Ep.90: Learn True Health Interview with Dr. David Katz

Robyn:             Hey everyone. It’s Robyn Openshaw and welcome back to Vibe. Today is a really important interview that I’ve been looking forward to for a long time with one of my all time heroes. David Katz, MD is the founding director of Yale University’s Prevention Research Center. He’s also a past president of the American College of Lifestyle Medicine and he’s the founder and president of the True Health Initiative, which brings nutrition experts together from all over the world from 40 different countries. He’s earned degrees from Dartmouth College. His MD is from Albert Einstein College of Medicine. He got a master’s degree in public health from Yale University School of Public Health.

The reason I’m super interested in talking to Dr Katz is that he is super committed to looking at published evidence. And in a world right now where there are some food fads and diet fads and people selling books and courses that really, I believe lead us astray from what is known out there in the body of evidence, Dr Katz is unrelenting and absolutely clear about staying focused on what the evidence shows.  He’s not looking at one pet project that he’s in charge of. He’s actually doing literature reviews to write the textbook for other clinical nutritionists and doctors who guide patients out there and what to eat.

So He’s been named one of the nation’s top nutrition experts, by a lot of different organizations. He holds five US patents. He’s the principal inventor of the Overall Nutritional Quality Index algorithm. He’s had a lot to do with bringing together the research evidence on nutrition with government and regulations. And he’s going to talk to us about the fad diets. He’s going to talk to us about what the evidence shows us. He’s going to talk to us about the shiny objects that we are chasing out there and that lead a lot of people astray. He’s going to talk to us about why cardiologists and other medical doctors aren’t really doing much in terms of guiding their patients when it comes to nutrition.

Robyn:             So welcome to the show Dr. Katz.

Dr. Katz:           Thank you very much, Robyn, great to be with you.

Robyn:             I have been dying to do this interview for so many months. You’re very, very busy and I would love for you to start at the beginning and talk about your career going into studying diet and nutrition. You’ve gotten to the point where you can take a very high level view and look at all the published research and you sit at all the highest levels sharing with the public as well as with clinicians and researchers, what the research actually tells us. Did you go into your work as a researcher, as an MD with a bias about diet? What was your upbringing, your own diet? Has it changed over the years as you’ve learned what you’ve learned? Share anything you want to about all that.

Dr. Katz:           All right, well thank you. So very briefly, in terms of the long sweep of my personal history, I grew up eating a typical American diet. I was a little better informed than the average person. My father’s a cardiologist, but my mother ran the house and did the cooking. And she had a traditional diet sort of passed down from northern European ancestors and then Americanized. So, you know, we ate like everybody else did. Maybe a little bit better.

I first acquired an interest in exercise and fitness as a teenager and then started thinking about food is the fuel for that exercise and kind of began a personal journey of interest about nutrition. So no very strong bias and certainly no interest in anything other than using diet as optimal fuel. And again, a little bit of an additional insight I think because my father is a cardiologist, was a little more focused and then maybe the typical person was at the time.

I went into medical training inspired in part by my father’s example and other experiences I had growing up. I trained in internal medicine and really it was during the intense phase of my training in internal medicine when I discovered my passion for preventive medicine. Because I was basically spending over 100 hours a week in the hospital taking care of desperately sick people. And I recognized how many of them never needed to get so desperately sick in the first place if they had ever used diet and lifestyle to be the medicine it might have been.

And I also had the sense that I was being trained to be one of the king’s horses and one of the king’s men. In other words, you know, just like that famous story about Humpty Dumpty, we could never put vitality together again. The best we could hope to do with all of our modern resources and tools was to forestall death to confront the ravages of severe illness. But if we were going to do anything to keep people truly vital. It really meant leveraging lifestyle over time rather than reacting after the fact once there was already serious chronic disease.

So I did a second residency in preventive medicine and I guess we can say the rest is history. My career really has been focused on using diet and lifestyle to prevent chronic disease and promote health ever since. That’s my only bias. So I, my, my career long interest is using what we know about diet and lifestyle to add years to lives and life to years. I suppose I also have a bias that, you know, for people to be healthy, they need to have a habitable planet. And so, as we learn evermore about the ravages, uh, to the planet being imposed by a voracious hoard of nearly 8 billion Homo Sapiens, that does figure in my thinking evermore, we really can’t talk about a healthy diet without addressing sustainability, without thinking about planetary impact.

And then frankly, I love some creatures that are not members of my own species. I’ve got three dogs. I love them. I have a horse, I love him. I think how we treat other creatures matters too. So I suppose the ethics of how we treat other species both directly and indirectly, and in some sense, the way we eat, the things that we do to the planet have indirect effects on the planet’s biodiversity. All of that matters to me. I don’t know whether that qualifies as a bias or not. But I care about the planet, I care about animals and I care about human health. Those things influenced my thinking.

