Are Nutrition Labels Misleading You with Dr. David Katz

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Are Nutrition Labels Misleading?

Jonathan: Hey, everyone, Jonathan Bailor back and I am delighted about today’s guest for you. He is an individual who absolutely practices what he preaches. In fact, he is joining us just after getting off his elliptical trainer after eating an incredibly nutrient-dense breakfast. He is the author of over 12 books and the founding Director of Yale University’s Prevention Research Center, internationally recognized as one of the most influential individuals in disease prevention, as well as obesity treatment and prevention. His most recent book, of which there are also 11 others, is called Disease-Proof: The Remarkable Truth About What Makes Us Well. He is, again, over at Yale University. Dr. David Katz, welcome brother. How are you?

David: Jonathan, great to be with you. Thanks so much. I feel good, how about you?

Jonathan: Well, I didn’t just get off my elliptical, but I do have my dress shirt with sweat pants on.

David: That’s the beauty of this. Nobody needs to know what’s going on below the waist, right?

Jonathan: I love it, I love it. David, one of the reasons I wanted to have you join us is that we’ve been focusing a lot on the advancements that have been made in eating and exercise over the past 50 years. Like everything else in life, we don’t do things the same way today that we did 50 years ago, for heart surgery, or for cell phones, or for computers, so why would we for eating and exercise? You are one of the pioneers in the field of redefining what we perceive as healthy. In fact, and let me make sure I get it right here, your NuVal scoring system is a perfect example of this. Can you take a step back and say what inspired you to create NuVal and what else is going on in this space that requires us to take this new approach to nutrition?

David: I’m happy to do that, but the interesting thing, Jonathan, is that when this story is told in its entirety, I think, in essence, we’re going back to the future. I kind of like to invoke Michael Pollan who wrote that 13,000-word treatise in the New York Times magazine entitled, Nutritionism, essentially pointing out that we lost our way when we got too New Age about the fundamentals of healthy living because they’re the same as they ever were. Our Paleolithic ancestors ate food direct from nature, got lots of physical activity, had no tobacco, and went to sleep when it got dark. In terms of the fundamentals of healthy living, it is sort of what we are natively adapted to, so it really is a case of back to the future. The trouble is, the world is modern all around us, and we can’t just tell people to eat real food, because they have to be able to find it, and they have to be able to do something with it. Pollan’s advice to eat food, not too much, mostly plants, is excellent, but you’re standing in the cereal aisle of any supermarket in the country, you’re looking at a whole bunch of boxes, and you’re trying to figure out which box is more mostly plants than which other box, and well, forget about it, right? You just can’t get there from here.

That’s where NuVal comes in. I think that in order to get back to simplicity, sometimes you need complex tools. The tools should be easy to use, but they may be quite sophisticated, and a beautiful example of that is GPS. We could navigate by the stars, or by points on a compass, but in the modern world, most of us are dealing with highways and roads and lots of turns, and you can’t get there as the crow flies. You’ve got to get there as the roads allow and you need to know when to turn left and when to turn right. GPS is pretty sophisticated, it’s bouncing beams off of satellites and using trigonometry to sort that out for us. But in the end, the goal is a simple one: Here’s how you get there from here.

Well, NuVal is exactly the same. I do believe we should eat food, not too much, mostly plants, but I also live in the real world and frankly, a lot of my own food comes in bags, boxes, bottles, jars and cans. The NuVal story begins back in 2003. I was privileged to be a member of a group of 15 academics invited to Washington, D.C. by then Secretary of Health, Tommy Thompson. At the time, the Department of Health and Human Services was establishing an obesity task force to help advise the FDA on steps it could take to combat the trends in obesity and diabetes. What the secretary had planned, inviting 15 of us, was to sit us around a conference table with the commissioner of the FDA sitting next to him, the head of the NIH, the head of the CDC and the Surgeon General. He said, “I’m going to run this meeting and here’s how it’s going to go down. I’m going to call on each of you characters one at a time and you each get one three-minute turn to give us one good idea to help us fix what’s wrong. Let’s rock and roll.” And all due credit to the secretary, he ran a beautiful meeting, that’s how it went down.

