Dr. David Katz takes us on a journey through the evolution of lifestyle medicine and its critical role in addressing our dual crises of chronic disease and environmental degradation. With characteristic wit and wisdom, he explains how our healthcare system has become primarily "disease care," waiting for patients to "fall off the wall" rather than preventing falls in the first place.
Drawing on decades of experience in preventive medicine, Dr. Katz reveals the stark reality that diet quality has become the number one predictor of all-cause mortality in the United States. More sobering still is his assertion that 60% of COVID-19's impact in America was attributable to our population's poor metabolic health—a preventable tragedy had we addressed the "prior neglected pandemic" of lifestyle-related diseases.
The conversation takes a delightful turn when Catherine Katz, neuroscientist and French foodie, joins to share how theory meets practice in their kitchen. Through her website Cuisinicity, she demonstrates that healthy eating need not be bland or restrictive. Her innovative approach transforms traditional recipes by maintaining the sensory experience while dramatically improving the nutritional profile—like her fiber-rich, protein-packed chocolate mousse that satisfies both the body and the most discerning palates.
Together, the Katzes offer a masterclass in "taste bud rehab," explaining how our preferences can adapt to healthier foods in just weeks. They contrast this natural approach with ultra-processed foods engineered to maximize consumption before satiety signals activate. Their message is ultimately one of integration: we need both acute care for emergencies and systems that build "vitality at its origins," recognizing that the shifts in personal behavior that benefit human health also redound to the benefit of our planet.
Ready to transform your relationship with food and health? Discover how small changes can yield enormous benefits for you and the environment.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dave Pavlik (00:02):
Welcome to the Reverse Mullet Healthcare
Podcast from BP2 Health.
We are in Orlando, Florida,live at the ACLM Conference 2024
.
I'm your host, Dave Pavlik.
Ellen Brown (00:11):
And I'm Ellen Brown and we are at the American
College of Lifestyle MedicineConference, their 20th
anniversary celebration, whichis rather significant to this
conversation because we havelegend in our midst and I think
you were supposed to come lastnight for the hot ones, right
yes?
Oh, going to be part of the?
Uh, it wasn't Tom Fullery, it'sum, thank you.
Dave Pavlik (00:33):
I was like one of those words oh, I'm still
willing to do the shenanigans,but they just got it.
Okay, we got to fit it into aschedule, so anyway.
Ellen Brown (00:39):
So please, without further ado, tell us your
background, tell us like andagain, we've got a lot of folks
that listen, that are notfamiliar with lifestyle medicine
, and that's part of our passionand mission is we're trying to
affect real change in healthcare, and so we think it's
really important that folksunderstand lifestyle medicine
and the tools and the power ofit.
And so that's why we came toreally boost that as much as we
(01:01):
can, because we think themessage is super important.
And we think the message issuper important and we think it
could.
It's a tool me it's one of thefew tools that we have left to
pull from.
That could really change thegame yeah, for sure.
David Katz (01:10):
Well, thank you, then, for doing what you do, and
and let's recognize that theplanet is in peril and lifestyle
medicine is absolutely the onlyroom in the house of medicine
that has anything to offer there.
The shifts in personal behaviorthat are best for human health
outcomes, in particular dietarychange toward a
plant-predominant diet, redoundto the benefit of the planet as
well, and that's arguably thesignature issue of our time.
(01:32):
So, in answer to your question.
I'll tell you many long storiesall distilled down into a very
small tidbit.
I trained in internal medicine.
I felt like I was learning howto be one of the king's horses,
one of the king's men.
We'd basically just wait forpeople to topple off the wall
and send in an ambulance.
I thought we could do betterthan that.
Let's try to keep the nextbirth cohort from falling off
(01:52):
the wall quite so often.
So I did a second residency inpreventive medicine, public
health, lifestyle medicinedidn't exist at the time and I
was a newly minted preventivemedicine specialist.
When a paper came out in theJournal of the American Medical
Association in 1993, actualcauses of death in the United
States, which I think verypresciently looked past what's
listed on death certificates andasked the trenchant question
(02:15):
yeah, but what caused that?
So atherosclerosis isn't reallythe cause of the heart attack,
that's the cause of heartfailure, that's the cause of
death.
What you really want to know iswhat caused the atherosclerosis
?
So their answers were a list of10 factors which collectively
explained almost all thepremature deaths in this country
every year, and the first threeall by themselves accounted for
80% of the variance inpremature death and chronic
(02:36):
disease, and they were in orderat the time tobacco, poor diet,
lack of physical activity, baduse of feet, forks and fingers.
These 30 years later, becausewe're smoking less, diet hasn't
improved much.
Diet is number one.
Diet quality, measuredobjectively, is the single
leading predictor variable forall-cause mortality in the
United States.
So what lifestyle medicine doesis say we ought to be
(02:56):
addressing the root causes ofpremature death and chronic
disease.
We shouldn't just wait forHumpty to fall off the wall and
then try to unscramble an egg.
We should be trying to buildvitality at its origins.
When people have chronicdisease, the first line of
defense should be improvingtheir diet, their sleep, their
stress, their physical activity.
We should be addressing thethings that are causing the
disease.
And yes, of course we can alsouse pharmacotherapy and surgery
(03:20):
as needed.
But let's rely on lifestyle andlet's use lifestyle not just
after the fact.
Let's do everything we can topropagate access to the healthy
choice and help build vitalityat its origins.
And there's much more we couldtalk about, but essentially
that's been my career longcrusade from a time before
lifestyle medicine existed.
And then, when it came intoexistence, the people who were
(03:40):
part of that movement found me,said you really belong in our
tent and the rest is history.
I recruited you.