But I also care a lot about scientific evidence, Robyn, and so when I look at the literature and try to offer my opinion to the public or to my peers, I never distort what the evidence says. If there’s clear evidence for or against a particular dietary pattern, I am obligated to process that honestly. I’m obligated to look for the same strengths and weaknesses in studies that support my point of view as I am in studies that refute my point of view. One of the things I think is critical about being a good scientist is you ask the question before deciding on the answer. And I think all too often the opposite is the case these days.

Robyn:             Let’s just go to the million dollar question then. And that is, since you’re completely committed to looking at the scientific evidence, rather than going with a specific bias: What is an appropriate human diet? Is there this wide diversity of diets that we should be eating? And do your conclusions, looking at the evidence, lead you to the same place in terms of what people should eat for their health and what is best for the universe? You know, the big blue marble we live on as you mentioned, you care about that too.

Dr. Katz:           Yeah. And thankfully, the answer to that second question is definitely yes. The basic theme of the dietary pattern that’s good for homo sapiens is also the basic theme that’s much better for the planet. And one other thing to say right here at the start Robyn before getting into the particulars of the answer, is there’s something else about my own opinion that’s important to me, and that is, my own opinion is not that important to me.

One of the things that I think corrupts the dialogue about diet in particular is that everybody falls in love with their own opinion. And so even people who mostly agree wind up talking about their disagreements. So, you know, my particular favorite diet is “x” and the other person’s particular favorite diet is “y”, and it sounds like we are at odds with one another. I say x, she says y. As opposed to noting that x and y overlap 95 percent. So I’ve decided I don’t really care about my own opinion. What I care about is the weight of evidence and the global consensus among true experts. And I want to represent what a world of experts think the best evidence means. And I would rather talk about our shared opinion, the overlap, then talk about my own personal opinion. And I’ve really tried to do that in every way possible.

And the most formal expression of that commitment is a nonprofit organization called “The True Health Initiative”, which I founded. We have a council of directors, roughly 500 strong from over 40 countries and these are world leading experts and major influencers. And essentially our mission is to come together and say we agree. And what we want to tell the world about is our agreement. We may disagree about our personal favorite variant on the theme of optimal diet, but we all agree about the theme. And that’s what we need to talk about because that’s what the public needs to know.

New Speaker:   So I’m going to talk about that theme now, but it’s not my perspective on the theme. It’s the perspective I share with my colleagues all around the world. Essentially when you look at all of the relevant evidence, and I’ve been obligated to do this a number of times. I’ve authored three editions of a leading nutrition textbook called “Nutrition in Clinical Practice”. It’s just about time to work on the fourth edition. But the third edition which came out in 2014 has about 10,000 scientific citations. So it really is the obligatory view from altitude. And then on a smaller scale, also in 2014, I published a review paper in the Annual Review of Public Health entitled: “Can We Say What Diet is Best for Health?” So same basic project, but on a smaller scale, look at all the relevant literature, look across the full expanse from Vegan to Paleo, and everything in between. Look at the arguments for and against and reach a summative conclusion.

And having then engaged in that exercise multiple times across the span of years, it’s entirely clear, and this is considering evidence as diverse, as randomized controlled trials and the fate of whole populations over a span of generations, that people do well on a diet of: “Real Food. Not too much. Mostly plants.” to put it in Michael Pollan’s words. And, you know, what makes that line so memorable and so quotable is in so few words, it expresses so much truth. If your diet is mostly made up of vegetables, fruits, whole grains, beans, lentils, nuts, seeds, and if when you’re thirsty, most of the time you drink plain water, you simply cannot go too far wrong.

There is room in that diet to have some wine or not have wine.  There is room in that diet to have some dairy or not have dairy. There’s room to have seafood and fish or not. To have poultry or not. To have some meat or not. But mostly, your diet is made up of some combination of vegetables, fruits, whole grains, beans, lentils, nuts and seeds and plain water for thirst. If that really is the fundamental makeup of the diet. All of the nutrients sort themselves out. All these things that we debate all the time sort themselves out And so frankly, that diet could be put together in a way that looks fairly Paleo. It could be put together so that it’s Vegan. It can be put together so that it’s Mediterranean or Pescatarian or Flexitarian.

That’s where the dialogue falls apart, in my opinion. We really don’t have decisive evidence that any one very specific prescriptive diet is best for human health. We have overwhelmingly clear evidence that the basic theme of the diet made up mostly of minimally or unprocessed plant foods is best for human health. And frankly, that is what’s best for this blue marble too. So when we think about everything from water utilization and what happens to our aquifers to greenhouse gas emissions to ecosystem incursions and the effects on biodiversity, eating a diet of minimally processed foods, mostly plants is vastly better for the planet than any alternative to that.

