Calories Are Down. Exercise Is Up. So Why Is Obesity Exploding with Dr. Dariush Mozaffarian

Mark Hyman, MD

Dr. Mark Hyman is leading a health revolution—one focused on using food as medicine to support longevity, energy, mental clarity, happiness, and so much more. Mark Hyman, MD is a practicing family physician and an internationally recognized leader, speaker, educator, and advocate in the field of Functional Medicine. He is the founder and director of The UltraWellness Center, Founder and Senior Advisor for the Cleveland Clinic Center for Functional Medicine, a sixteen-time New York Times best-selling author, and Board President for Clinical Affairs for The Institute for Functional Medicine. He is the founder and chairman of the Food Fix Campaign, dedicated to transforming our food and agriculture system through policy.

He is a co-founder and the Chief Medical Officer of Function Health. He is the host of one of the leading health podcasts, The Dr. Hyman Show with 150+ million downloads. Dr. Hyman is a regular medical contributor to several television shows and networks, including CBS This Morning, Today, Good Morning America, The View, Fox, and CNN.

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Full Transcript

Automatically generated. Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. Dariush Mozaffarian
So calorie intake has gone down or is about the same as 2000. And physical activity has gone up, and obesity has dramatically gone up since 2000. So we have a paradox.

Dr. Mark Hyman
So eat less, exercise more, which is what we're all told doesn't seem to be working.

Dr. Dariush Mozaffarian
What's truly amazing is the science of of of how food affects our biology. What we're learning is that the type of food we eat long term is way more important than its calories. This is why we we can't blame willpower.

Dr. Mark Hyman
Welcome back to the podcast, Darius. I'm so excited for your new book, Food is Medicine, which just came out. It is been the work of my life, and to have someone like you also getting it is just amazing. And for those who are listening who don't know who doctor Mazafarian is, he's an iconic leader in the field of nutrition and nutrition research. He's the guy who I went to to learn all about nutrition from his scientific papers well before we were friends.

He's he's one of the most prolific, and published authors in the space of nutrition and is deeply thoughtful and has come to mostly the same conclusions as I have about chronic disease and food and how we're kind of trying to solve the problem of chronic disease with drugs, which is not why we have chronic disease. It's the lack of drugs. It's the lack of proper nutrition. And the whole idea of food as medicine is so central to his work, to my work. He's the former dean of the Tufts School of Nutrition Science and Policy.

He's now the head of the Foodist Medicine Institute at Tufts. And we have worked together and collaborated for many years in policy stuff in Washington, DC. And, you know, we have really just kind of walked this walk together around how do we make our food system better because it's not just a personal problem. The fact that we're obese and have chronic diseases in America is not everybody's fault because they're weak willed, morally corrupt, or have no willpower. It's something else.

And we're gonna talk about what that is. We're gonna talk about the key controversies in nutrition, about protein, about seed oils, about what we should be eating, what we shouldn't be eating, about what is ultra processed food. And we're gonna also talk about some of the key, issues that have been kinda controversial and are still controversial, which is calories. Are calories all the same? We're gonna talk about policy a little bit.

I won't bore you with that too much, but I think it's important because if we don't change the food system, we're gonna not be able to solve this problem. It's like trying to bail a boat. It's got a giant hole in the bottom without fixing the hole. So, Dari, welcome, and let let's, sort of get into it. Tell us how you as a, Stanford trained biologist, as a Columbia trained doctor, as a Harvard, you know, trained Miles per hour, MD, cardiologist, straight up doctor, how you somehow had the epiphany that food might be important considering we learn nothing about food in medical school or in our training.

Dr. Dariush Mozaffarian
You know, I I wrote this book to really put together everything I've learned in my career and and try to explain it to people. Know, you get to have a few hours with someone, and I get asked so many questions, and it's often the same questions again and again. And I and I thought, you know, if I can write down everything I know, explain the science, how we got here, you know, where we are today, and how we actually have to get out of this mess, you know, I could I could help, you know, an individual person understand what to do today and tomorrow for what they eat, but also really help us all kind of understand what we don't know and and where where there we shouldn't, you know, probably worry too much because there's not a lot of certainty. And, also, what the solutions are, as you said. So so it's it's great to be here.

To to get to your to get to your question, I mean, you know, you're you're absolutely right. You know? After high school, I did fifteen years of training to be to become a doctor. Right? Four years of college, four years of medical school, three years of internal medicine, four years of cardiology.

And in that fifteen years, the nutrition we learned was basically biochemistry. What's the Krebs cycle? Where does ATP come from? How is glucose broken down? Right?

And that's important. You need to understand that. But really, true nutrition food was missing from fifteen years of training. And and yet, the more I saw patients, you know, on both coasts or, you know, wherever wherever my clinics were, I realized that food was really a big deal and and important for their health. And so that was my first epiphany that I that I write about in the book that how how the the top cause of poor health facing many patients is missing from health care.

And that's a pretty big sentence, a pretty big statement that's pretty important and actually explains so much of the mess we're in with rising health care spending and people getting sicker every day and and, you know, bankrupting our future with with, you know, buying buying hospitals and and MRI machines and and drugs from from from Europe. And then the second epiphany I had was I said, well, I'm going to read all the science myself, and I'm going to at least try to be the best and most informed doctor I can be. And this was around 2000, And so I started reading all the science.

Dr. Mark Hyman
The nutrition science. Because it was there. It's just ignored.

Dr. Dariush Mozaffarian
That's right. And I still have the text of a presentation I gave as a cardiology fellow to the cardiology attendings and what I wrote. And what I wrote was that this focus on fat and saturated fat is mistaken. We need to be thinking beyond, you know, LDL cholesterol. We need to be thinking about inflammation and endothelial function and kind of the complex effects of foods and whole diet patterns and actually thinking about protective foods.

What are the protective foods missing from the diet? And an an example of that would be like the Mediterranean diet. Now remember, this was 2000. This was the height of the low fat diet fetish.

Dr. Mark Hyman
Right?

Dr. Dariush Mozaffarian
We were everything was low fat. You know, Snackwells and fat free frozen yogurt and fat free salad dressing and, you know, everything low fat. And so that was the second epiphany.

Dr. Mark Hyman
When you presented that to this group of cardiologists, there was heresy that saturated fat may not be the big issue, and LDL may not be the whole story. Did you get rotten tomatoes thrown at you?

Dr. Dariush Mozaffarian
Unfortunately, very few tomatoes in a hospital setting. But but lots of fries. Lots of fries.

Dr. Mark Hyman
Got french fries on it, yeah.

Dr. Dariush Mozaffarian
Yeah. The the the that was the second epiphany I had, though, Mark, is that that we had the science in hand, and it wasn't being translated to public and dietary guidelines and policymakers. I would write a patient would be admitted with a heart attack, and I'd write cardiac diet. And when I sort of went under the hood to see what's a cardiac diet, low fat, low salt, low cholesterol, and low saturated fat. They're And high sugar and carbs.

High sugar

Dr. Mark Hyman
and carbs.

Dr. Dariush Mozaffarian
Processed carbs. Jell O and ginger ale and soda and Kool Aid right? Yeah. And for heart disease patients. And so I realized those two things, that the top cause of poor health is missing from health care and that even the science we we have is not being translated to people.

Dr. Mark Hyman
Yes.

Dr. Dariush Mozaffarian
And I wanted to help fix both those things.

Dr. Mark Hyman
That's amazing. Yeah. I mean, it it it I remember being at Cleveland Clinic. I mean, this is the number one heart hospital in the world, and I started there in 2014. And I was like, okay.

What is the cardiac diet they're serving here? And I was like, it was this super low fat, high starch and sugar diet. And for everybody listening, you know, the causes of heart disease have changed, but predominantly, most cardiac disease now, heart attacks, are caused by insulin resistance and metabolic dysfunction, and that's caused by high sugar and starch and not by the typical things we thought of, which was too much fat. And and and we worked on the dietary guidelines together and advised the government on this. And that was one of the things that we we talked about, which was, hey.

We're we've kinda kinda get off of this fear of fat problem that everybody's had. So I think we're getting there, but it's it was quite a it was it was quite heresy in 2000. It's pretty impressive that you said that. So what did your colleagues say? Like, they were like

Dr. Dariush Mozaffarian
Well, you know, they they were polite. I presented a study. I said I wanted to do, a Mediterranean diet trial in The United States to replicate a Mediterranean a a small trial that had been done in France called the Lyon Diet Heart Study that showed that a Mediterranean diet lowered heart attacks by sixty two percent sixty two percent in people with heart disease. And so I said, I wanna replicate that study in The States. And, you know, people were polite and and, you know, where weather pagers went off, and they went back to, you know, taking care of of the other end of the spectrum, which is after everybody's sick, you know, we have to save people.

That's that's important. We can't we can't ignore that. But there wasn't a lot of a lot a lot of interest. And so I really had to continue to get training, and I went on to get my PhD in public health and nutrition and epidemiology in Boston at Harvard, and then, you know, started my career there at first at Harvard and now at Tufts. And and my career, I think I've I've tried hard not to be an armchair academic, you know, to where I just sit at my desk and do research and publish it and hope someone reads it.

