stop. It’s making me fat and sick. The will power to that approach to that problem is do I have to give up dessert? But you want dessert. It’s calling out to you. So there’s a desperate struggle there and usually in time you lose when you make the decision your willpower’s at its peak, you take the leap based on inspiration – like a New Years resolution. The New Years Resolution never lives to the see the crocuses come up because it wears off. That’s the will power process approach I have to give up dessert. The skill power approach and we lay this out in detail in the book is there is actually stealth sugar hiding in all sorts of food you never realized were sweet in the first place. Every supermarket in the country sells marinara sauce side by side on the shelf. One has more added sugar than ice cream topping and the other has none. You wouldn’t even notice the difference because you’re not looking for it. Well once you learn to look for it. You look for it. You chose the one that doesn’t have the sugar and you do the same when you buy salad dressing and crackers and chips and bread and so forth. The net effect of this is your taking gram after gram after gram of sugar out of your daily diet and your already much better off because you don’t have all that sugar and you don’t have all those calories. If you did nothing else you’d be better off than when you started but because you’re no longer bathing your taste buds in all of that sugar that was hiding foods. They wake up. They come out of their coma. They go through rehab and they become more sensitive to the sugar that you are still eating. All of a sudden that dessert you thought you’d love starts to taste a little too sweet and not giving it up and trading it for something better is no longer dependent on will power, it’s something now you want to do. You can rehabilitate your taste preferences by trading up choices that are easy to do and the rising tide lifts all boats, and you actually start to improve all of the choices you make and again because you become more sensitive to sugar you’re not sacrificing sugar you actually prefer food less sweet and that sets you well on your way toward loving food that loves you back. You do the same thing with salt. You do the same thing with other aspects of nutrition. There’s an enormous opportunity to apply skills and relieve the burden we place on will and what we wind up doing is we ask too much of will power. It lasts awhile, it wears out. We fall off the wagon and then not only did we fail to get the health results we wanted but we blame ourselves for our failure and we beat up on ourselves and we self incriminate and it’s a very toxic thing. Again if you are trying to ride a bike you’ll keep falling off until you give up. If you know somebody who knows how to ride a bike and is willing to teach you and you’re willing to learn a few easy lessons you will know how to ride that bike for the rest of your life. The skills for being healthy are much the same.
Caryn: Now most Americans are on a very bad diet over the last 100 years especially, the last 50 years due to Industrialization and marketing and changes in our food system and government subsidies and tax structures. We have been encouraged to make bad choices and here we are in a really bad situation. Our disease care is thriving and our economy is not. So many people are unfortunately are suffering. I say this book has something really basic that can help most Americans move to a better place.
Dr. Katz: Thank you Caryn and in fact, I do the same. I tie it in with the Affordable Care Act, so called ObamaCare and healthcare reform because really what’s being reformed is disease care and I’m a supporter of the reform but it’s the tip of the iceberg. The CDC is projecting that unless we disease proof ourselves to a substantial agree, 1 and 53 Americans will be diabetic by the middle of the century. Well that’s one hundred million people with diabetes. We only have 27 million now and we can’t pay the bills already. Yes, The power to transform our personal faith, faith of our family and probably the fate of our nation resides more with each of us than anywhere else. We can make our nation more vital, more solvent by making ourselves healthier and this is true healthcare reform, but nobody is going to do this for you, the power resides with you. It’s an extraordinary opportunity. It’s totally evidence based. We make the case right on the cover of the book 80% reduction chronic disease. That’s not plucked out of the air. We cite study after study after study confirming that we can do exactly that. We site the study showing that DNA is not destiny. There’s study to show you can alter gene expression in the way it changes your risk for developing cancer or redeveloping cancer or for cancer progressing. This is also good for people that have chronic disease and want to modify the course of chronic disease. We have incredible latent power. We like to say that knowledge is power, but that’s only true if you use it. Knowing what but not knowing how is failing to put the promise of an 80% reduction in chronic disease to us that’s incredible lack of power. This book is designed to fix that. It’s an empowering dose of really transformative truth. I’ll do my part. I’ll share the relevant skills as long as the reader does their part and says ok, I’m not going to look for magic here. I want the practical magic of skill power. I’m willing to sign that contract and do my part of the bargain and learn how to do this.
