it's a pleasure to be here with all of you and approve village and in honor August company and it's not just particularly nice to be here with the leadership both of the University and the city but when you are a public speaker you're in public and you speak and all too often that's both where it starts and where it ends but the real motivation in public speaking is the action that might follow and for that you need champions and you need leadership so when I tell you it's an honor president cost and mayor to be here with you I mean that quite genuinely and I thank you all for the opportunity the other thing I wanted to say is I love dolphins the gray was an easy match I do have to say that the pastel green and I'm sort of guessing it that was a little outside my customary color wheel but I can learn to love it I think so thank you very much it was six men of in distiller nning much inclined who went to see the elephant though all of them were blind that each by observation might satisfy his mind the first approached the elephant in happening to fall against his broad and sturdy side at once began to bawl god bless me but the elephant is very like a wall ii feeling of the tusks cried home what have we here so very round and smooth and sharp to meet his mighty clear this wonder of an elephant is very like a spear the third approached the animal and happening to take the squirming trunk with in his hands thus boldly up and spake i see quote ii the elephant is very like a snake the forth reached out an eager hand and felt about the knee what most this wondrous beast is like is mighty plain quoth he it is clear enough the elephant is buried like a tree whoops was very like a tree v who chance to touch the ear said he in the blindness man can tell what this resembles most deny the fact who can this marvel of an elephant is very like a fan the sixth no sooner had begun about the beast to growth then seizing on the swinging tail that fell within his I see quoth he the elephant is very like a rope and so these men have in distend disputed loud and long each in his own opinion exceeding stiff and strong though each was partly in the right and all were in the wrong so often theologic wars the disputants i ween rail on in utter ignorance of what each other mean and prate about the elephant not one of them has seen well my friends I fear were prone to much the same tendency in epidemiology nutritional epidemiology in particular so my mission here in the time we spend together is to convey the view from altitude the big picture the forest through the trees or if you will the elephant in the room now when you look from altitude whoops little hard to control this when you look from altitude you see the menu and there is I concede a potential liability in that and that's the possibility of overlooking the needs of just the one so while I will spend my time this evening talking about the big picture the basic care and feeding of Homo sapiens if you will I think it's important to acknowledge that one of the prominent trends in modern medicine is personalization and I can make a bow to that yes that too is important so for instance my good friend at Stanford University Christopher Gardner and his colleagues has run studies where they put people on all the different popular diets to see who loses the most weight and who has the greatest improvement in their metabolic profile but dr. Gardner is not interested in which diet wins because no diet wins all diets work all diets fail there's really not much of the difference what he's interested in is why this some people do well on any given diet and why do other people on the exact same guy do less well and they might do better on a different type can we customize so he's now running a trial called diet fits looking to customize dietary prescriptions to genetic profile and I think that kind of research is full of promise similarly fascinating study in the very prominent journal Cell demonstrating that glycemic responses to the same foods those are blood sugar responses after a meal very depending on the composition of the microbiome so this kind of customization is absolutely where personalized medicine nutrigenomics microbiome --ax can help take us but I don't think we need to talk anybody into that everybody's sort of waiting for that so as we think about the many we can acknowledge that there is a great deal of human diversity and that it's relevant to the things we do with diet and lifestyle but out of many one one am I supposed to aim this in a particular direction e pluribus unum out of many one and I think what we tend to overlook is that we are many individuals but we are one species one great big human family and I don't really think we need to choose I think there's a basic theme of healthy living that pertains to us all and we can customize within that theme in other words this little girl can have her watermelon and eat it to correspond with her genetic polymorphisms - and so that's the case I'd like to make this evening so on the menu we started with elephant bits we considered a pluribus unum will now talk about the dark wood Archimedes lever a fork in the road which way to point the clicker choices the big spoon voices fork in the road revisited and elephant bounds are there any questions about the agenda at all perfect clarity all around delighted to hear it all right the dark wood the dark wood I have in mind is the dark wood of modern epidemiology we're chronic diseases kill people and it's worse than that because these are chronic diseases heart disease cancer stroke diabetes dementia they don't just kill people prematurely they are chronic diseases before ever they take years from life they first take life from years and we've known for a long time what the leading causes of premature death are heart disease is number one cancers number two stroke is number three respiratory diseases number for diabetes number five so it is so it has been and for the foreseeable future so it shall be except it hasn't helped us very much to think of things that way and so there's a different way to think of this there's a case to be made that in 1993 these chronic diseases stopped being causes of premature death because they aren't really causes at all they are in fact effects and that was the point of this seminal article which came out just as I was completing my second residency in preventive medicine I would say in many ways this was a founding stone of my career in preventive and lifestyle medicine Mill foggy and Mike McGinnis analyzed all of the mortality data in the United States trying to explain what it counted for premature deaths and they weren't interested in what we sleepy residents in hospitals at 3 o'clock in the morning wrote on death certificates they said those aren't causes you're not telling us anything we didn't know when you fill out a death certificate and say that somebody who died of complications of heart disease had coronary atherosclerosis what we really want to know is what caused that so they got their arms around that issue wrestled the data under control and reached the conclusion that a list of 10 modifiable factors were the true root causes of premature death in the United States and those 10 factors collectively accounted for all of the premature deaths that occur in our country every year but for a rounding now some of the factors on McGinnis and Phoebe's list are modifiable by any one of us diet physical activity and so forth some of them are only modifiable by all of us working in concert or we need the help of our civic leaders things like traffic related accidents guns toxic exposures in the environment and so forth sometimes the best and sometimes the only robust defense of the human body resides with the body politic but overwhelmingly the action was in the realm of personal behaviors the first three things on McGinnis and figis list just the first three accounted for 80% of the premature deaths in our country and those three things were tobacco use poor diet and lack of physical activity or as I like to call them for ease of memory of nothing else bad use of feet forks and fingers 80% of the premature deaths in our country every year as of 1990 the paper was published in 1993 pretty astounding quite an epiphany the only problem with it is the vintage those are rather old data I presume you like your data fresher than that right although it is worth considering there's something quite interesting in the vintage of these data we knew how to eliminate 80 percent of premature deaths and chronic diseases 24 years ago and we all have cause to ask ourselves in one another what have we done with that information we'll return to that theme in any event if you like fresher data no problem ten years later Ali Mok dad and colleagues at the CDC reanalyzed this issue reaching substantially the same conclusion all that had really changed in the span of that decade is