Calories Are Down. Exercise Is Up. So Why Is Obesity Exploding?

So calorie intake has gone down or is about the same as 2000, and physical activity has gone up, and obesity has dramatically gone up since 2000. So we have a paradox.

So eat less, exercise more, which is what we're all told, doesn't seem to be working.

What's truly amazing is the science of, of, of how food affects our biology. What we're learning is that the type of food we eat long-term is way more important than its calories. This is why we, we can't blame willpower.

Welcome back to the podcast, Dari. I'm so excited for your new book, Food Is Medicine, which just came out. It has been the work of my life, and to have someone like you also getting it is just amazing. And for those who are listening who don't know who Dr. Mazaffarian is, he's an iconic leader in the field of nutrition and nutrition research. He's the guy who I went to to learn all about nutrition. his scientific papers well before we were friends. He's one of the most prolific and published authors in the space of nutrition and is deeply thoughtful and has come to mostly the same conclusions as I have about chronic disease and food and how we're kind of trying to solve the problem of chronic disease with drugs, which is not why we have chronic disease, is a lack of drugs. It's the lack of proper nutrition. And And the whole idea of food is medicine is so central to his work, to my work. He's the former dean of the Tufts School of Nutrition Science and Policy. He's now the head of the Food Is Medicine Institute at Tufts. And we have worked together and collaborated for many years in policy stuff in Washington, DC. And, you know, we have really just kind of walked this walk together around how do we make our food system better? Because it's not just a personal problem. The fact that we're obese and have chronic diseases in America is not— It's not personal. everybody's fault because they're weak-willed, morally corrupt, or have no willpower. It's something else. And we're going to talk about what that is. We're going to talk about the key controversies in nutrition about protein, about seed oils, about what we should be eating, what we shouldn't be eating, about what is ultra-processed food. And we're going to also talk about some of the key, uh, issues that have been kind of controversial and are still controversial, which is calories. Are calories all the same? We're going to talk about policy a little bit. I won't bore you with that too much, but I think it's important because if we don't change the food system, we're going to not be able to solve this problem. It's like trying to bail a boat that's got a giant hole in the bottom without fixing the hole. So, Dari, welcome. And let's sort of get into it. Tell us how you, as a Stanford-trained biologist, as a Columbia-trained doctor, as a Harvard-trained MPH, MD cardiologist, straight-up doctor, how you somehow had the epiphany that food might be important considering we learn nothing about food in medical school or in our training.

You know, I wrote this book to really put together everything I've learned in my career and try to explain it to people. You know, you get to have a few hours with someone and I get asked so many questions and it's often the same questions again and again. And I thought, you know, if I can write down everything I know, Explain the science, how we got here, you know, where we are today and how we actually have to get out of this mess. You know, I could help, you know, an individual person understand what to do today and tomorrow for what they eat, but also really help us all kind of understand what we don't know and where we shouldn't, you know, probably worry too much because there's not a lot of certainty. And also what the solutions are, as you said. So, it's great to be here. To get to your question, I mean, you know, you're absolutely right. You know, after high school, I did 15 years of training to become a doctor, right? 4 years of college, 4 years of medical school, 3 years of internal medicine, 4 years of cardiology. And in that 15 years, the nutrition we learned was basically biochemistry, right? What's the Krebs cycle? You know, where does ATP come from? How is glucose broken down, right? And that's important. We need, you need to understand that, but really true nutrition food was missing from 15 years of training. And yet the more I saw patients, you know, on both coasts or, you know, wherever my clinics were, I realized that food was really a big deal and important for their health. And so that was my first epiphany that I write about in the book, that how the top cause of poor health facing many patients is missing from healthcare. And that's a pretty big sentence, a pretty big statement. That's pretty important and actually explains so much of the mess we're in with rising healthcare spending and people getting sicker every day and bankrupting our future with buying hospitals and MRI machines and drugs from Europe. And then the second epiphany I had was I said, well, I'm going to read all the science myself and I'm going to at least try to be the best and most informed doctor I can be. And this was around 2000.

And so I started reading all the science, The nutrition science, because it was there, it was just ignored.

Yeah, that's right. And I still have the text of a presentation I gave as a cardiology fellow to kind of the senior cardiology attendings and what I wrote. And what I wrote was that this focus on fat and saturated fat is mistaken. We need to be thinking beyond LDL cholesterol. We need to be thinking about inflammation and endothelial function and kind of the complex effects of foods and whole diet patterns. And actually thinking about protective foods. What are the protective foods missing from the diet? And an example of that would be like the Mediterranean diet. Now, remember, this was 2000. This was the height of the low-fat diet fetish, right? Everything was low-fat, SnackWell's and fat-free frozen yogurt and fat-free salad dressing and everything low-fat. And so, that was the second epiphany.

When you presented that to this group of cardiologists, That was heresy, that saturated fat may not be the big issue and LDL may not be the whole story. Did you get rotten tomatoes thrown at you?

Unfortunately, very, very few tomatoes in a hospital setting. But, but lots of fries, lots of fries and French fries on you.

Yeah.

The, the, the, that was the second epiphany I had though, Mark, is that, that we had the science in hand and it wasn't being translated to public and dietary guidelines and policymakers. I would write, a patient would be admitted with a heart attack and I'd write cardiac diet. And when I sort of went under the hood to see what's a cardiac diet, low fat, low salt, low cholesterol, and low saturated fat. And they're—

And high sugar and carbs. And high sugar and carbs.

Processed carbs, Jell-O and ginger ale and soda and like Kool-Aid. And right. And for heart disease patients. And so, I realized those 2 things that The top cause of poor health is missing from healthcare, and that even the science we, we have is not being translated to people.

Yeah.

And I wanted to help fix both those things.

That's amazing. Yeah. I mean, it, it, it, it, I remember being at Cleveland Clinic. I mean, this is the number one heart hospital in the world, and I started there in 2014 and I was like, okay, what is the cardiac diet they're serving here? And I was like, it was this super low fat, high starch and sugar diet. And for everybody listening, You know, the causes of heart disease have changed, but predominantly most cardiac disease now, heart attacks, are caused by insulin resistance and metabolic dysfunction. And that's caused by high sugar and starch and not by the typical things we thought of, which was too much fat.

That's right.

And we've worked on the dietary guidelines together and advised the government on this. And that was one of the things that we talked about, which was, hey, we've got to kind of get off of this fear of fat problem that everybody's had. So I think we're getting there, but it was quite heresy in 2000. It's pretty impressive that you said that. So, what did your colleagues say? They were like—

Well, they were polite. I presented a study. I said I wanted to do a Mediterranean diet trial in the United States to replicate a Mediterranean, a small trial that had been done in France called the Lyon Diet Heart Study that showed that a Mediterranean diet lowered heart attacks by 62%. 62% in people with heart disease. And so, I said, I want to replicate that study in the United States. And, you know, people were polite and, you know, their pagers went off and they went back to, you know, taking care of the other end of the spectrum, which is after everybody's sick, you know, we have to save people. That's important. We can't ignore that. But there wasn't a lot of interest. And so, I really had to continue to get training and I went on to get my PhD. in public health and nutrition and epidemiology in Boston at Harvard. And then, you know, started my career there first at Harvard and now at Tufts. And my career, I think I've tried hard not to be an armchair academic, you know, where I just sit at my desk and do research and publish it and hope someone reads it, right? I've also tried to translate that, which is how we met.

Yeah.

To translate that to whether it's healthcare, the food sector, nonprofits, government in the United States and around the world. And, and what's exciting, as you said, is we are at a moment, which I think we'll talk about, a tipping point where real change is possible. And that's different than in, you know, the last 25 years of my career.

What I wanna do next is, thank you for that introduction about your, how you got here, which is, which is quite amazing. 'Cause, 'cause I would say to people listening that, you know, Dari's one of the most honest and high-integrity doctor scientists I know that's not ideologically driven, that follows the evidence wherever it leads, including heresy, which is saturated fat may not be the boogeyman we thought it was. So as a cardiologist, the American College of Cardiology still holds on to that. Okay, so I want to, I want to sort of zoom out for a minute and just have you paint a picture of how did we get here? Like, we are in a Totally screwed up food system that's causing Americans to be sick and increasingly a global population to be sick. And we're we created the worst food system in the world and spreading it to every country on the planet except maybe Burma and Cuba because we have no relations. It's amazing. I went to Cuba and there's like nobody's overweight. Everybody's thin. It's quite amazing. And they don't have American anything. So how do we get here? And then we're going to go into switch the channel and go to the everybody's favorite radio station, which is WIFM What's in it for me? We're gonna talk about calories, we're gonna talk about protein, we're gonna talk about fat, we're gonna talk about seed oils, we're gonna get all into that. So zoom out and first help us understand how did we get into this crazy system we're in now that's causing so much disease?

