Health at Its Origins: Food, Lifestyle, and Planetary Well-Being with David and Catherine Katz

Welcome to the Reverse Mullet Healthcare Podcast from BP2 Health . We are in Orlando , Florida , live at the ACLM Conference 2024 . I'm your host , Dave Pavlik . And I'm Ellen Brown and we are at the American College of Lifestyle Medicine Conference , their 20th anniversary celebration , which is rather significant to this conversation because we have legend in our midst and I think you were supposed to come last night for the hot ones , right yes ?

Oh , going to be part of the ? Uh , it wasn't Tom Fullery , it's um , thank you . I was like one of those words oh , I'm still willing to do the shenanigans , but they just got it . Okay , we got to fit it into a schedule , so anyway .

So please , without further ado , tell us your background , tell us like and again , we've got a lot of folks that listen , that are not familiar with lifestyle medicine , and that's part of our passion and mission is we're trying to affect real change in health care , and so we think it's really important that folks understand lifestyle medicine and the tools and the power of it . And so that's why we came to really boost that as much as we can , because we think the message is super important .

And we think the message is super important and we think it could . It's a tool me it's one of the few tools that we have left to pull from . That could really change the game yeah , for sure . Well , thank you , then , for doing what you do , and and let's recognize that the planet is in peril and lifestyle medicine is absolutely the only room in the house of medicine that has anything to offer there .

The shifts in personal behavior that are best for human health outcomes , in particular dietary change toward a plant-predominant diet , redound to the benefit of the planet as well , and that's arguably the signature issue of our time . So , in answer to your question . I'll tell you many long stories all distilled down into a very small tidbit . I trained in internal medicine .

I felt like I was learning how to be one of the king's horses , one of the king's men . We'd basically just wait for people to topple off the wall and send in an ambulance . I thought we could do better than that . Let's try to keep the next birth cohort from falling off the wall quite so often .

So I did a second residency in preventive medicine , public health , lifestyle medicine didn't exist at the time and I was a newly minted preventive medicine specialist . When a paper came out in the Journal of the American Medical Association in 1993 , actual causes of death in the United States , which I think very presciently looked past what's listed on death certificates and asked the trenchant question yeah , but what caused that ? So atherosclerosis isn't really the cause of the heart attack , that's the cause of heart failure , that's the cause of death .

What you really want to know is what caused the atherosclerosis ? So their answers were a list of 10 factors which collectively explained almost all the premature deaths in this country every year , and the first three all by themselves accounted for 80% of the variance in premature death and chronic disease , and they were in order at the time tobacco , poor diet , lack of physical activity , bad use of feet , forks and fingers . These 30 years later , because we're smoking less , diet hasn't improved much .

Diet is number one . Diet quality , measured objectively , is the single leading predictor variable for all-cause mortality in the United States . So what lifestyle medicine does is say we ought to be addressing the root causes of premature death and chronic disease . We shouldn't just wait for Humpty to fall off the wall and then try to unscramble an egg .

We should be trying to build vitality at its origins . When people have chronic disease , the first line of defense should be improving their diet , their sleep , their stress , their physical activity . We should be addressing the things that are causing the disease . And yes , of course we can also use pharmacotherapy and surgery as needed .

But let's rely on lifestyle and let's use lifestyle not just after the fact . Let's do everything we can to propagate access to the healthy choice and help build vitality at its origins . And there's much more we could talk about , but essentially that's been my career long crusade from a time before lifestyle medicine existed . And then , when it came into existence , the people who were part of that movement found me , said you really belong in our tent and the rest is history .

I recruited you . So I think it's so critical because I am very much on this platform of affecting real change and I started on the journey I mean , I've been on the journey for many decades but really got determined about it about a year and a half ago and I think it's that idea of like legacy and you get to a certain point in your career and you're like what am I really doing here ? You know , like , am I really ? I thought I was doing purpose , but now I feel like maybe I'm watching paint dry and I started thinking we needed to fix the existing system .

And now I have really come to the determination that we need sick care . Unfortunately , that's all we've created is to keep people alive and to treat people when they're acutely ill . When they fall off the wall . Correct and what we don't have is healthcare and we need a parallel system .

Right , we still need acute care and there's a lot we can do to that too , right , but it's the whole idea that , as we get caught up in arguing about prevention and that's an economic conversation , in my opinion that we talk about like who finances that , and like that's why it falls kind of on deaf ears . Yep , but with 80 to 90% of our population population not metabolically well , we're talking about reversing a lifestyle disease syndrome that's cost us $2 trillion . And , by the way , which cost us dearly during the COVID pandemic .