So, my turn came, and I said, “Mr. Secretary, thank you so much, it’s an honor and privilege to be here, and I’m going to use half of my three-minute turn to tell you a story. My wife, Catherine, is French, born in North Africa, raised in Southern France, spoke barely a word of English when she was brought to the United States by her mother at age 14, went to high school in Texas, learned English there, graduated, went on the UC Berkeley, graduated with a degree in Psychology, and then went on to Princeton University where she got a Ph.D. in Neuroscience. It’s the cliché, right? You know, we say, it’s not rocket science, it’s not neuroscience? Well, it was neuroscience, of all things. Pretty smart lady, basically. We met, fell in love, got married, it’s five kids later.

Over the years, she learned everything I know about nutrition, and after the third kid she stopped doing neuroscience and said, “I’ll run the household, that’s a full time job.” She is a fantastic cook, she learned cooking from her mother, French Mediterranean cuisine, but I’m extremely fussy about nutrition standards, so it was her job to marry everything she knew about the culinary arts, a real foodie, to my very fussy standards in nutrition. So, you will not meet a more knowledgeable, motivated, savvy, experienced shopper in the country. She has fed seven people all these years, married to a nutrition expert, she is a Ph.D. in Neuroscience from Princeton, and even she doesn’t know how to pick out the most nutritious bread in the supermarket, because Bread A has the most fiber of all, but also the most sodium. Good tradeoff for bad? Can’t tell. Bread B, less sodium, slightly less fiber, but it has added sugar in the form of high fructose corn syrup, but it’s way down in the ingredient list, so it’s not much, but is it better or worse than Bread A? Can’t tell. Bread C doesn’t have the added sugar, but the fiber is pretty decent, the sodium is not too bad, and it says zero grams trans-fat right on the front of the bag, but in the ingredient list, in parentheses, it says it may contain one of more of the following, and there is partially hydrogenated oil. Is it in there or not? You don’t know. But is it better or worse than Bread A or B? Nobody can tell. Bread D is a multigrain with amber waves of grain on the packaging, but has the least fiber of all. Is any of them actually a whole grain? You can’t tell.

So I said, “Mr. Secretary, with all due respect, if a Ph.D. in Neuroscience from Princeton is not enough to pick out a loaf of bread, I think you guys set the bar a little too high. Here is what you ought to do. Convene a multidisciplinary panel of the top nutrition and public health experts in the land who have nothing to sell except good ideas and good guidance, give them all the support they need to take everything they know and pool it, along with the best available scientific evidence, and turn it into GPS for nutrition, a guidance system that anyone can understand and use at a glance and where nobody can get lost, and let’s be done with it. And put simple labels, A-B-C, 1-2-3, on every bag, box, bottle, jar, and can in the food supply, and let’s be done with it.

Well, I waited about two years for the feds to do this and they didn’t, and my patience ran out and I said, you know, the idea has merit, let me see if I can get it done. So I called on my colleague, Walter Willett, Chair of Nutrition at Harvard, and he said yes. And I called on my colleague, David Jenkins, the inventor of the glycemic index, and he said yes. And I called on John Seffrin, the President of the American Cancer Society, and he said yes. I called on Becky Rees, past President of the American Dietetic Association, and Fran Kaufman, past President of the American Diabetes Association, and on it goes.

Unbelievable dream team, multidisciplinary, cardiovascular, epidemiology, pediatric endocrinology, nutritional biochemistry. We worked together for two years, with the bills being paid by Griffin Hospital, a not for profit community hospital affiliated with Yale and home to my lab, the Yale Prevention Research Center. My staff supported. We built The Overall Nutritional Quality Index algorithm which incorporates not only about 30 different nutrient properties of foods, but weights every nutrient property based on epidemiology for the actual health effects it has. We didn’t treat all nutrients as if they exert comparable health effects. Vitamin C is important, but in the modern diet we don’t have a lot of scurvy, let’s face it, so it is not as important as fiber, which is clearly a very limited nutrient, that sort of thing. Omega 3 fat is very limited in the modern diet. So we weighted the nutrients accordingly. Sugar is negatively weighted.