Well, first, Mark, I want to start with, with how bad it is today, because you talked about that, but let's really paint the picture because one of the messages of this book, which I think is really important, is that food is the single biggest problem facing humanity, period.

Amen.

You know, I'm not saying it's among them. It is the single biggest problem facing humanity and it's fixable. It's fixable. It's kind of amazing. It's the single biggest cause of poor health, which causes in the United States and in many countries around the world, the single biggest cause of economic devastation through, you know, loss of human productivity, healthcare spending, out-of-pocket medical costs, huge economic consequences for businesses that self-insure their employees and so on. It's the number one cause of environmental devastation, climate, soil, water, oceans pollution. And it's also a major cause, not the top cause, but a major cause of inequities across society, within countries and across countries. And so if you put together the health costs, the economic costs, the environmental costs, and the costs in human equity, this is the biggest problem. There's nothing bigger. War, Infectious disease, energy, there's nothing else that's bigger and it's all fixable. So, that's one thing I want people to put down the book and realize that the food they're eating is maybe the single most important thing they're doing every single day for not only their health, but for the national security and economy of their community, their family, our nation, and for the environment as well. And so, that's really critical. And so, you know, we're so sick, Mark. We have shown that 10,000 Americans die every week directly from poor nutrition, mostly from chronic diseases like diabetes and heart disease and other obesity. That's 3 September 11ths every single week. And we're just all kind of shrugging because it's happened slowly. It's like the frog in the boiling pot, right? It all happens slowly and we just sort of shrug now. So it is devastating us and it's devastating our economy, at least $1.5 trillion a year. And if you adjust for kind of healthcare inflation, I think it's closer to $2 trillion. At least $1.5 trillion a year is lost to the economy in healthcare spending and lost human productivity from poor nutrition. Not from all diet-related disease, it's much larger, just from poor nutrition and its impacts. So, $1.5 trillion with a T every year over 10 years, $15 trillion, right? We could pay off the deficit if we could secure that funding back and prevent these diseases. So, that's the first message. The second message of the book is that we arrived where we are today through a series of interconnected, sometimes accidental events of just 100 years where new science came together with government priorities and business innovation to purposefully create the food system to meet certain goals that were not evil. They were trying to meet goals that made sense at the time.

You helped me understand this. Everybody listening, Dari helped me with my book Food Fix and helped me understand this context of why we got here. And I really appreciate that. And I also came to the same conclusion that food is the nexus where all of our global problems meet. And that if we fix food, we fix everything. It's quite amazing. I mean, even our mental health crisis, I mean, it just goes on and on.

We don't fix everything, but we fix a lot.

Not everything, not everything, but we fix a lot.

We fix a lot.

We can't fix war and all that stuff, but aside from war and natural disasters, it's pretty It's a pretty big lever.

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So we'll talk about, you know, I'll get into quickly the goals that we were trying to meet, but it's really important to understand that we don't just start the history of food with like evil food companies making us sick. Because if we start there, the only solution is to tear down the food sector and burn everything down and destroy everything. We have to understand that we got here through conscious decisions, science, government policy, business innovation, because if we take that same roadmap, science, government policy, and business innovation now, we can fix it. We can fix it. And we did that in the last century in about 30 years. And so we can fix it again in 30 years or less. And so that's really important. So how did we get here? Healers for millennia have known that food is critical to health, right? Egyptians putting liver on people with night blindness so vitamin E would seep into the eye and cure night blindness. And yet, understanding the medicinal properties of herbs in Persia, in China, of course. But modern nutrition science where we really started to understand what was doing that I date the birth of that to 1932. So less than 100 years. It's a very, very new science. What happened in 1932? The very first vitamin ever was discovered, isolated, and synthesized, vitamin C. So even in the 1920s, vitamins were unknown. Nobody knew what vitamins were. They hadn't been discovered or, you know, they had some theories and ideas about them in the 1910s, but it was really 1920s, 1930s. And so for the first time, There were diseases that had been plaguing humanity for hundreds of years. Pellagra, which had killed 100,000 Americans just a couple decades before, and 3 million Americans were afflicted by pellagra, an awful, awful disease of itchy, cracked skin and neurologic abnormalities and anxiety and delirium and then death, right?

It's a B vitamin deficiency. It's a B vitamin deficiency.

Niacin deficiency, a B vitamin. Scurvy, which killed more sailors, you know, in the 18th and 19th century than anything else, than anything else on the sea. Scurvy was the killer of the sea, vitamin C deficiency. Night blindness, which is vitamin A deficiency. Rickets, which is terrible bone deformities, which is vitamin D deficiency. These were endemic diseases, you know, where you had children that were afflicted, you know, by these conditions. And so—

And what's amazing is that deadly debilitating diseases could be fixed with pennies worth of nutrients overnight almost. It's one of the most miraculous cures of medicine.

It was incredible. Doctors today don't know what pellagra is. Nobody's seen a case of pellagra or scurvy or rarely night blindness or rickets. It doesn't— these were serious diseases, Mark, and people thought they were infectious. People thought they were infectious diseases. And I kind of walk through these discoveries and it's on the shores of Indonesia, in the island of Jakarta and in the south in the United States and in Poland and scientists kind of Figuring this out and discovering that, oh my God, food is responsible for some of the major diseases that they thought were infectious or bad humors or just in the—

But they were deficiency problems.

They were deficient. So, so the accident of history was that that coincided with the Great Depression, World War II, when there were very real concerns about national security, fitness for military duty, real food shortages. And so that led government to act. And greatly magnify this research. And as just one example, President Franklin Delano Roosevelt convened a conference in 1941 before Pearl Harbor saying, we're going to war. What do we need to do to address these new vitamins and these new deficiencies? And this scientific panel of blue ribbon scientists looked at all the science and they said, well, we're getting these diseases because we've stripped away food through processing. We stripped away the vitamins. And so, for example, they said grains, we stripped away, you know, with refined grains and wheat flour and rice, white rice and all that. We've stripped away all these nutrients. They could have come to the conclusion we need to process our foods less, but they came to the conclusion we need to supplement, you know, our foods with these missing vitamins. And so, in enriched wheat flour, which is still the dominant wheat flour in the United States and is a good thing, it's not a bad thing. If you get any package and you look on the back, it says enriched wheat, it open parentheses has this list of like, you know, funny, weird words. It's just a bunch of vitamins, right? And so, and so that greatly accelerated this focus on vitamins. And what's amazing, Mark, like you said, in about 10 years, we largely eliminated these diseases that had been just devastating humanity for centuries. And so it was a massive win. And it led to supreme confidence, overconfidence that, hey, we figured out nutrition, we can fix food to address human disease. That was the one big thing that happened. The second big thing that happened was in the '50s and '60s, demographers realized that the world population was exploding. It quadrupled from about 1.5 billion in 1900 to 6 billion in 2000, and of course approaching 9 billion today. But people just did the math. They looked at the acreage of land and the output of crops and where the population was going. And this was in the middle of the century. And they said, we don't have enough food to feed 6 billion people and hundreds of millions of people, maybe a billion people are going to starve. We just didn't have the ability to feed them. And there were books like The Population Explosion that were written by Stanford professors that said, we just have to pick the countries where we can feed people and the countries where people are just going to starve, we just have to give up on them. And they used India as an example. They said, we're no way we're going to feed India. We just have to give up, not even try to send food to India. Let the people starve because we just, we can't do it. And so what they didn't count on was the Green Revolution. The Rockefeller Foundation found Norman Borlaug, this plant geneticist, I, you know, wrestler, wrestler, you know, tough, tough, tough, tough guy, never give up, who went to Mexico. And for 10 years he spent, you know, laborious, laborious seasons breeding first wheat and then eventually rice and corn to really understand how we can maximize yield, how we can get the most yield out of an acre of land, not nutrition, not taste or flavor, but yield.

Wow.

How can we get the most yield?

Yield, which essentially means calories, right?

