A conversation with Director of Yale University’s Prevention Research Center.
Question: How did you become interested in preventative medicine?
David Katz: I went on to do an initial residency in Internal Medicine, and during that training as I spent time on the wards in the hospital, I couldn’t help but notice that eight out of ten hospital beds were filled with people who needn’t have wound up there if they done things differently over the preceding decade; and in some cases longer. Most of what we were treating was preventable so we were all experts in putting out fires. That’s what you do in the hospital. And sometimes you actually used that kind of terminology. And these fires didn’t need to ignite most of the time.
I naturally gravitate toward the big picture which isn’t necessarily advantageous when you go on to a career in research because successful researchers usually choose a pretty narrow channel. So having tunnel vision actually helps you stay where you are supposed to stay. I don’t have that for better or worse. The big picture in medical care was looking at the underlying causes of all of this pathology. And I really wanted to get there. I really wanted to do something about that and play a meaningful role in changing the trajectory of people’s lives and their health and by changing their health, changing the quality of their lives.
So I actually started shopping around during my internal medicine training, looking for what should I do next so that I could leverage lifestyle to change health outcomes and I had a particular interest in nutrition—personally, because I became interested in exercise and eating well as a teenager and walked the walk and was experiencing those benefits in my personal life. I knew that this was possible. And then of course we have literature indicating that overwhelmingly, health is influenced by a very short list of modifiable behaviors topped by three: tobacco use, physical activity and dietary pattern. Essentially, what we do with our feet, our forks and our fingers. You could modify those three things; you can change people’s fate. I wanted to change those. Smoking cessation, important but relatively simple - a lot of people are working on that. Physical activity: important to me, important to health but also relatively simple.
I like nutrition. It’s complicated; you really need to learn a lot of stuff to be an expert there. So I shopped around and got all sorts of different advice about what does an internist do, who wants to be an expert in nutrition, and used that clinically. Become an endocrinologist, become a cardiologist, become a gastroenterologist, get a PhD in Nutrition about Chemistry. And ultimately I found my way to a Preventive Medicine Residency Program at Yale which allowed me to focus on Nutrition and Lifestyle Factors in the Prevention of Chronic Disease, and the rest is history.
Question: What influenced your medical training?
David Katz: When I went to medical school, I was taught about two basic kinds of diabetes: juvenile onset and adult onset. From the time I did my training in medical school to the end of my residency we were already seeing the transformation of adult onset diabetes into Type II, which is what we call it now, which from my perspective is a euphemism we have draped over this condition to conceal the fact that what was a chronic disease in midlife is now epidemic in children. Frankly, Type II diabetes in a seven year old is adult onset diabetes. We just don’t want to confront that unpleasant fact.
So this was the big picture. This was what was playing out around me. And also I was very much influenced by a seminal publication that came out in 1993 and this was really just at the end of my training in internal medicine. As I was training in preventive medicine, a paper came out in a journal of the American Medical Association called “Actual Causes of Death in the United States”.
Now, up to this time in front of any audience, lay audience, professional audience, it wouldn’t have mattered, if you posed the question: What is the leading cause of death in the United States? Most people would get it right. They’d guess heart disease. They’d either know or they’d guess and they’d be right. And if you pushed them and said “Okay, how about the second leading cause?” they’d usually get that right too and say “Cancer.” By the third, the non-professional members of the audience would start to get a little bit uncertain. It happens to be stroke and then diabetes.
Well, two authors, McGinnis and Foege, published this paper in 1993 that said, “You know it isn’t all that illuminating. When someone dies of a heart attack, to say the cause of that is disease of the heart, there’s not much of a revelation there. What we really want to know is what caused that. What are the underlying root causes of all this pathology?” Well they did the math. They reached the conclusion that of the 2 million deaths that occurred in the United States each year, give or take, roughly half are premature and deferrable by changing this very short list of modifiable behaviors we all control everyday – topped by tobacco use, dietary pattern, physical activity.