that the gap between tobacco as the number one cause of premature death and the combination of bad use of feet and forks is number two had narrowed it had narrowed for one good reason we were smoking less and one not so good reason deteriorating use of our feet degenerating use of our forks worsening epidemics of obesity and diabetes to show for it this then was the Darkwood of modern epidemiology in 2004 also getting to be an old vintage you prefer fresher data right let's jump ahead then - ok 2009 Earl Ford and colleagues at the CDC published results of Survey Research conducted among 23,000 adults living in and around Potsdam Germany the researchers asked these 24 23,000 people about four factors related to their health they asked them do you smoke yes or no do you eat well yes or no and that's what I'm supposed to be talking about this evening so let's pause there for just a second they asked them do you eat well yes or no well clearly their definition of eating well must have involved adjustment for the concentration of gluten consideration of whether or not the food was genetically modified and a very esoteric ratio of these fatty acids to those fatty acids to say nothing of the distinction between intrinsic and added sugar and other adjustments into the bargain right I mean obviously know they define eating well as habitual intake of vegetables fruits and whole grains and it was enough it was enough despite all the noise our culture makes all the time about how complicated diet is they said if you eat vegetables fruits and whole grains routinely you're eating well if you don't you're not and it was enough enough for what I'll tell you in a second but they asked you smoked yes or no do you eat well yes or no are you physically active on a regular basis yes or no and do you have a healthy weight yes or no and they then went on to compare the two ends of the spectrum so they compared I don't smoke I eat well I'm active my weights fine too I smoke eat badly don't exercise and my weights kind of out of control these people over the entire multi year span of the study had an 80% lesser rate of developing any major chronic disease than these people flip the switch from bad to good on any one of these factors and the probability of developing any major chronic disease goes down about 50% but fire on all four cylinders and as best we can tell the lifetime probability of ever developing heart disease cancer stroke diabetes dementia the slings and arrows of modern epidemiologic misfortune goes down a stunning 80 percent now imagine if the news were to break tomorrow used to be front-page above the crease now it's on a glowing screen but whatever you like to read there's a new drug available it's been approved by the FDA don't worry about it it's available in bountiful supply it's shockingly inexpensive and stunningly free of side effects safe enough for children and octogenarians alike and take in once daily for the rest of your life will reduce your risk of ever developing any major chronic disease by 80% who do you call first your doctor for a prescription or your broker to buy stock in the company selling the stuff frankly I think both would be excellent ideas but for the fact that there is no such pill and in my professional opinion there never will be any such pill but lifestyle is exactly that medicine and we've known about it since 1993 at least and arguably since the early wisdom of Hippocrates anyway if you happen not to like Potsdam for some reason and obviously you prefer Jacksonville and with excellent reason I might say or if you prefer fresher data these findings were reaffirmed in a cohort study in the UK a few years back reaffirmed yet again in another cohort study I'll figure this out before I'm done here in the US and and frankly this finding an 80% variance in the rate of premature death and all chronic disease is one of the more impressive repetitive drum beats in all of the peer-reviewed literature with study after study after study after study showing these effects this one is the diabetes prevention program a hundred and seventy four million dollar clinical 3,500 adults on the brink of diabetes randomly assigned the usual care drug treatment with metformin or glucophage and a lifestyle intervention it's an excellent drug metformin prevented diabetes a third of the time one in three people who would have developed diabetes did not lifestyle is a much better drug it prevented diabetes two times and three twice as good as the best drug we've got 58 percent of the time people did not develop diabetes that would have because they ate a moderate sensible balanced diet and got routine physical activity the stuff that you have in the works throughout the City of Jacksonville again mayor my thanks because it ultimately it's the translation of the oratory into action that really matters and is the measure of a saw and this drumbeat in the literature telling us over and over again of the power of this short list of lifestyle factors over nothing less than our medical destinies reverberates to our very pith and marrow to within the double helix of DNA this study whoops it's gonna be a little touchy here this study by my friend Dean Ornish and colleagues involved 30 men with early-stage prostate cancer and as some of you may know in its early stages prostate cancer may or may not require treatment we can't tell it might progress it might not progress and that invites what's called watchful waiting so under medical supervision you wait to see if the cancer is going to progress and then you react if it does but dr. Ornish and colleagues thought we can do better than just watch and wait while we're doing that let's give these men the benefit of lifestyle as medicine and so they did optimal plant-based nutrition routine physical activity obviously no tobacco and in addition plenty of good sleep stress mitigation strong social interactions or as the immediate past president of the American College of lifestyle medicine what I like to call the six-cylinder engine of lifestyle as medicine feet forks fingers sleep stress love fired on all six cylinders and over a span of several months went on to study not so much the men and not so much the cancer in the men but preferentially the genes in the men with the cancer and what they found is that the lifestyle intervention took 500 cancer suppressor genes rather 500 cancer promoter genes and dramatically downregulated their expression and 50 cancer suppressor genes shown here and dramatically upregulated their expression left as before right is after red is off green is on and this is a change in genetic activity directly attributable to a change in lifestyle and this is not just one study but actually this is a whole branch of the literature and so at the start of the genomic age we had the misguided notion that DNA was destiny it's generally not true there are rare exceptions sickle cell anemia Huntington's disease where the gene means you'll get the condition or two copies of the gene but for the most part DNA is not destiny because our lifestyles actually will change what our very genes do so to a degree our culture mostly ignores dinner is destiny and every other thing we do every day as well and we even have evidence that dinner and breakfast and lunch and physical activity and other elements of lifestyle can reshape the actual architecture of our chromosomes those green tips are called telomeres their caps at the ends of our chromosomes the length of our telomeres is the single most potent predictor in all of biology of the length of healthy lifespan not quite a guarantee you can have long telomeres it's still a bad idea to get hit by a train but in general potent correlation between long telomeres long healthy life and there's evidence in fact linked to Nobel prize-winning work in medicine by Elizabeth Blackburn at the University of California San Francisco showing that lifestyle interventions lifestyle practices this can lengthen our telomeres we can change not just the activity of our genes with the architecture of our chromosomes with lifestyle and there's evidence that we can overcome a genetic deck that's stacked against us by playing the hand particularly well everybody hear me okay I noticed when I get close to that speaker we've got a buzz alright so this was a study published the New England Journal of Medicine limited to adults who had established markers of high genetic risk for heart disease showing that their rates of heart disease could be cut in half with a lifestyle intervention and this is the power of epigenetics 95% of our chromosomal real estate is not genes it's levers and switches that tell the genes what to do and that is malleable we don't get to change what genes we have we do get to change the instructions our genes receive daily about what to produce and what to do and that effect seems to win out so I think the case can be made and indeed their hope