How to Eliminate 80% of Diseases with Dr. David Katz
Dr. David Katz
Jonathan: Hey everyone Jonathan Bailor back with another bonus Smarter Science of Slim podcast. Friends you know sometimes when we have some, all of our guests are obviously brilliant people, some of guests there’s just a residency, there’s a rapport, there’s an insight where I am just like man we’ve got to get that person back on the show. Today’s guest is, he’s like superman. I mean the amount of concept this man generates is, the amount of brains he has is amazingly impressive.
He is always a font on insight on scientific information. He is the author of the wonderful new book Disease Proof: The Remarkable Truth about What Makes Us Well. Which we talked about in detail in our first show. But today we’ve got some really provocative topics to cover. You know he is just an internationally renowned expert in chronic disease prevention and weight management.
Back in 2012 he was recognized and still is one of the most influential figures in health promotion internationally. He’s a specialist in preventative medicine and the founding director of Yale Universities Prevention Research Center. He’s authored eleven other books besides Disease Proof. So there is no shortage of work. He’s working right now on essentially ridding the world of disease so you know why I love him. Dr. David L Katz welcome back to the show brother.
David: Jonathan great to be with you. Love the intro. I hope my mother’s listening in cause she’d love that.
Jonathan: David I recently was speaking with one of my delightful friends in the industry, gentlemen by the name of Jimmy Moore who’s just out there. He’s talking about his life experiences and some great success he’s had and someone commented on Twitter and said a comment which could be interpreted as hyperbolic but really wasn’t. That was people who are out there telling these stories and helping individuals to live better are saving lives.
They really are and that’s why I get really excited about this stuff because obviously you cover this in detail in your book and in some of your recent articles. But dedicating your life to saving lives I think is worth celebrating, that’s pretty awesome.
David: Well thank you, I think so to. You know when you have the opportunity to do something like that you know the question is why wouldn’t you? Of course everybody in medicine is involved in addressing health and protecting health. In many cases, there are some exceptions. You know maybe dermatologists aren’t often involved in life and death situations.
Most of us in the clinic trenches do face life or death situations pretty routinely. Literally are involved in saving lives when people come into the emergency room and are on the brink of death. What we are talking about here I think Jonathan is more fundamental. We are trying to get into the bedrock of what really set’s the course of health in motion over the lifespan. What are the major influences?
We know those answers. We arguably have known those answers for a very long time and maybe have known them back to Hippocrates and Galen. But in the modern era we have certainly known those answers back a couple of decades. The trail I like to trace leads back to a 1993 publication in the Journal of Medical Association entitled Actual Causes of Death in the United States. I’m sure your familiar with it and most of us in the preventive medicine space sort of site this paper as scripture.
Because what it pointed out is that while we often talk about chronic diseases as the leading causes of death, so heart diseases, cancer, stroke, diabetes, etc. The authors of this seminal paper Bill Foege and Mike McGinnis pointed out that diseases aren’t really cause, diseases are effects. The real questions are, effects of what? So they wrestled that issue under control and they told us. They wrestled that issue under control and they told us.
There were ten factors on the list that accounted for almost all the premature deaths that occur every year in the United States. But the list of ten was overwhelmingly dominated by the first three. I routinely refer to those three as feet, forks and fingers. Physical activity, dietary pattern and tobacco use. Ever since that paper in 1993 there’s been a repetitive drum beating the literature telling us the same thing. Where it lands us and this of course was the basis Disease Proof is that if we avoid tobacco, and that’s not always easy but it’s at least not complicated.
If we are physically active on a regular basis and if we eat a nearly optimal diet we can eliminate close to 80% of all chronic disease. So talk about saving lives. It’s incredible. 80% of heart disease can go away. 90% of diabetes can go away. Virtually all of the obesity epidemic can go away. We could not just save lives because people on the brink of death don’t die. We could save lives because people have more years in life and more life in years because chronic disease never develops.