The result, the ONQI, is the only nutritional guidance system on the planet directly correlated with health outcomes. In a Harvard study, and this was obviously long after the work was done, of 100,000 people, ONQI or NuVal scores, and obviously the system sees daylight as NuVal, Nuval scores were attached to all of the foods consumed by 100,000 people, and a weighted average score for their diet was calculated, and health outcomes were tracked over a 20-year span and the higher the average NuVal score of the foods these people ate, the lower their rate of cardiovascular disease, the lower their rate of diabetes, the lower their body mass index on average, and the lower their rate of premature death from any cause whatsoever. We can get the better diets and better health one well informed choice at a time.

In addition to the research that we have, and there is more and more of it all the time, we have these incredibly compelling testimonials from the real world, Jonathan, where the rubber hits the road. On the NuVal website, which is, there is a community section, and there are these unbelievable stories. The one I like best is a woman named Sally Galvin, who is a wife and mother of two, lives in the Midwest and shops in a Hy-Vee supermarket in, I think it’s Kansas or Iowa, where they have NuVal, and the scores go on the price tag, right in front of everything in the supermarket, right next to the price. Over 18 months, Sally Galvin lost 115 pounds. That rivals bariatric surgery. But the beauty of it is, obviously, she didn’t have to go under general anesthesia or deal with a scalpel. But more importantly, she didn’t spend extra money, she didn’t have to pay for anything, and she took her family with her because by trading up her groceries, this was something she shared with her family, that’s health, and if there is anything in life we want to share with the people we love, it’s health and vitality. Well, her husband lost weight because she improved the ingredients in all the food she prepared, and her kids lost weight and got healthy. It’s beautiful, and we have innumerable stories like that.

One of the many virtues of more nutritious food is that it fills us up on fewer calories. When you and I debate, brother, it’s about calories and what they mean, and I think where we land, basically, is that both the quantity and the quality of calories matters. The argument I make is that, yes, a calorie is a calorie, but the quality of foods we choose has a huge influence on the quantity of calories we consume. Nobody overeats apples, and everybody overeats potato chips. So, both matter, and one of the best ways to deal with quantity is to improve quality, because foods that are wholesome fill us up.

The food industry taunted us. They said that you can’t eat just one. NuVal puts the power back in your hands so you can answer, “Wanna bet? Because I know the best chips, I know the best bread, I know the best cereal, and I don’t have to spend extra money for them, and I don’t even have to make a choice in a totally different category.” It’s all well and good to tell people broccoli is good for them. That’s true. Everybody should eat broccoli, I love broccoli. But when I want a chip to dip into salsa, I’m not interested in broccoli, and I don’t think anybody else is, either, but I am interested in the best possible chip, the most wholesome chip. Whole grain, healthy oil, minimum sodium. And that is there for you, and the range in NuVal score.

And by the way, the way the system works, 1-100, the higher the number the more nutritious the food. Over 100,000 foods have been scored and it is in over 1700 supermarkets nationwide now, reaching about 30 million people, so I feel pretty good about that. Miles to go, but I feel pretty good about it. And by the way, in the new book, Disease-Proof, we provide hundreds, I think it is about 500-1000 of the NuVal scores to show people how the system works, and even if you don’t have it in your supermarket, how you can use the power of trading up for many, many benefits, obviously general health benefits, but also that wonderful benefit of, “I want to get to thin, and I don’t want to go hungry, and if I can trade up the quality of my groceries – better chips, better pasta sauce, better salad dressing, better bread, better cereal – I can make all the choices I wanted to make, but by making better specific choices within those categories, I get all the benefits of more nutrient dense foods, including that I fill up on fewer calories, I can get to this without going hungry, I can share the benefits with my whole family.” That’s a beautiful thing. That’s the NuVal story in a nutshell.

Jonathan: There is so much beauty in NuVal, Dr. Katz, and one of the things that I love about it is that you say, “I’m a busy person, I’m in the grocery store, and even if I have a Ph.D. in Neuroscience that might not be enough,” and by providing something like the NuVal score we look at much more than the old simplifier, which was calories. The old simplifier was just look at the bread, and whichever has the least calories per serving is the one you should pick, but you and I know that is obviously false.