Ellen Brown (03:46):
So I think it's so critical because I am very much
on this platform of affectingreal change and I started on the
journey I mean, I've been onthe journey for many decades but
really got determined about itabout a year and a half ago and
I think it's that idea of likelegacy and you get to a certain
point in your career and you'relike what am I really doing here
?
You know, like, am I really?
I thought I was doing purpose,but now I feel like maybe I'm
(04:06):
watching paint dry and I startedthinking we needed to fix the
existing system.
And now I have really come tothe determination that we need
sick care.
Unfortunately, that's all we'vecreated is to keep people alive
and to treat people whenthey're acutely ill.
David Katz (04:20):
When they fall off the wall.
Ellen Brown (04:21):
Correct and what we don't have is healthcare and we
need a parallel system.
Right, we still need acute careand there's a lot we can do to
that too, right, but it's thewhole idea that, as we get
caught up in arguing aboutprevention and that's an
economic conversation, in myopinion that we talk about like
who finances that, and likethat's why it falls kind of on
deaf ears.
Yep, but with 80 to 90% of ourpopulation population not
(04:43):
metabolically well, we'retalking about reversing a
lifestyle disease syndromethat's cost us $2 trillion.
David Katz (04:50):
And, by the way, which cost us dearly during the
COVID pandemic.
Absolutely 60% of the toll ofthe pandemic in the United
States was attributable to theprior neglected pandemic.
Absolutely, had we come intothe pandemic healthy, 60 fewer
hospitalizations, 60 percentless which is right.
I mean it's, I mean that that'sso much more powerful than any
(05:10):
vaccine is that nationally here?
is that worldwide?
that's in the united states,because actually we're
substantially less healthy thanour european counterparts yeah
it.
It made a contribution in othercountries, but it was a smaller
contribution but this, thisconcept of reversing and not
just treating I want to speak tothis idea that we need sick
(05:32):
care.
I completely agree.
So again, I'm an internist.
I took care of patients for 30years and, frankly, it's an
incredible privilege to have thetraining and credentials to be
the person who runs in wheneverybody else is in panic.
In the moment of a family'smost urgent need, you step in to
try and save the day.
You have that opportunity.
It's incredible and stuff willalways happen.
(05:54):
We could have a seatbelt on thewall, we could give Humpty
balance training, we could havecushions at the base of the wall
and yet on some particular day,when the wind blows just so,
humpty's going to fall off thewall and hurt himself badly.
We're going to need anambulance, we're going to need
an emergency room.
That stuff's not going away.
So we need disease care, but wealso ought to populate the full
expanse of what we're thinkingwe mean when we say health care.
(06:17):
And I see ways for this tohappen.
One is your suggestion, ellen,that we could have parallel
systems.
We could have a disease caresystem and a wellness or
wellbeing system.
The danger in unbundling thetwo is that wellness space could
become the home of woo andcharlatans.
Ellen Brown (06:32):
Oh, totally.
Dave Pavlik (06:33):
Right, it could lack the tether to evidence and
science is so critical, call ithealthcare and not.
Ellen Brown (06:39):
That's why I always say healthcare.
Dave Pavlik (06:40):
Right.
Ellen Brown (06:41):
Because I'm exactly with you.
David Katz (06:42):
The alternative would be to think of the disease
care system the way we ought tobe thinking of the fossil fuel
industry now.
These are large corporateentities with a great deal of
financial might.
They're not just going to goaway.
They're not going, gentle, intothat good night.
They will rage, rage againstthe dying of their light.
And so let's work with them andsay, hey, take that vast
(07:04):
fortune.
You've accumulated fossil fuelby peddling your product disease
care by taking care of sickpeople, and start investing in
models that produce betteroutcomes.
We'll drop the fossil fuelanalogy, but obviously that
would be wind and solar andhydro and so forth.
But on the disease care side, ina capitated system, in a
value-based care system,anywhere where you benefit from
(07:27):
improving population levelhealth, okay, what we're going
to do is we're going to startinvesting in those models and
profiting from those models,because if we do a good job, the
difference between what wespend and what was available to
spend is profit.
We'll take that.
We also know that people arewilling to spend their money and
we could attach subsidies tothis so they didn't need to
spend less of their personalmoney to spas and fitness
(07:48):
centers and recreationalopportunities and fine dining
opportunities and there's noparticular reason.
And my wife is sitting into thepodcast.
I know, I feel like we haven'teven gotten, we haven't even
she's a fantastic cook, and whatwe've put together in our
collaborations over the years isnutritious and delicious and
you can combine the two.
I love it so there's noparticular reason why the
(08:11):
fortunes that trade hands in thedisease care space couldn't
start being invested infranchises where healthy food
becomes readily available toeverybody everywhere?
Then, over some extended timehorizon, as more and more people
are partaking of the actualhealthcare side of the system,
they start to decommission someof their hospital beds and some
(08:33):
of their ER space and we needfewer ambulances.
They don't go away and there'san analogy for this and that
would be the way we deal withdrowning as a society.
When people drown and arebrought into the emergency room,
they get the full court press.
We do everything we possiblycan to resuscitate them and they
may wind up in the intensivecare unit for some number of
days and fortunes may be spent,but that's okay.
(08:55):
They deserve that.
But mostly what we do isprevent people from drowning in
the first place.
We have fences around pools, weteach people to swim, we have
lifeguards at the beaches, weexpect parents to be vigilant
when their little ones are nearwater and we put up signs that
say don't go in the water.
Today there's a massive surf ora riptide.
If we did all of that withregard to health, food and
obesity and chronic disease risk, it would completely change the
(09:18):
game.
So we need to change in mindsetand we need to evolve the
disease care system, expand itsspectrum of activity.
I don't think it needs to loseor be left behind.
