Dr. David Katz is the founding director of the Prevention Research Center at Yale University and President of the American College of Lifestyle Medicine. Dr. Katz has published over 200 scientific articles and textbook chapters, and 15 books on preventive medicine and nutrition. His numerous contributions to health promotion, behavior modification, holistic care, and evidence-based interventions have earned him a place as one of the 100 most influential people in health and fitness for the past four years.
Food Tank had the opportunity to speak with Dr. Katz about his work in preventive health, integrative medicine, and nutrition, and how we can make food choices that support both human and environmental health.
Food Tank (FT): Can you talk about how you became interested in preventive health, integrative medicine, and nutrition?
David Katz (DK): I think it all comes down to an inability to stop seeing the forest through the trees. In clinical care, for instance, the desire to lose weight, better control diabetes, sleep better, or be less fatigued is almost inevitably subsumed within a cascade of influences. For instance, diabetes may occur in the context of weight gain; which in turn may occur in the context of sleep deprivation; which may in turn occur in the context of stress, anxiety, and chronic pain; which in turn may be related in whole or in part to a toxic marriage, a horrible job, kids in some kind of trouble, or almost any of the slings and arrows of outrageous fortune. Modern medicine is extraordinary when reductionism is the right way to go, but all too often at the cost of missing the big picture—the forest through the trees—or per that famous parable about Blind Men, the elephant in the room. For me, integrative medicine was simply a way to operationalize the holistic care that is so essential, and so often neglected. It also allows for careful, responsible, yet creative decisionmaking with patients in those all-too-common patches where human need goes on, but the results of good Randomized Controlled Trials run out.
Preventive medicine is far more fundamental to who I am and what I do; it is, really, an entire philosophy while integrative medicine is more a matter of methods.
While completing my training in internal medicine and spending over 100 hours a week in the hospital, I was overcome by the relative futility of our efforts. We were, in essence, all the King’s horses and all the King’s men (and women), just cast in the guise of all the hospital’s resources and personnel. And we could not put Humpty Dumpty back together again, by which I mean, we generally could not restore health and vitality once they were gone. You simply cannot unscramble an egg. We were good at treating things; we could hold death at bay; and every now and then, we had a real triumph. But mostly, when vitality was gone, it was gone for good.
The answer that asserted itself to me was: back, to the future. In other words, these desperately sick, hospitalized people needed to go back in time, a decade or several, and live differently—to secure a much better future than the present they had. That was not possible for them, of course, but it was certainly possible for the next crop of us, and the next…
I never wanted to stop tending the sick, but I knew it would be a whole lot better to help a whole lot of people avoid getting sick in the first place. I started shopping around for ways to play that role, found preventive medicine, and the rest, as they say, is history.
As for the focus on nutrition, that was simply a matter of being where the action was. Just as I was completing my Master in Public Health and my Preventive Medicine Residency at Yale in 1993, a paper came out in JAMA entitled “Actual Cause of Death in the United States”. I had been headed in this general direction already, but this paper indicated clearly and compellingly that tobacco, lack of physical activity, and poor diet together accounted for roughly 80 percent of the annual toll of premature deaths in the United States. By extension, fixing these—daily use of feet, forks, and fingers, if you will—could prevent some 80 percent of premature deaths, and the chronic diseases leading up to them. That was a compelling invitation to focus on this cluster. The preferential focus on diet is for the obvious reason: the other two are far simpler. It is in the area of diet where there is the most work to be done to clarify what is “best,” and how to put what we know to good use. Since the publication of that paper in 1993, a bountiful, consistent literature has reaffirmed that basic message with the reliability of a drumbeat.
FT: In 2000, you founded the Integrative Medicine Center (IMC) at Griffin Hospital, which you are currently the director of. What inspired you to found the holistic center?
DK: This has been a very important endeavor to me, and by establishing this model, and running a training program in evidence-based Integrative Medicine for Naturopathic physicians, I think we have left a permanent imprint on this space of which I am proud. But that said, other matters have taken over my life to the point where at present, for the first time in 25 years, I am not seeing patients. So, my attention is principally directed to leveraging the power of lifestyle for health promotion and disease prevention.
FT: You were the nutrition columnist for O, The Oprah Magazine. How did your column, "The Way to Eat" guide readers to establish healthy eating habits?