Right? I've also tried to translate that, which is how we met, to translate that to whether it's health care, the food sector, nonprofits, government in The United States and around the world. And and what's exciting, as you said, is we are at a moment, which I think we'll talk about, a tipping point, where real change is possible, and that's different than in, you know, the last twenty five years of my career.

Dr. Mark Hyman
What I wanna do next is thank you for that introduction about your how you got here, which is which is quite amazing. Because because I would say to people listening that, you know, Dari is one the most honest and high integrity doctor scientists I know that's not ideologically driven that follows the evidence wherever it leads, including heresy, which is saturated fat may not be the boogeyman we thought it was. So as a cardiologist, the American College of Cardiology still holds on to that. Okay. So I wanted I wanna sort of zoom out for a minute and and just how you paint a picture of how did we get here.

Like, we are in a totally screwed up food system that's causing Americans to be sick and increasing our global population to be sick. And we're we're we we the worst food system in the world and spreading it to every country on the planet except maybe Burma and Cuba because we have no relations. And it's amazing. I went to Cuba, and there's, like, nobody's overweight. Everybody's thin.

It's quite amazing, and they don't have American anything. So how do we get here? And then we're gonna go into switch to the channel and go to the everybody's favorite radio station, is WIFM, what's in it for me. We're talking about calories. We're talking about protein.

We're talking about fat. We're talking about seed oils. Gonna eat all of that. So zoom out and first help us understand how did we get into this crazy system we're in now that's that's causing so much disease.

Dr. Dariush Mozaffarian
Well, first, Mark, I wanna start with with how bad it is today, because you talked about that. But let's really paint the picture, because one of the messages of this book, which I think is really important, is that food is the single biggest problem facing humanity, period.

Dr. Mark Hyman
Amen.

Dr. Dariush Mozaffarian
I'm not saying it's among them. It is the single biggest problem facing humanity, and it's fixable. It's fixable. It's kind of amazing. It's the single biggest cause of poor health, which causes in The United States and in many countries around the world the single biggest cause of economic devastation through loss of human productivity, health care spending, out of pocket medical costs, huge economic consequences for businesses that help ensure their employees, and so on.

It's the number one cause of environmental devastation, climate, soil, water, oceans, pollution. And it's also a major cause, not the top cause, but a major cause of inequities across society within countries and and across countries. And so if you put together the health costs, the economic costs, the environmental costs, and the costs in in human equity, this is the biggest problem. There's nothing bigger. War, infectious disease, energy.

There's nothing else that's bigger, and it's all fixable. So that's one thing I want people to put down the book and realize that the food they're eating is maybe the single most important thing they're doing every single day for not only their health, but for the national security and economy of their community, their family, our nation, and for the environment as well. And so and so that's really critical. And so, you know, we're so sick, Mark. We we have shown that ten thousand Americans die every week directly from poor nutrition, mostly from chronic diseases like diabetes and heart disease and and other, you know, obesity.

That's three September 11 every single week, and we're just all kind of shrugging because it's it's it's happened slowly. It's like the the frog in the in the boiling pot. Right? You know, it all happens slowly, and and we just sort of shrug now. So so it is devastating us, and it's devastating our economy at least $1,500,000,000,000 a year.

And and if you adjust for kind of health care inflation, I think it's closer to $2,000,000,000,000, at least $1,500,000,000,000 a year is lost to the economy in health care spending and lost human productivity from poor nutrition. Not from all diet related diseases. It's much larger. Just from poor nutrition and its impact. So we're, know, $1,500,000,000,000 worth of tea every year.

Over 10, $15,000,000,000,000. Right? We could we could pay off the deficit if we if, you know, if we if we could could secure that funding back and and prevent these diseases. So so that's the first message. The second message of the book is that we arrived where we are today through a series of interconnected, sometimes accidental events of just a hundred years where new science came together with government priorities and business innovation to purposefully create the food system to meet certain goals that were not evil.

They were trying to meet goals that that made sense at the time.

Dr. Mark Hyman
You helped me understand this. Everybody listening, Dari, helped me with my book Food Fix and helped me understand that this context of why we got here, and I I I really appreciate that. And I also came to the same conclusion that food is the nexus where all of our global problems meet, and that if we fix food, we fix everything. You know, it's quite it's quite amazing. I mean, even, you know, our mental health crisis, I mean, it just goes on and on.

Dr. Dariush Mozaffarian
We we we don't fix everything,

Dr. Mark Hyman
but not everything. We fix

Dr. Dariush Mozaffarian
a a lot. We lot.

Dr. Mark Hyman
We can't even war and all that stuff. But, you know,

Dr. Dariush Mozaffarian
like Yeah.

Dr. Mark Hyman
Aside from war and natural disasters, it's pretty Yeah. It's a pretty big pretty big lever.

Dr. Mark Hyman
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Dr. Dariush Mozaffarian
So we'll talk about you know, I'll I'll get into quickly the the the the goals that we were trying to meet, but but it's really important to understand that we don't just start the history of food with, like, evil food companies making us sick. Because if we start there, the only solution is to tear down the food sector and burn everything down and destroy everything. We have to understand that we got here through conscious decisions, science, government policy, business innovation. Because if we take that same road map, science, government policy, and business innovation now, we can fix it. We can fix it.

And we did that in the last century in about thirty years with with and so we can fix it again in in in thirty years or less. And so and so that's really important. So how do we get here? So I you know, healers for millennia have known that food is critical to health. Right?

You know? You know? Egyptians putting liver on people with night blindness. A vitamin E would seep into the eye and and cure night blindness. And, you know, you had to get understanding the medicinal properties of herbs in Persia, in China, of course.

But modern nutrition science, where we really started to understand what was doing that, I date the birth of that to 1932. So less than a 100 years. It's a very, very new science. What happened in 1932? The very first vitamin ever was discovered, isolated, and synthesized, vitamin c.

So even in the nineteen twenties, vitamins were unknown. No nobody knew what vitamins were. They hadn't been discovered or, you know, they had some theories and ideas about them in the nineteen tens, but it was really nineteen twenties, nineteen thirties. And so for the first time, there were diseases that had been plaguing humanity for hundreds of years. Palagra, which had killed a hundred thousand Americans just a couple decades before, and three million Americans were afflicted by palagra, an awful, awful disease of itchy cracked skin and neurologic abnormalities, and anxiety, and delirium, and then death.

Right?

Dr. Mark Hyman
It's a B vitamin deficiency.

Dr. Dariush Mozaffarian
It's a B vitamin deficiency. Niacin deficiency, a B vitamin. Scurvy, which killed more sailors you know, in the seventh in the eighteenth and nineteenth century than anything else than anything else on the sea. Scurvy was the killer of the sea, vitamin c deficiency. Night blindness, which is vitamin a deficiency.

Rickets, which is terrible bone deformities, which is vitamin d deficiency. These were endemic diseases, you know, where where you had children that were afflicted, you know, by these conditions. And so

Dr. Mark Hyman
And what what's amazing is that deadly, debilitating diseases could be fixed with pennies worth of nutrients overnight almost. It's it's one of the most miraculous cures of medicine.

Dr. Dariush Mozaffarian
It it was it was an incredible doctors today don't know what pellagra is. Nobody's seen a case of pellagra or cervi or or, you know, rarely rarely night blindness or rickets. It doesn't these were serious diseases, Mark, and people thought they were infectious. People thought they were infectious diseases. And I kinda walked through these discoveries, and it's you know, on the shores of Indonesia, you know, in in island of Jakarta and in in the South in The United States and and in Poland, and scientists kind of figuring this out and discovering that, oh my god, food is responsible for some of the major diseases that they thought were infectious or bad humors or just in the

Dr. Mark Hyman
But they were deficiency problems.

Dr. Dariush Mozaffarian
They were deficient. So the accident of history was that that coincided with the Great Depression, World War two Mhmm. When there were very real concerns about national security, fitness for mill the military duty, real food shortages. And so that led government to act and greatly magnify this research. And as just one example, president Franklin Delano Roosevelt convened a conference in 1941 before Pearl Harbor saying, we're going to war.

What do we need to do to address these new vitamins and these new deficiencies? And the scientific panel of blue ribbon scientists looked at all the science, they said, Well, we're getting these diseases because we've stripped away food through processing. We've stripped away the vitamins. And so, for example, they said grains. We've stripped away with refined grains and wheat flour and white rice and all that.

We've stripped away all these nutrients. They could have come to the conclusion we need to process our foods less, but they came to the conclusion we need to supplement our foods with these missing vitamins. So in in enriched wheat flour, which is still the dominant wheat flour in The United States and and is a good thing, it's not a bad thing, if you get any package and you look on the back, it says enriched wheat. It open parenthesis has this list of, like, you know, funny weird words. It's just a bunch of vitamins.

Right? And so and so that greatly accelerated this focus on vitamins. And what's amazing, Mark, like you said, in about ten years, we largely eliminated these diseases that had been just just devastating humanity for for centuries. And so it was a massive win, and it led to, you know, supreme confidence, overconfidence that, hey. We figured out nutrition.

