The Dr. Hyman Show - How COVID-19 Shines A Light On Our Broken Food System with Dr. Dariush Mozaffarian

Episode Date: May 18, 2020

Only 12% of us in the US are metabolically healthy—it’s pretty alarming when the healthy population is the minority. And in the age of COVID-19, it’s important to recognize that those with a chronic disease are at an exponentially higher risk of hospitalization than someone who is metabolically healthy. If we as a population were healthier (think less obesity, type 2 diabetes, cardiovascular disease, cancer, etc.), the evidence supports that we’d be faring much better throughout this pandemic. Of course, a major driver of chronic diseases and the risks they create is our food system. We can’t expect to be a resilient population if we aren’t feeding our bodies real food with real nutrients we can use to function optimally.  To dig into this topic further, I was excited to sit down with Dr. Dariush Mozaffarian on this episode of The Doctor’s Farmacy. Dr. Mozaffarian is a cardiologist, Dean and Jean Mayer Professor at the Tufts Friedman School of Nutrition Science and Policy, and Professor of Medicine at Tufts Medical School. As one of the top nutrition institutions in the world, the Friedman School’s mission is to produce trusted science, future leaders, and real-world impact. Dr. Mozaffarian has authored more than 400 scientific publications on dietary priorities for obesity, diabetes, and cardiovascular diseases, and on evidence-based policy approaches to reduce these burdens in the US and globally. He has served in numerous advisory roles including for the US and Canadian governments and, in 2016, Thomson Reuters named him as one of the World’s Most Influential Scientific Minds. For context, this interview was conducted on April 30, 2020. Here are more of the details from our interview:  Three ways COVID-19 influences food and nutrition, and visa versa (3:28) How our national health and economic outcomes from COVID-19 might be different were we a metabolically healthy society (7:37) We can improve our metabolic health in real time (9:53) Micronutrients and their potential for preventing and reducing COVID-19 severity (11:32) Strategies to address our chronic disease pandemic and problems with our food system (28:41) How obesity is affecting our military and national security (33:23) Why we need a coordinated national organizing office around food and nutrition policy (48:18) Functional Medicine for our food system (54:55) Obstacles to changing and improving our food system (56:12) Educating policymakers through strategic collaboration among stakeholders (1:00:30) Find the “Report of the 50th Anniversary of the White House Conference on Food, Nutrition, and Health: Honoring the Past, Taking Actions for our Future” at https://sites.tufts.edu/foodnutritionandhealth2019/ Follow Dr. Mozaffarian on Twitter @Dmozaffarian.

Coming up on this episode of The Doctor's Pharmacy. Our policies are not in line to help or support people to eat healthy food. We have almost three in four American adults who are overweight or obese. And about half of American adults have diabetes or prediabetes. Welcome to The Doctor's Pharmacy. I'm Dr. Mark Hyman, and this is a special episode focused on COVID-19, and I'm so lucky to have my friend and colleague, Dr. Dari Shmazafarian, known as his friends as Dari, who's an extraordinary doctor. He's one of the few guys out there in academic medicine who really understands that food is medicine and talks

about it nonstop other than me, which is pretty awesome. He's a cardiologist. He's the Dean and John Mayer Professor at the Tufts Friedman School of Nutrition Science and Policy. He's Professor of Medicine at Tufts Medical School. He's one of the top nutrition researchers in the world. And their goal at the Tufts Friedman School is to produce trusted science, future leaders, and real world impact. It's not just an academic center. It's about focusing on policy and changing the world. And there is no one in medicine and academia who I know who's done more to advance nutrition

in the policy frontier to speak out about the things that matter than Dari. And he has authored more than 400 scientific publications, which is unbelievable. I've read most of them. I've quoted most of them. Well, not really. I probably haven't read most of them, but I read a lot of them. If you read my book, he's like a key feature in the book.

They're on how we focus on issues of obesity, diabetes, heart disease, and evidence-based policy approaches to really reduce this burden of chronic disease in the United States and globally. He's all over the place. He's on advisory roles in the U.S. and Canadian governments, the American Heart Association, the World Health Organization, the United Nations, and he's been featured in the New York Times, Wall Street Journal, NPR, Time Magazine. And he was named as one of the world's most influential scientific minds. And I think of all the people out there talking about food and health and chronic disease and food policy changes, there's no one with more depth, with more humanity and more brilliance

addressing this than Dr. Mazzafarian. So welcome to the Doctor's Pharmacy. Wow, Mark, thank you so much. And with that introduction, we've set up the listeners for disappointment. You're my hero. You're my hero. You're an intellectual and a hero, and I learned so much from you. And we want to talk today about what seems to be unrelated to COVID-19, which is an infectious disease, but it's diet and chronic disease.

And you wrote an article with the former Secretary of Agriculture, Dan Glickman, that was posted on CNN entitled, Can Diet Flatten the Curve for COVID-19? And it's sort of like, hmm, how does that even make sense? So we've heard all about these ideas of flattening the curve with social distancing and hand washing and contact tracing and isolation and testing. But your article presented a very different view about how we can use food and nutrition and specific nutrients to actually help us address this pandemic. So can you tell us why you wrote this article and why this is more important now than ever to address these issues? Yeah, I think, you know, Mark, it's really clear

that to those of us following this crisis, that COVID19 has really laid bare these incredible challenges, these incredible disparities, these incredible unreasonable aspects of our food system. There's so many ways that COVID-19 influences food and nutrition and food and nutrition influence COVID-19 back. You know, I'll just go through them quickly and we can talk about each of them. So, you know, one is immunity, the actual immune response to COVID. And then, you know, actually the blunting of the excessive inflammatory response to COVID. We can talk about nutrition and actually the immune response. Two is, you know, hunger and food insecurity, which of course

cause incredible human suffering with this economic shutdown and lost wages and schools being closed. But also malnourishment, we know from long clinical experience, malnourishment further predisposes people to infection. So that's the second. And that, and that doesn't mean, and that doesn't mean you're skinny and wasted away. It could be that you're nutrient deficient, which is really common in America. Absolutely. Absolutely. There's what we call hidden hunger. People look like they're getting enough food, but there's hidden hunger because they're

