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A
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Race the sails.
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B
Over. Roger, wait.
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When we're talking about why Americans health outcomes are the way they are in terms of lifestyle related chronic disease, it's not because we're lacking science. It's not because the science is confusing even. It's quite the opposite. Again, it's been consistent for decades. It's because we're not meeting those recommendations. And we're not meeting those recommendations because of the systems that we've built through policy decisions and policy choices.
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A
Americans spend more on healthcare than any other industrialized nation and yet we are notoriously unhealthy. Why? And what can we do about it? Dr. Jessica Nurik is a registered dietitian with a PhD in nutrition science. She is a vocal critic of the Maha movement make America healthy Again, not because she disagrees with the goal, but because she disagrees with the diagnosis and solutions. Not surprisingly, she has her own solutions. And that's what we're going to talk about. Welcome. Great to have you. Thank you. Americans are notoriously unhealthy. What is the biggest reason why and what's the most effective, easiest thing we can do about it?
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B
Well, that's a big question.
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A
It is. We'll start off big.
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B
Yeah. I think when you're talking about unhealthy, we have to define what that means. Right. So when we, when, when it's talked about kind of like the way that we are, it's really focused on lifestyle related chronic disease. Right. So we, we underperform other high income countries when it comes to lifestyle related chronic disease. Things like cardiovascular disease, type 2 diabetes and those types of things. And I think when you look at kind of the main causes and the main drivers of Those, it's really an entire system that, that is kind of built against us. Right. It's built for the most people to fail rather than the most people to succeed. And so when, when I'm talking about that, we're talking about determinants of health, our food environments. Our food environment is very much set up for us to fail. It's by some estimates 50 to 70% ultra processed food. A lot of that is low nutrient ultra processed food. Right. So what's available for us to eat is, is not necessarily what's best for our health for the most part, you know, that's on the food environment side. But then you have a lot of other things. Physical activity we have, you know, versus other high income countries. We have towns and cities that are kind of built for automobile, the automobile industry and not necessarily walkable and bikable. We don't have access to parks for a lot of. And so it kind of like makes it more difficult to get in just kind of physical activity that you would otherwise just get living your daily life. Healthcare access. In this country, millions of people don't have healthcare access and many millions of others are underinsured. So they're not going to visits that are more preventive. And so, you know, they kind of get farther down the line. And so maybe we could have caught something, some sort of chronic disease early on, but now it's pretty far down the path. And so now they need to be medicated, things like that. And so it's really like a systems approach. And so if we want to improve health, which I think is what your question was, we have to look at the whole system and we have to start building those systems to maximize the most people to be able to be healthy versus the alternative.
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A
And you're incredibly smart about policy. And we will get to policy. Let's just start with individuals.
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B
Sure.
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A
So what can we all do? And when I say that, I've listened to a lot of this Silicon Valley personal optimization folks who are constantly arguing about the exact amount of exercise you should have and different things like that. What can normal, busy, stressed people who do not have a lot of money or time do?
- [04:44]
B
Yeah. So there's a few pillars of health. Right. So let's talk about diet first. So I'm a dietitian. So if I'm working with you one on one, what are we going to talk about in terms of diet? We're going to talk about increasing the amount of fiber that you take in. Right. 90% of Americans don't meet fiber intake Guidelines.
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A
And I'm so sorry, but what has fiber in it?
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B
So fiber comes from plants, so vegetables, fruits, beans, legumes. So any, any sort of plant based food is where you're going to get fiber from. So that's really what you want to focus on. And again, we're not meeting our fiber needs. And I think we could, we could do so much health wise by just getting people to get their fiber intake right, their daily fiber intake. Over 90% of Americans aren't meeting vegetable intake guidelines. That's also going to help with fiber. It's also going to bring in a lot of micronutrients and antioxidants and just wonderful polyphenols, lots of different things in those vegetables. So we're trying to get increased vegetable intake, increased fiber intake, you know, decreasing your intake of kind of like low nutrient, high sugar foods. Many Americans, over half of us eat too much added sugar in our diet. And that's just sugar from anywhere, right? All sugar is sugar. So just the problem is overconsumption of sugar and so kind of decreasing that. Increasing your water intake, that's on the dietary side, making sure you get a variety of protein sources, making sure your grains, you're getting a variety of grains and a lot of them are whole grains. That's gonna bring fiber too. So grains are a good source of fiber. And so then you look at physical activity. So average American walks about three to 4,000 steps a day. That's just not enough walking. Right. And we could do a lot, I think a lot of us, we kind of get in this mindset, oh, we have to like exercise hard an hour a day, for five days a week. We don't have to do that. A lot of us would benefit from just getting more steps and movement in our day. Right. And then also strength training and also cardiovascular training, which walking can do. But definitely just focusing on walking as well and getting more steps in the. And then, you know, the other pillars of health are making sure you get adequate, adequate sleep. So seven to eight hours of sleep. Many Americans don't get that because of our systems and the way they're built. Stress reduction, that's really difficult right now, right? Getting off social media, getting off our phones, trying to reduce stress, getting in nature, getting in the sunshine, all of those things. It's kind of like a holistic approach to health. So from an individual perspective, that's what I would tell you. And then obviously there's systems built up around all of those individual things.
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A
So let's talk about each one of those in particular food, ultra processed foods, what are they and why are they bad?