We can fix food to address human disease. That was the one big, big, big thing that happened. The second big thing that happened was in the fifties and sixties, demographers realized that the world population was exploding. It it quadrupled from about one and a half billion in 1900 to 6,000,000,000 in 2000, and of course, approaching 9,000,000,000 today. But people just did the math.

They looked at the acreage of land and the the output of crops and where the population was going, and this was in the middle of the century, and they said we don't have enough food to feed 6,000,000,000 people, and hundreds of millions of people, maybe a billion people are gonna starve. We just didn't have the ability to feed them. And there were books like The Population Explosion that were written by Stanford professors that said we just have to pick the countries where we can feed people and the countries where, you know, people are just gonna starve. We just have to give up on them. And they used India as an example.

They said, we're no way we're gonna feed India. We just have to give up. Not even try to send food to India. Let the people starve because we just we can't do it. And that was and so what they didn't count on was the green revolution.

The Rockefeller Foundation found Norman Borlaug, the plant geneticist, you know, wrestler wrestler, you know, tough tough tough tough guy, never never give up, who went to Mexico, and for ten years, he spent, you know, laborious, laborious seasons breeding first wheat and then eventually rice and corn to really understand how he can maximize yield, how he can get the most yield out of an acre of land. Not nutrition, not taste or flavor, but How can we get the most yield?

Dr. Mark Hyman
Yield, which essentially means calories. Right?

Dr. Dariush Mozaffarian
Calories. Starch. How can we get the maximum starch in wheat? Right? And how can we also then maximize that by adding artificial pesticides, DDT, which was discovered in World War two, and he knew about DDT because he came from DuPont, which had discovered DDT.

How can we add artificial fertilizers to support this massive growth because it depletes the soil? And so all these bomb factories had leftover ammonia, and so we took the nitrogen and made nitrogen fertilizers. And then how do we add intensive irrigation because there's not enough water? And so he started depleting the aquifers with intensive irrigation. And and what was incredible to his to his great credit, yields of wheat, rice, and corn went up a thousand to 2000% per acre.

Right? Not doubled. Not tripled. They went up 10 to 20 fold in in in just a handful of years. And so Mexico and then India, Pakistan went from countries that were on the brink of starvation to food exporting nations in five years.

Five years by the time. So modern agriculture, the monocropping of wheat, rice, corn, and soy, which is about 60% of our calories come from five species.

Dr. Mark Hyman
Yeah. We swung from starvation to obesity because of the amount of starch in the food and the volume of calories that were presented. I mean, we have 500 calories more of corn per person in America than we used to have, and it's crazy, and we're eating it.

Dr. Dariush Mozaffarian
This saved a billion people from starving. It was a huge win, right, obviously, because if we didn't have the green revolution, we would have had massive famine and and disruption and war and social disruption. So so give credit to it, but but it led to a a massive loss of biodiversity of the food that we eat. Right? And and reliance on starchy crops that were bred for for starch.

And then the third thing that happened, Mark

Dr. Mark Hyman
And there's less protein and less nutrients in those crops too.

Dr. Dariush Mozaffarian
Absolutely. Absolutely. Yeah. And then so now we're in the sixties. So the first was forties and fifties, and then calories was fifties and sixties.

Radical, rapid changes to food. Totally you know, food was totally different by 1970 than it had been in 1910. And and then in the eighties, we sort of have the rise of ultra processed food. That's the third big big thing that happened. And and while there's not exactly the same obvious date of of why and how this started like there is for vitamins and for the green revolution, I think one of the major things that accelerated this was the low fat dietary recommendations of of 1980.

Dr. Mark Hyman
Yeah.

Dr. Dariush Mozaffarian
Because once we had to take fat out of foods, companies had to figure out how to make all these products and have them have the same taste and mouthfeel and flavor and take out all the fat, which is terrific for those things, which was a big mistake. And so all of a sudden, we had to have emulsifiers emulsifiers and stabilizers and, you know, other additives and flavorings and colorings and kinda to make make these foods. Now, that wasn't the only reason. We also then had the tobacco companies, the two biggest tobacco companies, Philip Morris and RGR, bought pretty much they bought almost every food brand that you know.

Dr. Mark Hyman
Both more of Krass, RGR, Yeah. It's like

Dr. Dariush Mozaffarian
All of them. Yeah. And and and they've since sold them. They've since divested, so they don't really own them anymore. But there was about twenty ten or twenty years where they owned all of them, and they took the exact same scientists, exact same scientists and teams that had worked on the brain addiction

Dr. Mark Hyman
cigarettes, yeah.

Dr. Dariush Mozaffarian
And marketing to kids, and they figured out how can we create foods that are addictive, and we can market to kids, and create brand loyalty just like they did with the Marlboro Man, And that was the the the really that's the nefarious part of all of this. Up until now, it had been good intentions.

Dr. Mark Hyman
But I would say I'm just gonna pause for there for a second. I'd say it started even before the eighties because I think it was late fifties, sixties, General Mills had a big meeting of all the food companies in Minneapolis saying, hey. So there's there's a movement towards people eating real food. There's this woman, Betty, who's a home ec teacher, who's trying with the home federal extension workers training mothers and families how to cook and eat and grow gardens, and and they were freaking out that people weren't gonna eat their food. So they basically made convenience king, and then they started inserting people into the culture like Betty Crocker, who was an imaginary person.

Betty Crocker was I thought it was Betty Crocker, but but all the recipes that, you know, add a can of Campbell's Cream mushroom soup, add a roll of Ritz crackers to your gas I was like insinuating highly processed food into the American kitchen, and then they hijacked the American kitchen. And I remember I grew up in the sixties. We had, you know, TV dinners. We had Tang. We had Fleischmann margarine.

We had a craft macaroni and chewy, all this crap that I grew up with. And so it started even before that, and it was deliberate. And then there was that, you know, those two Harvard scientists who I think, you know, were the leading nutrition scientists at Harvard in the sixties who who were basically paid by the sugar industry to say that it was fat, not sugar, that was causing heart disease. And that was published in the New England Journal of Medicine, and and that recently sort of was exposed. But they paid them the equivalent of, like, $50 to do this, and that couldn't happen now because of ethics rules, but it was pretty bad.

And that kind of led and sort of seeded the whole low fat thing with with, you know, Ancel Keys and all of his disciples. It was it was quite it was quite bad. Well, I don't I wouldn't say they were all good intentioned.

Dr. Dariush Mozaffarian
Well, no. As as I said, I I think the the you know, I'm talking about, like, the major trends. You know? Yeah. Yeah.

And I do I do cover a lot a lot of those things you mentioned in the book. A couple of points, though, Mark, important. You know, one is that they not only created Betty Betty Crocker, but they actually started paying for and infiltrated the board of the the national kind of home economics programs across in in high schools and and across the country. Yeah. And home ec went from trying to teach people how to cook to teach people how to get processed packaged items and, like, prepare them from from packages.

Right? And so they actually took over Home Ec. They literally paid for and took over Home Ec purposely. So so for sure, I mean, food industry but, you know, every every industry is trying to sell their products and make a profit, so it's it's not different for phones or cars or anything else. But but the nefarious stuff was when they really, I think, started trying to make the the the food the food addictive.

But but the point you made about fat, I wanna get back to because the the reason that, fat people say, why was fat vilified? Why did they pick fat? And also, by the way, in 1980, they also did recommend low sugar at the same time, but fat was really vilified. Why was it vilified? Because scientists had figured out the nutrient that caused scurvy, vitamin C.

They figured out the nutrient that caused night blindness, vitamin A. They figured out the nutrient that caused pellagra, niacin. And so in the seventies, when all those diseases had been conquered, they said, well, what should we do now? And they started looking at chronic disease, and they started with heart disease, because that was the top killer. And so the mistake that was made, which wasn't nefarious, but was just accidental or natural maybe, They said, well, we figured out the nutrient for these other diseases.

What's the nutrient that causes heart disease? There must be a nutrient. And they picked saturated fat as the nutrient from this research, and then total fat. And so to me, Mark, what we've learned since, since the eighties, is that if you have a simple vitamin deficiency disease, a nutrient causes or cures that disease. There's a one to one correlation.

But when you have complex chronic conditions that develop over years, mental health, obesity, diabetes, type two diabetes, heart disease, stroke, poor gut health, cancers, the list goes on and on, cognitive decline, kidney dysfunction, peripheral vascular disease, gut health, liver health, all influenced by nutrition, there's no nutrient fix. It's about complexity, molecular it's about food as medicine. It's about I've heard you say, and I borrowed, and now I repeat, food is information. Food is not calories. Food is information for our bodies.

And so they mistakenly took what had worked so well, this nutrient focus, and extended it to chronic disease, and that was big mistake of 1980.

Dr. Mark Hyman
It's so important. I think we did get there in some ways unintentionally, but once we got there, the food companies really wanted to hold on to their stomach share. You call it profit share, they call it stomach share. And they don't wanna give that up. Now now I wanna kinda switch into into the the topics I think people really are confused about.

Calories, protein, fat, sugar, and and also protective foods. So let's let's start with calories. There was a really important paper that I I read, and I would think it was the American Journal of Clinical Nutrition that you wrote, where basically you said that and you presented the science pretty clearly. Our calorie consumption has gone down while our obesity has gone up. Can you unpack that?