not getting the right nutrients. And what's paradoxical is the most obese are often the most nutrient deficient when you look at their numbers, right? It's just kind of interesting. Yeah. nutrient deficient when you look at their their numbers right it's just kind of interesting yeah and I think then you know these other aspects of COVID that are crucial to you know kind of just quickly mention are you know third the the incredible intersections of supply chains and food waste and getting food to people we don't really have a national food system or even a global food system we have this fractured supply chain that's now become very, very dire. And then I think one of the

most important things for really thinking about COVID long-term, because this is going to be with us for some time, many years, is the incredible relationship between poor metabolic health, diabetes, hypertension, heart disease, obesity, and poor outcomes with COVID. The latest analysis from New York, which has had the most cases in the United States, showed that with each of those conditions, diabetes, hypertension, obesity, there was about two or three-fold higher risk, two to three times higher risk of hospitalization. And if you put those three things together, lots of people have diabetes, hypertension, and obesity, there would be 16-fold higher risk of hospitalization. And so it's very

plausible, and we're modeling this now, it's very plausible that, you know, if we had a metabolically healthy population, COVID would be much, much less severe. And so, you know, thinking about nutrition and the immune response, malnourishment and hunger and food insecurity, disparities, the very high rates in African Americans, very likely related to nutrition in a major way. The challenges to food systems and supply chains and food waste, and then metabolic health. These are all things that you and I and others who study food have known about, that food and nutrition are a dire challenge and an incredible opportunity to improve the health of the population. But COVID-19 has really taken a knife and sliced down this curtain that was kind of hiding it and made it very obvious. And so if five years from now, we're back to just where we were a couple of years ago,

and there's no improvement in our food system and the quality of the food and the way we get it to people and the science that we have to address these questions, I would be just devastated. I would be so disappointed that we haven't realized the opportunity here to fix the food system. So let me get this straight. What you're saying is that if you have chronic diseases and multiple chronic diseases, that your risk of being hospitalized is 16 times higher, that if you're metabolically unhealthy, you're more likely to get sick because your immune system isn't working, and that only 12% of us are actually metabolically healthy. So that means if we actually had a healthy population that was eating a diet that created metabolic health instead of the

opposite, which we're doing now, that this may just be like a bad flu and we wouldn't have full hospitals and a society that's shut down and trillions of dollars in economic losses? All the evidence supports that. Of course, we can't do a randomized trial and wave a wand and make everybody know about healthy to test that. But all the evidence suggests that, you know, as you said, based on national data, only 12% of adults in this country are metabolically healthy. That's just taking things like, you know, waist circumference, blood glucose, blood pressure, cholesterol.

If you just measure those things, only 12% of adults are metabolically healthy. And most of those are people in their 20s, right, who haven't yet really had a lifetime of poor diet and poor lifestyle. And so the vast, vast majority of American adults over 40 are metabolically unhealthy. And given these associations, you know, as I mentioned, even just one of these risk factors, you know, doubling or mentioned, even just one of these risk factors, you know, doubling or tripling the risk of hospitalization, and you start piling them up together. In terms of risk of death, there's been so few deaths, especially under age 70, unless there's at least one of these other conditions.

Yeah. And so it's very plausible that if we had a very metabolically healthy population, you know, instead of, you know, 12% metabolically healthy, we had 12% metabolically unhealthy. What if nine out of 10 of us were metabolically healthy? Then COVID-19 would be a far, far less severe disease, many, many fewer hospitalizations, many fewer deaths. We wouldn't be shutting down the economy. We wouldn't have these hospitals overloaded, our healthcare providers putting themselves in danger and fatigue and working triple shifts. And what's, you know, really important here is that we can actually fix

this now in real time. And so, you know, it doesn't take years and years and years to reverse diabetes or to reverse hypertension or to reverse poor metabolic health. It does take years and years and years to reverse diabetes or to reverse hypertension or to reverse poor metabolic health. It does take years and years to change weight for many people, but metabolic health, whatever your weight, we can pretty rapidly improve metabolic health over months, sometimes even shorter, but certainly over months. And so the country, in addition to the things that we're doing, social distancing and testing, we should be launching a national campaign to improve the way we move and eat to improve our metabolic health. To both protect ourselves and to protect our nation and globally to protect ourselves. I mean, this is what you're saying is pretty radical. is that, yes, we may take a long time to lose all the weight we need to lose, but that within a very short order, by changing the food that goes in,

putting in good stuff and taking out the bad stuff, which you've written so much about and thousands of articles, that we could quickly revert to a more normal metabolic health, reduce our inflammation, improve our immunity. And we see this. I've seen this. A great example for people to understand is when someone who's very, very overweight gets a gastric bypass, within weeks, their diabetes goes away. They're

still very overweight, but their metabolic health changes because they're eating a very different diet. And that's the key to remember, that your metabolic health can be really quickly reverted. So on a macro level, we sort of painted a picture of the poor quality diet we have that's leading to obesity and poor metabolic health, which would make a massive difference if we changed. But you also were talking about what happens on the micro level, on the micronutrient level. And that's really fascinating to me. And I just shared an article with you I read this morning that was done in China, where in China it has some of the most wide disparities in selenium levels in the soil. So in some provinces, there's almost

no selenium. In other provinces, there's abundant selenium in the soil. And so the populations, some are very deficient and some are adequately nourished with selenium. And in this one study, this was just one micronutrient, right? In the populations that had the highest levels, they had three times better cure rates for COVID-19 than the lowest levels. And the populations with the lowest level of selenium died five times as much as the ones with the highest levels. And that's just one nutrient. So you were talking the other day about what you're trying to do, which is develop a study to look at a collection of nutrients that together could bolster the immunity of our population. And you're trying to get this study going. So tell us about what are these nutrients? How does it work? And what are you trying to find out through looking at this study?