Calories, starch. How can we get the maximum starch in wheat, right? And how can we also then maximize that by adding artificial pesticides, DDT, which was discovered in World War II? And he knew about DDT because he came from DuPont, which had discovered DDT. How can we add artificial fertilizers to support this massive growth because it depletes the soil. And so all these bomb factories had leftover ammonia. And so he took the nitrogen and made nitrogen fertilizers. And then how do we add intensive irrigation? Because there's not enough water. And so we started depleting the aquifers with intensive irrigation. And what was incredible, to his great credit, yields of wheat, rice, and corn went up 1,000 to 2,000% per acre, right? Not doubled, not tripled. They went up 10 to 20-fold in just a handful of years. And so Mexico and then India, Pakistan went from countries that were on the brink of starvation to food-exporting nations in 5 years. 5 years with what, by the time— so modern agriculture, the monocropping of wheat, rice, corn, and soy, Um, which is about 60% of our calories come from like 5 species.

Yeah, we swung from starvation to obesity because of the amount of starch in the food and the volume of calories that were presented. I mean, we have 500 calories more of corn per person in America than we used to have, and it's crazy and we're eating it.

This saved a billion people from starving. It was a huge win, right? Obviously, because if we didn't have the Green Revolution, we would've had massive famine and, and disruption and war and social disruption. So, give credit to it, but it led to a massive loss of biodiversity of the food that we eat, right? And reliance on starchy crops that were bred for starch. And then the third thing that happened, Mark—

And there's less protein and less nutrients in those crops too.

Absolutely. Absolutely. Yeah. And then, so now we're in like the '60s. So, the first was '40s and '50s, and then calories was '50s and '60s. Radical, rapid changes to food. Food was totally different by 1970 than it had been in 1910. And then, in the '80s, we sort of have the rise of ultra-processed food. That's the third big thing that happened. And while there's not exactly the same obvious date of why and how this started, like there is for vitamins and for the Green Revolution, I think one of the major things that accelerated this was the low-fat, dietary recommendations of 1980.

Yeah.

Because once we had to take fat out of foods, companies had to figure out how to make all these products and have them have the same taste and mouthfeel and flavor and take out all the fat, which is terrific for those things, which was a big mistake. And so, all of a sudden, we had to have emulsifiers and stabilizers and other additives and flavorings and colorings and kind of to make these foods. Now, that wasn't the only reason. We also then had the tobacco companies, the 2 biggest tobacco companies, Philip Morris and R.J.R., bought pretty much, they bought every, they bought almost every food brand that, you know.

Philip Morris, Kraft, R.J.R., Nabisco. Yeah.

All of them. Yeah. And they've since sold them. They've since divested. So they don't really own them anymore, but there was about 20, 10 or 20 years where they owned all of them and they took the exact same scientists, exact same scientists and teams. That had worked on the brain addiction, cigarettes.

Yeah.

And marketing to kids. And they figured out how can we create foods that are addictive and we can market to kids and create brand loyalty just like they did with the Marlboro Man. And that was the, the really, that's the nefarious part of all of this. Up until now it had been good intentions.

But I would say, I'm just going to pause for there for a sec. I'd say it started even before the '80s because I think it was late '50s, '60s. General Mills had a big meeting of all the food companies in Minneapolis saying, hey, So this is a movement towards people eating real food. There's this woman Betty who's a home ec teacher who's trying with home federal extension workers training mothers and families how to cook and eat and grow gardens. And, and they were freaking out that people weren't going to eat their food. So they basically made convenience king. And then they started inserting people into the culture like Betty Crocker, who was an imaginary person. Betty Crocker was— I thought it was Betty Crocker, but all the recipes that, you know, add a can of Campbell's Cream of Mushroom Soup, add a roll of Ritz crackers to your casserole. It was like insinuating highly processed food into the American kitchen. And then they hijacked the American kitchen. And I remember I grew up in the '60s. We had, you know, TV dinners, we had Tang, we had flakes with margarine, we had Kraft macaroni and cheese, all this crap that I grew up with. And so it started even before that, and it was deliberate. And then there was that, you know, those 2 Harvard scientists, uh, who I think, you know, were the leading nutrition scientists at Harvard in the '60s. who, who were basically paid by the sugar industry to say that it was fat, not sugar, that was causing heart disease. And that was published in the New England Journal of Medicine. And, and that recently sort of was exposed, but they paid them the equivalent of like 50 grand to do this. And that could not happen now because of ethics rules, but it was pretty bad. And that kind of led and sort of seeded the whole low-fat thing with, with, um, you know, uh, Ancel Keys and all of his disciples. It was, it was quite, it was quite bad. Well, I do not— I would not say they were All good intention.

Well, no, as I said, I think the, you know, I'm talking about like the major trends, you know, and I do cover a lot of those things you mentioned in the book. A couple of points though, Mark, important. You know, one is that they not only created Betty Crocker, but they actually started paying for and infiltrated the board of the national kind of home economics programs across in high schools and across the country. And Home Ec went from trying to teach people how to cook to teach people how to get processed packaged items and like prepare them from packages, right? And so they actually took over Home Ec. They literally paid for and took over Home Ec purposely. So for sure, I mean, food industry, but you know, every industry's trying to sell their products and make a profit. So it's not different for phones or cars or anything else. But the nefarious stuff was when they really, I think, started trying to make the food the food addictive. But the point you made about fat, I want to get back to because the reason that fat— people say, why was fat vilified? Why did they pick fat? And also, by the way, in 1980, they also did recommend low sugar at the same time, but fat was really vilified. Why was it vilified? Because scientists had figured out the nutrient that caused scurvy, vitamin C. They figured out the nutrient that caused night blindness, vitamin A. They figured out the nutrient that caused pellagra, niacin. And so in the '70s, when all those diseases had been conquered, they said, well, what should we do now? And they started looking at chronic disease and they started with heart disease because that was the top killer. And so the mistake that was made, which wasn't nefarious, but was just accidental or natural maybe, was they said, well, we figured out the nutrient for these other diseases. What's the nutrient that causes heart disease? must be a nutrient. And they picked saturated fat as the nutrient from, from, from this research and then total fat. And so to me, Mark, what we've learned since, since the '80s is that, you know, if you have a simple vitamin deficiency disease, a nutrient causes or cures that disease. There's a one-to-one correlation. But when you have complex chronic conditions that develop over years, mental health, obesity, diabetes, type 2 diabetes, you know, heart disease, stroke, poor gut health, cancers, The list goes on and on. Cognitive decline, kidney dysfunction, peripheral vascular disease, gut health, liver health, all influenced by nutrition. There's no nutrient fix, right? It's about complexity, molecular. It's about food is medicine. It's about— I've heard you say, and I've borrowed, and now I repeat, food is information. Food is not calories. Food is information for our bodies. And so, they They mistakenly took what had worked so well, this nutrient focus, and extended it to chronic disease. And that was the, the big mistake of 1980.

It's so important. And I think, I think we did, we did get there in some ways unintentionally, but once we got there, the food companies really wanted to hold onto their stomach share. They, you call it profit share, they call it stomach share, and they didn't wanna give that up. Uh, now, now I wanna kind of switch into, into the topics I think people really are confused about: calories, protein, fat, sugar, and also protective foods. So let's start with calories. There was a really important paper that I read, and I think it was the American Journal of Clinical Nutrition that you wrote, where basically you said that, and you presented the science pretty clearly, our calorie consumption has gone down while our obesity has gone up. Can you unpack that? Because we all were trained that calories in, calories out. You eat too much, you gain weight. You eat less, you lose weight. Somehow the science doesn't support that. And yet most physicians and nutritionists and most professional societies still adhere to that ideology. Can you kind of help us understand what the hell is going on?

So the first part of my book, Food Is Medicine, I kind of go through how we got here. And then the second part, I go through heart disease, Obesity, the microbiome, and kind of putting it all together to what we have to eat. And in doing so, I kind of go through how in each case we started out with a really oversimplified story about what we should do to prevent heart disease and so on. And then now what the new science is showing us, which is mind-blowing and really eye-opening. And so we've kind of, most people have kind of started to understand this for heart disease, that it's not about fat. anymore. And it's probably not even about saturated fat anymore because it's much more complicated. But as you said, the same is true for obesity, just like focusing on fat and saturated fat is horribly oversimplified when it comes to heart disease. Focusing on calories is horribly oversimplified when it comes to obesity. And the science shows that, but most people don't know that science. And so I really go into that cutting-edge science. So, you know, in the '70s and '80s and '90s, as As waistlines and body fat began to grow, people were eating more and food companies were making more food. And obesity epidemic wasn't really a thing. We didn't talk about the obesity epidemic in the '90s. It wasn't really recognized. And then around 2000, it started to be recognized. There started to be a lot of messaging around obesity. Around 2000, Americans started paying attention and calorie intake based on multiple different measures, Since 2000, it has either been flat or even slightly declining. So calorie intake has gone down or is about the same as 2000. And physical activity has gone up since 2000, not a lot. We're still as a nation, you know, under-exercising, but it hasn't gone down since 2000. It's gone up. More people are exercising. More people are in gyms. More people are doing marathons. More people are doing yoga. And even if you use objective measures of energy expenditure, like doubly labeled water over time in the United States and in Europe, Physical activity has gone up. So, so we have a paradox. Physical activity has gone up. Calorie intake has, is flat or has gone down and obesity has dramatically gone up since 2000. So how is it possible? How are our bodies violating the laws of thermodynamics?