Because we all were trained that calories in, calories out. You eat too much, you gain weight. You eat less, you lose weight. Somehow, the science doesn't support that, and yet most physicians and nutritionists and most professional societies still adhere to that ideology. Can you kind of help us understand what the hell is Yeah.

Going

Dr. Dariush Mozaffarian
So the first part of my book, Food is Medicine, I kind of go through how we got here. And then the second part, I go through heart disease, obesity, the microbiome, and kind of put it all together to what we have to eat. And and in doing so, I kind of go through how in each case, we we started out with a really oversimplified story about what we should do to prevent heart disease and so on, and then now what the new science is showing us, which is mind blowing and really eye opening. And so we've kind of most people have kind of started to understand this for heart disease, that it's not about fat anymore, And it's probably not even about saturated fat anymore because it's much more complicated. But as you said, the same is true for obesity.

Just like focusing on fat and saturated fat is horribly oversimplified when it comes to heart disease, Focusing on calories is horribly oversimplified when it comes to obesity, and the science shows that, but most people don't know that science. And so I really go into that cutting edge science. So so, you know, in the seventies and eighties and nineties, as as, you know, waistlines and and and body fat began to grow, people were eating more, and food companies were making more food, and and obesity epidemic wasn't really a thing. We didn't talk about the obesity epidemic in the nineties. It wasn't really recognized.

And then around 2000, it started to be recognized. There started to be a lot of messaging around obesity. Around 2000, Americans started paying attention, and calorie intake, based on multiple different measures, since 2000 has either been flat or even slightly declining. So calorie intake has gone down or is about the same as 2,000. And physical activity has gone up since 2000.

Not a lot. We're still, as a nation, under exercising, but it hasn't gone down since 2000. It's gone up. More people are exercising. More people are in gyms.

More people are doing marathons. More people are doing yoga. And even if you use object objective measures of energy expenditure, like doubly labeled water over time in The United States and in Europe, physical activity has gone up. So so we have a paradox. Physical activity has gone up.

Calorie intake has is flat or has gone down, and obesity has dramatically gone up since 2000. So how is it possible? How are our bodies violating the laws of thermodynamics?

Dr. Mark Hyman
So eat less, exercise more, which is what we're all told doesn't seem to be working.

Dr. Dariush Mozaffarian
We're doing it. We're doing it as a population. We're eating less, and we're exercising more. Everybody's paying attention, and we're gaining weight. And so what's kind of amazing, and what's truly amazing, is the science of how food affects our biology.

And while we're still unpacking the details, Mark, basically what we're learning is that the type of food we eat long term is way more important than its calories for weight gain. Of course, short term calories matter. You can count your calories and figure it out and cut calories, you'll lose weight. And that's why any fad diet works. You can go on any diet and pay attention to your calories.

You'll lose weight for a few months. But the biology fights back, and the biology becomes important, and people regain the weight. So what's the biology? I think two of the most interesting things we're learning about is, one, how food affects our resting energy expenditure. The amount of calories we're burning while we're not doing anything.

REE, resting energy expenditure. One of the most interesting things is thermogenesis, generation of heat by by the cells of the body. This was really understood well in hibernating bears. Bears have a lot of of brown fat, this type of fat that's different from white fat that doesn't store calories, but burns calories to give off heat. So imagine you're eating food.

It's going to your fat cells, and your fat cells aren't storing it. They're burning it and making you warmer. Right? And so and so for a long time, it was thought that, you know, after infancy, humans don't have brown fat, but science in the last ten or fifteen years has made clear that we do have brown fat. It's quite active.

People who have obesity have less active brown fat. And guess what activates brown fat? Good nutrition.

Dr. Mark Hyman
And coal plunges.

Dr. Dariush Mozaffarian
Polyphenols in blueberries, EGCG in green tea, quercetin other plant foods. Diet activates thermogenesis. And in fact, low fat diets seem to blunt thermogenesis, and kind of high fat ketogenic Atkins style diets seem to activate thermogenesis.

Dr. Mark Hyman
Protein activates it. Protein requires

Dr. Dariush Mozaffarian
more Protein calories activates thermogenesis, absolutely. And so we're not talking about small effects. These studies have shown that over the last twenty years, at a population level, our resting energy expenditure has gone down by 220 calories per day. That's more than enough to explain the obesity epidemic. Right?

We're doing everything right, everything we're being told to, but our resting energy expenditure has gone down. The second critical thing that isn't accounted for in the equations of of of energy balance, you know, eat eat less, move more, is what what our microbiome is doing. When we eat, we're sharing our calories. We should be sharing our calories. Our bodies are digesting some of the calories, and our microbiome is digesting some of the calories.

I'm not talking about fiber. People think of fiber. Fiber doesn't have calories for us. That's only for our microbiome. But our microbiome actually evolved because when we ate minimally processed foods out in the wild, they were in their intact natural structure, you chew them, nuts or beans or fruits or you catch animals, and not all the calories would get digested in the stomach and the small intestine.

The calories, the starch, the sugar, the protein, the fat, it would get to the microbiome, and the microbiome would digest those calories, harvest them, and give a little bit back to us and keep most of it for themselves, and we had a wonderful, symbiotic relationship. And so if you have a true kind of traditional minimally processed diet, we digest and consume about 80% of the calories, and the microbiome digests and consumes about 20%. So it's about a, you know, a four to one four to one split.

Dr. Mark Hyman
If you have a healthy microbiome.

Dr. Dariush Mozaffarian
And if you have a healthy microbiome, of course. Yeah. In the modern ultra processed diet, 98% of calories are consumed by us, and we're starving on microbiomes. So that's another 20% of calories. If you're eating 2,500 calories, we're talking about a 500 calorie swing in how many calories you're digesting versus your microbiome.

I think the bottom line point is the type of food we eat, the quality of the food, is really what's crucial for long term management of obesity, prevention of obesity, treatment of obesity. We have to focus on the quality of the food. Because if we focus on activating thermogenesis, on feeding our microbiome, then we don't have to count calories. We don't have to go crazy and follow packages and track our food. You just have to eat a healthy diet Yes.

And and pay attention to that.

Dr. Mark Hyman
Yeah. Well, that's so important. You know, our friend and colleague David Ludwig did a really important study where he did a clinical trial, and he fed people foods so they knew exactly what they're eating. It was same identical calories, and one was low fat and one was low sugar and starch. And the ones that had the low fat diet burned about 400 calories less a day eating the same amount of calories.

So he said it's not how much you eat that you should pay attention to, it's what you eat. So if you pay attention to what you eat, you don't have to worry about how much you eat. And I find that for myself. I never calories, I eat whatever I want, and I just eat real food. And it just your body it's like naturally regulates it.

And there was a great book I read by Fred Provenza called Nourishment. He talked about the study where they they gave kids and this was in an orphanage, think in the twenties. They couldn't do the study now, but it was in an orphanage in Canada. And they they gave these kids, like, brain and kidney and liver and all these weird things that you think kids would need and all these other foods. And they they the kids literally chose and selected the the foods that were the most nourishing that would actually help them develop and grow.

Like, animals do that naturally. They have this innate wisdom. They know to eat this plan for this medicine. They know to eat this plan for this calorie, you know, content or starch. And they they sample hundreds of plants and they have a couple of main food crops that are basically for calories, but then they eat all these other plants.

And it's quite interesting that they know. We've lost our innate wisdom when it comes to food, our innate signaling because all of our hormonal signaling, our immune signaling, our microbiome signaling, all the it's like a complete cacophony of of biochemical signals that is driving us to overeat and to be hungry all the time and to dysregulate our metabolic system and dysregulate our microbiome. And so that's why we're in this pickle. And and and the whole calories in, calories out thing is it's just such a distraction. I never have once told a person to lose weight.

I've never once told any patient to count calories. And I've had people lose literally probably hundreds and hundreds of thousands of pounds in my lifetime. And it's it's just by eating, like you said, eating real food.

Dr. Dariush Mozaffarian
Yeah. You're you're absolutely right, Mark. I I totally agree with with with everything you said, and and I cover a lot of this in the book. And and the the one of the signaling molecules that you're talking about is GLP one. And this is why we can't blame willpower and lack of knowledge, you know, and other things for the problem.

We're talking about biology. We've hijacked our biology. The food system has hijacked our biology so that we're most people are up against, you know, innate biology that they can't fight with with their conscious conscious decisions. Although, of course, you can start to move in the right direction, but you're you're you're fighting you're swimming upstream. And so, you know, GLP one lasts for just minutes in the bloodstream when it's naturally produced by the intestines in response to eating.

But its effects last for hours and hours, and more and more research is showing that's because there's metabolites that if you have a healthy diet and a healthy microbiome, there's metabolites that go into the bloodstream that activate the same receptors and the same pathways that GLP-one activates in the brain and around the body. So the microbiome is potentiating the effects of GLP-one signaling. About 25% of all the circulating signaling molecules in the bloodstream are directly from the microbiome, and about another 25% are altered by the microbiome. So you're talking about 50% of our signaling molecules directly produce fire altered by the microbiome. It's another organ that's affecting our mood, our behavior, our brain, our diet, or appetite.