All great, great questions. And so first, you know, first and foremost. What is the boiling ocean, right? Yeah, that's right. I think first and foremost, I've always been a guy who believes in foods, foods, diet patterns. From all the cardiovascular literature, there's been, you know, failed nutrient supplement after failed nutrient supplement. A single supplement doesn't

really make a big difference. It's really about your overall food. There are some exceptions. I think, you know, omega-3s, omega-3 fatty acids in particular, there's definitely been at least some studies, you know, for benefits, mixed findings. But on average, for complex chronic diseases like cardiovascular disease and, you know, cancers and some other conditions, supplements don't seem to replace foods. And so I raise that because I come at this as a skeptic. I come at this as an automatic skeptic that individual nutrients could make a difference. You know, yet, as soon as COVID hit, I started reading and consulting with colleagues, experts in nutrition immunology,

nutrition and infectious diseases. We have some of the world's leading experts. Wait, that's a thing, nutrition immunology. That's a thing, right? Absolutely, yeah. We have an incredible expert, Dr. Samin Maidani at Tufts, who's the former president of the American Society for Nutrition, the former head of all of research at Tufts, very, very much has had a career studying nutrition and immunology. And so together and recruiting other experts, we started looking at the evidence. And there's actually very compelling evidence from, you know,

cell models, animal experiments, and even human studies about single nutrient supplements and infections. And specifically for COVID, there's lots of research that's suggestive that some of the very same proteins that the COVID virus uses for its own entry and replication that have been in other viruses like SARS, these nutrients have specific benefit for, you know, activity against those proteins. And so I think there's, you know, maybe eight or 10 nutrients that are potentially promising that could have an effect. And I would put those effects in sort of three camps. You know, one camp is direct potential effects against COVID specific proteins. So there's proteins that are needed for the virus to enter the cell, and then there's proteins needed

for replication and reproduction. Like zinc, right? For example, yeah, zinc has um it it inhibits uh i'm looking at my notes here to to get the the terminology exactly correct it inhibits the rna dependent rna polymerase which is needed for viral replication that's been seen with sars the sars rna polymerase and that's a very similar polymerase to covet 19 and what that means is that the virus basically hijacks your genetic material and uses that little assembly line to produce and replicate And what that means is that the virus basically hijacks your genetic material and uses that little assembly line to produce and replicate itself. And that interrupts that assembly line production is what you're saying.

Exactly. And another nutrient is quercetin. Quercetin and flavanol binds to the ACE2 receptor of SARS, which, sorry, it binds to the ACE2 receptor, which SARS uses to get into the cell. And so, and high-level computer modeling has just very recently identified quercetin as one of the top candidates for blocking COVID entry into the cells. So one camp, and I can go through those nutrients, one camp is actually direct effects against specific effects against COVID.

A second camp of effects is just generally improving pathogen killing. And so we know, again, from animal experiments and even humans, if you're deficient in these nutrients, actually clinically deficient in these nutrients, zinc, selenium, you know, some of the B vitamins, some other vitamins, the immune system doesn't function as well. And in animal experiments and even some human trials, if you give these vitamins, some other vitamins, the immune system doesn't function as well. And in animal experiments and even some human trials, if you give these vitamins, you improve T cell function. The T cells are crucial to fighting viruses. You improve T cell function and you boost the immune response. So just general immune boosting response. And then the third category of effect of these, you know, about eight or 10 nutrients, which to me, I think is actually

the most interesting for COVID is some of these nutrients, you know, help fight the pathogens that are invading the lungs, but also importantly, dramatically ramp down, prevent, soften the excessive inflammatory response that really leads to death with COVID because COVID kills us mostly because not because of the virus itself, but because there's this, this overwhelming excessive inflammatory response in the lungs called cytokine storm, where you get way too high levels of inflammation. The body's trying too hard to fight a COVID, which may explain why people with inflammatory conditions like

diabetes and hypertension and obesity are at higher risk for hospitalization and death, because they're more likely to get this cytokine storm. And many of these nutrients have really clear experimental benefits against reducing cytokine storm. Zinc in particular, quercetin, EGCG, which is from green tea. EGCG, for example, multiple diverse models of lung injury. If you injure the lungs in many different ways, including viral infection in animal models, it blunts that excessive response and animals heal better and live longer. So if you put all these, you know, nutrients together, I can't tell you for sure that they would have efficacy against COVID. We don't know. But compared to some other things that have been tested,

you know, it's at least, there's at least as much evidence to test these and compared to, let's say say chloroquine or hydroxychloroquine yeah um and a lot less side effects and a lot less side effects these are very very safe and so we're really interested in doing a rigorous randomized trial um to to test these and you know one of my frustrations you know what really keeps me up at night right now is research takes time it takes time to put together the protocol get the human subjects approval and get funding and so we're going to go to major you know federal and foundation funders and and and get try to get this trial started as

soon as possible but we could complete this trial in a few months um if we have the sufficient funding and and and i can tell you more we can talk more about some of the specific nutrients. Yeah, well, it's fascinating. It's so fascinating because what you're saying is so based on science. It's so out of the purview of what we normally think about. And people go, where's the evidence? But it's like, it's there,

just it's not something you normally pay attention to. It's sort of in the side mirror. And if you think about just this one selenium study, if there was a drug that could reduce mortality fivefold, it would be headline news, right? But you're, I mean, so this is just one drug. And when you use them synergistically, they work synergistically with multiple different mechanisms. So I guess I know what I'm having for dinner. I'm having a couple of Brazil nuts. Don't have more than two or three because they can get too much selenium. I'm going to have chicken liver for the vitamin A. I'm going to

have oysters and pumpkin seeds for the zinc. I'm going to have quercetin containing onions and, and vegetarian spinach. And I'm going to have, I'm going to have porcini mushrooms and herring for the vitamin D. And I'm going to, I'm going to top it off with some green tea at the end. And I think it's going to help me with my immune system. Well, that's a pretty tough, tough menu for most people to get together. I know it all tastes so good together.

So I think, you know, in terms of specific nutrients, you know, we looked at, we looked at several. Oh yeah, I forgot. I'm going to make a curry because of the nutrients, you know, we looked at several. Oh, yeah, I forgot. I'm going to make a curry because of the turmeric that you mentioned. Yes, turmeric, yeah. So some of the promising nutrients that we think are less specific to COVID, but interesting, but not at the top of our list, are, you know, vitamin C, vitamin D, turmeric, selenium, and the B vitamins are all nutrients, which could have some efficacy and benefits for the immune system. They don't have the specific evidence for, you know, pathways specific to COVID-19. The selenium study you just mentioned is kind of one

of the first. So they're interesting. Vitamin A also. They're all interesting. You know, I think the ones that we have put together that we think are the top candidates are zinc, quercetin, vitamin E, and EGCG. And we actually think it's the combination, putting the four together, that would have benefit. Really testing the combination putting the four together that would have benefit i'm really testing the combination because they all have subtle mild small effects these aren't drugs this isn't and i'm sure you're getting a lot of i'm sure you're getting a lot of big pharma wanting to fund these studies right exactly there's no profit in testing these right but but if we if we test the combination we think that together they'll work synergistically and