the case has just been made that the master levers of medical destiny are in your hands and mine and have been all along they are not the tools of the medical tray they are not the stethoscope I've draped across my shoulders these past 25 years they're none of the technology in hospitals not pad or SPECT or fMRI or robotic surgery the master levers of medical destiny are what we do every day with our feet our forks and our fingers and I trust you know what our committee said about levers give me one long enough and I can move the whole world make no mistake these levers are long enough and should long since have served to move the whole world of modern epidemiology and public health to a better place but glass we like to say knowledge is power would that it were so the gap between what we know indeed what we have long known and what we do with what we know the lies that wishful thinking and again that's why it's so important to have leaders and of course we all are leaders in our own lives and our own households but leaders at multiple levels here in the audience tonight because my friends the charge before us all is not to earn the next Nobel Prize in medicine blazing a trail into the frontier of the unknown the task is to translate what we have long known into what we routinely put to good use at last because these 24 years later we are mired in epidemics of obesity and diabetes our children are succumbing to chronic diseases at ever younger ages should current trends persist by the middle of this century it's projected that well over a hundred million people in the United States may have diabetes and we can't pay the bills now and they're less than 30 million diabetics what a travesty that would be what a tragedy it would be to bequeath to our children and grandchildren that blighted future evermore chronic disease starting at every younger age evermore premature death when we have known for literal decades how to make 80% of it go away knowledge is not power and that begs the question why not why have we not yet done more with what we know something fairly monumental must be impeding our progress and I think something fairly monumental is in essence if you take this Homo sapiens in their native habitat you add this the modern environment you get something kind of like this yes the ultimate Mulligan right in much the same way as if you took this and added this and got this and I give you my figurative trademark for 25 years now the polar bear and the Sahara now when my wife and I first put this slide together way back then there was no imminent threat of this actually happening to polar bears and alas I'm not sure we can be confident about that anymore but that is a different topic for the most part I'm not going to get too far into climate change tonight so you'll have to invite Al Gore to the next spot in the distinguished he'll tell you all about that now my point is adaptation polar bears or marbles of survival but honestly adapted to only one particularly harsh environment and my point is the very traits and tendencies that make them polar bears that make them able to thrive in the cold of the Arctic conspire against them in the heat not just the heat of a warming Arctic but certainly the heat of the Sahara and summer what keeps you alive in the cold cook sure goose here and my point is we are the same we human beings are a species we have adaptations to a particular native habitat a land of golden arches isn't it and we are polar bears in the Sahara throughout most of human history calories were relatively scarce and hard to get and physical activity was unavoidable it did not require gym membership or specialized footwear it was called survival and everybody just did it every day we have devised a modern world where physical activity is scarce and hard to get and calories are unavoidable houston we have a problem and Jacksonville and every place in between I submit to you that as a species we have no native defenses against caloric excess or the lure of the couch never having needed them before no native defenses that is save one great big Homo Sapien brains we are arguably smarter than the average bear and can think our way out of this mess of our own devising and that my friends is the challenge before us all as we confront that challenge I think it bifurcates immediately into two component parts the first is can you even get there from here the modern world is so far from a world conducive to wholesome foods direct from nature routine physical activity is part of everyday enough sleep avoiding strike an you even get there from here and it can feel quite overwhelming but my answer is yes one sandbag at a time okay we're up against the flood a flood of highly processed hyper palatable nutrient dilute energy dense glow-in-the-dark bet you can't eat just one kind of foods a constant flow of marketing dollars telling us to overeat the very foods that propel us toward obesity and chronic disease wave after wave of technological advance giving us gadgets and gizmos that do all the things our muscles used to do at work and at play okay a great big obesogenic morbid agenting flood but we can contain that flood with a levee and we can build that levee one sandbag at a time I've used this metaphor throughout my career to keep me strong to keep me going because it can feel overwhelming yeah I'm routinely introduced in a lovely way as I was this evening as an expert in preventing obesity yeah except throughout the entire span of his career rates of obesity have been rising ok well then he's a an expert in preventing chronic disease second memo throughout the entire span of his illustrious career rates of chronic disease yeah so you know I sometimes feel like I pretty much suck and should just run up the white flag and I think about the levee and I think you know you can be doing good work but first of all you're not going to do it alone no one person builds a levee all you can do is stack sandbags and it doesn't matter how good your sandbags are unless you've got enough other sandbags it's not going to be enough and it doesn't matter how much good hard work you've done because until your levee is higher than the floodwaters your feet are going to be wet but one fine day when you've done all the necessary work and the company of other good people the height of your levy tops the height of the flood the ground at your feet dries out and a world of opportunity opens up before you this keeps me going I am a professional Sandbagger I'm in the company of many others such and proud to be and I think together we can build the levee I think we can dry out the land and open up all those trails of possibility and just a couple of quick examples here so this is really what I spend my time doing when I'm not traveling and giving talks I'm back at home figuring out what's the next sandbag I want to make practical tangible contributions to the levy myself in the company of many others doing the same and if this were a different lecture I could run through all the ones we've constructed and tested over the years but just a couple to give you a taste and in this instance a literal taste so Katherine was already introduced my wife she founded quiz Anissa T it's a recipe website freely accessible to all help yourselves love the food that loves you back and the idea really was precipitated by our kids saying you know these fantastic recipes that you make for us why don't you make them available to everybody let's pay this forward so the kids suggested Katherine's done the heavy lifting what we routinely say she likes to say on nutritious she's delicious okay I can go if that's true too but what we like to say is that I'm theory she's practiced so you know I know a lot about nutrition Katherine grew up in southern France so you know basically endowed with the legacy of the great French Mediterranean cuisine met my fussy nutrition standards we produce something really unique we have five children we have thrived on this diet all these years and quiz Anissa tea pays it forward and here's an example this chocolate lava cake is vegan it has only six ingredients they are dark chocolate black Beluga lentils walnuts medjool dates and sweet potato right and and flax meal and that's it there's no added sugar except the sugar that's in the dates and it's part of the dark cocoa spectacularly good tastes as good as it looked beautiful example of you having your cake and eating it too it's incredibly nutritious unbelievably delicious lots of recipes like that simple great help yourselves sandbag in the levee everybody who can produce one more really wholesome nutritious meal or dish at home it's a step in the right direction so visit quiz intensity dot-com pay it forward if you don't have any reason not to if you enjoy the recipes tell your friends about it let's teach everybody how to make meals that are as delicious as they are nutritious and we can all