And you see this now with GLP one drugs, which we can talk about separately, what their role is. But I think one of the most interesting things about them is that for for many patients, not all, for many patients, it not only makes them less hungry, it changes their preference for foods. And they no longer can actually even tolerate eating the processed foods they ate before. There's a great New York Times Magazine article that I write about that went with some of these patients in the grocery store, and the patients say, I crave cherries. I crave kale and vegetables.

I crave fish. You know? I I went I went and I bought a you know, Ho Hos or a Twinkies or candy or a soda and tried it, and it tasted fake. It tasted fake in my mouth, they said. I had to spit it out.

And so I think for for those of us like, you know, you and me, Mark, who I think we've been fortunate, blessed, you know, good food growing up, microbiome, epigenetics, whatever it is that that we had, we have normal GLP one signaling. And so we crave naturally, just like those chisendorphanage, we crave healthy foods that are good for us. That's what we actually want. And and ultra processed foods taste awful. They don't actually taste good.

They really taste bad. And so and so I think the majority of the nation with, you know, ultra processed foods and generation after generation of sickness for the last thirty years and kids being born to mothers who are sick and all the changes that are happening have altered GLP one signaling. We basically have altered GLP one signaling on a national scale, and it's altered people's biologic preferences for food. And so what's, I think, really interesting about GLP ones, of course, they can be good for weight loss, but they're restoring the natural human biology. And and why I think that's important, Mark, is there's been a narrative that the food industry has hooked us on sugar, salt, and fat, that we innately crave ultra processed food, and so there's no way out.

We have thrifty genes, like, it's just it's just innate biology to get sick if we have a lot of food. And and what I think GLP-1s are showing us is that innate human biology is to eat healthy, minimally processed food that's actually delicious.

Dr. Mark Hyman
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Dr. Mark Hyman
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Dr. Mark Hyman
I think I want to double click on what you said because it was quick, I want to unpack it a little bit. One, you said that 25% of the biochemistry of the metabolites of the chemicals and molecules and messenger signaling things in our blood come from our gut, come from the microbiome.

Dr. Dariush Mozaffarian
From food. Yeah.

Dr. Mark Hyman
And then another 25% is modified by it. And second, you know, it's important for people to understand that they're eating for themselves, but they also have to feed their microbiome. I call it feeding your inner garden. Because what you're saying is that if your microbiome is healthy, it will help naturally regulate your appetite and weight among many, many other things, immune function, mood function. I mean, pretty much everything.

But importantly, around this conversation, you know, we don't think about how do I feed these critters? What are the prebiotic foods I need to eat? What are the what are the, polyphenols I need to feed the microbiome? What are the probiotic foods that I can eat? How do I eat extra fiber to feed these bugs?

I mean, what this is these are things that we should be really thinking about. And I think about them, like, yeah. I'm gonna have artichokes because I know it's good for microbiome. Or I'm gonna I do this. I'm gonna eat a plantain because I know it's good for my microbiome.

And I and I think that it's really important to actually start to learn how to not just feed yourself, but feed the little critters inside you that determine so much about your health, including your weight.

Dr. Dariush Mozaffarian
That that that's a perfect, you know, statement, Mark, for us to talk about protective foods. Because for for decades, we've sort of framed the fight against chronic disease for food as one of deprivation. Like, don't don't have salt. Don't have fat. Don't have sugar.

Don't have food that tastes good. Right? You know, you have to have to don't don't have calories. You have to reduce, reduce, reduce as though as though food is a bad thing. And, of course, there's negative things in foods that we have to avoid and we have to reduce.

That's true. But more disease is happening, Mark, and we've quantified this. More disease is happening and and is occurring because of insufficient intake of good things than too much intake of bad things. It's both. But there's more disease from people not eating enough good things.

And so everything you just said, you didn't say I'm avoiding this or I'm avoiding that. You said I'm craving, and I'm looking for it. I'm seeking out these foods that are good for me. And so that's the message of food is medicine. It's an optimistic message that that having a healthy diet is not about depriving yourself of something.

It's about embracing delicious foods that are protective for your for your body, for your gut, that taste great. And, ultimately, you know, we need system solutions so everybody can eat that way. Because right now, the way our system is, you know, you have to have a lot of things. You have to have time, knowledge, cooking equipment. You have to have a lot of things to be able to eat that way, and and we need to have systems where where that's that's the easy easy rock for everyone.

But but so, you know, eating eating more of the good is really critical, and and and so, you know, we can talk about kind of what what that priorities are, but I just wanted to highlight how important it is to embrace what's good in food.

Dr. Mark Hyman
I think you're right. It's it's like you know, we we focus on the bad, but it's not what you take out, it's what you put in that matters, And it's the protective foods that are so healing and will really reverse disease. And I I mean, I have been a practicing doctor. I'm not just a podcaster or an influencer. Like, I actually see patients, and I've seen a lot of Asians.

And it's amazing to me when you understand how to use food as medicine, how powerful it is. And we're talking in generalities about just eating good food, eating real food and so forth. But as a as a functional medicine doctor, I can tell you that there's it's very specific. If you think about drugs as medicine, there's different drugs for different diseases at different doses, at different frequencies, for different durations. It's the same with food.

I will treat a person with autoimmune disease, different than I'll treat someone with diabetes, different than I'll treat someone with migraines, different than I'll treat someone with SIBO. It's very, very specific, and it's personalized, and it's about what that person particularly needs. And when you understand how to apply food as medicine, it's miraculous the kinds of results people get around the whole spectrum of chronic disease, not just obesity or heart disease or diabetes. So I I just wanna say that because it's people don't understand how powerful it is. It's not just a a metaphor.

It's not just a nice phrase, food is medicine. It's actually a drug. Food is the most powerful drug on the planet. It works faster, better, and cheaper than any other drug. It filters your gene expression, your microbiome, your hormones, your brain chemistry, your metabolism.

Literally, your immune system. It regulates everything. And so that's that's kind of a really important insight that most people don't get. It's not just, I'm eating for energy. You're eating you're eating for everything.

Dr. Dariush Mozaffarian
And and it works fast. You you said it quickly, but I I don't wanna it works fast. So we're not talking about years and years and years to see benefits. Right? You can see changes to mic the microbiome and energy and mood and sleep within days.

You can see changes in glucose and blood pressure within weeks and cholesterol levels within weeks. You can reverse reverse diabetes, low risk of heart disease within, you know, months to a year. And we're not talking about waiting decades to see these benefits.

Dr. Mark Hyman
I think I gave a talk at Cleveland Clinic when I first got there, and I was talking about elimination diets and so forth. And and this guy came up to me, I who think it was even a patient actually, and he said, hey, Doctor. Hyman, I I just wanna say I I tried, you know, this elimination diet where I got a gluten, dairy, sugar, ultra processed food, and ate all these protective foods. My rheumatoid arthritis went away in ten days. Is that possible?

I'm like, well, yeah, it happened to you. You know? That's how quick it's like like that. If you you know, I'm sure he probably had a gluten related issue, which can cause autoimmune disease. So, you know, somebody else who had another cause for rheumatoid arthritis might not get better.

But in that case, it was, like, quite was quite amazing. Alright. So let's talk about a couple of things. Let's start at the big picture. Ultra processed food.

Right now, the federal government is in a process of defining it. Maybe when this podcast comes out, we'll have the definition. But, you know, you've been part of that. I've been trying to help with that as well. And I think, you know, there's a lot of controversy and confusion.

The food industry is very good at trying to, you know, poke holes and say, well, there's it's it's hard to define. You're gonna discriminate against this. It's because of that. And have all these kind of talking points that they use to sort of make people doubt that we can define ultra processed food. But most people know what it is.

Like, you know, it looks like what what it is. Like, a Twinkie is ultra processed food. Nobody's gonna debate that. So how how do you think about ultra processed food? How do define them?

And why are they so bad?

Dr. Dariush Mozaffarian
The concept of ultra processed food is actually pretty new. It it was really thought of in twenty eleven, fifteen years ago, by Carlos Montero, a friend and colleague in Brazil. And his insight was that there's got to be something going on with modern food beyond the typical nutrients and ingredients we look at, because food companies are formulating products. And if you look at the the numbers, they seem to be hitting all the targets. You know, it's low fat.

It's low salt, and it seems to be okay, but people keep getting sick. And so he he wondered, he hypothesized whether, you know, the processing itself beyond the actual nutrients could be really making a difference. And so he came up with this concept of ultra processed foods. Now ultra processed foods doesn't mean foods can't be processed. He had a separate category for processed food.

And so, you know, natural processing a natural, you know, bread, canned canned, you know, beans, jarred fruit, you know, a tin of tuna fish. Basically, if you just have food that's been slightly processed that you would do for to preserve it or in your home is fine. Ultra processed foods are things that you wouldn't see in a home kitchen. Right? It's molecular assembly and and disassembly of food, molecules, putting together packaged foods.