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B
Yeah, so what are they is a big question. I think HHS right now is kind of, they have a request for information out to kind of like define what ultra processed foods means. I can tell you from the nutrition science research, what we've used is something called the Nova classification, which it's relatively new, but it a couple, maybe like 20 years old now, I don't even know. But it defines ultra processed foods in a way that there is unprocessed, minimally processed, processed and then ultra processed. And so the best way I can explain it is with like corn. So unprocessed would be just corn you pick from the garden. Minimally processed would be something like frozen corn. So it's like minimal processing, but it's still in its form. Processed would be, you know, like canned corn. Cause they add some salt to the can, right. In order to preserve it and then ultrasound. Ultra processed would be something like a Dorito chip. Right. The basis is corn, but you cannot, it's essentially it has an ingredients or processing method that you don't have access to. So you can't replicate it in your kitchen. You can't replicate a Dorito chip in your kitchen. So that's what we've been using in nutrition science research. So if you ever see any research coming out looking at ultra processed food, that's generally the definition that's used. The problem with that definition is there's a ton of variability within that. So if it just has an ingredient like a preservative or something that we don't have access to, it's defined as ultra processed. There's a lot of high nutrient, you know, nutrient dense ultra processed foods. And so we don't necessarily know that those are negatively impacting health. Right. Like something like something like a soda that's just all sugar and no nutrients. And so the problem with being able to just like speak about ultra processed foods as if they're all bad is that that's not necessarily true and we don't necessarily know that. So when I talk about them in terms of reducing, I tend to talk about low nutrient ultra processed foods rather than just kind of like saying them all together. But the idea of them is that our food environment is comprised of these now very much because we are heavily reliant on prepackaged ultra processed foods that are shelf stable, can ship far because we don't really have good kind of like local food systems. Right. So we're heavily reliant on these prepackaged ultra processed foods.
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A
And so what is it about? Is it the processing, what is the problem with ultra processed foods?
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B
Well, that research was being done by my friend Kevin hall at the nih, who was really looking into this and some other researchers because what he found was that when a diet that was kind of comprised of these ultra processed foods, people would tend to overeat them. And what the idea has always been and what the evidence has always kind of suggested is that the reason for that, that is that they're very hyper palatable. And so to make something hyper palatable, you do a combination of salt, sugar and fat. Right. So any, any combination of two of those, some of them have three of them, they make it hyper palatable so you eat more. And that's, that's what they found as well, was that, you know, people who were consuming an ultra processed diet tended to eat more calories than people who were not. Even if they were just given kind of like ad libitum, they were able to eat as much as they wanted, they would overeat calories. What we know now is likely that that's because of that hyperpalatability. Whether or not that's because of other factors kind of remains to be seen and still needs to be studied to figure out like exactly why these ultra processed foods really do it.
- [10:43]
A
So I want to come back to the science and the current science and the evolving science, because I think that this is part of the much larger issue that you talk a lot about, which is distrust in science and people being experts on themselves. But let's just go right to that grocery store. So for somebody like me, I want to eat as well as I can. I also hate spending time cooking. So what should I do? What's the best way for me to eat in the fastest, most convenient possible way without actually learning to be a chef, just getting whole foods and spending several hours cooking, which a lot of people seem to be very happy to do, or at least willing to do.
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B
Yeah, so I don't love cooking either. So I'll tell you what I mean. I have this kind of like approach to healthful eating that it's like, I call it the anatomy of a meal. And it's essentially I will, you know, you can pre prepare like your grains if you want to. So like rice or quinoa or anything really.
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A
And you cook them pasta.
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B
Well, yeah, you do have to. Are you saying no cooking at all?
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A
I'm just, I definitely want to know how you eat. Not to cook a Little. We'll go from there.
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B
So yeah, you have to like, you pre prepare those and then there, then they can sit there for a few days. Right. And then what I do often is I'll just saute. I always have vegetables in my, in my refrigerator and I'll get a couple of different vegetables. I saute those and then I will make, I use, I really utilize my air fryer. Cause I think that that's like the best invention for people like us who don't like to cook. So you can throw your protein in there, whatever protein you want. It can be chicken, it can be tofu, it can be anything. Throw it in the air fryer. And then while you're sauteing, and then you can add beans for a bit more fiber. And then, you know, so then you have your rice and your veggies and your beans. You can add a sauce to it and then you just throw on the protein. And that's like 90% of my meals.
- [12:30]
A
Okay, so let's go back to science. Cause the way you just talked about it reminds me a lot of when I hear lots of scientists talk, which is, well, this is what we think right now. Yes, hedging, exactly. Lots of nuance. We're not sure yet. We need to study a lot more, which is often very different than the practitioners will talk about it, which is a black and white, good, bad, everything else. And I think this feeds into this whole conspiracy theory engine that you've talked a lot about. Some of the Maha folks who are, some of them are selling things, some of them are not. But let's talk about science and step back from this. So this skepticism around science, I will say that I am often skeptical of science. And, and what I mean by that is that it seems to evolve over time. And I go back to my childhood, this whole health craze. We've got to get cholesterol out, we got, everything's got to be low fat. My dad, his entire life was eating these healthy foods which were deeply ultra processed things that had things like butter taken out of them and replaced with things we thought were healthy. And then as an adult, we've, all the scientists have decided like, no, this is actually terrible. You should be eating real food. Maybe that's what contributed to my father's cancer, was he ate all these processed stuff. So talk about that. Talk about how science evolves and the current science. How confident are we that we know what we're talking about?
- [13:59]
B
Yeah, so I mean, science, it's often said as a noun, but it's really a verb, right? It's really a way of just understanding the world around you. It's a process for understanding the world around you. And the scientific method is the best process that we have for understanding the world around us. I mean, we've seen incredible advancements since using the scientific method that we didn't see for thousands and thousands of years. So, you know, it's certainly not the problem with it, as you rightfully state is it doesn't give you certainty about things necessarily. It gives you the best possible understanding of something for that time. And then that understanding might shift given better data, given new and better data. So I think understanding that and understanding that there will be changes with new evidence is really helpful. And I don't think, I think maybe some people don't realize that, like, they think that, like science is the truth and then if it changes, like it was a lie. Whereas that's not how scientists view it. They view it as like, this is what's best, our best available knowledge. And that's not great. Like, again, for like, people working with people day to day or like companies who want to sell things. So, like, with the low fat example, you know, in the scientific discourse, I wasn't alive back then, but back then I imagine it was more, okay, this is what we see right now. And that could change if we get new information. But that's not what corporations will do. Corporations will take kind of like what we know right now and then kind of pretend it's truth and it's an unchangeable truth and then just create products for it. Right. So I think there's a little bit of a difference between what's happening in the scientific discourse versus how that science is actually being used to then sell products. So I think there's a difference there. But yeah, I think overall it's important to understand it's a method for understanding the world around us and it's the best method we have. So that's what I think should be the biggest point.