I found that extremely compelling. And the people who were ahead of the curve and addressing this issue around me were beginning to say, “Any health care professional who doesn’t address these behaviors, who doesn’t address the influence of lifestyle on health, whatever else you do and however well you do it, you’re at the margins of what matters.” And I didn’t want to be at the margins of what matters. So the rest is history. I dedicated myself to learning everything I could about these lifestyle factors and their influence on health. And in particular, and this remains the challenge today, finding ways to convert knowledge to power. Because the gap between what we know and what we do belies the notion that knowledge is power. There are steps in between and when it comes to preventing chronic disease, we have not yet adequately taken those steps in between.
Question: How can we encourage people to be healthy?
David Katz: I find that one of the more polarizing topics in all of medicine and public health practice is the choice between environmental determinism at one end of the spectrum, and personal responsibility at the other. So we’ve got environmental determinists and at the extreme, I find that new to be something of an “Oh woe is me” attitude. You know, until the world improves enough around me there’s nothing I can do to help myself. And then there are the personal responsiblists who feel that everybody should pick themselves up by their bootstraps, regardless of whether or not they’ve got boots.
My view is, in between environmental determinism and personal responsibility, we say, “where there’s a will there’s a way.” It’s not true. You really need both and they’re somewhat independent. We must both cultivate will and pave the way. If you inspire an impassioned people so that they have the will but there’s no way, all around them are walls with no doors or windows. It’s terribly frustrating. On the other hand, if you put a very nice way at their feet and they have no will to follow it, that doesn’t produce anything very good either. Will is not way. You need both. Knowledge is not power. We need both knowledge and the tools the resources, the policies, and the programs to empower people to use what we know.
In fact, I’m inclined to quote the Spiderman movies. I imagine everybody viewing this is highly cultured and has seen the Spiderman movies. 1 was quite good, 2 is excellent, 3 was a little too complicated. But in any event, in the Spiderman movies, Peter Parker’s Uncle Ben says, “Peter, with great power comes great responsibility.” I think public health requires a corollary to that. Before we ask people to take responsibility and ultimately we must, people have to own their own health. They must take responsibility but before we ask them to, we must make sure they are empowered. So my view of chronic disease prevention of fighting epidemic obesity and diabetes, of turning the tide, is that it is the job of professionals to pave the way and to cultivate the will; to stir people up so that they understand the stakes, so that they recognize that adult onset diabetes stalking children is a clear and omnipresent danger. The wolves are at the door. You must defend hearth and home. And here are the means to do it: we must provide programs, policies, tools and resources so that everybody can do the job.
Question: What’s wrong with our health?
David Katz: We have a society that monumentally conspires against the pursuit of health. We have wave after wave of labor-saving technology that says don’t ever use your muscles for anything, along with messages that you should be more physically active. We have, every year, the introduction of hundreds, if not thousands, of new highly processed foods, the majority of which glow in the dark. At the same time we’re telling people: eat foods closer to nature. And we have crazy hectic routines that wear everybody out without doing any of the physical exertion that would actually good for them. We have schools where we teach children to sit still all day long so they can become adults we can’t get off couches with crowbars.
So there’s an awful lot about our society that is at odds with the basic message of “don’t smoke, be active, eat a healthy diet, and by the way control stress and get enough sleep.” We don’t make those things easy. We ideally would make health lie along the path of least resistance. But if not the path of least resistance, there at least needs to be a path so you don’t have to bushwhack your way there.
Question: How can policies and programs improve our health?
David Katz: If we look at sort of the emblem of our current problem with the lifestyle at odds with health as epidemic obesity and the related metabolic disorders, we can ask the question: How do we fix this? What is the way to fix this? And recently I was asked to give some commentary to a committee of the Institute of Medicine convened to address epidemic obesity and their question was very similar but not quite the same. They asked me how we use evidence to confront the epidemic of obesity. And my answer was: by thinking of a levy.