There is an argument to say, well, maybe it should be completely plants. And you know, I think one of the strongest arguments for a Vegan diet is saying, this is the dietary pattern that is consistent with optimizing human health and it’s kindest, and gentlest to animals, and it has the smallest environmental footprint as well. I think the confluence of those things does make an argument for even plant exclusive diets. But honestly, so much good would be done if we simply get the theme right. Have a diet of mostly plant foods, minimally processed. That’s where the focus needs to be.

Robyn:             Well, that put a really good fine point on what we can distill everything down to that you have published in your textbook, “Nutrition, in Clinical Practice for Healthcare Professionals”, that comprehensively reviews the diet literature. You mentioned that you have 10,000 references in that piece and just to review what you said before, in 2014 with your coauthor Stephanie Miller, you had published in the Annual Review of Public Health another review that’s out there for probably a bigger audience about what we actually know about nutrition.

I’m concerned about recent trends and fads that sort of denigrate whole classes of whole foods. And I ask quite a few of my PhD and MD guests to comment on this because I’m a little bit worried about the fact that the evidence points a different direction than where some of the fads point. Can you talk about, how clear is the evidence that foods like, night shade vegetables or legumes, beans, lentils, whole grains, these are foods that are falling out of favor with some of the diet fads. And it seems to me like there are thousands of published studies showing that the healthiest people all over the world have eaten these for maybe a millennia. What do you have to say about that?

Dr. Katz:           Exactly the same thing. Exactly right. I think the public really needs to finally cllue in to the idea that pseudo confusion about diet is enormously profitable for a lot of industries and individuals. If all of the major epidemiologic studies show that the healthiest, longest lived populations around the world routinely eat whole grains, then why are we debating whether or not whole grains are good for us? It’s an established fact. It’s like, you know, opening whole investigations into whether or not horses should eat grass and hay. It’s a silly question. It’s a waste of time. So, you know, yes, there are people who are gluten intolerant. They need to avoid gluten. That’s a different story. There are people with peanut allergies who need to avoid peanuts. But, you know, the question: “Are whole grains good for people”?  It’s answered, it’s done.

And then similarly, you know, the idea that it’s possible to publish a book “The Plant Paradox”, for example, arguing that every food containing lectins needs to be avoided even though all of the most nutritious foods contain lectins. So don’t eat beans, don’t eat lentils, don’t eat whole grains, don’t eat many vegetables and fruits. It’s preposterous. People who do the opposite, who eat those things consistently have the best health outcomes. What I’ve equated all of this to Robyn, is like pointing out to people: Oxygen is toxic and there’s oxygen in the atmosphere and I’m the only person willing to tell you about that. And it’s a great controversy. And…What? Hold your breath.? You know, the failure to consider the big picture. Yes, there is oxygen in the atmosphere. Yes, too much oxygen is toxic for people, but you know what, you really better breathe.

So the same thing about food. Sure, if you’re sensitive to gluten avoid it, but eat other whole grains because they’re consistently good for people. Yes, there are lectins in some foods and there are some theoretical arguments about the possibility of harm for some people from some dose of Lectins. But in general, the foods that contain them produce net health benefit. And there’s just no basis for confusion. Again and again across every population, every kind of study, no matter which way we aggregate the evidence, it’s perfectly clear that people do best when they eat diets of minimally processed foods, mostly plants, lots of vegetables, fruits, whole grains, beans, lentils, nuts, seeds, plain water for thirst, every time! And any argument that is at odds with that incredibly well established foundation is an attempt to sell you something. Period. End of story.

Now you know, again, you can customize a little bit. So I fully respect the fact that some people need to avoid certain grains because of their gluten content. Some people have food allergies or sensitivities and may need to avoid some members of the nightshade family, or pick anything else you like. You know, again, people allergic to peanuts shouldn’t eat them. But the replacement of the weight of evidence regarding human health outcomes with these isolated tidbits of that nutrition is a case of failure to see the forest for the trees, time and time again. And I think as long as we, the people, are willing to be suckers, are willing to be gullible and silly and pretend like the fundamentals of nutrition actually change every time a new book comes out, I think authors and publishers will be willing to keep selling us bad advice. So I really do think it’s time for us to stand up for good sense.

We want good science, but we have to filter it through good sense. It’s interesting, Robyn, you think about something that matters to people like money and everybody knows that get rich quick schemes are silly. They’re the stuff of sitcoms. You have to tune into reruns of the Honeymooners to watch that stuff. Sensible, responsible adults don’t get involved in get rich quick schemes. They don’t. People get an education, they work hard, they take care of their money. All we really need to do is grow up and start treating health the way most of us treat wealth, as something that serious people take seriously.

