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

Coming up on this episode of the Doctor's Pharmacy.

Our policies are not in line to help or support people to eat healthy food. We have almost three in four American adults are overweight or obese. And about half of American adults have diabetes or prediabetes.

Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman and this is a special episode focused on COVID-19. I'm so lucky to have my friend and colleague, Dr. Darsh Masafari, known as Dari, who's an extraordinary doctor. He's one of the few guys out there in academic medicine who really understands that food is medicine and talks about it nonstop other than me, which is pretty awesome. He's a cardiologist. He's the Dean and John Mayer Professor of at the Tufts Friedman School of Nutrition Science and Policy. He's professor of medicine at Tufts Medical School. He's one of the top nutrition researchers in the world. And their goal at the Tufts Friedman School is to produce trusted science, future leaders, and real-world impact. It's not just an academic center, it's about focusing on policy and changing the world. And there's no one in medicine and academia who I know who's done more to advance nutrition in the policy frontier to speak out about the things that matter than Dari. And he has authored more than 400 scientific publications, which is unbelievable. I've read most of them. I've quoted most of them. Well, not really. I probably haven't read most of them, but I read a lot of them. If you read my book, he's like a key feature in the book. They're on how we focus on issues of obesity, diabetes, heart disease, and evidence-based policy approaches to really reduce this burden of chronic disease in the United States and globally. He's all over the place. He's on advisory roles in the US and Canadian governments, the American Heart Association, the World Health Organization, the United Nations, and he's been featured in the New York Times, Wall Street Journal, NPR, Time Magazine, and he was named as one of the world's most influential scientific minds. And I think Of all the people out there talking about food and health and chronic disease and food policy changes, there's no one with more depth, with more humanity, and more brilliance addressing this than Dr. Muzaffar. Welcome to the Doctor's Pharmacy.

Wow, Mark, thank you so much. With that introduction, we've set up the listeners for disappointment.

You're my hero. You're an intellectual giant and a hero, and I learned so much from you. We want to talk today about what seems to be unrelated to COVID-19, which is an infectious disease, but it's diet and chronic disease. You wrote an article with the former Secretary of Agriculture, Dan Glickman, that was posted on CNN entitled, Can Diet Flatten the Curve for COVID-19? It's sort of like, how does that even make sense? We've heard all about these ideas of flattening the curve with social distancing and hand washing and contact tracing and isolation and testing. But your article presented a very different view about how we can use food and nutrition and specific nutrients to actually help us address this pandemic. So can you tell us why you wrote this article and why this is more important now than ever to address these issues?

Yeah, I think, you know, Mark, it's really clear that to those of us following this crisis that COVID-19 has really laid bare these incredible challenges, these incredible disparities, these incredible unreasonable aspects of our food system. There's so many ways that COVID-19 influences food and nutrition and food and nutrition influence COVID-19 back. I'll just go through them quickly and we can talk about each of them. So one is immunity, the actual immune response to COVID, and then actually the blunting of the excessive inflammatory response to COVID. We can talk about nutrition and actually the immune response. Two is hunger and food insecurity, which of course caused incredible human suffering with this economic shutdown and lost wages and so Schools being closed. But also malnourishment, we know from long clinical experience, malnourishment further predisposes people to infection. So that's the second.

And that doesn't mean you're skinny and wasted away. It could be that you're nutrient deficient, which is really common in America. Absolutely, absolutely.

There's what we call hidden hunger. People look like they're getting enough food, but there's hidden hunger because they're not.

Getting the right nutrients. And what's paradoxical is the most obese are often the most nutrient deficient when you look at their numbers, right? It's just kind of interesting.

Yeah. And I think then, you know, these other aspects of COVID that are crucial to, you know, kind of just quickly mention are, you know, third, the incredible intersections of supply chains and food waste and getting food to people. We don't really have a national food system or even a global food system. We have this fractured supply chain that's now become very dire. And then I think one of the most important things for really thinking about COVID long term, because this is going to be with us for some time, many years, is the incredible relationship between poor metabolic health, diabetes, hypertension, heart disease, obesity, and poor outcomes with COVID The latest analysis from New York, which has had the most cases in the United States, showed that with each of those conditions, diabetes, hypertension, obesity, there was about two or three-fold higher risk, two to three times higher risk of hospitalization. And if you put those three things together, lots of people have diabetes, hypertension, and obesity, there would be 16-fold higher risk of hospitalization. And so it's very plausible, and we're modeling this now, it's very plausible that if we had a metabolically healthy population, COVID would be much, much less severe. And so, thinking about nutrition and the immune response, malnourishment and hunger and food insecurity, disparities, the very high rates in African Americans, very likely related to nutrition in a major way, the challenges to food systems and supply chains and food waste, and then Metabolic health, you know, these are all things that you and I and others who study food have known about that food and nutrition are a dire challenge and an incredible opportunity to improve the health of the population. But COVID-19 has really taken a knife and sliced down this curtain that was kind of hiding it and made it very obvious. And so, If five years from now we're back to just where we were a couple of years ago, and there's no improvement in our food system and the quality of the food, and the way we get it to people, and the science that we have to address these questions, I would be just devastated. I would be so disappointed that we haven't realized the opportunity here to fix the food system.

So let me get this straight. What you're saying is that if you have chronic diseases and multiple chronic diseases, that your risk of being hospitalized is 16 times higher, that if you're metabolically unhealthy, you're more likely to get sick because your immune system isn't working, and that only 12% of us are actually metabolically healthy. So that means if we actually had a healthy population that was eating a diet that created metabolic health instead of the opposite, which we're doing now, that this may just be like a bad flu and we wouldn't have full hospitals and a society that's shut down and trillions of dollars in economic losses.

