Plant Based Health and Nutrition - Session I

well you are a rapidly settling crowd and you're still oriented you are in the geographic center of the borough now do you know that you've landed in central how many of you been to central Brooklyn or haven't been to central Brooklyn before aha welcome this is the place to be you'll never get out but but we're glad you here so welcome my name is rich Rosenfeld I have the honor of co-chairing this event with Bethel's nur who I will introduce very shortly but just wanted to give you all a warm welcome this is a really unique and special event for downstate it's our first ever plant-based conference and it really is a tremendous effort between the College of Medicine the School of Public Health and the Brooklyn borough presidents office so we're delighted to see you all many of you have never been to downstate and we're happy to welcome you and enjoy your company in conversation I'm going to introduce now really the mover and shaker of the conference who's Beth hell's nur and Beth is an associate professor of Epidemiology and biostatistics at the SUNY Downstate School of Public Health she specializes in epidemiology of Aging and neuro epidemiology and his research focused in those areas but most importantly she has an ever-expanding interest in nutrition education for the healthcare workforce and developing community-based approaches to foster and increase access the plant-based health and nutrition so let me introduce Beth Hell's nur our conference co-chair Beth thank you so much rich good morning everybody this is so exciting we are delighted to have you all here we're here today alert to learn about how eating a diet that's rich in whole plant foods can help prevent and and even reverse some chronic diseases we've got a fantastic day in store for you we're gonna hear from experts at the forefront of the plant-based movement well here from Brooklyn Borough President Eric Adams and his compelling testimony about how he is able to improve his own health we're gonna hear the insights and experiences of our wonderful keynote speaker dr. David Katz with then we're going to hear from dr. rich Rosenfeld about the efforts going on now at downstate when it comes to plant-based initiatives after lunch we're going to go over first of all lunch is very important we're gonna have a delicious plant-based lunch after lunch we're going to hear the story of a reformed cardiologist dr. Robert Oz Feld and the evidence supporting plant-based nutrition when it comes to cardiology then we're going to hear about the psychology that underlies vegetarian identity we'll wrap up the day with two wonderful panels of local experts the first is going to discuss how best to make the transition to plant-based nutrition and how to overcome barriers to this way of eating in the second panel is going to focus on how we can overcome institutional barriers to change and access to plant-based foods so thank you all for coming here to learn discuss in a network be inspired looking forward to speaking with you at lunchtime I hope you have a wonderful day and with that I would like to introduce down to the president of SUNY Downstate dr. Wayne Riley well good morning we are excited to have all of you on our campus today for a very important topic and that's about how we can prevent disease and illness not just treat disease and illness so again this initiative the focus on improving health and prevention through a plant-based diets is something that has been a long time coming in many places like this but we at downstate have embraced this because we know the data we know the science and it works and so so thank you for being here this is very important I want to salute dr. Richard Rosenfeld and dr. Elizabeth Elsner they had been the dynamic duo to get this conference organized and programmed so let's give them both a round Gopal's now the next gentleman I have the honor of introducing is one of the finest public servants I think I've ever met in my life and I've spent some time in government before becoming a physician and I know the sacrifices that public officials make to serve the public and sometimes we don't recognize our public officials for the sacrifices they make they're away from their family sometimes their finances go sideways because they serve us but the gratification that you get from public service is what draws you the public service and I can tell you that the Honorable Eric Adams is one of those types of individuals who is passionate about public service and serving our great borough of Brooklyn in New York City New York State and indeed the nation and so I have been honored to get to know the borough president he was here at my inauguration and he spoke passionately then about how his life had been transformed by adopting a plant-based diet lifestyle and I won't steal his thunder because he's going to give his own personal testimony but I can tell you as a primary care general internist I wish I had had patients like Eric Adams who had followed the prescription and literally I used to write out exercise three times a week eat less meat less fried food and I'd give it to my patients than they chuckles Oh doctor are you crazy just give me my medicine I said I give him their medicine but I was trying to teach them with that silly little stunt of writing it on a prescription pad to try to get them to adopt a healthier lifestyle in this great public servant our great borough president has done that and so it is an honor for me to introduce him now I got to tell you New Year's Day I've been up late with my kids and my wife we do the we watch the ball drop on TV and everything and we have our toast and we eat and then we go to bed and so I woke up a little late on New Year's Day and I turn on the news there was the borough president at Coney Island getting in the water I said my gosh what think what does Eric not do so there he was bare chested 20 degrees in the water in Coney Island I said well he makes us all look like slackers so it is now my honor to introduce the great borough president for the borough of Brooklyn of the Honorable Eric Adams it was it was cold that day also you know you know the this institution is a great institution downstate and we are great team they're great team and for far too many years whenever you have a team and I use the analogy of sports to talk about you know how do you move towards the championship how do you move towards building the synergy that's needed to allow a great team to materialize their success and you really need a marquee player you need a player that you can build the team around could bring the right energy and right here in Brooklyn we have the LeBron James of Medicine and dr. Riley dr. Riley is and I don't waste your capital dollars but when I see something come to my office about spending capital dollars to develop this institution and it says downstate trust me we are going to write the chat because we know it's not going to be wasted and it's going to deal with those issues so let me say this and we're going to hand it off to the professionals that are here this has been an amazing journey for me and the entire concept of wellness and if I can for just a moment part of the discovery because once you start peeling back the onion you start going deeper and deeper and I think what dr. Riley stated really hits home there's this concept that many of us are not aware of do you know that psychiatrists were the only doctors that never examined the organ they were attempting to fit if you are a cardiologist you look at the heart but psychiatrists never did that neuroscientists came forward and using technology they were able to actually look at the brain and they partnered with psychiatrists and they were able to see how the brain actually operates and in the process one part of that discovery is something that's called synaptic connections synaptic connections are so significant because every time we learn something new neurons connect and so you go from knowledge to thinking to doing to being being is when it becomes a habit that remains with you forever when you wake up in the morning and you brush your teeth you don't think about putting the two face on dampening it toothpaste and brushing your teeth you don't think about dressing yourself tying your tie in fact some of you if you want to do a real analysis can't even tell you what route Road route you took to get here today because you're so used to come in here that the synaptic connections are so solid and once you are in the state of being the synaptic connection becomes part of you and it becomes part of a habit and you no longer have to think through it now this is not a 9 o'clock biology class but this is important the synaptic connections these neurons that go off in our brain you we have more electronic pulse in our brains than all of the cellphones that takes place globally daily those synaptic connections learn how to ride a bike you create these synaptic connections of balancing yourself of pedalin of moving you can learn something and correct and then learn incorrectly so you have to disengage the set synaptic connection that taught you something incorrect and you start a new synaptic connection that teaches you how to do it correctly we don't have a healthcare problem we have a synaptic connection problem we were raised year after year life after life on our eating habits that taught us how to eat habits that is causing the diseases that's impacting us so if you go into a hospital and dr. Reilly give you a prescription of telling you the things that you need that you need to do to be healthy and you're used to the synaptic connection of the fried food of the junk food of the McDonald's of all those things that you need to do that you've celebrated ordering Thanksgiving and Christmas and and grandmother gave you a recipe that you handed down to your children you created these synapses connections and you went from thinking to doing to being and not as as part of you if we don't have in medicine methodologies to disengage the synapses connection of unhealthy behavior and have new synaptic connections of healthy behavior then we're not going to fix the problem that must be built in the conversation and what is interesting about the synaptic connection remember when you learn how to ride a bike you didn't do it correctly the first time because that was only the connection the connection become foster when you do it repeatedly now you don't think about getting on the bike and saying balance myself pedal steer you don't think about it because you went from thinking to doing to being so when I was told I was diabetic when I lost my vision and my left eye was losing in my right when I told me I had permanent nerve damage that was irreplaceable when I had an ulcer high cholesterol high blood pressure all other things that I looked fine physically but I was breaking down and I didn't take it internal selfie when I spoke to my doctor my doctor had a synaptic connection from medical school that said diabetes prescription give him insulin so when I went to the five other doctors in the city all experts all the prestigious degrees but they all came from a place where the synaptic connections were telling them diabetes prescription insulin heart disease prescription statin drugs they had a synaptic connection from their training that only told them the way to deal with the health issue was through the prescription pad and even if they thought you supposed to modify some of your eating behavior the reality was that their synaptic connection wasn't strong enough to tell them that is where the majority of our energy should go and so if you are nutritionists want your patients who do better and eat better but the reality was that even in some of the philosophies of nutrition in this country it's about eat leaner meat eat chicken instead one of the highest areas that you have salt contents is a right to eat a few eggs all the food that we were telling people to do was feeding the diabetes and when the decision was made that Eric listen be scientific in how you approach diabetes go to Google and Google reversing diabetes that's when I started to journey a reversal and finding doctors like