And no, the basic advice about it isn’t going to change every day on the Today Show. And no, we’re not interested in every contrary opinion that comes out every day. And we’re in it for the long haul. And we want to take care of it in a way that will protect us across the span of, not the next six weeks, but the next six decades. And we want to invest in it. And we want to bequeath it to our children and share it with our families. And you know, there’s just a whole different way of thinking about diet, lifestyle and health. And our culture really needs to grow up. I think we are acting like silly gullible children and so it’s a seller’s market for dietary nonsense.

And I do think unfortunately, given the profit incentive, as long as we’re willing to buy nonsense about fad diets, there will be people willing to sell it to us. And the result is, from my perspective, we have squandered literal decades going around the same circles by different names. You go back to the 1970’s, that’s when Robert Atkins first published his books about going low carbohydrate. They came out again in the 1990’s, when they really took off. You know, if it was such a terrific idea 20 years ago, where all the lean healthy people now? The reality is you can cut fat and eat low fat junk food and get fatter and sicker. You can cut carbs and eat low carb junk food and get fatter and sicker. And the only thing that’s a reliable defense against getting fatter and sicker is actually eating and living well. And that’s not about cutting one macronutrient class. It’s about choosing wholesome foods in sensible combinations. And you don’t get there by jettisoning lectins , or gluten or fructose or carbohydrate or fat. You get there by focusing on foods and dietary patterns that have stood the test of time.

I’m very disheartened by the current preoccupation with the Ketogenic diet, which from my perspective is basically just the low carb diet that’s been popular several times before under a new name. And the idea here is to restrict carbohydrates to the point where the body switches over from running on glucose in the bloodstream to running on a metabolite of fat called ketone bodies. And what bothers me about this is yes, of course, if you remove one of three macronutrient classes from the diet, you will produce weight loss. And if you produce weight loss in people who are overweight or obese, there’s a good chance you will improve in the short term, their blood pressure, their blood cholesterol, their blood sugar, because weight loss tends to do all of that.

The problem is leaving aside that it’s nearly impossible for most people to sustain a diet that cuts out one of three major sources of macronutrients, and in this case, cutting out most of the most nutritious foods, because all plant foods are carbohydrates. Vegetables are carbohydrates. Plants in general are rich in carbohydrates. Fruits are rich in carbohydrates. Nuts and seeds contain carbohydrates. Beans and lentils contain carbohydrates. Whole grains are principally carbohydrates. So all of the most nutritious foods are excluded when you cut carbohydrate out of your diet.

But you know, in addition to the doubts about anybody willing to live this way for the long term, there’s the simple fact that we have no evidence that this dietary pattern is consistent with long-term human health. And every reason to worry that it’s not. Since all of the best long-term outcomes occur in people who eat lots of carbohydrate. Not refined starch and added sugar, that’s bad carbohydrate, but lots of vegetables, fruits, whole grains, beans, lentils, nuts and seeds in their native unprocessed form. That’s all carbohydrate too, but that’s the best stuff. Those are the people who have the best health outcomes.

So you know, what’s the risk with a Ketogenic diet? Well, from my perspective, stating it quite bluntly, the risk is it’s like using cocaine to lose weight or a bout of Cholera. Yeah. These things will cause you to lose weight in the short term and yes, they will bring down your cholesterol and blood sugar. That really doesn’t mean they’re good for you. And we have every reason to be doubtful that this dietary pattern, which is fundamentally at odds with everything we know about long-term human health and vitality is a really bad idea. And yet, because it promises short term weight loss, it is the diet and lifestyle analog to the get rich quick scheme. People go into a trance and start reaching for their credit cards. And we really need to fix that.

Robyn:             I love your quote that you can lose weight using cocaine or cholera, but that doesn’t mean it’s a good way to eat. I feel like with 2016 on Google, the number one search term, I don’t know if you know this, was, “Ketogenic diet”. It’s the perfect example of how you talk about how Americans have gotten very, very silly and we want something to be discovered right now. Something that’s a hack and it’s easy. It’s like a quick fix. Take a pill, kind of a thing that overcomes thousands of published studies.

And so you’ve already done it very well. But what I hear you saying, and you could correct me if I’m wrong, is that the low carb diet is so dangerous because you’re removing the foods that have high fiber, which Americans are notorious for not getting enough fiber. You’re removing the foods that are highest in micronutrients. So do you feel, as I do, that in comparison to the body of evidence that the Ketogenic diet is one of the more dangerous diets we’ve seen in the last what, 50 years of the diet industry?