No, and it doesn't just need tocontract.
I think they can diversifytheir portfolio.
Ellen Brown (09:31):
So I won't belabor this because we're on a short
clip here and I still want tohear from your wife.
David Katz (09:35):
But I will say that you and I need to connect
afterwards because I have thiswhole sort of not whole visual.
Ellen Brown (09:48):
But I have started to put pen to paper and I'm
certain you have many of this,as much of this as well of
saying there's a whole newsegment that basically emerges.
You take that 2 million out fromthe lifestyle disease that
we're spending and youredistribute that and you give
people, you basically give themthe authority to start investing
those dollars of theirs backinto the types of things to your
(10:10):
point that you want to.
It's not there's this beliefthat you have to spend all of
this extra money, and I thinkthat's where, when you use
outcomes based care for good andyou have a full vision.
And the other piece I will addis I'm 100% with you on climate
and food and I much to mypartner's chagrin, I think
sometimes have gone very deepinto food, both on the ag and
(10:30):
farming side, the regenerativeside as well as the CPG side.
Yeah, because as a healthcareperson, I believe that all of
this it's soil to self, it's allpart of the same ecosystem and
for us in healthcare, like Ialways say, healthcare is going
to get blindsided by food.
They are the one food madehealthcare.
David Katz (10:48):
I won't belabor this , but we've.
So I spent most of my career atYale running a research lab
focused on preventing chronicdisease and we deployed
solutions into grocery stores.
Our partners were grocerystores and elementary schools,
because if the kids learn aboutwhat you're deploying into the
supermarket, mom may not noticeit, but the kids do oh we
learned about this in school,and they tug on mom's elbow and
(11:09):
say hey, we've got to use thissystem.
This is going to help us choosebetter food.
So, yeah, we could create anintegrated ecosystem that
reinforces the messages abouthealth and the requisite skill
power so people can actually getthere from here.
Ellen Brown (11:23):
Yeah, they are invited in, so without further
ado.
Oh my goodness, oh no Please.
David Katz (11:29):
Tell us about yourself.
Ellen Brown (11:30):
Tell us, since you're delicious, I'm delicious,
he's delicious, he's theory,and.
David Katz (11:34):
I'm practice.
Ellen Brown (11:36):
Theory and practice .
I thought it was delicious andnutritious.
Well, delicious and nutritious,okay, all right, but truly.
David Katz (11:41):
I'm a French foodie.
I was born and raised in Franceand when we met it was a
challenge because, in order tobe at his level of nutritious,
just perfect.
Ellen Brown (11:56):
They know nothing about this being my business
partners.
Nothing, I won't belabor it.
David Katz (12:04):
It was a challenge, but what was nice is I'm
originally a neuroscientist, soI'm a scientist.
And when we decided, you know,we raised our family, we needed
to make it work, the way that wewould feed our family.
And I love to cook, and littleby little, without even being
aware of it, I titrated the waythat I, you know, I changed the
(12:26):
way that I cook, but the outcomevariable was always
deliciousness, visually, theflavor, but I had to make sure
that it was while varying theingredients yes, eat one
ingredient at a time, enhancingthe fiber content and, you know,
lowering the sodium, makingsure they're vegetable and whole
(12:46):
grains.
And out of that was bornCuisinicity, which is about
loving food that loves you backand then those incremental
adjustments to recipes.
Dave Pavlik (12:58):
They accumulate over time.
So the result is a portfolio ofrecipes that are completely
transformed not one ingredient,but every ingredient, and all
passing a French foodies testfor delicious and visually
appealing.
And all of that and satisfyingmy very fussy nutrition criteria
and testimony to the fact thatyou can love food that loves you
back.
One of the things that peopletend not to know about our food
(13:20):
preferences is that taste budsare very adaptable, little
fellas.
When they can't be with foodsthey love, they learn to love
the foods they're with, and ittakes a very little bit of time.
Now, if you eat junk food allthe time, you will prefer junk
food.
It's spiked with salt and sugarand flavorings and so forth,
and that that becomes normal foryou and anything else is just
bland and dull.
If you migrate away and thishas been done in randomized
(13:43):
control trials you migrate awayfrom ultra processed junk food
to whole food.
Within as little as a few weeksyou start to develop aversions
to the junk food you used toprefer and preference for the
food you're eating.
And if you hang in there for 12weeks now maybe three months
sounds like a long time topeople, maybe it doesn't.
But this is the hill you needto get over to change your
relationship with food for therest of your life.
(14:05):
It's a small I and a huge R,small investment, huge return
really, because you start tofeel the changing in preference
in just a few weeks and thenit's really rock solid in 12
weeks and you can love the foodthat loves you back for the rest
of your life.
David Katz (14:19):
I have to add, though, that with the kids, we
have five kids and the kids thatwere not.
They were our children'sfriends, who were not used to
healthy eating when they wouldcome to our house and say, wow,
this is so good because you knowyou have to do it.
Well, it has to be what theyexpect If it's a chicken nugget
it should be crunchy and tender.
Dave Pavlik (14:40):
It's the texture, the flavor.
David Katz (14:42):
I would put stealth ingredients in there.
Dave Pavlik (14:45):
But do it your right and so doing, that
actually amplifies theopportunities of taste bud rehab
, that's what I call thisprocess it happens faster, it
happens easier, there's lessresistance.
So, absolutely, if you knowwhat you're doing in the kitchen
and, by the way, catherine'srecipes are freely available
that's what I was going to ask.
You said Quizzinicity.
David Katz (15:01):
Quizzinicity.
Ellen Brown (15:02):
How do you spell that?
Is that a business?
Is it a web?
It's a website.
Yeah, give it a plug.
