How COVID-19 Shines A Light On Our Broken Food System with Dr. Dariush Mozaffarian
Coming up on this episode of the Doctors Pharmacy. Our policies are not in line help or support people to eat healthy food. We have almost three and four. American adults are overweight or obese and about half of American adults have diabetes or prediabetes. Welcome to the Doctors Pharmacy. I'm Dr Mark Hyman and this is special episode focused on cove in nineteen. And I'm so lucky to have my friend and colleague Dr Dash Safari known as as friends to as Dari. Who's an extraordinary doctor? He's one of the few guys out there in academic medicine who really understands. That food is medicine and talks about it nonstop other than me. Which is pretty awesome. And he's a cardiologist. He's the Dean and John Mayer professor of at the tops. Friedman School of Nutrition Science and policy. He's professor of medicine at Tufts Medical School. He's one of the top nutrition researchers in the world and their goal at Tufts Freeman school is to produce trust the science future leaders and real world. Impact is not just an academic center. It's about focusing on policy and change in the world and there is no in medicine and academia. I know who's on more it to advance nutrition in policy frontier to speak out about the things that matter than than Dari and he has authored more than four hundred scientific publications which is unbelievable. I'd read most of them. I've quoted most of them. Well not really probably most but I read a lot of them. Have you read my bug? He's like a key feature in the book. There on how we focus on issues of obesity diabetes heart disease and evidence based policy approaches to really reduce this burden of chronic disease in the United States and globally. He's all over the place he's on visory grows in the US and caning governments the American Heart Association. The World Health Organization the United Nations and he's been featured in New York Times Wall Street Journal. Npr Time magazine and he was named as one of the world's most influential scientific minds. And I think of all the people out there talking about food and health and chronic disease food Pasi changes. There's no with more depth with more humidity and more brilliant addressing this than Dr Modifying so welcome to the Doctors Pharmacy. Wow Mark thank you so much and with that interaction we've set up the listeners for disappointment You're my hero. You're my hero. Your intellectual and hero and I learned so much from you and we want to talk today about what seems to be unrelated to Cova Nineteen which is an infectious disease but it's diet and chronic disease and you wrote an article with the former secretary of agriculture. Dan Glickman that was posted on. Cnn entitled Can Diet Flatten the curve for covert nineteen and it's sort of like How does that even make sense? So we've heard all about these ideas of fighting. The curb was social dissing handwashing washing and contact tracing an isolation testing but your article presented a very different view about how we can use food and nutrition and specific nutrients to actually help us address. This pandemic so. Can you tell us why you wrote this article and why this is more important than ever to address these issues? Yeah I think markets really clear that that to those of US following this crisis that cove nineteen has really laid bare these incredible challenges. These incredible disparities is incredible unreasonable aspects of our food system. Are there so many ways that that covered nineteen influenced student? Nutrition and nutrition Kobe. Nineteen back up at at all. Just go through quickly and we can go about each of them so you know. One is immunity the actual immune response to Cova and then you actually the blunting of the excessive inflammatory response to cove. We can talk about nutrition and actually the immune response to is is hunger and food insecurity which of course 'cause incredible human suffering with this economic shutdown lost wages at schools being closed but also we know from long clinical experience malnourishment further predispose people to infection. So that's the site and that doesn't mean and that doesn't mean skinny and wasted away could be that your nutrient deficient which is really common in America. Absolutely absolutely. There's one call hidden hunger. People look like they're getting food but there's hidden hunger because they're not getting the right the right nutrients and what's paradoxical is the most obese are often the most nutrient deficient when you look at their numbers. Right it's kind of interesting. Yeah and then. These other aspects of Kobe crucial to to you know of just quickly mention our third. The incredible intersections supply chains and food. Waste and getting food to people we. We don't really have a national food system even global food system. We have this fractured supply chain. That's now becomes you know very very dire And then I think one of the one of the most important things for really thinking about covert long term. Because this is going to be with us for for some time. Many ears is the incredible relationship between for Metabolic Health Diabetes Hypertension Heart Disease Obesity and poor outcomes with Cova. The the latest analysis from New York which has had the most cases in in the United States showed that with each of those conditions diabetes hypertension of city. There is about two or three full higher risk two to three times higher risk of hospitals. And if you put those three things together lots of people have diabetes hypertension and obesity. There be sixteen fold higher risk of hospitalization. And so it's very it's very plausible. And we're modeling this now. It's very plausible. That you know. If we had a metabolic healthy population job it would be much much less severe. And so you know thinking about nutrition and immune response malnourishment and hunger and food insecurity disparities very high rates and african-americans very likely related to nutrition in a major way the challenges to food systems and supply chains food waste and then metabolic health. You know these are all things that that you and I and others who study food at about that that food nutrition or a dire challenge and an incredible opportunity to improve the health of the population but Kobe. Nineteenth really liked taking a you know a knife and slice down dessert that was hiding immediate objects and so you know if five years from now we're back to where we were a couple years ago and there's no improvement in our food system quality of the food the way we get it to people in science that we have to address questions. I would be just devastated. I would be so disappointed that we haven't realized the opportunity here to fix the food system. So filming in the straight. What you're saying is that if you have chronic diseases and multiple chronic diseases that your risk of being hospitalized sixteen times higher that if you're metabolical unhealthy more likely to get sick because your immune system isn't working and then only twelve percent of us are actually healthy so that means if we actually had a healthy population that was eating a diet that created metabolic health instead of the opposite. Which we're doing now that this may just be a bad flu and we wouldn't have full hospitals in a society that shutdown and trillions of dollars in economic losses. All the evidence supports that you know. Of course we can't do a