David: It doesn’t work. And it’s been many things, right? And that’s what Michael Pollan and others rant against. It was calories, it was fat, and it was carbs, right? It’s been many things. I guess now, who knows, it’s sugar or fructose, or whatever it may be. But the reality is that yes, the quantity of calories clearly matters because ultimately weight is about energy balance and we do have epidemic obesity and most of us are struggling to get to slim, and need to be smarter to get there from here. That’s really important.

But, unless we’re on a diet, we don’t eat on a daily basis to fill a quota of calories. Nobody wants to live that way. We want to eat to get to satisfaction. We don’t want to be in Mick Jagger’s sinking boat where we can’t get no satisfaction. We want satisfaction. And the thing is, people are willing to put up with getting no satisfaction for about six weeks, to look good in a bathing suit, or a black dress, or a business suit, or whatever, for a special occasion, but then everybody goes off the wagon. But I never go off the wagon. I weigh about what I weighed when I graduated high school, I’m a 50-year-old guy with five kids and a desk job. I exercise every day, I eat well, and I love good food. My wife is a spectacular cook. We’re really foodies. A good dinner and a good glass of wine, I love it. But, we eat really wholesome foods, they fill us up on fewer calories.

The problem is with the bread with the fewest calories, if it’s not a really wholesome bread, and the same thing with those 100-calorie packs. I was never a supporter of 100-calorie packs, because here’s the thing. You buy the lowest-calorie bread, or you buy the 100-calorie snack-pack, but the food is junky. You’re going to be hungry again in 30 minutes. It’s all well and good that it’s a 100-calorie snack, but if you eat 17 of them, what good does that do? As opposed to eating walnuts, or avocado, or hummus, or nut butters, all of the different foods, whole grains, all the foods that are nutrient dense, and in some cases they are also energy dense – almonds, walnuts, avocado, really nutritious foods. They are packed with calories, but they are satiating calories. You’re getting high-quality nutrition, you’re getting full, and you’re staying full.

We’ve actually published several papers using walnuts as an intervention, showing improvements in both diabetes and prediabetes. We have a trial ongoing right now where we are looking at the effect of eating walnuts every day on satiety and weight and appetite and total calories. Even though we’re adding about 350 calories to people’s diets every day in walnuts, we actually think the net effect of that will be to reduce calorie intake, because it will bump out less nutritious foods, create that lasting feeling of fullness, stabilize hormones like insulin, and result in net benefit. That low-calorie bread you buy, if it is not really nutritious, won’t have any of those effects – just the opposite. So, you and I both know that calories matter, but we also know that counting calories isn’t the best way to deal with that.

Jonathan: David, one of things you just covered, which I think is so profound and when we take a step back it seems obvious, but we need to be reminded of it, and that is that the body isn’t dumb. The body is a miraculous vessel, and if you think you can trick the body into being satiated on 800 calories of no nutrition, that’s never going to work. “Oh, 800 calories, and no essential amino acids or vitamins or minerals! Sounds good, I’m full.” But that is what these people will lead us to believe, that you can trick your body in that way.

David: Right. Well, actually, quite the opposite, and if you really muck around with things like that it can be lethal. Back in the 1970s we had the advent of the very low-calorie liquid diets for the first time, and at that time the focus was just reduce calories, trick the body, put it in starvation mode, everything will be okay. And what the doctors who were administering this at the time didn’t realize is, and you mentioned essential amino acids, that if you don’t give the body the full panel of essential amino acids, it has to get them. We have to reconstitute cells and hormones every day. That’s why they are called essential. They are essential for the construction processes of metabolism to play out every day. Well, the body has to get them, and if you don’t provide them in food, the only place it has to go is scavenging.