in a complementary way. And again, they're so safe to test. So what you're saying is that this is not something you use in an ICU, but this is in the general population could help us be more resilient in the face of COVID-19. Well, we think the best population would be people who are just diagnosed, right? You know, this could work for prevention. This could work in the sickest, sickest patients in the ICU, but that seems less likely. So I think based on mechanisms, you know, when you're first diagnosed, these nutrients could help reduce the progression, reduce the severity, reduce the days of illness, prevent you from getting to the hospital. If you're in the hospital already, prevent you from needing a mechanical ventilator. So that's the population we're going to target. And I want to

emphasize that I'm not recommending people go out and start taking these things because we don't know yet if they have activity against COVID. But you can eat my immune boosting dinner of chicken livers and herring, right? Eat healthy food. There's no problem with that. Eat healthy food. There's a lot of these there's a lot of these nutrients that are in food and if you eat them regularly you're going to up your levels of these nutrients and it's not that hard i mean vitamin d is a little hard you have to eat a lot of herring and a lot of porcini mushrooms or you have to go in the sun half naked for 20 minutes between 10 and 2 south of atlanta but or take a supplement. But for most of these,

you actually can get them from your food. And I think food first is always the strategy. And that's really why now, for two reasons, it seems like what you're saying. One, you want to improve your diet because you want to improve your metabolic health in terms of insulin resistance and the inflammation that goes along with being overweight and chronic diseases. But you also want to up-level your nutrient density, the micronutrients in your food by choosing smartly the foods that contain these nutrients. So you kind of have a double strategy for addressing your metabolic and your nutritional health to make yourself more strong in terms of preventing and maybe even recovering

from COVID-19. And you're also going to be helping society at large by taking care of yourself, by reducing the burden on our hospitals and healthcare systems, and helping us be able to open up the economy. That's maybe why some of these European populations are not struggling. I mean, look at Sweden. I mean, they're generally much healthier population. They're one of the healthiest populations in the world, and they have an open society, but they're not seeing the same rates as we are. And I'm wondering if maybe that's partly because of their general health. What do you think?

Well, we know for sure, again, from clear evidence in the United States, that if you don't have these conditions, you have far, probably the regions of the world where per infected person, we're going to see the fewest deaths are going to be the, you know, rural, low income regions of the world. And so there's our doorbell live, live, live podcasting. Oh, the beauties of working at home. Yes. I had my cat walk through the scene. I'm sure my children will run by. But I think that, you know, it's very plausible that in, you know, rural sub-Saharan Africa, rural Asia, you know, rural regions where there's, you know, a lot of poverty, there's going to be

huge rates of infection. I mean, very rapid rates of infection. But the percentage of people that are going to be hospitalized and dead among the infected, I think, is rapid rates of infection, but the percentage of people that are going to be hospitalized and dead among the infected, I think is going to be going to be quite low. And this is why getting to your point about why food is so important for this double benefit. This is why we need a policy fix. This is why, as you cover in your book, you know, our policies are not in line to help or support people to eat healthy food. We have almost three in four American adults who are overweight or obese. And about half of American adults have diabetes or prediabetes. When you start, you know, saying that the healthy population is the small minority of the population,

right? That's not, that's not okay. Right. It should be that people with disease are the minority and we generally have a healthy population. We've completely flipped that on its head and we have a tiny, tiny proportion of the population that's actually healthy and everybody else has disease. And most of that disease, not all of it, most of that disease, not all of it, most of that disease is strongly diet related. Yeah. So, so we have, you wrote in your CNN article that before COVID-19 that

poor diet kills 530,000 Americans every year, about 1500 deaths every day. That was before COVID-19. Yeah. So, you know, COVID-19 is, is, is tragic, and these 50,000 deaths already in the United States are tragic, and we need to be doing everything we can to reduce this. And at the same time, before COVID-19, around 40,000 Americans were dying every month directly from diet-related diseases that we've estimated that would not have happened if they had a healthy diet. And we weren't going up in arms and saying, we have to stop this. This is causing catastrophe, but it was. It's causing billions of dollars, tens of billions of dollars in preventable healthcare costs, which burdens our American businesses, which burdens our federal governments and state government budgets. It's causing incredible disparities, big differences between, you know, the haves and the have-nots in our society. And it's causing a lot of suffering,

and it's overwhelming our health care system. So here's where I think, you know, I'm, you know, moving beyond, you know, today to think about the rest of 2020, 2021, the next administration. We really need to take this learning from COVID that we do not have a healthy population. And that when you don't have a healthy population and a crisis strikes, it shuts down the economy and people suffer and businesses suffer. We need to take that knowledge and fix the food system. And there's some concrete things we can do. So we in medicine have a phrase, it's called acute on chronic.

If someone's a smoker, has emphysema, they get pneumonia, they're not gonna do so great. And if you're a healthy young guy and you get a little pneumonia, it's called a walk in pneumonia, it's like having a bad cold. And that's exactly what's happening now. COVID is the acute on the chronic disease, obesity pandemic we have. And it may seem like, well, why are we talking about chronic disease? We have a big infectious pandemic. Let's just focus on that. But now you're saying is a

more important time than ever to address this. And before, it's interesting, ironic, you created a report on the 50th anniversary of the White House Conference on Food, Health, and Nutrition that you published with your team from Tufts and colleagues at Harvard, which laid out early in March, right before this all took off, it was like perfect timing, a series of strategies to really address this chronic disease pandemic, the underlying failures in our food policies, and the food system. And it was really brilliantly done and addressed a lot of things we talked about in my book, including things like leveraging the power of the USDA programs to improve nutrition, utilizing economic incentives to get people to eat healthier food and disincentivize not so great food, protecting our children from, you know, avaricious marketing and advertising. You know, I would think if we were a foreign nation, we're doing to our kids what we're doing to it, we'd go to war to protect them, but we just let it happen. And then you sort of even focus on healthcare and health

professionals. How do we get healthcare to focus on food as medicine? How do we train our doctors and healthcare providers to understand nutrition and incentivize better nutrition knowledge and treatment of chronic disease? And then how do we address agriculture and sustainability? And these are all intersecting ideas. Not any one of them is going to fix the problem. And you sort of identified 11 different key sectors that have to be addressed within these five things. So can you talk about, given now, let's say you were hired by the next president to be the food czar, what are going to be your key strategies so that we, one, improve the overall health of our population and we make ourselves more prepared for the next