There's literal real food ingredients. There's chemical additives. There's packaging contaminants often from the plastics. There's agricultural contaminants because they tend to use the cheapest commodity crops from, you know, industrial farms. And so he had this this this just this hypothesis that maybe this is important.

And what's been amazing is in just the last fifteen years, nearly a 100 long term observational studies around the world in every, you know, country that's looked has seen that people who eat more ultra processed foods have higher rates of major chronic diseases from the brain to metabolism to the heart to to the gut and beyond, and that that that's true even if you adjust for kind of the major nutrients that we worry about, like salt and sugar and saturated fat and things like that. Yeah. And three three randomized controlled trials, relatively short term, one week to to eight weeks, have also shown that if you match diets on kind of all the macros, protein, fiber, sugar, everything else, but but you have one ultra processed, one minimally processed, people eat more and gain weight without realizing it. Sort of proving in trials that that for obesity, at least, is important. And so I think it's clear and obvious and convincing that ultra processed foods, which I would define as, you know, basically a food that you can't make in your kitchen.

Right? It's got it's got additives and and and contents and formulations and loss of food structure that you you wouldn't just be able to naturally make yourself. Ultra processed foods clearly are harmful, and they clearly need to be defined, and they need to be labeled, and they probably need to be taxed. We need to do a lot of things to address them, but as as a start, they need to be labeled so that we know what they are and we can be transparent to the consumer and they recognize them. And, of course, there's heterogeneity in the definition.

And so an ultra processed yogurt might be better for you than an ultra processed soda. An ultra processed you know, candy bar might be worse for you than an ultra processed whole grain. That's true. But what I really wanna emphasize here is that those are industry talking points that what we're gonna discriminate, right, against certain foods. Ultra processing isn't supposed to be replacing everything else we know about nutrition, Mark.

We're not supposed to forget that, well, whole grains are better than refined grains and yogurt is better than candy. Right? It's supposed to be added to our knowledge. We're still supposed to pay attention to the kinds of foods you eat and avoid salt and avoid added sugar. So as long as we remember that ultra processing isn't supposed to be the only rule that you follow, but it's one additional important principle, it's a very, very useful concept.

Right now, 50 to 60% of calories in The US food supply are ultra processed food. Yeah. And by the way, the next highest country is like 20%. So we are well well above the world in our consumption of ultra processed food, and it's causing it's devastating our our bodies.

Dr. Mark Hyman
Well, hinted at this. This is a sort of molecular science project. This is not food. Food industry commodity crops, they alter them biochemically, they break them apart into sort of these molecular components, they reassemble them into these things that are food like products. But they're not actually food.

If you if you define food according to the Webster dictionary or the Oxford dictionary definition, And I'm gonna I'm gonna be getting it's not exactly right, but it's something like this. The food is something that supports the health and the growth and the, you know, development of an organism, whether it's a a plant or a human. And these foods, by definition, are not foods. So ultra processed stuff. I don't even wanna call it ultra processed food.

And I think I think, you know, most people intuitively know what it is. It's junk food. And I always say there's no there's no such thing as junk food. There's junk and there's food. You know?

So I I think kind of that's where we are. And it's important people understand that this I don't have many hard lines, but this is not food. You should not be eating it. Don't eat a rock. You know?

Don't eat this stuff. It's ain't food. Okay. So let's talk about things that actually are food. And there's a couple of big, big things out there in the public zeitgeist right now that are very controversial.

One is protein, another is seed oils. We've had many conversations about this. But talk about this protein craze. Now you can get, you know, protein like Dunkin' Donuts milkshakes, which are just sugar with protein thrown in them. And I I I like to quote Sarah Palin, you put lipstick on a pig, it's still a pig.

So everywhere there's protein I went to the I went to the supermarket, it was like protein Cheerios. And I'm like, what is this? You know? Like and and so can you kinda help us unpack this whole protein craze and and the controversy about it? And are we eating too much?

Are we not eating enough? What do we actually need? And how do we get this right?

Dr. Dariush Mozaffarian
I unpack this in in in more detail, you know, in my book and really explain the science and tell stories and kinda make it make it fun and interesting, but I'll, you know, do do it quickly here. So I think there's three things we need to think about. Right? What does protein do? How much do you need?

And and what is coming with it? Right? And and what what else is coming with it in the food you're eating? And so the first thing is what does it do? It's it's There's lots of things protein does, but one of its major purposes to have more protein is to build muscle.

Again, there's other purposes for metabolism and other things, but the main purpose, the main thing people are thinking about is to build muscle. And it's certainly true that if you have a higher protein diet versus a lower protein diet and you're strength training, you're gonna build muscle faster and you're gonna get stronger if you're eating the higher protein diet versus lower protein diet. That's why bodybuilders take protein supplements and eat a lot of protein, right, because it does work. But there's a couple of key points to that. One is that most Americans are already eating enough protein.

That's the higher levels that's been studied in those trials. Right? So the average American is eating 16 or 17% of calories from protein, which means half of Americans are eating more. And in those trials, the high protein diets are around 16 or 17% of calories from protein compared to lower. So most Americans are already eating 90% of Americans actually are already eating enough protein for normal regular strength training to build muscle.

We're not talking like to be bodybuilders, but for normal strength training. There are certain populations, younger women and older women in particular, who don't eat a lot of animal products and might not be getting enough protein, but most Americans eat enough. The second key point to that is that if you're not strength training, the protein's not going to have a lot of benefit for muscles. You're not going to build muscles and look like a bodybuilder if you're not strength training. So protein, like sugar, like starch mark, if you eat excess protein and you have the amino acids circulating in your bloodstream, the muscle says, I don't need them.

You didn't work out in the last couple days. I don't need more amino acids. What happens? Insulin goes up. The counterregulatory hormone insulin, the same hormone that regulates glucose goes up and turns those amino acids into fat for storage in the body.

So protein gets turned to fat. So if you're going out and having protein drinks and protein energy bars and protein shakes and protein junk food, you're not exercising. You're just building body fat.

Dr. Mark Hyman
Especially eating protein with sugar like a Dunkin' Donut or a Starbucks, like, you know, drink.

Dr. Dariush Mozaffarian
And so I and and then the last point, I think, which is probably to me as a cardiologist, the most important is the muscle is not the only organ in your body. So even if you're strength training, don't go get your protein sources from foods that are gonna devastate every other organ in your body. Think about the food source. The food source matters because not for the amino acids. And and there's all this stuff about complete protein and incomplete protein.

That that's mostly not that important, actually. You can get your protein from plants or animals, you and you get mostly get all the same amino acids. What's really important is is it a processed food? Is it minimally processed or not? Does it have phenolics?

Does it have fiber? Does it have all the other protective qualities, you know, we we've talked about? And so to me, if you're gonna get your protein, think about the other health effects. And if we talk about the other health effects beyond muscle, you know, plant sources of protein and seafood seafood sources would be at the top. They're the best for overall health.

I'd say then, you know, yogurt and and cheese and fermented foods would probably be next. And then you'd have sort of your fresh animal foods like eggs and poultry and red meats, especially regeneratively grown or pasture finished red meats, have lower inflammatory levels. And then the worst is processed meats that have chemical nitrates and added sugars and other things, you know, salamis and bacons and blonies. And all the low fat processed deli meats that are in hospitals and in health conferences and in lunch boxes of kids because moms are trying to do the right thing, those are actually the worst source of protein. Plus all the junk food, all the soy protein isolates and junk food that's just being thrown, or protein's being added to it.

Protein Pop Tarts is a real thing. So that's how I would summarize things. First, you're probably getting enough protein if you're eating an average diet. You don't even need to think about it or or get more. Second, make sure you're strength training.

Everybody should be strength training, you know, at least three times a week doing at least thirty minutes of strength training, especially important as you age. And third, remember that you're more than muscle, and so, you know, make sure you're getting your protein from healthy sources.

Dr. Mark Hyman
Yeah. Very important. I think that's important. I think there's, you know, there's edge cases where if you're older, there's anabolic resistance and then you don't use protein as well, so you might need a little more. And I think it gets harder to build muscle as you get older.

Although, I I found that, you know, I'm 65 and had a catastrophic back infection and lost 25 pounds and was able to of muscle. I was able to gain it all back, which I didn't know it could, but I I really had to increase my protein and, like, whey protein shakes and make sure I was I was strength training. And it was it was amazing how how I've even gotten back better than I was before. The body's amazing, and I think you just need to provide the right fuels. Let's talk about seed oils for a minute.

You you and I have debated this for a long time, and I was really kind of pretty far in the extreme of I think they're evil and bad. And, you know, you you very, very lovingly and with a lot of a lot of patience has helped me really understand that it's a more nuanced conversation. And then then ultimately, a lot of the problems with seed oils are that they're a biomarker of bad food. In other words, they just are found in most ultra processed foods, and that's where we're getting most of our seed oils. But in and of themselves, they're they're not necessarily a, you know, a big issue.

So I think maybe you could kind of talk about, you know, where where we should be concerned about them and where we shouldn't be concerned about them.

Dr. Dariush Mozaffarian
Yeah. So, you know, most of our oils, I I don't call them vegetable oils. I call them plant oils, and I talk about that in the book. Because they're actually out

Dr. Mark Hyman
there. Bean bean oils, and I just see Nuts. Right?