randomized trial and wave a wand and make everybody know about healthy to test that but all the evidence suggests that you know as you said. I'm based on national data. Only twelve percent of adults in this country are metabolic Healthy that's just taking things like waste. Your Conference Blood Glucose blood pressure cholesterol. It just measure those things. Only twelve percent of adults or metabolic be healthy and most of those people in their twenties right. You haven't yet really had a lifetime of for die in for lifestyle. And so the vast vast majority of American adults over forty are metabolic late unhealthy and given these associations you know as I mentioned even just one of these risk factors. You're doubling or tripling the risk of hospitals ation and you start piling up together In terms of risk of death is in so few debts especially under age. Seventy unless there's at least one of these other conditions. Yeah and so. It's very plausible. That if we had a very healthy population you know. Instead of a twelve percent medically healthy. We had twelve percent metabolic the unhealthy. What if nine of were metaphor healthy then in nineteen would be a far far less severe disease? Many many fewer hospitalizations fewer deaths. We wouldn't be shutting down the economy we wouldn't have. These hospitals overloaded our healthcare providers but insulted dangerous petit and working chefs on an and. What's really important here is that we can actually fix this now in real time. And so you know. It doesn't take years and years and years to reverse diabetes or to reverse hypertension or Reverse for metabolic health. Yeah does take years and years to change. Wait for many people but metabolic health. Whatever your weight. We can pretty rapidly improving. Edibala cal over months sometimes even shorter. But so yeah so the country. In addition to the things that we're doing social distancing and testing we should be launching a national campaign to improve the way we move and eat to improve our metabolic health to both protect ourselves and to protect our nation and globally to protect ourselves. This is this is what you're saying is pretty radical is that is it yes. We may take a long time to lose all the weight. We need to lose. But they're very short order. We by changing the food. That goes in putting in good stuff and bad stuff which you've written about and you know thous- particles that we could quickly revert to a more normal metabolic health reduce inflammation improve our immunity. And we see this. I seen this great example for people to understand is when someone who's very very overweight gastric bypass within weeks. Their diabetes goes away. There's still very overweight. But their metabolic health changes because they're eating a very different diet and that that's the key to remember that your metabolic health really quickly reverted so on a macro level. We sort of painted a picture of the poor quality diet we have leading to obesity and metabolic health. Which would make a massive difference if we changed. But you also were talking about what happens on the micro level on the micronutrient level. And that's really fascinating to me and I just shared the Arctic with you. I read this morning. That was done in China. Where in China has some of the most wide disparities selenium levels in the soil so in some provinces almost no selenium and other provinces there's abundance selenium in the soil and so the populations some are very efficient and some somewhere adequately nursery selenium and in this one study this one micronutrient right in the populations that had the highest levels. They had three times better curates for Kobe. Nineteen then the lowest levels in the population of the lowest level is selenium died five times as much as the ones with the highest levels. And that's just one nutrient so you were talking today about what you're trying to develop a study to look at a collection of nutrients that together could bolster the immunity of our population. And you're trying to get this study going so tell us about what is nutrients. How does it work? And what are you trying to find out through looking at the study? All great questions first and foremost ocean right. I think I am foremost. I've always been a guy who believes in foods food diet patterns from all the cardiovascular literature there's been a failed nutrient supplement after failed nutrient supplement. A single supplement. Doesn't really make a big difference. It's really about your overall food. And there are some exceptions. I think a mega threes Mega three fatty acids particular. There's after we did only some studies you know for for benefits mixed mixed findings. But on average for complex chronic diseases like cardiovascular disease and You know cancers and other conditions supplements don't seem to replace foods and so so i. I raise that because I come at this. As a skeptic I come at this as an automatic skeptic that individual nutrients could make a difference You know yet. As soon as Cobain head I started reading and consulted with colleagues experts in nutrition immunology nutrition infectious diseases. We have some of the world's way bang nutritional immunology. That's a wrestler. Yeah we we have. We have a incredible expert. Doctors Sabine at absues. Former president of the American Society for attrition the former head of research at tops Very very Much had a career study tricia technology and so together and recruiting other experts. We started looking at the evidence. And there's actually very compelling evidence from cell models animal experiments and even human studies about single nutrient supplements and infections on and specifically recovered. There's lots of research that suggested that some of the very same proteins that the Cobra virus uses for its own entry and replication. That have been another viruses. Like SARS is nutrients have specific benefit for for activity against those proteins. And so now I think there's maybe eight or ten nutrients that are potentially promising that could have an effect and I would put those accidents or three camps One camp is direct potential effects against Kobe protein. So those proteins that are needed for the virus to enter the cell and there's proteins replication and reproduction exotic For example Zinc has it inhibits. I'm looking at my notes here. To get the terminology exactly crack inhibits the army dependent Arman race. Which is needed for bio replication dancing with SARS? The SARS are a race and that's our home race to cope in nineteen and and now that means that the virus basically hijacked your genetic material and uses that little assembly line produce replicate itself and that interrupts that assembly line production is what you're saying exactly and another nutrient is a Christian person a and all fines to the ace two receptor of SARS which which with sorry advisor the receptor which SARS uses to get into into the cell and so and high level computer modeling as just recently identified. I attend as one of the top candidates were blocking Hobart entry into the south so it was a one camp and all I can go through those insurance. One camp is actually direct effects against specific effects against Cohen. A second camp is just generally improving pathogen killing and so we know again from animal experiments in humans. If you're deficient in these nutrients actually clinically deficient in these nutrients zinc selenium You know some of the b-vitamins