dr. Esselstyn and dr. Greger and some of the great doctors dr. Katz who's here today finding those doctors who disengaged the synaptic connection that told us we couldn't reverse disease allowed me to disengage my synaptic connection and re-establish new synaptic connections and was able to reverse my diabetes reverse my blindness reverse my nerve damage reverse my cholesterol level reverse my lifestyle not only did I go from looking good outside but I started to healed inside I tell people all the time I don't have a six-pack I have the case my body is solid right now but the journey didn't stop there 79 year old mother 79 years of a synaptic connection of eating a southern diet similar to the Caribbean diet similar to the Hispanic diet Scimitar similar to the East Indian diet all of us have the same diets when I went to mom and said mom listen you could turn this around after 79 years 15 years of being a diabetic seven years of on insulin two months after taking her synaptic connection and creating a new one she calls me say baby I'm off insulin the doctor took me off insulin two months [Applause] where we are going is so amazing because not only are we heal in individuals but chronic disease hijacks your life every one of you in this room knows someone who is going through a chronic disease every one of us thinking about hospice care nurturing a girlfriend through breast cancer dealing with a family member who's going through prostate cancer I just lost my dad two years ago from prostate cancer my sister just went through breast cancer my other sisters just lost a kidney all of us can sit back and write their biology by the the biography of the family members who are going through a chronic disease your presence here today is part of the revolution of Medicine has taken place across this entire country and it's starting here in the borough of Brooklyn what we are doing is amazing removing processed meat from our schools a type 1 carcinogen by the WHL children our babies are going to eat healthy moving towards a vision of hydroponics showing young people how to grow food in a classroom there's no reason that every school building in this city can't have a rooftop garden while children can grow the food and serve it in a cafeteria starting a plant-based program at Bellevue Hospital this is amazing what we're doing the oldest hospital in America has the first plant-based unit where we are going to use reversal of diseases think to people like dr. Katz and others bringing in our faith-based institutions one of the most unhealthy places we assemble is in our churches our synagogues in our Mars we took it about the beauty of God wants us to be fruitful and multiply yet we become in taxes toxic and died from the food we're serving every day changing the game disengaging the synaptic connections that taught us how to eat unhealthy and be unhealthy and reconnecting a new synaptic connection to show us how to live and how to prosper that's what this journey is about and I'm going to give all of me to help us at least have the information so we can make intelligent decision the determination of live with diabetes is over live with heart disease is over live with conditions is over we're now moving into a new mindset a new synaptic connection we're moving to a direction a reversal and all we want to do today with all of you is to just give you a new synaptic connection and you will go from thinking to doing to being let's heal good morning I'm cut out and we see the Dean of the School of Public Health at SUNY Downstate so I'm here to introduce dr. David cards it's with a special excitement that I introduced him have you wondered how to prevent disease and avoid chronic diseases and live longer probably you will get the answer from dr. David when he talks about prevention of diseases a proper introduction of dr. David gas cans will take me a very long time I'm sure you're here not to listen to me so I will try to make it very brief he is a well recognized global expert in nutrition weight management and prevention of diseases he is the founding director of Yale University Ciel Griffin Prevention Research Center past president of the American College of life style medicine in founder and president of the true health initiatives dr. Koch is an exceptional and exemplary public health leader he has served as a role model a teacher in the mentor for several medical students and also public health professionals throughout the United States and the world his research has been influential in shaping public health policy particularly in preventive medicine and also in nutrition dr. K is the recipient of many many awards for his contributions to public health he has received many honorary degrees Doctorate degrees and he holds several US patents he has appeared widely on radio and television probably most of you have seen him on Good Morning America on ABC News he is widely recognized for his abilities as an orator dr. Kass has been praised by peers as the poet laureate of health promotion ladies and gentlemen please welcome dr. David Carr good morning ladies and gentlemen the borough president took us to church I mean really Eric Amen we'll start there pleasure to be here you know that there is a pleasant peril of these congregations going to the same church and that is you wind up preaching to the congregation right so there's a good chance we are already a friendly audience with regard to the fundamental truth the incontrovertible truth about lifestyle is medicine that's hiding in plain sight but then again stuff is notoriously good at hiding in plain sight like that pesky elephant in the room it was six men of in distinct lined 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 and 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 holy 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 the boldly up in spake I see quoth he the elephant is very like a help snake the forth folks gonna need some help here reached out an eager hand and felt about the knee what most this wondrous beast is like his mighty plain quoth he it is clear enough the elephant is very like a tree v who chance to touch the ear said he in the blindest man can tell what this resembles most deny the fact who can this marble of an elephant is very like a fan the sixth no sooner had begun about the beast to grope then seizing on the swinging tail that fell within his scope I see quoth he the elephant is very like a rope and so these men of in 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 distance I ween rail on in utter ignorance of what each other mean and prayed about the elephant not one of them has seen now my friends I fear were prone to much the same tendency in epidemiology nutritional epidemiology in particular and hence my mission here this morning at the borough president's church is to point point out the elephant in the room here's what's on the breakfast menu so we have looked past elephant bits we will visit the dark wood of modern epidemiology talk about Archimedes levers have some choices to consider okay have recourse to a big spoon okay consider the tip of the spear listen to voices come again to a fork in the road and see about elephant bounds are there any questions at all about this perfectly clear agenda alright I best clarify so I started out with an elephant in the room but of course the other metaphor is the forest through the trees it's my contention that if ever we are to escape the dark wood of modern epidemiology we must first see the forest through the trees and I was speaking to my good friend dr. Oz Feld about the fact that the very best scientists do science and science is intrinsically reductionistic it's how we know about things like synapses and build the technologies that can view the brain to advance psychiatry and public health for that matter we break things down into the smaller bits of smaller bits but there is a risk in that we can all honor the power of science everybody here who's using a smartphone damn those things are smart right I mean we can beam our thought to any other individual on the planet instantaneously it's almost magic science is practical magic but the peril in it is the reductionism that can cause us to lose the forest for the trees everybody is a tree expert we lose sight of the forest even as it burns down we need to fix that if we are to escape the dark wood of modern epidemiology we will need to see the forest through the trees and in this dark wood I speak of chronic diseases so eloquently described to us already this morning are taking years from people's lives and because their chronic diseases they're not just doing that they're not just killing us prematurely they are also first taking life from people's years and the idea that these chronic diseases are not the causes of premature death was revealed emphatically and decisively the year I completed my training in preventive medicine at Yale I was trained in internal medicine I decided taking care of people after they got sick wasn't enough I wanted to be more involved in helping keep people healthy in the first place trained in preventive medicine completed that program in 1993 and this paper came out actual causes of death in the United States Bill Fagan Mike McGinnis basically said in this seminal paper the stuff that goes on death certificates written there by sleepy medical residents at 3:00 in the morning in the hospital about cause of death is all nonsense it tells us nothing when someone dies of complications of a myocardial infarction to see that atherosclerosis was the cause of death it's true but entirely unenumerated what caused that so McGinnis and Figgy were among the first and arguably the best to get their arms around this issue wrestled under control and say no no all of those things are effects not causes it's the stuff that causes that that matters and that list is in our paper and they enumerated a list of 10 factors that collectively accounted for virtually all of the premature deaths that occur in our country every year and that list was fascinating it was fascinating because those 26 years ago everything on that list was already modifiable by knowledge in our hands and power we had the latent potential to exercise still mostly unrealized by the way and that list was fascinating because collectively it accounted for almost every premature death in the country but for a rounding error the power of modifiable root causes of death is extraordinary and that list was amazing because it was compiled of things we can change as individuals or we must come together to change sometimes the best and sometimes the only robust defense of the human body resides with the body politic and when that's the case we need to come together in a church like this one and get it done but for my purposes in terms of the trajectory of my career the singularly remarkable thing about McGinnis and figis list is that 80% of the action was clustered in just the first three entries on the list of ten and those three entries were in order in 1990 tobacco poor diet lack of physical activity or as I have called them my entire career bad use of feet forks and fingers bad use of feet forks and fingers by themselves accounted for 80% of the premature deaths in the US as of 1990 and the only problem with this epiphany is that the vintage is getting a bit old I suspect you convened here for fresher data than 1993 I can see it in your eyes okay fair enough fresher data 10 years later a Lee mock dad and colleagues at the CDC reanalyzed this issue reaching substantially the same conclusion all that had really changed in the span of a decade is that the gap between tobacco is the number one cause of premature death and the combination of bad use of feet and forks as number two had narrowed it had narrowed for one good reason less smoking 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 back in 2000 the paper was published in 2004 also now an old vintage nearly twenty years old let's jump ahead 2009 and while we're at it let's flip this coin over look at the other face what if people get the behaviors right Earl Ford and colleagues reported on Survey Research conducted among 23,000 adults living in and around Potsdam Germany they asked