 Hello everybody. First of all, congratulations to you. You have made it to near the end of Davos. I'm impressed with your health and well-being. Obviously, you're in a great place to learn more about health and well-being today. It's delightful to see you. My name is Mariette DiCristina. I'm the editor-in-chief of Scientific American, and I have a wonderful distinguished panel here to talk about the topic of let food be thy medicine. Before we begin that, I want to mention a couple of quick housekeeping things. Obviously, as soon as I can, I'm going to turn to the audience for questions. I see we have quite a number of people here, and I'm sure you all have lots of questions. There is a translator next to you, Joan Roca next to me, who will be speaking in Spanish. So please set it to one for English and two for Spanish if you need that. And as always, please turn off your phones. Please turn off the ringers if you can. And later when we come to questions, I'm going to be asking you to identify yourself. And before you ask the question, please, just to help the audience. Before I get underway, just out of curiosity, is anyone here on nutrition researcher? Okay, interesting. Yes. Right. Other than the distinguished panel. So the question today is, how can our daily diet and our dietary habits improve our health? And because our panelists all come from different perspectives, I've asked them to each introduce themselves with a minute or two of areas that they're particularly keen on. David August, could we start with you, please? Sure. So I am David Agus. I'm a professor of medicine engineering at the University of Southern California. I am a cancer doctor by trade. So two to three days a week, I look at someone in the eye and I say, I have no more drugs to treat your cancer. And I don't want to do that anymore. And so I believe in prevention. I push on prevention. And when you talk about nutrition, unfortunately, most people in the United States and Europe, as soon as you start to talk about health and nutrition, people's eyes glaze over. And the reason is, is there's a lot of noise, right? You hear one day something is good for you. The next day it's bad for you. You hear this diet is great. This diet is bad. And it changes all the time. So most people turn off. And so we had a session yesterday, the health governors, where we were talking about how to educate people about nutrition. And you know, the first question I ask is, how do you know what nutrition is? How do I know what health is? We don't have a definition of health. So I think it's very key, whenever we talk about nutrition, that we say, is there data for long-term outcomes? Outcomes are not changing the number. Outcomes are not making some aspect get better except preventing disease or living longer. Those are the two things that obviously we care about when we talk about these topics. So in the United States, we spend more on vitamins and supplements than we do in all of medical research. Yet there is no data that any of them have shown a benefit in the average individual. And in fact, in many of the studies, they've caused harm. When you take vitamin E for over three years in a $250 million study, it increased prostate cancer by 16%. It was actually meant to prevent it, and it increased it. Women who take high-dose vitamin D have increased bone fractures, not decreased. And so you can go on and on through these. And so I just want to say, let's look at the data, and let's really start to define things and say, are there long-term outcomes here? Because that's where we need to act. Thank you. Hi. I'm Simin Maydani. I'm a professor of nutrition and immunology and director of Nutrition Center on Aging at Tufts University. My passion is to find nutrition interventions and other lifestyle factors that can change the trajectory of older people from one that is burdened by diseases to one that is healthy, active, and successful. And I think there's a lot that we can do. It's only about 25% of our risk for diseases can be really explained by genetics. So there's a lot that we can do with nutrition and other lifestyle changes to impact how we age and be successful. And we use different types of methodology to ask that question, whether it is to animal studies or to human trials. And exactly what David was saying, that we really need to have clinical trials with definite outcomes that would answer questions that we're interested in. Thank you. Hi, I'm Dean Ornish. I'm a clinical professor of medicine at the University of California San Francisco School of Medicine and the founder and president of the Nonprofit Preventive Medicine Research Institute. I'm a big believer in research as they are. And for the last 37 years I've directed a series of studies that have shown how powerful changes in diet and lifestyle can be. You know, we tend to think of advances in medicine as being a new drug, a new laser, something really high-tech and expensive. And we're using these very high-tech, expensive state-of-the-art scientific measures, as David is doing in his work, to prove the power of these very simple and low-tech and low-cost interventions. We're able to show