So eat less, exercise more, which is what we're all told doesn't seem to be working.

We're doing it. We're doing it as a population. We're eating less and we're exercising more. Everybody's paying attention. And we're gaining weight. And so what's kind of amazing, what's truly amazing is the science of how food affects our biology. And while we're still unpacking the details, Mark, basically what we're learning is that the type of food we eat long-term is way more important than its calories for weight gain. Of course, short-term calories matter. You can count your calories and figure it out and cut calories and you'll lose weight. And that's why any fad diet works. You can go on any diet and pay attention to your calories. You'll lose weight for a few months, but the biology fights back and the biology becomes important and people regain the weight. So what's the biology? I think 2 of the most interesting things we're learning about is one, how food affects our resting energy expenditure, the amount of calories we're burning while we're not doing anything. Uh, REE, resting energy expenditure. One of the most interesting things is thermogenesis. The generation of heat by the cells of the body. This was really understood well in hibernating bears. Bears have a lot of brown fat, this type of fat that's different from white fat that doesn't store calories, but burns calories to give off heat. So imagine you're eating food, it's going to your fat cells and your fat cells aren't storing it. They're burning it and making you warmer. Right. And so, and so for a long time, it was thought that, you know, after infancy, humans don't have brown fat. But science in the last 10 or 15 years has made clear that we do have brown fat. It's quite active. People who have obesity have less active brown fat. And guess what activates brown fat? Good nutrition.

And cold plunges.

Polyphenols in blueberries, EGCG in green tea, you know, quercetin from, from, you know, other, other plant foods. Diet activates thermogenesis. And in fact, Low-fat diets seem to blunt thermogenesis and kind of high-fat ketogenic Atkins-style diets seem to activate thermogenesis.

Protein activates it. Protein requires more calories.

Protein activates thermogenesis. Absolutely. And so we're not talking about small effects. These studies have shown that over the last 20 years at a population level, our resting energy expenditure has gone down by 220 calories per day. That's more than enough to explain the obesity epidemic, right? We're doing everything right, everything we're being told to, but our resting energy expenditure has gone down. The second critical thing that isn't accounted for in the equations of energy balance, you know, eat less, move more, is what our microbiome is doing. When we eat, we're sharing our calories. We should be sharing our calories. Our bodies are digesting some of the calories. And our microbiome is digesting some of the calories. I'm not talking about fiber. People think of fiber. Fiber doesn't have calories for us. That's only for our microbiome, but our microbiome actually evolved because when we ate minimally processed foods out in the wild, they were, you know, in their intact natural structure and you chew them, nuts or beans or fruits, or you catch animals and not all the calories would get digested in the stomach and the small intestine, the calories, the starch, the sugar, the protein, the fat, it would get to the microbiome and the microbiome would digest those calories, harvest them, and give a little bit back to us and keep most of it for themselves. And we had a wonderful thriving symbiotic relationship. And so if you have a true kind of traditional minimally processed diet, we digest and consume about 80% of the calories and the microbiome digests and consumes about 20%. So it's about a, you know, a 4 to 1 If you have a healthy microbiome. And if you have a healthy microbiome, of course. Yeah. In the modern, you know, ultra-processed diet, 98% of calories are consumed by us and we're starving our microbiomes. So that's another 20% of calories. If you're eating 2,500 calories, we're talking about a 500-calorie swing in how many calories you're digesting versus your microbiome. I think the bottom line point is the type of food we eat The quality of the food is really what's crucial for long-term management of obesity, prevention of obesity, treatment of obesity. We have to focus on the quality of the food because if we focus on activating thermogenesis, on feeding our microbiome, then we don't have to count calories. We don't have to go crazy and like follow packages and track our food. You just have to eat a healthy diet and pay attention to that.

Yeah. Well, that's so important. You know, our friend and colleague David Ludwig did a really important study where he did a clinical trial. And he fed people food so they know exactly what they're eating. It was same identical calories. And one was low fat, and one was low sugar and starch. And the ones that had the low fat diet burned about 400 calories less a day eating the same amount of calories. So he said, it's not how much you eat that you should pay attention to, it's what you eat. So if you pay attention to what you eat, you don't have to worry about how much you eat. And I find that for myself, I never I don't count calories. I eat whatever I want, and I just eat real food. And it just— your body, it naturally regulates it. And there was a great book I read by Fred Provenza called Nourishment. And he talked about the study where they gave kids— and this was in an orphanage, I think in the '20s. They couldn't do the study now, but it was in an orphanage in Canada. And they gave these kids brain and kidney and liver and all these weird things that you think kids would need and all these other foods. And the kids literally chose and selected the foods that were the most nourishing that would actually help them develop and grow. Animals do that naturally. They have this innate wisdom. They know to eat this plant for this medicine. They know to eat this plant for this calorie content or starch. They sample hundreds of plants, and they have a couple of main food crops that are basically for calories, but then they eat all these other plants. It is quite interesting that they know. We have lost our innate wisdom when it comes to food, our innate signaling, because all of our hormonal signaling, Our immune signaling, our microbiome signaling, all the— it's like a complete cacophony of biochemical signals that is driving us to overeat and to be hungry all the time and to dysregulate our metabolic system and dysregulate our microbiome. And so that's why we're in this pickle. And the whole calories in, calories out thing is just such a distraction. I never have once told a person to lose weight. I've never once told any patient to count calories. And I've had people lose literally probably hundreds and hundreds of thousands of pounds in my lifetime. And it's, it's just by eating what, like you said, eating real food.

Yeah. You're, you're absolutely right, Mark. I, I totally agree with, with, with everything you said. And, and I cover a lot of this in, in, in the book. And, and the, the, one of the signaling molecules that you're talking about is GLP-1. And this is why we can't blame willpower and lack of knowledge and other things for the problem we're in. We're talking about biology. We've hijacked our biology. The food system has hijacked our biology so that most people are up against innate biology that they can't fight with their conscious decisions. Although, of course, you can start to move in the right direction, but you're fighting, you're swimming upstream. And so, you know, GLP-1 lasts for just minutes in the bloodstream when it's naturally produced by the intestines in response to eating, but its effects last for hours and hours. And more and more research is showing that's because there's metabolites that if you have a healthy diet and a healthy microbiome, there's metabolites that go into the bloodstream that activate the same receptors and the same pathways that GLP-1 activates in the brain and around the body. So the microbiome is potentiating the effects of GLP-1 signaling. About 25% of all the circulating signaling molecules in the bloodstream are directly from the microbiome, and about another 25% are altered by the microbiome. So, you're talking about 50% of our signaling molecules directly produced by or altered by the microbiome. It's another organ that's affecting our mood, our behavior, our brain, our diet, our appetite. And you see this now with GLP-1 drugs, which we can, you know, talk about separately, their role is. But I think one of the most interesting things about them is that for many patients, not all, for many patients, it not only makes them less hungry, it changes their preference for foods. And they no longer can actually even tolerate eating the processed foods they ate before. There's a great New York Times Magazine article that I write about that went with some of these patients in the grocery store. And the patients say, I crave Cherries. I crave kale and vegetables. I crave fish. You know, I went and I bought a, you know, a Ho-Hos or a Twinkies or candy or a soda and tried it and it tasted fake. It tasted fake in my mouth. They said I had to sit it out. And so, I think for those of us, like, you know, you and me, Mark, who I think we've been fortunate, blessed, you know, good food growing up, microbiome, epigenetics, whatever it is that we had, we have normal GLP-1 signaling. And so we crave naturally, just like those kids in the orphanage, we crave healthy foods that are good for us. That's what we actually want. And ultra-processed foods taste awful. They don't actually taste good. They really taste bad. And so I think the majority of the nation with ultra-processed foods and generation after generation of sickness for the last 30 years, And kids being born to mothers who are sick and all the changes that are happening have altered GLP-1 signaling. We basically have altered GLP-1 signaling on a national scale, and it's altered people's biologic preferences for food. And so, what's I think really interesting about GLP-1s, of course, they can be good for weight loss, but they're restoring the natural human biology. And why I think that's important, Mark, is there's been a narrative that the food industry has hooked us on sugar, salt, and fat. That we innately crave ultra-processed food. And so there's no way out. We have thrifty genes. Like it's just, it's just innate biology to get sick if we have a lot of food. And what I think GLP-1s are showing us is that innate human biology is to eat healthy, minimally processed food that's actually delicious.

