The following is a conversation between Dr. Dariush Mozaffarian, Dean of the Friedman School of Nutrition Science and Policy at Tufts University, and Denver Frederick, Host of The Business of Giving on AM 970 The Answer WNYM in New York City.
Dariush Mozaffarian, M.D., Dr.P.H., Dean
Denver: The long-held belief that white meat is less harmful for your heart than red meat may still be the case, but new research, which indicates they have an identical effect on your cholesterol level, has confused many consumers. And when it comes to food nutrition, there are a number of things that we are simply unclear about. So, to bring some clarity to all of this, it’s a pleasure to have with us tonight Dr. Dariush Mozaffarian, the Dean of the Friedman School of Nutrition Science and Policy at Tufts University.
Good evening, Dr. Mozaffarian, and welcome to The Business of Giving!
Dariush: Hello, Denver. Nice to be on the program.
And so, if you put that together – health, sustainability, social justice, massive, massive dollars costs for our government and for businesses, and national security – this is truly a global crisis…We can fix this incredible crisis in 10 or 20 years if we all get together and pull for effective change together.
Denver: You have said that there is a national, in fact, a global nutrition crisis, and I know you don’t use those words lightly. What are the dimensions of that crisis?
Dariush: I think everyone is starting to understand and have this sort of uneasy gut feeling that the food system is making us sick, but the true scope of this is beyond most people’s wildest nightmares. Our food that we eat is now the single leading cause of poor health in our country and globally, and that’s due to a combination of undernutrition, but mostly chronic diseases like obesity, type 2 diabetes, heart disease, stroke, and certain cancers. And so, if we care about health, this is the single leading health issue on our planet– is what we eat.
In terms of effects on sustainability, our food is the single biggest, again, issue for sustainability on the planet: about 30% of all climate change gases come from how we grow our food; 70% of the world’s water use; 90% of deforestation; stress to the oceans; and stress to topsoil. And so, if you put all that together, this is — we’ve been talking about solar panels and energy and cars — agriculture and food is the biggest single issue for sustainability.
This is a huge issue for social justice and… equity. People around the world and our country and elsewhere who are disadvantaged in various ways tend to have the worst foods and the worst diets, which make them sick. Kids can’t learn in school; you don’t concentrate well; parents get sick, and that leads to this vicious cycle, keeping people in poverty.
On top of those things, which are quite stunning, the health and sustainability implications lead to enormous economic costs, and so in our country… but really around the world… the economic consequences of this are just starting to be realized. And so for health care costs in our country, almost one in five dollars in our entire economy is spent on health care. In the federal government, 28% of all federal spending is on health care. And for many businesses, their number one concern is rising health care premiums for their employees, and that is being driven by diet-related illness. And so, there’s an economic imperative. Our country and the world are going to be swallowed; the economies are going to be swallowed by this tidal wave of diet-related disease, in particular obesity and type 2 diabetes, unless we do something about it.
And then, lastly, in terms of a crisis, this is not often brought up, but this is a national security crisis. There’s a group called Mission: Readiness — 750 retired generals and admirals; four-star, three-star, two-star military leaders who’ve declared childhood obesity a national security crisis because we don’t have enough fit young men and women to join the military. And for thousands of years, governments have recognized the importance of nutrition for having a healthy military, but somehow, in our country now, this has been forgotten.
And so, if you put that together – health, sustainability, social justice, massive, massive dollars costs for our government and for businesses, and national security – this is truly a global crisis. I’m an optimist; I don’t want to be all doom and gloom. We can fix it. We can fix this incredible crisis in 10 or 20 years if we all get together and pull for effective change together.
Denver: Absolutely. Well, let’s dig in a little bit, and let me start with calories. Has there been an overemphasis on calories in recent years? Because when I go to the store – it’s not that often to tell you the truth – but boy, on the packaging you see calories listed the way you never did; you certainly get them in restaurants.
So, I was just wondering what you thought about calories. Is a calorie a calorie? Or does it really depend on where you get that calorie from?
Dariush: One of the most exciting things is how rapidly the science is advancing. We’ve only been focusing on food and nutrition and chronic diseases – again, like obesity, diabetes, and cardiovascular diseases – we’ve only really been focusing on it in modern science for, let’s say, 30-, 35 years …serious focus. So it’s a very new science. And this partially explains the changing signs and changing messages that consumers receive. Science has actually advanced and changed.