David Katz (15:11):
It has lots of recipes and but this is
reflective of 30 years of ourlife and it did not begin
plant-based.
It was chicken, never red meatwe never ate red meat but
chicken and fish and a lot ofvegetables.
As it has evolved, it's becomemuch more plant-based.
Both love the food that lovesyou and your planet.
(15:35):
So it's become much more veganand it's become much more vegan
and it's Cuisine City.
Dave Pavlik (15:40):
Yeah, it's Cuisine City with an I in the middle
Cuisinicitycom, and it's apublic service.
Our kids said hey guys howabout you pay this forward and
make a website?
Catherine said great idea and Iam a ham, so I love to do
videos in my kitchen andeverything wrong happens, just
in case you weren't picking upthat vibe.
David Katz (16:00):
But that's what real food, real cooking.
You know I didn't have time forfancy schmancy.
I, you know, mother of fivehere.
Ellen Brown (16:09):
So if I have the little thing, we have the little
like soundboard thing it doeslike.
Dave Pavlik (16:13):
I can't reach it.
Ellen Brown (16:15):
I'd be like pushing that button right now.
Dave Pavlik (16:18):
I have two and I'm like, yeah, that's right, five
kids.
You can press it if you want.
Don't try this at home, so I do.
Ellen Brown (16:24):
I do have a question for you, though, on the
on the front of you know, oftastes, taste buds, rewiring,
but something that I think a lotof that gets overlooked and I'm
curious your, your thoughts onthis is satiety and right, and
this, like this was an epiphanyfor me a number of years ago of,
instead of focusing on like,what exactly I'm eating,
necessarily like calories ormacros, or even taste or size or
(16:46):
any of that was satiety.
It's like, hey, if I stay inthis sort of range of feeling
satisfied, right, not full, notempty, and trying to just kind
of stay in that space, it makesa huge difference, oh my
goodness.
And especially with ultraprocessed food, I find, because,
like, I'll be on a plane and ifI haven't remembered to bring
something, and I'm desperate,right, we've all been there and
(17:06):
I'll eat that biscoff cookie orwhatever they hand you, there's
no satiety and I'll give you anexample I make a creme au
chocolat, which is a chocolate,chocolate mousse.
Yeah, I'm coming over for that.
David Katz (17:17):
But literally it is and I've given that recipe to
Yale Dining and University ofMassachusetts at Amherst.
They have a beautiful diningprogram where a chocolate mousse
is usually with sugar and milkand cream and eggs.
I've done away with all of themand yet it's delicious.
Why?
Because I put tofu, you don'tknow.
(17:40):
It's there Dark chocolategranted 60% or 70%.
So that's where the added sugaris Medjool dates, a little
coconut milk and black lentilspuree.
Ellen Brown (17:53):
And talk about satiety.
I mean it fills you up and youdon't know they're there, and
it's creamy and delicious Icould see that, say, I've seen
black beans used in that manner,but this is this, yes, and it
passes the test with the frenchrelatives.
David Katz (18:08):
It's amazing, really let me fit, so I I've talked
about satiety a lot over this.
Dave Pavlik (18:12):
I agree with you completely.
So I just want to makelisteners aware of something.
You mentioned ultra processedfood.
So I commend to everybody'sreading list the extraordinary
science of addictive junk food.
It's a new york times magazinecover story.
You just have to google michaelmoss addictive you'll pull it
up.
Michael moss is a pulitzerprize winning investigative
journalist, wrote a couple greatbooks salt sugar, fat and
(18:33):
hooked excerpted this essay inthe new york times from salt
sugar, fat the extraordinaryscience of addictive junk food.
So your point about satiety ismore salient even than you
realize, because the junk foodthat prevails is willfully
engineered to sabotage satiety.
It's designed to maximize theeating you do before you feel
full.
And so part of the valueproposition of moving to real
(18:55):
food mostly plants, as weadvocate here at ACLM plant
predominant diets, whole foodyou eliminate that intentional
mischief in your diet and youminimize the calories it takes
to feel full.
You're eating foods that fillyou up on fewer calories and, in
addition to just reverseengineering what we might
blithely call the moss effectand steering clear of all that
mischief, you're also tappinginto opportunities to increase
(19:18):
fiber, which is good for youmetabolically.
But one of the reasons thismousse au chocolat is so
satiating is because it's fullof.
Your dessert is now a richsource of fiber right and you
feel good that they're eatingand it's got protein in it and
it's high in protein.
It's high in fiber.
Ellen Brown (19:36):
It actually addresses some antioxidants when
you put the chocolate in there.
David Katz (19:39):
Bioflavonoids and the other kids said how come
they can't?
And it's easy to make, it'svegan it's easy to make.
Ellen Brown (19:44):
Oh yeah, you just throw it in your blender?
The reason I ask is because mywife she's like too many steps.
She'll look at a recipe and gotoo many steps.
I'm not going to do it.
David Katz (19:52):
One of the reasons quizzinicity is called
quizzinicity Because I mean fivekids, you don't have time.
Three dogs Chocolate mousse.
Dave Pavlik (20:02):
Give the chocolate mousse, give it a try.
Ellen Brown (20:04):
Throw it in the blender.
We could always do it Wednesdaynight.
Dave Pavlik (20:07):
But you're right, satiety is really important,
because calories do count, butnobody wants to spend their life
counting them Counting yeah.
And if you eat the right foods,all you really need to do is
eat until you feel full andsatisfied, exactly, exactly
Wednesday night.
We're going to get it on camera.
It'll be bonus.
Ellen Brown (20:23):
Yes, it'll be bonus .
I love it.
David Katz (20:27):
As long as we have a blender, because we're going to
need a blender, you have tohave a good blender.
Yeah, I mean, if not, you justdo it several times.