If we are facing-- and we are-- a flood tide of factors into our daily lives and the lives of our children that conspire against weight control, and for that matter, health, any single policy or program we use to turn the tide is like a single sandbag. You put down the sandbag on the banks of the river. You could ask the question: Have we held back the flood? Well the answer of course would be NO because the question is silly. A sandbag isn’t designed to hold back the flood. A sandbag is designed to be part of a levy to hold back the flood. It doesn’t matter if it’s a good sandbag, maybe a perfectly good sandbag. By itself it can’t fix the problem.
What we need to do now is recognize that it is the sum total of human ingenuity that is responsible for the epidemics of chronic disease. Throughout most of human history, calories were scarce and hard to get, and physical activity unavoidable. Calories are now abundant, and physical activity is hard to get. Why? Because we fixed those problems we always had before. We took an unstable, uncertain food supply and fixed it. Human resourcefulness, human ingenuity has created a stable, reliable food supply. We just overshot. It’s far too big, far too diverse, far too stable. Everywhere we go, we have tasty calories. We used to depend on muscle power for everything. What now passes as exercise and requires specialized footwear used to be called “survival.” You had to do it. Now you never have to do it. We solved the problem of excessive demands on our musculature. We solved it too well. Now we don’t need our muscles for anything.
But that’s an enormous problem. We’re confronting the sum total of human ingenuity over millennia. It’s a pendulum that’s swung too far. We have to swing it back. So it should come as no surprise that solution must be built from the ground up on the banks of this flooding river and it must be raised to a height higher than flood waters. Now what does that look like? It looks like policies and programs that cultivate healthy levels of physical activity, healthy dietary patterns in homes, in schools, in supermarkets, in neighborhoods, in clinics, in churches, in workplaces, throughout our society, every place we can reach people.
Question: How do you motivate people to be healthy?
David Katz: The other thing many people require to avoid a feeling of futility and helplessness is what I refer to as medical absolution.
Somebody whose credentials they believe in telling them, “You are indeed partly responsible for your health and your future, but you are not to blame for the problems you’re having. You’re not to blame if you’re overweight. You’re not to blame that we have epidemic obesity. It’s not your fault.” And I find that with my patients, one of the critical elements in weight loss is setting down that weighty burden of failure and shame. People who struggle with their weight their entire life beat up on themselves. They feel like it’s their fault and honestly, it isn’t.
Tthat doesn’t mean that what they do with their feet and their forks is irrelevant. It’s absolutely relevant, but let’s face it, we have epidemic obesity. Nearly 80% of adults in the United States are currently overweight or obese and a recent publication suggests that should current trends persist by 2048, every adult in the United States will be overweight. Now, do we really believe that every adult in the United States in this generation has less willpower or self-control or is lazier than the previous generation? And do we believe that of our kids as well because they’re looking at similar trends? Are we actually producing kids with less willpower than the kids in previous generations? I don’t buy it and we don’t have a shred of scientific evidence to support it. What has changed is the world around us.
Human physiology and human psychology are pretty much the same as they ever were. The world around us, same as it never was before. Fast food, and crazy schedules, and no time for physical activity, and labor saving technology, and video games, and texting, and all the things that have changed the very nature of the way we get ourselves through our days. And perhaps the lives of kids have changed even more than those of their parents.
Well, you need to tell people it’s not your fault. The metaphor I routinely use for this is polar bears in the Sahara desert. And I point out that polar bears are marvels of survival but they’re adapted to the cold. They can’t do well just any old place. You take creatures adapted to the cold and put them in the heat, the very traits that allow them to survive in one environment will conspire against them in the other.
There is a unique homo sapien arrogance that allows us to talk about the world carved up into natural and manmade as if somehow we’re outside the box. We are not outside the box. We are creatures. We have a link with a native habitat just like every other species. Throughout most of human history, physical activity was unavoidable, calories were scarce and hard to get. In the modern era, calories are unavoidable, physical activity is scare and hard to get. The traits that allowed our ancestors to survive, and let’s face it, the survival of our ancestors is the reason that we’re here because the people who don’t survive and make very crummy ancestors, are our traits. But they’re very much at odds with the modern environment.