for the first time that even severe heart disease could actually be reversed. There's an emerging field called lifestyle medicine, lifestyle as treatment to reverse conditions, not simply to help prevent them. We showed that we could reverse heart disease using a comprehensive intervention of a Whole Foods plant-based diet that's also low on refined carbs, moderate exercise, walking a half-an-hour day, various stress management techniques, including yoga and meditation, and perhaps most important love and support, which we don't tend to talk about as being too touchy-feely and yet I think are central for reasons we can get into if you're interested. In our more recent studies we show that these same lifestyle changes that can reverse heart disease may slow, stop, or reverse the progression of early-stage prostate cancer, can reverse type 2 diabetes better than drug scan, and can change gene expression in over 500 genes turning on the good genes that protect us, turning off the bad genes, particularly what are called the RAS oncogenes that promote prostate breast and colon cancer. Most recently we published a study about a year ago with Elizabeth Blackburn who got the Nobel Prize in medicine five years ago for discovering telomerase, the enzyme that repairs our telomeres, which as you know are the ends of our chromosomes that control aging. As your telomeres get shorter, our lives get shorter, and the risk of premature death from pretty much everything goes up, we found that we could actually lengthen telomeres by simply making these lifestyle changes. And so even though we tend to think of drugs and surgery as being the primary interventions, we're now realizing that lifestyle can play a powerful role, not only to prevent, but also to treat disease. Thank you. For people who are interested in learning more about Dr. Blackburn's research by the way, I interviewed her for Davos last year, and that's on top link. Jean Roca, you come from a different perspective than the others. Could you speak about your areas that you're working on? Well, yes. My name is Jean Roca. I have a restaurant in Girona in Spain. What we do is known as autquisine, but I think what's essential is that there's a dialogue between chefs and scientists. Now that's a dialogue that exists. There is a dialogue between, if you like, the kitchen and the laboratory, and that's good. But now we face another challenge, which is to use the high profile that chefs have today, and that's something which is relatively new in our societies. But I think we can tap that high profile to really aid our cause. It means we have a responsibility as chefs to use our know-how to get messages across, messages that can be useful for society and how society eats. It's very important that we use scientific knowledge to be able to explain things clearly in a way that really can be heard by consumers, because consumers need to know what habits they should develop, what, above all, they should eat, and where their food is coming from. And even, as I should also say, we should really get into people's very mindsets, their very attitude to an ecological understanding, namely understanding not only how what they are eating affects their health, but how it can affect and benefit the planet if we take an ecological awareness to what we eat. Thank you. Thank you. Those are very interesting thoughts, and I'd like to come right back to that in a minute, please, because I want to connect it up. So for the people who are working in research, because I think you've raised an interesting point, and we've talked a lot at Davos about cross-disciplinary discussions, and I think that this is one of the great places to do that sort of thing. But just to begin to approach that, could we talk just another minute? You all mentioned, the three of you, several studies, different studies of things that were observations about people taking, eating certain things, and their outcomes not being as good as expected, or better than expected, or supporting more graceful aging, or healthier aging. Could we speak just for another minute or two about what we know about nutrition's effects in the body, and how do we know that from the standpoint of science? You've mentioned some observational studies. Can we see what's going on? No. I mean, there's no way. So we are a complex emergent system, and the notion of correcting a number or fixing one thing really takes the eye off the ball, and I think we do that over and over and get in medicine. Remember 35 years ago, we told people to eat margarine, not butter. What did we do? We accelerated heart disease. For the last 10 years, we told people, listen, you've got to watch your sugars, because sugar is bad, so don't eat these sugar substitutes. They're perfect food, right? They stimulate your sweet tooth, yet you don't absorb them, so they can't harm you in no calories. And an amazing study came out in nature a few weeks ago where they first gave mice these sugar substitutes, and after two weeks, they all got diabetes. Then they gave these mice antibiotics first, and then the sugar substitutes, and no diabetes. And the mice with diabetes, they took the