Adding Years to Your Life… and Life to Your Years

Dr. Cooper

Welcome to the latest episode of the catalyst health and wellness coaching podcast. I’m your host, Bradford Cooper and today we are extremely fortunate to have physician and researcher, Dr. David Katz joining us. Dr Katz and I met over dinner when he was the conference chair for the art and science of health promotion conference where I was also speaking earlier this year. If you’re confused, like many are about the craziness tied to all the fad based headline driving diets out there, today’s episode with Dr Katz will help bring that together in a reasonable evidence-based manner that frankly we can all apply. He also helps bring us back to the focus of health and wellness being a goal of adding years to our life and life to our years. Dr. Katz’s bio fills pages. So let me just give you a few of the highlights. He earned his BA from Dartmouth college, his MD from Albert Einstein college of medicine and his master’s in public health from Yale university school of public health.

Dr. Cooper

He’s the founding director of Yale university, Yale Griffin prevention research center, past president of the American college of lifestyle medicine and founder president of the true health initiative, which you’ll hear a little bit about in our discussion. He holds five US patents with others pending and has published roughly 200 scientific articles and textbook chapters as well as 16 books to date. Dr Katz has been quoted in most major magazines and newspapers and has appeared widely on radio and television serving as a regular on air medical contributor for good morning America, ABC news for over two years. He and his wife Catherine live in Connecticut and have five children.

Dr. Cooper

In terms of coaching, if you’re planning on pursuing your wellness coach certification before the national requirements increase, we have two fast tracks coming up in the next few months. One is November 9th and 10th one is February 8th and 9th that’s the process that gets you started towards that national board certification.

Dr. Cooper

We are recording this two weeks in advance, so by the time you hear this there, we may be full to capacity for November, but it’s worth checking. At this moment, we have a few spots open. You can find out all the details and registration at catalystcoachinginstitute.com and folks as always, feel free to reach out anytime if you’ve got questions about your career, how coaching fits into it, what’s changing with the national board certification next year, anything along those lines, the emails results@catalystcoachinginstitute.com. Thanks for joining us. Now, let’s tune in to hear Dr. David Katz share his wisdom and challenge our thinking on this episode of the catalyst health and wellness coaching podcast.

Dr. Cooper

Dr Katz, it is a privilege to have you join us. Thanks for jumping on today.

Dr. Katz

It’s great to be with you, Brad. Thanks so much for having me.

Dr. Cooper

Yeah, absolutely. Your background, I’ve shared with our audience the brief version. Can you give us the 10,000 foot view of how you ended up, where you are today, what took you from that to now?

Dr. Katz

You know, in terms of something that is replicable. If the idea here is sort of advice, the only thing I can really offer is strategic opportunism. You know, I think mapping out a career is far too complex to be able to say at the beginning exactly the best way to get there from here. I think it’s really important Brad to know where there is. So some notion of the change you want to be in the world. I think sometimes we overlook that the destination is critical and maybe we get hung up on the proximal steps of the journey. The journey tends to take care of itself if you’ve got real clarity about the destination. So I knew pretty early on I was going to go into medicine, in part because my dad’s a cardiologist and and inspired me. In part because it was an obvious choice and maybe in part because I wasn’t sure what else to do.

Dr. Katz

And then it was by making that step that I started to get clarity on, hey, there’s way too much stuff happening to people that never needs to happen. Heart disease, cancer, stroke, diabetes, dementia. We know so much about how to prevent this and are doing so little with it. That’s a career right there. I really want to help the next cohort avoid all of this preventable morbidity. And so then training in preventive medicine just kind of happened. And then opportunities to do things with the training and preventive medicine just kind of happened. So I really was a strategic opportunist, but I, you know, I knew very early on the mission here is do everything possible to add years to lives, to add life to years and then over time trying to keep up with the great public health imperatives as they shift. I’ve definitely added in a focus on the planet and the environment. There are no healthy people on a ruined planet. And so, you know, I’ve become an amateur environmentalist, but you know, I do think in 2019, if you call yourself a health professional, you have to advocate frequently, fiercely in every way you can for the health of the planet because it’s mission critical.

Dr. Cooper

Very good. I’ve read, you’ve mentioning that before, the adding years to life and adding life to years, but wow, what a powerful, personal, organizational vision. I love that. Let’s jump into the meat of the conversation. I’ve been following the last couple of weeks here as you’ve been talking about this article that came out and I loved your tongue and cheek references to running with scissors and IV use and the fact that we don’t have randomized controlled studies with those, but could you walk us through a little bit for those folks that aren’t up to date on what the article said, some of your thoughts around it, etc.