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Well, I think I want to double-click on what you said because it was quick and I want to unpack it a little bit. One, you said that 25% of the biochemistry of the metabolites of the chemicals and molecules and messenger signaling things in our blood come from our gut, come from the microbiome.

From food, yeah.

And then another 25% is modified by it. And second, you know, it's important for people to understand that they're eating for themselves, but they also have to feed their microbiome. I call it feeding your inner garden, because what you're saying is that if your microbiome is healthy, it will help naturally regulate your appetite and weight, among many, many other things. Immune function, mood function. I mean, pretty much everything. But importantly around this conversation, we don't think about, how do I feed these critters? What are the prebiotic foods I need to eat? What are the polyphenols I need to eat to feed the microbiome? What are the probiotic foods that I can eat? How do I eat extra fiber to feed these bugs? I mean, these are things that we should be really thinking about. And I think about them. I'm like, oh yeah, I'm going to have artichokes because I know it's good for microbiome, or I'm going to—

Yeah.

I do this. I'm going to eat a plantain because I know it's good for my microbiome. And I, and I think that it's really important to actually start to learn how to not just feed yourself, but feed the little critters inside you that determine so much about your health, including your weight.

That's a perfect, you know, statement, Mark, for us to talk about protective foods, because for, for decades, we've sort of framed the fight against chronic disease for food as one of deprivation. Like, Don't have salt, don't have fat, don't have sugar, don't have food that tastes good, right? You know, you have to, have to, don't have calories. You have to reduce, reduce, reduce as though food is a bad thing. And of course, there's negative things in foods that we have to avoid and we have to reduce. That's true. But more disease is happening, Mark, and we've quantified this, more disease is happening and is occurring because of insufficient intake of good things than too much intake of bad things. It's both, but there's more disease from people not eating enough good things. And so everything you just said, you didn't say, I'm avoiding this, or I'm avoiding that. You said, I'm craving and I'm looking for it. I'm seeking out these foods that are good for me. And so that's the message of Food Is Medicine. It's an optimistic message that having a healthy diet is not about depriving yourself of something. It's about embracing delicious foods that are protective for your body, for your gut, that tastes great. And ultimately, you know, we need system solutions so everybody can eat that way because right now the way our system is, you know, you have to have a lot of things. You have to have time, knowledge, cooking equipment, you know, you have to have a lot of things to be able to eat that way. And we need to have systems where that's the easy route for everyone. But so, you know, eating more of the good is really critical. And so, you know, we can talk about kind of what that priorities are, but I just wanted to highlight how important it is to embrace what's good in food.

I think you're right. It's, it's like, you know, we focus on the bad, but it's not what you take out, it's what you put in that matters. And it's the protective foods that are so healing and will really reverse disease. And I, I mean, I have been a practicing doctor. I'm not just a podcaster or an influencer. Like, I actually see patients and I've seen a lot of patients. And it's amazing to me when you understand how to use food as medicine, how powerful it is. And we're talking in generalities about just eating good food, eating real food, and so forth. But as a functional medicine doctor, I can tell you that there's— it's very specific. If you think about drugs as medicine, there's different drugs for different diseases at different doses at different frequencies for different durations. It's the same with food. I will treat a person with autoimmune disease different than I'll treat someone with diabetes, different than I'll treat someone with migraines, different than I'll treat someone with It's very, very specific, and it's personalized, and it's about what that person particularly needs. And when you understand how to apply food as medicine, it's miraculous the kinds of results people get around the whole spectrum of chronic disease, not just obesity or heart disease or diabetes. So I just want to say that because people don't understand how powerful it is. It's not just a metaphor. It's not just a nice phrase. Food is medicine. It's actually a drug. Food is the most powerful drug on the planet. And it works faster, better, and cheaper than any other drug. And it, it filters your gene expression, your microbiome, your hormones, your brain chemistry, your metabolism, uh, literally, uh, your immune system. It regulates everything. And so that's, uh, that's kind of a really important insight that most people don't get. It's not just, I'm eating for energy. You're eating, you're eating for everything.

And, and it works fast. You know, you said it quickly, but I, I don't wanna— it works fast. So we're not talking about years and years and years to see benefits, right? You can see Changes to the microbiome and energy and mood and sleep within days. You can see changes in glucose and blood pressure within weeks and cholesterol levels within weeks. You can reverse diabetes, lower risk of heart disease within, you know, months to a year. You know, we're not talking about waiting decades to see these benefits.

No, I gave a talk at Cleveland Clinic when I first got there, and this, I was talking about elimination diets and so forth. And, and this guy comes up to me, who I think was even a patient actually, and he said, hey, Dr. Hyman, Uh, I, I just want to say, I tried, you know, this elimination diet where I got rid of gluten, dairy, sugar, ultra-processed food, and ate all these protective foods, uh, and my rheumatoid arthritis went away in 10 days. Is that possible? I'm like, well, yeah, it happened to you. You know, that's how quick it's like, like that. If you, you know, I'm sure he probably had a gluten-related issue, which can cause autoimmune disease. So it, you know, somebody else who had another cause for rheumatoid arthritis might not get better, but In that case, it was quite amazing. All right, so let's talk about a couple of things. Let's start at the big picture. Ultra-processed food. Right now, the federal government is in a process of defining it. Maybe when this podcast comes out, we'll have the definition. But you've been part of that. I've been trying to help with that as well. And I think there's a lot of controversy and confusion. The food industry is very good at trying to poke holes and say, well, there's— It's hard to define. You're going to discriminate against this, it's kind of that, and have all these kind of talking points that they use to sort of make people doubt that we can define ultra-processed food. But most people know what it is like, you know, it looks like what it is like. A Twinkie is ultra-processed food. Nobody's going to debate that. So how do you think about ultra-processed food? How do you define them? And why are they so bad?

The concept of ultra-processed food is actually pretty new. It was really thought of in 2011, you know, 15 years ago by Carlos Monteiro, a friend and colleague in Brazil. And his insight was that there's gotta be something going on with modern food beyond sort of the typical nutrients and ingredients we look at because food companies are formulating products. And if you look at the numbers, they seem to be hitting all the targets, you know, it's low fat, it's low salt, and it seems to be okay, but people keep getting sick. And so he wondered, he hypothesized whether The processing itself beyond the actual nutrients could be really making a difference. And so, he came up with this concept of ultra-processed foods. Now, ultra-processed foods doesn't mean foods can't be processed. He had a separate category for processed food. And so, natural processing, a natural bread, canned beans, jarred fruit, a tin of tuna fish, basically, if you just have food that's been slightly processed that you would do to preserve it or in your home is fine. Ultra-processed foods are things that you wouldn't see in a home kitchen, right? It's molecular assembly and disassembly of food molecules, putting together packaged foods. There's literal real food ingredients, there's chemical additives, there's packaging contaminants often from the plastics, there's agricultural contaminants because they tend to use the cheapest commodity crops from industrial farms. And so, he had this hypothesis that maybe this is important. And what's been amazing is in just the last 15 years, nearly 100 long-term observational studies around the world in every country that's looked has seen that people who eat more ultra-processed foods have higher rates of major chronic diseases from the brain to metabolism, to the heart, to the gut and beyond. And that that's true even if you adjust for kind of the major nutrients that we worry about, like salt and sugar and saturated fat and things like that.

Yeah.