Absolutely 60% of the toll of the pandemic in the United States was attributable to the prior neglected pandemic . Absolutely , had we come into the pandemic healthy , 60 fewer hospitalizations , 60 percent less which is right . I mean it's , I mean that that's so much more powerful than any vaccine is that nationally here ? is that worldwide ?

that's in the united states , because actually we're substantially less healthy than our european counterparts yeah it . It made a contribution in other countries , but it was a smaller contribution but this , this concept of reversing and not just treating I want to speak to this idea that we need sick care . I completely agree . So again , I'm an internist .

I took care of patients for 30 years and , frankly , it's an incredible privilege to have the training and credentials to be the person who runs in when everybody else is in panic . In the moment of a family's most urgent need , you step in to try and save the day . You have that opportunity . It's incredible and stuff will always happen .

We could have a seatbelt on the wall , we could give Humpty balance training , we could have cushions at the base of the wall and yet on some particular day , when the wind blows just so , humpty's going to fall off the wall and hurt himself badly . We're going to need an ambulance , we're going to need an emergency room . That stuff's not going away . So we need disease care , but we also ought to populate the full expanse of what we're thinking we mean when we say health care .

And I see ways for this to happen . One is your suggestion , ellen , that we could have parallel systems . We could have a disease care system and a wellness or wellbeing system . The danger in unbundling the two is that wellness space could become the home of woo and charlatans .

Oh , totally . Right , it could lack the tether to evidence and science is so critical , call it healthcare and not . That's why I always say healthcare . Right .

Because I'm exactly with you . The alternative would be to think of the disease care system the way we ought to be thinking of the fossil fuel industry now . These are large corporate entities with a great deal of financial might . They're not just going to go away .

They're not going , gentle , into that good night . They will rage , rage against the dying of their light . And so let's work with them and say , hey , take that vast fortune . You've accumulated fossil fuel by peddling your product disease care by taking care of sick people , and start investing in models that produce better outcomes .

We'll drop the fossil fuel analogy , but obviously that would be wind and solar and hydro and so forth . But on the disease care side , in a capitated system , in a value-based care system , anywhere where you benefit from improving population level health , okay , what we're going to do is we're going to start investing in those models and profiting from those models , because if we do a good job , the difference between what we spend and what was available to spend is profit .

We'll take that . We also know that people are willing to spend their money and we could attach subsidies to this so they didn't need to spend less of their personal money to spas and fitness centers and recreational opportunities and fine dining opportunities and there's no particular reason . And my wife is sitting into the podcast . I know , I feel like we haven't even gotten , we haven't even she's a fantastic cook , and what we've put together in our collaborations over the years is nutritious and delicious and you can combine the two .

I love it so there's no particular reason why the fortunes that trade hands in the disease care space couldn't start being invested in franchises where healthy food becomes readily available to everybody everywhere ? Then , over some extended time horizon , as more and more people are partaking of the actual healthcare side of the system , they start to decommission some of their hospital beds and some of their ER space and we need fewer ambulances . They don't go away and there's an analogy for this and that would be the way we deal with drowning as a society .

When people drown and are brought into the emergency room , they get the full court press . We do everything we possibly can to resuscitate them and they may wind up in the intensive care unit for some number of days and fortunes may be spent , but that's okay . They deserve that . But mostly what we do is prevent people from drowning in the first place .

We have fences around pools , we teach people to swim , we have lifeguards at the beaches , we expect parents to be vigilant when their little ones are near water and we put up signs that say don't go in the water . Today there's a massive surf or a riptide . If we did all of that with regard to health , food and obesity and chronic disease risk , it would completely change the game . So we need to change in mindset and we need to evolve the disease care system , expand its spectrum of activity .

I don't think it needs to lose or be left behind . No , and it doesn't just need to contract . I think they can diversify their portfolio . So I won't belabor this because we're on a short clip here and I still want to hear from your wife .

But I will say that you and I need to connect afterwards because I have this whole sort of not whole visual . But I have started to put pen to paper and I'm certain you have many of this , as much of this as well of saying there's a whole new segment that basically emerges . You take that 2 million out from the lifestyle disease that we're spending and you redistribute that and you give people , you basically give them the authority to start investing those dollars of theirs back into the types of things to your point that you want to .