bacteria from the GI tract, gave it to another mouse, it got diabetes. So while we didn't, and they showed the same thing, by the way, in young men. So while we didn't absorb these, it changed our system to push us to diabetes. So anyone who tells you there's a super food or eat this to do this, you really got to question and take a step back, because there's no simple way. We don't understand yet this complex emergent system. This microbiome, and you have 10-fold more bacteria than cells in the body, we're just starting to even scratch its surface. So it's a whole new dimension, and I guarantee you over the next decade or more, there are going to be more dimensions coming out. So, but the good news is you don't have to understand a complex emergent system to control it. You know, the climate modeler doesn't go up every day 10,000 feet and measure the wind speed of the temperature. They look at the shape of the clouds, and it tells them what's going on. So we need to figure out more of those, and I want doctors like us to be much more like climate modelers than biologists in many respects going forward. Can I add to that? Well, I think we always need more studies. I take a slightly different point of view that we do know a lot, and we do know what I think for most people an optimal way of eating and living is. And in all of our studies, we use the same intervention. It was a whole foods plant-based diet that was naturally low, both in fat and in refined carbs, moderate exercise, stress management techniques, and love and support. And we found in all of our studies, it wasn't like there was one set of dietary recommendations for reversing heart disease, a different one for diabetes or prostate or gene expression or telomeres. It was the same intervention for each of these, and the more people changed, the more they improved. There's this reductionist tendency in science to try to want to like parse out what is this particular constituent. I debated Dr. Atkins many times before he died, and he got pegged as the low carb guy, and I was the low fat guy, and my work has never been just about any one thing. And it's not even just carbs versus fat. There are new studies coming out showing that animal protein itself may be harmful. There was a study that came out by Levine in cell metabolism last March, showing that people had a lot of animal protein, had a 75% higher risk of premature death from all causes, a 400% increased risk from all forms of cancer, and a 500% increased risk of type 2 diabetes, independent of the fat and the cholesterol. And also, I've been in these debates with Dr. Atkins or people who followed him, or there have been studies done comparing a so-called Ornish diet versus an Atkins or Paleo or these kinds of diets, and they'll say, well, the cholesterol levels weren't that different, and the weight also wasn't that different, so kind of eat what you like, because it doesn't really matter. But if you actually look at what happens in the arteries, it matters a lot. And there was a review article by Stephen Smith in the New England Journal of Medicine a few years ago where they actually showed that on a whole foods plant-based diet, like I'd recommend, the arteries are essentially clean. On a typical standard American or sad diet, in every sense of the word, they're partially clogged. And on a high animal protein, excuse me, low carb diet, they're severely clogged, even though it wasn't necessarily reflected in the risk factors or the weight changes. They're mediated through what are called nontraditional risk factors, things that most people haven't heard of like endothelial progenitor cells and other factors like that. So it's important when looking and asking these questions. First, to actually look at the bottom line, not the intermediary biomarkers, but the actual disease process itself. We've shown using quantitative arteriography, cardiac PET scans, radonucleid ventriculography, thallium scans, cardiac events that people get better. And to the degree they make these changes, there's a corresponding improvement. So I would hate for people to come away from this session thinking like, oh, these damn doctors, they can't make up their minds to hell with them, just, you know, bring out the bacon and eggs and don't worry about it, when in fact, while there's always more research to do. And the microbiome, as David mentioned, is particularly interesting to me because of how dynamic these changes can be measured. We know quite a lot already. So I think I can't agree more with what was said, but I do want to point out that I think the complexity of the issues should not take us away from what we already know and the importance of nutrition in terms of prevention. And I want to give a couple of examples and I think both the interaction of diet with our genes as well as with the microbiome is very important and something that- Can we stop for a second because I should have asked David to do this at the beginning. Tell the audience what the microbiome is. So microbiome is our bacterias that live in your guts and elsewhere in your body that we now understand that it's by itself another organ of our