And 3 randomized controlled trials, relatively short-term, 1 week to 8 weeks, have also shown that if you match diets on kind of all the macros, protein, fiber, sugar, everything else, but you have one ultra-processed to one minimally processed, people eat more and gain weight without realizing it, sort of proving in trials that for obesity, at least, it's important. And so, I think it's clear and obvious and convincing that ultra-processed foods, which I would define as basically a food that you can't make in your kitchen, right? It's got additives and contents and formulations and loss of food structure that you wouldn't just be able to naturally make yourself. Ultra-processed foods clearly are harmful and they clearly need to be defined and they need to be labeled. And they probably need to be taxed. We need to do a lot of things to address them, but as a start, they need to be labeled so that we know what they are and we can be transparent to the consumer and they recognize them. And of course, there's heterogeneity in the definition. And so, an ultra-processed yogurt might be better for you than an ultra-processed soda. An ultra-processed candy bar might be worse for you than an ultra-processed whole grain. That's true. But what I really want to emphasize here is that those are industry talking points that what we're going to discriminate, right, against certain foods. Ultra-processing isn't supposed to be replacing everything else we know about nutrition, Mark. We're not supposed to forget that while whole grains are better than refined grains and yogurt is better than candy, right? It's supposed to be added to our knowledge. We're still supposed to pay attention to the kinds of foods you eat and avoid salt and avoid added sugar. So as long as we remember that ultra-processing isn't supposed to be the only rule that you follow, but it's one additional important principle. It's a very, very useful concept. And right now, 50 to 60% of calories in the US food supply are ultra-processed food. And by the way, the next highest country is like 20%. So we are well above the world in our consumption of ultra-processed food, and it's causing— it's devastating our bodies.

Well, you hinted at this. This is a sort of molecular science project. This is not food. The food industry takes commodity crops, they alter them biochemically, they break them apart into sort of these molecular components, they reassemble them into these things that are food-like products, but they're not actually food. If you define food according to the Webster Dictionary or the Oxford Dictionary definition, and I'm going to maybe get it not exactly right, but it's something like this, that food is something that supports the health and the growth and the you know, development of an organism, whether it's a plant or a human. And these foods by definition are not foods, ultra-processed stuff. I don't even want to call it ultra-processed food. And I think, I think, you know, most people intuitively know what it is. It's junk food. Uh, and I always say there's no, there's no such thing as junk food. There's junk and there's food, you know. So I think kind of that's where we are. And it's important people understand that this— I don't have many hard lines. But this is not food. You should not be eating it. Don't eat a rock. You know, like, don't eat this stuff. It ain't food. Okay. So let's talk about things that actually are food. Uh, and there's a couple of big, big things out there in the public zeitgeist right now that are very controversial. One is protein, another is seed oils. Uh, we've had many conversations about this, but, um, talk about this protein craze. Now you can get, you know, protein, like, uh, Dunkin' Donuts milkshakes, which are just sugar with protein thrown in them. And I, I, I like to quote Sarah Palin, you put lipstick on a pig, it's still a pig. So everywhere there's protein. I went to the, I went to the supermarket and there was like protein Cheerios. And I'm like, what is this? You know, like, and, and so can you kind of help us unpack this whole protein craze and, and the controversy about it? And are we eating too much? Are we not eating enough? What do we actually need? Uh, and how do we get this right?

I unpack this in, in, in more detail, you know, in, in my book and really explain the science and tell stories and kind of make it, make it fun and interesting. But I'll, you know, do, do it quickly here. So, I think there's 3 things we need to think about, right? What does protein do? How much do you need? And what else is coming with it, right? And what else is coming with it in the food you're eating? And so, the first thing is what does it do? There's lots of things protein does, but one of its major purposes to have more protein is to build muscle. Again, there's other purposes for metabolism and other things, but the main purpose, the main thing people are thinking about is to build muscle. And it's certainly true that if you have a higher protein diet versus a lower protein diet and you're strength training, you're going to build muscle faster and you're going to get stronger if you're eating the higher protein diet versus lower protein diet. That's why bodybuilders, you know, take, take protein supplements and eat a lot of protein, right? Because it does, it does work. But there's a couple of key points to that. You know, one is that most Americans are already eating enough protein. That's the higher levels that's been studied in those trials. Right? So, the average American is eating 16% or 17% of calories from protein, which means half of Americans are eating more. And, in those trials, the high-protein diets are around 16% or 17% of calories from protein compared to lower. So, most Americans are already eating, 90% of Americans actually are already eating enough protein for normal regular strength training to build muscle. We're not talking to be bodybuilders, but for normal strength training. There are certain populations, younger women and older women in particular, who don't eat a lot of animal products and might not be getting enough protein, but most Americans eat enough. The second key point to that is that if you're not strength training, the protein's not going to have a lot of benefit for muscles. You're not going to build muscles and look like a bodybuilder if you're not strength training. And so, protein, like sugar, like starch, Mark, if you eat excess protein and you have the amino acids circulating in your bloodstream, the muscle says, I don't need them. You didn't work out in the last couple days. You know, I don't need more amino acids. What happens? Insulin goes up, the counter-regulatory hormone insulin, the same hormone that regulates, you know, glucose goes up and turns those amino acids into fat for storage in the body. So protein gets turned to fat. So if you're going out and having protein drinks and protein energy bars and protein shakes and, Protein junk food and you're not exercising, you're just building body fat.

Especially eating protein with sugar, like a Dunkin' Donuts or a Starbucks, like, you know, drink.

And so I think, and then the last point I think, which is probably to me as a cardiologist, the most important is the muscle is not the only organ in your body. So even if you're strength training, don't go get your protein sources from foods that are going to devastate every other organ in your body, right? Think about the food source. The food source matters because not for the amino acids. And there's all this stuff about complete protein and incomplete protein, and that's mostly not that important actually. You can get your protein from plants or animals, you know, and you mostly get all the same amino acids. What's really important is, is it a processed food? Is it minimally processed or not? Does it have phenolics? Does it have fiber? Does it have all the other protective qualities, you know, we've talked about? And so to me, if you're going to get your protein, Think about the other health effects. And if we talk about the other health effects beyond muscle, you know, plant sources of protein and seafood sources would be at the top. They're the best for overall health. I'd say then, you know, yogurt and cheese and fermented foods would probably be next. And then you'd have sort of your fresh animal foods like eggs and poultry and red meats, especially, you know, regeneratively grown or pasture-finished red meats, which have lower inflammatory levels. And then the worst is processed meats that have chemical nitrites and added sugars and other things, you know, salamis and bacons and bolognas and all the low-fat processed deli meats that are in hospitals and in health conferences and in lunchboxes of kids because moms are trying to do the right thing. Those are actually the worst source of protein, plus all the junk food, all the soy protein isolates and junk food that's just, you know, that's just being thrown, you know, for proteins being added to it as you Protein Pop-Tarts is a real thing. So that's kind of what I, how I would summarize things, you know, you know, first you're probably getting enough protein if you're eating an average diet, you don't even need to think about it or get more. Second, make sure you're strength training. Everybody should be strength training, you know, at least 3 times a week doing at least 30 minutes of strength training, especially important as you age. And third, remember that you're more than muscle. And so, you know, make sure you're getting your protein from healthy sources.

Yeah, very important. I think that's important. I think there's, you know, there's, there's edge cases where If you're older or there's anabolic resistance and you don't use protein as well, so you might need a little more. And I think it gets harder to build muscle as you get older, although I found that, you know, I'm 65 and had a catastrophic back infection and lost 25 pounds of muscle. I was able to gain it all back, which I didn't know I could, but I really had to increase my protein and like whey protein shakes and make sure I was strength training. And it was amazing how I've even gotten back better than I was before. The body's amazing, and I think you just need to provide the right fuels. Let's talk about seed oils for a minute. You know, you and I have debated this for a long time, and I was really kind of pretty far in the extreme of, I think they're evil and bad. And, you know, you, you very, very lovingly, with a lot of, a lot of patience, has helped me really understand that it's a more nuanced conversation.

Yeah.

And then ultimately a lot of the problems with seed oils are that they're a biomarker of bad food. In other words, they just are found in most ultra-processed foods, and that's where we're getting most of our seed oils. But in and of themselves, they're not necessarily a big issue. So I think maybe you could kind of talk about where we should be concerned about them and where we shouldn't be concerned about them.

Yeah, so most of our oils, I don't call them vegetable oils, I call them plant oils, and I talk about that in the book. Because they're actually out there.

I just see the bean oils and I just see that, right?

Yeah.

Yeah. Nuts, seeds, and fruits, right? Our oils come from nuts, seeds, and fruits. And so—

Beans like soybeans, right?