Dr. Katz:           You know, first of all, Robyn, I think everything you just said is fundamentally correct and really important. And I also think it’s really important that we stop talking about nutrients and start talking about foods and how we put them together. Because what we’ve proven abundantly to one another is that we can pick any nutrient we like and still get the diet wrong. In contrast, if you get the foods and dietary pattern right, you inevitably get the nutrients right because they simply come along for the ride. So I think one of the critical messages here is almost any dietary advice that’s focusing on an ingredient or a kind of food or a nutrient is going to be bad advice right from the start, because that’s the way it’s been for decades now. We’ve focused on one nutrient at a time and basically proven that there are lots of different ways to eat badly and we Americans seem committed to exploring them all. “And tell them what they’ve won. Johnny.” I mean just look at the rates of obesity and chronic diseases a result.

So that’s really the critical issue and it’s not just about the Ketogenic diet, it’s about whatever fad diet is going to come along next too. It’s time to stop having an interest in any fad diet. The places around the world where people live the longest and enjoy the greatest vitality do not change their diets every time a book gets published. They eat the way they’ve eaten for generations. That’s the message. So wholesome foods. Sensible combinations. Stands the test of time. It’s about foods and dietary patterns rather than nutrients. The nutrients sort themselves out when you get the foods right.

In terms of how dangerous the Ketogenic diet per se is, to me, it seems very likely that it’s dangerous. It’s a diet that emphasizes foods associated with higher risks for every major chronic disease: heart disease, diabetes, stroke, cancer, even dementia. I think it’s likely to be extremely injurious over time. But as a scientist who is careful about what the evidence tells us, I suppose I have to say I don’t know for sure because I’m not aware of any long-term studies of the Ketogenic diet because so few people in the real world stay on such a diet for any length of time. So what I can say is it seems likely to me that it would be harmful, not helpful over time.

It also seems likely to me that few people could stick to it anyway, which means you’ll lose the weight quickly and then gain it back with interest, which is what most people who go on fad diets do. That’s not a good idea either. And in contrast, diets of wholesome foods, mostly plants which are high in carbohydrate have also been associated with rapid weight loss, have also been associated with reversing type two diabetes, have also been associated with lowering blood pressure and lowering blood cholesterol and have been associated with the ideal outcomes we all really care about, which is years in life and life in years.

So if you can get everything you want with a dietary pattern we know is good for you and good for your family. And it’s suitable for your children and can stand the test of time. And oh, by the way, is also good for the planet too. Why on Earth would you take a chance of a leap of faith in another direction, which at best maybe could be good for you? But frankly I think is very, very unlikely. So again, I don’t have proof from a 20 year long study of the harms of the Ketogenic diet because that study has just never been done. But I very much suspect it would be harmful.

But even it’s fans have to admit, they can’t know it’s helpful because they have no evidence of that. And in contrast, those of us advocating for the basic theme of the diet we know to be good for people: wholesome foods, mostly plants, sensible combinations, and consequently, generally fairly high in carbohydrates, certainly not Ketogenic. We’re not making that recommendation based on a leap of faith. We’re making that recommendation based on what really happens to real people in the real world over lifetimes.

Robyn:             Interesting. So your father was a cardiologist. And I’ve watched the impact of Dr. Caldwell Esselstyn’s work on some pretty famous people, including Bill Clinton and most recently, Bob Harper, who had the widow maker heart attack. He’s the Biggest Loser guy, very well known and very nearly died of a heart attack. And then Dr Esselstyn guided him to a plant based diet. I see Dr Esselstyn, Dr Fuhrman, Dr McDougall, some of the older voices advocating for a plant based diet, recommending very, very low oils, a very low fat diet.

What do you think the evidence suggests in terms of oils? Because I think we can all agree that nuts and seeds where there are natural fats in the whole foods are good for us. But what’s your stance based on your review of the literature regarding how much fat to eat? I think we can rule out that you and I both don’t feel that the Ketogenic diet is supported by any long-term evidence eating that much fat, that much animal fat, that little fiber. But how do you feel about oils?

Dr. Katz:           So, I would argue, and you know, some of the names you just mentioned are friends, all are colleagues, and you know, again, this is one of those instances where I think people can kind of fall in love with what’s inside their own particular tunnels. So you take someone like Caldwell Esselstyn who did work with a very low fat vegan diet to bring people back from the brink when they had really advanced and dangerous coronary disease. You know, it’s easy to understand why Dr. Esselstyn is so passionate about that particular dietary approach. It’s where he has devoted his own effort and focus.

But frankly, I think it’s a very narrow window because when you look at populations that have the least coronary disease over their lifetimes, they include populations with very low fat diets like the Seventh Day Adventists in Loma Linda, California, and like the traditional Okinawan diet. But they also include very high fat diets like in Sardinia, Italy and Ikaria, Greece. The five Blue Zones, the five places around the world where people have the longest lives and the least chronic disease, range from very low fat vegetarian and vegan to very high fat Mediterranean.