So I tell my patients and anybody that wants to listen why you should approach this challenge refreshed, knowing it’s not your fault. We are polar bears in the Sahara with one important distinction: we are smarter than the average bear. Once we identify the nature of the problem, we can think our way out of it. That’s exactly what we have to do. But it begins by acknowledging you didn’t fail because you couldn’t succeed. Because you didn’t even know what the scope of the problem was. It’s not your fault.
I think by distinguishing fault from responsibility, we invite people to take control. So first is: change is possible. Second is basically medical absolution or forgiveness. It’s not your fault. Fault and responsibility are not the same thing. And then the third is to highlight to people, the capacity to own their own medical destiny.
And you have to be realistic about this because, you know, frankly, we don’t control everything. There are genetic influences. There are environmental exposures we don’t control. I cannot guarantee anyone I counsel that by following what I hope is the good advice I offer them, they will live long and prosper. That’s what I’m hoping for but I can’t guarantee that. What I can tell them is this: “Look, I can help you firmly grip the wheel, and you can steer the ship. You’re never going to control the winds and you’re never going to control the seas. But if you sail well you can get through just about anything.”
Topic: The Diabetes Prevention Program.
David Katz: One example of the kinds of programs and the power that we have coming from the research community is the diabetes prevention program. The diabetes prevention program took 3,500 or so adults with pre-diabetes, so we’re really on diabetes’ doorstep, and randomly assigned them to one of three treatments: usual care, drug treatment with a drug called Metformin or Glucophage, and the lifestyle intervention arm. And this study was funded by the NIDDK which is one of the institutes at the National Institutes of Health, or NIH, to the tune of 174 million dollars; big study, important study. It was stopped early after 4 years because the results were so dramatic.
3,500 adults who were going to get diabetes soon. The drug worked very well. It actually prevented diabetes in 30% of those high risk adults; so almost one in three, who would’ve gotten diabetes without that treatment didn’t. Pretty good. The lifestyle intervention however, prevented diabetes in 58%. It was twice as good. Now what was this? Was this some very creative diet? Only eat rutabaga under the light of the full moon while standing on one foot?
Balanced, sensible nutrition: eat food, not too much, mostly plants, a healthy diet ala Michael Pollan, modern physical activity on a daily basis, modest weight loss – translated into a 58% reduction in the occurrence of diabetes. A clear indication of the power of lifestyle over health. The challenge now and many people are working on this, is the development of the community-based programs that will translate what we learned in the diabetes prevention program and put it to work in every town in America. How do we make this play in Peoria? Or New Haven, Connecticut where I come from? Or any other town?
So in our case, we took that program which clearly is the best practice, there’s an educational program attached to the DPP. We said if we can find an inexpensive way to make this infiltrate the community, maybe we can see some of those gains in diabetes prevention where we live.
So we developed a program called “PREDICT – Partners Reducing the Effects of Diabetes Initiatives through Collaboration and Teamwork.” This was funded by the centers for disease control. We worked with African-American churches in New Haven and Bridgeport, Connecticut, to identify leaders in the congregation in the community who would become pure educators. So we trained them in diabetes prevention. We taught them the lifestyle arm of the diabetes prevention program and then we said “Pay it forward. You know your community. People listen to you. People respect you. If you care about this and you’re knowledgeable, you can reach people that we probably can’t.” Coming from academia, they distrust us. You really need to be part of community.
Question: What health programs have you developed?