Dr. Katz

So, this is arguably the greatest provocation in nutrition research that colleagues and I have seen in our careers. This was a cluster of systematic reviews all published in the annals of internal medicine by one particular group. Arguably, contrarians or iconoclasts or people inclined to sort of blow up what we know about nutrition. But interestingly, leaving aside whatever their personal goals may be in this cluster of systematic reviews. So they published four of them really that were content-based, they found that higher intakes of red meat and processed meat were consistently and significantly associated with a greater risk of dying prematurely of heart disease, of diabetes and cancer, which by the way, we all knew already.

Dr. Katz

But what this group then went on to do was say, yeah, but we’re going to score the evidence using a particular metric. That metric is called grade and we’re going to conclude that our own evidence finding harms of eating more meat and more processed meat is weak. We’re going to call the evidence weak. We’re then going to factor in that people like to eat meat and may not be willing to change and based on all of that we are going to publish guidelines telling people, go ahead and keep eating all the red meat and processed meat you like and act as if that’s what the evidence says because the evidence actually said the opposite, but we scored that evidence as weak and we’re prioritizing what people like to do. And so, you know, we saw these papers actually under embargo.

Dr. Katz

And by the way, it’s not the systematic reviews, the actual science that I and colleagues around the world object to. If there were new findings that showed people eating more processed meat, had better health outcomes, well that would shock us. It would be at odds with a vast amount of evidence gathered until now. But if there’s actually new evidence we have to look at, that’s what scientists do, then you’ll look at the new evidence you have to account for it. But there was no new evidence here. The results of these reviews were exactly aligned with the results of every prior review that eating more processed meat is bad for you. So the presumption of publishing in a prestigious medical journal, the annals of internal medicine guidelines, telling people to do the opposite of what all the evidence shows is good for their health, we thought was unprecedented. We thought was incredibly irresponsible of the researchers of the journal.

Dr. Katz

And the big concern here wasn’t about meat eating, although that’s important. It’s important for the health of people. It’s incredibly important for the health of the planet, the single most important dietary adjustment we can all make to address issues of sustainability and climate change and so forth is to reduce our intake of beef. So it’s really very important. But the bigger issue, Brad, was trust. If there are, you know, scientists all around the world agreeing about the harms of processed meat and then a prestigious medical journal publishes guidelines saying, go ahead and eat all the processed meat you want. You know, I think the public is just going to say, hey, you can’t trust experts at all. There’s no reason to listen to any of these guys. And you know, at the entry level you’ve got distrust and you’re probably not very far away from disgust where people just say forget it. You know, they just roll their eyes and you know, if you fundamentally undermine the credibility of an entire field, nutrition, you potentially do irreparable damage to public health.

Dr. Katz

And you know, people basically, they just decide we have a license to do whatever we like, whatever we want. And so then as you say, I thought, well, the bigger issue here is not helping people understand, yeah, there really is lots of evidence about the harms of eating too much beef and processed meat. The bigger issue is how do we know what’s true, how do we know what to trust? These researchers scored their evidence with a method that prioritizes the randomized controlled trial. Is that really valid? And the answer is no. The randomized controlled trial contributes to our understanding, but it’s just one specific tool.

Dr. Katz

So imagine for instance, if I chose to look at the issue of whether putting your hand in a fire will cause your hand to burn. Well actually we have no randomized trials addressing that issue. None at all. We just have observation. And so it may be that the fire and the burn are true. True, but unrelated. Maybe it’s all just a coincidence. Maybe the fact that every time in all of history, anybody other that has put a hand in a fire, it’s gotten burned. But you know, it’s just association. It’s not causation. So what if these researchers came along, scored the evidence and said, Oh no, it’s very, very weak. We issue guidelines telling people, go ahead and put your hand in a fire anytime you feel like it. I mean, how massively irresponsible is that of them, but more importantly, would you believe them? Would you take it seriously? Are you really waiting for some group of meta analysts using a particular way of scoring evidence to come along and tell you that what you think you know about fire is wrong because it hasn’t been subjected to a randomized controlled trial.

Dr. Katz

So the bigger issue here really is the nature of how human beings learn and understand what’s true. And frankly, randomized controlled trials have a modest contribution to make to that. But as somebody who spent a career running them and publishing them, I can certainly tell you that most of the most important things we know and the things we know most reliably, we know from observation, not from randomized controlled trials. Almost everything important that you will do over the course of your day is informed by observation and almost nothing will be informed by randomized controlled trials. And I don’t think we’re waiting for some particular group of researchers to tell us we’re wrong about all of that. I think they’re wrong about what that tool is for.

Dr. Cooper

Very good. Very good. Thank you. All right, so similar notes and take this any direction you’d like, but there’s constant discussion between different diet plans, and you and I probably both dislike that phrase and a lot of our audience does, but it’s out there. And so the banter between keto and vegetarian and all these other things, our listeners, whether they’re coaches or not get caught between those, they get caught between the huge success stories and the, Oh, you for sure should be doing this and they don’t know how to interpret the different aspects. You’ve spent your entire life researching this stuff, but how does the average everyday person with a busy schedule, who does want to be healthier, how do they stay up to date? How do they differentiate between what they’re seeing and hearing out there?