So my view is I don’t think the fat content of the diet per se, is what matters. I think it really depends on: Is it a diet of wholesome foods, mostly plants in some sensible combination? If the answer is yes, and it’s a Mediterranean diet that’s rich in extra virgin olive oil and also maybe getting some fat from fish and seafood and a fair amount of fat from nuts, seeds, olives and avocados. And so the result is a high fat but very wholesome diet, I think that’s perfectly good for people’s coronary arteries and for their longevity and vitality. On the other hand, I think you can put together a comparably optimal diet that happens to be very low in fat.

So the simple fact is we do not have evidence that the inclusion or exclusion of wholesome plant derived unsaturated oils is the principle determinant of health outcomes. And there might be a case to make that, you know, if you are dealing with people who have advanced coronary lesions and you’re talking about using a dietary approach as an alternative to coronary bypass surgery, that the evidence is stronger for the Ornish type approach or the Esselstyn type approach. And you know, that would be a case where, well, yeah, we, we really don’t have studies looking at the Mediterranean diet specifically, for example, to cause regression of plaque in the coronary arteries.

On the other hand, we go back a decade roughly, and there was a very important study called the “Lyon Diet Heart Study”, which randomized people throughout Europe who had had a heart attack to either a traditional European diet or a Mediterranean diet which was quite high in fat, but shifted all of the fat away from saturated to unsaturated with an emphasis on olive oil. And there was a 70 percent reduction in the rate of recurrent heart attack on the Mediterranean diet assignment, which is pretty much the same result that was seen with the Ornish diet intervention. Very comparable.

So from my perspective, I understand why people like Dr Esselstyn focus on fat content, but I think that’s a view through just one window. My interest is sort of drawing back, looking from altitude and yeah, I think that’s an approach. I don’t think the evidence suggests it’s the approach.

Robyn:             That makes sense. When I’m asked about this, I say: “Well, those clinicians you’re talking about are generally dealing with people with severe cardiovascular disease who probably need to really go to the mat to turn it around”. So, maybe it’s warranted that a higher level of fat, more like the Mediterranean diet is fine for the masses, for most people, for people who are healthy.

Dr. Katz:           And again, that’s often the response, but as I say, the “Lyon diet Heart Study”, was in people with established coronary disease who’ve had heart attacks. So this was a high risk population and the Mediterranean diet was about as effective as the results of the Ornish diet over time.

Robyn:             And still did well. Yeah.

Dr. Katz:           So again, I think what we need to do, and by the way, just to reference it again because I think it’s really important, and just about everybody you mentioned is a member of the True Health Initiative council, including Dr Esselstyn. And what we’re saying there, is we agree much more than we disagree. So, you know, Esse and I are friends, we agree about a lot. I think we disagree about the potential role of extra virgin olive oil in an optimal diet. But you know, so what if you prefer his approach and you want to adopt a low fat plant exclusive diet as a way of achieving optimal health, you can do that.

But from my perspective, the evidence is just as strong for an optimal high fat Mediterranean diet. He and I disagree about that, but, we agree about the fundamentals that make both of those diets good. You know, I don’t think it’s specifically the extra virgin olive oil that makes the Mediterranean diet good. I just think including the extra virgin olive oil doesn’t do it any harm. But you know, a diet that’s mostly made up of vegetables, fruits, whole grains, beans, lentils, nuts and seeds. That’s the foundation. And that’s the foundation in both cases.

The interesting thing about the True Health Initiative, is all those names you just rattled off, these leading proponents of a vegan diet with low fat or otherwise are on that council. But also on that same council are many leading experts on the Paleo diet and everything in between. And that’s the point, that the common ground really is critically important. That nutrition experts with very different perspectives from all around the world mostly agree and mostly choose the same kinds of foods and I don’t think the public ever gets that message.

But personally, I am not convinced that a low fat diet per se is better, even for treating coronary disease than a diet that is relatively rich in fat. Provided, that we’re talking about the right kinds of fat and that would be unsaturated fats, minimally processed, extracted naturally from their plant origin. So extra virgin olive oil is very different from highly processed olive oil. So it’s not just what plant is this coming from, but how is the oil produced? All those things matter. I think when you get those things right, the evidence is pretty clear that the fat content of the diet per se, is not really the determinant of health outcomes either for healthy people or for people with established chronic disease.

Robyn:             Interesting. So your father was a cardiologist, you’re working with lots of cardiologists. Why do so few of them address the diet piece? And what’s it going to take for the US to change dietary guidelines to favor a more plant rich diet? What are the politics there? What’s in the way?