These very low-calorie diets, 800 calories or lower, in the 1970s, killed people, because where they went to scavenge these proteins was anyplace they could get them, including heart muscle, and when you start leaching proteins from the heart, you create irritability there. That set up fatal dysrhythmias. People died of ventricular fibrillation. People who had no heart disease died. I was extremely concerned when I saw the advent of the HCG diet, human chorionic gonadotropin, because the argument was 500 calories a day, plus HCG injections. Talk about selling people the Brooklyn Bridge. You go on a 500-calorie diet, you’re going to lose weight – duh. What do you need the HCG injections for, right? It was kind of Dumbo’s feather. I just can’t believe how gullible we’re prepared to be when it comes to weight loss. But it wasn’t so much that this was selling snake oil that bothered me, it was the fact that if people ate 500 calories a day there was a good chance that people were going to die, and I actually wound up being contacted by a couple of attorneys, representing families where someone had died, so that is appalling.

Not only can we not trick the body, but food is the fuel that runs the body. We shouldn’t be trying to trick the body. So, back to our conversation, again, really the goal here is not to get New Age and funky and fancy. There is a reason why Koala bears eat eucalyptus leaves, and the reason is that’s what Koala bears are adapted to eat. There is a reason why giant pandas eat bamboo. Bamboo is extremely non nutritious stuff. Nothing else on the planet can survive on bamboo, but it’s the only food giant pandas can eat, because they are adapted to it. Well, we’re creatures, too, and eating what we’re adapted to eat is really important. We don’t have mammoth anymore, and we don’t have all the plants that grew in the Stone Age, but the closest approximation is a wide variety of mostly plants, when we eat meats, eat lean meats, closer to nature the better.

But, again, we have to navigate to that simplicity through the complexity of a food supply that has something like 800,000 items in it. Because of NuVal we’ve actually had the birds-eye view. If we scored everything in the food supply in the U.S., how many items would that be? And although your account for almost everything with 100,000, if you get down to all the local stuff, and there are something like 800,000 food items in this country, but even in any given supermarket there are about 50,000. If you think about how many fruits or vegetables you could name and then throw in meats, fish, poultry, seafood, and try to come up with 50,000 for crying out loud. So, you have this enormous complexity of foods in bag, boxes, bottle, jars and cans, many of which glow in the dark, and we’ve got to be able to get to good nutrition through all of that.

That’s why I think, in some sense, we need sophisticated new age tools like GPS, to get back to simplicity. I just want to get where I want to go. I want to get to the mountains, I want to get to the ocean, but there are a lot of turns between here and there. I can’t fly there as the crow would, I need GPS. Similarly, I want to get to healthy nutrition and I know in the end it’s simple. I know it is as close to nature as possible; the shorter the ingredient list, the better. But I’ve got to navigate through 50,000 choices in the supermarket, and frankly, I can’t tell which is the best bread, and I can’t tell which is the best pasta sauce. And even if I can tell, I don’t want to spend six hours in the supermarket trying to figure it out. I just want to look at the label and know that, 1-100, the higher the number the more nutritious the food, isn’t about telling anybody what to do. One of the beauties of GPS is that it tells you how to get where you want to go, it doesn’t tell you where to go. NuVal is exactly the same. It doesn’t tell you what to do, it just tells you what’s what, and gives you the power you ought to have so you’re not being manipulated by all the marketing hype.

I think one of the things people forget is that the front of every package is real estate owned by the company selling the product. It’s advertisement. It’s not intended to be informational, it’s intended to be persuasion. You can put lipstick on a pig, you can make junky food, but then highlight the fact that it has no cholesterol. You see labels like, no cholesterol, or no trans-fat, on items that couldn’t possibly have cholesterol, or trans-fat. You see no trans-fat on items where 90% of the calories come from added sugar. Well then, so what? And conversely, I actually took a picture and posted it on Facebook not too long ago. My wife took my son out for breakfast. We always get hung up on these one-nutrient-at-a-time fixations and lately our attention has been focused on sugar, fructose specifically. There was this syrup on the table when they went out for breakfast, big banner ad on the front of the bottle: “Now with no high fructose corn syrup.” But the first ingredient in this syrup was corn syrup, this wasn’t high fructose corn syrup, and there was no maple in this syrup, it was just a concoction of sugar by seven different names and artificial coloring. It was garbage! But that’s what we get on the front, and so if you think that’s all I need to know to know what’s good for me, you’re going to be deceived, and somebody is going to laugh about that all the way to the bank, and NuVal is intended to fix that. The power belongs with you and with me and everybody else who is shopping for food and cares about their health and the health of their family, and NuVal levels the playing field.