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A
Okay, so let's go back to a couple of things that are much more in the wheelhouse of what we're talking about, which is what to eat. Yeah, eggs. When I was young, I loved eggs. Then I remember from my teenage years or whenever it was the Atlantic had a cover. An egg a day could kill you. Cholesterol, terrible. So I didn't have eggs for years. Then a decade ago, somebody said, no, actually eggs are good for you. So I was able to eat them. And then I just checked yesterday and it seems like, well, they're not as bad as people say and so forth. So if something like eggs people can't agree with, first of all, are eggs okay. Can I eat eggs?
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B
Yeah.
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A
Okay, good. Why do you eat eggs?
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B
For most people. For most people.
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A
For most people, like, who shouldn't eat eggs?
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B
I mean, somebody with like, pretty bad cholesterol issues potentially just cause there's some saturated fat in the yolk. But for the vast majority of. Eggs are great.
- [16:43]
A
Eggs are great. And so we. Highly nutritious scientifically. There's not likely to be a study in five years. Like, no, we finally looked at everything. Eggs are bad.
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B
Yeah. So we should talk about nutrition research a little bit and the nutrition discipline. Nutrition is what I call a baby science compared to many of the other scientific disciplines, chemistry, biology, all those. And nutrition science research is chronically underfunded and has been for a very long time. And so that, that, that means that we will see changes in, in this, these types of things. You know, maybe more so than other scientific disciplines because we're getting new data that we didn't otherwise have. Now the basis of like healthful eating has been fairly consistent for decades. Like, that hasn't really changed even like throughout all the dietary guidelines. You know, as much like, as much as we talk about these like changes with eggs and things like that, there's not that many examples of things that have like really drastically changed over the decades. Like, it's always been clear, like, like whole foods, you know, nutrient dense foods, more plants, you know, like limited meat and especially like processed meats and those types of things like that has been very consistent, I think, with eggs. It's a special case just because of our understanding of cholesterol and how dietary cholesterol impacts blood cholesterol evolved over the last few decades. And so that's why we saw that kind of shift. Because it used to be, you know, we really, the evidence kind of pointed to that dietary cholesterol could negatively impact blood cholesterol. So if somebody had like cholesterol issues, that could potentially be problematic. So it was. And then, and then the science gets translated to practice by clinicians. Right? And then clinicians will give kind of just blanket advice. Cause that's, that's what's most helpful to a patient. And so it's like, oh, avoid eggs. Which, you know, there's so much nuance there, but that unfortunately kind of gets lost sometimes in the office.
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A
All right, so before we move away from food to exercise and sleep and all those other good Things. Let's talk about Maha.
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B
Sure.
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A
What is going on with Maha? I've heard you say they understand the problem but have the wrong solutions. What does that mean?
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B
Yeah, so I think what is interesting about the Maha movement and what I appreciate about the Maha movement is that they've kind of like galvanized people and captured the nation in a very bipartisan way about problems that I've been, you know, working on and studying for a decade and a half and been concerned about, which is, you know, we do have a lifestyle related chronic disease issue in this country. We do have a food environment that is built not, not for our health and for really the profit, profitability of industry. And you know, we, we should be pushing for change where, where I take issue is the, the causes. So where they kind of place blame in terms of why these issues exist. And then obviously if you get the causes wrong, you're going to get the solutions wrong. And so, you know, when we're just talking about the food environment, for example, they will, they really lean heavily into this idea of like toxins and additives. And I think where the nuance comes in is I'm not like pro all the toxins and additives. Right. Like, that's not, that's not what I am. I'm actually, I mean we could talk about like closing the grass loophole, but I've been, I'm actually very on board with like more oversight of the ingredients in our food. Right. Like, let's fund the FDA and put more scientists in the fda so we have more oversight and they're able to do more analyses, particularly like post market analyses once they're already in the food supply. But what Maha says, they'll say like we're concerned about all these additives. Then they will kind of like take studies that show like 50% of a rat's body weight was exposed to this particular nutrient and then it induced some sort of like harm and then say that it's linked to that harm as if that means that like humans are experiencing that harm when there's no evidence that they are. So they kind of fear monger about these ingredients and toxins without data to suggest they're actually harmful in humans. And I think it plays into this idea, this conspiratorial idea that, you know, the US is like poisoning our food. And it's kind of this idea that like they're trying to keep us sick and that leads to again, if the causes are wrong, the solutions will be wrong. So then the idea is, okay, well these People are all corrupt. So we're going to defund our health agencies and not trust scientists, which are the very people who are trying to improve the food supply without. And they're not recognizing that, like if you want fewer toxins in the food supply or fewer ingredients in the food supply that potentially are harmful, you need more funding at the fda. You need more oversight of these ingredients. So that's one example. But I think the idea is that the movement is really focused on like corruption and ingredient swaps, like changing the color additive in candy or Fruit Loops, as if that's going to make a meaningful impact on our food system that is built for, again, corporate profits and like completely comprised of these low nutrient, ultra processed foods. Swapping the color additive in one of them is not going to make a meaningful difference on health. And so it's distracting from kind of what we can talk about, the real solutions to improve, improving the food environment. Great.
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A
So Maha is right that there's a problem is right that it has something to do with our food, but wrong about exactly what the cause is and what the solution is. Is that a fair way of saying it? Yeah, which in a way is a credit to Maha. I mean, at least people are noticing that we do have this problem now and something has gone very wrong. So what is the solution then to the food system?
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B
Well, we have to talk about the causes first.
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A
Good, let's start with those. Sorry.