Dr. Katz:           Yeah. Well, so you kind of provided the answer along with the question by referencing politics. So you know, if we’re going to talk about dietary guidelines, dietary guidelines are a political product. So there’s the dietary guidelines advisory committee that’s the group of scientists that generates the report that informs the dietary guidelines. But the official dietary guidelines are produced by the USDA. And of course you know this is the same USDA that is involved with the farm bill and has very strong ties to the big industrial elements in agriculture, big companies. And so this is not just about public health or what’s good for people to eat. It’s about the economy and what’s good for big businesses.

Well, that’s an enormous glaring conflict of interest. It’s really hard to serve both of those agendas. So, you know, most of us feel, most of us in public health feel that the dietary guidelines should not reside at USDA. They should be outsourced to an organization like the National Academy of Medicine, something that has some connection to the government and considerable imprimatur but is not subject to the same influences of corporate lobbying that the government is.

And ultimately the USDA is accountable to Congress.  And Congress is influenced by lobbyists. So for the dietary guidelines to improve the politics need to be taken out of the equation. Otherwise we need to ignore the dietary guidelines. And certainly for example, in 2015, the most recent completed version of the dietary guidelines advisory committee report, I think it was a stellar committee and I think they did stellar work. And that report, by the way, is available online. I encourage everybody to ignore the official dietary guidelines. They’re political gobbledygook. And just Google: “2015 dietary guidelines advisory committee report” and you can go right to the source material.

In terms of the other part of your question, what will it take for more physicians, cardiologists, health professionals to be addressing diet? Well, there are a couple of issues there. First, we can improve medical education, health professional education. We can provide better supports in terms of digital therapeutics. So programs that are delivered online, apps, you know, the more good information we deliver directly to patients via the web, via their smartphones, via wearable tech. The less heavy lifting clinicians need to do in the office, the more that can be done outside the office. I think we’re more likely to get traction with clinicians when they don’t feel like they’re trying to do the whole job by themselves.

But Robyn, if I may, a bit of a reorientation, I don’t think bad diet really is a clinical problem. I think it’s a cultural problem. The places around the world where people get good health from diet, where the diet contributes to a bounty of years in life and life in years. You don’t hear people saying: “Hey, you know, my culture runs on Dunkin and multicolored marshmallows are part of a complete breakfast. But at least my doctor gives me really swell clinical counseling. So all is well”. You never hear that. What you find is that those places around the world where people routinely managed to eat well, it’s because their culture makes eating well the norm. I think the huge unaddressed problem in American culture is that America runs on epidemic obesity and chronic disease. America profits from epidemic obesity and chronic disease.

Do you know that we’ve been told twice, bluntly, a decade apart, that our food supply is willfully engineered to be addictive?! We first got that memo in 2005 – 2006 in a four part Expose in the Chicago Tribune that literally said, Sientists from ‘Philip Morris’ and scientists from ‘Kraft’ collaborated directly. Shared functional MRI machines to engineer both cigarettes and food products that we’re maximally appealing and addictive to get new people hooked. In the case of the food products, they wanted to design food that people couldn’t stop eating.

And then much more recently, 10 years later, there was a New York Times magazine cover story by Pulitzer Prize winning investigative journalist Michael Moss, entitled: “The Extraordinary Science of Addictive Junk Food”. That’s the title. And what Moss went on to describe is how all the big food companies hired teams of scientists, gave them functional MRI machines and marching orders to design food that people can’t stop eating. And then we wonder why we have epidemic obesity. And we wonder why physicians are not addressing it more effectively.

Well, you know, to be honest, even physicians addressing it effectively are whistling in the wind, the mighty wind of our culture that’s blowing in the wrong direction, encouraging us to overeat all the wrong foods. We’ve told a nation of parents, twice, that big food is willfully designing a food supply you cannot avoid overeating, your children cannot avoid overeating. Basically, companies are giving scientists and executives bonuses if they design a food that you are going to overeat, no matter how much personal responsibility you have. And I have yet to see the collective outrage that disclosure warrants. And I think until we muster that outrage and say: “We want a food supply that is nurturing and nourishing and sustaining”, I don’t think clinicians are going to solve the problem.

Robyn:             I think you’re entirely right. And I’ve tried to educate my audience about the fact that there are boardrooms that sit around and take a look at taste test labs where they tried to find the sweet spot of how much MSG, with refined salt, with processed sugars, with GMO corn syrup, is the place where people will eat the most. And I’m not seeing the outrage either. But in the meantime, for the regular people, non-clinicians who are listening to this show, what are things we can do? What are things you can do to speak up? What are things we can do to model better behavior, change our lifestyles? Obviously eat a mostly or all plant based diet of whole foods. But what else? What else can we do to be part of this big change?