body. We live in homeostasis with them. And if that homeostasis is disturbed, then a lot of time it has been demonstrated to be associated with pathological conditions. And as David said, we have probably 100 times more bacteria in our guts than cells in our bodies. So it's a very important component. And it's not just in humans. Microbiomes are in soil. Yeah, everywhere. And we are understanding more and more how important they are in terms of our metabolism, in terms of our health, and as well as how they interact with nutrition. So I think I can give you an example. For example, I know vitamin E was mentioned and it's probably the most controversial nutrient in terms of it's good, it's bad. And I think understanding how it interacts, for example, with our genetic background can tell us why we see all this controversy. We did a study a few years back where we were giving vitamin E about 200 IU per day to a group of older people. It was the largest study. And we were interested to see if it has an anti-inflammatory effect. And in animal studies, we had observed that there was an anti-inflammatory effect. But in humans, we did not see that. And we were looking at some of the cytokines that are, cytokines are proteins that are known to cause inflammation in the body. And so when we looked at this population, we did not see an effect of vitamin E. But when we looked at the genetic background of the subjects, we noticed that in certain subjects with a particular genetic background, and those were the people who were producing more of these inflammatory cytokines, vitamin E could reduce the level of the inflammatory cytokines. But in others, it did not. And I think often we go into studies very simplistically. We don't characterize the population that we are looking at. We don't know what their genetic backgrounds are. We now, I mean, we don't know what their microbiota is like. Often, we don't even know what the nutritional status of them are. And whether we need to improve it or change it in any way. So I agree with Dean that we shouldn't, the complexity and the controversy should not keep us away from asking the questions and realizing the importance that nutrition plays in terms of prevention of many of the age-associated diseases that is in this case. And now we know that early nutrition is also very, very important in terms of your lifeline diseases. We know that what your mother and even now your father ate has a significant impact on how you grow up and your risk of diseases. And there's a lot of evidence for that. So we did a study, for example, where we looked at the impact of obesity during pregnancy on the newborn's nutritional status. And what we found was that the infants who were born to mothers who were overweight and obese had lower iron status compared to control mothers. And as you know, iron is very important for cognitive function and for many things. So I think it's important to know that there are many factors that contributes as to how nutrition will impact your health. And we need to be aware of that and we need to be asking the right questions and not sort of just call it off because it's complex. Can I just ask, build on one thing that she said or would you rather come back? Yeah, I'd like to come back if you don't mind. Just because I want to tap Jean Roca about this. So, Jean, I loved what you said about how chefs are sort of newly higher status and well known and that you can use this to good effect to help with nutrition and maybe even to support better ecology through that. We've just listened to some of the research about how nutrition is complex. There are emergent phenomena in the body nonetheless. We can see some positive effects in various areas at different life stages and with different mechanisms. How can scientists help the chefs better to do what you need to do to communicate to the public? And how, you know, how is that working now? How could it be improved? Well, they really are helping us. I think it's a process which is well underway, but which we need to strengthen. Sometimes at these cuisine congresses, there are scientists present who enable us to better understand the physical and chemical processes that take place when you're actually cooking food. And that really makes us understand this whole world of science that's behind this understanding. We are a bit immersed in our world of odd cuisine. We try to, through our work, get people excited to put emotion into our food. But we want to be sure as well that that's not just a question of this instant emotional impact, but rather that we have an impact on society as well, that people get excited about it, that they watch us on television, buy our books. So when we're trying to get people excited, we also need to bear in mind that we need to be responsible, that we need to have a deep understanding of nutrition and the impact of the message that we're getting across. What techniques are we using in preparing food? There are food preparation, culinary techniques and approaches that are far more respectful to the food and the health of the individual than others. And to have a kind of scientific underpinning to that