Dr. Dariush Mozaffarian
Yeah. Nuts, you know, seeds, and fruits. Right? Our our oils come from nuts, seeds, and fruits. And

Dr. Mark Hyman
so Beans like soybeans. Right?

Dr. Dariush Mozaffarian
And beans. Yeah. Nuts, seeds, beans, and fruits. Yeah. And so those are the healthiest foods in the food, you know, among the healthiest foods in the food supply.

Nuts, seeds, beans, and fruits. And so oils from from all of those foods are amazing. They're they're packed with both monounsaturated and polyunsaturated fatty acids, which are both really, really good for health. They often have especially if they're more virgin oils, they often have the phenolics and other beneficial compounds that come along with those nuts and seeds and oils that are fat soluble. And so just first remember, when you're talking about a seed oil, you're talking about the healthy fats from seeds, which are among the healthiest foods on the planet.

And so just based on first principles, we'd expect these to be to be really healthy. Why has there been concern that seed oils are are not healthy? I've thought about this a lot, and it doesn't come from, I think, any ill intent. I think it comes from people looking at pieces of science and history and kinda putting it together in ways that seem to make sense, but when you actually, you know, pull the the card out, the whole house of cards kinda falls down and doesn't make a lot of sense. And and it's basically a few things.

You know? One, vegetable oils that were industrially produced for, you know, decades were partially hydrogenated. And partial hydrogenation, which would make Crisco and sick margarines and a lot of packaged almost every packaged sweets had partially hydrogenated, you know, soybean oil, partially hydrogenated vegetable oils. Those had trans fats, these industrial fats that were really toxic. And it took the FDA twenty years.

It took them way too long to remove them, but finally, by 2018, those had been banned from The US food supply. They're banned in Europe. They're banned in a lot of countries. Not not all countries.

Dr. Mark Hyman
By the way, they're still there in the food. They you can still go buy Crisco and things that are are full of, hydrogenated fats in the grocery store because I checked. It's not a it's not a ban. It's like a it's a that's non grass. So it's not recognized as safe, and they're supposed to take it out, but it's still there.

Dr. Mark Hyman
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Dr. Dariush Mozaffarian
Those are fully hydrogenated, so they don't have trans fat anymore. So it's the partial hydrogenation that made the trans fat. That's really gone, Hark. Partial hydrogenation is really gone. There's fully hydrogenated oils, which we can talk about.

They don't have the trans fats anymore. So even Crisco and those things don't have the trans fat. So that's true, and so that really led people to think, okay, industrial fats and oils are bad for us, because they were. They were for a long time. So then the second thing is this concept that omega-six polyunsaturated fatty acids are pro inflammatory, which comes from molecular theories and animal research that was done by Bill Lands, who I knew and spoke to before he passed away a few decades ago, really a wonderful scientist.

And that kind of biochemistry and animal science has been now tested in humans, and it doesn't happen in humans. Omega sixes are not pro inflammatory in humans. It's it's not a concern. And so that's the second thing which most people kinda don't understand. And I think the third thing is just this back to this idea of ultra processing.

You know, to get oil out of seeds, you can't just squeeze them like avocados or olives. Right? You you can't have a virgin sunflower oil because you can't just use squeezing in low temperature. You have to really use high heat and chemical processes to get oils out of a seed. And those processes do introduce some trace toxins, right, some trace toxins that are not in virgin oils.

And so, yeah, because of the presence of those trace toxins, virgin oils are probably better for you on average than industrial oils. But but this is the key point. Countless studies, randomized trials, carefully done studies, observational studies, feeding trials have shown again and again and again that industrial seed oils net are still really good for our health. And so I think of them as perfectly fine. Soybean oil and canola oil are probably the best choices amongst seed oils because they have plant omega threes in them.

They have the highest levels of plant omega threes on average. But I think any plant oil is good for you. So if you have to choose, go ahead. You know, we use extra virgin olive oil because I like the taste. You know?

We we use avocado oil because I like the taste. But if we wanna deep fry, you know, those aren't good. We use canola oil, and and and it's fine. So so I think you're right cold

Dr. Mark Hyman
pressed versions. Right? Just for the better carbohydrates.

Dr. Dariush Mozaffarian
If can find and afford cold pressed versions, they're they're they're probably better, but the industrial versions aren't bad for you. And so and so I think, you know, like you said, Mark, it's a distraction because they're they're a marker of processed foods, and the processed foods are bad in other ways. But it's not the Cdolls that are the problem.

Dr. Mark Hyman
And I think there's one other point. I don't know if cover this in your book, but it's something I see clinically. At Function Health, we test everybody's omega three fats. It's just part of your standard panel, which has probably hasn't been done at scale like that ever. We asked Quest, like, is unheard of.

They had to they literally had to build a new lab for us because we're doing so many omega three tests. Well over half of our members or or more have a low omega three index, meaning they're they're lower in omega threes than we should be. And so it may not be the omega sixes that are the problem. It may be the fact that we're low in omega threes, which are anti inflammatory. And so when you when I looked carefully at all the trials in my book, EFAC, at ten years ago, I was like, oh, this is interesting.

This is really it's about not just the excess of omega sixes, it's the lack of omega threes in our diet. And I think that's a really key point. And and when you actually look at the data, the studies where they had oils that were just pure omega six had a little bit worse outcomes than when they added the oils with omega three. So I think there's a subtle point there, but I think it's important. I think people need to make sure they're eating those because they're not typically in our food anymore.

We used to eat wild food. They're in wild plants, they're in wild animals, they're in wild fish. You know, we get it in, you know, we eat sardines and things like that that are wild, but it's rare to get them nuts and seeds have some, but they're not well converted, you know, into the EPA DHA that we need. So I think that's a kind of a nuance. If I were to say anything about it, I think focus on omega threes and don't worry so much about the others.

Dr. Dariush Mozaffarian
So so my my all my first research focused on omega threes. That was kind of in the omega three mafia, you know, with all the researchers doing this real omega three research. And so you are 100% correct. I'm surprised it's even 50%, you know, have reasonable levels. It's it's it's

Dr. Mark Hyman
I I can't remember the exact number, but I well

Dr. Dariush Mozaffarian
Yeah. We have crisis a of omega-three deficiency. We really do. Much more important than many other vitamins that we talk about. So most Americans aren't getting enough omega-3s, and so that's why when people talk about the omega six to omega three ratio, yes, if you have a high ratio of omega six to omega three, it's really bad for you, but it's because the omega threes are low.

Dr. Mark Hyman
That's

Dr. Dariush Mozaffarian
right. Trying to fix the ratio by moving the omega six isn't gonna do anything. You gotta move the omega three. Yeah. And so I have

Dr. Mark Hyman
to take home for people. Yeah.

Dr. Dariush Mozaffarian
Absolutely right. Yeah.

Dr. Mark Hyman
That's a take home. Okay. So we've covered a lot of why we got here, how we got here. We've covered calories. We've covered protein.

We've covered seed oils. We've covered, fat to some degree. I wanna sort of end by briefly kind of talking about system change because I wrote a book, Food Fix, How to Save Our Health, Our Economy, Our Communities, and Our Planet One Bite at a Time, and it really talked about the nexus where food touches everything that we care about almost. And it is the solution for a lot of what we care about. You have come to the same conclusion, and that's why a lot of your work as a doctor is now in policy.

It's like I was sitting in my office, I'm like, I can't cure diabetes in my office. It's cured, you know, on the farm, in the in the grocery store, in the restaurant, in the kitchen. That's where where diabetes is cured. And so you and I have come to the same conclusion. And you you spend a lot of time thinking about it, a lot of time working on these policies, a lot of time actually doing research showing how food as medicine can be a tool by medically tailored meals and a lot of other ideas.

What are the biggest levers to pull when it comes to policy change? Let's say we have two years left in this administration, and we have the most friendly administration aside from all the other complications and problems in administration. We have the most friendly administration when it comes to food policy. So can you talk about what what would be your dream changes over the next two years that would be implemented if if you could be king for two years?

Dr. Dariush Mozaffarian
Well well, we shouldn't we shouldn't I wanna I wanna emphasize what you said about the system being broken. Right? Because when you have, you know, young kids, five years old with with obesity or with type two diabetes and insulin resistance, when you have when you have ninety four percent of Americans, Mark, ninety four percent of adults have suboptimal cardiometabolic health. Hypertension, blood pressure, glucose, body mass. Ninety four percent, only six percent of American adults have optimal cardiometabolic health.

The system is broken, right? And so while of course you can go out and do your best and everybody should go out and do their best and try to eat as healthy as they can, When the system is broken, it's hard for everyone, especially for people who have lower income, lower education, are facing structural racism, are facing physical debility, other challenges, which is a lot of Americans. A lot of Americans are struggling. Costs. You know?

So so so we need to fix the system. And what's what's really exciting is we now have the solutions in in our hand, and we could actually implement them and fix this. And and there's no one solution, but there's a handful. There's just a handful of things we need to do. So I go through them in the book.