It's not there's this belief that you have to spend all of this extra money , and I think that's where , when you use outcomes based care for good and you have a full vision . And the other piece I will add is I'm 100% with you on climate and food and I much to my partner's chagrin , I think sometimes have gone very deep into food , both on the ag and farming side , the regenerative side as well as the CPG side . Yeah , because as a healthcare person , I believe that all of this it's soil to self , it's all part of the same ecosystem and for us in healthcare , like I always say , healthcare is going to get blindsided by food .

They are the one food made healthcare . I won't belabor this , but we've . So I spent most of my career at Yale running a research lab focused on preventing chronic disease and we deployed solutions into grocery stores . Our partners were grocery stores and elementary schools , because if the kids learn about what you're deploying into the supermarket , mom may not notice it , but the kids do oh we learned about this in school , and they tug on mom's elbow and say hey , we've got to use this system .

This is going to help us choose better food . So , yeah , we could create an integrated ecosystem that reinforces the messages about health and the requisite skill power so people can actually get there from here . Yeah , they are invited in , so without further ado . Oh my goodness , oh no Please .

Tell us about yourself . Tell us , since you're delicious , I'm delicious , he's delicious , he's theory , and . I'm practice . Theory and practice .

I thought it was delicious and nutritious . Well , delicious and nutritious , okay , all right , but truly . I'm a French foodie . I was born and raised in France and when we met it was a challenge because , in order to be at his level of nutritious , just perfect .

They know nothing about this being my business partners . Nothing , I won't belabor it . It was a challenge , but what was nice is I'm originally a neuroscientist , so I'm a scientist . And when we decided , you know , we raised our family , we needed to make it work , the way that we would feed our family .

And I love to cook , and little by little , without even being aware of it , I titrated the way that I , you know , I changed the way that I cook , but the outcome variable was always deliciousness , visually , the flavor , but I had to make sure that it was while varying the ingredients yes , eat one ingredient at a time , enhancing the fiber content and , you know , lowering the sodium , making sure they're vegetable and whole grains . And out of that was born Cuisinicity , which is about loving food that loves you back and then those incremental adjustments to recipes .

They accumulate over time . So the result is a portfolio of recipes that are completely transformed not one ingredient , but every ingredient , and all passing a French foodies test for delicious and visually appealing . And all of that and satisfying my very fussy nutrition criteria and testimony to the fact that you can love food that loves you back . One of the things that people tend not to know about our food preferences is that taste buds are very adaptable , little fellas .

When they can't be with foods they love , they learn to love the foods they're with , and it takes a very little bit of time . Now , if you eat junk food all the time , you will prefer junk food . It's spiked with salt and sugar and flavorings and so forth , and that that becomes normal for you and anything else is just bland and dull . If you migrate away and this has been done in randomized control trials you migrate away from ultra processed junk food to whole food .

Within as little as a few weeks you start to develop aversions to the junk food you used to prefer and preference for the food you're eating . And if you hang in there for 12 weeks now maybe three months sounds like a long time to people , maybe it doesn't . But this is the hill you need to get over to change your relationship with food for the rest of your life . It's a small I and a huge R , small investment , huge return really , because you start to feel the changing in preference in just a few weeks and then it's really rock solid in 12 weeks and you can love the food that loves you back for the rest of your life .

I have to add , though , that with the kids , we have five kids and the kids that were not . They were our children's friends , who were not used to healthy eating when they would come to our house and say , wow , this is so good because you know you have to do it . Well , it has to be what they expect If it's a chicken nugget it should be crunchy and tender . It's the texture , the flavor .

I would put stealth ingredients in there . But do it your right and so doing , that actually amplifies the opportunities of taste bud rehab , that's what I call this process it happens faster , it happens easier , there's less resistance . So , absolutely , if you know what you're doing in the kitchen and , by the way , catherine's recipes are freely available that's what I was going to ask . You said Quizzinicity .

Quizzinicity . How do you spell that ? Is that a business ? Is it a web ?

It's a website . Yeah , give it a plug . It has lots of recipes and but this is reflective of 30 years of our life and it did not begin plant-based . It was chicken , never red meat we never ate red meat but chicken and fish and a lot of vegetables .

As it has evolved , it's become much more plant-based . Both love the food that loves you and your planet . So it's become much more vegan and it's become much more vegan and it's Cuisine City . Yeah , it's Cuisine City with an I in the middle Cuisinicitycom , and it's a public service .

Our kids said hey guys how about you pay this forward and make a website ? Catherine said great idea and I am a ham , so I love to do videos in my kitchen and everything wrong happens , just in case you weren't picking up that vibe . But that's what real food , real cooking . You know I didn't have time for fancy schmancy .