David Katz: I have five children: four daughters and a son. My son is the youngest. The reason I have five children is that we had four daughters in a row. We thought we were done. Then we came out of retirement to try once more for a little gender balance in the troops and we got Gabriel. Now, Gabe is now ten but when he was five, I gave a talk at Dartmouth, my alma mater, to families in the evening and this was on health promotion. And it was a big auditorium filled with families including my own. So in the front row was my wife Catherine, my four daughters lined up on one side of her, and my then five-year-old son Gabe on the other side who did not want to be sitting still at seven in the evening listening to his dad drone on. So he was very fidgety and basically driving my wife crazy by fidgeting out of his seat. This got completely out of control and I had to excuse myself and say, “Forgive me folks but my son is torturing my wife. I have to intervene.” And I had my son get up, basically, and do a lap around the auditorium to try and work out this restlessness so he could sit still. So he did his lap, came back, sat down next to his mother, and then gave me this impish in-your-face-dad-you-asked-for-it look and took off again and took another lap.
At the end of lap two he never bothered to sit down, he just waved and kept right on going. And three kids got up and took off after him. And when the four of them came around nobody sat down, they all kept going and every kid in the audience under the age of twelve got up and took off after these guys. So we now had thirty-five kids running laps around the audience. To make a story short, what I wound up telling the audience was, you know actually this is much more important than anything else I could be saying now. My son is healthy; I assume your kids are healthy; he’s a healthy five year old boy. Now Lord knows if you’re cooped up with him for any length of time you need to medicate either him or yourself but let’s face it. Rambunctiousness in a little boy is normal. And rambunctiousness should be treated with recess, not riddling. These kids are telling us something.
So looking at that response, just that native, rambunctious response of my son I thought we really should be able to find a way to let kids get up and do exactly this run around for a minute when they need to. A program called ABC for Fitness was born. It stands for Activity Burst in the Classroom. Since that day five years ago, it has been refined by experts in both physical activity and teaching and it is now a detailed instruction manual broken down by grade level and subject matter that teaches elementary school teachers how to take kids through brief bursts of physical activity throughout the day anytime they need it; when the kids are restless, not paying attention, apathetic. Instead of just wasting their time saying “sit still, keep your hands to yourself, pay attention,” take them through an activity burst.
We’ve implemented this in a school district in the Midwest and tested it there. And we found significant improvements in fitness, stable performance on standardized tests, no reduction in teaching time, no increase in the disruptions in the classroom, and a significant reduction in medication used for both asthma and ADHD. You can actually replace riddling with recess if you break recess up so it fits into the school day. The schools have trouble these days finding time for a block of Phys Ed or a block of recess.
So ABC for Fitness is a program developed by my lab that is now in the public domain, free. To the best of our knowledge, we are in hundreds, if not thousands of schools because the program works. It’s very easy, all the materials are readily available and it costs nothing.
Question: How should healthcare be reformed?
David Katz: I think we need two parallel systems of reform right now. We need a disease care reform system. I think basic disease care access and basic access to health care is a human right. I think we should acknowledge it as such. Frankly, if we need a constitutional amendment to put it in the Bill of Rights, if that’s what it will take to prevent us from walking away from this challenge, then that’s what we ought to do. Nobody with a conscience would leave the victim of a shark attack to bleed while we figure out whether or not they could pay for care. That tells us that at some level, health care access is a basic human right. It should be codified as such. And our system should be aligned so that our policies match our morality. And then within that system where everybody has access, we need to incentivize prevention, both for the patient and the provider. There are a variety of ways to do this. I’ll cite just a few.
We have an organization called the United States Preventive Services Taskforce. It’s an independent group of experts who reviewed the literature and identified the evidence based practices in disease prevention that truly work. An example would be mammography. It really works to find breast cancer early and prevent the death that might otherwise result from it. Similarly, colonoscopy, which can actually prevent colon cancer outright because we can find polyps that are precancerous and remove them.