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B
Yeah. So I mean, okay, again, we have a food environment that's 70% ultra processed food by some estimates. Right. Many of those are low nutrient ultra processed foods. What has caused that is decades of policy decisions, starting with our agricultural policy all the way down through the, through the line in terms of food accessibility and what is being marketed to us. Right. And so if you want to look at like, what are the causes? Well, let's start with the fact that in the 70s we really shifted heavily to commodity crops and big agribusiness. Right. The idea it was like go big or go home was, was the USDA the head of the USDA's kind of like idea at the time. And it was basically, you need to start. We need to start like really funding large scale farms to grow commodity crops, which are corn, wheat and soy. Why? Because that's very profitable. We grow those things very well in the United States. You know, it decreases the cost if you can have larger kind of farms growing one crop instead of, of smaller farms growing multiple crops. And it's great for exports because we grow it so well and we can export It. And so that, that was a shift based on policy decisions during that era. And then you kind of combine that with through the 80s and even the 90s, kind of this deregulatory era that we were in, that really allowed a lot of mergers and acquisitions of these, of these corporations, these food corporations to kind of capitalize on this food environment. And so what it did was it really decimated local food systems, regional food systems, and it brought the food system kind of to really like, like segregated. Right? So it was okay, we have these like big agribusiness, we're subsidizing, so making cheaper corn, wheat and soy, which are, you know, we don't even grow our, our food for necessarily human food. Like it's, it, it is. But like if you think about corn, 40% of corn goes to animal feed, 40% of corn goes to fuel and 20% of corn goes to human feed. That's not the best way to say that. But human food and the vast majority of that goes to these ultra processed foods to make them cheaper. And so when you have an agricultural system like that, it's gonna result. And then you have food corporations that because of our economic system, which there's a lot of pros to, but you also have to understand that the consequences of that are they're going to try to maximize profit, not to make you unhealthy, but at the expense of your health. It's not really a thought for them because their goal is to maximize growth and profit. And so when you have that, they're gonna choose the cheapest ingredients for their foods. Right. To maximize profit. And they're gonna market to people. And so they're gonna heavily market these ultra processed products that have bright colors that are super exciting with the characters and all of that to kids and low income populations. And so that all plays a role in terms of that entire food system. And then you have to talk about food accessibility. So because we kind of removed these regional food systems and combined that with what we term food deserts, which are these areas in the country. Millions and millions of Americans live in food deserts. And there are these areas of the country where they don't have easy accessibility to fresh food, so to fruits and vegetables and things like that. Because there aren't, in a lot of places, there's just no grocery stores available. So a lot of these people, particularly in urban populations, their reliance on things like dollar stores or gas stations for their, for their food. So those are the causes.
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A
Okay, let me, before we get to the dissolutions and the Policies.
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B
Because that's a lot.
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A
Yes, it is a lot. Let me defend food companies, okay? Which is that, first of all, it's very easy to villainize corporations and capitalism and profit making and so forth. Everybody who works for for profit is evil and they're trying to screw us. And it's all about money. Having worked for a lot of those companies, not food companies, but other companies, people are trying to do the right thing. They have their job. Sure, they have their mission. Lots of companies try to have a dual mission. Yes, we have to serve shareholders, but also we want to create products that are good. A lot of food products. I think a lot of companies are saying, hey, what do people want? They're really busy. They don't have much money. They want cheap, convenient, fast and delicious. And I would say that our food industry has done a remarkable job of creating cheap, easy, fast and delicious. And now suddenly we're realizing there's a lot of problem there. But I do think it's a lot on consumers, which is, that's what we want.
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B
That's the easiest thing.
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A
That's what I, I mean, bag of Doritos you mentioned earlier. Wow, Doritos are great. I mean, we used to just go crazy with Doritos and all these things. Not knowing back then, hey, this probably isn't. Maybe we had an idea. I mean, it doesn't seem particularly healthy, but boy, they're delicious. So I just want to, before we get to the solution, I just want to introduce that. But now, no, let's get to the solution.
- [27:17]
B
Well, let's talk about that though, because I think you bring up a good point. And I think you've probably heard me talk about a similar thing before, because I think this is a very nuanced issue. Right? And so there's certainly, I mean, corporations are meeting demand, right? So there's certainly demand for these things. What I would say is that a lot of policy decisions have helped to shape demand over decades in America. And so what I always try to talk about when I talk about corporations, again, corporation. There's this like, idea in social media that corporations are like intentionally making people sick. And that's just not the reality. They're just again, meeting demand and then also trying to maximize profit and growth for their corporations. So I think you're right to identify that it's also that this is what people are wanting and asking for. And also because of policy decisions, we have created these environments that sometimes it's all that's available, which again, shapes demand as well. And so Some of the policies that we would talk about in terms of improving this would focus on kind of education campaigns and working with people on education. So an example of that is snap, which is the Supplemental Nutrition Assistance Program, which is, you know, the biggest food assistance program in this country. And it directly reduces food insecurity. So 13.5% of this country live in food insecure households, which means they don't always have access to the nutrition that they need to meet their nutrient needs. And within SNAP there was a program or there is, it's being cut right now, but it's called SNAP ed, which is SNAP Education. And it was dietitians and, and nutrition professionals who worked within SNAP ED, who worked with SNAP participants to help them understand what a healthful diet looks like. Right. Cause a lot of this is an education deficit as well. And it was a great program. I mean, it improved. I mean, there's data to show that it improved vegetable and nutrient intake and improved food quality in their diets. And so I think a lot of it will start with education campaigns, particularly with programs like snap, and then also obviously in our education system as well.
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A
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- [31:31]
A
And so you've talked a lot about behavioral issues. Changing behavior is very difficult. Changing taste is very difficult. So when you actually try to change behavior and this is going to individuals who actually would prefer not to eat things that make them sick or overweight or what have you, but don't know what to do, what works within SNAP ed, like what really resonated, what changed behavior. Behavior.
- [31:56]
B
So there's again just education, I think helps to change behavior again because a lot of people just don't know. And so then they'll start and, and not only just education about like what's good to eat, but also how to prepare it. So like I just talked about like the anatomy of a meal because a lot of people you'll give them vegetables and they'll sit in the refrigerator because they don't necessarily know how to prepare those. So part of SNAP ED is like cooking courses and helping people to understand like how to implement some of these things. How do you. And this is why registered dietitians shout out to them because they're so great at this. They can help me with like how do you take, you know, a health promoting food and implement it into what you're already eating, right? And so it's not just like this crazy change or this extreme change that you know, you, you otherwise wouldn't be able to, it wouldn't be sustainable. But like, how can we make these like Small changes, sustainable. So maybe you, you know, maybe you make like some sort of pasta dish every, every week for your family, and it's like full of, of lots of cheese and sauce. And then like, I don't know, like crackers over the top, which is like something that I've seen people do. And then, so it's like, what can, what can some, like, healthful swaps be there? Like, maybe we can remove the crackers because it's a pasta dish. Add in some, like, protein into that, into that pasta dish. Right. Maybe a sustainable protein or, or like a meat product, something that they can afford. And then how do we get some vegetables in there? Right? Do we make them on the side? Do we do this? So you're taking what they're already eating and then, and then it's gradual, right? So they're making gradual shifts. Shifts. I think that's one of the most important things is kind of like educating how to implement these as well. With SNAP in particular, there are also these programs called Double Up Bucks, which are these incentive programs to buy more fruits and vegetables. So essentially it'll be okay. You're a part of snap. And if you use these dollars, states do this. So like, my state of Colorado has it, Nebraska has it, lots of different states have it. And essentially, if you use it to buy fruits and vegetables, you, you double the amount of money that you have. So you can buy, let's say you have $5, you can buy $10 of fruits and vegetables. So, so you're incentivizing people to purchase these products and then giving them education on how to actually prepare them.