All the evidence supports that. Of course, we can't do a randomized trial and wave a wand and make everybody know about the healthy to test that, but all the evidence suggests that. As you said, based on national data, only 12% of adults in this country are metabolically healthy. That's just taking things like, you know, waist circumference, blood glucose, blood pressure, cholesterol. If you just measure those things, only 12% of adults are metabolically healthy. And most of those are people in their 20s, right, who haven't yet really had a lifetime of poor diet and poor lifestyle. And so the vast, vast majority of American adults over 40 are metabolically unhealthy. And given these associations, you know, as I mentioned, even just one of these risk factors doubling or tripling the risk of hospitalization and you start piling them up together. In terms of risk of death, there's been so few deaths, especially under age 70, unless there's at least one of these other conditions. And so it's very plausible that if we had a very metabolically healthy population, instead of 12% metabolically healthy, we had 12% metabolically unhealthy. What if nine out of 10 of us were metabolically healthy? then COVID-19 would be a far far less severe disease, many many fewer hospitalizations, many fewer deaths. We wouldn't be shutting down the economy, we wouldn't have these hospitals overloaded, our healthcare providers putting themselves in danger and fatigue and working triple shifts. And what's really important here is that we can actually fix this now in real time. And so it doesn't take years and years and years to reverse diabetes or to reverse hypertension or to reverse poor metabolic health. It does take years and years to change weight for many people, but metabolic health, whatever your weight, we can pretty rapidly improve metabolic health over months, sometimes even shorter, but certainly over months. And so, the country, in addition to the things that we're doing, social distancing and testing, we should be launching a national campaign to improve the way we move and eat to improve our metabolic health.

To both protect ourselves and to protect our nation and globally to protect ourselves. I mean, this is what you're saying is pretty radical, is that yes, we may take a long time to lose all the weight we need to lose, but then within a very short order, by changing the food that goes in, putting in good stuff and taking out the bad stuff, which you've written so much about and thousands of articles, that we could quickly revert to a more normal metabolic health, reduce our inflammation, improve our immunity, We see this. I've seen this. A great example for people to understand is when someone who's very, very overweight gets a gastric bypass, within weeks their diabetes goes away. They're still very overweight, but their metabolic health changes because they're eating a very different diet. That's the key to remember, that your metabolic health can be really quickly reverted. On a macro level, we sort of painted a picture of the poor quality diet we have that's leading to obesity and poor metabolic health. which would make a massive difference if we changed. But you also were talking about what happens on the micro level, on the micronutrient level. And that's really fascinating to me. And I just shared an article with you I read this morning that was done in China, where in China it has some of the most wide disparities in selenium levels in the soil. So in some provinces there's almost no selenium. In other provinces there's abundant selenium in the soil. And so the populations, some are very deficient and some are adequately nourished with selenium. And in this one study, this was just one micronutrient. In the populations that had the highest levels, they had three times better cure rates for COVID-19 than the lowest levels. And the populations with the lowest level of selenium died five times as much as the ones with the highest levels. And that's just one nutrient. So you were talking the other day about what you're trying to do, which is develop a study to look at a collection of nutrients that together could bolster the immunity of our population. And you're trying to get this study going. So tell us about what are these nutrients, how does it work, and what are you trying to find out through looking at this study?

All great questions. So first, you know, First and foremost.

Let'S boil the ocean, right?

Yeah, that's right. I think first and foremost, I've always been a guy who believes in foods, foods, diet patterns. From all the cardiovascular literature, there's been failed nutrient supplement after failed nutrient supplement. A single supplement doesn't really make a big difference. It's really about your overall food. There are some exceptions. I think omega-3s, omega-3 fatty acids in particular, definitely been at least some studies for benefits, mixed findings. But on average, for complex chronic diseases like cardiovascular disease and cancers and some other conditions, supplements don't seem to replace foods. And so I raise that because I come at this as a skeptic. I come at this as an automatic skeptic that individual nutrients could make a difference. Yet, as soon as COVID hit, I started reading and consulting with colleagues, experts in nutrition immunology, nutrition and infectious diseases.

We have some of the world's- Wait, that's a thing, nutrition immunology.

That's a thing. Yeah, right. Absolutely, yeah. We have an incredible expert, Dr. Simeen Medani at Tufts, who's the former president of the American Society for Nutrition, the former head of all of research at Tufts, very, very much has had a career studying nutrition and immunology. And so together and recruiting other experts, we started looking at the evidence. And there is actually very compelling evidence from, you know, cell models, animal experiments, and even human studies about single nutrient supplements and infections. And specifically for COVID, there's lots of research that's suggestive that some of the very same proteins that the COVID virus uses for its own entry and replication that have been in other viruses like SARS, these nutrients have specific benefit for activity against those proteins. And so I think there's maybe eight or 10 nutrients that are potentially promising that could have an effect. And I would put those effects in sort of three camps. One camp is direct potential effects against COVID specific proteins. So there's proteins that are needed for the virus to enter the cell and then there's proteins needed for replication and reproduction. Like zinc, right? For example, yeah, zinc has, it inhibits, I'm looking at my notes here to get the terminology exactly correct, it inhibits the RNA dependent RNA polymerase, which is needed for viral replication. That's been seen with SARS, the SARS RNA polymerase, and that's a very similar polymerase to COVID-19.

And that means is the virus basically hijacks your genetic material and uses that little assembly line to produce and replicate itself, and that interrupts that assembly line.

Production is what you're saying. Exactly, and another nutrient is quercetin. Quercetin and flavanol binds to the ACE2 receptor of SARS, which, sorry, it binds to the ACE2 receptor which SARS uses to get into the cell.

And.