Dr. Katz

So I’m going to give you answers along two channels here Brad and I’m going to get to the content second. The first, I’m going to mention a whole new strategy for dealing with this issue and it’s really what my career is focused on now. So I started out with strategic opportunism. So you know I was a physician starting in, I finished medical school in 1988. So I’ve been a doctor since then and my career in the early going was very much focused on clinical care. Then when I completed my training in preventive medicine, I got into teaching more and then research more. And now at this stage of my career I’m an entrepreneur. And the reason for all of these shifts from clinical care, teaching, research and different tactics is I want to make a difference. I want to find the most effective ways to make a difference. And those change over time and the opportunities change over time.

Dr. Katz

So I run a startup company called Diet ID and people can go to a dietid.com and learn more. We have completely reinvented dietary assessment for the digital age, so we can, for any body, we can generate a detailed analysis of your current diet, including your dietary pattern, an objective measure of your diet quality using the healthy eating index 2015, and estimates of up to 150 different nutrient intake levels in under a minute. It’s easy, it’s fun, it’s a radical departure from all other methods. We can use this same method to identify a specific goal diet related to your health objectives. And here’s how this is relevant to the question you asked. We have top quality versions using the objective diet quality score that’s best in the world, the healthy eating index 2015 which is correlated directly with health outcomes for every kind of diet.

Dr. Katz

So, you know, if you wanted to do low carb, well we’ve got a top quality version of that. If you wanted to do low fat, we’ve got a top quality version of that. We’ve got Mediterranean, pescatarian, flexitarian, vegetarian, vegan, paleo and everything in between. And so part of the answer to your question is we don’t need to tribalized, we don’t need to Balkanize we don’t need to be as fractious as we are. There are fundamental aspects of better quality diets, but they can be generalized to a wide array of variations on the theme of eating well. And rather than tell everybody, there’s just one way to do this, we can actually devise tools that help people conjoin their specific health objectives with the way they actually like to eat. You know, pescatarians want to eat fish, but vegans don’t and paleo will want to eat some meat, but the vegetarians don’t.

Dr. Katz

And well, okay, you know, there are variations on the theme of optimal eating. So Diet ID is a tool that services that concept. In terms of the concept, I have spent my career really wrestling with that issue and addressing it every way I can. So I’ve written multiple books on the topic of nutrition, both textbooks and books for the lay public. The most recent of those is The Truth About Food. 750 pages, everything I know, and it’s, you know, it’s not just everything I know about diet and health, but how I know it. But a much smaller version of that same project was an article that I wrote, an annual review of public health in 2014 entitled, Can We Say What Diet is Best for Health? That title wasn’t my idea. The editors came to me and said, we’d like to commission this paper. Are you willing to do it? We need somebody who is looking at the big picture. We need somebody who isn’t trying to pedal a particular kind of diet. We need somebody willing to suppress all native bias and follow the evidence where it leads. Are you willing to do that?

Dr. Katz

And my answer was yes. And it was quite a bit of work, but closely related to what I do anyway. And my answer, can we say what diet is best for health was both yes and no. If we mean any one specific prescriptive, my diet can beat every other diet, then the answer’s no. You know, there really is no such one best diet. But if we mean a general theme of optimal eating, then we definitely can answer with a yes, all of the diets that are associated with more years in life, more life in years, are diets of whole, minimally processed foods and rich in vegetables, fruits, whole grains, beans, lentils, nuts and seeds and plain water for thirst.

Dr. Katz

That a commonality. That’s the common denominator. And you can adapt that so that it’s paleo, you could make it low carb or high carb, low fat or high fat Mediterranean, pescatarian, flexitarian, vegetarian, vegan, and a whole bunch of other stuff too. But as Michael Pollan said, eat food, not too much, mostly plants. That really is sort of the bedrock. So, you know, I think that’s really important. We tend to tribalize and we tend to hoist the flag of some particular diet that’s captured our imagination. And of course we tend to be faddish. So you know, the fascination with keto or intermittent fasting, these are fads. They’ve come before, they’ll go, they may come back. It’s what we do. We’ll be much better off when we embrace the basic theme of feeding homo sapiens well, recognize that there are variations on the theme and we can adapt those to our personal preferences and interests and stop arguing so much with one another.

Dr. Cooper

Love it. All right, so a question I didn’t have written down. I actually want to talk about your book here in a second. Something kind of out of the blue when you and I had dinner whenever it was three months ago, you know your wines really well, they’re obviously something you enjoy. How do you, you know, the research on wine is yes, maybe good for you, but it’s probably not unless you’re having 40 gallons a day in terms of the antioxidants. So where does that fit into your, on a personal level equation or what could our audience members who enjoy wine, can you help them with perspective on that in some way?