some other vitamins. The immune system doesn't function as well and in animal experiments. And even some human trials if you give these vitamins you improve. T. Cell Function T. cells are are crucial fighting viruses. You improve saw option. And you get you boost. Immune responses general immune-boosting response and then the third category of these about eight or ten nutrients which to me. I think is actually the most interesting. Cogan is some of these nutrients help fight pathogens that are invading the lungs but also importantly dramatically ramp down prevent soften the excessive inflammatory response that the death with code because kills us because not because the virus itself. But because there's this this overwhelming excessive inflammatory response in the lungs called cited kind storm where you get way too high levels of inflammation the body's trying too hard to fight a code which may explain why people with inflammatory conditions like diabetes hypertension and obesity are at risk for hospitalization and death. Because they're more likely to get this kind storm and many of these nutrients have really clear experimental benefits against reducing cited kind storm zinc in particular Quercetin IGGY CG which is from from Green Tea EG CG for example multiple diverse models of lung injury if you injure the lungs in many different ways including violent faction in animal models it blunts that excessive response in animals. He'll better and live longer. So so if you put all these nutrients together. I can't tell you for sure that they would have efficacy against covy. We don't we don't know but compared to some other things it's at least there's at least as much evidence to test leads and and compared to let's say chloroquine hydroxy Lawless side effects. A lot in the side effects are very very safe and so we're really interested in doing a rigorous randomized trial to testes and one of my frustrations what really keeps me up at night. Right now is research takes time. It takes nine to put together the protocol the human subjects approval and get funding. And we're GONNA go to Major Federal Foundation funders and get try to get. This trial started as soon as possible. But we could complete this trial in a few months. if we have a sufficient funding and and I can tell you where we can talk more about. This is good nutrients and yeah well. It's fascinating it's fascinating because what you're saying is based on science. It's so out of the purview. But we normally think about and people go there worth the evidence but it's like it's there it's not something you normally pay attention to sort of been the aside mirror and if you think just selenium study if there was a drug that could reduce mortality. Fivefold Headline News. But I mean this is just one Dragon. Use The synergistically. They work synergistically with multiple different mechanisms. So so I guess what I'm having for dinner. I'm having a couple of Brazil. Nuts don't have more than two or three because they get too much selenium. I'm going to have chicken liver for the vitamin A. I'm GonNa have always tres and pumpkin seeds for the zinc. I'M GONNA have courson containing onions and eventually spinach and I'm going to have I'm GonNa have mushrooms and Herring Vitamin D. And I'm I'm going to top it off with some green tea at the end and I think it's by mute system. That's a pretty tough for most people to take out. I'll taste day together so I think you know in terms of specific nutrients we looked at. We looked at several. I forgot I'm GonNa make a curry because of the turmeric that you mentioned so some some of the promising nutrients that that we thinker less specific decoded but interesting but but not at the top of our list are are know vitamin C. VITAMIN IN D. Two merick selenium and the b-vitamins Are All nutrients which could have some efficacy in beneficial benefits for the immune system. They don't have the specific evidence for you know. Halfway Specific Nineteen Selenium study. Just you just mentioned is kind of one of the first. There are interesting vitamin A. Also they're all interesting. I think the ones that we have put together that we think are off. Candidates are Zinc Carson vitamin E and E G. Cg and actually think it's the combination putting before together now would have benefit. I'm really testing the combination because they all have subtle mild small effects. These aren't drugs this is and I'm sure you're up here. You're getting a lot of big Pharma wanting to fund these studies right but if we if we test the combination we think together they'll work synergistically in a complimentary way and again there so safe. The chats three. You're saying this is not something a user an ICU. But this is the general population could help us be more resilient in the face of Kobe. Nineteen well we think the best population would be people who are just us This could work for prevention. This could work in the sickest sickest patients in the ICU. That seems less likely. So I think based on mechanisms when you're first leg nosed these es nutrients could help reduce the progression reduce the severity reduced. The days of illness prevent you from getting to the hospital. If you're in the hospital already prevent you from needing a mechanical ventilator. So that's the population we're GONNA target. And I want to emphasize that I am not recommending taking these things because we don't know yet if activity against against my immune boosting dinner of chicken livers inherent right helped. Say the problem with that because there's a lot of nutrients that are in food and if you eat them regularly you're going to up your levels of these nutrients and it's not that hard. I mean vitamin D is a little hard yacky. Harry and a Lotta Pechiney Mushrooms. Or you have to go in the Sun half-naked for twenty minutes between ten and two south of Atlanta but they are take a supplement but for most of these you actually can get them from your food and I think food is always the strategy and that's really why now for two reasons. It seems like it. You're saying one you want to improve your diet. Because you want your metabolic health in terms of insulin. Resistance and the inflammation goes along with being overweight and chronic diseases. But you also want to up level your nutrient density the micro nutrients in your food by choosing smartly the foods that contain these nutrients. So you kind of have a double strategy for addressing your metabolic and nutritional health to make yourself more more strong in terms of preventing and maybe even recovering from in nineteen and. You're also going to be helping society at large by taking care of yourself by reducing the burden on our hospitals and healthcare systems and helping people to open up the economy. That's maybe why some of these European populations are struggling. I mean look at Sweden. I mean there are generally much healthier population they want to help us populations in the world and they have an open society but they're not seeing the same rates as we are and I'm wondering if maybe that's partly because of their general health. What do you think well we for sure again from clear evidence the United States? That if you don't have these conditions you have far far lower risk of hospitalizations and deaths and so I actually think that you know. Probably the regions of the world where per infected person. We're GONNA see the fewest deaths are going to be the you know rural low income