Ellen Brown (20:32):
Yes, exactly, we'll figure it out.
I didn't bring my Vitamix onthis trip.
Dave Pavlik (20:37):
It's a well-equipped house we rented it
is.
It's a blender Good, good, goodWell.
Ellen Brown (20:42):
I really appreciate you guys taking the time and I
would love to have you join usfor a full episode at some point
.
Dave Pavlik (20:49):
Love to do that.
Ellen Brown (20:51):
When did you realize that your husband was a
rock star?
David Katz (20:53):
Oh, I knew it before everybody else did.
Oh, there you go, I just heardtoday.
Dave Pavlik (21:00):
Yes, thanks guys.
Ellen told me oh, gosh, oh yeahthank you so much.
David Katz (21:04):
Thank you, thank you so much.
Welcome to the Reverse Mullet Healthcare
Podcast from BP2 Health.
We are in Orlando, Florida,live at the ACLM Conference 2024
.
I'm your host, Dave Pavlik.
Ellen Brown (00:11):
And I'm Ellen Brown and we are at the American
College of Lifestyle MedicineConference, their 20th
anniversary celebration, whichis rather significant to this
conversation because we havelegend in our midst and I think
you were supposed to come lastnight for the hot ones, right
yes?
Oh, going to be part of the?
Uh, it wasn't Tom Fullery, it'sum, thank you.
Dave Pavlik (00:33):
I was like one of those words oh, I'm still
willing to do the shenanigans,but they just got it.
Okay, we got to fit it into aschedule, so anyway.
Ellen Brown (00:39):
So please, without further ado, tell us your
background, tell us like andagain, we've got a lot of folks
that listen, that are notfamiliar with lifestyle medicine
, and that's part of our passionand mission is we're trying to
affect real change in healthcare, and so we think it's
really important that folksunderstand lifestyle medicine
and the tools and the power ofit.
And so that's why we came toreally boost that as much as we
(01:01):
can, because we think themessage is super important.
And we think the message issuper important and we think it
could.
It's a tool me it's one of thefew tools that we have left to
pull from.
That could really change thegame yeah, for sure.
David Katz (01:10):
Well, thank you, then, for doing what you do, and
and let's recognize that theplanet is in peril and lifestyle
medicine is absolutely the onlyroom in the house of medicine
that has anything to offer there.
The shifts in personal behaviorthat are best for human health
outcomes, in particular dietarychange toward a
plant-predominant diet, redoundto the benefit of the planet as
well, and that's arguably thesignature issue of our time.
(01:32):
So, in answer to your question.
I'll tell you many long storiesall distilled down into a very
small tidbit.
I trained in internal medicine.
I felt like I was learning howto be one of the king's horses,
one of the king's men.
We'd basically just wait forpeople to topple off the wall
and send in an ambulance.
I thought we could do betterthan that.
Let's try to keep the nextbirth cohort from falling off
(01:52):
the wall quite so often.
So I did a second residency inpreventive medicine, public
health, lifestyle medicinedidn't exist at the time and I
was a newly minted preventivemedicine specialist.
When a paper came out in theJournal of the American Medical
Association in 1993, actualcauses of death in the United
States, which I think verypresciently looked past what's
listed on death certificates andasked the trenchant question
(02:15):
yeah, but what caused that?
So atherosclerosis isn't reallythe cause of the heart attack,
that's the cause of heartfailure, that's the cause of
death.
What you really want to know iswhat caused the atherosclerosis
?
So their answers were a list of10 factors which collectively
explained almost all thepremature deaths in this country
every year, and the first threeall by themselves accounted for
80% of the variance inpremature death and chronic
(02:36):
disease, and they were in orderat the time tobacco, poor diet,
lack of physical activity, baduse of feet, forks and fingers.
These 30 years later, becausewe're smoking less, diet hasn't
improved much.
Diet is number one.
Diet quality, measuredobjectively, is the single
leading predictor variable forall-cause mortality in the
United States.
So what lifestyle medicine doesis say we ought to be
(02:56):
addressing the root causes ofpremature death and chronic
disease.
We shouldn't just wait forHumpty to fall off the wall and
then try to unscramble an egg.
We should be trying to buildvitality at its origins.
When people have chronicdisease, the first line of
defense should be improvingtheir diet, their sleep, their
stress, their physical activity.
We should be addressing thethings that are causing the
disease.
And yes, of course we can alsouse pharmacotherapy and surgery
(03:20):
as needed.
But let's rely on lifestyle andlet's use lifestyle not just
after the fact.
Let's do everything we can topropagate access to the healthy
choice and help build vitalityat its origins.
And there's much more we couldtalk about, but essentially
that's been my career longcrusade from a time before
lifestyle medicine existed.
And then, when it came intoexistence, the people who were
(03:40):
part of that movement found me,said you really belong in our
tent and the rest is history.
I recruited you.
Ellen Brown (03:46):
So I think it's so critical because I am very much
on this platform of affectingreal change and I started on the
journey I mean, I've been onthe journey for many decades but
really got determined about itabout a year and a half ago and
I think it's that idea of likelegacy and you get to a certain
point in your career and you'relike what am I really doing here
?
You know, like, am I really?
I thought I was doing purpose,but now I feel like maybe I'm
(04:06):
watching paint dry and I startedthinking we needed to fix the
existing system.
And now I have really come tothe determination that we need
sick care.
Unfortunately, that's all we'vecreated is to keep people alive
and to treat people whenthey're acutely ill.
David Katz (04:20):
When they fall off the wall.
Ellen Brown (04:21):
Correct and what we don't have is healthcare and we
need a parallel system.