- [34:05]
A
And is there evidence that SNAP ED for example, works, that people change behavior?
- [34:12]
B
Yeah, funny you asked me that. I just looked up the evidence this morning.
- [34:15]
A
Excellent.
- [34:15]
B
So, yeah, there are some studies on it. There's studies that show that SNAP ED participants increase diet quality. Their, their diet quality is higher intake of fruits and vegetables. So, so yes, that those studies exist. And there's also evidence on the Double Up Bucks program that, that people are actually, they're. They're actually adopting them and purchasing more fruits and vegetables.
- [34:34]
A
So let's say I want to help. I'm an entrepreneur. I want to create a company that's good, makes food that's actually healthy, and supports employees and ultimately rewards shareholders for investing in the company. What kind of stuff should I make?
- [34:50]
B
Oh, well, I don't know. That's a good question. You know, like, I, I would say if we're thinking of like, what, in terms of people, what are people Already eating, they're eating these prepackaged foods. Right. So if you're making a prepackaged food as like an alternative, again, what makes them hypersatiate and hyper palatable and, and ne. What we want to reduce is added sugar, a lot of sodium and high amounts of fat. Right. So making kind of products within that product suite that kind of reduce those am can, can be helpful I think, because people can still kind of eat what they're used to, but kind of with like a bit of a lower sugar or a bit of a lower sodium intake or fat. So I think that there's a way to kind of start looking at some of these, like what the problems are in the space and where the demand is and then making kind of like better products. There's certainly, there's certainly space for that.
- [35:47]
A
Okay, while, while we have you, let's move on to a couple of other elements of general health. Let's talk about ex. Wow. There are almost as many views on the ideal exercise as there are about food. You said three to 4,000 steps isn't enough, but we shouldn't be spending hours a day in the gym. What should normal people do?
- [36:09]
B
Well, I would say start with walking. Like I kind of more than 3,000, 4,000 steps more. And there's no like exact amount. Right. But just more, more for the vast majority of us. Right. I mean 10,000 is like thrown out there. I don't know that that's like 100% evidence based. That' just more of like, you know, you have to make a recommendation that people can meet. But you know, trying to get up towards that amount I think can be helpful. And, and I think a lot of people just don't even think walking is exercise. But for normal people, as you say, for the, for the average person, that's going to be an improvement on what they're doing right now. Because right now 80% of Americans aren't meeting physical activity guidelines. And physical activity guidelines are 150 minutes per day or not per day per week. Right. So that's like 30 minutes, five days a week of walking, of physical activity, of walking fast. Yep. That could be involved in the cardio and then a couple of days of just some strength training. So, you know, and it's kind of a combination of the two. So getting cardio and cardio, again, walking is cardio for a lot of people. And then, and then also implementing some strength training can, can be the most beneficial. So I would say, you know, start. It would depend on where you're starting. But if you're starting nowhere, you're not doing any physical activity, like the most of America, start with walking. Get yourself up to, you know, that 150 minutes a day of walking. And that will do great. Yeah, A week, not a day. Oh, did I say a day? Again, not a day.
- [37:33]
A
A week, if we can afford it. Should we have a watch or a Fitbit or a ring that is monitoring every second of what we're doing?
- [37:41]
B
Yeah, it's interesting, this wearable technology. I think there are pros and cons to it. I think for some people it is inspiring and it can help people to improve their step count and improve their activity. So I think you have to know kind of who you are about, about that because other people can become really obsessive about it and it can be a negative thing for them. And, and I've actually talked to a lot of people who have, you know, they've been wearing a watch or whatever it is, and, and they, they become fixated on it and, and it can lead to like, unhealthy behaviors. So I think, I think it depends on who you are. But there's pros and cons there.
- [38:12]
A
All right, last big area, maybe not the last. Healthcare, obviously a huge piece of it too. But sleep, again, normal people have all these things going on that they can't control. I listen to the optimizers. Oh, you must go to bed at 8 o'. Clock, the room must be cold. You have to have a heavy blanket. Everything, all light has to be cut out. It must be eight to nine hours, which for, again, I think a normal person, all it is, is stressful to hear that because you can never go to bed. You don't get to sleep. You're worried I'm awake, I'm losing my hour again. What's the best policy for normal, normal people?
- [38:48]
B
Yeah, and I do want to just like mention you're mentioning something that's really important, which is like kind of biohacking, optimizing space versus what I talk about a lot. Because what I talk about is really like, what's gonna help 90% of Americans. Right. Or even 95% of Americans. Maybe there's 5% of Americans that are doing everything already at baseline and they like, they can afford to kind of like go into all this biohacking stuff and like optimize everything that they're doing. But for the vast majority of people, they're struggling, meet basic recommendations. And so when we're talking about sleep, you know, I, I don't actually know what like the biohackers are saying about the best thing to optimize sleep. But the vast majority of Americans are not getting good quality sleep seven to eight hours a day. Right. So, so we have to start there. We have to start with getting them adequate sleep. And again, there's systems that are involved in that, which is this over. We're overworked without a lot. We have our devices. Right. So you know, good sleep, sleep hygiene essentially would be like to not be on your phone right before you go to bed. I certainly don't follow that. And I need to. But you know what I mean, there's what I recommend versus what I actually do. But yeah, so not be on devices. And just to prioritize sleep. Sleep tends to fall down on the priority list for us and we kind of devalue it in terms of how it impacts our health. And I don't think we should do that. We need to kind of value sleep. Sleep and kind of bring it up on the priority list and make sure that we're getting those seven to eight hours every night. And I think just starting there for the, for most people just trying to get those eight hours, you don't necessarily need like a whoop or whatever it is that's like gonna track your sleep. Just trying to get eight hours, seven to eight hours.