is very important for us. That's what we get from this dialogue. That's, if you like, very nourished by this dialogue. We need to make sure that we avoid excessively high temperature, excessively high fat content, excessively high burning. We know these principles, but as I said, it's good to have a scientific underpinning to things like avoiding salt, sugar, red meat in excess. And if you like to have a hierarchy of nutrition, which is something that is taught in schools, but it's really a side issue. And I talk about having learned as a trainer's a chef, having been a father and a son as well. And in light of all of those roles I play in life, I think it's important that in schools where chefs are trained, but not only in schools where chefs are trained in schools as well, if young people are taught to appreciate food, to know how to prepare it responsibly, to know where the food comes from, knowing, for example, if it comes locally, if it's grown locally it'll be fresher, all of those questions. But it's also important that young people, as they grow up, really understand food and cooking and how it impacts on society as a whole. And do you have, do you have any advice for these scientists to help them to foster what you're doing as well in particular? I mean I was interested to hear that they come to your cuisine in congresses. Are there other things that they could be doing? Well, in Catalonia we have a foundation, the Alithia Foundation. Alithia in Spanish is short for food and science. And now that foundation promotes dialogue and it tries to build and maintain direct contact between people from the world of science and people from the world of cuisine, chefs. We are constantly asking questions. We're looking for these answers which come up from our work as we get involved in a creative process. Questions arise. We're thinking of introducing new techniques and then we would like to turn to scientists and say, would this be a beneficial process or would it be damaging to health? And sometimes the answer is yes, it might be damaging and you need to take that into account, obviously. Chefs have an empirical training by dint of their vocation and they really need to, like I say, have a scientific underpinning to their understanding of what they're doing. And when they then are explained to the public what they're doing, they can use that scientific knowledge to do it more responsibly. Thank you. So I think you give me a good segue. I wanted to ask everybody about different culinary systems and effects that they have. You're mentioning trying things and then asking, will it work well or not? And then after this I'd like to take some audience questions. But could we speak to that in a bit? Yeah, please go ahead. Sure. Actually, I think what chefs do particularly is very important in terms of older population because there are changes in their taste and in their smell. And it's very important to produce food that is appealing as well as as healthy. And so I think working scientists working very closely with chefs is very important in terms of encouraging both healthy cooking and preparation of food. I mean, Spain of course is different than US, but in US people don't spend the time to cook as much. And so one of the things that we've been doing at our center is to bring chefs and scientists together and have sessions that will talk about healthy foods. And you know, we choose, for example, something say pumpkin. And we talk about the health benefits of that. And then we have a chef that works and prepares healthy food with that. And it's, you know, it's very popular for people because they see that it's not so difficult to prepare food that has health benefits. And I think we need to have more of those collaborations. Other thoughts? I think it's great. So I think, I think we've, just to, just to briefly summarize, I think we've heard about emerging processes. I think we've heard about, I, I'm going to say finding a... Can I criticize one thing though? Go ahead. What, what I love what you're doing. But what I would love even more is for you to explain on your menu why you're doing what you're doing. You have this remarkable opportunity for every person who has the privilege of sitting at your table to learn. Why can't we take it a step further? Is your question, why am I doing what I'm doing in my, in my position as chef? Can you explain it more on your menu, right? So you've, you've learned in the congress from scientists and you don't use a high tent. But why not explain that beneath each item on the menu? Say why you do what you do. So when everybody leaves, they can leave with a level of knowledge about food and nutrition that's greater. Be an evangelizer. Well, yes, that would be good. People come to enjoy themselves. People come to escape a little bit. For three or four hours. So once they come into the restaurant, our job is to make them happy. It's very important as a principal. Obviously health is related not only to the body, but the mind as well. So what we're trying to do is to really communicate on that level. Make people happy. Paradoxically in the restaurant, we don't have the issues we're