High-Level computer modeling has just very recently identified Quercetin as one of the top candidates for blocking COVID entry into the cells. So one camp, and I can go through those nutrients, one camp is actually direct effects against specific effects against COVID. A second camp of effects is just generally improving pathogen killing. We know again from animal experiments and even humans, if you're deficient in these nutrients, actually clinically deficient in these nutrients, zinc, selenium, some of the B vitamins, some other vitamins, the immune system doesn't function as well. And in animal experiments and even some human trials, if you give these vitamins, you improve T cell function. The T cells are crucial to fighting viruses. You improve T cell function and you boost the immune response. So just general, immune boosting response. And then the third category of effect of these, you know, about eight or 10 nutrients, which to me, I think is actually the most interesting for COVID, is some of these nutrients, you know, help fight the pathogens that are invading the lungs, but also importantly, dramatically ramp down, prevent, soften the excessive inflammatory response that really leads to death with COVID Because COVID, kills us mostly because not because the virus itself, but because there's this overwhelming excessive inflammatory response in the lungs called cytokine storm where you get way too high levels of inflammation. The body's trying too hard to fight COVID, which may explain why people with inflammatory conditions like diabetes and hypertension and obesity are at higher risk for hospitalization and death because they're more likely to get this cytokine storm. And many of these nutrients have really clear experimental benefits against reducing cytokine storm. Zinc in particular, quercetin, EGCG, which is from green tea, EGCG for example, in multiple diverse models of lung injury, if you injure the lungs in many different ways, including viral infection, in animal models, it blunts that excessive response and animals heal better and live longer. So if you put all these nutrients together, I can't tell you for sure that they would have efficacy against COVID. We don't know. But compared to some other things that have been tested, there's at least as much evidence to test these. Compared to, let's say, chloroquine or hydroxychloroquine.

And a lot less side effects.

And a lot less side effects. These are very, very safe. And so we're really interested in doing a rigorous randomized trial to test these. And one of my frustrations, what really keeps me up at night right now, is research takes time. It takes time to put together the protocol, get the human subjects approval, and get funding. And so we're going to go to major you know, federal and foundation funders and try to get this trial started as soon as possible. But we could complete this trial in a few months if we have sufficient funding. And I can tell you more, we can talk more about some of the specific nutrients. Yeah, well it's fascinating.

It's so fascinating because what you're saying is so based on science, it's so out of the purview of what we normally think about. And people go, where's the evidence? But it's like, it's there, it's not something you normally pay attention to. It's sort of in the side mirror. If you think about just this one selenium study, if there was a drug that could reduce mortality five-fold, it would be headline news, right? So this is just one drug. And when you use them synergistically, they work synergistically with multiple different mechanisms. So I guess I know what I'm having for dinner. I'm having a couple of Brazil nuts. Don't have more than two or three because they can get too much selenium. I'm going to have chicken liver for the vitamin A. I'm going to have oysters and pumpkin seeds for the zinc. I'm going to have quercetin containing onions and spinach. I'm going to have porcini mushrooms and herring for the vitamin D. I'm going to top it off with some green tea at the end. I think it's going to help me with my immune system.

Well, that's a pretty tough menu for most people to get together.

I know it all tastes okay together.

So I think in terms of specific nutrients, we looked at several.

Oh yeah, I forgot. I'm going to make a curry because of the turmeric that you mentioned.

Yes, turmeric. So some of the promising nutrients that we think are less specific to COVID, But interesting, but not at the top of our list. R, vitamin C, vitamin D, turmeric, selenium, and the B vitamins are all nutrients which could have some efficacy and benefits for the immune system. They don't have the specific evidence for pathways specific to COVID-19. The selenium study you just mentioned is kind of one of the first. So they're interesting, vitamin A also. They're all interesting. I think the ones that we have put together that we think are the top candidates are zinc, quercetin, vitamin E, and EGCG. And we actually think it's the combination putting the four together that would have benefit. I'm really testing the combination because they all have subtle, mild, small effects. These aren't drugs.

This isn't a cure. I'm sure you're getting a lot of big pharma wanting to fund these studies, right? Yeah, exactly. There's no profit.

In it. testing these, right? But if we test the combination, we think that together they'll work synergistically and in a complementary way. And again, they're so safe to test. Yeah.

So what you're saying is this is not something you use in an ICU, but this is in the general population could help us be more resilient in the face of COVID-19.

Well, we think the best population would be people who are just diagnosed, right? You know, this could work for prevention. this could work in the sickest, sickest patients in the ICU, but that seems less likely. So I think based on mechanisms, you know, when you're first diagnosed these nutrients could help reduce the progression, reduce the severity, reduce the days of illness, prevent you from getting to the hospital. If you're in the hospital already, prevent you from needing a mechanical ventilator. So that's the population we're going to target. You know, and I want to emphasize that I'm not recommending people go out and start taking these things. because we don't know yet if they have activity against COVID.

But you can eat my immune-boosting dinner of chicken livers and herring, right? Eat healthy food. Eat healthy food. There's no problem with that. Because I've been talking about this. There's a lot of these nutrients that are in food, and if you eat them regularly, you're going to up your levels of these nutrients. And it's not that hard. I mean, vitamin D is a little hard. You have to eat a lot of herring and a lot of porcini mushrooms. or you have to go in the sun half naked for 20 minutes between 10 and 2 south of Atlanta or take a supplement. But for most of these, you actually can get them from your food. And I think food first is always the strategy. And that's really why now for two reasons, it seems like you're saying, one, you want to improve your diet because you want to improve your metabolic health in terms of insulin resistance and the inflammation that goes along with being overweight and chronic diseases. But you also want to up level your nutrient density, the micronutrients in your food by choosing smartly the foods that contain these nutrients. So you kind of have a double strategy for addressing your metabolic and your nutritional health to make yourself more strong in terms of preventing and maybe even recovering from COVID-19. And you're also going to be helping society at large by taking care of yourself, by reducing the burden on our hospitals and healthcare systems and helping us be able to open up the economy. That's maybe why some of these European populations are not struggling. I mean, look at Sweden. I mean, they're generally a much healthier population. They're one of the healthiest populations in the world, and they have an open society, but they're not seeing the same rates as we are. And I'm wondering if maybe that's partly.