Its interesting Jonathan we talk about saving lives, we are going to die eventually right? You never actually prevent death. The issue is protecting life, what we really want is years of life and life in years. The potential to do that to protect both of those is phenomenal. It’s largely in your hands, my hands, in everybody’s hands but we don’t know what to do with it. That is something we’ve got to fix. It’s dangling right in front of us just like ripe fruit there for the plucking. It’s irresistible, so absolutely, totally committed to protecting life.
Jonathan: David one thing I really admire about you is it seems like there are a lot of people who are moving to, historically there has been “conventional” medicine and then alternative medicine. I’ve seen and spoken to many people who have lost a little bit of faith in conventional medicine, and I bring this up with you because you are at the top wrongs of “conventional” medicine. I think you do a unique job at that.
The reason they have moved away is they go to their conventional medicine practitioner and their conventional medicine practitioner does not reflect the simple and seemingly obvious truth you just said and you talk about in Disease Proof which is what you eat matters.
David: There are a number of issues here Jonathan. One of the thing’s I’d like to encourage listeners to avoid is either/or choices. I see all the time with my patients. As you say they have had maybe a bad experience with a doc, a doc who should have talked about life style or respected the power of nutrients and didn’t and the patients lose faith. They lose faith in all of science and they lose faith in modern pharmacotherapy. The reality is modern pharmacotherapy is saving lives every day.
There are people who are not having heart attacks because of the drugs they take and people who are not having strokes because of the drugs they take. Whatever your worries about modern big pharma frankly having a stroke to put it quite bluntly really sucks. If taking a pill every day that is safe and effective is the difference between having a stroke and not having a stroke, that’s a really important pill to take.
The problem is then many of my conventional colleagues seem to think that’s the only basket and all the eggs go there. That’s not true either because the major action is on the life style side. If you do eat well, your physically active, you take good care of yourself you never need the pill in the first place. The pills come in when either you’ve had bad luck and sometime things go wrong even though you take good care of yourself.
But more often than not it’s because you didn’t leverage the master levers of medical destiny, feet, forks and fingers. Then you need pharmacotherapy to compensate. My world view encompasses both. I practice integrated medicine. We place the emphasis on the kinder gentler more natural treatments whenever possible. I work side by side with naturopathic physicians. But I am a card carrying member of the evidenced based medicine club as well.
One of those other books I have written is a text book on evidence based medicine and clinical decision making. There is no question you will look at the epidemiology and pharmacology is saving lives every day. What I think makes the most sense is take advantage of the power in your hands, protect your health from the get go, don’t need drugs in the first place. But if you wind up needing drugs, if you hyperlipidemia or hypertension or diabetes then recognize that your much better off having the power of modern medical science at your disposal then not.
There was a time not that many decades ago when people got those diseases and just died. People got congestive heart failure and just died. Even in our lifetimes one of the interesting things we can look at, anybody who doubts the power of modern pharmacotherapy look at the lifecycle if you will of HIV AIDS. HIV AIDS that epidemic broke when I was in medical school. We were just surrounded by the mystery of it when I was training in the Bronx and it was scary.
It was a death sentence, nobody knew what to do with it. We watched patients get this infection and die within a span of months and generally horrible death. Now people are getting decades and it’s totally the result of advances in pharmacotherapy. So right there before our eyes is a demonstration of how powerful modern science can be. But that doesn’t in any way change the great power of life style as medicine. My mission is to get more people to use life style as medicine so we need big pharma less. But I think we should be open to both.
Really the goal here of the prize is vitality and any which way we can get it is probably a good way to get it.
Jonathan: David I really like that let’s not make there be a false dichotomy when there doesn’t need to be. I was speaking with a wonderful physician based out of Chicago, Dr. Oh. He has another podcast and he was talking about how in some circles there’s two fields of medicine. There’s almost like emergency medicine and there’s never been a better time to get in a car accident. Cause if you get in a car accident and you need to go to the hospital to get your leg set or something, you know back in civil war time’s you’d get your leg cut off. Like cut off the leg, whatever.
So there’s no question that this emergency traditional medical treatment has advanced and is saving lives. The good thing about that field of medicine is everybody understands. That doesn’t mean let’s all go get in car accidents.