pandemic from an infection? And how do we address the health disparities, the economic challenges, the climate and environmental challenges, all these intersecting issues, which often are siloed? And you're a big systems thinker. And often people are in silos within Congress or within medicine or academia. But somehow you've got to go, wait a minute, let me go 30,000 feet and see how are all these things connected? And how do we solve all of them by working on them in a coherent way? Well, you know, the inspiration for that report was that in 1969, there was a White House conference on, you know, food, food, nutrition and health that was focused on the big problem of the day, which was true

calorie malnutrition, true hunger. I mean, there were, you know, populations in the United States where, you know, you would see kids with the tiny arms and the distended bellies that you now see and, you know, sort of the famine-stricken nations elsewhere. There was true lack of food in many places in this country. And it was dire. And so Jean Maier, who went on to become president of Tufts and found our school, and I hold the Jean Maier professorship, I'm quite humbled to do that. Jean Maier worked with President Nixon, a Republican, to organize

this conference. They brought together all the stakeholders, and they put together about 1,600 recommendations to fix the food system, thinking about pure hunger. Only 1,600? Yeah. I say that because there wasn't one fixed, right? But they looked, two years later, 1,400 of them had been implemented. And so that conference dramatically changed in a positive way, the way we approach hunger in this country. So it led to expansion and standardization of school lunch, expansion and standardization of the food stamps program. It led to WIC. There was no program for mothers

with infants. It led to the creation of WIC, which is the program that one in two babies in our country are born on WIC, which is this federal program that gives healthy food to moms with babies. It led to nutrition facts labeling. It led to other consumer protections at FDA. It was quite instrumental in changing our food policy and essentially eliminating caloric hunger. We have another kind of hunger now. People don't have healthy food, but it eliminated that sort of severe caloric malnutrition that the country had. And so, you know, 50 years later, we said that was the last time there was a high-level federal attention on our food system. We have new problems, right? We have diabetes, obesity,

hypertension, incredible disparities, diet-related cancers, all the new things we're learning about diet and brain health, food allergies, autoimmunity, inflammatory diseases, gut health. We are facing a very, very different food crisis now than 50 years ago. The military, you know, more than half of young Americans can't enroll in the military because they don't qualify. And the number one medical reason is overweight or obesity. And so a large group of retired admirals and generals, mission readiness, more than 750 retired admirals and generals have said that childhood obesity is a national security crisis. We're not going to have the military. So this was the inspiration behind the report.

Just to piggyback on that, and then I want to continue, is in that report, the most striking statistic I saw was that the evacuations from Afghanistan and Iraq, there were 72% more evacuations related to obesity-related problems than for war injuries, which was just mind-blowing to me. This is not even the people trying to get in. These are people already in the military who are struggling with overweight and obesity and poor health. Well, I'm going to divert away from the report and come back, but a colleague of mine at Harvard who studies occupational health was very interested in first responders, in helping policemen and firemen and improving their health and understanding what was causing their risks,

which, you know, again, in this era is more important than ever. And so he started studying what was killing, you know, police and firefighters on the job, on the job deaths. And to his great surprise, the number one cause of their on the job deaths were heart attacks and other challenges, not getting shot or getting killed in the fire. And then when he started looking at, well, what's so different about firemen and policemen, he found that they had higher rates of heart attacks for their age than the average American adult. And the number one difference, the number one risk factor was actually their diet. They had just horrible diets because of working shifts, working in their cars, working overnight, you know, the sort of the proverb, you know, the donuts, you know, the cop car pulling up the donuts, right?

And so he sort of shifted his focus to seeing how he could improve the nutrition of police and firefighters. So, you know, it is this quiet and overwhelming disaster that, you know, our fighting forces or policemen or firefighters or children are all getting killed, mowed down by metabolic diseases. And where we sort of shrug because it's happened over decades. And humans are evolved, we're evolved biologically to respond to acute risk. This is going to kill me today. We're not biologically evolved to understand in the same way risk that might kill us over months to years. Because, you know, back in the day when we were out on the savannah, right, we cared about that that saber tooth, you know, tiger right in front of us, oh, my God, I could die, changes everything. And yet diabetes, obesity, hypertension, cancers, autoimmune disease, allergies, chronic kidney disease, you know, all these things that are diet related that are still killing our population in incredible numbers. We're sort of assuming is normal. So I think, you know, to go back to the report, I think there are three big picture principles that I'd like to highlight, you know, that I think our report highlights. You know,

one is that there are concrete solutions. There are very real, very concrete solutions that we can fix this. Two, you know, many of these are win-win. So this is not like tobacco where we're just trying to get rid of an entire industry. We want to help the food industry from farmers to manufacturers to restaurants to producers to retailers. We want to help them get healthier, more sustainable, more affordable food to people. So it can be win-win. And three, this can happen quickly. This is not a 50-year plan. We could change things within a few years if we implemented

the right policies. As you said, there's no single magic bullet. What are the slow-hanging fruit? We had a great conversation the other day talking about the dietary guidelines for America. The dietary guidelines are interesting because they're designed for a healthy population. And you just said that only 12% of us are healthy. So it doesn't apply to most of us. Yeah, it is amazing. You know, the dietary guidelines are an incredibly positive process. I'm not somebody to bash the dietary guidelines.

They're one of the great things the government does, which is get scientists together, review the guidelines carefully, put out guidelines every five years. There are problems in the process. So, you know, one of the biggest problems is that the scientific report that the scientists write and then goes to the federal government and they change it, you know, without us exactly knowing how to put out the guidelines.

And usually it's 90% similar, but, but some big things are changed probably because of industry influence so there are there are problems but the other problem that you mentioned that or really the lost opportunity is that the dietary guidelines by definition by law i think are for the generally healthy population and so they specifically say these dietary guidelines are not to treat any disease or to help give anybody specific dietary guidance. If you have any specific disease, you should see your doctor. But, you know, that means that 90% of Americans, the dietary guidelines don't apply

to them because they have diet related diseases, right? So that's a challenge. But so the low hanging fruit, well, I think that, you know, there are there are several. It's not it's not one. I think one is to engage and leverage the power, expertise and finances of the health care system for food and nutrition. So so the number one cause of poor health in our country, poor nutrition is ignored by the health care system. And so we have to take this massive system that we've created, you and I are both doctors, our healthcare system has a lot of wonderful things about it. We have to take this massive system that we've created and use its resources and power to help improve food and nutrition. So food is medicine. And, you know, things like healthy produce prescription programs, where you go to the doctor if you're food insecure and have diabetes or

hypertension or some, one of these other conditions and you get a prescription to pay for some or all of healthy food as, as one example. That's, that's a clear low hanging fruit to get food as medicine into healthcare. Another one I think is to better use, better leverage the investment of SNAP, the program formerly known as food stamps. About one in seven Americans were on SNAP before COVID hit. And, you know, it's going to go up for sure.