Because of their general health. What do you think? Well, we know for sure, again, from clear evidence in the United States, that if you don't have these conditions, you have far, far lower risk of hospitalization and death. And so I actually think that, you know, probably the regions of the world where per infected person we're gonna see the fewest deaths are going to be the, you know, rural low income regions of the world. And so there's our doorbell live, live, live podcasting.

Oh, the beauty of working at home. Yeah, I have my cat walk through the scene.

I'm sure my children will run by. But I think that it's very plausible that in rural Sub-Saharan Africa, rural Asia, rural regions where there's a lot of poverty, there's going to be huge rates of infection, I mean, very rapid rates of infection. But the percentage of people that are going to be hospitalized and dead among the infected, I think, is going to be quite low. And this is why, getting to your point about why food is so important for this double benefit, This is why we need a policy fix. This is why, as you cover in your book, our policies are not in line to help or support people to eat healthy food. We have almost three in four American adults who are overweight or obese, and about half of American adults have diabetes or prediabetes. When you start, saying that the healthy population is the small minority of the population, right? That's not okay, right? It should be that people with disease are the minority and we generally have a healthy population. We've completely flipped that on its head and we have a tiny, tiny proportion of the population that's actually healthy and everybody else has disease. And most of that disease, not all of it, most of that disease is strongly diet related.

Yeah. So we wrote in your CNN article that before COVID-19 that poor diet kills 530,000 Americans every year, about 1,500 deaths every day. That was before COVID-19.

Yeah, so COVID-19 is tragic and these 50,000 deaths already in the United States are tragic and we need to be doing everything we can to reduce this. And at the same time, before COVID-19, around 40,000 Americans were dying every month directly from diet-related diseases that we've estimated that would not have happened if they had a healthy diet. And so, and we weren't, you know, going up in arms and saying, this is, we have to stop this. This is causing, you know, catastrophe. But it was, it was, it's causing, you know, billions of dollars, tens of billions of dollars in preventable healthcare costs, which burdens our American businesses, which burdens our federal governments and state government budgets. It's causing incredible disparities, big differences between the haves and the have-nots in our society. And it's causing a lot of suffering and it's overwhelming our healthcare system. So here's where I think, I'm moving beyond today to think about the rest of 2020, 2021, the next administration. We really need to take this learning from COVID that we do not have a healthy population and that when you don't have a healthy population and a crisis strikes, it shuts down the economy and people suffer and businesses suffer. We need to take that knowledge and fix the food system. And there's some concrete things we can do.

So we in medicine have a phrase that's called acute on chronic. Someone's a smoker, has emphysema, they get pneumonia, they're not going to do so great. If you're a healthy young guy and you get a little pneumonia, it's called a walking pneumonia, it's like having a bad cold. That's exactly what's happening now. COVID is the acute on the chronic disease, obesity pandemic we have. It may seem like, why are we talking about chronic disease? We have a big infectious pandemic. Let's just focus on that. But now you're saying it's a more important time than ever to address this. And before, it's interesting, ironic, you created a report on the 50th anniversary of the White House Conference on Food, Health and Nutrition that you published with your team from Tufts and colleagues at Harvard, which laid out early in March, right before this all took off, was like perfect timing. A series of strategies to really address this chronic disease pandemic, the underlying failures in our food policies and the food system. And it was really brilliantly done and addressed a lot of things we talked about in my book, including things like leveraging the power of the USDA programs to improve nutrition, utilizing economic incentives to get people to eat healthier food and disincentivize not so great food. protecting our children from avaricious marketing and advertising. I would think if we were a foreign nation, we're doing to our kids what we're doing to it, we'd go to war to protect them, but we just let it happen. And then you sort of even focus on health care and health professionals. How do we get health care to focus on food as medicine? How do we train our doctors and health care providers to understand nutrition and incentivize better nutrition knowledge and treatment of chronic disease, and then how do we address agriculture and sustainability? And these are all intersecting ideas. Not any one of them is going to fix the problem. And you sort of identified 11 different key sectors that have to be addressed within these five things. So can you talk about given now, let's say you were hired by the next president to be the food czar, what are going to be your key strategies so that we one, improve the overall health of our population and we make ourselves more prepared for the next pandemic from an infection. And how do we address the health disparities, the economic challenges, the climate environmental challenges, all these intersecting issues which often are siloed. And you're a big systems thinker and often people are in silos within Congress or within medicine or academia, but somehow you've got to go, wait a minute, let me go 30,000 feet and see how are all these things connected? And how do we solve all of them by working on them in a coherent way?

Well, the inspiration for that report was that in 1969, there was a White House conference on food, nutrition, and health that was focused on the big problem of the day, which was true calorie malnutrition, true hunger. I mean, there were populations in the United States where you would see kids with the tiny arms and the distended bellies that you now see. sort of the famine stricken nations elsewhere. There was true lack of food in many places in this country. And it was dire. And so Jean Mayer, who went on to become president of Tufts and found our school, and I hold the Jean Mayer professorship, I'm quite humbled to do that. Jean Mayer worked with President Nixon, a Republican, to organize this conference. They brought together all the stakeholders and they put together about 1600 recommendations to fix the food system thinking about pure hunger.

Only 1600?