these 23,000 people about four factors related to their health they asked do you smoke yes or no do you eat well yes or no when we must digress there because I can see you want a definition of eating well and I understand you expect that definition to somehow factor in coconut oil and I certainly know that you expected to reference both gluten and lectins and obviously you expect there to for whether or not a foods been genetically modified I mean duh and clearly you're interested in the ratio of omega-6 to omega-3 fat right and I think we should differentiate among the saturated fatty acids so that we carve-outs the Eric and lauric acid from PAL medic and myristic you clearly are expecting all right well anyway forward and colleagues didn't do all of that they defined eating well as habitual intake of vegetables fruits and whole grains and it was enough it was enough that simplistic definition of eating whoa hang on enough for what I'll tell you in a minute back to our regularly scheduled program so they said do you smoke yes or no do you eat well to find that simple-minded way 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 let's digress again for just a second because one of these things is not quite like the others arguably one of these things just doesn't belong did anybody in the room wake up and decide what to weigh today would that it were so right weight is not a decision weight is not a choice weight is not a behavior weight is an outcome and as a physician taking care of patients for over 25 years I can tell you it is a fact of metabolism that two people can eat the same exercise the same one gets fat one stays thin it's not fair but unpleasant things can happen to thin people too that's not always fair either life is just like that right and we know some of the reasons why this is the case variations in genes variations in resting energy expenditure ethnic variations and other stuff we haven't figured out yet but we know that it's true and one of my concerns as we think about incentivizing healthy behavior is all too often BMI winds up on that list as if it were a behavior it's not a behavior you can choose whether or not to exercise you can choose whether or not to eat well you don't wake up and decide what to weigh today nobody does okay end of digression - back to long suffering dr. Ford studies so they asked these 23,000 people do you smoke do you eat well are you active do you have a healthy weight and they 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 - I smoke eat badly don't exercise my way it's not so good these people over the entire multi-year span of the study had an 80% lesser rate of all 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 is slashed a stunning 80 percent now imagine if the news were to break tomorrow you used to be able to say front page above the crease but now it's on a glowing screen that we all like so whatever website you prefer there's a new drug available fda-approved it's available in bountiful supply it is shockingly free of side effects stunningly inexpensive safe enough for children and octogenarians alike and taken once daily for the rest of your life will reduce your risk of ever getting any major chronic disease by 80% who would not want a prescription for that the doctors wouldn't be able to keep up with the calls for prescriptions except the doctors wouldn't be in their offices even to answer the phone they'd be meeting with their broker trying to buy stock in the company selling the stuff because both taking that pill and owning the stock 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 insights of Hippocrates anyway if you happen not to like Potsdam for some particular reason or you're really fussy and want your data fresher still we have reaffirmation of these findings and 80% variance in the risk of all major chronic disease and a cohort study by Kovac at all a few years ago in the UK more recently still by McCullough at all here in the US and by the way I'll be happy to share slides so those of you don't capture images of all the bibliography you can get access to it otherwise you can just email me I'm happy to share and and I would argue that this is one of the more repetitive drumbeats in all of the peer-reviewed literature again and again oh no don't start that again and again and again we are reminded that a short list of lifestyle factors effectively what we managed to do with our feet our Forks and our fingers could shift our medical destinies by a summit of 80% 80% less risk of all major chronic disease and Eric I'm routinely inclined to do exactly what you did and ask people to think about the people they love who were going through a chronic disease and we can do this exercise who loves somebody who's been affected by heart disease show of hands who loves somebody who's been affected by diabetes show of hands who loves somebody affected by cancer show of hands who loves somebody affected by stroke show of hands who loves somebody affected by dementia show of hands these Scourge --is of modern epidemiology have invaded our homes they have invaded our families we speak in public health about statistics and epidemiology and it can seem remote but it's not it's up close it's intimate it's personal imagine a world where eight times in ten those questions did not result in people raising their hands eighty percent of us who just put our hands up would not because those things don't happen that world is possible that world is within reach if only we would grasp it and the power of this has virtually no limits it reverberates to our very pith and marrow to within the double helix of DNA itself we were giddy with the potential of genomics at the start of the genomic Age thinking that medical destiny resided there in fact it does not DNA is not destiny with very rare exceptions sickle-cell disease and actually some of the genetic work may fix that Huntington's disease rare exception but to a largely neglected degree in our culture dinner is destiny and we have research to show that so Dean Ornish one of the leaders in lifestyle medicine plant-based nutrition as medicine did this study with colleagues some years ago they enrolled 30 men with early-stage prostate cancer we heard about prostate cancer already this morning in its early stages we're not sure whether or not to treat prostate cancer because it may progress it may not and if it doesn't the treatment could be worse than the disease so we do watchful waiting doctors carefully monitor these patients to see if the disease progresses they treat only if it does but dr. Ornish and colleagues said well we can do better than just watching wait while we're doing that let's give these men the benefit of lifestyle as medicine and so they did they gave them optimal plant-based nutrition routine physical activity obviously no tobacco and in addition plenty of good sleep they helped them mitigate their stress and they cultivated strong social interactions and is the past president of the American College of lifestyle medicine I argue that is the six-cylinder engine of lifestyle is medicine so plant-based nutrition is the centerpiece but we're talking about feet Forks fingers sleep stress and love the six-cylinder engine of lifestyle is medicine so they were firing on all six cylinders in this study and over a span of months the researchers went on to study not so much the men with the cancer and not so much the cancer and the men but preferentially the genes in the men with the cancer and what they found is that this intervention took 500 cancer promoter genes and effectively turned them off and 50 cancer suppressor genes shown here and radically turned them on left as before right is after red is off green is on the power of lifestyle is such that it can refashion our fate at the very level of our genes you change your behaviors it can change the behaviors of your genes this is a power we're only beginning to realize and this is a branch of the literature that's filling up fast so again we thought DNA was destiny mostly it's not mostly dinner is and lunch and breakfast we even have evidence that lifestyle can alter the very architecture of our chromosomes these green caps our telomeres the length of our telomeres the caps at the ends of chromosomes arguably the single most potent predictor in all of biology of the length of healthy lifespan long telomeres long healthy life now other things being equal ill-advised even with very long telomeres to stand in front of moving buses and trains for example but other things being equal long telomeres long healthy life and there is evidence again our friend dr. Ornish who turns up everywhere in the lifestyle medicine space but also Elizabeth Blackburn a Nobel laureate in medicine that lifestyle interventions can lengthen telomeres so we're starting to understand the cellular mechanisms by which lifestyle medicine is the most potent medicine ever conceived and we know although we cannot alter the genetic hand were dealt we have massive control over how that hand is played that's called epigenetics and before I tell you about this study very briefly I'd like to point out to all of you that to some extent your medical destiny was shaped in the womb of your maternal grandmother we are all a mix of genes from mother and father our mother was a mix of genes from her mother and father but the genes our mother gave us formed inside our mother they were imparted to us by her egg which formed inside her ovary and that egg inside our mother's ovary formed in the womb of our maternal grandmother infant girls are born with all the eggs they will ever have the ovaries ultimately mature and deliver those eggs but they're already there fully formed the genes in those eggs are fully formed and the environment of our maternal grandmother's womb exerts an influence on the epigenome in that egg 95% of chromosomal real estate is not genes 5% is genes 95% is the epigenome the levers and switches that turn genes on and off up or down those levers and switches were set in our mother in her mother's womb and imparted to us what a profound responsibility there really is transmission across a sweep of generations not just to one Lamarque who argued that the blacksmith's muscles should be bestowed upon his children was a little bit right after all Mendel was more right Darwin was more right Lamarck was a little bit right actually our behaviors are transmissible they influence the epigenome and we transmit that too but here's the good news at any moment including at age 79 we can take control of our epigenome and reset those levers and switches and so this study high-risk people for heart disease bad genes got a lifestyle intervention and they outdid the bad genes slashed their rates of cardiovascular events in half even if we're Delta bad genetic and we can play it masterfully we can still win the game and winning the game doesn't mean lowering your cholesterol in six weeks it doesn't mean losing 27 pounds in 22 minutes no matter what they tell you and the infomercials winning the game means more years in life more life in years healthy people have more fun that's winning the game so I make the case hope I have that the master levers of medical destiny are not the tools of the medical trade not the stethoscope we Doc's carry across our shoulders through the carters of hospitals nor anything at the cutting edge of technological advance not pad or SPECT or fMRI the master levers of medical destiny were in our hands all along there what we managed to do every day with our feet our forks and our fingers and I trust you know what Archimedes said about a lever give me one long enough 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 alas we like to say knowledge is power would that it were so knowledge is necessary for power knowledge is prerequisite for power knowledge is not commensurate with power until we use it and the gap between what we know indeed what we have long known and what we do with what we know belies the wishful thinking that knowledge is power and so a luminous opportunity to add years to lives in life two years has been squandered this quarter century and more not lost in translation but lost in want of translation the failure to take what we