Jonathan: Dr. Katz, certainly NuVal has been a great step in the right direction in terms of simplifying healthy eating for everyone. It shows a marked improvement over just judging by calories, just judging by fat, just judging by sugar. Where do you see the next advancement coming into play? Where is the future, or NuVal 2.0, is there one planned?

David: Actually, NuVal 2.0, again for me, the focus is on the algorithm that powers NuVal, the ONQI, and the Overall Nutritional Quality Index algorithm. We just finished ONQI 2.0, so NuVal scores will be refreshed, and they are fortified with the latest nutritional thinking, the best and most current research science, all of that. But in some ways, that’s a minor change. The scores will be reshuffled, but it is still the same basic idea. It is providing guidance 1-100, the higher the number, the more nutritious the food.

I think the next big advance, Jonathan, is changing our entire relationship with health. For example, let’s talk for just a second about food stamps, the SNAP program, because right now, one of the things that has the whole farm bill bogged down in Congress is disagreement about whether or not to fund food stamps and help poor people get food. I am a left-leaning public health type. It will surprise no one to hear that I support food stamps, but I’m also a public health pragmatist, and I pay taxes, and frankly, here is what is going on right now. We, the American taxpayer, send 100 billion dollars a year to the federal authorities to underwrite SNAP, food stamps, to help poor people choose poor food to get to poor health. We then spend a ton more money through Medicaid to pay the cost of that poor health. Who in this scenario wins? Everybody loses. The SNAP beneficiaries get food, but they get lousy food and they get sick; they’re not winning. Taxpayers are basically setting fire to their money; we’re not exactly winning. And the government runs out of money, and they’re losing too.

What if, instead, we attach financial incentives to the NuVal system? We have 100,000 foods scored. Why don’t we put those scores into categories – bread, cereal, meat, dairy – and within categories put the scores in quartiles, and then if you are a SNAP beneficiary and you are getting vouchers to buy food, if you buy a food in any given category in the bottom quartile of scores a dollar is worth a dollar? If you buy food in the next quartile up, though, a dollar is worth $1.25, in the third quartile $1.50, in the top quartile, $2.00. You’re spending power doubles when you buy the most nutritious foods. Why? Because if you buy the most nutritious foods and eat them consistently, you, too, just like in that Harvard study, will have less heart disease, less diabetes, lower body mass index, less chronic disease overall, less likely to die prematurely. It costs a hell of a lot more to pay for coronary bypass and bariatric surgery than to incentivize a better pasta sauce, bread, cereal, cracker, or anything in the produce aisle. So, we’re penny wise and pound foolish.

I think one of the next great advances in health promotion is a win-win scenario where we get off of that ridiculous cycle of spending very little money up front and an awful lot of money at the back end for bad outcomes, and incentivize the healthy option up front and save a ton of money at the back end.

Here’s what could happen. We would provide a SNAP system that not only helps people get food, but it helps them get good food and rewards them for getting it, so SNAP beneficiaries get good food and good health. We would spend a little more money up front to help them get the better nutrition, but suddenly we’ve got a lot less surgery and a lot less pharmacotherapy to pay for, and we save a ton of money. And now everybody wins. The SNAP beneficiary wins, the taxpayer wins, and the government wins. And if this works in the public sector, why not the private sector?

I envision big insurance companies and self-insured employers getting together with the executives of a supermarket chain and saying, “Our clients shop in your grocery stores. We want to add something to you loyalty card. You offer NuVal, in fact we’ll pay for you to offer NuVal, and we’ll also add an incentive to your loyalty card so when they swipe at the checkout counter they get a discount every time they trade up their choices, because frankly, you win big if you do this. You can now advertise it. You not only offer GPS for nutrition in the form of NuVal, but there is a financial reward for using it and shopping in your store. You are going to increase your market share so you win. Shoppers win because they are now getting the financial reward to make better choices and take their family to better health, but we win, too, because we’ll spend less money on incentivizing healthy food than we are currently spending to pay for chronic disease. If our premiums stay fairly constant and our costs go down, our profit margins go up.”