Caryn: You mentioned a number of different diets that people are following these days and there’s a bunch of them where there are a lot of similarities and then some clear differences. I’m a Vegan. I’ve been a Vegan for 25 years and I’m quite passionate about it because I never wanted to kill animals and I realized the powerful impact on the environment as well as health but there are unhealthy vegans and there are all kinds of Vegan diets. There’s all kinds of diets period but then when you try to fine tuned there’s all kinds of whatever it is your following and there’s all kinds of Paleo diets now. They’re all over the place and you mentioned them and found your approach all encompassing.
Dr. Katz: Thank you. Well. I don’t have a dog in the race for one thing. I don’t care what diet is best for health. I’m not an ideologue. I care about the truth and so I review the evidence subjectively. I’ve done this in a number of contexts. Right now I’m finishing up the third edition of my nutrition textbook for physicians of the healthcare professionals nutritional clinical practice. That has over 5000 scientific references in it. So it’s a birdseed view of the relevant literature. I’m a best diet reviewer for US News and World Report and I recently finished an invited peer review paper for Annual Reviews in Public Health entitled “Can We Say What Diet Is Best For Health?” and my job in all these situations is to objectively review all of the evidence. The answer is, Caryn, first of all, I fully support your Veganism and I think Veganism done well is kinder, gentler, better for the planet and clearly one of the contenders for best diet laurels but not everyone wants to be a Vegan and it’s a mistake to assert that being a Vegan is the only way to have a healthy diet. What about that Mediterranean diet? There are many variations on the Mediterranean diet in the blue zones as there are low fat, plant-based diets and there are more than there are Vegan diets. Essentially what’s very well established in this time sensitive literature, we’re talking about health. It’s the basic theme of healthy eating for human beings. We are not clueless about the basic care and feeding of Homo sapiens. We know that theme, frankly, Michael Pollan, pretty much nailed it, “eat food, not too much, mostly plants” and then there’s room for variation on that theme. It could be only plants, it could be vegan. It could be Vegetarian where you include dairy and eggs. It could pesca-vegetarian. It could be a Mediterranean style diet. There are variations on that theme and the beauty of that is just the truth about what we know. It’s the truth about what we don’t know and it’s the latitude for you to be in charge of your life. I tell every one of my patients and I tell my readers, I’m not the boss of you. My job is to do my job. To be an expert, provide expert guidance and knowledge imparted to you and then let you chose how to use it to suit your life. The fact that there are variations on the theme of optimal eating puts you in the driver’s seat where you belong and you’ve chosen to drive for Veganism. It’s an excellent choice. It’s not a choice everybody’s going to make and I think that’s okay. You could choose an omnivorous Mediterranean diet as long as it’s mostly plants. The evidence we have suggested that in terms of human health outcomes it’s just as good. You know if you combine that with whatever animal products you eat choosing, being sensitive to issues of how the animals are being treated and how they are raised. I think potentially, that to can soften the effect we’re having on the earth. I think that’s an important issue. There are 7 billion of us. That’s the game changer. You know we have to think differently about food when there’s 7 billion of us even if it’s good for human health to be omnivorous, we have to change the way we’re omnivorous just because there’s so many of us and the high environmental cost of that. Again, I don’t advance a particular diet because of ideology. I wrote a column for the Huffington Post awhile back entitled Separation of Church and Plate and I find people just argue for their favorite diet with a great deal of religious zealotry and they leave the science behind. The clearest indication of that, Caryn, is the equally smart, equally credential people make mutually exclusive claims. The problem is all fructose or lately we’re hearing the problem is wheat and gluten but we got other people with just as many adherence, arguing that the problem all along is animal food or the problem is just dairy. If anyone of them is right, all the others are wrong, more logically they’re just latching onto one piece of the available evidence and sort of falling in love with their particular hypothesis. I don’t indulge myself in that. I’m very careful not to do it.