know and turn it into what we do routinely and folks it is a privilege to come to a place like Brooklyn where that will exists to work together to mobilize the body politic to turn the promise of knowledge into power at last it is long overdue and we have been reaping the whirlwind when knowledge isn't power things do not improve in fact they tend to go south and so all these years since McGinnis and figis memo we have been watching rising rates not falling of chronic disease rising rates of obesity in the US and around the world this paper the global burden of disease focused on the u.s. tells us that with the most recent data the single leading cause of premature death in the United States is food this thing that should sustain us this thing that should nourish and nurture us the construction material for the growing bodies of children and grandchildren we love is killing us it's really quite a travesty and despite all we know about how to control weight by eating well and being active rates of obesity just continue to rise this is the latest color-coded map from the CDC with red representing a prevalence of obesity greater than 30 percent they had to introduce this color just in the most recent map gives a whole new meaning to red state and not so good and and by the way there is considerable overlap but that's a topic I'll defer that one to the politicians moving on quickly what is the problem why all these years has knowledge not been power well I think arguably you could say if you take this homosapiens in their native habitat and you add this the modern food scape as it were you pretty much inevitably get this you've noticed you notice the pause I've learned to anticipate to beat appreciation for this slide so I wait for that second beat before I move on in much the same way as we as if we took this and added this we would get this and I give you my figurative trademark for more than 25 years the polar bear and the Sahara I note hastily that when my wife who's sitting right here and I put this slide together 25 years ago there was no imminent threat of this actually happening to polar bears and alas that has changed so our point was not climate change here I'll come back to climate change before I'm done our point was adaptation polar bears are marvels of survival but beautifully adapted to just one particular habitat and that is a cold habitat and the very traits and tendencies that foster their survival and the cold would conspire against them as indeed they're doing as things warm up you retain warmth where it's scarce it keeps you alive you do the same beneath the burning Sahara Sun and summer and it cooks your goose and my point in this slide is that 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 Brooklyn 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's just what we need to do as we begin that job I think we find that immediately the problem fractures into two component problems the first is it may seem such a mess this land of golden arches where multicolored marshmallows masquerade is part of a complete breakfast it may seem you just can't get there from here I would argue we can one step at a time one sandbag in a levy to control the rising tides of toxic tribulation at a time we can get there from here and in some other talk at some other time I'll talk to you about all those steps but for now I want to spend time on the other component problem and that is we will never get there from here if we don't know where there is now again I realize this congregation knows where there is that's why you're here you're here because you know where there is I got that okay but we must all go out and preach the gospel and we must preach the gospel predicated on both our native sense and the relevant science because we must be persuasive we must win converts we will never get there from here if we can't agree we know where there is now with regard to fingers not much argument smoking is bad not smoking is better any dissent see how easy that is with regard to feet generally little descent there to using them good staying on our rear ends all day long not so much for the most part movement is good any disagreement but when we come to Forks our there's the rub because even in this audience if I went around the room there'd be different theories about things like the importance of gluten or lectins or which vegetables are better than which others and how much fructose actually matters and all of they even here even in our congregation there would be dissent and out there in the world damn it's so much worse basically the public says well hey we don't know anything because you know what I heard on The Today Show that somebody just came along and threw all you guys under the bus and everything we thought we knew up until yesterday is wrong again until tomorrow when somebody comes to throw this guy under the bus and around and around we go getting nowhere acting as if we don't know where there is and leading most people to ask this time-honored question what to trust about food what y'all think and bringing us to a fork in the road along one time we remain forever befuddled about the basic care and feeding of Homo sapiens and I'd like to propose the alternative Road I've devoted my career to this I won't belabor it but books including my most recent text books articles making the case that the truth is hiding in plain sight I'm in the excellent company of people like Darius Moser Ferry and Dean of the Freedman school of nutrition at Tufts Jim man at the University of Auckland Frank hew who chairs nutrition at Harvard and many many others if you look without bias at arguments for or against low-fat diets and vegan diets and low glycemic diets and the - diet and the diabetes prevention program in Palio and low carb and Mediterranean our culture runs on the dialog that one of these is better than the others today wait until tomorrow my diet can beat your diet and we bicker and make no progress and the reality is the olive in the middle nicely skewered by Michael and when he said eat food not too much mostly plants and although that leaves quite a bit to the imagination in the generalities it is fundamentally correct real wholesome food plant predominant plant exclusive fine not necessary for everybody but let's just get everybody moving in the right direction let's not make perfect the enemy of good and frankly much the same conclusion in the five hundred and seventy two pages of the 2015 Dietary Guidelines Advisory Committee report yes it's true pithy Michael Pollan got it down to seven words this was 572 pages but no offense borough president this is government work what are you going to do right we actually reached much the same conclusion in 2015 when old ways sponsored a common ground conference I was privileged to co-chair with Walter Willett in Boston we convened disagreeing nutrition experts from all around the world Mediterranean Palio vegan and over a few days we mapped out the common ground and decided we agree about eighty to ninety percent of everything it's just that when you get put a microphone in front of us all we ever talk about is our disagreements I'm right they're wrong listen to me now we got to stop doing that right we mostly agree and I knew that because I'd had lunch with these characters and they said hey everybody's eating most of the same stuff that matters let's tell people oh and by the way this idea that we've got to pick one scapegoat right so you know sugars bad now so saturated fat must be good nonsense no sorry folks there are Mark Hyman fans in the audience apologies but dr. Hyman did not singularly discover the harms of sugar in his garage last Wednesday we've actually known for forty years that excess sugar is harmful they've only been dietary guidelines in the US since nineteen eighty these were those 1987 bullets number five avoid too much sugar we've been delivering the memo for decades it's just that nobody is bothering to read it they're too busy eating multicolored marshmallows as part of their complete breakfast or something oh and by the way this whole pop culture narrative this might be Gary Taubes you know we cut fat and got fatter and sicker so we picked the wrong macronutrient we need to cut carbs and also nonsense for many many reasons one of which is everything from lentils to lollypops this carbohydrate how can you pass summary judgment on that vast expanse of the food scape but we never cut fat in the first place you know there are two ways to cut fat as a percent of calories there is the sensible way that might actually help people and there's the American Way you know so you know in the sensible way you would actually eat a bit less fatty food America we don't like less less it's bad it's bad concept more we like more so we went that way and if you want to reduce the percent of calories you get from fat all you need to do is keep eating the same amount of fat and eat a lot more of everything else do the math you grow the denominator right you guys math is that good right you can either shrink the numerator grow the denominator we grew the denominator these are data for dietary intake trends for the past 40 years or so total intake of fat actually went up but total intake of refined carbohydrate added sugar went up more so calories went up more than fat fat as a percent of calories went down but folks here's what it tells us we were eating more of everything and then we carry on as if the ongoing obesity epidemic is some mystery that requires more biochemical and epigenetic insights hello we're eating more of everything and we know that this is great this is a flow diagram just Google America diet changes Fox not necessarily right now I'd rather you pay attention to me but at some point when you're not paying attention to me Google America diet changes Vox you'll pull up this flow diagram it'll show you the shifts in food intake over the past 40 years in the u.s. it's very illuminating but what I was going to say is we even know why Michael Moss author of salt sugar fat wrote this New York Times magazine cover story the extraordinary science of addictive junk food he's not the first to give us this news but he's a fuel at surprise winner and he does it beautifully what he tells us is that every major food company in the US and around the world hires teams of PhDs gives them those functional MRI machines we used to look at brains and marching orders to design food we stop eating unfortunately synaptic connections can be exploited and big food is in the business of doing just that these guys are instructed to design food people cannot stop eating until their arm gets tired from lifting it to their mouths and again then we the docs give our patients advice about portion control and send them out into this world and this is why I would argue we need enlightened leaders like the borough president here people who say we've got to work together on this this is an unfair challenge for the individual so we know why we've been eating more as we reflect on solutions some people would argue this is the elephant in the room we need to think about the Stone Age we need to think about our Paleolithic origins mostly the Paleo diet argument has become an excuse to eat pastrami and bacon and folks I've got news for you there was no Paleolithic pastrami all right I never see it used as an excuse to walk 12 miles every day and eat a hundred grams of fiber which by the way the expert the true experts in paleo tell us we ate a hundred grams of fiber my guess is that the Palio people doing all the opining in the blogosphere wouldn't have time to do all the opining in the blogosphere if they ate 100 grams of fiber in the day because they'd be in the bathroom so they're not interested in that back to the pastrami but there is utility in thinking about the Stone Age we are creatures like all others like that polar bear of mine we are adapted to a native habitat so what the Stone Age teaches us is that we are constitutional omnivores adaptational e physiologically metabolically we are omnivorous we can thrive eating plants or animals now our Stone Age ancestors hunted and ate wild animals who in turn ate wild plants we clearly are adapted to digest me other animals