regions of the world. So there's our door doorbell live live live on gassing the beauties of working at home my cat walk through the scene. I'm sure my children won't will run by on but I think that you know. It's very plausible. That in you know rural sub Saharan Africa Rural Asia. You know rural regions where there's a lot of poverty there's going to be huge rates of infection. I mean very rapid rates of infection by the percentage of people are going to be ostracized and dead among infected. I think is going to be going to be quite low and this is why getting to your point about food. Food is so important for this. Double Benefit This is why we need policy fix. This is why as you covered your book. You know. Our our policies are not in line to help or support people to eat healthy food. We have almost three and four. American adults are overweight or obese And about half of American adults have diabetes or prediabetes. When you start you know saying that a healthy population is the small minority of the population right and should it? Not Okay Right. It's it should be. That people with disease are the minority and we generate healthy. You've completely flip that on its head and we have a tiny tiny Population is actually healthy and everybody else has disease and most of that disease all of it. Most diseases is strongly rated. Yes so so we wrote you wrote in your CNN article that before Cova. Nineteen that poor diet kills five hundred and thirty thousand Americans every year about fifteen hundred deaths every day before over nineteen yeah so cove nineteen is is is tragic and these fifty thousand deaths. You're already in. The United States are tragic and and we need to be doing everything we can to reduce this and at the same time before cove in nineteen around forty thousand. Americans were dying every month directly from Diet related diseases that we estimated that would not have happened at Diet and so and we. Weren't you know going up in arms and saying this is that we have to stop this. This is causing catastrophe. But it was it was it's causing you know Billions of dollars. Tens of billions of dollars in provincial. Health care costs which burdens are American businesses which burdens are federal governments and state state government budgets. On it's causing incredible disparities big differences between the haves and have nots in our society and it's causing a lot of suffering and it's overwhelming healthcare system. So so here's where I think you know I and moving beyond the today to think about the rest of twenty thousand eight twenty twenty one next administration. We really need to take this learning from Cova that that we do not have healthy population. And when you don't have the healthy population in crisis strikes it shuts down the economy and people and business upper. We need to take that knowledge and fix the food system. And there's you know concrete things we can do. So we we. We in medicine have a phrase. It's called acute on chronic. Someone is a smoker as emphysema. They get pneumonia. They're not going to do so great. And if you're a healthy guy and you get a little ammonia. It's called walking pneumonia. It's like having a bad cold and that's exactly what's happening now. Cove is the acute on chronic disease. Obesity pandemic we have and and it may seem like why are we talking about chronic z? We have a big infectious pandemic. Let's just focus on that but now you're saying is more important than ever to address and before it's interesting ironic. You reported created a report on the fiftieth anniversary of the White House. Conference on food health and nutrition that you publish with your team from Tufts and colleagues Harvard. Which laid out in early in March where red for this. All took up was like perfect. Timing a series of strategies to really address this chronic disease pandemic the underlying failures in our food policies and the food system and it was. It was really brilliantly done and address a lot of things we talked about my book Including things like leveraging the power of the USDA programs to improve nutrition utilizing economic incentives to get people to eat healthier food and incentivize not so great food protecting our children from you know avaricious marketing and advertising. I think we if we if we were foreign nation. We're doing to our kids. We're doing what we'd go to war to protect them but we just let it happen. And then you even focused on healthcare and health professionals. How do we get healthcare to focus on food medicine? How do we train our doctors and healthcare providers to understand nutrition and incentivize better nutrition knowledge and treatment of chronic disease? And then how do we address Agriculture Sustainability? And these. These are all intersecting ideas. Not any one of them is going to fix the problem and you sort of identified eleven different key sectors addressed within these five things so so can you talk about given now say you were hired by the next president to be the foods are what are you going to be your key strategies so that we can improve the overall health of our population and we make ourselves more prepared for the next pandemic from infection. And how do we address? The health disparities. The economic challenges the climate environmental challenges all these intersecting issues which offers silos and you're a big system's thinker and often people are in silos within Congress or within medicine or academia. But somehow you've got to go wait a minute. Let me go thirty thousand feet and see how all these things connected. And how do we solve all them by working on them in a coherent way? Well you know the the Inspiration for that report. Was that nine hundred sixty nine. There is a White House conference on food food nutrition and health. That was focused on the big problem of the day which was true calorie malnutrition true hunger. I mean there were operations in the United States. Where you'd see kids with the tiny arms and distended bellies that you now see. And you know sort of famine-stricken nations elsewhere. There is true lack of food and in many places in this country And it was dire and so John Mayer who went on to become president of tops and found our school and I hold John Mayer Professorship quite humble to do that. John Mayer worked with President. Nixon a Republican organizes conference. They brought together all the stakeholders and they put together. about Sixteen hundred recommendations to fix the BOOT system thinking about sheer hunger. Only six hundred. Yeah I say that because there wasn't fixed right but they looked two years later. Fourteen hundred of them have been implemented and so that conference dramatically changed in. Osita way the way we approach hunger in this country so led to expansion standardization of school lunch expansion and standardization of the food stamps program it led to Wick. There was no program for mothers with infants and led to the creation of Wick. Which is the program that one and two babies in our country are born on wick which is errol program gives healthy foods to MOMS with with babies on the lead team nutrition axe labeling it led to other consumer protection that FDA it was quite instrumental in changing our policy and essentially eliminating caloric unger. We have another kind of hunger now. People have healthy food. It eliminated that sort of severe orrick. Malnutrition the country country And so you know. Fifty years later we said