Dr. Katz

And by the way, 40 gallons a day, ill advised, let us start there. Yeah, so I love good wine. In fact, I’d go so far as to say, Brad, really great wine is one of the few inarguable indications of intelligent life down here. It’s just such a refined product and, you know, frankly, just the perfect wine paired with a meal, it’s such a great source of elegant pleasure, and I really do enjoy it. But to be clear, you know, I drink in moderation. I certainly favor quality over quantity and I don’t drink to enhance my health. I, you know, I will have a glass of wine with dinner because I really enjoy it. And you know, frankly, yes, I do think pleasure is good for health and there may be certain health advantages from moderate intake of alcohol, but it’s not clear enough. And the advantages are not great enough to justify drinking for the sake of health.

Dr. Katz

So I would say, you know, whether it’s it’s wine, beer or whatever you might like, you know, in reasonable quantities, at reasonable frequency do it because you get a lot of pleasure out of it. And then by the way, you may derive a health benefit too, but that would be a bonus. In terms of the health issue, what really roiled this conversation was a study published in the Lancet. I guess it’s a better part of year and a half ago now. Something like that. And this sort of captured the media’s attention because it professed to show that any alcohol intake is bad for health and this was at odds with the idea that actually drinking moderately could confer a health advantage, but that’s not really what the study showed. This particular study, and again it made headlines all around the world. It wasn’t looking at the health effects of alcohol and individuals, it was looking at the health effects of alcohol in whole populations.

Dr. Katz

So it looked at countries all around the world and asked the question, what level of alcohol intake in a population is associated with the least net harm? Well, the obvious answer there is zero because in a population, if people drink, somebody is going to drink and drive and then that car crash will be the result of the alcohol and it would not have happened without the alcohol and somebody is going to be alcoholic and get cirrhosis or pancreatitis and on and on it goes. So there’s no question that alcohol can do harm and in a population level inevitably will. This study actually had nothing to say about the individual who very carefully drinks for pleasure, moderate quantities, doesn’t drink and drive, doesn’t do anything in judicious and dangerous. Can that person derive a net benefit from alcohol and all of the evidence still suggests yes, potentially.

Dr. Katz

So, but it’s a close call because alcohol is associated with a slight increase in cancer risk, particularly breast cancer, particularly in women. It is however associated with a slight reduction in the risk of cardiovascular disease. So the argument then becomes, if you’re not at particular risk of cancer, if you’re not a woman with a strong family history of breast cancer, if you do maybe have a family history of heart disease or if you have some cardiovascular risk factors, there may be a net health benefit for you from moderate alcohol intake, but it’s not clear enough. It’s not strong enough and there are better ways to achieve that benefit than focusing on alcohol. So drink for pleasure if you choose to do so and drink judiciously and you may get a health benefit too. And the Lancet’s study did not rule that out. But again, I wouldn’t specifically recommend alcohol as a way to improve health.

Dr. Cooper

Sure, sure. Very good. Well said. All right, so your book 746 pages or somewhere in that range?

Dr. Katz

Something like that. It’s an excellent doorstep.

Dr. Cooper

Well, I’m going to pull some stuff out of here. So from your book or just your research in general, are there a few surprises? Where people might go, really, I had no idea.

Dr. Katz

I think there are many, maybe the single biggest surprise is that nutrition is not controversial at all. I mean, if you really do dive in and you really follow all the different lines of evidence, I think the single biggest myth about nutrition is that, you know, we have all this disagreement and confusion and mostly that does issue from people arguing about methods. You know? So back to that issue of we can only know if we’ve done randomized controlled trials. Well, you know, I mean, frankly, we’re never going to do the definitive randomized trials of diet.

Dr. Katz

I mean, who is willing? I’m not, you’re not. To be randomized for the rest of our lives to either be vegan or paleo or some alternative, right? I mean, I don’t want a researcher deciding what I can eat for the rest of my life. It’s absurd. And even if we could be randomized, generally that’s not enough. We want randomized double blind placebo controlled trials, well there’s no placebo diet. There’s no such thing. Right? And you can’t blind people to what they’re eating every day. So you know, the idea that there’s just one way to know is one of the great myths. If you follow all the lines of evidence to where they converge, there’s really very little controversy, again about eat food, not too much. Mostly plants, all the best diets mostly made up of whole minimally processed vegetables, fruits, whole grains, beans, lentils, nuts and seeds, plain water for thirst.