aren't I have a horse my horse cannot eat meat they're animals that must lions are obligate carnivores we're in between we have choices this discussion my friends is about good choices being good people to one another to the world to our communities to our own bodies who make good choices so we have choices for diet what do we know this study out of Harvard shows the higher the percent of total calories from saturated fat from the usual sources meat processed meat dairy process dairy the higher the rate of premature death from all causes the higher the percentage of fat from unsaturated sources mostly nuts seeds olives avocados fish and seafood the lower the rate of premature death from all causes that's pretty stark this is in over a hundred thousand people followed for 30 years and yet we wind up here again and again with the argument that saturated fat is good for us now butter is back is it really no it is not I I won't spend the time to belabor this issue you can ask me about in the Q&A if you want more but basically the two meta analyses that are the foundation for the argument that saturated fat is good for us now showed that across a relatively high and relatively narrow range of saturated fat intake rates of heart disease were high in constant therefore saturated fat is good for us now no no not so fast it implied something to me maybe there's more than one way to eat badly and Americans are committed to exploring them all and in fact that's exactly what's going on when we cut saturated fat in this culture we're not loading up on broccoli and lentils for crying out loud we ate low-fat junk food like snack well cookies so thank goodness Lee and colleagues at Harvard came along and said let's look at this what happens when people cut saturated fat well if they cut those calories and replace them with snack Wells sugar and refined carbohydrate lateral move two ways of eating badly two ways of having lots of heart disease if they replace saturated fat with trans fat calories they stop eating butter start eating stick margarine things go from bad to worse frying pan to fire but if they replace saturated fat calories with whole-grain calories massive reduction in heart disease risk and if they replace saturated fat calories with unsaturated fat calories from nuts and seeds olives avocado massive reduction in heart disease risk no saturated fat is not good for us now and no all carbohydrate is not created equal but we all know that right lentils two lollipops pinto beans two jelly beans summary judgment about carbs is just so much pop-culture nonsense it's got to stop we need to be talking about foods as I suspect all of us do not macronutrients it's just not helpful we have choices for protein again a hundred thousand people 30 years the higher the intake of protein from animal sources the higher the rate of premature death from all causes the higher the percent of protein calories from plant sources beans and lentils in particular the lower the rate of premature death from all causes and here we see that two somewhat more granular fashion just scan down the list bottom line biggest reduction this is women heart disease biggest reduction substituting beans for beef and by the way in the past year a study out of well a little more than a year ago now Loma Linda suggested that if the average American would routinely eat beans in the place of beef just that we could achieve roughly 60% of the greenhouse gas emissions reductions pledged in the Paris Accord yes we need responsible government action but sometimes my friends the powers right in our hands and in our kitchens we can take action ourselves we have choices for preserving our aquifers we heard a lot about this during the peak of California's drought off the charts in terms of water utilization is beef a thirsty world must consume less beef period end of story and so I'm making the case as we think about the power of plant-based nutrition for health that we also must project beyond the limits of our own skin and think about this world we're and in fact let me pause here now I'm in a school of public health I'm honored to be here today I don't know if you need my invitation or not my fellow health professionals but on the chance you do let me issue it you cannot call yourself a health professional in 2019 if you are not advocating forcefully emphatically and every chance you get for the health of the planet there are there is no public health left to protect on a ravaged planet it is our patient - okay so we need to protect our aquifers we have choices for the climate again massive reduction in greenhouse gas emissions possible with a shift to plant-based eating I love this piece in the conversation couple years old now but still good meat may or may not be a complex health issue most of us think it's not but they said it was okay fine but it's a simple environmental one the world needs to eat less of it we have choices for the economy this was just out group at Tufts including dairy Schmo Safari and cost-effectiveness of financial incentives encouraging people to eat more plants massive reductions in the expenditures through Medicaid and Medicare we scientists need to do the work that empowers enlightened leaders like the borough president here so they can make the economic argument for investing in plant-based nutrition and lifestyle transformation it's not just good for people and good for the planet it's good business too everybody can win here and there was a bigger analysis a few years ago out of Oxford showing savings to the tune of many trillions of dollars over a time horizon of a decade and longer if we were to shift the world's dietary patterns to more plant-based eating we have choices for biodiversity we are ruining fragile ecosystems cutting down rainforests to grow palm plantations for palm oil in Borneo cutting them down to graze cattle in the Amazon and I don't know about you but I don't want to be the person who's processed snack is the reason the last orangutan no longer has a tree to climb these are the things we're doing these are the implications of our dietary choices and we have the choice of a grand confluence eating better for the sake of ourselves and the planet it's all one thing and this was beautifully encapsulated in the recently announced eight Lancet Commission that was their conclusion the same fundamentals of a healthy diet for people are good for the planet and vice versa and yet we do find ourselves mired here this is the typical American diet from the book hungry planet what the world eats and so the question in these last few minutes as we sprint to the finish line is okay fine whoops lifestyle is the best of all possible medicine with plant-based nutrition as the centerpiece how on earth do we at last get the medicine to go down Lord knows the last thing we need is more spoonful of sugar but we need some kind of spoon to get this dang medicine to go down it can't look like this and this is the status quo I told you about the work of Michael Moss the good guys are bailing a sinking ship with pipettes the bad guys are flooding it with a firehose and folks how many of you are parents grandparents answer uncles no a kid just I'd like us all to be in on this I want to ask you another question so health professionals advocate for the planet it is your duty here's another one be outraged where is the outrage when we hear when we hear in a New York Times magazine cover story that our food supply is wilfully manipulated to make people fat and diabetic for the profit of big companies where the hell is the massive outrage among loving parents and grandparents because when loving parents and grandparents org becomes a special interest group I pity the fool that gets in our way right we could be the greatest special interest group the world has ever known but it is time past time for outrage we know how important it is to eat well we have rigged the food supply making it damn near impossible to do I don't see nearly enough outrage righteous indignation my friends so I invite you to advocate for the planet and I invite you to be outraged join me I'm outraged all the time and I mean all this very literally these were the new kids cereals introduced in 2017 we're wringing our hands about epidemic type 2 diabetes and kids and corporate America is responding with sprinkled donut crunch be outraged it's time the solution we need looks less like the status quo more like this we got to the moon for three reasons so far as I know we wanted to go we're an ingenious and relentless species and we all agreed where to find the damn thing I think we want to go to a world where there's 80 percent less chronic disease we're still in genius in relentless I think agreeing on where there is is a crucial missing piece of this puzzle and I think it's also time to recognize we're asking too much of individuals the big spoon is culture lifestyles the medicine culture is the spoon yes doctors can issue prescriptions but we really need neighborhoods and communities in a culture that fosters healthy living as the norm and we have evidence of culture as the big spoon in the world's blue zones where people routinely live to be a hundred and don't get chronic disease they eat well they're active they tend not to smoke they sleep enough they're not stressed out and they have a strong sense of community in these five sites around the world but it's because it's normal it's not because individuals are overcoming the currents of their culture it's because the currents of their cultures in eco Riya Greece Sardinia Italy Loma Linda California Okinawa Japan and the Nicoya Peninsula Costa Rica flow towards health not away and we see the same thing in the Bolivian Amazon where the CH Amani have the cleanest coronary arteries known to science and we even do know borough president that Blue Zones can be converted to blueprints and transplanted north karelia Finland had the highest rates of premature heart disease and death from it in the world in the middle of the 20th century they learned the lesson lessons of the seven countries study they reformed diet and lifestyle they reduced heart disease rates by over 82 percent they added ten years to average life expectancy one of the most stunning achievements in the history of modern public health we could do this we should do this we've been waiting too long so lifestyles the medicine culture is the spoon but yes we healthcare professionals want to be at the tip of the spoon or spear and leading the effort and I think there are new ways to do that and again I'll get to the end here momentarily but I'd like to point out one contribution in this space let's acknowledge that we tend only ever to manage what we measure we should measure what matters and frankly diet matters most so blood pressure's important to health imagine all this talk about blood pressure and never measuring it well of course we measure it and we know that glucose is really important to health for people with impaired glucose metabolism and it would be silly not to measure that and track it and fitness is important to people's health so of course we are very interested these days in measuring Fitness but the single most important variable in the health equation in the modern world is diet and we just about never measured how many of you have completed the food frequency questionnaire or seven-day food diary small minority in an audience of people attending a nutrition conference in the world outside it's virtually nobody and with good reason right these damn things make your eyeballs catch fire don't they I mean I mean if we got up close to those of you who just raised your head we would see that your eyelashes are singed right I mean you know it just goes on and on it's tedious and well we need to fix that we need to take a page from Matt Damon y'all see the Martian he's stranded alone at spoiler alert he's stranded alone on Mars he's an engineer he's up there stuck and he's talking to his video diary and he says so I've can come to the conclusion that and you expect him to say I'm gonna die cold and alone up here but he said he says and forgive me I quote I'm gonna have to science the out of this and well frankly you know to some extent our