Right, we still need acute careand there's a lot we can do to
that too, right, but it's thewhole idea that, as we get
caught up in arguing aboutprevention and that's an
economic conversation, in myopinion that we talk about like
who finances that, and likethat's why it falls kind of on
deaf ears.
Yep, but with 80 to 90% of ourpopulation population not
(04:43):
metabolically well, we'retalking about reversing a
lifestyle disease syndromethat's cost us $2 trillion.
David Katz (04:50):
And, by the way, which cost us dearly during the
COVID pandemic.
Absolutely 60% of the toll ofthe pandemic in the United
States was attributable to theprior neglected pandemic.
Absolutely, had we come intothe pandemic healthy, 60 fewer
hospitalizations, 60 percentless which is right.
I mean it's, I mean that that'sso much more powerful than any
(05:10):
vaccine is that nationally here?
is that worldwide?
that's in the united states,because actually we're
substantially less healthy thanour european counterparts yeah
it.
It made a contribution in othercountries, but it was a smaller
contribution but this, thisconcept of reversing and not
just treating I want to speak tothis idea that we need sick
(05:32):
care.
I completely agree.
So again, I'm an internist.
I took care of patients for 30years and, frankly, it's an
incredible privilege to have thetraining and credentials to be
the person who runs in wheneverybody else is in panic.
In the moment of a family'smost urgent need, you step in to
try and save the day.
You have that opportunity.
It's incredible and stuff willalways happen.
(05:54):
We could have a seatbelt on thewall, we could give Humpty
balance training, we could havecushions at the base of the wall
and yet on some particular day,when the wind blows just so,
humpty's going to fall off thewall and hurt himself badly.
We're going to need anambulance, we're going to need
an emergency room.
That stuff's not going away.
So we need disease care, but wealso ought to populate the full
expanse of what we're thinkingwe mean when we say health care.
(06:17):
And I see ways for this tohappen.
One is your suggestion, ellen,that we could have parallel
systems.
We could have a disease caresystem and a wellness or
wellbeing system.
The danger in unbundling thetwo is that wellness space could
become the home of woo andcharlatans.
Ellen Brown (06:32):
Oh, totally.
Dave Pavlik (06:33):
Right, it could lack the tether to evidence and
science is so critical, call ithealthcare and not.
Ellen Brown (06:39):
That's why I always say healthcare.
Dave Pavlik (06:40):
Right.
Ellen Brown (06:41):
Because I'm exactly with you.
David Katz (06:42):
The alternative would be to think of the disease
care system the way we ought tobe thinking of the fossil fuel
industry now.
These are large corporateentities with a great deal of
financial might.
They're not just going to goaway.
They're not going, gentle, intothat good night.
They will rage, rage againstthe dying of their light.
And so let's work with them andsay, hey, take that vast
(07:04):
fortune.
You've accumulated fossil fuelby peddling your product disease
care by taking care of sickpeople, and start investing in
models that produce betteroutcomes.
We'll drop the fossil fuelanalogy, but obviously that
would be wind and solar andhydro and so forth.
But on the disease care side, ina capitated system, in a
value-based care system,anywhere where you benefit from
(07:27):
improving population levelhealth, okay, what we're going
to do is we're going to startinvesting in those models and
profiting from those models,because if we do a good job, the
difference between what wespend and what was available to
spend is profit.
We'll take that.
We also know that people arewilling to spend their money and
we could attach subsidies tothis so they didn't need to
spend less of their personalmoney to spas and fitness
(07:48):
centers and recreationalopportunities and fine dining
opportunities and there's noparticular reason.
And my wife is sitting into thepodcast.
I know, I feel like we haven'teven gotten, we haven't even
she's a fantastic cook, and whatwe've put together in our
collaborations over the years isnutritious and delicious and
you can combine the two.
I love it so there's noparticular reason why the
(08:11):
fortunes that trade hands in thedisease care space couldn't
start being invested infranchises where healthy food
becomes readily available toeverybody everywhere?
Then, over some extended timehorizon, as more and more people
are partaking of the actualhealthcare side of the system,
they start to decommission someof their hospital beds and some
(08:33):
of their ER space and we needfewer ambulances.
They don't go away and there'san analogy for this and that
would be the way we deal withdrowning as a society.
When people drown and arebrought into the emergency room,
they get the full court press.
We do everything we possiblycan to resuscitate them and they
may wind up in the intensivecare unit for some number of
days and fortunes may be spent,but that's okay.
(08:55):
They deserve that.
But mostly what we do isprevent people from drowning in
the first place.
We have fences around pools, weteach people to swim, we have
lifeguards at the beaches, weexpect parents to be vigilant
when their little ones are nearwater and we put up signs that
say don't go in the water.
Today there's a massive surf ora riptide.
If we did all of that withregard to health, food and
obesity and chronic disease risk, it would completely change the
(09:18):
game.
So we need to change in mindsetand we need to evolve the
disease care system, expand itsspectrum of activity.
I don't think it needs to loseor be left behind.
No, and it doesn't just need tocontract.
I think they can diversifytheir portfolio.
Ellen Brown (09:31):
So I won't belabor this because we're on a short
clip here and I still want tohear from your wife.
David Katz (09:35):
But I will say that you and I need to connect
afterwards because I have thiswhole sort of not whole visual.
Ellen Brown (09:48):
But I have started to put pen to paper and I'm
certain you have many of this,as much of this as well of
saying there's a whole newsegment that basically emerges.
You take that 2 million out fromthe lifestyle disease that
we're spending and youredistribute that and you give
people, you basically give themthe authority to start investing
those dollars of theirs backinto the types of things to your
(10:10):
point that you want to.
It's not there's this beliefthat you have to spend all of
this extra money, and I thinkthat's where, when you use
outcomes based care for good andyou have a full vision.