Yeah. I say that because there wasn't one fixed, right? But they looked two years later, 1400 of them had been implemented. And so that conference dramatically changed in a positive way the way we approach hunger in this country. So it led to expansion and standardization of school lunch. expansion and standardization of the food stamps program. It led to WIC. There was no program for mothers with infants. It led to the creation of WIC, which is the program that one in two babies in our country are born on WIC, which is this federal program that gives healthy food to moms with babies. It led to nutrition facts labeling. It led to other consumer protections at FDA. It was quite instrumental in changing our food policy and essentially eliminating caloric hunger. We have another kind of hunger now, people don't have healthy food, but it eliminated that sort of severe caloric malnutrition that the country had. And so, 50 years later, we said that was the last time there was a high level federal attention on our food system. We have new problems, right? We have diabetes, obesity, hypertension, incredible disparities, diet-related cancers, all the new things we're learning about diet and brain health, food allergies, autoimmunity, inflammatory diseases, gut health. We are facing a very, very different food crisis now than 50 years ago. The military, you know, more than half of young Americans can't enroll in the military because they don't qualify. And the number one medical reason is overweight or obesity. And so a large group of retired admirals and generals, mission readiness, more than 750 Retired admirals and generals have said that childhood obesity is a national security crisis. We're not going to have the military. So this was the legislation behind that.

Just to piggyback on that, and then I want to continue, is in that report, the most striking statistic I saw was that the evacuations from Afghanistan and Iraq, there were 72% more evacuations related to obesity-related problems than for war injuries, which was just mind blowing to me. This is not even the people are trying to get in, these are people already in the military who are struggling with overweight and obesity and poor health.

Well, I'm gonna divert away from the report and come back, but a colleague of mine at Harvard studies occupational health was very interested in first responders, in helping policemen and firemen and improving their health and understanding what was causing their risks, which again in this era is more important than ever. And so he started studying what was killing police and firefighters on the job, on the job deaths. And to his great surprise, the number one cause of their on the job deaths were heart attacks and other challenges, not getting shot or getting killed in the fire. And then when he started looking at, well, what's so different about firemen and policemen? He found that they had higher rates of heart attack their age than the average American adult. And the number one difference, number one risk factor was actually their diet. Just horrible diets because of working shifts, working in their cars, working overnight, you know, the sort of the proverb, you know, the donuts, you know, the top car pulling up the donuts, right? And so he sort of shifted his focus to seeing how he could improve the nutrition of police and firefighters. So, you know, it is this quiet and overwhelming disaster that, you know, our fighting forces or policemen or firefighters or children are all getting killed, mowed down by metabolic diseases and where we sort of shrug because it's happened over decades and humans are evolved were evolved biologically to respond to acute risk. This is gonna kill me today. We're not biologically evolved to understand in the same way risk that might kill us over months to years. Because back in the day when we were out on the savanna, we cared about that saber-toothed tiger right in front of us, not something that was gonna happen a year later. And so something like COVID, a true crisis, that we think, oh my god, I could die, changes everything. And yet diabetes, obesity, hypertension, cancers, autoimmune disease, allergies, chronic kidney disease, all these things that are diet related that are still killing our population in incredible numbers, we're sort of assuming is normal. So I think, to go back to the report, I think there are three big picture principles that I'd like to highlight that I think our report highlights. One, is that there are concrete solutions. There are very real, very concrete solutions that we can fix this. Two, you know, many of these are win-win. So this is not like tobacco, where we're just trying to get rid of an entire industry. We want to help the food industry from farmers to manufacturers to restaurants to producers to retailers. We want to help them get healthier, more sustainable, more affordable food to people. So they, it can be, it can be win-win. And three, this can happen quickly. This is not a 50-year plan. We could change things within a few years if we implemented the right policies. And as you said, there's about, there's no single magic bullet.

It's a combination of things. One of the slow-hanging fruit. I mean, we had a great conversation the other day talking about the dietary guidelines for America. And the dietary guidelines are interesting because they're designed for a healthy population. and you just said that only 12% of us are healthy, so it doesn't apply to most of us.

Yeah, it is amazing. The dietary guidelines are an incredibly positive process. I'm not somebody to bash the dietary guidelines. They're one of the great things the government does, which is get scientists together, review the guidelines carefully, put out guidelines every five years. There are problems in the process. One of the biggest problems is that the scientific report that the scientists write then goes to the federal government and they change it, you know, without us exactly knowing how to put out the guidelines. And usually it's 90% similar, but some big things are changed probably because of industry influence. So there are problems. But the other problem that you mentioned, or really the lost opportunity, is that the dietary guidelines by definition, by law, I think, are for the generally healthy population. And so they specifically say these dietary guidelines are not to treat any disease or to help give anybody specific dietary guidance. If you have any specific disease, you should see your doctor. But, you know, that means that 90% of Americans, the dietary guidelines don't apply to them because they have diet-related diseases, right? So that's a challenge. But so the low-hanging fruit, well, I think that, you know, there are several. It's not one. I think one is to engage and leverage the power, expertise, and finances of the healthcare system for food and nutrition. So the number one cause of poor health in our country, poor nutrition, is ignored by the healthcare system. And so we have to take this massive system that we've created. You and I are both doctors. Our healthcare system has a lot of wonderful things about it. We have to take this massive system that we've created and use its resources and power to help improve food and nutrition. So food is medicine. And things like healthy produce prescription programs where you go to the doctor if you're food insecure and have diabetes or hypertension or one of these other conditions and you get a prescription to pay for some or all of healthy food as one example. That's a clear low hanging fruit to get food is medicine into healthcare. Another one I think is to better use, better leverage the investment of SNAP. the program formerly known as food stamps. About one in seven Americans were on SNAP before COVID hit and, you know, it's gonna go up for sure.