excesses in engineering got us into this mess top modern world we need the same kind of ingenuity to get us out and we certainly ought to be able to measure what matters in 2019 I've launched a startup company called Diet ID to reinvent dietary assessment tracking and coaching to help in that enterprise and so we borrowed from a fir after this device you use when you go to the eye doctor they ask you which image is clear which is blurry you well played this game and you pick and you pick and you pick again in 30 seconds later they don't guess at your prescription they've got an exact match for your eyes we do that with diet we have a fully-realized library of dietary prototypes we say which of these looks like you after we know a little bit about you we say pick and pick and pick again and within 30 seconds we know your diet type down to the specific levels of nutrients and the 2015 HEI score so objective measures of diet quality we help people find a gold diet we help navigate them from here to there I'm not selling this to you it's a b2b I'm just making you aware these kinds of innovations are possible should happen and we can change the world but the single most important thing to do is to rally around these fundamental truths hiding in plain sight and I'd like to ask you to join this congregation too I founded the true Health Initiative it's a federally authorized 501c3 to bring together the fractious voices in lifestyle nutrition to tell the world what most of the experts already know but the public doesn't and that is across the divide from vegan to paleo we agree more than we disagree you don't go to a conference with actual experts the vegans have a plate full of greens and lentils or beans for protein the Palio experts have the same greens and maybe wild salmon or maybe bison but their plates look more like one another than either looks like the typical glow-in-the-dark American food plate and the public deserves to know that too so the true Health Initiative is predicated on the work of an illustrious colleague he wrote a case report about a pachyderm with extraordinary auditory acuity or uncompensated schizophrenia we've never really known which but Horton could hear who's that nobody else could hear until the who's all came together and said we are here in the case of the true Health Initiative we have 500 world leading experts from over 40 countries coming together not to say we are here but to say we agree because I think it's time to generate a signal that can be heard above the noise and if you agree please check out true health initiative dot org add your voice join the chorus in unity there is strength and my latest book the truth about food which covers all these things I'm talking about is written in the service of the true health initiative all proceeds from the book go to support the true health initiative so you may want to check that out as well truth about food why pandas eat bamboo and people get bamboozled and that brings us to the final fork in the road for far too long we have let health languish in our culture along the road less traveled for far too long we have let squander a luminous opportunity in want of translation it's an honor and a privilege to be with you here this morning in Brooklyn because we must come together to generate the strength born of unity to take it last the road less traveled add years to lives at life two years save the planet and when we do all of that the elephant in the room still won't be able to fly but will look like this thank you all very much thank you everyone and now we have some time for some to take some questions from the audience Thank You dr. Katz can we please have the last slide that had his on email it just flashed on and it went off in two seconds but I I'm I'm too easy to find to be honest but it it's it's pretty straightforward so David Katz at yale.edu and and by the way let me warn you in advance you'll get an auto-response that says something along the lines of I can't answer every email I'll probably answer you I try I really do try good morning thank you so much for the great presentation so you spoke on it a little bit about our argument and you know we need to kind of get together but novel and new and arguing is fun to look at so it's something that we continue to get that's a problem so I just wonder how you can speak to that because I think that's you know it keeps it interesting for people and that's why it sustained for the public ya know it's an extremely important point so I worked for two and a half years on air for a Good Morning America and it's a poorly kept secret and broadcast media that the mantra in the control room is comfort the afflicted afflict the comfortable so you know it is not the purpose of Good Morning America or the Today Show or People magazine to educate you it is their purpose to titillate you and in fact the more often they can refute today what they told you yesterday so you buy another copy and tune in tomorrow the better so on the one hand this does require ongoing efforts between the Health Professions and the media we need to offer to train them in understanding how science works no you really shouldn't make a whole lot of noise about every study as if it refutes everything we knew up until yesterday science is incremental you should remind people this adds to what we knew here's someone to tell us what they think it means in context invite those experts make sure you land in a sensible place make sure even if you titillate and tease at the beginning of the piece you end with something that makes sense of it so there there is a need for us to collaborate on the other hand ultimately you could you could pose exactly this question you're posing about media about the food supply right we could say you know people like salty food and they like sweet food and they like fatty food and they're giving us what we want well that's true but there are two issues in play first they help to create what we want so we have a culture where we've created this desire for titillation in our news rather than news in our news we could decide it's time to change our tastes a movement begins with a small group of thoughtful and committed citizens right Margaret Mead never doubt that a small group of thoughtful and committed citizens can change the world indeed nothing else ever has with the possible exception of large asteroids but we could change our taste for media right and we could say no you know actually we're going to start tuning out the stuff that gives us titillation and overhyped things and looking for media that deliver well-considered information this study doesn't change everything here's how to interpret in context the other thing to note is that maybe diet needs to come off that list I've been one of the judges for US News and World Report for the annual best diet context for the past decade and I play but every year I also tell the editors there you do realize those places around the world where people actually eat well they are not waiting for news about the best diet every year they eat the way their parents say who ate the way their parents they read the Blue Zones they've been eating the same way for generations diet does not need to be news every day and then my final component to your answer is okay if we still want diet to be news because there's such fascination let's have the news be how rather than what so we all know now what is a healthy diet it's incontrovertible it's incontestable everybody agrees how do you get there from here today we have another expert on to talk about culinary tips and Hulan airy medicine and what's happening in medical schools and how you can engage children and what should be happening in secondary school and on and on the house let's have endless stories about the how really cool stories about the how and let's hear from individuals who've used the power of diet and lifestyle to transfer like you know at the borough president story I mean I that's that's great media right there right I mean that was fantastic well you know there are a lot of people like him out there who can tell their stories so here's what it can do for you and now let's talk about how right let's shift the narrative we do not have to listen to nonsense just because there's nonsense to be heard yeah first of all thank you that was beyond fabulous thank you so much I really appreciate it thank you rich Rosenfeld and the question I have for you is this you alluded to the congregation who's here and it's sort of like when you send out satisfaction surveys in a medical office and you get a note back saying why is it that the only offices that send these out are the ones who don't need to you know it's sort of fish discover water last and we have a conference here we're blessed we have close to 250 people coming if you look at the registration we have 30-40 medical students which is great lots of folks from the community and last time I checked there were three resident physicians we have I think 20 residency training programs at downstate with about 800 residents and this has been promoted promoters promoted and three and one for my department maybe four have found a way to come today I promoted it to the chairs of medicine to family practice to others some of them are here but very few practicing physicians who can't take time off from their busy day to come here talks like this so how do we crack that nut it's great that we're all here and the choirs here and the congregations here but how do we get it to the mainstream the people that really need to absorb the message yeah so first of all thank you again for convening us thank you for inviting me excellent question I I'd like to speak up in defense of those medical residents which I probably don't need to do because the docs in the room are all on their side so we've all been there you know I mean those guys are working a hundred hours a week if they can spend a few minutes napping they should probably spend a few minutes napping right so I mean it you know we have to fit this in where it works best so a few answers and I realized the question is both real and rhetorical you're just sort of throwing it out there this is our problem we wind up getting together with members of our own congregation we preach a gospel we share we all say Amen but have we converted anybody have we changed the world so first this must be culture why'd we need to acknowledge that the burden cannot be preferentially on healthcare professionals we cannot live in a culture where big food profits massively by making people fat and sick and expect doctors in moments of clinical counseling or other health professionals to fix it in the blue zones where people routinely live to be a hundred where food is medicine where they don't get chronic disease and we're at the age of a hundred and two they go gentle into that good night because they go to sleep one night and just don't wake up the next morning they never go to the ICU in the Blue Zones you ask them how they got there nobody says my doctor gave me great counseling they don't even know how they got there they just floated in the currents of their culture their whole lives right so it must be culture wide the education should begin in preschool in headstart we should be serving good food there and talking about it the education must extend into kindergarten we developed years ago at the prevention center program called nutrition detectives it was for elementary school kids it taught them how to differentiate good from bad food essentially to make it simple using a food label we taught them five clues that fit on a refrigerator magnet we did a randomized trial in 1,200 families the kids who got this 90 minute program 90 minutes out of a whole school year and we gave it away for free by the way kids who got the program massive improvement in their food label literacy and their attitude they you know instead of pulling on mom's elbow and saying I want the one with spongebob on the cover they would pull mom's elbow and say no this has partially hydrogenated oil put it back I mean really quite but what we found in this randomized trial published in the Journal of school health by the way is that the kids were effective