Win, win, win. I see an enormously bright future for health promotion and win-win scenarios. Right now I think we’re squandering huge opportunities for just that sort of thing. NuVal and other innovations like it figure into these contexts where we think in terms of what are we doing now, what is a better way to do this, and how do we do this so nobody gets hurt, and everybody can win.

Jonathan: Dr. Katz, even adding another win to that equation, I think you are spot-on, and you touch on this in Disease-Proof. Not only do you not get sick, but now you’re healthy and able to function in the capacity that, if you believe in God, if you believe in a higher power, what you were put here to do. You are not in a mental fog, you’re not sick, you’re not tired. What’s the economic benefit of having millions more fully-functioning healthy people in our country?

David: Incalculable. Yes, that’s right. And it doesn’t matter what higher authority you answer to, all of us want that. We all want to be firing on all cylinders, clearly. And the work that I do at the Prevention Research Center and in my nonprofit, Turn the Tide, is all about putting empowering programming where the rubber hits the road. We have a lot of programming for schools. When you are a health promotion guy and you want to put your programming into schools, one of the things you have to deal with is the fact that they’re working hard in schools already. They had plenty to do before we ever came along. It’s not so easy to teach little devils reading, writing and arithmetic, it’s really not. Pedagogy is a high calling all by itself.

I’ve been at this for 20 years and have had conversations with school administrators all over the country, and the issue was, “You tell me what your issues are.” And it is, “We’ve got to do well on standardized tests, and there are these things that we are accountable for, and I don’t have extra time, and I don’t have extra money, and I don’t have extra space, or extra personnel.” So as the health promotion person wanting to add, then, to school programming, my job is to say, “Okay, I hear you. So how about if the health promotion programming doesn’t take extra time, and doesn’t take extra money, and doesn’t take extra personnel, but makes the kids better learners? I care about making them healthy, that’s my mission, but if I can also make them better learners, then are you going to be okay with what I am proposing?” And the answer tends to be, “Okay, we’ll give it a try, but prove it.” And we’ve been proving it.

For example, we have a school-based physical activity program available for free, by the way, called ABC for Fitness, (Activity Bursts in the Classroom). We conducted a controlled intervention in 1000 kids and published this in a peer reviewed journal, and what we found was significant improvement in key measures of fitness, so it did what it was supposed to do, stable performance on all standardized tests, so it didn’t get in the way of reading, writing and arithmetic at all, a significant improvement in the behavior of the kids in the classroom. Fewer kids got in trouble, fewer kids got sent to the principal, they were more attentive, they listened better. Significant reduction in medication use for all conditions, significant reduction in medication use for asthma, 33% reduction in medication use for ADHD, because frankly, the proper remedy for rambunctiousness in children is recess, not Ritalin.

Essentially what we’re doing is we are promoting health and enabling the kids to do the thing they’re in school to do better: Learn. Well, we have similar programming for the [?? 36:28] as do many others, so exactly as you say, this isn’t just about health because health is good, it’s about health because when health is good, living is good, and whatever it is you’re doing, you do better. If you are a kid in school, you learn better. If you are an adult in the workplace, you work better. And if it’s the weekend and you are recreating, you recreate better, because you feel better, you have more energy, you have more vitality.

One of the things I’ve started talking to my patients about quite a lot, and all of these things are covered in Disease-Proof, by the way, and one of the beautiful things about the book is that it’s really comprehensive. It’s me, with the help of my co-author, Stacy Colino, telling the full story. We say, “We’re not going to just say one little bit of the story, we’re really going to tell the whole story of what it takes to get to health. Here’s the skill set. And then here’s why it matters.” So, in the book, and when I talk to my patients, I say, “Health isn’t the prize. The prize is living the way you want to live.” But it’s just about impossible to do that without health, so health buys you the prize, and the prize is great. The prize is more to life in years, and probably more years in life, too, and something you can pay forward, because you know how to be healthy, chances are it’s going to affect the people in your life.