talking about at the forefront of our minds. What we're really focused on is pleasure, is a subtle complexity that might awake a certain nostalgia, lost memories, exotic travel. More than a question of whether the food is scientifically good. What we are trying to communicate is the language of cuisine, which is evocative of stories, experience, travel. Obviously it's very complex, not directly related to what we're doing at the moment now, but that's really our job and directly linked to my restaurant, my position as a chef. But I'm also saying, and that's why I'm here today, that as a chef, I do have a social responsibility. So when we're working in the Alitha Foundation with the scientists and when we're talking about cuisine, we don't lose sight of that picture. We understand that we are ambassadors for a profession which has its own set of ethics and values and which is very deeply concerned about the state of the food that people are eating and the state of the planet. Respond to that briefly. One thing I just want to clarify is that there's this common misconception that there's this false choice between is it good for me or is it going to taste good? Am I going to live longer or is it just going to seem longer if I eat healthy food? One of the things that I love about what you're doing is that we found that the best way to make healthy food tastes good is to work with great chefs, not necessarily health food chefs or whatever, but great chefs and then say work within these parameters and then the food can be delicious and nutritious. You don't have to make a false choice. And I also wanted to respond to what David, to what you said. I totally agree with you that when we go to these false foods like margarine and artificial sugar and so on, that was not a good direction. But at the same time, it's not necessarily true that butter is a good choice either. And there's this kind of often repeated, almost become a meme lately that Americans have been told to eat low fat. They're fatter than ever, so low fat has failed, so we should do some other things. First of all, the problem is that when people began eating lower-fat foods, they were often eating higher sugar foods. And so, trading one bad thing for another is not a good choice. But also, I went back to the USDA and said, what have Americans been doing since 1950? Are we really eating less fat? And it turns out that every decade since 1950, Americans have been eating more fat, more sugar, more calories and more meat. And to be precise, 67% more fat, even though we've been told to eat less fat, we're actually eating 67% more fat, 39% more sugar, 57 pounds more meat and 800 calories more per capita. And yet, we're living longer every year. Yeah, well, that's another issue. But the point is, is that it's no surprise why we're gaining weight. It's not because we're eating too little fat, it's because we're actually eating more than ever. And so, I just want to clarify that. Yeah, energy in versus energy out. I think that's a good place to maybe start to take questions from the audience, although I would like to come back to David and see me later about maybe the dangers of feeling too strongly about certain kinds of remedies with nutrition. But I think there are many factors. Because people tend to take things all one way or all the other and science is never like that. But to get away from this reductionistic view that it's all one thing and it's never one thing. And it's not even just all diet, it's the entire lifestyle choices that you make. I was just going to say that there are many factors that have contributed to us living longer. And we are living in a different world. And so, I think to say that the fact that people are eating more fat goes against saying that nutrition is important as to how you age. I don't know if you meant it that way. But I think it's sort of, the association does not necessarily follow because there are so many other interventions that we have antibiotics. We have a lot of other things that are helping. Not that antibiotics overuse of them is a good thing. But there are other things that have contributed to that. So we have to sort of be looking today and what is going to happen in the next few years in terms of our lifestyle and what we eat, I think. What I think we're hearing is, of course, it's complicated. Nobody ever expected human systems to be simple. But there are some things that we have learned and continue to learn. And with that, I'd love to start to take questions from the audience. Please raise your hand. Please identify yourself. Please wait for the microphone. And maybe somebody over there can help me with folks who are behind me. So I'm going to go here, then here, then here. So first question here. Does the mic right next to you? Yeah, good morning. Stephen Cross from Aeon Financial Services. Nothing to do with financial services. It's a question for Senior Rocha and the panel indeed. The concept that you mentioned was about not high temperature or excessive burning. The concept of raw foods, where you're making food that's under 42 degrees centigrade, what's the general feeling on where that's going? Is it