And the other piece I will addis I'm 100% with you on climate
and food and I much to mypartner's chagrin, I think
sometimes have gone very deepinto food, both on the ag and
(10:30):
farming side, the regenerativeside as well as the CPG side.
Yeah, because as a healthcareperson, I believe that all of
this it's soil to self, it's allpart of the same ecosystem and
for us in healthcare, like Ialways say, healthcare is going
to get blindsided by food.
They are the one food madehealthcare.
David Katz (10:48):
I won't belabor this , but we've.
So I spent most of my career atYale running a research lab
focused on preventing chronicdisease and we deployed
solutions into grocery stores.
Our partners were grocerystores and elementary schools,
because if the kids learn aboutwhat you're deploying into the
supermarket, mom may not noticeit, but the kids do oh we
learned about this in school,and they tug on mom's elbow and
(11:09):
say hey, we've got to use thissystem.
This is going to help us choosebetter food.
So, yeah, we could create anintegrated ecosystem that
reinforces the messages abouthealth and the requisite skill
power so people can actually getthere from here.
Ellen Brown (11:23):
Yeah, they are invited in, so without further
ado.
Oh my goodness, oh no Please.
David Katz (11:29):
Tell us about yourself.
Ellen Brown (11:30):
Tell us, since you're delicious, I'm delicious,
he's delicious, he's theory,and.
David Katz (11:34):
I'm practice.
Ellen Brown (11:36):
Theory and practice .
I thought it was delicious andnutritious.
Well, delicious and nutritious,okay, all right, but truly.
David Katz (11:41):
I'm a French foodie.
I was born and raised in Franceand when we met it was a
challenge because, in order tobe at his level of nutritious,
just perfect.
Ellen Brown (11:56):
They know nothing about this being my business
partners.
Nothing, I won't belabor it.
David Katz (12:04):
It was a challenge, but what was nice is I'm
originally a neuroscientist, soI'm a scientist.
And when we decided, you know,we raised our family, we needed
to make it work, the way that wewould feed our family.
And I love to cook, and littleby little, without even being
aware of it, I titrated the waythat I, you know, I changed the
(12:26):
way that I cook, but the outcomevariable was always
deliciousness, visually, theflavor, but I had to make sure
that it was while varying theingredients yes, eat one
ingredient at a time, enhancingthe fiber content and, you know,
lowering the sodium, makingsure they're vegetable and whole
(12:46):
grains.
And out of that was bornCuisinicity, which is about
loving food that loves you backand then those incremental
adjustments to recipes.
Dave Pavlik (12:58):
They accumulate over time.
So the result is a portfolio ofrecipes that are completely
transformed not one ingredient,but every ingredient, and all
passing a French foodies testfor delicious and visually
appealing.
And all of that and satisfyingmy very fussy nutrition criteria
and testimony to the fact thatyou can love food that loves you
back.
One of the things that peopletend not to know about our food
(13:20):
preferences is that taste budsare very adaptable, little
fellas.
When they can't be with foodsthey love, they learn to love
the foods they're with, and ittakes a very little bit of time.
Now, if you eat junk food allthe time, you will prefer junk
food.
It's spiked with salt and sugarand flavorings and so forth,
and that that becomes normal foryou and anything else is just
bland and dull.
If you migrate away and thishas been done in randomized
(13:43):
control trials you migrate awayfrom ultra processed junk food
to whole food.
Within as little as a few weeksyou start to develop aversions
to the junk food you used toprefer and preference for the
food you're eating.
And if you hang in there for 12weeks now maybe three months
sounds like a long time topeople, maybe it doesn't.
But this is the hill you needto get over to change your
relationship with food for therest of your life.
(14:05):
It's a small I and a huge R,small investment, huge return
really, because you start tofeel the changing in preference
in just a few weeks and thenit's really rock solid in 12
weeks and you can love the foodthat loves you back for the rest
of your life.
David Katz (14:19):
I have to add, though, that with the kids, we
have five kids and the kids thatwere not.
They were our children'sfriends, who were not used to
healthy eating when they wouldcome to our house and say, wow,
this is so good because you knowyou have to do it.
Well, it has to be what theyexpect If it's a chicken nugget
it should be crunchy and tender.
Dave Pavlik (14:40):
It's the texture, the flavor.
David Katz (14:42):
I would put stealth ingredients in there.
Dave Pavlik (14:45):
But do it your right and so doing, that
actually amplifies theopportunities of taste bud rehab
, that's what I call thisprocess it happens faster, it
happens easier, there's lessresistance.
So, absolutely, if you knowwhat you're doing in the kitchen
and, by the way, catherine'srecipes are freely available
that's what I was going to ask.
You said Quizzinicity.
David Katz (15:01):
Quizzinicity.
Ellen Brown (15:02):
How do you spell that?
Is that a business?
Is it a web?
It's a website.
Yeah, give it a plug.
David Katz (15:11):
It has lots of recipes and but this is
reflective of 30 years of ourlife and it did not begin
plant-based.
It was chicken, never red meatwe never ate red meat but
chicken and fish and a lot ofvegetables.
As it has evolved, it's becomemuch more plant-based.
Both love the food that lovesyou and your planet.
(15:35):
So it's become much more veganand it's become much more vegan
and it's Cuisine City.
Dave Pavlik (15:40):
Yeah, it's Cuisine City with an I in the middle
Cuisinicitycom, and it's apublic service.
Our kids said hey guys howabout you pay this forward and
make a website?
Catherine said great idea and Iam a ham, so I love to do
videos in my kitchen andeverything wrong happens, just
in case you weren't picking upthat vibe.
David Katz (16:00):
But that's what real food, real cooking.
You know I didn't have time forfancy schmancy.