love food that loves us back and then this is the part where I have to make a disclosure because I'm an accidental entrepreneur I've always looked over the course of my career how can you get stuff done a lot of it's been in academia a lot of it has been giving programs away but every now and then it's private-sector activity so I founded a company of my own where we are reinventing dietary intake assessment which is very important in all of the efforts to know what are people eating now what should they be eating and how can they get there from here and this is called diet quality photo navigation or DQ PN but when you see the app launched it'll be called diet ID and I believe we have a two-minute video to tell you just a little bit about that getting to a better diet for health or weight loss is like a journey you need to know where you're starting you need to know your destination and you need to know the route in between and this simple dietary information has been very elusive until now identifying your starting diet has been a tedious process requiring food by food meal by meal or even day by day details from you this time consuming process is labor-intensive memory dependent and prone to inaccuracies in approximating your actual diet not anymore now you can determine where you are where you want to go and how to get there in mere seconds thanks to diet ID diet ID starts with a few brief questions to help us focus on the diets relevant to you and your region of the world diet ID then sorts and presents you with photos of relevant diets for each of these we already know the overall quality and precise nutrient makeup all you have to do is pick the one that looks most like your diet just like choosing the clearer image of the I doctor and now we know all the nutrient details of your diet all in a matter of seconds in just seconds more you or your health coach can identify your specific diet destination this diet ideal is based on your goals priorities and preferences all you do is select the diet you want to adopt from our library and now we know all the nutrient details of your goal diet also in a matter of just seconds and then we help you map the path from where you're starting to where you want to go you can choose the faster route or a more leisurely one diet ID is like a GPS for your diet it just got a lot easier to get there from here picture your good health with diet ideal as anybody ever filled out a food frequency questionnaire or 24-hour recall or food diaries to put it bluntly a pain in the ass right pain in the ass for you a pain in the ass for the researchers to analyze and incredibly inaccurate into the bargain we can determine baseline diet using this method in about 30 seconds and we can do it through the face of a SmartWatch so for the first time ever anybody have a Fitbit talk to you about activity doesn't talk to you about nutrition right because really can't there's no way to know what your baseline diet is and direct you from there this has the potential to change that so we'll be launching this next month its entrepreneurial I am running this business but the idea was another sandbagging the levy to try and advance the overall mission so lots of sandbags I've worked on some other good people work on many but there's a second problem so the levy is can we get there from here but there's a prerequisite issue and that is do we even know where there is you can't get there from here if you don't know where there so with regard to fingers I think we're probably okay smoking is bad not smoking is better no dissent right we're all in agreement there that's an easy one with regard to feet we're probably in good shape to moving them as good sitting on our rear ends all the time not so much but when it comes to forks there's the rub because somebody comes along every day at least every week to tell us that everything we thought we knew about nutrition up until yesterday was wrong throws everybody under the bus and expects us to start all over again right this is how the book sales run this is how Good Morning America and Today Show run and so if you're paying attention to this trend you're hopelessly befuddled about the basic feeding of homosapiens if not the other aspects of care and this I think invites people to ask the time-honored question what to trust about food and it brings us to a fork in the road along one time we remain forever befuddled about the basic feeding of ourselves I'd like to propose an alternative time and this really has been the focus of my life's work so I've written three editions of a nutrition textbook for health professionals nutrition and clinical practice it's at the bottom of the slide the third edition came out in 2014 has about 10,000 scientific citations it's the obligatory view from altitude and then this this citation up here at the top was a commissioned review paper for annual review of public health same basic theme can we say what diet is best for health so I've worked on this most of my career but I'm an excellent company darush Moza Farion is the Dean of the Friedman school of nutrition at Tufts University Jim Mann is a leading researcher at the University of Auckland in New Zealand Frank Hugh the senior author of that third article cited there is now chair of the nutrition department at the Harvard School of Public Health and here's an interesting tidbit so that this paper you see by dr. Hugh and his colleagues prevention and management of type 2 diabetes dietary strategies it came out around the same time as my review paper can we what died is best for health and dr. Hugh and I are good friends and we recognized that the conclusions in these two completely independent papers were so similar despite not working with one another at all that we ought to tell the world something about that so we got together and wrote this in the Huffington Post and you may recognize the title as the title of tonight's talk knowing what to eat refusing to swallow it we both agreed the issue is not confusion the issue is pseudo confusion all the stuff that gets in the way of people knowing the truth so when you look without bias at evidence for or against low fat diets vegan diets low glycemic diets Dietary Approaches to stop hypertension diabetes prevention program paleo diets low carb diets Mediterranean diets what you hear about in our culture all the time is why my diet can beat your diet and really all that matters is none of that but actually the olive in the middle because what makes good diets good is what they have in common with all other good diets and that olive was pretty nicely skewered by Michael Pollan when he said eat food not too much mostly plants I mean really that's the beating heart of a good diet he nailed it right there just those few words now admittedly that leaves a fair amount to the imagination that's actually not a bad thing what it means is you're the cook in your kitchen in other words you can customize adhere to the theme eat real foods lots of plants vegetables fruits whole grains beans lentils nuts and seeds when you're thirsty mostly drink water if you do that you can't go too far wrong you want to have some dairy do you want to eat eggs do you want to have fish and seafood do you wanna have some poultry do you want to eat some meat do but mostly eat minimally processed vegetables fruits whole grains beans lentils nuts and seeds and when you're thirsty drink plain water and you cannot go too far wrong honestly that's it simple right I'm writing a whole book about this can you believe that I mean though the book should be like you know the same line four times the end thank you it's the whole book crazy anyway Pollan pretty much nailed it he's not alone the 572 page Dietary Guidelines Advisory Committee report not the official Dietary Guidelines for Americans the mayor should be here to hear this the official dietary guidelines are political gobbledygook they're what politicians think we ought to be told about what actual scientists think is true this is what actual scientists think is true and it took them 572 pages to say what Michael Pollan said in seven words eat food not too much mostly plants almost a haiku right and I was privileged to co-chair a meeting with Walter Willett the former chair of nutrition at Harvard a couple years ago in Boston where we brought nutrition experts from all around the world and we argued with one another for several days but we produced a consensus statement about the common ground and guess what the common ground was eat plenty of vegetables fruits whole grains beans lentils nuts and seed when you're thirsty drink plain water and you cannot go too far wrong everybody everywhere vegan to paleo agrees that's the formula and yet we seem to be mired in controversy and we keep revisiting things to see if we've gotten it right so we get these high profile research papers the cardiovascular nutrition controversy so they