Is it one in four kids?

And I don't know the exact statistic, Mark, but there are more kids than adults on SNAP. So maybe one in four kids. Yeah, there's a large number of children on SNAP. There's a large number of elderly on SNAP. There's a large number of military, active duty military on SNAP. There's people in the military whose families are on SNAP because they don't have enough money for food. And so it's not just for, you know, it's not just a handout. This is for families, elderly, veterans, active duty military who really need a helping hand with finding food. SNAP is a wonderful program, a powerful program to get money to people who need money to buy food. And that's crucial and we need to strengthen it. There's a lot of people who say it costs too much. It's $70 billion a year. It costs too much. We've got to cut its funding. What I say is instead of cutting its funding, let's use it to lower healthcare costs and then it'll pay for itself. And so we could use it to lower healthcare costs by incentivizing and disincentivizing certain kinds of foods so that people still have choice. They can still choose what they want to eat. but we're actually leveraging SNAP to make people healthier.

It's kind of like double bucks for the farmers market. You get double your money if you use food stamps at your farmers market.

Yeah, we did a national simulation model in a very rigorous modeling science to say what would happen if you did something which we called SNAP+. SNAP+ would be if you bought fruits, vegetables, nuts, whole grains, fish or other seafood, healthy plant oils, beans, a whole range of produce, you'd get 30 cents more on your dollar. You'd get $1.30 per dollar SNAP benefit. And at the same time, to help pay for that and also disincentivize unhealthy foods, if you bought soda or other sugar-sweetened beverages or junk food or highly processed, cured meats, you get 30 cents less on your dollar, you get 70 cents on the dollar. And you know that. You know up front you have a choice of what you want to get and you can get a little more or a little less on your dollar. That SNAP+ program would immediately be cost savings. It actually wouldn't add anything to the SNAP budget. Like billions of dollars, right? And it would save tens of billions of dollars in health care costs that the government and others are paying. So it's just kind of a natural thing to test.

It almost would offset the cost of SNAP, right? Is what you're saying? It's like a almost be- It wouldn't.

Fully offset the cost, but it would, you know, because still, you know, at the end of the day, we're giving food to everybody, including children. And so, you know, it would take a long time to see returns on health care investment for children. But it would save tens and tens of billions of dollars in health care spending without increasing the cost of SNAP. at all. And so it would certainly lead to lower government spending. So I think those are two clear things that could be done. I think two other things I'll just mention, one is to really help spur and catalyze the ongoing revolution in innovation and entrepreneurship. So businesses everywhere from farm to retail to personalized medicine to packaged foods are rapidly trying to innovate because customers are demanding different food. They want food that they think is going to make them healthier, that's sustainably sourced, that's good for the environment, that comes from sustainable labor or fair labor practices. And so companies are scrambling to figure this out to how do we get healthier, affordable food to people. And right now, it's just the market, is determining what works and what doesn't. And so that means that companies that are really trying to innovate and do the right thing, if their product costs a little more because they're making it healthier, if it doesn't taste quite as good because they've made it healthier, they're at a disadvantage. And that's insane, right? Those companies should be at an advantage. And so I think we need a national program to spur innovation in business to help reward through tax policy and other policies help reward those companies that are trying to do the right thing. And then I guess I would give two more things. Those are three items. A fourth item I think is to really expand federal nutrition research. You know, as a percentage of overall research, federal nutrition research has been pretty flat for 40 years, and while diet-related illness has skyrocketed. And so, you know, we should be really prioritizing at the National Institutes of Health, at USDA, at the Department of Defense, at the VA, at the FDA, all these places at NASA, all these places that actually already do nutrition research, we should be really prioritizing and amplifying and coordinating that research.

We need to do the right kind of research.

Yeah, we need strong. Wouldn't it have been great if over the last 10 years we had had multiple well-funded studies on nutrients in the immune system? And so when COVID hit, we had already stockpiled that armamentarium of evidence. And so as soon as COVID hit, we could leverage that stockpile, release that stockpile, and on COVID and and not have this crisis, right? So we really need to much better understand food in the microbiome and links to health, personalization, all the phenolics and flavanols that are in foods, many, many research questions, supply chains, disparities. So I think that fourth thing is we really need a major new investment in federal nutrition.

Well, you talk about the National Institute of Nutrition. Right?

Yeah, that's one option. We've been reviewing the options funded by the Rockefeller Foundation and we've come up with several options and we're going to release that report this summer. One of the options could be a new institute at the National Institutes of Health. There's 27 institutes and centers at the National Institutes of Health.

And actually, it's the wrong name. It should be called the National Institutes of Diseases. because there's no health in there. This would be the first one that focuses on health.

Most of them are disease focused. There's one on heart disease, one on cancer. There are some, I mean, there's an Institute on Complementary Medicine. It's fairly small, but there are some that are more focused on nutrition. But there's no National Institute of Nutrition.

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

That was last year and in this year's plan that was released, actually nutrition is mentioned, which is an advance mostly around precision nutrition, understanding kind of individual personalized nutrition, which is great. So that's in advance. So we want to congratulate.

Good, good. I didn't know about that.

Yeah, but they need more funding. We don't want to take away from the existing institutes. We don't want to say, okay, we're going to create a new National Institute of Nutrition and take away some funding somewhere else. We want it to be additive, right? Congress has to realize this is a.

National priority and take this on. It just seems so obvious, Darry, because If food is the biggest driver of disease in America, how do we have no institute or organization with the government focused on studying that? It's like a what?

Well, Mark, you hit the nail on the head. Let's step back. Our healthcare system doesn't address the leading cause of poor health. The National Institutes of Health doesn't have an institute focused on the leading cause of poor health. and the number one cause of death and disability in this country is diet related diseases and preventable healthcare spending and why active duty military recruits, sorry, why otherwise qualified military recruits can't get into the armed forces. I mean, on and on and on, the number one cause of death for first responders is diet related illness.