Isn't it one in four kids? And I don't know the exact statistic, Mark, but there are more kids than adults on SNAP. So maybe one in four kids. Yeah, there's a large number of children on SNAP. but there are more kids than adults on SNAP. So maybe one in four kids. Yeah, there's a large number of children on SNAP. There's a large number of elderly on SNAP. There's a large number of military, active duty military on SNAP. There's people in the military whose families are on SNAP because they don't have enough money for food.

And so it's not just for, you know, it's not just a handout. This is for families, elderly, veterans, active duty military who really need a helping hand to find food. SNAP is a wonderful program, a powerful program to get money to people who need money to buy food. And that's crucial and we need to strengthen it. There's a lot of people who say it costs too much. It's $70 billion a year. It costs too much. It's $70 billion a year. It costs too much. We've got to cut its funding. What I say is instead of cutting its funding, let's use it to lower healthcare costs, and then it'll pay for itself. And so we could use it to

lower healthcare costs by incentivizing and disincentivizing certain kinds of foods so that people still have choice. They can still choose what they want to eat. But we're actually leveraging SNAP to make people healthier. So I think those are two – So like double bucks for the farmer's market. You get double your money if you use food stamps at your farmer's market. Yeah, we did a national simulation model, a very rigorous modeling science to say what would happen if you did something

which we called SNAP plus. SNAP plus would be if you bought fruits, vegetables, nuts, whole grains, fish or other seafood, healthy plant oils, beans, a whole range of produce, you'd get 30 cents more on your dollar. You'd get $1.30 per dollar of SNAP benefit. And at the same time, to help pay for that and also disincentivize unhealthy foods, if you bought soda or other sugar-sweetened beverages or junk food or highly processed, cured meats, you get 30 cents less on your dollar.

You get 70 cents on the dollar. And you know that. You know up front you have a choice of, you know, what you want to get, and you can get a little more or a little less on your dollar. That SNAP plus program would immediately be cost savings. It actually wouldn't add anything to the SNAP budget. Like billions of dollars, right? And it would save tens of billions of dollars in healthcare costs, you know, that the government and others are paying. So it's just kind of a natural thing to test, you know, offset the cost of SNAP, right? That's what you're saying.

It's like a, almost because it wouldn't fully offset the cost, but it would, it would, you know, because still, you know, at the end of the day, we're, we're, we're giving food to everybody, including children. And so, you know, it would take a long time to see returns on healthcare investment for children, but, but it would, it would take a long time to see returns on healthcare investment for children, but it would save tens and tens of billions of dollars in healthcare spending without increasing the cost of SNAP at all. And so it would certainly lead to lower government spending. So I think those are two, you know, clear things that could be done. I think two other things I'll just mention, you know, one is to really help spur and catalyze the ongoing revolution in innovation and entrepreneurship. So

businesses everywhere from farm to retail, to personalized medicine, to packaged foods are rapidly trying to innovate because customers are, are demanding different food. They want food that they think is going to make them healthier. That's sustainably sourced. That's good for the environment that comes from, you know, sustainable labor or fair labor practices. And so companies are scrambling to figure this out to how do we get healthier, affordable food to people. And right now, you know, it's just the market is determining what works and what and what doesn't. And so that means that companies that are really trying to

innovate and do the right thing, if their product costs a little more, because they're making it healthier, if it doesn't taste quite as good, because they've made it healthier, they're at a disadvantage. And so and that's insane, right? Those companies should be should be at an disadvantage. And so, and that's insane, right? Those companies should be, should be at an advantage. And so I think we need a national, you know, program to spur innovation in, in, in business to help reward through tax policy and other policies, help reward those companies that are trying to do the right thing. And then I guess I, I, I would give two more things. Those are three items. A fourth item, I think, is to really expand federal nutrition research. You know, as a percentage of overall research, federal nutrition research has been pretty flat for 40 years. And while diet-related illness has skyrocketed. And so, you know, we should be really prioritizing at the National Institutes of Health, at USDA, at the Department of Defense, at the VA, at the FDA, all these places, at NASA, all these places that actually already do nutrition research.

We should be really prioritizing and amplifying and coordinating that research. And doing the right kind of research. Yeah. We need strong, you know, wouldn't it have been great if over the last 10 years we had had multiple well-funded studies on nutrients in the immune system? Yeah. And so when COVID hit, we had already stockpiled that, you know, armamentarium of evidence. And so as soon as COVID hit, we could leverage that stockpile, release that stockpile and, you know,

on COVID and not have this crisis, right? So we really need to much, much better understand, you know, food in the microbiome and links to health, personalization, all the phenolics and flavonols, you know, that are in foods, many, many research questions, supply chains, disparities. So I think that fourth thing is we really need a major new investment in federal nutrition. Well, you talk about the National

Institute of Nutrition, right? Yeah, that's one option. We've been reviewing the options funded by the Rockefeller Foundation, and we've come up with several options, and we're going to release that report this summer. One of the options could be a new institute at the National Institutes of Health. There's 27 institutes and centers at the National Institutes of Health. They're actually, it's the wrong name. It should be called the National Institutes of Diseases, because there's no health in there. This would be the first one that focuses on health.

Most of them are disease-focused. There's one on heart disease, one on cancer. There are some. I mean, there's an institute on complementary medicine. It's fairly small, but there are some that are more broad-focused. That's fair, okay. But there's no National Institute of Nutrition. Well, I remember Dan Glickman, that are more broad-focused. That's fair, okay. But there's no National Institute of Nutrition, so, you know.

Well, I remember Dan Glickman, who, you know, your friend and former Agriculture Secretary, said he reviewed the NIH, the National Institute of Health, strategic plan, and nutrition was, sorry, food was mentioned in there only once, and it was in the context of the Food and Drug Administration. Yeah. So that's,'s like really sad. That was last year.