DK: I was honored to contribute a monthly column for eight years. Now, my writing on the topic is found in my blogs for LinkedIn, The Huffington Post, U.S. News & World Report, and About.com.
My basic platform is that the fundamentals of eating well are very clearly established on the basis of vast and consistent evidence, and are supported (and practiced) by a who’s who in nutrition, public health, and medicine. On that basis, I am devoted to getting past the pseudo-confusion about diet our culture propagates for profit, helping the public know what the experts know (and do) and deriving enormous benefit from it, for public health, and the planet alike. Fortuitously, the dietary theme most conducive to human health is much better for the planet than the patterns that are now prevailing, and propagating—so we can do enormous good, in many flavors as it were, by eating in accord with the evidence.
My perspective here is not at all about ideology; it is all about epidemiology. I am simply following where the evidence leads. I have had the privilege, and obligation, to look at the evidence from altitude—both while writing the three editions of my textbook, Nutrition in Clinical Practice, and in writing papers such as the review commissioned by Annual Review of Public Health, “Can We Say What Diet is Best for Health?”
FT: You and your wife Catherine developed The Nutrition Detective Program to emphasize the importance of healthy nutrition at a young age. How has your program been received by elementary school students and their parents and are there plans to expand the program?
DK: This was really a classic case of “think globally, act locally.” Nutrition Detectives, a food label literacy program, was born when one of my own daughters asked me to speak to her elementary school class about nutrition, and I asked Catherine what I should say! We came up with the initial program together, but then it evolved. It evolved into a robustly proven, validated way to teach kids, and their parents, how to identify and choose more nutrition foods.
We now offer Nutrition Detectives as a free DVD available in English and Spanish. We have given away over 50,000 of these, and the program is active in schools and households in countries all around the world.
We also extended this work into the area of nutrient profiling, an even "easier" way for people to identify and choose more nutritious foods. I led the team that developed the Overall Nutritional Quality Index algorithm, available as NuVal in nearly 2,000 supermarkets throughout the United States. This is, to the best of my knowledge, the world’s most robustly validated nutrient profiling system.
FT: How can individuals advocate for preventive medicine in a healthcare system that spends the majority of its resources on alleviating health issues after they manifest themselves?
DK: To some extent, each of us can take such matters into our own hands. Preventive medicine is much about lifestyle, and lifestyle is the choices we make for ourselves, and our families. So, no matter what the health care system does, we can ‘practice’ preventive medicine ourselves to some extent.
But we can also nudge doctors and the system in that direction by saying at every opportunity: I am interested in doing all I can to be healthy and vital. What should I be doing that I am not? The more the healthcare system hears that patients care not just about disease care, but actual health care, the greater the opportunity for movement in that direction.
There are organizations devoted to this space, notably the American College of Preventive Medicine and the American College of Lifestyle Medicine. So support us, and look to us for guidance in this critical area.
Finally, of course, we are all citizens of the world, and can express our support for policies we favor. What we say, and how we vote, can be directed to the support of policies that put physical activity into daily routines rather than taking it out; that make healthy food more accessible and affordable; and that factor in sustainability. We should vote with our feet and our forks every day. And we should vote at the voting booth, too!
FT: How can Food Tank readers make nutrition choices that contribute to their own health as well as a healthy, sustainable food system?
DK: First, they need to know that the fundamentals of healthy eating are not controversial. This is a case I have made many times in many ways, but here, I will simply let a global coalition of experts speak for me. The Council of Directors of the True Health Initiative is a who’s who in nutrition, medicine, public health, environmental impacts, the culinary arts, and more from 30 countries with devotions ranging from vegan to Paleo, who have come together to say: We Agree!
We agree about the fundamentals of eating well, and we agree that those fundamentals are conducive to the health of people and planet alike. The basic principles are spelled out in the pledge taken by all members of the True Health Coalition.
So, the basic truths here are very clear, and pretty simple. The trouble is: simple does not mean easy! It is not easy to eat well in a modern world that peddles junk food so aggressively, and effectively. But a whole lot of good can begin by rallying around a common understanding. It is the first step. Then, we can do our best to act on that understanding as individuals, and families. And when enough of us are doing that, it becomes something else altogether: culture change. Please join in that movement, by adding your voice to the True Health Coalition.