Well, you know, it all makes sense. The front of my book, the opening quote is from Wendell Berry says, We have a food industry that pays no attention to health and a healthcare industry that pays no attention to food. I think that's how it sums it up.

Well, what's exciting is I'm an optimist by nature after all the doom and gloom. I'm an optimist, Mark, and I think your book really lays out some of these options really well. That the healthcare industry is now starting to pay attention to food.

Yes. Yes.

Is, you know, waking up to this. And the food industry is starting to pay attention to nutrition and saying, so these worlds are starting to converge, but it's happening too slowly. I don't want to wait 50 years to fix this, right?

I'll be 110.

Yeah, yeah. Health care is getting it. Groups like Kaiser Permanente, John Hancock Insurance, others are starting to incentivize and care about healthy eating. And food companies are starting to try to create more nutritious products. And so, you know, government has to take on this crazy complicated system and help spur it and catalyze it and leverage it and nurture it, you know, faster. Which brings me to the fifth, you know, kind of low-hanging fruit, you know, that I think we could do in the next administration would be to create a national organizing, you know, office to organize all of these federal food and nutrition policies and programs. After September 11th, there was, you know, which was a devastating crisis to our country, there was recognition that all of the national intelligence agencies did amazing work separately, but that it wasn't coordinated. And so, you know, the FBI and the CIA and all these other groups weren't talking to each each other. And that was limiting our ability to respond quickly and effectively to intelligence and crises. So the Office of the Director of National Intelligence was created, the ODNI, which is a cabinet-level office, reports to the Office of the President, and coordinates all of our national intelligence and brings that coordinated single message and information to the President, to Congress, to the heads of agencies, and creates coordinated actions. With the unbelievable fragmentation of our food system and our nutrition response that COVID has really laid bare, it's time, I think, for a similar office around food and nutrition policy. We would call it the Office of the National Director of Food and Nutrition, the ONDFN, very similar to the ODNI, would be a cabinet level position that for the first time ever, would say we're spending well over $100 billion a year in the federal government on food and nutrition issues, let's coordinate it. Let's bring it together so that- well.

I mean, more than that if you count in the healthcare costs, like, you know, I mean, 80% of the trillion dollar, 1.2 trillion dollar- Way more than that.

Medicare. We're talking about trillions of dollars. The federal government alone, federal government with the states, because the states pay for it for Medicaid, but the government alone, pays $160 billion a year for direct medical care for type 2 diabetes alone. So just type 2 diabetes, which is a mostly preventable condition if you can eat well and treatable condition, is $160 billion a year. So absolutely. So well over $500 billion a year if you count the healthcare spending. We should coordinate it so that, you know, what's going on in the centers for Medicare and Medicaid services and what's going on in school lunch and what's going on in SNAP and what's going on in WIC and what's going on in food labeling what's going on in health claims, and what's going on in the Department of Defense research around performance and recovery from injury, and what's going on in the VA around our military veterans. All this work, all this programming, which is disjointed and disconnected, all the USDA, incredible USDA agricultural research and policy to help stimulate farmers and rural development, right? USDA has massive programs to develop rural development. The USDA, actually, the Farm Bill is the biggest single supporter of conservation. People criticize the Farm Bill, but it's the single biggest conservation program we have to help coordinate all of that. And so I think a new national coordinating office is actually not pie in the sky. It's actually really an idea whose time has come.

Well, I hope you're talking that into the ear of the candidates because this is the moment to make that happen. and drawing the connections, helping people see the intersection of chronic disease, the pandemic we have, our environmental crises, climate change, national security, academic performance, on and on, social inequities, health disparities. I mean, these are not separate issues. And what's amazing to me, Dari, is these are not hard problems to solve. It's not rocket science. It's not going to come up for the cure for Alzheimer's. or something really hard, this is something we know about. You've been writing about for decades, your colleagues and everybody at Tufts and Harvard have been shouting from the rooftops. The problem is nobody's really been listening. And I think now it's time for them to really listen. And it seems like there's a real openness to listen. This is that moment in history where there's a crack in the door and I think we can walk through and tell a different story and actually help transform our our national food policies and agricultural policies across all these sectors you talked about. And I encourage you all to check out this report. I mean, it's fantastic. You can just Google it, the report of the 50th anniversary of the White House Conference on Food, Nutrition and Health that was put out in March as this pandemic started. And it really lays out kind of unwittingly the solution for what we have right now. And if it literally was implemented tomorrow, I think we'd all be be better off.

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

Yeah.

You briefly mentioned kids learning in school, you know, productivity of the workforce, incredible disparities and injustice across different segments of the population. So much of this is related to our food and nutrition system and we have to stop trying to put our fingers in the dike one at a time and try to fix these things one at a time and say, we have a systems problem. And it's not rocket science. It's not brain surgery. It's pretty basic stuff that we can do. And it's win-win. It's win-win for industry. It's win-win for farmers. It's win-win for pretty much everybody. So I think it's the time has come and let's walk through that door.