explored these deep controversies and at the end of it all what conclusion did they reach in the Journal of the American College of Cardiology here are the revelations extra-virgin olive oil and oil in general from nuts and seeds good for you shocked surprise does anybody want to fall out of their seat berries and fruits good for you we need to resuscitate anybody after that revelation nuts seeds good for you green leafy vegetables good for you plant-based proteins meaning beans and lentils eat more of that less red meat for example good for you this is where we landed after sorting out these very arcane mysteries and controversies right there are no controversies we just keep dredging up nonsense over and over and over again and confusing ourselves unnecessarily I already mentioned dr. Moses Aryan Dean of nutrition at Tufts they did an analysis there that looked at all of the deaths in the United States for reference year 2012 and the dietary factors associated with premature death here's what they found we would be better off less likely to die prematurely if we ate less highly processed food especially processed meat we would be better off if we ate less fast food drank less soda ate more nuts and seeds more vegetables more fruits and if we ate fish and seafood in the place of other animal foods again anything even remotely surprising this is stuff we probably all thought we have known for decades and yet all we ever hear about is how hopelessly confused we are we keep finding our way back to the same fundamental truths and we keep being told by the media we're hopelessly confused so even as we're getting all of these answers again and again and again Time magazine gives us this cover we get articles telling us butter is back you heard about that butter is back compared to what and by the way that's the question they often fail to address well you know yeah I mean there's stuff that the butter is better than I suppose like partially hydrogenated oil that you know but not much definitely not olive oil so bad compared to what and many studies are I think hopelessly misrepresented by both the scientists and the media did any of you get the news recently there was a big study saying that fruits and vegetables aren't good for us anymore if that happened to come to your attention that was a result of something called pure which is the prospective urban and rural epidemiology study but which I thought should mean poverty undermines reasonable eating they basically reach the conclusion that high carbohydrate intake was bad for people but they were studying people in 18 countries and the highest carbohydrate intake was very poor people living in Bangladesh who only had white rice to eat and really wish they could eat something else I mean completely misleading research so anyway we keep going round and round in circles one of those circles of late has been the idea that saturated fat isn't bad for us anymore maybe it's even good for us now how many of you heard that saturated fat it's all fine now right that one some of you none of you anybody away anybody eat anything ever come on people give me something anyway a lot of noise about saturated fat is fine now and it's mostly confabulated there are actually two big studies that found that across the range of saturated fat intake that prevails in populations like the u.s. from high to low rates of heart disease are the same both times and the reason well first of all the range isn't very wide everybody eats too much saturated fat in the United States but the other reason is there's a critical question again that issue of what are people eating instead well in this country if you eat a bit less pepperoni pizza you don't replace it with lentils and broccoli you replace it with low-fat junk food right so what we basically found is that there's more than one way to eat badly and we the American people are committed to exploring them all this was actually investigated by Lee and colleagues who looked specifically at what happens when saturated fat calories are replaced and they looked at the various things that could replace those calories and they found that when saturated fat calories were replaced by unsaturated fat calories by nuts and seeds olive olive oil avocado and so forth rates of heart disease plummeted when they were replaced by whole-grain calories rates of heart disease plummeted but when they were placed by refined carbohydrate and added sugar like snack while cookies rates of heart disease stayed the same there is more than one way to eat badly you're not doing yourself a favor by shifting from one to the other we can do much better than that whoops and by the way one of the other things we hear not only that saturated fat is fine now which is false but that there's been inadequate attention to the evils of sugar you get that memo right nobody's been paying enough attention to sugar that's also nonsense there have been Dietary Guidelines for Americans since 1980 these were the first from 40 years ago there were seven takeaway points number five avoid too much sugar we've been talking about it for 40 years we just can't get anybody to listen okay so that's not the problem and by the way this is America there are two ways you could potentially reduce your intake of dietary fat as a percent of your total calories there's the right way then there's the American Way now there the right way would be to actually eat a bit less fat but we don't like Wes in this country we're not good with less we like more there's another way to reduce your intake of fat as a percent of calories just eat more calories keep your fat the same eat more of everything else fat as a percent of calories will go dead that's what we've done believe it we never cut our fat intake at all we just increased our intake of grains even more so we didn't stop eating pepperoni pizza we just added the snack gold cookies and now we're supposed to be confused about why everybody in this country is fat and sick well no it's not a great mystery and by the way in case you don't believe me you can check out the trends over 40 years for diet in the u.s. at voxcom just type in American diet changes box you'll pull up this flow diagram it'll show you these really cool images of the diet changing by food category over a 40-year span and then this I think is a critical tidbit we even know why we're eating more of everything Michael Moss is a Pulitzer prize-winning investigative journalist his book is salt sugar fat his next book due out very soon it's called hooked now the big food companies like PepsiCo for instance got us hooked on Doritos and Tostitos and Fritos and Cheetos and you don't make cheeto see is that somewhat cheeto still hard cheese we're gonna need to talk over there yeah okay so in any event what-what Moss describes in this New York Times magazine cover story the extraordinary science of addictive junk food is how the big food companies hire teams of PhDs give them functional MRI machines and marching orders to engineer foods we cannot stop eating when Lay's told us bet you can't eat just one it was a threat and they knew they could take it all the way to the bank but they're not alone so this I think actually all due respect mr. president should evoke outrage I mean you know you think about the struggle against epidemic obesity and diabetes and you know many of us in this science how many of you are parents grandparents aunts or uncles no a kid right we're all working we're all good we're all part of the same group here you know here we are struggling with epidemic childhood obesity and diabetes and we've got big food companies engineering food our kids cannot stop eating so mom and dad say enough is enough and they want more but it's not an accident you know so the average parent is up against teams of highly paid scientists using cutting-edge technology with marching orders to hit the Bliss point and make food irresistible not fair where is the outrage right a nation of loving parents and grandparents and aunts and uncles looking out for the well-being of kids we should collectively be outraged across the political spectrum and say this has got to stop this just will not do you are mortgaging the health of the future generation to fat and corporate profits this must stop we will not sanction it so I'd like to see the outrage all right I told you in the beginning about an elephant in the room this could be the elephant in the room this is what Hallie oh enthusiasts suggest should be the elephant in the room hard to find mammoths these days to be honest but more importantly there are two good reasons why we cannot all adopt a paleo diet and they all have something to do with the fact that we're not in the Stone Age anymore first many people wave the Palio Banner is an excuse to eat bacon and pepperoni and I Got News for you there was no Stone Age pepperoni right and in fact even grain fed beef is markedly