David: Exactly. I think that’s a very good point Jonathan and it can be expanded. Another effective treatment is bariatric surgery but do we really want to reroute of gastrointestinal tracts to fix a problem, obesity. That we could prevent at a level of our culture if we made good use of feet and forks, the prevailing norm. It’s exactly like well let’s just get in a car accident and get put back together. That’s clearly less good then staying healthy in the first place or avoiding that car accident in the first place.
It’s absolutely true, the acute interventions of modern medicine are not only impressive they can be quite stunning. It isn’t limited to the emergency room. You think about people with bad vascular disease, I mean the revascularization procedures that can be done these days. I mean the ways that gummed up hearts if you will can be cleaned out and restored. The way that people in the middle of heart attacks can not only have their lives saved but have their heart muscle saved.
If the heart attack is aborted it just doesn’t happen. All of these are examples of stunning advances. You know another thing Jonathan, people seem to be oblivious to this. With all the concern that prevails, and I hear about it all the time. I hear about it from audiences, I hear about it online and I hear about it from my patients worries about all the contamination that we put in the food supply, the environment and it’s got to be doing bad things. Raising rates of cancer.
I am worried about it all too but there’s a simple reality here and that’s cancer rates are declining and cancer deaths are declining even faster. There again it’s largely due to the application of modern medicine, good detection methods and highly effective treatments. But like that car accident yeah it’s terrific that when you get to the emergency room and need to be put back together that the team in the emergency room can do a slightly better job than all the kings horses and all the kings men. It’s much, much better to not fall apart in the first place. That power is in our hands.
We really can disease proof ourselves if we use life style as medicine and the beauty of that is it’s inexpensive, it’s readily available, it doesn’t just defend you against disease it cultivates vitality and you can share it with the people you love. As a parent if you learn how to make good use of your feet and your forks your kids will take advantage of that as well. Their going have a longer more vital life. I meant there is no greater gift a parent can give a child. This is the way to go. Let’s use the medicine that is available when we need it. Let’s need it less.
Jonathan: David let’s continue the car analogy maybe and hopefully I won’t take this too far off the farm here. I love analogies.
David: We’re going to drive the car analogy right off the road.
Jonathan: Yeah drive the car analogy right off the cliff. One of the areas both you and I feel so passionate about, we’ve already talked about let’s not drive around our car at a hundred and twenty miles with our eyes closed and no seatbelt on because yes the treatment when we crash will be better than it ever has, why not just not crash in the first place? Much better. We would especially not like to put our children in that car going a hundred miles an hour with our eyes closed with no seatbelts on.
But it seems like in our culture as you’ve identified in your writing, as I’ve spoken to, the definition of children’s food is basically means that the “food” the edible product, sugar, starch, processed fat, garbage is analogous from a nutritional perspective putting your child in the front seat of a speeding car that you are driving with your eyes closed and no seat belt on.
David: Exactly right Jonathan. So I think that’s a very adapt analogy. The difference is time. You know basically by feeding out kids junk we’re building their growing bodies out of junk. Pretty much playing Russian roulette with their health. The difference whether it’s a speeding car or a speeding bullet and feeding kids junk is the timeline. A car crash, a bullet are things we can see cause and effect play out in seconds so the connection is indelible in our lives. Our brains are basically hard wired to perceive cause and effect that way.
If the cause is now and the effect is immediately after we connect the dots. But the cause and effect of feeding kids junk and then a lifetime of greater risk for obesity and chronic disease is every bit as indelible it just plays out over years and decades instead of seconds and we tend to be blind to that. It’s absolutely as indelible link and it’s absolutely as irresponsible to neglect it. I’ve gone on this rant of late, I’ve written a couple of pieces online from my usual sources are Right for US News and World Report and Huffington Post and Linked In.
One of the pieces that I wrote was Dieting Must Die and what I mean by that is we live in a culture where every year roughly a hundred million people go on diets, adults go on diets. We know that overwhelmingly those people are parents with kids living at home. You look at the demographics of the United States and some very high percentage of that group has kids living at home and we also know that when people go on diets they don’t take their kids. Here we got epidemic childhood obesity, we’ve got kids who really need to learn how to eat well, we have parents going on quick fix diets and leaving them out of it so dieting must die.