For calories, this is very controversial. I have my own views on the science, but many people disagree with me. So I think this is a hot, controversial area right now. And I believe, if you look at all the evidence together, that you cannot judge a food by its calorie count. Of course, in a Bunsen burner, you take foods and measure their calories, and yes, that’s the right number. You can’t violate the laws of physics; calories are calories, burned in isolation.
But food has information in it that changes how our bodies respond to it: it changes our brains; it changes our microbiomes; it changes our insulin and glucose responses; it changes our liver fat production. And there’s even evidence that what we eat changes the energy we burned; so what you eat changes our metabolic rate. And so, if you put all that together, I think it’s very, very clear that a focus on calories is misleading for the consumer, that it’s much, much better to eat a thousand calories of healthy food than 750 calories of unhealthy food for long-term weight.
Now, short-term, of course, if you count calories short-term, and you count calories and you just focus on that, you’ll lose weight for a few weeks or a couple of months, but your body will start fighting back. We have so many pathways in our body to maintain our weights that have been hardwired into us as humans that our body will fight back. And so, we have to eat foods that help those natural pathways maintain our weights and avoid foods that hurt those pathways.
We can talk about what those foods are; that’s the trillion-dollar question. But I believe that a focus on calories alone has actually been misleading and, in some cases, actually led people to harmful decisions and purchasing of harmful foods because they’re focused on calories rather than quality, and I think quality is what matters most.
Denver: Well, let’s go to the trillion-dollar question. I know there’s always a danger of being reductionist here and trying to be simple in terms of what the shorthand is, but with that being said, what would you consider to be a good diet?
Dariush: This is a thing that I haven’t figured out how to answer in one or two words. And so people say plant-based or vegetarian or natural or organic. Unfortunately, none of those single words addresses the complexity.
And so, the way I look at it is: there’s sort of three buckets of foods. There’s a bucket of really healthy foods that we should be seeking out and eating as much as we can because it’s good for our general health and seems to be linked to lower risk of diseases across multiple dimensions. There’s a bucket of foods that’s kind of neutral. It’s not as good as those healthy foods, but they’re much better than really bad foods, and we should be eating some neutral foods for a variety and fun and other things. And then there’s a third group of really harmful foods that we should be avoiding.
And I’ll kind of go through what foods are in those groups, but to me this is the opposite of the message of: “everything in moderation.” Everything in moderation is not correct because we want to eat as much as we can of the good foods; eat the neutral foods kind of in moderation, and then minimize and really consider as treats or occasional foods the foods that are bad for us. Everything in moderation is kind of an industry message, right? You can eat doughnuts in moderation and soda in moderation and French fries in moderation. No, you don’t eat those things in moderation; you minimize those things.
So, in the group of foods that I think is really good for us, what I would describe them as is a little technical, but I would describe them as minimally-processed foods that are bioactive rich, or rich in these trace compounds that seem really good for our bodies. Most of them, interestingly, are foods that are what I say are foods that give rise to life. You can plant them in the ground and they’ll give rise to a new plant life. And if you think about what a new plant life needs, this gentle little shoot coming out of the ground in the harshest of conditions, the thousands of compounds that these foods have to nurture that new plant life is what our bodies need as we grow and we age.
So, things like nuts, seeds, fruits, beans and whole grains. Those are all things that give rise to life. And even vegetables. Most vegetables that I think of as really healthy are actually fruits. And so, squash, eggplant, cucumber, tomato, pumpkin, avocado, and olives; those are all fruits. And the oils from these plants. They’re actually fruit oils or nut oils. So, olive oil is a fruit oil; avocado oil is a fruit oil; canola oil is a bean or seed oil. So those are foods that give rise to life: fruits; nuts; seeds; vegetables, many of which are actually fruits; whole grains; and beans are in the top category. And the other two foods that I would put in that top category is fish, because of its omega-3s, and yogurt, because of its probiotics.
