The Dr. Hyman Show - How the Food System Makes Food Choices For Us

Episode Date: August 16, 2019

How much personal choice do we really have when it comes to our food choices? The science is clear—our processed, sugary, starchy diet is the single biggest cause of disease and death. And health outcomes are disproportionately worse in minority communities. There are social and cultural inputs at play and many reasons we need to begin looking at health beyond the individual to a community and population-based level. In this mini-episode, Dr. Hyman speaks with Dr. Sonia Angell about how when it comes to social determinants and what we view as cultural tendencies for food choices, much has been imposed from outside influences. He also speaks with Pam Koch about the need to move away from a system that overwhelmingly supports growing commodity crops such as corn, soy, and wheat, and move toward incentivizing the production and purchase of fresh fruits and vegetables. Dr. Sonia Angell is a former Deputy Commissioner at the New York City Department of Health and Mental Hygiene (DOHMH), where she oversaw the Division of Prevention and Primary Care. Dr. Angell is a practicing physician, board certified in internal medicine, and on faculty at the College of Physicians and Surgeons of Columbia University and New York Presbyterian Hospital. Pam Koch, EdD, RD. Pam teaches both Nutritional Ecology and Community Nutrition to master and doctoral students at Teachers College, Columbia University. She conducts research about the connections between a just, sustainable food system and healthy eating. She translates her research into curricula for schoolteachers and recommendations for policymakers.  Find Dr. Hyman’s full length conversation with Dr. Sonia Angell: https://DrMarkHyman.lnk.to/DrSoniaAngell Find Dr. Hyman’s full length conversation with Pam Koch: https://DrMarkHyman.lnk.to/PamKoch

Coming up on this week's episode of The Doctor's Pharmacy. It's very hard for people to feel like they have the ability to control their life and their destiny. I think it's really tough to own that. And scientific research is really clear about this. When you look, for example, at your socioeconomic status and your risk of disease. It's more of a risk than obesity or smoking or a lot of exercising. And the defining aspect of that is powerlessness. Hi, I'm Kea Perowit, one of the producers of the Doctors Pharmacy podcast. Research shows that your social environment, a lack of access to healthy food, your level of education, and even the safety of your neighborhood determine

your health outcomes. Yet, when it comes to chronic disease, we often place the blame on the individuals. In this mini episode, Dr. Hyman speaks with former New York City Department of Health Deputy Commissioner, Dr. Sonia Angel, about the social determinants and the fallacy of personal choice in our food system. You were part of the initiative in New York that said no more trans fats in the deep fryers. Right. And I think, you know, because nobody goes into a fast food restaurant and says, I want my French fries with trans fats in them. Like that's, that's a false choice. We didn't ever have that choice. It was put in there and we just received it that way. And when we talk about added sugar or sodium, right? The vast majority of

sodium in our diet is already in the food when you purchase it. It's coming from processed and packaged foods. It's not what you're putting on at the table. It's not the salt that you're putting on your food when you're cooking. That seems to be the most difficult thing for me to tackle with, because how do we start to push the food industry to do the right thing? Yeah, I mean, the first thing that we need to acknowledge is that the healthiest diet is one that's based on whole foods, not a processed food diet and not an ultra processed diet. So while we can work with industry around packaged foods and beverages, and we have

to because we rely heavily on them, we don't want to lose sight of the fact that the best foods that we really should have as a central part of our diet are not in that realm. So, let's now look at the processed and manufactured foods. Because it's already in the food when you purchase it, you don't have the choice of having a lower sodium diet because the vast majority of foods already has it in there. If industry, however, lowers the amount of sodium in processed and packaged foods, then you do have the choice. The choice is back in the hands of the consumer. Now they can add it at the table. If they want, they can add it to taste or they can choose not

to add it at all. But at least it's a choice that the consumer has. I always say you can't make healthy choices if you don't have healthy choices. The thing that was causing most of the illness that I was seeing in my clinic was not just about an individual making a choice that may not have been a good choice for their health. It was actually where they were living and what was around them that was pushing them into having choices that weren't healthy for them, which is very different. And I don't think people realize the degree of health disparities in this country. I mean, it's really like two countries. It's a developing country and a developed country. And you've got African-Americans having far greater rates of diabetes, heart disease, early death, cancers. You've got

same thing in the Hispanic population. I mean, and it's not surprising because the environments that they live in are heavily targeted by processed food, fast food outlets, and even advertising and marketing. It's pretty easy to see that where the disease is higher is also where the neighborhoods have less resources, not only with respect to food. We have higher rates of crime. When you have higher rates of crime, it's much more difficult to walk in the streets, to use the parks.

Kids are kept indoors. All of that, it's sort of, it snowballs. And in the end, you can see very much that this is about the structure. So, the question is, how did that happen? And we in the United States have a long history of racism, of discrimination, of limitations, of opportunities and access. It's remarkable how a lot of things that have been in our community for a long time, we start to assume it's because there's some sort of cultural tendency towards that, when in fact, some of it may be imposed from the outside for all of the reasons that we've just been discussing. Many of our industrial processed

foods have been found to be addictive. It is not a failing of personal responsibility, moral fiber, or even willpower that drives people to overconsume these unhealthy foods. Columbia University Teachers College Professor Pam Cook discusses how government policy drives a food supply that acts as a main source of our chronic disease epidemic. We have a big system that we have to change. I think we need to change our food supply. I think we need to make our food supply better. I think if we're going to look at it that way, we need to look at what's available in the communities where people are. There may be that there isn't any fresh fruits and vegetables. And so they're not buying it, not because that's what they want,

but because that's the only thing that's available to them. 60% of the calories we consume in this country are from commodity crops, mostly wheat, corn, and soy, which has turned into refined foods. Right. That's turned into all the ultra-processed food products. We say to Americans, the government says eat five to nine servings of fruits and vegetables a day. But if everybody did that, we'd only have enough for 2% of the population. That's right. Only 5% of American adults eat enough fruits and vegetables a day. But if everybody did that, we'd only have enough for 2% of the population. That's right. Only 5% of American adults eat enough fruits and vegetables because we're not producing enough. It is the Farm Bill that is supporting a food system that is a food system that has a lot of highly processed foods in it. Basically, the big agriculture companies

and the big food industry have been very influential over what goes into the Farm Bill. There's $500 million spent by 600 lobbyists just on the Farm Bill from the food industry. Exactly. That's frightening. It's very frightening. And they have a lot of power and they are very, very inside. So just to give you an example is- Yeah, get us into the dirt on this.

What they're really pushing for is supports for the big commodity crops. And so that's corn and soy and a couple other crops. And wheat. And wheat. And so for the current farm bill, $40 billion went into supporting commodity crops. Then fruits and vegetables in the farm bill are called specialty crops. I think that we have to really figure out what we can do to get more programs that provide incentives for healthy foods and make more high-quality food available everywhere because it's not right now. So take some of that $40 billion and push it over to supporting the production of healthy

foods like specialty crops, right? Fruits and vegetables. That's right. Collectively, we have the potential to reverse the chronic disease epidemic by moving away from a system which overwhelmingly supports the production of commodity crops, the distribution of unhealthful foods, and disproportionately targets our most vulnerable communities. This is a systemic generational problem, and it will only change with our voices. When the things that create health are easy to access and the things that create disease are

hard to get to, extraordinary change can occur. I hope you enjoyed this mini episode of The Doctor's Pharmacy. Thank you for being a part of the conversation.