Vaccination. The pneumonia vaccine, the flu vaccine and the variety of immunizations for children of course are highly effective and highly cost effective. So we actually have this bible on clinical preventive services we know can save lives and in many instances dollars as well. Or frankly, we could incentivize the use of clinical preventive services for doctor and patient alike. If a patient is in compliance with recommended clinical preventive services for their age and sex group, we could perhaps waive their co-pays and deductibles. In other words, you could pay for the care you want by getting the care we know you need. It’s basically a link between rights and responsibilities. Yes, you have the right to healthcare access but you have the responsibility to use that access well. And one of the ways to use it well is to use those very procedures we know are most effective at saving lives and dollars. We could incentivize physicians; frankly in the same way by saying, this is really a partnership.
Patients are probably not going to have colonoscopy if you don’t address the issue, but even if you do they may say, “No, thanks anyway doc.” We'll incentivize both of you. Your reimbursement rates will be higher if a certain percentage of your patients are in compliance with recommended clinical preventive services. We can establish routine methods of doing chart review that look for evidence that you're monitoring weight and talking about it. That you're routinely addressing tobacco use, physical activity and diet and that you're using state of the art methods to address this topics. That's not rocket science. We can do that now and with the proliferation of electronic medical records it gets easier. If you are above a certain threshold, if you address this with a certain percentage of your patients, your reimbursements rates are higher, you'll get a bonus.
Question: How can individuals and business work together to promote healthy lifestyles?
David Katz: One interesting anecdote is the whole Atkins diet craze. Atkins, and we needn’t talk about the merits or lack thereof in a just cut carbohydrate approach to dieting although I will note that everything from lentils to lollipops is carbohydrates so that kind of sums up my view on that topic. But let’s face it, it became a very popular diet in particular after a cover story in the New York |Times Magazine: “When Fat Doesn’t Make Us Fat” by Gary Taubes, the diet took often into the stratosphere. It went from millions of readers to tens of millions of readers. What happened? What happened was every supermarket in America filled out with low carbohydrate foods. Frankly most of these are high calorie low carbohydrate crap but it was there for your selection and the interesting thing about this was there was no policy reform, there was no legislation that Congress passed that said very supermarket must offer low carb food. Every supermarket in America filled up with low carb food for one reason and one reason only. You wanted it. Maybe not you personally, we wanted it, our society wanted it. We talk about the food supply as if it’s the Himalayas. As if it’s this immutable thing. It's not.
There is one thing that very reliably try to trumps the food supply and that is food demand. At the end of the day, the business of business is business and they are just trying to keep the customers satisfied, it depends what we want. The problem in our current mess is we want all the wrong stuff. Why do we want the wrong stuff? Because tastes buds are very malleable little fellows. They learn to like what they know. We're bathing our taste buds in too much sugar, too much salt, too much processed food all day long. That’s what they know and crave. This in its own right is a complicated potentially lengthy topic.
The average breakfast cereal is saltier than your diet should be. If breakfast cereals are pulling your average up, what the heck is going pull it down. There are many pasta sauces that have more added sugar than ice cream topping. Should diabetics eat as much ice cream topping as they want but run like hell when they see a jar of marinara sauce? We created a food supply that's pretty cacamimi but the result of this is, you’re getting all this sugar when you eat pasta sauce, just imagine how much sugar you need at dessert time to feel satisfied. So that changes your demand and then the food supply matches your demand which exacerbates your demand which further erodes the supply.
The solution to a lot of these is illumination. Knowing what's actually in your food, knowing how it affects what you prefer because taste buds are malleable little fellows and when they can’t be with the foods they love they learn to love the foods they're with and you can rehabilitate them. You can learn to love foods closer to nature and when you do that you actually taste the salt in breakfast cereal. I can’t eat those breakfast cereals anymore, neither can my family. And neither can most of my patients. You actually taste the sugar and pasta sauce. You won’t want those pasta sauces or those salad dressings. And when you rehabilitate your diet and your taste buds, you need a lot less sugar at dessert time to feel satisfied. And you need a lot less salt when you're salting things to feel satisfied. Your demand changes, suddenly you're shopping for different foods. Well, now you do that all by yourself? You're going to have to work hard with the current food supply to find what you're looking for.