In the middle category, foods that seem kind of neutral include foods like cheese, eggs, milk, poultry – chicken, turkey, things like that – butter, and even unprocessed red meats. Fresh red meats that’s not preserved is probably kind of in the neutral category. Now, of course, there’s a grading in there. So unprocessed red meats are probably a little bit worse than some of the other foods in there, and cheese actually might be a little bit better than some of the other foods in there if it’s fermented – fermented hard cheeses. But as a class that’s kind of neutral foods that, sure, you’re better off eating a blueberry or eating a carrot or eating a bean, but once in a while you want to have an egg, or you want to have a piece of meat once a week or something. Have butter once in a while; that’s okay.
And then the worst stuff, the stuff that we should really be avoiding is really the hyper-processed foods that are rich in starch and sugar. I say starch because the country and the world is starting to really focus on sugar, but we’re missing starch, and starch is just glucose. So white bread is 100% glucose. Cornflakes is 100% glucose. A potato is almost 100% glucose if you don’t eat the skin. So, starch is really a big problem.
So I think all of these hyper-processed packaged foods that are rich in starch and sugar, and even things like white bread and white rice and crackers and breakfast cereals that are just really starch and sugar, that don’t have a lot of true whole grains and high fiber, those are the things we should be avoiding. So that’s not a short answer that fits on a bumper sticker, and so it leads to a lot of confusion about what’s healthy.
Denver: Let me ask you about Beyond Meat and some of those other plant-based substitutes, including the additives, to make them taste like meat and have the texture of meat. Have you done any preliminary research or have initial thoughts on that?
Dariush: One of the first things we need to understand is: if there are health harms of meat, what is it in the meat that’s harmful? And for decades, guidelines have focused on the fat– lowering the saturated fat; lowering the total fat. Eat lean meats; eat nonfat dairy and other things. Again, this is very controversial. Many smart people that I respect don’t agree with me, but I think that most of the evidence shows that it’s not the fats in meat that are actually that harmful; it’s probably other things. And the most harmful things about meat seems to be the processing and preserving of some kinds of meats like bacon and salami, and even all the low-fat deli meats that you see at work luncheons– all the sliced pastrami and turkey and other things that are highly processed.
My current thought is that most of these processed plant-based meat substitutes are good for the earth because we’re not producing cattle, which take up a lot of resources; so they’re better for the earth. I won’t say they’re good for the earth. They’re better for the earth. But whether they’re better for humans, I think, still needs to be understood.
Denver: Why can’t we do something about this processing? I mean, it would be nice to be able to eat those things, but you can’t because they haven’t been able to figure it out… the processing.
Dariush: Well, this is all new science, and so I think this is so controversial, but to me I think that it’s the sodium and the nitrites and the high-temperature cooking and other processing of these meats that’s harmful. I think it’s mostly sodium and nitrites, but there’s controversy about that. But I think, absolutely, the public should demand the meat industry should figure this out, should pay for the research, understand what’s harmful in those meats so we can take them out, and we can all eat our bacon and enjoy it. How great would that be, right? If it’s not the meat itself, but it’s how we’re processing it… if we could figure that out, I think that would be really important.
So that leads us then to: are these other plant-based alternatives healthy? It depends on what’s in them. And so if they’re loaded with sodium or nitrites or other preservatives, then no. Even heme iron. Some of these versions, they’re happy that they were able to put heme iron in the plant-based protein because heme iron gives it that red color and kind of taste, but too much heme iron– which is what makes red meats red– seems to be a factor for increasing risk of type 2 diabetes when people eat meat more than, let’s say, once a week. So, we really have to figure this out.
My current thought is that most of these processed plant-based meat substitutes are good for the earth because we’re not producing cattle, which take up a lot of resources; so they’re better for the earth. I won’t say they’re good for the earth. They’re better for the earth. But whether they’re better for humans, I think, still needs to be understood.
It’s a win-win if we figure out how to help industry make those protective foods, make them less expensive for consumers, lower healthcare spending, and use those dollars to go back to the consumer and the companies to make it economically viable… That’s a win-win solution.
Denver: Let me ask you about government policy, and I probably know the answer to this already, but is government policy keeping up with the science?