- [40:30]
A
So all of these things, food, exercise and sleep. You have young kids, you are an incredibly ambitious professional. You are a professor now. You are taking the message to the world in a marvelous way for all of us. Thank you, by the way. And we're gonna come back to that in a second. How do you juggle all this?
- [40:50]
B
I wish I had a good answer for you.
- [40:53]
A
You travel. Travel's exhausting.
- [40:56]
B
Yeah, I try not to travel too much. Cause I do have a two and a five year old and so I always have to bring them something back whenever I travel. My son wants like a sticky lizard this time. I don't know where I'm supposed to buy him that, but it's gotta be somewhere in New York City. City. But yeah, I think I, I think what helps is that I have been studying this particular area for so long that it's. It comes fairly naturally to me to discuss these issues. Now that doesn't mean that I'm not constantly studying new things, but I think that it helps because I stay within my scope of practice and I'm not kind of like talking outside of it. That's one of the things that's helpful in terms of efficiency. But yeah, I, and I Just love it. So I'm very passionate about it, which I think, you know, you can probably speak to this too. Like, if you're passionate about something, something, it doesn't feel as hard. But I am having to figure out because, again, I do have young kids kind of where the barriers and where those need to go. So I don't know that I have a great answer. I wish I did. I'll come back in a few months and tell you.
- [41:54]
A
Great. And so you talked about how when you were a professor, things like social media were looked at. Oh, you're out there mixing with the people, you shouldn't be doing that, and so forth. And it does seem to me that one of the things that's happening, happened is that the scientific community has disappeared down its own rat hole, a rabbit hole, let's say it. Better. Fighting about nuance, fighting with each other, writing impenetrable studies that seem to disagree. Every new study, and yet the message to the public is often, you idiots don't trust science. You should trust us. Even though it's changing all the time and the nuance and so forth. You have figured out a way, way to be a scientist, but also now communicate with normal people and from everything that I can see, improve lives in a way that most scientists do not. So what's the message there? Should we encourage academics to actually get out of the ivory tower and start doing what you're doing? Will that help?
- [43:00]
B
Yeah, I would say there's some nuance there. I think that. I think that scientists are improving lives, just not necessarily explaining how they're improving lives. And I, and I don't know necessarily think that every scientist needs to be a good communicator. I think that science communication is kind of like a skill set on its own because some of our best scientists are doing incredible work in the lab and they may not be able to communicate their work in the most effective way. And so we, I think that, like, there's an understanding and kind of an acknowledgement now that science communication is important and forever. There was not that acknowledgement. That was not a thing. Right. Like, and science, scientists and public health experts are really, like, we need to take a lot of blame here. And I talk about this a lot in terms of the distrust that we're seeing with science right now because. And it comes surprising to many of us because we're like, we're very trustworthy people. What do you mean? We're just trying our best here. But the problem is that we write in a language that's not accessible to people. We speak in a language that's not accessible to people. And so it's very easy to kind of like villainize scientists because they're not accessible to people. No one sees them, no one talks to them, and they don't explain what they're doing to the public. Right. And so I think that the acknowledgement is now that, okay, we need to actually like take an active role in explaining where the science is, what the nuances. And I'm. One of the things I'm hopeful about is that, you know, for, for all of the kind of problems we're seeing right now, there's a, there's a hunger for it, there's a hunger to understand kind of like what is, what is happening in the science, scientific disciplines and what, what does the science actually say? And people are more willing to listen right now. And so I think, I think that science communicators, this is really a time for them to kind of like rise up and help to bridge that gap between what's actually happening in the science, what is science and then what people actually want to hear and know.
- [44:46]
A
And so given the current situation with our health secretary who has some theories that a lot of people regard as conspiracy theories that are hurting us, certainly on the anti vax side, this big movement of people saying we got to change things, we're not held healthy, and you've pointed out some of their, their causes and solutions are, are wrong. But at least there's real movement like let's make America healthy again. That's a basic message that we should all be able to agree with.
- [45:13]
B
Yeah.
- [45:13]
A
How do you as scientists start to restore the, your credibility with what I would say is the majority of Americans who are open minded, who want to do smart things things and are getting bombarded on both sides with what I would say actually are credible views, which is the scientists saying, hey, we've studied this, we know even though it changes constantly and it's just a best theory at a time, and other people saying like, look where science has gotten us. Look what happened in Covid, look what happened with eggs and coffee and all these different things and low fat food. Obviously they don't know what they're talking about. Let's do the work ourselves and fix it. Both of those are appealing, I think, to somebody in the middle who is not focused on health at all. They're just focused on surviving their life. How do we rebuild credibility in the science of it?
- [46:13]
B
Well, it starts with meeting people where they are and acknowledging kind of their frustrations and what they're concerned about. I think it's interesting that you said look where science has gotten us and then you, you kind of mentioned negative things. Because what I thought you were going to say is look where science has gotten us like in the last 150, 200 years, a doubling of life expectancy, the eradication of multiple diseases, birth outcomes are incredibly better. Absolutely.
- [46:42]
A
And let's stipulate that it's getting better all the time. But in this one area, which is, I think where RFK is speaking to is look where it's got hotness. You know, we have this incredibly unhealthy country, we spend more on healthcare than any country and we have the worst outcomes and life expectancy is lower. And that's after decades of what is held up as the best scientific research health institutions in the world. And look where they've gotten us.