And in this year's plan that was released, actually nutrition is mentioned, which is an advance, mostly around precision nutrition, you know, understanding kind of personalized nutrition, which is great. Yeah. So that's an advance. So we want to congratulate. Good. I didn't know about that. Yeah. But, you know, they need more funding. We don't want to congratulate. I didn't know about that. Yeah, but you know, they need more funding. We don't want to take away from the existing institutes. We don't want to say,

okay, we're going to create a new National Institute of Nutrition and take away some funding somewhere else. We want it to be additive, right? Congress has to realize this is a national priority and take this on. It just seems so obvious obvious, Darrell, because if food is the biggest driver of disease in America, how do we have no institute or organization within the government focused on studying that? It's just, it's like a what? Well, you know, Mark, you hit the nail on the head. Let's step back. Our healthcare system doesn't address the leading cause of poor health. The National Institutes of Health doesn't address the leading cause of poor health or the national institutes of health doesn't have an institute focused on the leading cause of poor health and the number one cause of death and disability in this country is diet related diseases and preventable health care

spending and why active duty military recruits you know sorry why otherwise qualified military recruits can't get into the armed forces i mean on and on and on the number one cause of death for you know first responders you know is diet it all makes sense the front of my book the opening quote is from wendell berry says we have a food industry that pays no attention to health and a health care industry that pays no attention to food i think that that sort of sums it up. Well, what's exciting is I'm an optimist by nature. After all the doom and gloom, I'm an optimist, Mark.

And I think your book really lays out some of these options really well. That the healthcare industry is now starting to pay attention to food is waking up to this. And the food industry is starting to pay attention to food yes is you know waking up to this um and the food industry is starting to pay attention to nutrition and so these worlds are starting to converge but it's happening too slowly i don't want to wait 50 years to fix this right yeah i'll be 110 yeah yeah yeah health health care is is getting it um uhs like Kaiser Permanente, John Hancock Insurance,

others are starting to incentivize and care about healthy eating. And food companies are starting to try to create more nutritious products. And so, you know, government has to take on this crazy, complicated system and help spur it and catalyze it and leverage it and nurture it, you know, faster. Which brings me to the fifth, you know, kind of low hanging fruit, you know, that I think we could do in the next administration would be to create a national organizing, you know, office to organize all of these federal food and nutrition policies and programs. After September 11th, there was, you know, which was a devastating crisis to our country. There was recognition that the, all of the national intelligence agencies did amazing work separately, but that it wasn't coordinated. And so, you know, the FBI and the CIA and all these

other groups weren't talking to each other. And that was limiting our ability to respond quickly and effectively to intelligence in crises. So the Office of the Director of National Intelligence was created, the ODNI, which is a cabinet level office, reports to the office of the president and coordinates all of our national intelligence and brings that coordinated single message and information to the president, to Congress, to the heads of agencies, and creates coordinated actions. With the unbelievable fragmentation of our food system and our nutrition response that COVID has really laid bare, it's time, I think, for a similar office around food and nutrition policy. You know, we would call it the Office of the National Director of Food and Nutrition, the ONDFN, very similar to the ODNI, would be a cabinet level position that for the first time ever would say we're spending well over $100 billion a year in the federal government on food and

nutrition issues. Let's coordinate it. Let's bring it together. So that, I mean, more than that, if you count in the healthcare costs, like, you know, I mean, 80% of the trillion dollar, 1.2, way more Medicare. We're talking about trillions of dollars. The federal government alone, federal government with the States because the States pay for Medicaid, but the government alone pays $160 billion a year for direct medical care for type 2 diabetes alone. So just type 2 diabetes, which is a mostly preventable condition if you can eat well and treatable condition,

is $160 billion a year. So absolutely. So well over $500 billion a year, if you count the healthcare spending, we should coordinate it so that, you going on in the Centers for Medicare and Medicaid Services and what's going on in school lunch and what's going on in SNAP and what's going on in WIC and what's going on in food labeling and what's going on in health claims and what's going on in the Department of Defense research around performance and recovery from injury and what's going on in the VA around our military veterans. All this work, all this programming, which is disjointed and disconnected, all the USDA, incredible USDA agricultural research and policy to help stimulate farmers and rural development, right? USDA has massive programs to develop rural development. The USDA, actually, the Farm Bill, is the biggest single supporter of conservation. People criticize the Farm Bill, but it's the single biggest conservation program we have to help coordinate all of that. And so I think a new national coordinating office is actually

not pie in the sky. It's actually really an idea whose time has come. Well, I hope you're talking that into the ear of the candidates, because this is the moment to make that happen. And drawing the connections, helping people see the intersection of chronic disease, the pandemic we have, our environmental crises, climate change, national security, academic performance, on and on, social inequities, health disparities. I mean, these are not separate issues. And what's amazing to me, Dari, is these are not hard problems to solve. It's not rocket science. It's not going to have to come up for the cure for Alzheimer's or something really hard. This is something we know about. You've been writing about for decades. Your colleagues and everybody at Tufts and Harvard have been shouting from the rooftops. The problem is nobody's really been listening.

And I think now it's time for them to really listen. And it seems like there's a real openness to listen. This is that moment in history where there's a crack in the door. And I think we can walk through and tell a different story and actually help transform our national food policies and agriculture policies across all these sectors you talked about. And I encourage you to check out this report. I mean, it's fantastic. You can just Google it, the report of the 50th anniversary of the White House Conference on Food, Nutrition, and Health that was put out in March as this pandemic started. And it really lays out kind of unwittingly the solution for what we have right now.

And if it literally was implemented tomorrow, I think we'd all be better off. Well, you know, I thank you so much for having me and for letting us discuss these issues. You know, this is kind of the principle of functional medicine, right? Functional medicine isn't for patients, isn't some pokey pokey, you know, magic magic it's just that when somebody comes in with hypertension and diabetes and joint pain and obesity you don't treat each of those as separate problems and and give one drug for you say well what's the underlying you know function cause of all of this and let's go to the root and try to fix the root of the problem well this is functional medicine for our country and for our food system you You know, we haven't even talked about regenerative agriculture. You briefly mentioned kids learning in school, you know, productivity of the workforce,

the incredible disparities and injustice across different segments of the population. So much of this is related to our food and nutrition system. And we have to stop trying to like put our fingers in the dike one at a time and try to fix these things one at a time and say, we have a systems problem and it's not rocket science. It's not brain surgery. It's pretty basic stuff that we can do. And it's win-win. It's win-win for industry. It's win-win for farmers.