We need to reimagine it as approaching healthful living as a way we can sustain and share. The other things I’ve started arguing for is the eradication of kid food and this was a piece on US News and World Report. Actually working now with colleagues Jonathan to organize a national day of boycott to shine a spotlight on this issue. You know I imagine you watch nature programing, I do. I think probably at one time or another everybody does and inevitably whatever critters we are looking at and enjoying a big part of the show is about parenting. You know the parents are struggling to raise their offspring.
If you really think about the details of what’s going on there it’s almost always about the pursuit of food. It’s about often parents teaching their kids what to eat and how to get it. Throughout nature one of the critical elements of childhood is learning about sustenance, learning what to eat for a lifetime of sustenance. Parents teach their kids that. Every species, certainly all of our fellow mammals that’s what they do. Then there is us and we market aggressively to our children multicolored marshmallows and call it breakfast right?
Literally we have breakfast cereals for kids where the first ingredient is sugar, where the ingredient list runs off the box, where there are all sorts of chemical names nobody could pronounce or identify and literally got multiple shaped, multicolored, artificially flavored, artificially colored marshmallows. This sonorous announcer comes on to tell us part of a complete breakfast, fortified with eleven essential vitamins and minerals. Yeah it’s the crappy part of a complete breakfast and every parent with half a wit should say no this is the growing body of my child we are talking about.
I love this little person. I am not building this little person out of junk for crying out loud. The very concept of a whole class of foods that is selectively, preferentially junky as the construction material for the growing bodies of the kids we love is unconscionable. It needs to end. We need at least in this area to get back to nature where it’s the job of the adults of any species to teach the kids to eat for a lifetime and frankly kid food needs to go. Now there are exceptions, obviously kid portions are acceptable, dressing things up in ways that makes it fun for kids. You know I don’t know there is any problem in turning carrots into the carrot crusaders.
I think there is advantages in that. There is actually research and marketing to show that you can get kids to get more fruits and vegetables when you sort of market them. What I am talking about is the whole cottage industry in junk food. There’s evidence Jonathan in DC that between 30-50% of the calories the average kid’s diet in the United States comes from junk. You know food that basically does more harm than good. That is a national and cultural travesty and it’s time for it to end.
Jonathan: David you know I share your passion for this and I am curious of what your thoughts, so I saw this the other day I’ve seen two instances of this and hopefully we don’t get in trouble for naming companies. You don’t have to say their names if you don’t want to. The two most noteworthy are Coca Cola who says it’s just a hundred and forty calories per can. It’s just a hundred and forty calories which is not that many calories and if I walked by a McDonalds and I saw they had these little promotional flyers and they were smart McDonalds choices based on having choices on the McDonalds menu that were four hundred calories or less.
With again the assumption being if we stopped thinking about food, you know I am passionate about this. We stop thinking about food and we just say everything’s about calories then you could see this paradigm in peoples mind saying there’s no such thing as kid food because it’s just calories. A calories a calorie and if I don’t feed my kid too many calories then I can feed them a hundred and forty calories of Coke because it’s only a hundred and forty calories. What are your thoughts on this?
David: We approach this differently Jonathan and you and I have had some interesting discussions and debate about the whole calorie issue. In some ways I think a calorie is a calorie as a unit of measure. But human reaction to calories varies with the quality of those calories. A couple important reflections here. First let’s think about those hundred and forty calories from say Coca Cola. There are only two possible fates for those calories, either your adding them to a full days’ worth of calories. So you ate all the calories you needed and added a hundred and forty in which case those calories are going to help you get fat.
Pure and simple. Or there part of the calories in which case you bumped out of your diet a hundred and forty calories that might have been worth something with a hundred and forty calories that are worth absolutely nothing. It’s just a dose of sugar and useless junk. Consequently the displacement is bad for your health. One the one case it’s bad for your waistline, the other case is bad for your health. Folks wake up and smell the slim fast there is no way to win here.