Dr. Katz

So how simple it is, how clear it all is. I think that’s maybe one of the great surprises. I think otherwise, it may surprise people that most of what populates our dialogue about nutrition is utterly useless. So, you know, low fat, utterly useless. Some of the world’s best diets and best defined as producing lifelong vitality, producing longevity, minimal levels of chronic disease. Some of them are very low in fat, some of them are very high in fat. The whole conversation is a distraction, right? So who cares? The same is true really about carbohydrate. Maybe to a slightly lesser extent. So, you know, maybe surprising that so much of our discussion is about nutrient properties. And almost everything that really matters is about foods and patterns of foods. And if we shift the conversation in that direction, again, all the answers become very clear.

Dr. Katz

I think the other potential surprise is while the truth about food, and that’s the title of the book, the truth about food, why pandas eat bamboo and people get bamboozled is the subtitle. And so I think the big surprise is okay, if it’s so simple, eat food, not too much. Mostly plants. Michael Pollan said it in seven words, why is the damn book 750 pages? So I think the big surprise is the truth about food really is quite simple. It’s hiding in plain sight, but the lies about food are incredibly complicated and intricate. And they come at us from many different corners and with many different motivations. In some cases they issue from fools who are just misguided. In some cases they issue from fanatics who think they’re the only ones who know the truth. In some cases they issue from hucksters who are really just trying to sell us something and they know it’s not true.

Dr. Katz

But in many cases they’re institutionalized. So they come at us from big food. They come at us from big medicine and big pharma, you know, the status quo in America today is essentially we have a food supply that is willfully corrupted to be addictive. Michael Moss, a Pulitzer prize winner has written about, this is New York times magazine cover story was entitled the extraordinary science of addictive junk food. And it’s an incredible read and very eyeopening if you don’t know this tale already, but literally people working for big food companies get bonuses if they can make it impossible to stop eating what they’re selling us. So essentially, you know, we’re paying bonuses to big corporations to make us fat and sick and then we’re paying bonuses to executives in the pharmaceutical industry for selling us drugs to treat diseases we never needed to get in the first place and around and around we go.

Dr. Katz

So I think the many layers of the, if you will, military industrial establishment that run on the misuse of food and misapplications of nutrition and essentially the idea that we can leverage the food supply not to make people well nourished and healthy but to make people over eat for the sake of corporate profit and then we can make more corporate profit by treating the bad health outcomes of a bad diet. I think those are where the surprises tend to reside.

Dr. Cooper

And we’ll let everybody breathe on this cause you’re giving us so much, this is fantastic Dr. Katz. In terms of headlines, what recommendations would you have for the lay person who their job isn’t to research, their job isn’t to dig into this stuff for two, three hours a day, but they’re not satisfied with the headlines. They’re not wanting to get sucked into the fads. Any suggestions for how they stay up to date on what the real research is telling us?

Dr. Katz

I have one very specific one. So you know, we were talking before Brad about all the different ways I’ve wrestled with the fact that we really are not clueless about the basic care and feeding of homosapien. So, you know, I’ve written multiple additions of a nutrition textbook for healthcare professionals just about to start the next one. I’ve written multiple books for the lay public. But I think the single greatest contribution I’ve been able to make is to align myself with colleagues all around the world and say what’s most important is not I said this and she said that what’s most important is the common ground. If you get people with good intentions and expert knowledge together and say, you know what, what is the overlap?

Dr. Katz

Okay. So you know, you’ve studied nutrition your whole life and you prefer a paleo style diet and she’s studied nutrition her whole life and she prefers a vegan style diet. And but do we agree more than we disagree? And what does that agreement look like? Well, the answer is we do agree more than we disagree. And I’ve been able to prove it with an organization called the true health initiative. And you’re familiar with it. Brad. And the council of directors of the true health initiative is now something like 500 strong from 45 countries and actually does range from paleo to vegan and everything in between. So, you know, these are people who have many different dietary preferences and yet they say in public, we agree much more than we disagree. We publish a monthly newsletter, we issue responses to stories that are breaking in the media all the time. And so I think one of the best places to keep track of what’s true and what’s important is that true health initiative.org you can sign up, get the newsletter, and what we’re trying to do is produce a signal, audible above the noise.

Dr. Katz

We bogged down way too much in the he said, she said, and frankly, you know, when you bring experts on TV, one of the things you’re obligated to do, and I’ve done this many times myself, is you know, talk about what’s new and different today. It’s very rare to be given a high profile media opportunity to say, okay, we really want to know where do you agree with all of your colleagues and how big is that relative to the thing you could say that is new and provocative and titillating right now. So all we ever hear about is what’s new and different and provocative and titillating. But when you get all the experts together and wrestle with this, what you discover is actually that’s about 5 to 10% of everything. 90% of everything is common ground and that never gets discussed and the public, has no idea, and it doesn’t change with every new cycle and it’s incredibly empowering.