different from the kind of meat our Stone Age ancestors ate just to give you a quick for instance paleoanthropologist estimate that the meat of the Stone Age was a lot like antelope about 7% of the calories in antelope steak come from fat virtually none of it saturated much of it is omega-3 which we now call fish oil contrast that with grain fed beef 35% of the calories are from fat much of its saturated none of its omega-3 it's night and day that's one reason the bigger reason there nearly 8 billion of us on the planet now I actually did the math that for 8 billion people to live like Stone Age foragers would require 15 times the surface area of the planet cannot happen right so we're not in the Stone Age anymore I don't think the mammoth is the elephant in the room I think what the elephant in the room is that we are omnivores who have choices to make and we can make good ones or we can make bad ones we have choices for fat this study of Harvard and a hundred thousand people tells us that the higher the percentage of calories we get from saturated fat which would be meats dairy processed foods the higher the rates of cardiovascular disease and premature death from all causes the higher the percentage of calories we get from unsaturated fats nuts seeds avocado olive oil fish and seafood the lower the rates of cardiovascular disease and premature death from all causes we have choices for protein another study out of Harvard the same basic conclusion the higher the percentage of calories from animal protein meats dairy etc the higher the rates of premature death the higher the percentage of protein from plant sources beans lentils and so forth the lower the rates of premature death from all causes and here's a direct substitution chart from a 2010 study and we'll just get through this very quickly because I think we're probably short on time now but just look at this line the mid line is basically the the baseline risk to the left is risk reduction to the right is risk increase that we looked at here beans for beef the single largest reduction in the risk of heart disease this was a study and a hundred thousand women if we just swapped out beef for beans as a matter of routine significant reduction heart disease but we need to think outside our own skin this is a changing planet it's a crowded world our dietary choices have major implications for our aquifers during the peak of the California drought the new york times around an article and infographic on our contribution to the California drought and they plotted the water required to produce different food beef was off the charts compared to everything else an order of magnitude more water is used to basically grow the plants to feed the cattle to produce the meat that we then eat as opposed to just growing crops that we eat directly an order of magnitude and you know there was a time that didn't matter but in a thirsty world of nearly 8 billion people it matters we all have to be thinking about this and to be clear folks is I'm going to give a very strong eat more plants less animals message I didn't ask to be born into a world of nearly eight billion Homo sapiens and neither did you I didn't ask to be were born into a time of climate change desiccating aquifers greenhouse gas emissions mass extinction shrinking biodiversity all these things I didn't ask for any of this neither did you but we are citizens of this world we were born into and we could be good or bad stewards of it and if what we do with our Forks impacts the planet we must think about it we have no other choice and however inconvenient it is for me or for you we're in this together and I think we have to address it we have choices for the climate interesting article in the conversation meat may be a complicated health question it's a simple environmental one the agriculture footprint with regard to carbon is enormous much of it has to do with animal husbandry for the sake of the climate we need to eat less meat that's pretty much the conclusion all scientists have reached and for the sake of biodiversity we're actually displacing wild animals so we can raise more domestic animals and eat them and frankly I don't want to be the guy you know who is responsible for the last Borneo that an orangutan might once have climb being cut down to produce more palm oil to make more processed food to feed me I don't want to be that guy I don't wanna be the guy that eats the world's last swordfish either and we're facing these difficult choices now and our diets all right at that scale have major implications for all of these things and we even have choices for the economy this was a fascinating modeling study out of Oxford University projecting decades into the future savings to the tune of tens of trillions of dollars with a shift to more plant predominant diets why better health outcomes but also stabilizing the climate protecting the planet we have choices and yet as we near the finish line here we've not made much progress this is the typical American diet pretty much same as it ever was this is an image from a book called hungry planet what the world eats so at the end here we come back to this question even if it's clear where there is it does sort of feel like we're not able to get there from here or in other words if lifestyle is the best medicine we seem to lack the spoons to get the medicine to go down now lord knows the last thing we need these days is more spoonful of sugar but we clearly need some kind of spoon to help the medicine go down so as we think about that how do we get lifestyle which we've known since 1993 could eradicate 80% of all chronic disease and premature death and now we know could save the planet into the bargain how do we get that medicine to go down well it doesn't look like this it doesn't look like a few of us in white hats on white horses trying to save the world while corporate America mortgages the health of our children for profit that's got to stop and frankly you know the big suppliers the big food companies they're trying to keep the customer satisfied we have to change the food demand if we want to change the food supply but there does need to be more corporate responsibility to I think paying engineers to produce willfully addictive junk food needs to stop and maybe collective outrage is the antidote but we're bailing a sinking ship with pipettes it is being flooded with a firehose and if you think I'm kidding these are breakfast cereals introduced by major food companies this year so in an age of epidemic childhood obesity who thinks that sprinkled donut crunch for breakfast is going to help no I don't think so okay however the solution could look like this we got to the moon for three reasons so far as I know we wanted to go we're an ingenious species and we knew where to find the damn thing I think the same formula could get us to a world where there's 80 percent less chronic disease I think we want to go we're still ingenious we just have to agree we know where there is and stop going around in circles if we straightened out those circles and made them linear the progress would be incredible we are not clueless about the basic care and feeding of Homo sapiens the big spoon is culture lifestyles the medicine culture is the big spoon and we know this thanks to the world's Blue Zones five places where people routinely live to be a hundred and don't get chronic disease acharya greece sardinia italy okinawa japan Loma Linda California and the Nicoya Peninsula of Costa Rica what do they do in all those places they're very different high fat Mediterranean diet occur in Sardinia low-fat vegan diet and Loma Linda traditional Asian diet in Okinawa omnivorous diet in Costa Rica in every one of these places they eat diets of real food mostly plants they're physically acted they tend not to smoke they get enough sleep they're not stressed out and they have strong social connections feet forks fingers sleep stress and love every time at the level of culture they routinely live to be a hundred they don't get chronic disease they go to sleep one night at 102 and they just don't wake up they go gentle into that good night and the fullness of time they live long they prosper with vitality and they pass peacefully tis a consummation devoutly to be wish'd why can't we all have that if we rallied around what we know I think we could all have that similar experience with the Shema knee in the Bolivian Amazon cleanest coronary arteries on the planet modern-day foragers they eat mostly plants they do some hunting absolutely pristine coronary arteries basically also living something of a blue zone existence and we even have evidence that blue zones can be transplanted turned into blue prints North Karelia Finland one of the highest rates of premature death from heart disease in the world in the middle of the 20th century they took the learnings of an selkies in the seven countries study shifted from