I , you know , mother of five here . So if I have the little thing , we have the little like soundboard thing it does like . I can't reach it . I'd be like pushing that button right now .

I have two and I'm like , yeah , that's right , five kids . You can press it if you want . Don't try this at home , so I do . I do have a question for you , though , on the on the front of you know , of tastes , taste buds , rewiring , but something that I think a lot of that gets overlooked and I'm curious your , your thoughts on this is satiety and right , and this , like this was an epiphany for me a number of years ago of , instead of focusing on like , what exactly I'm eating , necessarily like calories or macros , or even taste or size or any of that was satiety .

It's like , hey , if I stay in this sort of range of feeling satisfied , right , not full , not empty , and trying to just kind of stay in that space , it makes a huge difference , oh my goodness . And especially with ultra processed food , I find , because , like , I'll be on a plane and if I haven't remembered to bring something , and I'm desperate , right , we've all been there and I'll eat that biscoff cookie or whatever they hand you , there's no satiety and I'll give you an example I make a creme au chocolat , which is a chocolate , chocolate mousse .

Yeah , I'm coming over for that . But literally it is and I've given that recipe to Yale Dining and University of Massachusetts at Amherst . They have a beautiful dining program where a chocolate mousse is usually with sugar and milk and cream and eggs . I've done away with all of them and yet it's delicious .

Why ? Because I put tofu , you don't know . It's there Dark chocolate granted 60% or 70% . So that's where the added sugar is Medjool dates , a little coconut milk and black lentils puree .

And talk about satiety . I mean it fills you up and you don't know they're there , and it's creamy and delicious I could see that , say , I've seen black beans used in that manner , but this is this , yes , and it passes the test with the french relatives . It's amazing , really let me fit , so I I've talked about satiety a lot over this . I agree with you completely .

So I just want to make listeners aware of something . You mentioned ultra processed food . So I commend to everybody's reading list the extraordinary science of addictive junk food . It's a new york times magazine cover story .

You just have to google michael moss addictive you'll pull it up . Michael moss is a pulitzer prize winning investigative journalist , wrote a couple great books salt sugar , fat and hooked excerpted this essay in the new york times from salt sugar , fat the extraordinary science of addictive junk food . So your point about satiety is more salient even than you realize , because the junk food that prevails is willfully engineered to sabotage satiety . It's designed to maximize the eating you do before you feel full .

And so part of the value proposition of moving to real food mostly plants , as we advocate here at ACLM plant predominant diets , whole food you eliminate that intentional mischief in your diet and you minimize the calories it takes to feel full . You're eating foods that fill you up on fewer calories and , in addition to just reverse engineering what we might blithely call the moss effect and steering clear of all that mischief , you're also tapping into opportunities to increase fiber , which is good for you metabolically .

But one of the reasons this mousse au chocolat is so satiating is because it's full of . Your dessert is now a rich source of fiber right and you feel good that they're eating and it's got protein in it and it's high in protein . It's high in fiber . It actually addresses some antioxidants when you put the chocolate in there .

Bioflavonoids and the other kids said how come they can't ? And it's easy to make , it's vegan it's easy to make . Oh yeah , you just throw it in your blender ? The reason I ask is because my wife she's like too many steps .

She'll look at a recipe and go too many steps . I'm not going to do it . One of the reasons quizzinicity is called quizzinicity Because I mean five kids , you don't have time . Three dogs Chocolate mousse .

Give the chocolate mousse , give it a try . Throw it in the blender . We could always do it Wednesday night . But you're right , satiety is really important , because calories do count , but nobody wants to spend their life counting them Counting yeah .

And if you eat the right foods , all you really need to do is eat until you feel full and satisfied , exactly , exactly Wednesday night . We're going to get it on camera . It'll be bonus . Yes , it'll be bonus .

I love it . As long as we have a blender , because we're going to need a blender , you have to have a good blender . Yeah , I mean , if not , you just do it several times . Yes , exactly , we'll figure it out .

I didn't bring my Vitamix on this trip . It's a well-equipped house we rented it is . It's a blender Good , good , good Well . I really appreciate you guys taking the time and I would love to have you join us for a full episode at some point .

Love to do that . When did you realize that your husband was a rock star ? Oh , I knew it before everybody else did . Oh , there you go , I just heard today .

Yes , thanks guys . Ellen told me oh , gosh , oh yeah thank you so much . Thank you , thank you so much .