So truehealthinitiative.org the common ground is vastly bigger than the dissent, but all that ever makes primetime news is the dissent. Because in the media world, the mantra is comfort the afflicted and afflict the comfortable. So if you start getting comfortable with knowing what’s what about nutrition, the media’s job is not to educate you. It’s not to reaffirm that you’re right, it’s to afflict you with information at odds, with everything you thought was true. So you’ll tune in tomorrow and tune in the next day. You always want to be a little off balance so you’re a little bit unsure. So you’ll keep tuning and that’s their goal. But for your sake, that’s not what you want. You really want to know what’s true. So you and your family can act on it every day.

Dr. Katz

And, to be clear, those of us in the true health initiative, we’re real people too. We have families too. We love them too. We eat too! Every day. And we have to make choices. And part of the reason I created this, it was empirical. Here I was attending nutrition conferences all around the world with colleagues and some were vegan and some were paleo and some were Mediterranean. And then it would be time for a meal. And although it would seem like everybody disagreed, we’d get in line and everybody’s plate wound up looking more alike than different. So yeah, I mean the paleos would fill up their plates with a wide variety of whole plant foods, greens, and then leave room for wild salmon or venison if that was an option or you know, whatever it might be. And the vegans would fill up their plates with exactly the same greens and where the wild salmon would go, they would have beans or lentils, but those two plates looked so much more like one another than either looked anything like the typical Americans plate of, you know, glow in the dark frankenfoods and I thought that’s a critically important message. The public is not getting, well, you can get it at truehealthinitiative.org.

Dr. Cooper

Beautiful. Beautiful. Let’s pull out the crystal ball. Where do you see, you’re engrossed in this, where do you see the health and wellness industry shifting, leaning towards etc., over the next decade? Are there some areas you see being emphasized 10 years from now that maybe aren’t getting the attention now?

Dr. Katz

You know, there’s a famous expression, Brad, the best way to predict the future is to create it. And you know, I’ve always tried when I thought something was really important and related to what I do professionally to address it rather than just hope for it. So interestingly, as we have this conversation, just a month or two ago, there was an op-ed in the New York times by Dariush Mozaffarian, the Dean of the Friedman school of nutrition at Tufts University and Dan Glickman, former secretary of agriculture.

Dr. Katz

The title of the op ed is Our Food is Killing Far Too Many of Us. Now that’s a pretty provocative in your face title. And, they go on to make the case that diet is the single leading predictor of premature death in the United States today, which is really quite incredible. What should be a source of nourishment and sustenance, what should be nurturing our health and what should be the construction material for the growing bodies of children we love is killing us. It’s quite incredible. But that’s how corrupted our food supply is. What they then go on to do is talk about the many components of the solution. And one of the things they suggest is that diet in the future should be captured in every electronic health record. Well, the problem with that is we historically have no good tools to measure diet.

Dr. Katz

You can take up to 90 minutes to do a food frequency questionnaire, which will be extremely painful. And I’ll ask you, Brad, how many times in the past six months have you had marinara sauce? And by the way, exactly how much each time, and that’s just not realistic. Yeah, it really makes your eyeballs catch fire. Or you can log everything you eat for three days or seven days, and maybe that’s even worse. Or you can try to remember everything you ate yesterday. So we don’t have the tools to put nutrition on every electronic health record until now. And again, back to diet ID. We built that tool. So I think one of the shifts we’re going to see is that lifestyle medicine is going to address these critical deficits in our ability to measure what matters.

Dr Katz

In business they say we don’t tend to manage what we don’t measure. It’s true in medicine too. So if something matters, we have to measure it. And if we don’t have tools to measure it now, we have to invent those tools. And so I think the tools of capturing what matters in the realm of lifestyle are going to improve dramatically. And you know, at diet ID we say diet is a vital sign. It really is. Your diet quality is a vital indicator of what your health is likely to be now, in the near term, and over the course of your life. Well then we have to measure that routinely so that we can manage it effectively. I think that’s going to be one of the big shifts. So I think diet literally will be a vital sign and you know, I very much hope we will be in the vanguard of making that possible. I think objective measures of diet quality will populate every electronic health record.

Dr. Katz

I think that will then empower many more health professionals to address the importance of diet to their patients. And then I think we’re going to start to see the dots connect. So you know, one of the areas of medicine that’s really burgeoning now is digital therapeutics. So, these are effectively digitally delivered lifestyle medicine programs and there are many of them. I’m involved with one called better therapeutics, which is about treating chronic diseases like diabetes with lifestyle. There are others that that are directed more at prevention like Omada, which essentially is an adaptation of the diabetes prevention program. There are many, many more of these and there will be more. And you know, essentially what they provide that traditional approaches to healthcare can’t provide is continuity of contact. You know, essentially you can be engaging with this digital therapeutic platform anytime you want every day throughout the day.