animal food predominant diets to more whole grains beans lentils vegetables fruits shifted to seed oils from dairy fat they slashed rates of heart disease by over 80 percent and added ten years to average life expectancy over the past half century there is no basis for confuse about the basic care and feeding of homeless savings we've long had the relevant evidence there's just profit to be made from confusion I work for Good Morning America they wanted me to talk about a different diet every week this by the way is why I no longer work for Good Morning America right you cannot tell people two weeks in a row that vegetables and fruits are good for them it's boring tell them something else is tell them about the pickle juice diet this week I'm not going to tell them about the pickle juice that you're fired okay fine it wasn't quite like that but sort of it's okay fine we've known for decades how to feed ourselves well but we need people to hear the message and this is where we end how do we change the rules of the game so we can win it it's not for want of knowledge our problem is translation a luminous prize the potential to add years to lives life two years has been lost not in translation but in want of translation the failure to translate what we know into what we do because most people don't know that we know it so at this stage of my career in addition to being a Sandbagger I want to take a page from the PlayBook of an illustrious colleague who wrote up a case report in the peer-reviewed literature about a pachyderm with either extraordinary auditory acuity or possibly uncompensated schizophrenia we've never not never known for sure which but I trust you know the story of Horton in the who's horton heard the who's nobody else did everybody know about horton in the who's okay in the case of public health our message is not we are here that was the message of the who's to avoid being boiled to death in bezel nut oil in the case of Public Health our message is we agree so I have established a global coalition of leading experts and when I tell you leading experts I mean three former surgeons General of the United States people like Sanjay Gupta deans of schools and chairs of departments famous chefs like Alice Waters Sam Kass who was the Obama chef all the years they were in the White House and many others to come together and tell the world across the spectrum from vegan to paleo we all eat more like one another than any of us eats like the tip America we all agree about the fundamentals we really do you never hear us talking about that because we're always invited to come on air and tell you about you know the particulars thing we're most interested in but if you ask us how we feed ourselves and our families a lot like one another so we now have over 400 experts from 37 countries ranging from the world's most famous vegan advocates to the founding fathers of the Paleo diet saying we agree and if what I've been saying make sense to you please check out the true Health Initiative at true health initiative org and add your voice to the chorus we want more and more people to say yeah I want the world to know the fundamentals that we have long known and that experts all around the world agree could eradicate 80% of premature death and chronic disease we have let that prize languish these 24 years and so we end back at a fork in the road for far too long we have let the luminous opportunity to add years to lives in life two years lie fallow we have left health on the road less traveled collectively and frankly I think only collectively we could finally at last turn knowledge into the power of routine action translate what we have long known into what we routinely do put health on a path of lesser resistance and if ever we get around to doing that the elephant in the room will look like this thank you all very much [Applause] [Music] yes ma'am but I'll go there first oh you got the mic but and I'll come back to you yep so you know again let's let's consider the case of well two things really Michael Moss is willfully addictive junk food and the fact that we've got you know epidemic childhood obesity and we are developing cereals like sprinkled donut crunch I think there's an argument there for supply-side regulation I think you know willfully engineering food to undermine appetite control portion control I think there should be regulations there I think there should be regulation about food marketing to children and there there's been advocacy for this for years you know we're obviously a very divided country on matters of policy people argue now we're at the nanny state you know I think we're the nanny state right now it's just that we're being told what to do by big corporations as opposed to a government that's at least a little bit accountable to us but I don't think it's fair to directly mark it willfully addictive food to five and six-year-olds and expect them to defend themselves and I don't think it's fair to expect their parents to defend their kids from that either because you know they're watching TV they're on the internet wherever they're exposed they're bombarded with those messages it's a huge amount of parental bandwidth to undo all that damage it's a little bit like being a physician in 2017 it used to be my patients didn't know what was what now everybody knows everything and most of it's wrong it's much harder now you know I mean teaching people stuff when they come in and they're humble and they say you're the expert tell me relatively easy but when everybody thinks they already know what's what huge amount of work just to get back to baseline same with kids you know if they're already convinced they know what they want and it's bad for them you have to undo that it's not fair so I think there's a tremendous opportunity to address some of the critical needs with policy but unfortunately the body politic is so divided a lot of the necessary from my perspective policy has stalled a soda tax I think that would be reasonable yeah all the evidence suggests it's not bad for business it raises revenue that revenue can be put to all sorts of good use it isn't always but it certainly can be and it produces net benefit in terms of diet quality and no it's not regressive because you know what is regressive type-2 diabetes which falls disproportionately on poor populations and it's much more costly than the tax added to soda at a penny an ounce or something so you know basically poor people are paying a very high tax on poor diets right now it's all the cost associated with for health so I am an advocate for all sorts of policy however I believe in personal responsibility I believe that at the end of the day what I do with my feet and my fork is up to me I would just put it this way the choice is that any of us makes are subordinate to the choices all of us have I think we need to address both I think we need to empower individuals I do think the single most potent way to change the food supplies to change the food demand and we even have evidence of that so when Atkins was most famous in the 1990s into early 2000 2000 to 2002 is when Gary Talbot wrote a New York Times magazine cover story what if it's all been a big fat lie and the idea was we'd fallen in love with low-fat we've gotten fatter and sicker and the problem wasn't that we were nincompoops who were exploring lots of different ways of eating badly the problem was we picked the wrong macronutrient and by the way I know Gary saying we're friends is probably too much I think he's been wrong about everything across his entire career and you know to me the idea that we cut fact that fatter and sicker let's cut carbs now it was absolutely idiotic but it Atkins came along tabs put him into the stratosphere we had a natural experiment what happened to the food supply every supermarket in the United States in a span of less than 12 weeks had low-carb items on their shelves that had never existed before they manufactured them out of the ether what would happen if we had a revolution not to shift from one silly way of eating badly to a new way of eating badly but actually educating people we want wholesome minimally processed food we will not eat junk if it's junk it's not food if it's food it's not junk we're done well frankly the big manufacturers would accommodate us pretty damn quick - that's what they do so I've spent my career trying to change the demand more than the supply and lending my support to Center for Science in the Public Interest the Rudd Center which was at Yale it's now at UConn the Robert Wood Johnson Foundation that are working to address this through policy Mike Bloomberg when he was mayor of New York tried to do some things regulating soda size so the tax but the policy sides really hard in a divided population right the legislators can't get stuff done if the public won't stand behind them and we are a house divided on these issues so I say let's