that was the last time there was a high level role attention on our food system. We have new problems right. We have diabetes. Obesity hypertension incredible disparities diet related cancers. All the new things we're learning about diet and brain health food allergies auto immunity inflammatory diseases health. We are facing a very very different food crisis. Now than fifty years ago the military you know More than half of young. Americans can't enroll military because they off by and number one. Medical reason is overweight or obesity and so a large group of retired admirals and Generals Mission Readiness. More than seven hundred. Fifty retired admirals and generals had said that that childhood obesity is a national security crisis or not ery so so this was just said piggyback on that and then Orleans. She continues in that report. The most striking statistic I saw was that the evacuation from Afghanistan and Iraq. There were seventy two percent more evacuations related to A. B. C. D. related problems than for war injuries which was just mind blowing to me. This is not even the people trying to get people already in the military who are struggling with overweight and obesity in poor health. Well I'm GONNA divert away from report and come back but a line. Art Refers Occcupation Health was very interested in first responders in helping policemen and firemen and improving their health and understanding what was causing their risks. Which you know again in this era's more important never and so he started studying. What was chilling police And Fire fighters on the job on the job and to his great surprise the number one cause of their of their on the job deaths where heart attacks and other you know a challenge is not getting shot or getting killed in the fire and then he started looking at well. What's so different about? Firemen and policemen found that higher rates are attack their age than than the average American adults and the number one number one factor lecture. They're just horrible. Diet because of working shifts working cars working overnight. You know the sort of the pervert. You know the the The the the donuts are donuts. Writer that's so he. He sort of shifted his focus to seeing how we can improve the nutrition police and firefighter so so it is it. Is this this quiet overwhelming disaster that you know? Our fighting forces policemen firefighters. Children are all getting killed. Mowed down by metabolic diseases. And where we sort of shrug. Because it's happened over. Decades and and humans are evolved were evolved biologically to respond to acute risk. This is GonNa kill me today. We're not biologically evolved to understand in the same way risks. That might kill us over months to years because you know back in the day when we were out on the Savannah right we about that that Sabertooth Tiger right in front of us. Not something that was going to happen. You know a year later and so something like Kobe. A true crisis at we think. Oh my God I could die. Changes everything and yet diabetes. Obesity HYPERTENSION CANCERS. Autoimmune diseases allergies chronic. Kidney disease you know all these things that are diet related that are still killing our operation and incredible numbers on. We were sort of assuming as normal so so so I think get to go back to to the report. I think there are three big picture principles that that. I'd like to highlight that I think are report highlights One is that there are concrete. Solutions are very real very concrete solutions that we can fix this to you know. Many of these are win win so this is not like tobacco where we're just trying to get rid of it an entire industry. We want to help the food industry from farmers to manufacturers restaurants to producers to retailers. We WANT TO HELP THEM. Healthier more sustainable more affordable food to people. So they can do. It can be win win and three. This can happen quickly. This is not a five year plan. We could change things within a few years if we implemented that the right policies and as you said there's about you know there's no single black magic bullet. It's one of those hanging fruit. I mean you know. We had a great conversation. They talking about the dietary guidelines for America and the dietary guidelines are interesting because they're designed for a healthy population and you just said that only twelve percent of us are healthy so it doesn't apply to most of us it is amazing you know. The dietary guidelines are incredibly positive process. I'm not somebody to bash. The doctor guidelines are one of the great things the government does which is get scientists together review the guidelines carefully put on islands. Every five years. There are problems in the process. So one of the biggest problems is that the scientific report at the scientists right then goes to the federal government and they change it. You know without exactly knowing how to put out the guidelines and usually it's ninety percent solar but but some big things are changed probably because of industry influence so there are problems but the other problem that you mentioned that or really the lost opportunity. Is that the Nitra guidelines by definition by law. I think are for generally healthy population and so they they specifically say these Dietrich islands are not to treat any disease or to help give anybody specific dietary guidance. If you have any specific disease you should see your doctor. You know that music. Ninety percent of Americans die Drei. Islands don't apply to them because they diseases right. And that's a challenge but so the low hanging fruit. Well I think that You know there are. There are several. It's not it's not one. I think. One is to engage and leverage the power expertise and finances of the healthcare system for food and nutrition. So so the number one cause of poor health in our country poor nutrition is ignored by healthcare system. And so we have to take this massive system that we've created our doctors. Our healthcare system is a lot of wonderful things about it. We have to take this massive system that we've created and use. Its resources our to help improve through nutritious food as medicine and and you know things like healthy produce prescription programs. We go to the doctor if you're food insecure and have diabetes or hypertension or some of these other conditions and you get a prescription to to pay for summer all healthy as one example. That's that's a clear low hanging fruit to get food as medicine into healthcare. Another one I think is to better use better leverage the investment of snap the The the the program formerly known as food stamps about one in seven Americans were on snap before Kobe hit. And you know it's it's going to go up for isn't it one in four kids and I don't know the exact statistic art with Burr. More kids in so maybe one on four kids. Yeah there's there's a large number of children on south. There's large number of elderly on snappers larger military active duty military staffers people in the military whose families are on snap. Because they don't have enough money for food and so it's not just for you know it's not just a hand. This is families. Elderly veterans active duty military. Who really need a helping hand to snap is a wonderful program powerful program to get money to people who need money to buy food and and and that's crucial and we need to strengthen There's a lot of people who say what's in Costumer at seventy billion dollars a year. It