Dr. Katz

And where I think we’re going to start to see the intermittent exposure to health professionals routinely conjoined to continuous element of care that’s digitized. That’s the obvious big trend in society now. Right? I mean more and more we connect to one another digitally. And that’s why social media has become such a huge influence because hey, you know, I have a busy schedule, I’m where I am. You’re where you are, but we can connect with electronics. Well that’s happening more and more in medicine. So I think one of the huge trends will be we will effectively combine what can happen most productively in brief intermittent clinical encounters with what needs to happen related to lifestyle in between those encounters using digital therapeutics. And I think we will populate the gaps in measurement with inventions.

Dr. Katz

Diet ID being one of them, diet as a vital sign. We can measure it now, but the wearable health tech that’s giving us more and more information about the quality of our sleep variations in our heart rate, our physical activity level, all of that really starts to now populate what used to be a list of biomarkers limited to blood testing. And then of course, you know one of the answers people expect here is we’re going to be doing more with individual profiling, right? Personalized medicine. And I think that’s true too. And we will be learning more from genomics and to some extent that will inform selection of medications to some extent. Over time Nutrigenomics will mature and we’ll have better ways of using what we know about our genes to inform selection of the best variant on the theme of eating well.

Dr. Katz

Right now I think personalization is being a little bit overplayed. You know, you think about any species other than ours and you know the basic care and feeding of wildebeest or zebras or koala bears or dolphins doesn’t really require that you know, the genome of an individual member of that species. You really just need to know what does this type of animal need, right? I think we need a bracing dose of humility. We humans, we are a species. Our needs are more alike than different. We should start on the common ground of what’s good for all of us. And then layer personalization on top of that. I think we will get better and better at that too. And I think all of these forces will start to come together. So we’ll be working with better information. It will be more actionable and we’ll be able to reach people with it all the time, wherever they are in the most convenient ways. And that’s a revolution.

Dr. Cooper

Beautiful. Let’s flip the mirror. Health and wellness is personal. Let’s bring it back to Dr. David Katz. What is something in your area with everything you’re reading, and we’re all in this journey of better than yesterday, what are you looking at? What are you working through? What are your struggles and how are you addressing maybe one example in your own life right now?

Dr. Katz

Well, I don’t know that I’m addressing it effectively, but the combination of stress and sleep. So, you know, I’m running a startup company, it’s new to me. It’s a whole new set of challenges. It’s incredibly stressful. And you know, there’s no way to avoid that, it’s just sort of part of the gig. And there are times I manage stress effectively and times it gets the better of me. And then, you know, what tends to happen when your mind is racing, it’s hard to sleep. And even if you make sleep a priority, and I do, I fully respect how important it is. Sometimes I’m just not good at it.

Dr. Katz

And, and you know, then if you don’t sleep well, you know, then you start out the day tired, cranky and overwhelmed, which makes you more vulnerable to the stresses of the day and kind of around and around you go. So I struggle with striking, you know, what in some ways is sort of the great philosophical balance and that is looking at what really matters. I mean, you could argue that the contributions you make to the world are what matter most. But you could also argue that the people who love you and that you love are what matter most. And, you can derive enormous comfort by focusing on the love in your life and the intimate relationships in your life. And yet you don’t want to let that pull you away from contributing as much to the world as you possibly can. So that balance is a constant struggle for me.

Dr. Katz

How much of this is about chasing the big goals on the horizon versus hugging my wife and for that moment, pushing everything else out of my mind and really letting the importance of that force, love, take me over and restore me, or hugging my kids. So I wrestle every day with the right balance between engaging with the world at large and letting my little world shelter me. And, you know, we all talk about, you know, sort of work life balance, but it’s hard. It’s a hard balance to strike. And so, I think the best we can do is essentially be in balance and then back out and then try to get back in, fall back out, it’s not like you find it and you stay there forever. At least I don’t. And, I do try to derive wisdom from people who are better at that balance than I am.

Dr. Katz

You know, one of the things I’m not very good at, this is another thing I struggle with, I’ve dabbled in meditation. I’ve never managed to really commit to doing it every day. Do you meditate routinely? Brad?

Dr. Cooper

Not routinely, no. Yeah, everything you’re saying resonates so much. I mean, that exact struggle I’m going through right now and I’m just nodding my head. Everything you’re saying. Oh man.

Dr. Katz

Yeah. So it’s hard. It’s just, I mean, admittedly, it’s hard. So, you know, I eat optimally. I exercise, I’ve never smoked, I don’t drink excessively and all that good stuff, but the sleep, the stress and certainly again, this work life balance, really, really tough. And so I’ve dabbled in meditation but I’ve yet to make a formal sustainable commitment that, you know, I keep telling myself I’m going to and then on any given day I argue I do not have the time to fit in one more thing like trying to get good at meditation and you know, I think of the people who are good at meditation echoing in my head saying the days you say you don’t have time to meditate are the days you most need to meditate and they’re probably right. But you know, what can I say? I am not perfect. These things are all a struggle for me.