I tell the stories of who's really on the cutting edge and really doing exciting things and what the barriers are. And so I'll just go through the list of them, and maybe I'll just focus on health care. But agriculture, right? We need to fix agriculture, and it's doable. We can make farmers make profits having healthy food.

We need to fix our education, our dietary guidelines, labeling, kind of all the things we do for information for consumers. That's number two. We need to fix the FDA in terms of its regulation of food safety, the additives, the chemicals, marketing, you know, with that with that FTC. We we and and FCC. We need to fix kind of the regulation of food for things that we're supposed to regulate, food safety around around chemicals.

We we regulate food safety for infectious disease, like E. Coli, but we don't regulate food safety for chemical safety. Right? All the chemicals in in our food. We need to leverage health care and make sure nutrition is in health care, we'll come back to that in sec.

Wanna We highlight need to leverage our federal nutrition programs. Almost 150,000,000,000 a year goes to SNAP, WIC, school meals, meals for the elderly, like like meals for early childcare. So we need to leverage that sending, which is, you know, basically going to industry to make sure it's going to to healthy food. We need to leverage nutrition science, and we to have far more investment at the National Institutes of Health, which is supposed to be our country's leading organization focused on health, but is not investing in the top cause of our health, which is nutrition. Right?

So we need to really have a a new food shot in nutrition science. And then lastly, I would love to see a national program where the government, federal, states, local, prioritize innovators and entrepreneurs in the food system from farmers to restaurants to supply chain to food manufacturers that are truly making better food. Right? We we've done this for railroads, for cars, for electronic chips, for energy. We've done it for all kinds of things that the government recognized were national priorities to fix.

We need to do this for food. We we can't let the, you know, companies that are trying to do well just fight it out with the consumer and try to we have to reward them and and and encourage the industry. So so that suite of of things done together would shift our food system in ten or twenty years. And and I think health care to me is one of the most important just because of the size of of the dollars. Right?

We spend now almost

Dr. Mark Hyman
trillion. 6

Dr. Dariush Mozaffarian
It's almost 6, Mark. It's almost Oh, damn.

Dr. Mark Hyman
I was last week, it was 5.

Dr. Dariush Mozaffarian
It's it's incredible. I've I've been saying 5,000,000,000,000. Last year, it's up to 5.6, and this year's estimated to be close.

Dr. Mark Hyman
Daria, I went back and saw a slideshow I did in 2000, and it said 1.6.

Dr. Dariush Mozaffarian
Our health care spending is swallowing up everything else. Like, it's it's almost, you know, unfathomable how much we're spending on health care. People just can't wrap their mind it's so much money you can't wrap their mind around it. The the numbers that I use to make it real, for the average family of four, we spend $50,000 a year on health care. So imagine how much they spend on their food, on their transportation, even on their housing.

50,000 a year for the average family of four. One in $5 that goes through our pockets goes way bigger than all the money that's being spent on AI and data centers and all that. All the money the country's spending on on AI and data centers is about 2% of GDP. 2% of our gross domestic product is being spent on AI. We're spending almost 20%, tenfold more on health care than everything we're spending on AI.

And at the federal government, almost 35% of every dollar in the federal government is being spent on health care, which is massively increased. And so how do we use those dollars? And so you've worked on this. We've worked on this together, Mark. We need to get doctors educated in nutrition.

That's happening. We need to have effective treatments, not not prevention, but treatments that are food based for disease. And so if you have diabetes, sure, you could get put on a drug. You could get, you know, a a a surgery or a device if you need it, but you could also get a healthy food prescription. If you have kidney disease or heart failure or cancer and we find that certain foods can help, you know, amplify your chemotherapy, as as has been seen with certain immunotherapies and other therapies that that work with the gut microbiome.

You can get medically tailored meals where you're actually getting medical meals that support your your disease. There's no reason that food can't be part of medical treatment for the right patients, under the right conditions as a treatment. We're not talking about handouts. We're not talking about using health care to, you know, to to as social welfare. We're talking about medical treatments that are medically indicated.

And we have shown that giving food to people with heart failure, depression, diabetes, cardiovascular disease not only makes them feel better, but it keeps them out of the hospital, keeps them out of the emergency room. And in some cases, you actually save money. Even accounting for the cost of of the food you're giving people, you save money. So I think health care is really exciting, and and what a lot of people don't don't are not familiar with is that this is happening. This is happening now at scale.

There's 30 states 30 states, Mark, that are testing these kinds of food as medicine interventions in Medicaid, which is the health insurance program for the poor. The VA Hospital for our Veterans is testing these programs. The Indian Health Service is testing, you know, these these food as medicine programs for tribal communities. Medicare advantage programs are are testing these programs. And so I would estimate now there's no single number, but I would estimate now that at least $10,000,000,000 are being spent in health care on food.

Now imagine if health care is 6,000,000,000,006 trillion. So imagine if 3% of that, you know, 4% of that was spent on food. Right? We're talking 240,000,000,000. Our total spend on food right now is about 2,000,000,000,000.

So if we spent another 240,000,000,000 on healthy food, that's a massive, massive signal to the to the market. Right? To farmers, to restaurants, to grocery stores. It's a massive influx of dollars to to change their practice and make them more profitable. So to me, health care is the single biggest lever and and where I'm really focused the most.

Dr. Mark Hyman
Yeah. And I I think the food industry is very good at obfuscating, confusing, and misdirecting us. And telling us it's complicated, it's difficult, it's hard. You know, we don't have all the answers. We need more science.

And I'm just gonna call BS on that. We know enough about what to eat and what not to eat to be healthy. We know enough about policies that need to change to fix the problem. And if we do that in the next ten to twenty years, we could meaningfully impact the health of America. We could meaningfully impact our mental health crisis, our obesity crisis, our environmental crisis, our economic crisis.

I mean, I know for a fact that, you know, they went to a governor who wanted to ban the dyes in food. And I think food additives and dyes are, you know, they're not the biggest problem we have, but it's a thing. And the the food industry came to him and was like, you're gonna put grandma in jail for making red dye cupcakes. Do you really wanna do that? And, like, manipulating him and making him scared of what's gonna happen to his consumers, his election.

And he called me and was like, what what should I do? Like, what's going on? Like, well, let me tell you. And he ended up, you know, doing the right thing. But it was the pressure they put on is massive.

I mean, the Consumer Brands Association, I know for a fact, has created a war room to basically fight back against the policies that need to change. It's not just that they're doing things unintentionally and and and, you know, benignly and then they, oh, sorry, we didn't know. They're like, they know and they know what they're doing and they're very deliberate about it. And and to me, you know, it's it's it's it's really it's really bad. So I think, you know, your book, Food is Medicine, Healing Our Bodies, Nourishing Our Minds, and Transforming Our Food System is a really important book.

I think everybody should get a copy. It's about what you can do for you and what we can do for us to really transform our health and our food system over the next few decades. And I hope all of our dreams come true. And honestly, when I wrote Food Fix seven years ago, I never dreamed that we'd be in the position we're now where there's actually things starting to happen that we that I talked about. I thought it was just I was putting it out there and maybe sometime after I died, maybe things would change.

But we're seeing change. And I think we just, as a society, as individuals, we really need to continue to push things in the right direction for ourselves. And those choices we make individually, the choices we make at the ballot box, they all matter. So vote with your fork, vote with your vote, and and let's change the system.

Dr. Dariush Mozaffarian
And what I'm excited about, and this is why I have a whole chapter on business innovation, Mark, is that the food sector is doing some terrible things, but it's not like tobacco, where there's one product and a handful of companies. The food sector, farmers to restaurants to retailers, supermarkets, and food manufacturers, there's a broad set of actors, and there are many trying to do the right thing and trying to make healthier products. Farmers trying to make healthier food. There's manufacturers trying to make healthier products. Supermarkets trying to highlight and sell their produce and other things.

And so we need to elevate and and and celebrate those stories and use policies that give them more demand and help them, and and and we need to do, you know, punitive and and disincentive and other policies to deal with the bad actors. And and so this isn't an industry we wanna kill. This is an industry we wanna help shift. And we did it with energy. We did it with energy.

We we've shifted, you know, 25% of all energy in The United States is clean energy, you know, almost 50% in some European countries. And so we've done it with energy. We were able to shift away. And so ultra processed foods is kind of the coal and the coal and and of gas of of, you know, the body, and we need to shift towards clean food. And and, you know, we can do it.

And so I'm I'm really excited. I I hope that people read the book and come away, you know, knowing what to eat for themselves, but also knowing what to do in their community, in their organization they work in, you know, what what to do what to do, what to tell their elected officials, you know, what they wanna see in the world.

Dr. Mark Hyman
Well, thank you, Dore, for your work for decades to help build the scientific foundation for what we're doing now, for your advocacy, for your mentorship for me, and and for your friendship. This is a great journey to be on with you, and I think I'm very hopeful for where we're going. So thanks for everything. Every buy the book, food is medicine. You can get it anywhere you get books.

Thanks so much for being on the podcast again, Dari.

Dr. Dariush Mozaffarian
Great to great to see you, Mark. Thanks. Thanks for everything you do.

Dr. Mark Hyman
If you love that last video, you're gonna love the next one. Check it out here.