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

I think it depends on the approach, right? If the approach is only punitive, if the approach is, which some countries are doing, like Chile, Mexico, some of these new food system programs, they say, look, we think there's too much salt and sugar and saturated fat in the food supply, and so we're going to penalize companies through warning labels or other things if they have those, and we're going to restrict marketing, and that's it. If that's the only approach, food industry is going to be kind of annoyed. They're going to say, you know, all you're doing is, you know, hitting us for the negatives in our products. What if we have a fermented product? What if we add fruits in a product? What if we increase whole grains? You know, what if we, you know, try to have more healthy oils? You're not giving us any credit for that. So, so I think that if you take a punitive approach, there's going to be some big time opposition from publicly traded companies that have stockholders, shareholders, excuse me, that they're, you know, beholden to and financial responsibilities. I think if you take a win-win approach that, look, we're gonna use sticks and carrots. We're gonna help companies that are doing the right thing. We're gonna help you shift your portfolio. We're gonna reward farms that are doing the right thing. Of course, there's some products that are gonna be losers, right? So some single products may not be around that much longer or they might not be sold that much. or they may cost more. But, you know, food companies are diverse and they can sell lots of things. Restaurants are diverse and can sell lots of things. Farmers can, over time, grow lots of things. So we don't have a monolithic system with one product like tobacco that we have to get rid of. So I think that the real opposition is going to be fear of loss, right? So nobody wants to lose what they have now. So whether it's fear of loss in research that, you know, existing research agencies say, well, a new research agency focused on nutrition, I don't want to lose what I'm doing now. A food company says, look, I don't want to lose 20% of my portfolio. A farmer says, I don't want to lose what I have. It's fear of loss, right?

Yeah.

So there's no, I don't think there's anybody entrenched with a line in the sand that I'm going to grow, you know, you know, corn and I want that corn to go to corn syrup in soda and that's it no matter what. I don't care what you say to me, that's what I want to do. I don't think there's many people that are going to say that. I think that people say, look, oh yeah, if I can grow corn and that corn can go and make whole grain, whole corn meal that can be healthy and paired with vegetables and be part of a healthy meal. And I get actually a little bit more because my crop tastes better and is nutritionally sound and is grown on regenerative agriculture and I can get a little more profit because customers will pay for that because it lowers health care spending. It can be win-win.

I think the report is really brilliant because it threads the needle on that really tough question of how do you bring everybody along on the team, even the reluctant ones. I think that's the brilliance of this report. It's not blow up the world and start again. It's like how do we make some smart choices in the policies so that we can get alignment on every side of the aisle, on all sides of business, on consumers. Look, I don't think there's anybody in any business, in any seat of government, or any one of our citizens who wakes up and says, you, know what? I want to create a system that makes people sick and fat and kids not be able to learn and people depressed and make our national security worse. and causes destruction of our agriculture environment. There's nobody that says that or wants that as a human being. And so I believe we appeal to human beings who are behind these companies and behind these policies that most of them will be able to be brought along. There'll be a few, but most of them will be able to be brought along. And I think it's-- we've been in Washington, and I think you've been a lot in Washington, probably more than I have. And what's really striking is that there's a really general lack of education awareness about these issues. The level of being informed of policymakers is so low on this. They're hearing a lot of information from the food industry and from big lobbyists, but there's not a lot of lobbyists for the good guys. We run down to Washington and we pay our own way, we run around. It's like, but it's far and few between.

Well, you know, these are complicated issues, right? It's a complicated system, you know, living in Boston now almost 20 years, I'll say it's wicked complicated with a really bad Boston accent. Wicked. It's wicked complicated, right? We have a wicked complicated system, right? And so, you know, you asked me what's the low hanging fruit? I couldn't give you a 10 seconds sound bite answer, right? There are complicated issues here. So getting that complicated message to the public, to policymakers, when they're so busy, they're so overwhelmed, they have so much they're doing, you know, they're thinking about every possible issue under the sun, and getting people to see these interlinkages and these solutions is challenging. And so I think that, you know, communication is a huge, huge part of this. It's not the solution, right? talking about it doesn't fix things. But communication through what we're doing through other avenues is crucial. And there has been historically no funding for that, right? Nobody's paying public health experts and physicians and scientists to communicate. People pay us to teach and to do research. And people pay clinicians to see patients, scientists to do research. Nobody pays us to actually go out and spend our time, you know, to do this work. And I don't mean we need to get paid extra. I just mean the staff and structures to do that communication, which costs money, don't exist. And so I actually think that, you know, an effort building around the themes in our White House report, building around the themes in your book, I think an effort to bring some, you know, interested people together to create a coalition of people and some funding to bring this message out and to tell people there are actually solutions that will help us right now. Yeah, I think would be really wonderful.

Well, we're on the way. You and I are collaborating on what's called the Food Fix Campaign, which is a nonprofit and an advocacy group exactly designed to do this, bringing together a coalition of all the stakeholders across all sectors involved in the food system and science and healthcare and agriculture. to really have a coordinated strategy and bring these ideas into the 2000 key people in Washington who make the decisions at the White House and Congress and agencies that can make a difference. I think this has really never happened before. I'm super excited about it. If anybody listening is excited about this, if anybody wants to get behind it, whether you have money or you have relationships that can make a difference or connections or just ideas, we'd love to hear from you. I'm so excited that this is going to be, even though this is a horrific time, this is going to be a little window of opportunity for us to actually make a big difference. So I just applaud what you've done, what you're doing. You're my hero in all this, and I vote for you for the head of that office in the cabinet that's going to be in charge of food, whether you want the job or not. I think I'm.

Quite happy at the Friedman School of Nutrition Science and Policy. Thanks for the vote, Mark. Of course.

Well, thank you so much for being on the Doctor's Pharmacy. I really appreciate your time. I know you're busy. And if you've been listening to this podcast and you love what you heard, please leave a comment. We'd love to hear from you. Share with your friends and family on social media. Subscribe wherever you get your podcast, and we'll see you next time. I'm the Doctor's Pharmacy. Hey, everybody, it's Dr. Hyman. Thanks for tuning in to the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks, it's my weekly newsletter, and in it I share my favorite stuff, from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health, and I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays, nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter, and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger, longer. Now back to this week's episode. Hi everyone.

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