Dr. Cooper

Thanks for sharing that again, just nodding my head up and down as much as you go through that cause that is, that’s a struggle for me and I’m sure a lot of people listening so thank you. A couple more and we’ll wrap this up. Uh, you get the chance to compose a message that shows up on everybody’s phone home screen tomorrow morning. What’s it say?

Dr. Katz

Yeah, I’m going to make this easy on myself. Diet is a vital sign. You know, I’ve devoted my career to nutrition. I’ve done everything I could to help clarify what’s true. I think everybody needs to start thinking that way. Diet is a vital sign. It’s a vital indicator of our own health now because it’s the fuel we’re running on today. It’s a vital indicator of how we’re going to wake up feeling tomorrow and it’s a vital indicator of what our health is going to be for the long run and arguably even more important than any of that. Our dietary choices are a vital indicator of what’s going to happen to the planet. The EAT Lancet commission report, one of the most seminal products in nutrition science anytime in recent years, looks at the kinds of dietary patterns that are and are not sustainable for a population of 8 billion or more homosapiens in a world of climate change and declining biodiversity and so forth.

Dr. Katz

What do we need to do if we want to keep lions and tigers and bears in the world? What do we want to do if we want to be able to feed all the people and not burn down the Amazon? That’s, I mean that’s vital. That’s absolutely vital. That’s vital to everything that matters, that’s vital to the future we’re going to give our children and grandchildren. So I would say you know, all it is is a provocation because I think it immediately starts raising questions. Okay, diet’s a vital sign. What should I do and how do I do it and how do I get there from here? Okay, that’s good. If you’re asking good questions, that’s a great place to start. But the message I would want, that everybody wake up tomorrow, turn on their computer and flashing at them is the message diet is a vital sign.

Dr. Cooper

Mm. So good. Last question, wide open. Any final words of wisdom? Something I haven’t teed up with the questions that you’d like to get out there to our audience?

Dr. Katz

Well, we’re mostly talking about health, Brad, and you know, again, my thanks for the opportunity. It’s really been a pleasure. I guess the one thing that we’ve not mentioned, and this would be a good place to do it, is to remind people that health, and you know, I’m a preventive medicine lifestyle medicine physician. My whole career is all about health. Health is not the prize and health should never be something at the end of an admonishing finger wagging at you. That’s a complete misconstruction. Health is a currency you get to spend on doing the stuff you like to do. The reason health matters is not because somebody like me with alphabet soup after their name says so. The reason health matters is because other things being equal, healthy people have more fun. And I, you know, at the end of it all, I think that’s just so important to remember that that’s, oh yeah, that’s why I care.

Dr. Katz

I mean, I’m not trying to be healthy for somebody who says I should be. This is not about a moral imperative. Healthy people have more fun, dammit. You know, you have more energy, more vitality to do the stuff you like to do, to do it for longer. I think that’s a critical part of the message that routinely drops out. It starts to feel like obligation and burden. And I’m doing this because I’m supposed to no, no, no, no, no. I think everybody is entitled to pursue, you know, assuming that we do this in a way that is good for other people, or at least not harmful to anybody else, we’re all entitled to pursue the best possible life we can and it’s almost impossible to have your best possible life without your best possible achievable health. And that’s what it’s for.

Dr. Cooper

What a way to wrap up. Health is a currency that is, that is powerful, my friend. That is good stuff. Good stuff. I’ve been looking forward to this interview for a long time. You did not disappoint. Fantastic job. Appreciate you taking the time in the midst of your crazy schedule.

Dr. Katz

It’s been a great pleasure, Brad. Again, thanks so much for having me.

Dr. Cooper

I love the way he tied a ribbon on the discussion by reminding us that health is a currency, what a great way to remember that it’s not the outcome we’re pursuing. It’s the currency that allows us to live full lives, full lives of meaning and impact. Such a great reminder and it was shared in a way that it just sticks. As always, we want to thank you. This podcast continues to grow, so thanks for sharing it with, with peers, with friends, with people you run into that are into podcasts. We really appreciate it. If you ever want to talk through the idea of wellness coach certification or the changes coming up in 2020 with the national board exam, please don’t hesitate to reach out to us at results@catalystcoachinginstitute.com anytime. And of course you can find all kinds of tools and resources related to coaching on our website at catalystcoachinginstitute.com. In the meantime, what’s your better today? Maybe today’s discussion provided some additional food for thought towards this idea of better. I know it did for me. Thank you again for joining us. Make it a great rest of your day and I’ll speak with you soon. On the next episode of the catalyst health and wellness coaching podcast.

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