vectors we never talked to their parents we just infected their offspring with the knowledge but the kids took it home and infected their parents we did before and after testing and the parents of the kids who either got the program or didn't the parents of the kids who got nutrition detectives had a massive improvement in their food label literacy so kids are powerful agents of change we need to do this in kindergarten elementary school then we need peer to peer educational programs in old for older kids health corps member dhadges program in high schools teaches good nutrition using peer mentors we need more programs in colleges there's a real great movement ken to get you mass is in the vanguard of this basically culinary directors at colleges and universities who say we've got a captive audience we've got young people who aren't yet parents but are going to be that are getting all their meals from us we can both feed them great stuff and teach them why it's great stuff while we've got them and when they leave here they'll have a whole host of new synaptic connections they will have reprogrammed their thinking about nearly huge opportunity and then at the level of those of us who are already out in the world well yeah I mean clearly we need transformation of health professional education - that's happening I'm really excited about keulen airy medicine David Eisenberg the work of many others Tim Harlan at Tulane but these programs that say no you can't teach doctors nutritional biochemistry and expect them to be able to counsel patients you need to teach them good recipes they can make and eat and then they can take that kind of information and pay it forward that needs to happen - but ultimately I think what we need to say is we're all in this together we all care and it really does become a force for cultural change and I do think one of the key impediments one of the reasons we're not seeing more and more programming with good information is because there's so much debate about what constitutes good information and that is factitious debate that is distraction that is diversion that is squandered resources and so I submit to you as one of the potential remedies there the true health initiative we need an organization that can pull us together one of the things I wanted to do there was make sure everybody's hero was represented so on the council of directors we have three former surgeons General of the United States we have household names like Sanjay Gupta we have famous chefs like Alice Waters but perhaps most importantly we have the world's leading vegan experts so everybody who's been mentioned here this morning Gregor and Esselstyn and Ornish and all the others but on the same panel willing to say in public we agree with those guys are the world's leading experts on the Paleo diet Loren Cordain Mel Connor Boyd Eaton standing arm in arm with their vegan colleagues saying we agree more than we disagree I think that's a potential game-changer we're working to reach three audiences through the true Health Initiative health professionals the media is I agree with you crucial right so you know instead of all of these he said this she said that pieces we're looking to the day when at the end of that article or at the end of that piece they say so we asked the true health initiative a global aggregation of world's leading experts from many different perspectives and disciplines and they had this fundamental truth to share right I'd like to get us there and the general public because the general public obviously constitutes the source of political will to make all these other things happen so a long answer to a good rhetorical question thank you [Music] [Music] but worry so I just imagine people kind of think this guy probably thinks he's smart I'm gonna ask a question I know he can't answer I'm asking question I know nobody could answer make him look like a giant doofus and then and then he can say thank you and goodbye so you know I mean it's the 64 million billion trillion dollar question and and the answer is there are many many answers so you know we want to teach people to cook we need to make it fun and engaging and frankly we have all sorts of ways to do that now it's a digital world one of the great barriers in our work over the years the Prevention Center has been reaching people getting them together you know being where they are but you know now where people are is Facebook and Instagram and they're whole new ways to reach people with information and and fit it into their digital lives recipes vignettes videos they're wonderful tools not to be self-promoting but my wife who's a brilliant cook grew up in southern France basically at one point one of our kids coaxed her into turning all of the cats family greatest-hits into a free recipe site quiz Anissa decom everything we eat at home quiz Anissa t-dot-com like cuisine city but with an eye in the middle quiz aniseed home we just paid it all forward and Katherine's done a magnificent job not just posting all these great recipes but filming herself making them in the kitchen showing you here's how you do it's simple it's fun it's engaging some of them are oriented toward kids so it's a great resource there are others like it but quiz honesty calm these kuelen airy medicine programs are teaching people how to cook at mid-career it's a CME program basically doctors can get continuing medical education credit learning how to cook great recipes I could go on and on they're many components the cost issue first diabetes is expensive obesity is expensive and a ruin planet is really expensive so we are not looking at the real cost of eating well versus eating badly either for individuals so they're people who will claim I can't afford fruits and vegetables but I can't afford the copay to my endocrinologist for the rest of my life they're wrong right so you know we need a reality check there we also need a correction in the farm bill which ought to be a food bill so we're subsidizing the right foods they're also creative engineered solutions for people who and afford better food but maybe you're too busy to take the time to cook we can send curated meal kits to their homes they're more and more interesting opportunities in that space and there's even really exciting stuff going on in the world of cookery Brava is a smart oven you can check out Brava just Google Brava ovens you can upload recipes from now again not everybody can afford this but here's my fantasy third party payors would pay to put this oven in the home of somebody for whom food should be medicine but who can't afford it because it's less expensive than all those trips to the endocrinologist this oven will accept uploads from your smartphone you put all the foods for a recipe on a single tray press one button it will cook multiple foods at different temperatures in half the time simultaneously so we can look to technological advances and we can look to connect the dots so the third party payors say yes food is medicine we will start thinking about using the equipment that can get people there from here the way we use medical equipment now right so no one short discrete simple answer to your question but if we committed to it could we crack this nut hell yeah we could thank you Thank You dr. Katz that was fantastic thank you so next up we have dr. Richard Rosenfeld and dr. Rosenfeld is distinguished professor and chairman of Otolaryngology at SUNY Downstate Medical Center where he's also a program director for residency training and president of the medical and dental staff he is the founder and chair of SUNY Downstate s-- Committee on plant-based health and nutrition and also the vice chair of SUNY Distinguished Academy dr. Rosenfeld glad I got up early and worked out in case I got to do the contortionist things to advance the slides but I think we're past that so I'm in the really envy of a position of one speaking after two of the best speakers you've probably ever heard right you know and three being the only thing between you and plant-based lunch you know which is really bad and before I forget if you do leave early and skip the plant-based lunch we should really be foolish too if you did turn in your CME forms okay so we'll make this quick and then we'll go eat a good lunch and talk we have a position statement that really gets you excited doesn't it I mean you know how many of you woke up today and said I hope I'm going to learn about a position statement right yeah exactly well it's in your handout but what is this kind of thing you know it's a point where you kind of articulate your beliefs as an organization about something you try and build understanding and support which is what we're doing today and hopefully it's based on the best evidence that's been filtered through someone other than yourself like a committee so that's what we've done at SUNY Downstate and here's the website which I would encourage you all to go to it's our website on the committee on plant-based health and nutrition one of the good things about being president of the medical and dental staff is I can just create committees it's a wonderful thing so I said I'll create a committee on plant-based health and nutrition about a year ago we did this and this is the culmination of that but it's on the handout on the back of the position statement and your folder I encourage you go to the website which is at the bottom there and there's great resources evidence for example evidence summaries you can see all the studies that are behind what I'm going to speak to you about now you can see myths and facts documents you can see frequently asked questions about all sorts of aspects of plant-based health and there's even a really good getting started guide that sort of demystifies a lot of the aspects of making a shift towards more plants in the diet so please go there now here's the question I was introduced as the chairman of Otolaryngology right that means ear nose and throat in English so you know I'm normally up here I do a lot of speaking it's normally about ear wax you know or you know too many boogers in your nose sinus infections you know you're clearing your throat because you you didn't eat enough plant food you got reflux alright so why should you listen to this guy especially before lunch talking about plant-based health and nutrition right well I'll tell you it always begins with a case study there I am in all my glory I think I must have been about two right you can see I was already becoming an advocate of good health and fitness and nutrition right you know but don't worry I was very interested in Fitness you know getting opposes out there at that time alright good you know terrific so then what happens well my dad was really into fitness and you get to high school and you say alright it's time to do something then you go off to college and you start pumping iron alright there I am in college you know 140 pounds pumping away the days of Arnold right franco lou ferrigno the hulk right and then what happens life there it is career kids and life where all of you are now 158 pounds this is about three years ago and I woke up one day and I said gosh it's gonna take my kids forever to get married and have grandkids do I want to be around for that I said yes then I better do something a little differently right so first I'll show you where I am now then I'll show you what I did differently so where am I now all right that is not Photoshop don't ask me that okay now our BP talked about his four pack or six pack or a pack or whatever okay so I'm 60 years old and change all right I have such fun teasing the residents in our training program about showing me their eight pack and stuff but yes I really do this stuff so so how did I get from the middle to the right you know and how do you do that you know well I thought it was things I did but I learned from dr. Katz's talk that I'm manipulating my epigenome you know it's like okay so manipulate your fpg mode I suggest you all read Gregor's book how not to die if you haven't done that yet I mean that is really the classic on this and you know I'm fortunate and my family one of my sons who you'll hear from later on the program Daniel is really becoming an expert in