Dariush: Well, yes and no. I mean, things are changing pretty fast in the scale of centuries, right? So in the scale of compared to 50 years ago, there are–I don’t know–now 15 countries around the world that have soda taxes. Chile has one of the most comprehensive programs with black box warning labels, restrictions on marketing to kids, other things. The US School Lunch Program, following the 2010 Healthy Hunger-Free Kids Act, is much better than it was before; although, of course, there’s still room for improvement. Food stamps now has fruit and vegetable incentives in it that help the low-income Americans buy fruits and vegetables.
So there are lots and lots of policies that are better today that weren’t in place 10 years ago. But that being said, I’d say we’re 5% or 10% of where we need to be. A lot of our policies are still focused on kind of fat and calories and sugar and salt, thinking about this kind of reductionist approach to food, and I think we need to shift our policies more and more toward increasing the consumption of protective foods, that first category of foods that I described. It’s a win-win if we figure out how to help industry make those protective foods, make them less expensive for consumers, lower healthcare spending, and use those dollars to go back to the consumer and the companies to make it economically viable…. That’s a win-win solution.
So, I think that the major focus of the 21st century should be on how to get protective foods to everybody in the population, and how to reap the economic benefits of that through less diabetes and obesity and cardiovascular disease and cancers.
Denver: Would a lot of that be done through tax policy?
Dariush: Economic policy would be very straightforward and would be a quick fix. So if you taxed, let’s say, most ultra-processed foods, and then use all of that tax to subsidize, at the retail level even, minimally-processed, bioactive-rich healthy foods like I described, you would change incentives overnight for everybody – from agriculture, to retai,l to restaurants, to producers, to the customer – but that’s a really tall political ask. And again, other countries are taxing soda, so that’s a start. But, unfortunately, they’re not mostly using that to subsidize healthy foods. I think if you’re going to tax any unhealthy food, all of that money should be used to subsidize healthy foods because then that helps low-income purchasers. You’re taxing their unhealthy purchases; at least help them buy healthier foods.
So I think tax policy is important, but in this country, it’s a ways away at the national level, but I think there’s other things that could be done. So, again, the feeding programs like SNAP, the food stamps program, that could be used and you could figure out incentives and disincentives within SNAP; you have the VA system; you have health care.
One really interesting and new phenomenon, Denver, is fruit and vegetable prescriptions in health care. So having your doctor write a prescription for fruits and vegetables, and in some cases, whole grains and fish and chicken, and you go out and you use that prescription and you get free or discounted food, that’s being actually implemented now in private healthcare systems around the country with great results.
And in the farm bill that was passed, the federal government getting involved… there’s a $25-million program to test this nationally. So the federal government has put $25-million in the farm bill to test these healthy produce prescription programs in healthcare. So imagine in five years, you go to your doctor; instead of just writing a prescription for a super expensive drug with side effects, they give you a prescription for healthy food.
Denver: That’s a great idea. It’d be nice if all this information was included on your electronic medical record, I bet.
Dariush: You’re really spot on. One of the great ironies is the number one cause of poor health – bad nutrition – is not captured in the health record, and that single fact, plus it’s not captured in medical education. If you think about that, our doctors aren’t learning about the number one cause of poor health, and our electronic health record is not capturing it. That explains a lot of where we are today in the healthcare system.
If we had a concerted national effort to really address the most fundamental nutrition questions of our time in the United States, we would become the world’s leader for a 21st century bread basket of healthy food that’s good for people and reduces health care costs, and good for the planet.
Denver: And you’ve been a big champion of the National Institute of Nutrition. Tell us about that and what kind of progress we’ve been able to make.
Dariush: What I think we need is a real kind of moonshot for nutrition research. We need to understand these questions. I mean, people ask me–I’m a cardiologist. I’ve studied nutrition all of my career, and I can’t answer some of the most basic questions people ask me because there hasn’t been enough science. And so we know a lot, but there’s even more that we don’t know.
And so you asked me the question about processing of meats: what’s harmful in them? I should know the answer to that question, and I don’t. People ask me, “Is dairy toxic?” or “Is yogurt and cheese good for you?” I don’t know the answer to that question. I have my thoughts and ideas based on the research, but I don’t know the strong answer to that question because of insufficient research. Is cocoa a health food? I think so. I eat dark chocolate every day, but can I say that conclusively? No. Are garlic and turmeric good for cancer or anti-inflammatory? How does food affect our microbiome? What about personalization? What about my own diet for me? There are so many fundamental questions, and we’re not going to answer these questions for another 50 years at the pace that we’re going, if ever.