And beans. Yeah. Nuts, seeds, beans, and fruits. Yeah. And so, those are the healthiest foods in the food, among the healthiest foods in the food supply, nuts, seeds, beans, and fruits. And so, oils from all of those foods are amazing. They're packed with both monounsaturated and polyunsaturated fatty acids, which are both really, really good for health. They often have, especially if they're more virgin oils, they often have the phenolics and other beneficial compounds that come along with those nuts and seeds and oils that are fat soluble. And so, just first remember, when you're talking about a seed oil, you're talking about the healthy fats from seeds, which are among the healthiest foods on the planet. And so, just based on first principles, we'd expect these to be really healthy. Why has there been concern that seed oils are not healthy? I've thought about this a lot, and it doesn't come from, I think, any ill intent. I think it comes from people looking at pieces of science and history and kind of putting it together in ways that seem to make sense. But when you actually, you know, pull the card out, the whole house of cards kind of falls down and it doesn't make a lot of sense. And it's basically a few things, you know, one, vegetable oils, that were industrially produced for decades were partially hydrogenated. And partial hydrogenation, which made Crisco and stick margarines and a lot of packaged, almost every packaged food had partially hydrogenated soybean oil, partially hydrogenated vegetable oils. Those had trans fats, these industrial fats that were really toxic. And it took the FDA 20 years. It took them way too long to remove them. But finally, by 2018, those have been banned from the US food They're banned in Europe. They're banned in a lot of countries. Not all countries.

But by the way, they're still there in the food. You can still go buy Crisco and things that are full of hydrogenated fats in the grocery store because I checked. It's not a ban. It's like a— it's non-grass. So it's not recognized as safe and they're supposed to take it out, but it's still there.

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Those are fully hydrogenated, so they don't have trans fat anymore. So, it's the partial hydrogenation that made the trans fats. That's really gone, Marc. Partial hydrogenation is really gone. There's fully hydrogenated oils, which we can talk about. They don't have the trans fats anymore. So, even Crisco and those things don't have the trans fat. So, that's true. And so, that really led people to think, okay, industrial fats and oils are bad for us, because they were. They were for a long time. So then, the second thing is this concept that omega-6 polyunsaturated fatty acids are pro-inflammatory, which comes from molecular theories and animal research that was done by Bill Lands, who I knew and spoke to before he passed away a few decades ago. Really a wonderful scientist. And that kind of biochemistry and animal science has been now tested in humans, and it doesn't happen in humans. Omega-6s are not pro-inflammatory in humans. It's not a concern. And so that's the second thing which most people And then, I think the third thing is just this, back to this idea of ultra-processing, to get oil out of seeds, you can't just squeeze them like avocados or olives, right? You can't have a virgin sunflower oil because you can't just use squeezing and low temperature. You have to really use high heat and chemical processes to get oils out of a seed. And those processes do introduce some trace toxins, right? Some trace toxins that are not in virgin oil. And so, yeah, because of the presence of those trace toxins, virgin oils are probably better for you on average than industrial oils. But this is the key point. Countless studies, randomized trials, carefully done studies, observational studies, feeding trials have shown again and again and again that industrial seed oils net are still really good for our health. And so, I think of them as perfectly fine. Soybean oil and canola oil are probably the best choices among seed oils. Because they have plant omega-3s in them. They have the highest levels of plant omega-3s on average. But I think any plant oil is good for you. So, if you have to choose, go ahead. You know, we use extra virgin olive oil because I like the taste. You know, we use avocado oil because I like the taste. But if we want to deep fry, you know, those aren't good. We use canola oil and it's fine. So, I think you're right.

You can get extra virgin cold-pressed versions, right?

Just for the benefit of the environment. Yeah. So, if you can find and afford cold-pressed versions, they're They're probably better, but the industrial versions aren't bad for you. And so, and so I think, you know, like you said, Mark, it's a distraction, uh, because they're, they're a marker of processed foods and the processed foods are bad in other ways, but it's not the seed oils that are the problem.

And I think there's one other point. I don't know if you cover this in your book, but it's something I see clinically at Function Health. We test everybody's omega-3 fats. It's just part of your standard panel, which has probably hasn't been done at scale like that ever. We asked Quest, like, this is unheard of. They had to— they literally had to build a new lab for us because we were doing so many omega-3 tests. Well over half of our members or more have a low omega-3 index, meaning they're lower in omega-3s than we should be. And so it may not be the omega-6s that are the problem. It may be the fact that we're low in omega-3s, which are anti-inflammatory. And so when you— when I looked carefully at all the trials in my book Eat Fat, Get Thin years ago, I It was like, oh, this is interesting. This is really— it's about not just the excess of omega-6s, it's the lack of omega-3s in our diet. And I think that's a really key point. And when you actually look at the data, the studies where they had oils that were just pure omega-6 had a little bit worse outcomes than when they added the oils with omega-3s. So I think there's a subtle point there, but I think it's important. I think people need to make sure they're eating those because they're not typically in our food anymore. We used to eat wild food. They're in wild plants, they're in wild animals, they're in wild fish. You know, we get it in, you know, if we eat sardines and things like that that are wild, but it's rare to get them. Nuts and seeds have some, but they're not well converted, you know, into the EPA/DHA that we need. So I think that's a kind of a nuance. If I were to say anything about it, I think focus on omega-3s and don't worry so much about the others.

Uh, so, so my, my, all my first research focused on omega-3s. I was kind of in the omega-3 mafia, you know, with all the research It's doing this real omega-3 research. And so, you are 100% correct. I'm surprised it's even 50%, you know, have reasonable levels. It's—

I can't remember the exact number, but—

Yeah, we have a national crisis of omega-3 deficiency. We really do. Much more important than, you know, many other vitamins that we talk about. And so, most Americans aren't getting enough omega-3s. And so, that's why when people talk about the omega-6 to omega-3 ratio, Yes, if you have a high ratio of omega-6 to omega-3, it's really bad for you, but it's because the omega-3s are low. That's right. Trying to fix the ratio by moving the omega-6 isn't going to do anything. You got to move the omega-3.

Yeah.

And so I think that's the take-home for people.

Yeah, absolutely right.

Yeah, that's the take-home. Okay, so we've covered a lot of why we got here, how we got here. We've covered calories, we've covered protein, we've covered seed oils, we've covered, uh, fat to some degree. Uh, I want to sort of end by briefly kind of talking about system change, because I wrote a book, Food Fix: How to Save Our Health, Our Economy, Our Communities, and Our Planet One Bite at a Time. And it really talked about the nexus where food touches everything that we care about almost. And it is the solution for a lot of what we care about. You have come to the same conclusion, and that's why a lot of your work as a doctor is now in policy. Like, I was sitting in my office, I'm like, I can't cure diabetes in my office. It's cured, you know, on the farm, in the grocery store, in the restaurant, in the kitchen. That's where diabetes is cured. And so you and I have come to the same conclusion. And you spend a lot of time thinking about it, a lot of time working on these policy issues, a lot of time actually doing research showing how food is medicine can be a tool, medically tailored meals and a lot of other ideas. What are the biggest levers to pull when it comes to policy change? Let's say we have 2 years left in this administration and we have the most friendly administration, aside from all the other complications and problems in the administration. We have the most friendly administration when it comes to food policy. So can you talk about what, what would be your dream changes over the next 2 years that would be implemented if you could be king for 2 years.

Well, well, we should, we should, I want to, I want to emphasize what you said about the system being broken, right? Because when you have, you know, young kids, 5 years old with, with obesity or with type 2 diabetes and insulin resistance, when you have, when you have 94% of Americans, Mark, 94% of Americans have suboptimal, of adults have suboptimal cardiometabolic health, hypertension, blood pressure, glucose, body mass, 94%, only 6% of American adults have optimal cardiometabolic health. The system is broken, right? And so, while of course you can go out and do your best and everybody should go out and do their best and try to eat as healthy as they can, when the system is broken, it's hard for everyone, especially for people who have lower income, lower education, are facing structural racism, are facing physical debility, other challenges, which is a lot of Americans. A lot of Americans are struggling. Costs, So we need to fix the system. And what's really exciting is we now have the solutions in our hand and we could actually implement them and fix this. And there's no one solution, but there's a handful. There's just a handful of things we need to do. So I go through them in the book. I tell kind of the stories of who's really on the cutting edge and really doing exciting things and what the barriers are. And so I'll just kind of go through the list of them and maybe I'll just focus on healthcare. Agriculture, right? We need to fix agriculture and it's doable. We can make farmers make profits, you know, having healthy food. We need to fix kind of our education, our dietary guidelines, our labeling, you know, kind of all the things we do for information for consumers. That's number 2. We need to fix the FDA in terms of its regulation of food safety, the additives, the chemicals, marketing, you know, with the FTC. We, we, and, and FCC, we need to fix kind of the regulation of food for things that we're supposed to regulate food safety around, around chemicals. We, we regulate food safety for infectious disease like E. coli, but we don't regulate food safety for chemical safety, right? All the chemicals in, in our food. We need to leverage healthcare and, and make sure nutrition is in healthcare. And, and, and we'll, we'll, I'll come back to that in a little sec. I want to, yeah, I want to, I'm going to hide the camera.