But if we can make the identification in selection of helpful foods, the cultural norm we could make it a craze, the way the Atkin's diet was a craze. Every supermarket in the United States will reliably fill up with more wholesome food to satisfy the demand. So one anecdote is the natural experiment. We had the Atkin's diet, it made people want low carb food. Whether it was an enlightened desire is a different story but people wanted it, the supplier made it available. That’s very encouraging. Now all we need to do is get everybody to want nutritious food and I suspect the food supply will come around.
Question: How do we encourage people to eat more nutritious food?
David Katz: In 2003, I was invited by then Secretary of health Tommy Thomson as part of a group of 15 to come to DC sit around the conference table with the secretary, with the commissioner of the FDA with the heads of the NIH and CDC and certain general and go around the table take a turn and offer up a suggestion as to what the FDA could do to combat the trends in obesity and diabetes. So I was there, I participated. It was a great privilege and when my turn came I said, “Mr. Secretary, Mr. Commissioner, Mark McClellan at the time, we need a food supply for dummies. We got everything for dummies in this country. We need a PhD in Nutritional Biochemistry to know which bread to buy if you care about the health of your family.
Now I know this, not any PhD will do because my wife has a PhD from Princeton in neuroscience. But it's not Nutritional Biochemistry. Now, she's a very smart woman, we have five kids, she's been married to me for twenty years. I very much doubt there's too many more sophisticated shoppers in the entire country. And she knows everything there is to know. Even she, periodically comes home from the supermarket with smoke coming out of her ears because she'll say, “David, I know you want the most nutritious bread but listen bud, this one got the most fiber but also has the most sodium, this one has less sodium doesn’t have quite as much fiber but it has high fructose corn syrup, this doesn’t have the high fructose corn syrup it’s got intermediate high fiber, less sodium and although it says euro gram trans fat on the front, it says partially hydrogenated oil in the ingredient list. You want the most nutritious bread, you figure it out which one it is.” Well, that’s just too hard.
We need the food supply for dummies. Convene a multidisciplinary panel of the best nutrition public health experts in the land, give them the support they need, and let them take everything we know about nutrition and express it in symbols as simple as ABC, 123, green, yellow, red, put it in the front of every bag, box, bottle, jar, and can in the food supply so that everyone is a nutrition expert. And then when people know what is truly better for them the question will be, will they care? Let's work on making them care. Let's get out and tell them how much this matters. ‘Cause if they care and they know then they can act. And if they act, if they change their demand, if they voted every cash register in every supermarket in the country, the food supply will change. Because all they really want to do at the end of the day is sell their products and make the customers happy. If it takes something different to make the customers happy, this immutable thing, the typical American diet, the food supply will change. We can change it.
Well they said, “Thanks for coming Dave, don’t call us and we probably won’t call you.” That’s pretty much what happened. Because what we have is the problem between the food supply the way it exist and the entanglements between for example the department of agriculture and large agri-businesses. You know, there’s always a great deal of incentive to preserve the status quo. The military industrial complex, we all heard about that. So the status quo is self perpetuating, but I got to be in my bonnet after that discussion. I thought, “If the secretary and the commissioner, the FDA or the IOMs isn’t going to do this, it ought to be done nonetheless.” So I did it.
I was very privileged to be in a position where when I called upon my colleagues to work with me, to develop such a system, just about everybody I asked said, “Yes.” The President of the American Cancer Society past presidents of the American Diet Ethic Association, the American Diabetes Association, the Inventory of the Glycemic Index, the Chair of Nutrition at Harvard, the Elite of Nutrition in Public Health came together, and we worked together for two years and developed the overall nutritional quality index which takes 30-50 nutrition entries, puts them through an algorithm that is basically 18 pages of completely mind-numbing computer programming for which I’m primarily responsible. But at the end of all that complexity, spits out a number between one and 100. The higher the number, the more nutritious the food. That simple. A food supply for dummies. At this point, NuVal is available in over 500 supermarkets around the United States.
Recorded on: July 06, 2009