good? Is it healthy? Or is it a fad? Well, yes, I think that maybe the scientists will be able to back me up on this or not. But we had understood that excessive burning and barbecues, charring, really isn't healthy. So that if we want to preserve nutrients in the food, then low temperature preparation is very healthy. And the transition from raw to cooked has to be made in a way that is as respectful as possible to the characteristics of the food. We need to avoid loss of water dehydration. And we find that if we do that, then texture is improved, taste is improved. So we're talking about very long cooking times at low temperature. We don't want to lose taste at the same time. So what we're doing is avoiding cooking methods that char, that dehydrate excessively. And we believe in that way. And as I say, the scientists can back me up, but that is less harmful to health. It's so hard to talk as a scientist after this kind of beautiful artistic description of food. And I love the fact that he's manipulating my mind with tastes of the past and other things. I realize that I'm kind of a puppet when I go to a restaurant now. But certainly the scientific data, if you look by techniques at the cooking styles, raw food, you get certain nutrients. When you cook food in these beautiful ways, you get other nutrients. And so your grandmother was probably the smartest that comes to when she said moderation. So some of everything, some raw, some cooked. If you really look at it, the Mediterranean diet, as they call it, is a very powerful thing. There was a question here, right here in the front row. Thank you. Thank you. I am Dr. Han from Korea, and then I am the CEO of National Medical Center. And I'd like to raise the issue that, you know, in Korea, it has been a long thing that medicine and food has the same origin. So we deal with food as a medicine as well. So it has been in Korean traditional medicine, always we are dealing with food as a medicine, and at the same time in a drug for treat disease. So I think that we are going to, it's going to be a really good idea to collaborate in those kinds of studies in Western medicine all together. And then to answer your question, Dr. Agus, that, you know, we, in temple food especially, that we always know what we are, I mean, why we are doing and what we are doing in terms of cooking. So probably, you know, from the Western side, and I don't think it has been a long time, philosophy or value about it. So I think in terms of scientific research, I'd like to put those kind of ideas and what has done in Asian countries into Western medical research on that in terms of nutrition and medicine at the same time. So to ask your question that, what's your thought in terms of those kind of collaboration or research, what has been done already in Eastern countries, including Korea? I would say, first of all, we're not good at treating most of the diseases we have no matter what you hear. The death rate of cancer has not fallen dramatically in 50 years. We're still dying of heart disease, etc. So any new idea, any new experience we want to certainly jump onto, most of the medicines we have are derived from plants and foods. So most of the chemotherapy drugs they have are derivatives from plants. So I would love to work with scientists anywhere, whether it be a custom of you ate this when you had this disease. If you look back, there's probably a reason it survived 1,000 years. Most of the customs we have that last a long time, drinking wine, you name it, that's lasted, there's a reason for it. And if we look back in most of the times it does have a benefit. And so any ideas you have, we would love to either work with you or put you to the right person to work because those collaborations can yield success. Thank you. My name is Stefan Thanna. It's really a request and maybe a bit of a pushback to you, Dr. Argus. The request is let's not throw out the baby with the bath order. Vitamins are 100 years old. They have been very, very well researched. They're called vitamins because they're vital to this body cells function. We cannot live without them. I fully agree that the best way to get them is through our diet, like Dean described. The sad fact is that 85% of the population doesn't do it or can't afford it. When you look at the reason why we have iodine in salt or we have folate in our flower to reduce neural tube defects, why we have vitamin A in our milk, tremendous advances have been made that population doesn't know why they are there. They are there for a reason. We deal a lot here with the World Food Program and the development community to get the same kind of public health benefits that have been researched by the John Hopkins Institute, Tufts, Linus Pauling Institute. And it is a real shame that now in the West all that is forgotten. And I think part of the reason I would like to hear you view on that is that since the science has been established over the last 100 years to get new science, you really, really have to make a very narrow study. Somebody who had the second heart attack at 55 takes a multivitamin to see whether it reduces the risk of a second heart attack. And