costs too much about had it spending. You know what I say is instead of cutting its funding. Let's let's use it to lower healthcare costs and then it will pay for itself and so we use it to lower healthcare costs by incentivizing disincentivising certain kinds of foods so that people still have have choice. They cancelled choose what they want to eat. But we're actually leveraging snap to make people to make people healthier for the farmers market you get double your money if you use food stamps at your farmers market yeah we. We did a national simulation model in very rigorous modeling science to say. What would happen if you did something which we call snap plus no snap plus would be if you bought fruits vegetables nuts or rains fish or other seafood healthy plant oils beans a whole range of produce? You'd get thirty cents more on your dollar you'd get a dollar thirty per dollar snap benefit on and at the same time to help to help paper that and also disincentivize healthy foods unhealthy foods if you bought you know soda or other sugary beverages or junk food or you know highly processed cheered needs you get thirty percents less on your dollar you get seventy cents on the dollar and you know that you know upfront you have a choice of you know what you. WanNa get and you can get a little more or a little less on your dollar that snap plus program would immediately be cost savings. That actually wouldn't add anything to the SNAP. Budget billions of dollars right would save tens of billions of dollars in healthcare costs. You know that the government and others are paying. So it's just kind of a natural thing knows would offset of snap right. So you're saying he got it wouldn't fully offset the cost but it would. It would still in the day were were giving to everybody including children and so it would take a long time to see returns on healthcare investment for children but it would it would save tens and tens of billions of dollars in healthcare spending without increasing costs of snap at all and so it would certainly be lead to lower government spending so. I think those are two clear things that could be done. I think I think to other things mentioned. No one is to really help. Spur and catalyze the ongoing revolution in in innovation and entrepreneurship so businesses everywhere from farm to retail to personalized medicine to packaged foods are rapidly trying to innovate because customers are demanding different foods. They want food that I think is going to make them healthier. That's sustainably sourced. That's good for environments. That comes from sustainable labor or fair Labor practices and so companies are scrambling figure this out too hot or get healthier affordable food to people and right now you know it's just the market is determining what works and what doesn't and so that means that companies that are really trying to innovate and do the right thing if their product costs a little more because they're making it healthier if it doesn't taste quite as good because they've needed healthier they're at a disadvantage and so an that's insane right with those companies should be should be at an advantage we we need a national program to spur innovation in in in business to help reward through tax policy and other policies help reward. Us companies. That are trying to do the right thing and then I guess I would give two more two more things already. A fourth item. I think is to really expand federal nutrition research You know as the as a percentage of overall research federal nutrition research has been pretty flat for for forty years and while Diet related illness has skyrocketed. And so you know we should be really prioritizing at national health at USDA at the Department of Defense at the Va at the FDA. All these places the at NASA all these places that actually already nutrition research. We should be really prioritizing amplifying or meeting that research I love research. Yeah we need. We need strong. Wouldn't have been great if over the last ten years. We had multiple well-funded studies on you treatments and immune system. Yeah and so. When Kobe hit we had already stockpile that you know army metareum of evidence and so as soon as go hit we could leverage this file release that stockpile and and you know enthoven and and not have this crisis right. I'm so so we. We really need to much much better. Understand you know food in the microbiome and winks to health personalization all the phenolics and flab animals You know that are in veteran foods. Anything research questions supply chains disparities. Yes I think that fourth thing is we really need a major new investments in federal nutritional. You talking about the national suit of nutrition right. Yeah that's one option. We we've been reviewing options funded by the rock were found nation. And we've come up with several options and we're going to release that report the summer. What are the options could be a new institute at the National Institutes of Health? There's twenty seven institutes and centers at the National Health and ratchet. They're actually asking the wrong name. It should be called the national institutes of diseases. Because it's not. There's no health in their. This'll be the first one that focuses on health. Most of them are deceased focused. There's one on heart disease one king answer. I mean there's an institute on complementary medicine it's fairly small but there are some Y- okay but Trish in so you know what Dan Dan? Glickman who your friend and former agriculture secretary said he reviewed the NIH national health strategic plan and nutrition was off. Sorry food was mentioned in there only once and it was in the context of the Food and Drug Administration. So that's likes really sad that that was that was last year and this year's plan that was that was released actually is which is an advance mostly around precision nutrition Understanding induced personalized nutrition. Which is Great? Yeah so that's in advance so we go. We Wanna go gradually good. I didn't know about that but you know they were fun. We don't WanNa take away from the existing institutes. We don't want to say okay. We're going to create a new national soon attrition and take away some funding somewhere else. We want to be added. It right has realized this is a national priority. And take this on. It just seems so. Have you started? Because if food is the biggest driver of disease in America. How do we have no institute? Organization within the government focused on studying. It's just it's like a what well you know. Mark Mark you hit me on the head. Let's let our healthcare system doesn't address the leading cause of health are the nationalities of health. Doesn't have a institute focused on the leading cause of Corell and the number one cause of death and disability in this country is diet related diseases and venable health spending and why active duty military recruits starry white otherwise qualified military coots can't get into you forces on and on number one cause of death for first responders is dying and all make sense the the front of my book. The opening quotas from Wendell. Berry says we have a food. Industry either pays no attention to health and the health care industry. That pays no attention to food. I think that's not a optimist by nature after all the doom bloom on optimus mark. And I think your book really lays out some of these options options really well that that the healthcare industry is now starting