Dr. Katz:           Yeah. So, first we can start the revolution under our own roof. Look after yourself. Look after your family. Don’t get caught up with fads. Be one of those reasonable people who is a grownup about diet and says:  “I’m going to treat this like other stuff that matters. Like managing money, a career, an education. I’m not going to change my mind every 20 minutes. I know what matters. And I’m going to focus on wholesome foods in sensible combinations. And I’m not going to get talked out of that every time a new book gets published or a TV show comes on.

And I’m going to advocate that to my family. I’m going to say we care about health and vitality, not because somebody is wagging a finger at us, but because we love one another. And because the single greatest gift we can share is a bounty of years in our lives and life in our years to live together. And people die it alone, but we live it together. We, as a family are going to focus on living it together. I’m not going to go on a diet to lose weight in six weeks and leave my significant other and children out of it. I want to eat well with the people I love, so we’re looking out for one another.”

Apply that kind of common sense. Make it a family value. Start there. And then get informed. Get educated, get the resources you need. If you’ve got questions, find a health professional and ask them. If you’re looking for information on the web, make sure that the sources are credible and not just trying to sell you something. Let me encourage people to check out the True Health Initiative at truehealthinitiative.org and see what a who’s who all around the world agrees is important about a diet for health and sustainability and the planet. Sign up for our free monthly newsletter.

If people want to learn healthy recipes, I’ve got another free resource. And that’s what my family actually eats. My wife is a brilliant cook and she’s paid it all forward on her website: cuisinicity.com It’s the Katz family greatest hits, if you will. Help yourselves to all those recipes there. So you know when you want those kinds of resources, they’re out there for you.

I think it really does begin though with a commitment to the long-term. To vitality. To family. I think the word family is missing all too often from our discussions about diet. Our whole discussion of the Ketogenic Diet. Does the word family ever figure in it? Does anybody put their children on a Ketogenic Diet to control their weight or promote their health? Not that I’m aware of. Well, I think that’s a fundamental mistake. We should be practicing diets for ourselves that we can proudly and safely share with our children as we immunize them against chronic disease and future obesity.

So a bracing dose of sense is a great place to start. We can all vote every time we are at a cash register. The foods we choose, collectively become the foods that manufacturers sell. One of the interesting things about the food supply, we tend to talk about it as if it’s this unchangeable thing, but it is subordinate to the food demand. Manufacturers will only sell us stuff we’re willing to buy. So, you know, acquire food label literacy, make good choices, you are casting a vote.

And then yes, we can also start to influence what happens with the way we vote. We should vote for people who care about good nutrition policies and the safety of the food supply and a reasonable balance between personal responsibility and corporate responsibility and policy. There’s a balance to be struck there. The choices any of us makes our subordinate to the choices all of us have. So we should be personally responsible for making good choices, but we should be collectively committed to making sure we all have good choices and certainly a food supply willfully engineered to be addictive, does not deliver us the good choices we and our children deserve. So I think there’s a lot of action we can take and I think little by little the actions we take as individuals add up to the sea change that we really need.

Robyn:             Well, as we close this, I just want to share with you, because that was a really great way to remind us that this is about our families and our families health and happiness. I just want to tell you that my family, I had a very, very sick one year old. He was on constant steroids and antibiotics and bronchodilators. And I became aware that our diet probably had something to do with why he was sick in the first place and it changed it radically 23 years ago. And that little boy who was a failure to thrive baby, who had been on five courses of steroids in one year, we turned his health around quickly.

I lost 50 pounds and ditched my own 21 diagnoses and five drugs that I was on, five prescription medications that I was on. And in the last 23 years., I’ve raised three more children. And play a competitive sport at a high level. And have written 15 books. And my four children are healthy and thriving. And I could not have done that if it weren’t for you and the work of your colleagues in the True Health Initiative. They are my heroes. I’ve followed all of your work for many years and I needed somebody to help put the evidence in front of me because there are a lot of shiny objects to chase.

My failure to thrive son ended up most valuable player at the state playoffs at six foot three inches and hit two grand slams in the finals. And pitched a shut out and got to live out his destiny. And now my youngest child is in the state quarter finals tonight, on the same team, same position, pitching and outfield. And I just feel so grateful for your work and the work of your colleagues that you have everything to do with organizing everyone to get on the same page about what is good nutrition. So thank you so very much for this interview and for your great work.

Dr. Katz:           Well Robyn, it’s great to join you on the show and I thank you for that. And I congratulate you for turning your health around. And then the beautiful success in raising healthy children, restoring health where it was adversely affected. If I’ve had anything to do with you finding that path, I’m delighted and honored. But I was still out of the credit, it just goes directly to you. And I thank you for helping to spread the good word.