- [47:08]
B
Right. But Henry, that's not science, that's not because of science. So, and this is what I talk about all the time, people aren't adopting evidence based recommendations. So we, we, we do have things like a eggs that like have you know, like changed a bit. But like again over what is evidence based. Health information hasn't changed all that much over decades. Like it's been pretty consistent. We need to be more physically active, we need to eat more whole foods, we need to eat, you know, a more nutrient dense diet, we need to get better sleep, we need to reduce our stress. Like those things have been very consistent over time and Americans are overwhelmingly not meeting any of those evidence based recommendations. So science, scientists will continue to figure out and do the research and figure out what is the optimal or what is the best, especially for people who have conditions. Right. If you have cardiovascular disease or you have some sort of illness, understanding what the best diet is, that's where we need more research. And so we'll be continuing to do that research. But when we're talking about why Americans health outcomes are the way they are in terms of lifestyle related chronic disease, it's not because we're lacking science. It's not because the science is confusing even. It's quite the opposite. Again, it's been consistent for decades. It's because we're not meeting those recommendations and we're not meeting those recommendations because of the systems that we've built through policy decisions and policy choices. And so that's where the difference is, that's where the kind of the narrative gets manipulated a bit, is to blame scientists and public health experts who are public health institutions for example, let's look at the cdc. They make recommendations, right? They advise, they don't enact policy, they don't get to dictate what people do. They're giving evidence based information. You go on the CDC's website insight that their information is good. It's sound in terms of like what people should be doing in order to maximize their health. But we're not doing that right? And so then we have to look at why are we not doing that. And that's because of a lot of policy decisions, a lot of systems and a lot of personal choice. It's both right, because we all make personal choices within systems. And so if those systems we can build those systems to maximize the success for people or for the most people to fail. And unfortunately what we've done is we've built systems that kind of set people up for failure in this country. When did making plans get this complicated? It's time to streamline with WhatsApp, the secure messaging app that brings the whole group together. Use polls to settle dinner plans, send event invites and pin messages so no one forgets mom 60th and never miss a meal or milestone. All protected with end to end encryption. It's time for WhatsApp message privately with everyone. Learn more@WhatsApp.com this episode is brought to you by State Farm. Checking off the boxes on your to do list is a great feeling. And when it comes to checking off coverage, a State Farm agent can help you choose an option that's right for you. Whether you prefer talking in person on the phone or using the award winning app, it's nice knowing you have help finding coverage that best fits your needs. Like a good neighbor, State Farm is there. It's Pro Savings days at Lowes. Get up to 35% off select major appliances and save an additional $1,000 when you buy four select LG major appliances plus get a free Dewalt 20 volt max 5amp hour battery. When you when you buy a select Dewalt 20 volt max tool, get the job done for less At Lowe's we help you Save valid through 926. Selection varies by location while supplies last. See associate or lowe's.com for more details and qualifying items.
- [50:47]
A
So if it is the policy that's the issue, what are some things that we can do to improve the situation through what I would describe as achievable policy? Like I've heard you talk about be great to have universal healthcare. I think a lot of people people agree with that. We've Tried for decades, very entrenched insurance.
- [51:07]
B
Some people have not tried for decades.
- [51:09]
A
It's some, some people have tried, some people have not. Yeah, tough. I think maybe Medicare for all in some future universe, but even that's going to be a really tough lift. What do you think is achievable that we could do right now? Like if you could get some time in RFK's head, what would you have him do?
- [51:27]
B
There's a lot of things from a food systems perspective. So let's just kind of like stick to the food system perspective so we can. And, and what's interesting is the Biden administration was, was doing some of this. So I'll kind of point out some areas. You know, I talked about why our food system is the way it is. And a lot of that was like reducing regional food systems. Right. So trying to get more regional food systems and local food systems back. Trying to enact programs that are like farm to school programs or farm to food bank programs. Right. Where you're actually incentivizing farmers to grow a variety of crops and then also you're giving them kind of a stream for where they're going to be selling those crops, which would be schools. And you're improving school nutrition at the same time. Those are great programs to help not only help our smaller farmers, but also improve school lunches and school food. So doing things like that through grants and then helping them kind of get started and then also kind of again rebuilding regional farms. So if you're helping people, like helping smaller farmers get right now the vast majority of our insurance, which are subsidies. Subsidies is mostly like insurance based subsidies. You can start redirecting some of those. You don't want to do it all at once because obviously you don't want to hurt our farmers. But you can start kind of like shifting some of those subsidies to these smaller farms and kind of giving grants. If they're willing to diversify what they're growing, you can start doing some of that in the food. And I think RFK Juniors talked about that. But what's interesting is what we're seeing from a policy perspective is the exact opposite of that at the usda. So again, he talks about some of these issues. It's just not, we're not seeing action on it. So kind of starting to shift some of that. You can do things like front of package labeling which has been being worked on, which helps consumers to make better choices and easier choices. You can limit corporate marketing to particularly children and low income populations for some of these low Nutrient ultra processed foods you can give grants to maybe. And this is just so random, but the bean industry help them to make some ads on tv that would be great. So doing those types of things and then again, increasing accessibility of food is a big one as well. And so increasing snap, the Supplemental Nutrition Assistance Program, which we're seeing the opposite of that happen right now, but increasing that. And I am somebody who really leans into this idea of incentivizing healthier purchases. So I would really heavily lean into something like SNAP Ed, which is helping kind of educate people, increasing also education in our schools for nutrition education. But leaning into SNAP Ed and leaning into these incentive programs that are like, hey, if you spend on fruits and vegetables and then, you know, you take one of these classes that's showing you you can get like double the amount. And that helps to kind of again shift demand and shift and shift what people are consuming.
- [54:18]
A
And so unfortunately, as you note right now we seem to be going the opposite direction on a lot of those. One of the things that we haven't talked about that comes up very quickly when you really look into food in particular is just money and income and the high cost in many cases of trying to eat healthy. And an anecdote I went out and thought I got what I thought was a reasonably healthy lunch the other day, a sweet green salad and a seltzer, $26. I read yesterday the McDonald's CEO saying yes, low income consumers are really under pressure, so we're really tripling down on the $5 meal. Yeah, that is a huge gulf and but I have enormous sympathy for people for whom that's all they've got is $5. And you can't go to squeaky and maybe it's not even that healthy to begin with. Can you be healthy and also be completely strapped? Like is there a way for me to be healthy on $5 a day?