If we had a concerted national effort to really address the most fundamental nutrition questions of our time in the United States, we would become the world’s leader for a 21st century bread basket of healthy food that’s good for people and reduces health care costs, and good for the planet. That would put our economy into overdrive instead of tech. This is the century of food. The 20th century was a century of tech; I really think this is a century of figuring out food. And so the country that does this, the companies that do this, are going to be leaders and make trillions of dollars.
And so, I think that we need a national effort. The National Institutes of Health is an unbelievably powerful, positive force in our country. It leads to incredible research that drives discovery in our economy, and there just isn’t a focus on nutrition. So I do think that a clear and strong focus at the NIH on nutrition would pay enormous dividends to our country.
We have to be sure that there’s sound science in these innovations and that the things that we’re making are actually better for us.
Denver: I can’t agree more. And when you look at the numbers, the amount of money that’s being spent on research, and compare it to the advertising that a candy company does, it is like night and day. It is absolutely dwarfed.
Well, let me close with this, and picking up what you just said, is there a food revolution occurring, or is there one on the way? And if so, what do you think our diets are going to look like, let’s say, a decade from now?
Dariush: I think there’s absolutely a food revolution occurring. The average consumer is no longer buying sort of the traditional brands. The sales of all kinds of the conventional brands are going down, and an interesting thing has happened. For most parts… sectors of our economy, big companies are more trusted. You go to the big companies to get the product that you trust, and that was true in food in the ‘60s and ‘70s. People trusted those big food companies. Now, the reverse is happening, whether it’s agriculture, retail, restaurants, or food manufacturers: consumers aren’t trusting the big companies anymore because they feel like they’ve been hoodwinked a little bit. All of the growth is these small innovative companies.
Now, the consumer is asking for three things: health, transparency, and sustainability. Especially millennials, this is really powerful in millennials. So there’s definitely a food revolution happening.
Now, what I’m worried about is that most of these small, new companies that are going to turn into the big companies of the future don’t have their science quite right. And so they’re trying to do the right thing, but if we go from gummy bears to organic gummy bears, I don’t see that as progress. That’s a real product, I’m not making that up. And so, we have to be sure that there’s sound science in these innovations and that the things that we’re making are actually better for us.
That’s what I’m worried about. I’m not worried that a food revolution is not going to happen; it’s going to happen. The big companies that are here today may not be here in 20 years if they don’t change quickly. Kraft Heinz is an example of that. Huge drop in their stock price this year, massive decline. But I’m worried that if in 20 years, we sort of use junk science, we might be where we are today in terms of health or even worse.
Denver: All so interesting.
Well, Dr. Dariush Mozaffarian, the Dean of the Friedman School of Nutrition Science and Policy at Tufts University, I want to thank you so much for being here this evening. Where can people go to learn more about the things we just discussed or look more closely at your research?
Dariush: So, of course, please feel free to come to the Tufts University website and the Friedman school website. We have lots of information about these things. The Tuft’s also has a monthly newsletter, the Tufts Health and Nutrition Letter, which covers these kinds of issues for people.
I think that there’s good information on other websites at other universities. I would be very skeptical of information that you just read from a blogger or a book author because they usually have an agenda to sell books or get people to their blogs, and that means usually hyping things more. There are some good ones. I don’t want to say they’re all like that, but there’s so many.
So I think: go to a trusted university website that has a strong program in nutrition. Most government/ USDA websites have sound information as well. There’s some kind of outdated stuff here and there that people are trying to find and fix, but get your news from a trusted source.
Denver: Fabulous. Well, thanks, Dr. Mozaffarian. It was a real pleasure to have you on the show.
Dariush: Thank you so much, Denver.
Denver: I’ll be back with more of The Business of Giving right after this.
The Business of Giving can be heard every Sunday evening between 6:00 p.m. and 7:00 p.m. Eastern on AM 970 The Answer in New York and on iHeartRadio. You can follow us @bizofgive on Twitter, @bizofgive on Instagram and at www.facebook.com/businessofgiving.