In my case, I adore my wife, I love my kids. Gosh, there’s nothing more important to me than them having vital, long, good lives. And I’m able to pay it forward. I have a skill set I share with them, and it just becomes part of who they are. Everybody can get there from here, but not by wishful thinking, and not by magical thinking, and not by false gimmicks, but with skill power. We need to learn a skillset, which is what Disease-Proof is all about. What is the skillset I have that not only allows me to get to vitality and live the benefit of it every day, but to share it with the people I love? Boy, that’s the prize. It’s not health because health is important, I’m the doctor, and I say you should be healthy. No, it’s because healthy people have more fun. If you’re healthy, your life is better. That’s the prize!

Jonathan: And it’s as simple as eating and living in that high-quality way that enables you to then experience life in a high-quality way. High-quality leads to high-quality, it sounds like.

David: It does, yes. And actually, it’s important to be holistic about it and one of the other issues that always affects my clinical work, and that we address in Disease-Proof, is that there may be something else in the way. For example, imagine you have sleep apnea, or you have terrible insomnia for some other reason. It’s all well and good to talk about eating well and being active, but you’re so depleted, you’re so exhausted, you can’t do it. You can’t begin the journey. For somebody like that, the first step actually has nothing to do with their feet or their forks, and everything to do with their mattress and pillow. You have to help them sleep better. Somebody in chronic pain, whatever the cause may be, and osteoarthritis for instance, they’re not going to exercise because it hurts too much, so you have to address the pain somehow. Somebody who is totally stressed out, for whatever reason, difficult relationship, maybe it’s work, whatever it may be, that’s going to be an obstacle that will prevent focusing on diet or physical activity.

The short list of things that matter most to health as far as I’m concerned, I talk all the time about feet, and forks, and fingers. The master levers of medical destiny are feet, forks, and fingers – physical activity, diet, and avoiding tobacco. But the super six would be feet, forks, fingers, sleep, stress and love. If you are physically active, eat well, avoid tobacco, get enough sleep and it’s good quality, dissipate the stress that all of us encounter, and have loving relationships; frankly, after that, who cares? Really, everything after that is vanishingly unimportant, but all of those things matter a heck of a lot. Even being lonely, just the love part of the equation, if you’re lonely that’s going to sabotage your ability to focus on these other things, because maybe you just won’t care enough about how you eat or whether you’re active.

So, we do need to think holistically. Each of these is interdependent, and it has to be customized. The first thing to do, for you, or for me, or for someone else may be different. If my relationships are good and my stress is okay and I’m sleeping okay, then we can move right on to talk about my diet and physical activity. But somebody else, where sleep is terrible, where they are in chronic pain, those may be the things you have to talk about first. Again, I have been taking care of patients for 20 years, and you are only a good clinician if you are a good clinician for the single patient you’re talking to right now. It’s always [?? 41:01], right? One of the things that informed the writing of Disease-Proof was that same notion that we can map out the full skillset but then we have to provide a way for anybody reading the book to say, “Okay, here’s where I fit in, and here’s the thing that I would need to focus on first.” We actually have the opportunity to customize the approach built into the book. I think that’s really important, because there’s always a way to get there from here, but it’s not exactly the same way for everybody because the circumstances of our lives and the things that make daily existence challenging differ for us, and we have to be prepared to personalize the approach.

Jonathan: Brilliant, brilliant. Well, Dr. David Katz, as always, thank you for joining us today. Always a beacon of hope and wonderful information.

David: Thanks so much, Jonathan, a great pleasure. I appreciate it.

Jonathan: Listeners and viewers, I hope you enjoyed this conversation. Again, the brilliant man we’ve been speaking with is Dr. David L. Katz. He is the founding director of the Yale University Prevention and Research Center, also one of the pioneers of the NuVal score, and his most recent book, again, this is number 12, a dozen, is Disease-Proof: The Remarkable Truth About What Makes Us Well. Check him out at Have a great week.

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