I, you know, mother of fivehere.
Ellen Brown (16:09):
So if I have the little thing, we have the little
like soundboard thing it doeslike.
Dave Pavlik (16:13):
I can't reach it.
Ellen Brown (16:15):
I'd be like pushing that button right now.
Dave Pavlik (16:18):
I have two and I'm like, yeah, that's right, five
kids.
You can press it if you want.
Don't try this at home, so I do.
Ellen Brown (16:24):
I do have a question for you, though, on the
on the front of you know, oftastes, taste buds, rewiring,
but something that I think a lotof that gets overlooked and I'm
curious your, your thoughts onthis is satiety and right, and
this, like this was an epiphanyfor me a number of years ago of,
instead of focusing on like,what exactly I'm eating,
necessarily like calories ormacros, or even taste or size or
(16:46):
any of that was satiety.
It's like, hey, if I stay inthis sort of range of feeling
satisfied, right, not full, notempty, and trying to just kind
of stay in that space, it makesa huge difference, oh my
goodness.
And especially with ultraprocessed food, I find, because,
like, I'll be on a plane and ifI haven't remembered to bring
something, and I'm desperate,right, we've all been there and
(17:06):
I'll eat that biscoff cookie orwhatever they hand you, there's
no satiety and I'll give you anexample I make a creme au
chocolat, which is a chocolate,chocolate mousse.
Yeah, I'm coming over for that.
David Katz (17:17):
But literally it is and I've given that recipe to
Yale Dining and University ofMassachusetts at Amherst.
They have a beautiful diningprogram where a chocolate mousse
is usually with sugar and milkand cream and eggs.
I've done away with all of themand yet it's delicious.
Why?
Because I put tofu, you don'tknow.
(17:40):
It's there Dark chocolategranted 60% or 70%.
So that's where the added sugaris Medjool dates, a little
coconut milk and black lentilspuree.
Ellen Brown (17:53):
And talk about satiety.
I mean it fills you up and youdon't know they're there, and
it's creamy and delicious Icould see that, say, I've seen
black beans used in that manner,but this is this, yes, and it
passes the test with the frenchrelatives.
David Katz (18:08):
It's amazing, really let me fit, so I I've talked
about satiety a lot over this.
Dave Pavlik (18:12):
I agree with you completely.
So I just want to makelisteners aware of something.
You mentioned ultra processedfood.
So I commend to everybody'sreading list the extraordinary
science of addictive junk food.
It's a new york times magazinecover story.
You just have to google michaelmoss addictive you'll pull it
up.
Michael moss is a pulitzerprize winning investigative
journalist, wrote a couple greatbooks salt sugar, fat and
(18:33):
hooked excerpted this essay inthe new york times from salt
sugar, fat the extraordinaryscience of addictive junk food.
So your point about satiety ismore salient even than you
realize, because the junk foodthat prevails is willfully
engineered to sabotage satiety.
It's designed to maximize theeating you do before you feel
full.
And so part of the valueproposition of moving to real
(18:55):
food mostly plants, as weadvocate here at ACLM plant
predominant diets, whole foodyou eliminate that intentional
mischief in your diet and youminimize the calories it takes
to feel full.
You're eating foods that fillyou up on fewer calories and, in
addition to just reverseengineering what we might
blithely call the moss effectand steering clear of all that
mischief, you're also tappinginto opportunities to increase
(19:18):
fiber, which is good for youmetabolically.
But one of the reasons thismousse au chocolat is so
satiating is because it's fullof.
Your dessert is now a richsource of fiber right and you
feel good that they're eatingand it's got protein in it and
it's high in protein.
It's high in fiber.
Ellen Brown (19:36):
It actually addresses some antioxidants when
you put the chocolate in there.
David Katz (19:39):
Bioflavonoids and the other kids said how come
they can't?
And it's easy to make, it'svegan it's easy to make.
Ellen Brown (19:44):
Oh yeah, you just throw it in your blender?
The reason I ask is because mywife she's like too many steps.
She'll look at a recipe and gotoo many steps.
I'm not going to do it.
David Katz (19:52):
One of the reasons quizzinicity is called
quizzinicity Because I mean fivekids, you don't have time.
Three dogs Chocolate mousse.
Dave Pavlik (20:02):
Give the chocolate mousse, give it a try.
Ellen Brown (20:04):
Throw it in the blender.
We could always do it Wednesdaynight.
Dave Pavlik (20:07):
But you're right, satiety is really important,
because calories do count, butnobody wants to spend their life
counting them Counting yeah.
And if you eat the right foods,all you really need to do is
eat until you feel full andsatisfied, exactly, exactly
Wednesday night.
We're going to get it on camera.
It'll be bonus.
Ellen Brown (20:23):
Yes, it'll be bonus .
I love it.
David Katz (20:27):
As long as we have a blender, because we're going to
need a blender, you have tohave a good blender.
Yeah, I mean, if not, you justdo it several times.
Ellen Brown (20:32):
Yes, exactly, we'll figure it out.
I didn't bring my Vitamix onthis trip.
Dave Pavlik (20:37):
It's a well-equipped house we rented it
is.
It's a blender Good, good, goodWell.
Ellen Brown (20:42):
I really appreciate you guys taking the time and I
would love to have you join usfor a full episode at some point
.
Dave Pavlik (20:49):
Love to do that.
Ellen Brown (20:51):
When did you realize that your husband was a
rock star?
David Katz (20:53):
Oh, I knew it before everybody else did.
Oh, there you go, I just heardtoday.
Dave Pavlik (21:00):
Yes, thanks guys.
Ellen told me oh, gosh, oh yeahthank you so much.
David Katz (21:04):
Thank you, thank you so much.
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