do judo instead of karate karate is two opposing forces everybody winds up bleeding judo is you take the prevailing forces and say let's work with this if we can educate ourselves change the food demand everybody only really wants to buy healthy food then I think we can probably get manufacturers to sell us more healthy food and a rising tide can lift all boats so I am a fan of policy I've just mostly worked on changing the demand side I think we tend to overlook the primacy of demand over supply and I've adopted that as my mission my question around the mic okay my question is about telomeres I know you had that up there and the length of your telomeres can you influence that can you influence the length of your telomeres and I've also seen you know vloggers talking about supplements for telomeres so so let me refer you to the best source on the topic it's called the telomere effect it's by ELISA Pell and Elizabeth Blackburn at the University of California San Francisco and dr. Blackburn is the one who won the Nobel Prize for work in this area and it's pretty comprehensive so it's about all of the studies looking at all of the lifestyle factors including nutrient supplements that actually have been shown to influence telomere length so the answer to your question is yes maybe with regard to supplements there have been studies of some particular supplements showing a potential effect on on telomere length probably because of influence on gene complexes and those effects have mostly been shown in animal studies very limited evidence in people but but some reason to think that the right nutrient supplements could potentially exert an influence there it's very clear that lifestyle can do it much more reliably so yes we can change the length of our telomeres the only thing that I would offer is any kind of a proviso here we don't need to eat to feed our telomeres we don't need to eat to feed our microbiomes we can pretty much safely assume that if we are eating and living in a way that is conducive to good health it's probably good for our genes it's probably good for our chromosomes and it's probably good for the critters living in our gut too right so one of the modern variants on the theme of fads is I'm gonna write a book and there is one the microbiome effects so now you need to eat to feed your microbiome which may give you a whole different set of principles from eating to feed your telomeres and so forth get the basic formula for your overall health right your telomeres your genetic activity your microbiome your heart your liver your kidneys your spleen and your great left toe are all connected right they're all just part of you but the telomere effect really good available on Amazon answers all those questions in far more detail than I could hope to thank [Applause] [Music] if I could ask you to stay up there one more second Ashley I always uh we all learned a great deal tonight dr. Katz um you know congratulations to you and your wife you have people in the room you may or may not know we have the Penguins here the Keigwin School of Nursing you've got senior executives Marty chill MEAC with Johnson & Johnson you've got the former CEO of acosta one of the world's great food companies when you've got and I worked at PepsiCo I agree that's am I am I gonna make it out of the room yeah you're gonna need a little help so you've got faculty you've got students here we're just honored to have you and your wife it was a wonderful conversation you've changed what I'm gonna have for dinner tonight of course but you do that everywhere you go I'm also impressed you can say someone's a friend and then say you've disagreed with everything he's ever stood for it about career well but my last question and I always reserved the office to ask one last question if you got two minutes there are companies that are out there trying to do good things and I will not put PepsiCo neck review right nor Coca Cola I wonder if you could give us a thought on that and then the other side of that is children you know three to eight years old how best to teach them it's not happening in the elementary schools you know their eyes would be popped wide open seeing just your cartoons tonight so right on the one side your allies on the company side on the other side how to educate the children then we'll let you go have dinner thanks thank you very much so actually let me put PepsiCo right in the list both because I think you know the CEO in Newry has really tried to do good and then we had a brief exchange about our mutual friend Derrick yak who was reporting to you at PepsiCo I believe and so Derrick worked for many years the World Health Organization was one of the leaders in the global campaign against tobacco was a public health hero then came to Yale then went to the Rockefeller Foundation and then went to PepsiCo and everybody thought he'd gone over to the dark side and I think he was senior vice president of agriculture and health policy or something right and and his idea was I've got a receptive CEO I really want to try to do good and he did and we met multiple times and it was all very sincere and a number of things that PepsiCo was trying to do to improve the health and nutrition portfolio of the product line ran afoul of consumer demand I mean you know ultimately you have to account to the shareholders for the business that you do the business of business is business first and foremost you know you weren't gonna make and sell what nobody was willing to buy where Derek and I wound up having a really interesting conversation and we weren't able to operationalize it although I haven't given up on the idea it was the notion that we need to share a taste for change so you know for example if food companies just make better foods overnight and we're used to junk foods and we like foods with lots of sugar salt and added chemicals we're not going to like the changes your products will tank and you'll go back to the old way on the other hand if we want met or better products and you don't provide any we have few options and we can't make good choices if you don't give us good choices but what about a public health campaign that teaches people about what I call taste bud rehab taste buds are very adaptable little fellas when they can't be with the foods they're used to loving they learn to love the foods they're with you can shift to ever more wholesome food and little by little you actually habituate to it one of the reasons Americans like the food they like is because our taste buds are soaking in too much sugar and salt all the time we could work together to fix that in what what dr. yak and I agreed was that it would be very hard for either to do it alone people can't make good choices if they're not given good options but it's hard to change the food supply and fail in the marketplace because the demand hasn't been changed so there are many very virtuous companies I think some of the big companies are willing to be virtuous but I think we really sort of need a combined corporate public health effort to say what are the fundamentals in our culture that we need to address so there's receptivity for better food and we in the business world can do well by doing good we were perfectly happy to do good we have to do well we've got to report to our shareholders nobody wins if our company goes out of business right now I completely respect that so you know I think there's a lot of opportunity there on the issue of kids a very practical answer one of the sandbags didn't tell you about tonight is a food label literacy program we developed at the Prevention Research Center called nutrition detectives specifically designed to teach eight-year-olds how to identify good food from bad what to look for an ingredient list what to look for in the nutrition facts panel and we've given out over 50,000 DVDs of this program all around the world the program is available in English and Spanish it's in multiple countries reaching millions of kids and what routinely happens is kids start out they pull on mom's elbow at the supermarket and they say hey I want the one with Dora the Explorer or whoever the hero of the week is on the front of the package sprinkled donut crunch maybe and then they go through nutrition detectives which takes all of 90 minutes it can be done in school or at home and at the end of the program they tug on mom's elbow and they say we can't buy this it's got high-fructose corn syrup in it and it's amazing how kids can actually be the agent of change for a health transformation in their families so we found we could teach the kids and the kids would teach their parents nutrition detectives is freely available just google it and you can get it from our shop it's available online we've got YouTube videos instruction manuals so they could be adopted in in local schools and there are other things that can be done too but it's a good place to start [Applause]