to pay attention to food. Is You know waking up to this and the food industry starting to pay attention to nutrition so these worlds are starting to converge. Happening too slowly. I don't WanNa wait fifty years the fixed. That's right now. Ten Yeah Health. Health care is is getting groups like Kaiser Permanente John Hancock insurance others are starting to incentivize and care about healthy. Eating and food companies are starting to try to create more nutritious products. And so you know it has to take on this crazy complicated system and help spur it. In catalyze leverage it nurture it faster. I'm which brings me to the fifth. You know kind of low hanging fruit You know that that that I think we could do in the next administration Would be to create a national organizing. You know office to organize all of these federal food and nutrition policies and programs. I'm after September eleventh. There was which was a devastating crisis to our country There was recognition that the all of the national intelligence agencies did work separately but that it wasn't coordinated and so you know the FBI and the CIA and always other groups were talking to each other and that was limiting our ability to respond quickly and effectively to intelligence prices so the office of the Director of national intelligence is created Odeon. I which is a cabinet level office reports to the Office of the President and coordinates Oliver National Intelligence and brings that coordinated single message and information to the president to Congress that the heads of agencies and freights coordinated actions with the unbelievable fragmentation of our food system in our nutrition response that Kobe has really laid bare. It's time I think for a similar office around food nutrition policy. You know we would call it. The opposite of national director of ood nutrition we Owen Defen- very similar to the Odeon. I would be a cabinet level position for the first time ever would say we're spending well over a hundred billion dollars a year in the federal government on fishing shoes. Let's coordinate it. Let's bring it together so now I mean the mad if you count in the healthcare costs like you know eighty percent of the trillion dollar one point of care we're talking about trillions of dollars that the federal government alone with the states because the states paper for Medicaid but government alone Hayes hundred sixty billion dollars a year for direct medical care for type two diabetes alone so suggest type two diabetes which is mostly preventable condition. If you can can eat well and treatable condition is one hundred and sixty nine years absolutely so well over five hundred billion a year you count healthcare spending on. We should coordinate it so that you know what's going on in the Centers for Medicare and Medicaid Services. And what's going on in school lunch and what's going on and snap or what's going on with and what's going on food labelling and once going health claims and what's going on in the Department of Defense Research around performance and recovery from injury and what's going on. Va around the our military veterans. All this were all this programming which is disjointed and disconnected all the USDA INCREDIBLE USDA agricultural research and policy to help stimulate farmers and rural development right US massive programs to develop rural development USDA. Actually the farm bill is the biggest single supporter of conservation. People criticized the FARMVILLE. But it's the single biggest conservation program. The APP to help coordinate all of that and so I think a new National Coordinating Office is actually not high in the sky. It's it's actually really an idea whose time has come while. Hope you're talking that into the ear of the candidates because this is. This is the moment to to make that happen. And drawing the connections helping people see the intersection of chronic disease pandemic we have our environmental crises climate change now security academic performance on social inequities health disparities. I mean these are not separate issues. And what's amazing to me is. These are not hard problems to solve. It's not rocket science. It's not going to have to come up for the cure for Alzheimer's or something really hard. This is this is something we know about. You've been writing about three decades. Your colleagues and everybody at Tufts and Harvard have been shouting from the rooftops. The problem is nobody's really been listening and I think now it's time for them to really listen and it seems like there's a real openness. Listen this is that moment in history where there's a crack in the door and I think we can walk through and and tell a different story and actually help transform our our national foods policies and agriculture policies across all these sectors. You talked about encourage you to check out this report I mean it's it's fantastic. You can just google it. The report of the Fiftieth Anniversary of the White House conference on food nutrition and Health. That was put out in. March as this condemning started and and it really lays out Kind of unwittingly the solution for what we have right now literally. It was implemented tomorrow. I think we'd all be better off. Thank you so much for having me and for letting us discuss these issues you know. This is kind of a principal. Functional Medicine Right. Functional medicine isn't for patients isn't some Hokey pokey magic. It's just that when somebody comes in with hypertension and diabetes and joint pain and obesity. You don't treat each of those a separate problems and and get one dry for you say well. What's underlying functional of all of this and let's go to the root and try to fix the root of the problem well. This is functional medicine for our country and for our food system. We haven't even talked about regenerative agriculture. You briefly mentioned kid learning in school. You know productivity of the workforce on it incredible disparities and injustice across different segments of the population. So much of this is related to our food and nutrition system and we have to stop trying to put our fingers in the dike. One at a time to fix this time and say we have a systems problem and it's not rocket science not brain surgery. It's pretty basic stuff that we can do and it's win win. It's win win for industry. It's win win for farmers it's win win for pretty much. Everybody so I think it's the time has come through that door so I've asked you all the easy question. I WanNa ask you a hard question. You say win win but you know. What are the obstacles other than lack of education awareness to actually make this happen? Who are the people or the organizations are companies that are going to be resisting the change because I think there will be and how? How do we work around that? How do we? How do we work around that? It depends on the approach right if the approach is only Punitive if the approaches which some countries are doing like Chile Mexico. Some of these new food system programs They say look. We think there's too much salts and sugar and You know saturated fat in the food supply. So we're going to penalize companies through warning labels or other things if they have those and we're gonNA restrict marketing and that's it. That's the only approach food industry is going to be kind of annoyed. Her going to say you know all you're doing is is hitting us for the negatives in our products what if we have a fermented product if we