It's win-win for pretty much everybody. So I think it's the time has come and let's walk through that door. So I've asked you all the easy questions. I want to ask you a hard question. You say it's win-win, but you know, what are the obstacles other than lack of education awareness to actually make this happen? Who are the people or the organizations or companies that are going to be resisting the change? Because I think there will be. And how do we work around that? How do we work around that?

I think it depends on the approach, right? If the approach is only punitive, if the approach is, which some countries are doing, like Chile, Mexico, some of these new food system programs, they say, look, we think there's too much salt and sugar and saturated fat in the food supply. And so we're going to penalize companies through warning labels or other things if they have those. And we're going to restrict marketing. And that's it. If that's the only approach, food industry is going to be kind of annoyed. They're going to say, you know, all you're doing is, you know, hitting us for the negatives in our products. What if we have a fermented product? What if we add fruits in a product? What if we increase whole grains? You know, what if we, you know, try to have more healthy oils? You're not giving us any credit for that. So I think that if you take a punitive approach, there's going to be some big time

opposition from publicly traded companies that have stockholders, shareholders, excuse me, that they're, you know, beholden to and financial responsibilities. I think if you take a win-win approach that, look, we're going to use sticks and carrots. We're going to help companies that are doing the right thing. We're going to help you shift your portfolio. We're going to reward farms that are doing the right thing. We're going to help you shift your portfolio. We're going to reward farms that are doing the right thing. You know, of course there's, there's some products that are going to be losers, right? So some, you know, single, you know, single products may not be around that much longer, or they may not be sold that much, or they may cost more, but you know, food companies are diverse and they can sell lots of things. Restaurants are diverse and can sell lots of things.

Farmers can, over time, grow lots of things. So we don't have a monolithic system with one product like tobacco that we have to get rid of. So I think that the real opposition is going to be fear of loss, right? So nobody wants to lose what they have now. So whether it's fear of loss in research that you know existing research agencies say well a new research agency focused on nutrition i don't want to lose what i'm doing now a food company says look i don't want to lose 20 of my portfolio a farmer says i don't want to lose what it's fear of loss right yeah so there's no i don't think

there's anybody entrenched with a line in the sand that I'm going to grow, you know, corn and I want that corn to go to corn syrup in soda. And that's it, no matter what. I don't care what you say, oh yeah, if I can grow corn and that corn can go and make whole grain, you know, whole corn, corn meal that can be healthy and paired with vegetables and be part of a healthy meal. And I get actually a little bit more because my crop tastes better and is nutritionally sound and is grown on regenerative agriculture. And I can get a little more profit because customers will pay for that because it lowers health spending. It can be win-win. I think the report is really brilliant because it threads the needle on that really tough question of how do you bring everybody along on the team, even the reluctant ones. I think that's the brilliance of this report.

It's not blow up the world and start again. It's like, how do we make smart choices in the policy so that we can get alignment on every side of the aisle, on all sides of business, on consumers? I don't think there's anybody in any business, in any seat of government, or any one of our citizens who wakes up and says, you know what? I want to create a system that makes people sick and fat and kids not be able to learn and people depressed and make our national security worse and causes destruction of our agriculture environment. There's nobody that says that or wants that as a human being. And so I believe, you know, we appeal to human beings who are behind these companies and behind these policies that most of them will be able to be brought along. There'll

be a few, but most of them will be able to be brought along. And I think it's, you know, we've been in Washington, and I think you've been a lot in Washington, probably more than I have. And what's really striking is that there's a really general lack of education awareness about these issues. Like the level of being informed of policymakers is so low on this. They're hearing a lot of information from the food industry and from, you know, big lobbyists, but there's not a lot of lobbyists for the good guys, right? You know, we run down to Washington and like we pay our own way and like run around and it's like, but it's far and few between well you know these

are complicated issues right it's a it's a complicated system um you know living in boston now almost 20 years i'll say it's wicked complicated with a really bad boston accent it's wicked complicated we have a wicked complicated system right and and and so you know you asked me what's the low-hanging fruit i couldn't give you a 10 second soundbite answer right there are there are complicated issues here so so getting that complicated message to the public to policymakers um when they're so busy they're so overwhelmed they have so much they're doing you know they're they're thinking about every possible issue under the sun. And getting people to see these interlinkages and these solutions is challenging. And so I think that, you know, communication is a huge, huge part of this. It's not the solution, right? Just

talking about it doesn't fix things. But communication through what we're doing, through other avenues is crucial. And, you know, there's no, there has been historically no funding for that, right? Nobody's paying public health experts and physicians and scientists to communicate where people pay us to teach and to do research. And, you know, people pay clinicians to see patients, scientists to do research. Nobody pays us to actually go out and spend our time, you know, to do this work. And I don't mean we need to get paid extra. I just mean the staff and structures to do that communication, which costs money, don't exist. And so I actually think that, you know, an effort building around the themes in our White House report, building around the themes in your book, I think an effort to bring some, you know,

interested people together to create a coalition of people and some funding to bring this message out and to tell people there are actually solutions that will help us right now. Yeah. I think would be really wonderful. Well, we're on the way we, you and I are collaborating on what's called the food fix campaign, which is a nonprofit and an advocacy group exactly designed to do this, bringing together a coalition of all the stakeholders across all sectors involved in the food system and science and healthcare and agriculture to really have a coordinated strategy and bring these ideas into the 2,000 key people in Washington who make the

decisions at the White House and Congress and agencies that can make a difference. And I think this has really never happened before. And I'm super excited about it. So if anybody listening is excited about this, if anybody wants to get behind it, whether you have money or you have relationships that can make a difference or connections or just ideas, we'd love to hear from you. So I'm so excited that this is going to be, even though this is a horrific time, this is going to be a little window of opportunity for us to actually make a big difference.

So I just applaud what you've done, what you're doing. You're my hero in all this. And I vote for you for the head of that office in the cabinet that's going to be in charge of food, whether you want the job or not. Oh, I think I'm quite happy at the Friedman School of Nutrition Science and Biology, but thanks for the vote, Mark. Of course. Well, thank you so much for being on The Doctor's Pharmacy. I really appreciate your time. I know you're busy. And if you've been listening to this podcast and you love what you heard,

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