this and he's the one who sort of pushed this in the family you know stay away from the junk you've heard that right run I started running I never ran in my life three years ago I lost a little weight I was late for a meeting I ran I said huh I ran three blocks this is really cool you know I could I can run and now I'm running 3540 miles a week and gonna do a marathon in September we'll see work out hit the weights you can't just do you know extra sec I do the fitness to resistance training alright and there I am again eight pack you know got to go for it I literally get up at 3:30 in the morning almost every day except weekends before coming here this morning I ran seven and a half eight miles okay every day I do this stuff every day of week it's a habit all right it's in the genes now I feel great I got a lot more energy I can still be awake even before lunch my case countless others and volumes of research show that this works so let's get into the real research part now that's how I got interested in this stuff and you know I think you got to get a little mission driven here to really spread the word ok so what about this position statement that I know you're all just excited about so here it is plant-based nutrition emphasizing all the good stuff can prevent treat and even resource chronic diseases and adults now this is a statement that has been accepted and endorsed by the medical leadership of this institution the medical Executive Committee that's a big deal alright that doesn't happen in a lot of places so all the luminaries very few of which have come to this conference but they're still luminaries some of them are here and you know they're actually I have to acknowledge Beth didn't acknowledge it to start but we couldn't do this without support and the medical Executive Committee medical and dental staff have generously supported this conference as have the president's office dr. Reilly's office the Brooklyn borough president has really helped a lot with getting the word out and organization and there are others as well they're acknowledged in the program but this is the statement so what does this mean well we have a few things within the statement first we say that you know if you eat more plants you have less of all these problems you get all the good stuff now this is only based on evidence from 700,000 or more people in various studies that are shown here these are epidemiologic studies we're typically at baseline they'll do dietary assessments they might repeat it and they'll follow people for long long periods of time and then see how they do but even at baseline they have a lower weight lower body mass lower cholesterol you know lower inflammatory things etc now the real cynic wanan in medicine is the random nice trial you don't see a lot of this is difficult in nutrition and lifestyle research but there are some and that really helps you tell if treatment works so what about treatment what about randomized trials where we take a group of people with some disease type 2 diabetes being overweight cardiovascular disease we randomized half of them to primarily a plant-based diet and the other half to some eat what you want well we see that you can reverse and treat all these problems just by changing your diet and these studies go on only a few months typically maybe six months or a year at most a couple the ones we highlight in our evidence report are shown here about weight is particularly good and the good thing about plant-based thighs you don't just lose weight but you keep it off you know the problem with many of these diets you'll lose weight everybody can do that but you don't keep it off and coronary artery samples two of the folks you've heard about already Esselstyn and Ornish I mean are really luminaries and I suggest you look at their book so you you can prevent reverse and treat these diseases shown in randomized trials now you don't just want to have a population study and randomize people you want longitude you need to see what happens over time and that's where a lot of these real big population-based studies are helpful some of them are going out 20 30 years now median follow-ups 10 12 14 years on samples which is great you know so what's the longitudinal impact of this well if you eat more plants you're less likely to develop hypertension heart disease type 2 diabetes colon cancer gastrointestinal cancer etc you know this is shown in these studies we're not gonna get randomized trials that go out 30 years and control everything but the data are there and again these are some of the main studies big cohorts that are out there collectively over 700,000 people and growing and they find new ways to get information you know like they say an geology a fundamental statistical principle is if you torture the data sufficiently they will eventually confess to something right so if you know people are torturing these datasets in new ways looking at indices of healthy foods and etc and it's really showing the benefits of this approach now other longitudinal things probably the most important longitudinal outcome is death right mortality well good news eating more plants you're less likely to die from all these chronic diseases ischemic heart disease cardiovascular disease cancer pancreatic lymphatic and haematic cancers as well as all cause mortality I'm not sure if that means the taxi taxi person on Clarkson Avenue hitting you with their illegal cab but it might help with other things I don't know good evidence out there vegan versus vegetarian do you have to be all-in with this or can you just shift to the plants the the evidence is not robust on this there are not there are not a huge number of studies that strictly randomized to a vegan whole food plant-based versus vegetarian but the ones that do are starting to show that you really do better if you stick to the whole food plant-based than if you just get your toe in the vegetarian end of it okay what else is in that position statement a few other statements that we're really pushing here as much as meatless Monday would be a global sensation and eliminating all type 1 carcinogens who process meats would be great we're just looking to push the needle towards more plants and that's what the evidence really shows is the more plants the better a whole food plant-based diet which I'll describe briefly in a moment seems to be the way to go if you're going to pick one of these and there are all sorts of different diets in the studies it's hard to figure it out and as was nicely unlike it's all about lifestyle medicine and yes diet is at the center of lifestyle medicine but there's a lot of other good things that people do when they're eating better and that may confound a little bit our interpretation of the outcomes here okay so let's few words on what is all this plant-based nutrition now that you're hopefully all revved up about it from the borough president from dr. Katz and now this thrill-a-minute position statement right okay so let's let's take a look and you can raise here how many of you are omnivores come on fess up yeah there's a few of you I thought I'd say five ten percent all right let's go up the chain now all right flank so teri in the new word you wish you were vegetarian you're not you still eat some meat but you pretend that you're vegetarian how many of you do that yeah it is a bunch of you out there another 10% popped in all right the semi veggie folks you're a good veggie but you slip in a little chicken and fish now and then right I did this for most of my life how many of you do that oh this is a couple here that was like five percent vegetarian there you are you might eat some dairy some fish who's that vegetarian a very few very few okay five percent at best all right now we're gonna get really tough here vegans all right Wow probably about 15-20 percent of the audience very good now the ultimate Nirvana and self actualization and dietary and lifestyle changes whole food plant-based diets right who really does that about 10 percent I've been doing it now for for about two years it's not easy but whole food plant-based diets so that's the direction we want to go in more plant foods less animal foods I don't think you need perfection but that's where you want to go now what is this whole food plant-based diet well it means you're gonna eat the good stuff right the fruits the vegetables the whole grains legumes beans nuts and seeds all right you're not going to eat too much of this the refined processed stuff you know the the extracted oils even heart-healthy oils like olive oil which is only heart-healthy because it hasn't been compared to other things that are healthier as was said before but extracted oils are in general not very good for you they're fairly empty calories and you're going to avoid this stuff if you do that you're following a whole food plant-based diet but it's boring right eating lentils and grains and chickpeas and nuts right it's boring here now can you have fun eating awful plant-based you know food is the joy in life well I mean there's a lot of good stuff out there and you'll see it with lunch and to a lesser extent breakfast but lunch you will see it with lunch does good stuff how do you learn more about this you know a conference is one thing again go to our website we put a lot what's different about our website I think is we've tried to be very evidence-based so we've taken out the hype in a lot of these materials and they've been looked at by dieticians by nutritionists by medical students by practicing doctors by community folks by public health professionals so there's a lot of great stuff there that we're we're happy to share with you and there's a table out there about plant-based world they're bringing it right to your doorstep the Javits Center it's common you know the 7th and 8th really major big conference on this I signed up for this I think it's gonna be a lot of fun this was mentioned before by dr. Katz this global burden of disease we're now its diet I mean diet is driving chronic disease in the u.s. especially things like diabetes type 2 diabetes the cardiovascular stroke the hyperlipidemias that the cardiac the the cardiac profiles pre-diabetes obesity it's all being driven by diet yet we don't talk about it and and we talk about it here but not in general if you haven't already seen it see forks over knives okay I mean it's you can get it on netflix free everybody's got netflix now I think it's kind of like its ubiquitous but it's the story of campbell and esselstyn's you know quest for this and and their research where they follow patients who are really really really sick have had multiple bypasses and other problems multi morbidity not just a little morbidity multiple chronic morbidities and most interesting I thought was the producer you know Lee fulkerson who kind of took this thing on and said while I'm doing it I'll go whole food plant-based for a couple of months and see what happens and he just dropped his weight improved his cardio metabolic profiles and and really did well so that is the end of what I have to say about the position statement and I you know I think the the committee the position statement was great this conference is really a turning point for us we're really blessed and delighted that you have ventured here today and are sticking around and again thanks to dr. Katz I know the borough president had to leave and upcoming dr. oz fell than others for sharing their their wisdom and hopefully this is a start of some big changes in Brooklyn that you'll all be part of so I don't want to do Q&A cuz it's it's noon I'm happy to stick around if anybody has a particular question just come up but it is 11:58 and it is always better to release you for lunch two minutes earlier than two minutes later so there will be people outside guiding you to the the lunch which is a short walk away enjoy and we'll see you back at one o'clock

Channel: Downstate TV

Views: 594,966

Rating: 4.6330371 out of 5

Keywords: SUNY, SUNY Downstate Medical Center, Medicine, Health, Health Care, Health Care Providers, Plant Based Health, Plant Based Health and Nutrition, Preventive Medicine

Id: BhG9easNpAo

Length: 114min 50sec (6890 seconds)

Published: Thu Apr 04 2019