The other thing here is when we think about the issue of calories, nobody wants to eat over a course of a lifetime, people do this while they are on a diet or while they are counting stuff but when you think about our relationship of food over the course of our lifetime it isn’t about filling a calorie quota it’s about satisfaction. We want to eat and feel satisfied. The simple reality is the quality of calories changes the number it takes to feel full and satisfied. Just think about it. Think about cheese doodles and French fries where mindlessly you could eat three thousand calories and not even think about it.
Think about eating pure wholesome foods, wild salmon, quinoa, fresh vegetables, a big mixed green salad, thing’s that fill you up with nutrients and fill up your stomach and help you reach satisfaction with very few calories and a whole lot of nutrients. The quality of calories dramatically influences the quantity of calories it takes to feel full. The junkiest of foods, those McDonalds choices and certainly the soda, Coca Cola and other’s do exactly the opposite.
Those are calories that totally fail to fill you up. They result in wide swings in insulin and hormone levels, you will be hungry again in just a little while. Not only will those calories not fill you up they will make you want more of the same kinds of calories and you will lose and lose and lose everything but weight which you certainly will wind up gaining. I think the key here and you know I think at the end Jonathan even though we approach it somewhat differently we arrive with the same basic conclusion.
It’s the quality of calories that matters because it dramatically influences your health all by yourself. The quality of calories is the quality of food and sustenance and that’s crucial. The quality of calories dramatically influences the quantity of calories it takes to feel satisfied. By the way this is something that is pretty well substantiated in the [inaudible 0:23:19] literature. I have some very interesting direct real world experience with this. As you know I am the principle inventor of the algorithm used in the NuVal nutritional guide and system.
One to a hundred, the higher the number the more nutritious the food and it incorporates roughly thirty different nutrient properties. We actually lay out a lot of the details of the NuVal system in Disease Proof and explain to people what it does and how it works. The NuVal system is available for shoppers in about seventeen hundred supermarkets throughout the United States, coast to coast. Some thirty million people have access to it which means a lot of people are using it and we get a lot of stories.
Some of those stories, and these are available on the NuVal website by the way, nuval.com. Some of these stories involve people who have lost over a hundred pounds, I heard from one guy who lost over two hundred. The beauty of this is no extra money is being spent, no particular product, no program, just trading up the quality of groceries in every isle of the supermarket. Of course when you do that since you’re not on a diet you are sharing with your family. We have heard stories I have lost over a hundred pounds in eighteen months and my husband lost wait and got healthier or my kids lost Wight and got healthier to because I was trading up grocery quality for my whole family.
Now what does that mean? Foods that are more wholesome, less highly processed, richer in fiber, higher in volume, richer in nutrients and density, lower energy density, lower glycemic, higher quality protein, you know all the things that influence satiety. Which by the way is what the Smarter Science of Slim is all about. It’s about eating foods that really help fill you up. I can back you up brother when you talk about the Smarter Science of Slim and say you’re absolutely spot on right.
We have this real world evidence of when people shop smarter they can get slim without going hungry. That’s where I land on the issue of calories. Calories count but counting calories is not the way to deal with the little buggers. The way to deal them is to improve the quality of your food choices and then the number of calories tend to take care of itself. If you go the other way and say forget about quality I will focus on quantity you’re going to lose and big food will laugh at you all the way to the bank.
Jonathan: Sir I could not have said it better myself. So that is very well stated. Well David we always run out of time with no shortage of additional topics to cover so I do hope you will come back to the show. I have a whole list of follow up questions here.
David: Excellent. It would be my pleasure Jonathan anytime.
Jonathan: Again folks the man joining us today is the brilliant Dr. David L Katz. The author of many books, the most recent of which is quite recent, I believe it came out on September 26 so definitely check it out if you have not already is Disease Proof. Subtitle The Remarkable Truth about What Makes Us Well. You can learn more about the book online, you can also learn more about the man at davidkatzmd.com. David thank you so much again for joining us.
David: My pleasure Jonathan take good care.
Jonathan: Listeners I hope you enjoyed this conversation as much as I did and please remember this week and every week after, eat smarter, exercise smarter and live better. Chat with you soon.