Yeah.

We need to leverage our federal nutrition programs. Almost $150 billion a year goes to SNAP, WIC, school meals, meals for the elderly, like meals for early childcare. So, we need to leverage that spending, which is basically going to industry to make sure it's going to healthy food. We need to leverage nutrition science and we need to have far more investment at the National Institutes of Health, which is supposed to be our country's leading organization focused on health, but is not investing in the top cause of poor health, which is nutrition, right? So we need to really have a new food shot in nutrition science. And then lastly, I would love to see a national program where the government, federal, states, local, prioritize innovators and entrepreneurs in the food system, from farmers to restaurants, to supply chain, to food manufacturers that are truly making better food, right? We've done this for railroads, for cars, for electronic chips, for energy. We've done it for all kinds of things that the government recognized were national priorities to fix. We need to do this for food. We can't let the companies that are trying to do well just fight it out with the consumer and try to— we have to reward them and encourage the industry. So that suite of things, done together would shift our food system in 10 or 20 years. And I think healthcare to me is one of the most important just because of the size of the dollars. We spend now almost $6—

$5 trillion.

It's almost $6, Mark.

It's almost $6.

Oh, damn. Last week it was $5.

It's incredible. I've been saying $5 trillion. Last year is up to $5.6, and this year's estimated to be close to $6.

Dari, I went back and saw a slideshow I did in 2000, and it said $1.6 Our healthcare spending is swallowing up everything else.

Like it's almost unfathomable how much we're spending on healthcare. People just can't wrap their mind. It's so much money you can't wrap their mind around it. The numbers that I use to make it real, for the average family of 4, we spend $50,000 a year on healthcare. So imagine how much they spend on their food, on their transportation, even on their housing. $50,000 a year for the average family of 4. 1 in $5 that goes through our pockets goes healthcare. Way bigger than all the money that's being spent on AI and data centers and all that. All the money the country's spending on AI and data centers is about 2% of GDP. 2% of our gross domestic product is being spent on AI. We're spending almost 20%, tenfold more on healthcare than everything we're spending on AI. And at the federal government, almost Almost 35% of every dollar in the federal government is being spent on healthcare, which has massively increased. And so, how do we use those dollars? And so, you know, you've worked on this, we've worked on this together, Mark. We need to get doctors educated in nutrition. That's happening. We need to have effective treatments, not prevention, but treatments that are food-based for disease. And so, if you have diabetes, sure, you could get put on a drug, you could get, you know, a surgery or a device if you need it, but you could also get a healthy food prescription. If you have kidney disease or heart failure, Or cancer, and we find that certain foods can help amplify your chemotherapy, as has been seen with certain immunotherapies and other therapies that work with the gut microbiome. You can get medically tailored meals where you're actually getting medical meals that support your disease. There's no reason that food can't be part of medical treatment for the right patients under the right conditions as a treatment. We're not talking about handouts. We're not talking about using healthcare As social welfare, we're talking about medical treatments that are medically indicated. And we have shown that giving food to people with heart failure, depression, diabetes, cardiovascular disease, not only makes them feel better, but it keeps them out of the hospital, keeps them out of the emergency room. And in some cases, you actually save money, even accounting for the cost of the food you're giving people, you save money. So I think healthcare is really exciting. And what a lot of people don't are not familiar with is that this is happening. This is happening now at scale. There's 30 states, 30 states, Mark, that are testing these kinds of Food Is Medicine interventions in Medicaid, which is the health insurance program for the poor. The VA hospital for our veterans is testing these programs. The Indian Health Service is testing these Food Is Medicine programs for tribal communities. Medicare Advantage programs are testing these programs. And so, I would estimate now there's no single number, but I'd estimate now that at least $10 billion are being spent in healthcare on food. Now imagine if healthcare's $6 trillion, $6 trillion. So imagine if 3% of that, you know, 4% of that was spent on food, right? We're talking $240 billion. Our total spend on food right now is about $2 trillion. So if we spent another $240 billion on healthy food, that's a massive, massive signal to the market. Right. To farmers, to restaurants, to grocery stores. It's a massive influx of dollars to, to change their practice and make them more profitable. So to me, healthcare is the single biggest lever and, and where I'm really focused the most.

Yeah. And I, I think the food industry is very good at obfuscating, confusing, and misdirecting us and telling us that it's complicated, it's difficult, it's hard. You know, we don't have all the answers. We need more science. And I'm just going to call BS on that. We know enough about what to eat and what not to eat to be healthy. We know enough about policies that need to change to fix the problem. And if we do that in the next 10 to 20 years, we could meaningfully impact the health of America. We could meaningfully affect our mental health crisis, our obesity crisis, our environmental crisis, our economic crisis. I mean, I know for a fact that they went to a governor who wanted to ban the dyes in food. And I think food additives and dyes are, you know, they're not the biggest problem we have, but it's a thing. And the food industry came to him and was like, you're gonna put grandma in jail for making red dye cupcakes. Do you really want to do that? And like manipulating him and making him scared of what's going to happen to his consumers, his election. And he called me and was like, what, what should I do? Like, what's going on? Like, well, here, let me tell you. And he ended up you know, doing the right thing. But it was the pressure they put on is massive. I mean, the Consumer Brands Association, I know for a fact, has created a war room to basically fight back against the policies that need to change. It's not just that they're doing things unintentionally and, you know, benignly, and then they do, oh, sorry, we didn't know. They're like, they know, and they know what they're doing, and they're very deliberate about it. And to me, you know, it's, it's, it's, it's really, it's really bad. So I think, you know, your book, Food Is Medicine: Healing Our Bodies, Nourishing Our Minds, and Transforming Our Food System is a really important book. I think everybody should get a copy. It's about what you can do for you and what we can do for us to really transform our health and our food system over the next few decades. And I hope all of our dreams come true. And honestly, when I wrote Food Fix 7 years ago, I never dreamed that we'd be in the position we're in now where there's actually things starting to happen that we— that I talked about. I thought it was just, I was putting it out there and maybe sometime after I died, maybe things would change, but we're seeing change. And I think we just, as a society, as individuals, we really need to continue to push, uh, things in the right direction for ourselves. And those choices we make individually, the choices we make at the ballot box, they all matter. So vote with your fork, vote with your vote, and, and let's change the system.

And what I'm excited about, and this is why I have a whole chapter on business innovation, Mark, is that the food sector is doing some terrible things, but it's not like tobacco where there's one product. And a handful of companies. The food sector, from farmers to restaurants to retailers, supermarkets, and food manufacturers, there's a broad set of actors, and there are many trying to do the right thing and trying to make healthier products. Farmers trying to make healthier food. There's manufacturers trying to make healthier products, supermarkets trying to highlight and sell their produce and other things. And so, we need to elevate and celebrate those stories and use policies that give them more demand and help them. And we need to do punitive and disincentive and other policies to deal with the bad actors. And so this isn't an industry we want to kill. This is an industry we want to help shift. And we did it with energy. We did it with energy. We've shifted 25% of all energy in the United States is now clean energy. Almost 50% in some European countries. And so We've done it with energy. We were able to shift away. And so ultra-processed foods is kind of the coal and gas of the body, and we need to shift towards clean food and we can do it. And so I'm really excited. I hope that people read the book and come away knowing what to eat for themselves, but also knowing what to do in their community, in their organization they work in, what to do, what to tell their elected officials, what they want to see in the world.

Well, thank you, Dari, for your work for decades to help build the scientific foundation for what we're doing now, for your advocacy, for your mentorship for me, and for your friendship. This is a great journey to be on with you. And I think I'm very hopeful for where we're going. So thanks for everything. Everybody, buy the book, Food Is Medicine. You can get it anywhere you get books. Thanks so much for being on the podcast again, Dari.

Great. It's great to see you, Mark. Thanks. Thanks for everything you do.

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