- [55:23]
B
Yeah, it's far more difficult. Right. The number one, the main driver of health in this country is, is wealth. Right. So if we look at kind of health outcomes across the country, there's huge disparities between high and low income populations. I mean huge. Like some, some research shows a 15 year life expectancy age gap for men and a 10 year life expectancy age gap for women. But it's not just life expectancy, it's also just every lifestyle chronic disease across the board. If you look at them, they're much higher in low income populations than, than high income populations. And so one of the ways and strategies that you, you would kind of work on in order to kind of improve food accessibility and the health of a population. And again, this is a public health lens, right? If you're trying to improve public health, you have to help the group and the groups that are the most impacted by these lifestyle related chronic diseases. And so in America that those are low income populations and so decreasing income inequality and those types of things can go into that. But to answer your question more directly, it is possible. It just takes a lot more work and a lot more knowledge of how to do it. And so that's where some of these education campaigns can come into play. Particularly, you know, when we're working with SNAP, we're working with low income populations and 40% of SNAP recipients, that's their entire budget. So that it's not supplemental for them. So they're literally, you know, they're eating about $7 a day. They have in terms of a budget. And so you know, figuring out, okay, well what are some of the like best cost for our dollar things here, which are like beans and you know, whole grains and some fruits and vegetables that you can get at a lower cost. The problem is, is do shop like that, that you're heavily reliant on time, right? You need time to prepare all of that. And a lot of the people who are, you know, low income populations, they don't have that time there. You know, it's single mom with four kids or whatever it is. And so, you know, that's the role of an educator in some of these programs to try to figure out, okay, I have, you have very little time, you have very little money, how can we like maximize the health for you. So again, it's possible, it's just, just not probable. Right.
- [57:31]
A
And do you see a path to having those policies?
- [57:34]
B
I do not currently, but potentially in the future if we're able to. Again, this is kind of like why I do what I do. I think that we all are very concerned about these things and we look at the chronic disease rates in the United States and we're like, oh my gosh. And we compare them to other high income countries and we're like, how? Why are we so sick? And so my goal is really to help people to understand why this is happening so then we can all put our collective effort into eliciting change. Change in the right direction. Right, because that's like what, what I'd like to see is kind of some of the systemic change so that we can set more people up to succeed.
- [58:09]
A
And talk about and then we'll wrap Up. Talk about other countries. Why is it that other countries that do not have the money we have, so forth are so much healthier? What's going on?
- [58:21]
B
Well, they have strong social support systems just across the board. So if you think of all of the social determinants of health and all of the determinants of health really. So social determinants of health are all these non health factors that direct impact health. There's a lot of data on each of them. So that's healthcare access. Every other industrialized country in the world has universal, some form of a universal healthcare system where everyone has access to healthcare. In the United States, millions and millions of people don't have access to healthcare. And again, less, even more people have limited access to healthcare right where they're not going in. And so that, that's a major one. Food accessibility. So just, just the food environment is different in a lot of these countries. It's not what we see which is like again, nearly 70% of these ultra processed foods. It's, it's. And there's more regional foods. You know, I talk about this sometimes, but my husband's from Romania and we go back there most summers and I'll just walk down the street with my mother in law and you know, go to the market on the street. And there's this, everywhere you go there's these huge markets on the street and they're cheap, they're much cheaper than if you go into the grocery store because it's just local farmers kind of coming and selling their stuff. You know, here we have farmer's markets, but they're like twice the price of the grocery store. It's like, it's like an elite thing to do to go to a farmer's market. So it's a very different culture. And I think also it's just like a cultural difference, right. Which again, culture is somewhat shaped by policy decisions. And so there's a difference in terms of culture, which is why we don't see there's a lot being made about an ultra processed food that is really bright in the United States and then not as bright in a different country. And as a reason that we're using harmful ingredients when it's not that, it's just the demand is not there for that in a different country. Right. So they're not looking for bright blue cereal, they're looking for a more muted cereal like grape nuts or something. So that. And then education access is another social determinant. A lot of these countries really value education and pour a lot into education, housing disparities, having some of these social safety net programs for housing that we don't necessarily have here and then Social Security supports. So a lot of these countries, they have this collective mindset. It's just a different culture. Right. And so we don't necessarily have that in the US I think we're much more of like individual rugged culture here, which there's a lot of benefits to that and then there's some consequences primarily on the health side of things. And you know, they have programs like paid family leave and like strong vacation policies and all of those things play into some the of and play into their ability to meet these kind of like evidence based recommendations that we're giving out and their countries are giving out. It's just more people in those countries are adopting them.
- [61:07]
A
Last question.
- [61:08]
B
Sure.
- [61:09]
A
Best advice for normal people who want to be healthy, but they're incredibly busy, they don't have much money, they're stressed. What do they do?
- [61:18]
B
Start small. You want to kind of like make a plan and do what's achievable and then kind of baby step. So don't just like say I'm gonna change my whole life and just jump in like that. That seems very exciting. But it doesn't, I mean what we see is it doesn't work for most people. So start where you can. If it's just walking, you know, a few minutes a day, start there and then work your way up. Really, I think the, the main point that I would say is just kind of like quiet the noise about all of this because especially if you're on social media, it can seem like nothing makes sense and everything's conflicting and it's just not true. In, in the research that we see, again, the pillars of health have been fairly consistent for a very long time. So just focusing on those like pillars of health is going to get you so much farther than any supplement or life hack or anything like that. Like focus on stress reduction, focus on sleep, focus on getting as many whole foods, nutrient dense foods, it doesn't even have to be whole foods, but nutrient dense foods as you can, a variety of fruits and vegetables and legumes and grains and all of those different things. Just kind of focus on that. You can still have snacks, right? It's like you, but, but focus, like make the most of your diet if you can, if you have, if you have access to this, like those, those nutrient dense foods, move your body. Again, walking, whether it's walking or, or exercising and, and you're just going to be so just again, those pillars, you're going to be far, much, far better than, than getting kind of bogged down by all this wellness talk.
- [62:55]
A
Jessica, thank you. Thank you for today. Thank you for your work in general, which is terrific and is helping people and making a difference. And I hope you enjoy New York.
- [63:05]
B
Thank you. Thank you so much for having me.
- [63:09]
A
Solutions is produced by Meghan Cunane. Jim Mackle is our video editor. Our theme music is by Trackademics. Nishat Kurwa is Vox Media's executive executive producer of podcasts. Thanks for listening to Solutions from the Vox Media Podcast Network. I'm your host, Henry Blodgett. We'll see you soon.