add fruits in product. What if we increase for grains what if we tried to have more healthy oils? You're not getting credit for that. So so I think that if you take a punitive approach there's GonNa to be some big time opposition from publicly traded companies that have stockholders the shareholders. Excuse me there You know All too and and financial responsibilities. I think if you if you take a a win win. Approach that look. We're going to use sticks and carrots. We're GONNA help companies that are doing the right thing we're GONNA help you shift your portfolio. We're reward farms. That are doing the right thing you know of. Course there's there's some products that are GonNa you losers right so some single you know. Single products may not be around much longer or they may not be sold that much or they may cost more. But you don't food. Companies are diverse in bait console. Lots of things restaurants or diverse inconsolable beans farmers in overtime. Lots of things. So we don't have a monolithic system with one product like tobacco that we have to get rid of so so. I think that the real oppositions going to be fear of loss right so nobody wants to lose what they have now so whether it's fear of loss in research that research agency say well the new research agency focus on nutrition. Lose it on now. A Food Company says look. I don't WANNA lose. Twenty percent of my portfolio. A farmer says I don't want to lose their. It's fear of loss right so there's no I don't think there's anybody entrenched with a line in the sand that I'm going to grow you know You know corn and I want that horn to go to corn Syrup in soda and that's it no matter what and I don't I don't care what you say to me. That's what I WANNA do now. I don't think there's many people that are going to say that. I think that people say. Oh Yeah biking grew corn in that. Corrigan go in make whole grain whole corn corn meal. That can be healthy and impaired with vegetables and be part of a healthy meal and I get actually a little bit more because my crop tastes better in his nutritionally. Soundness grown regenerative agriculture and I can get a little more profit because customers pay for that because it lowers. Yeah it can be win win. I think the report is really brilliant because threads the needle on that really tough question of. How do you bring everybody along on the team? Even the reluctant wants that's that's the brilliance of this report. It's not it's not blow up the world and start again. It's like how do we make smart choices in the policies? So that being get alignment on every side of the aisle on all sides of business on consumers everyb-. I don't think there's anybody in any business in any seat of government or any any one of our citizens who wakes up and says you know what I want to create a system that makes people sick and fat and kids not people learn and people depressed and in make our national security worse and causes destruction of our agricultural environment. There's nobody that says that or once that as a human being and so I believe we appeal to human beings who are behind these companies and behind these policies that that most of them will be able to be a few but most of them will be able to brought along. And I think it's you know we've been in Washington and I think you've been lot in Washington probably more than I have. And what's really striking is that there's a really general lack of education awareness about these issues. Like the level. Of of being informed of policymakers so low on their hearing a lot of information from the food industry from big lobbyists. But there's not a lot of lobbyists for the good guys right. We run down to Washington and we like we pay our own way like run around. And it's like but it's it's it's farm. Who Between. Well you know these are complicated issues right. It's a complicated system. You know living in Boston almost twenty years. I'll see it's wicked complicated with a really bad Boston accent. Wicked complicated Wicked complicated system right and and so you ask me. What's the low hanging fruit? I couldn't give you and second sound bite are complicated issues here. So so getting that complicated message to the public policy makers when they're so busy they're so overwhelmed. They have so much they're doing you know they're they're they're thinking every possible issue under the sun and getting people to see these interlinkages any solutions challenging and so I think that you know. Communication is a huge huge part of this It's not the solution righteous. Just talking about it doesn't fix things but communication through what we're doing through other avenues is crucial. And you know there's no. There has been historically no funding for that right. Nobody's paying public health experts and physicians and scientists to communicate where people pay us to teach into new research and people pay clinicians to see patients scientists to do research. Nobody pays us to actually go out and spend our time you know and I don't need to get paid extra. I just mean the staff instructors to do that. Communication Jocelyn Murnian don't exist and so I actually think that you know an effort building around the themes in our White House report building around the themes in your book. I think effort to bring some you know interested people together to create a coalition of of people in some funding to bring this message out and to Tell People. There are actually solutions. That help us right now. I think would be really wonderful. Well we're on the way we you and I are collaborating on the food fixed campaign which was a nonprofit advocacy group exactly designed to do this bringing together. A coalition of all the stakeholders across all sectors involved in the food system and science and health care and agriculture to really have a coordinated strategy and bring these ideas into the two thousand keep people in Washington who make decisions at the White House and Congress and agencies that can make a difference and I think this is really never happened before. I'm super excited about some anybody. Listening is excited about this. Anybody wants to get behind it whether you have money or you have relationships that can make a difference or connections or just ideas. We'd love to hear so I'm so excited that this is going to be. Even though this is a horrific time this is going to be a little window of opportunity for us to actually make a big difference so I just what you've done what you're doing. You're my hero in all this and I vote for you for the head of that office in the cabinet. That's going to be in charge of whether you want the job or not. I'm quite happy at the Friedman School of nutrition science cars. Well thank you so much being on the doctors pharmacy. I really appreciate your time. And you're busy and if you've been listening to this podcast and you love what you heard. Please leave a comment. We'd love to hear from you. Share with your friends and Family. Social Media. Subscriber every podcast. And we'll see you next time on the docket. Everybody's soccer hyman. Thanks for tuning into the doctor's pharmacy. I hope you're loving this podcast. One of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from and I'm WanNa tell you about something else. I'm doing which is called marks picks. It's my weekly newsletter and in it. I share my favorite stuff from foods supplements to gadgets tools to enhance. 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