Caryn: Here is what I like to see. I like to see everybody get healthy. I like to see everybody reducing their animal products and their junk food products and eating more plant foods. When everybody is fit and trim and healthy, then we can really start talking about the ideal diet and we’ll have a lot, a bigger pool of people that fuel it.
Dr. Katz: I totally agree with you. The one thing that’s perfectly clear is that we’re a hell of along way from there now and we are reaping the world wind. It’s just incredible what’s going on all around us that we accept as normal. Again, 50-year-old guy. People my age routinely drop dead of a heart attack. I can’t imagine the possibility of that. There’s just so much energy and vitality at this stage in my life and our kids are succumbing to what used to be adult onset diseases. Type 2 diabetes in childhood should not exist. It shouldn’t exist a generation ago. It just didn’t exist and it keeps getting worst. We’re allowing this to happen. We talk about junk food as if it’s a legitimate food group. We wouldn’t build anything we care about out of junk. You wouldn’t build a house out of junk. You wouldn’t build a car out of junk.
Caryn: Some people do.
Dr. Katz: Well maybe, maybe but the idea that we, sort of, look on and complacently watch the growing bodies of children and grandchildren we love get constructed out of junk. Some are shocking. This sort of thing when you take the blinders off, you say wow what were we doing? That only takes you so far. Ok, now I know there is a problem I want to do something about it but I don’t know how to fix it. Well that’s what we have to change and if everybody is empowered to be the solution in their life, I’m with you. I think we can get there. Absolutely, once we come along…
Caryn: You know how we have to get there, David? We have to have our doctors especially telling us this because many doctors don’t. They quickly brush over “Oh you can change your diet… well here’s a pill” A lot of people think their doctor is God.
Dr. Katz: Well, I don’t know, they used to Caryn, As a Doctor myself, I see less and less. In fact, people routinely surf the Internet. They come in with information and what I encounter often is that somebody who spent two hours surfing the net think they know as much as somebody who has 9 years of post graduate education. I think we can err in both directions. Anybody listening who thinks their doctor is God, they’re not God they’re fallible. I totally agree with you that doctors should be part of the solution and I’m working very hard to make that so, along with three additions of nutrition textbooks, teaching nutrition to medical students and residents. My colleagues and I have also developed a free online course for doctors that offer continuing medical education credit called Online Weight Management Counseling for Healthcare Professionals. We talk about that in the book but where we may differ Caryn, I’m not sure we do, as a doctor myself; I think doctors are a small part of the solution here because fundamentally, at its origins, this is not a clinical problem. It’s a cultural problem. Doctors and clinics, hospitals and the bio medical establishments, we’re about treating disease. We do very little to build health at its origin. Health is built with lifestyle and it’s built in the places we live and, love and learn and work and pray and play and doctors have very little influence on all of that. The advice they give should be good. The guidance they offer should be relevant. The counseling we do should be constructive and compassionate. I always argue if you just wag your finger at a patient and say don’t you realize you should lose weight you make them feel about an inch tall and if their height goes down and their weight doesn’t, they actually raise their body mass index. That’s counterproductive all of that has to stop. Clearly we can do better than that but this is a cultural problem. We need cultural medicine to solve this and frankly culture begins under our roof. We talk about family values. Well, health can be a family values, and the culture of your household starts to take you towards health and again, I think that this proof offers the exact skill set to set that in motion. That’s what it’s for.
Caryn: Well thank you very much. Thank you for joining us on It’s All about Food. Thank you for all the work that you’re doing and you’re somebody that walks the walk and we need more like you.
Dr. Katz: Thank you so much Caryn. It’s a pleasure to join you.
Caryn: Okay be well.
Dr. Katz: You too.
Caryn: Okay, that’s it. It’s All about Food, thank you.
Dr. Katz: Very good.
Caryn: Bye Bye. We’ve come to the end of It’s All About Food, I’m Caryn Hartglass. Send me an email. I love to hear from you: firstname.lastname@example.org. You can visit my website http://ResponsibleEatingAndLiving.com because that’s what is all about, I think anyway. All right, have a delicious week.
Transcribed by Marci Skinner, October 29, 2013