then the study says no. And then the headline is vitamins don't work. With that short attention span of the public, we're really doing a disservice to throw out the 100 years of progress in public health. I certainly don't mean to throw out progress in public health. I mean there are clearly examples of pregnant women, people in lesser developed countries who don't have fruits and vegetables where they need vitamin A. Pregnant women need folate among other nutrients and pregnancy vitamin makes all the sense in the world. But I'm just saying is that every time we've guessed in humanity, let's take lots of this and correct this, we've been wrong. How many friends of yours have rickets, have scurvy, have true vitamin deficiencies in developed countries? And the answer is almost none. Yet when you give vitamin A and beta carotene to smokers or former smokers, it dramatically increased both lung cancer rate and the death rate. And by the way, death is a bad side effect. And when you start to look at these, again, I would love there to be a benefit. All I want is progress and people to live better and longer. So we can find a situation where taking these supplements help. I'd be the first one to jump on board. But most of the time they're not. And when you have this complex system and you take, remember, when you look at the vitamins, you're taking a lot of something. When you take a lot of vitamin D, for example, you down-regulate the sensor, the receptor, you change the whole signaling molecules. It's not just filling up a gas tank. It's that system. And when you take it in a pill form, which we're really not meant to do. Remember, we have a very exquisite mechanism. So we don't get too much vitamin D, for example. It's called tanning. The reason we tan is to block vitamin D absorption, because too much at once isn't good. Yet we take these pills with lots of it. And I'm just saying, let's get some data. You know, 97% of African-Americans and 70% of Caucasians in the United States are quote, low on vitamin D. So first of all, who defined what normal was? And so we're really going to take a step back and say with everything we do, is there data that doing it actually helps. Question back. Hi, my name is Henry. I'm heading a food retailer in Denmark. And I think that we have a huge responsibility towards people's health, to what they consume. And when we're talking about this, it's getting very complex and very complicated. And like you said before, with the clouds, when you look at the clouds, you know whether it will rain. And I think that people, when they listen to these kind of conversations, they get confused and they give up. So my question would be to you, how can we simplify so people know more about what's right and what's wrong? Before you answer that question, would you raise your hand if you're feeling confused right now in the audience? Can I take a shot at that? Go ahead. You know, my experience is that people who don't know much about something and people who spend their whole lives doing it can make it simple. One from ignorance and one just from doing it all the time. And I spent my whole life doing it. And it is really pretty simple. Yes, we do need to, I mean, I'm continuing to do more research. I spend most of my time doing research until recently. I'm still doing it because I believe in the power of research. But the fact that we still need to know more doesn't take away from what we already do know. And it goes something like this, you know, eat well, stress less, love more, move more. And that's pretty much it. So from the standpoint of eating more, eating well, you know, like I say, in all of our studies, we use the Whole Foods plant-based diet that's naturally low in fat, naturally low in refined carbs and sugars. It's and when you eat a lot of fruits and vegetables, you're not only not getting the things that cause disease, we're getting hundreds of thousands of other substances that are protective, you know, phytochemicals, bioflavonoids, carotenoids, retinols, isoflavones, genocene, lycopene, on and on and on that have any cancer, any heart disease, any aging properties. Not things you take in a pill, but things that are in your food. And so your body has this remarkable capacity to begin healing if we can begin working at this level. And there's an emerging field called lifestyle medicine, which is lifestyle is treatment. And that's what I've spent so much of my time doing, presuming that if you can reverse the disease, and certainly you can help prevent it. And with all this interest in personalized medicine, we found that it's essentially the same lifestyle intervention for all of these conditions, whether it was reversing heart disease, diabetes, prostate cancer, you name it. It's almost as though if you give your body the right raw materials, it can extract what it needs in order to heal. And after 16 years, and I also used to think that if we just did good science, that would change medical practice. And to some degree it did, but it really didn't as much as I thought. So I spent 16 years working with Medicare to cover our program. And now Medicare is covering this program for reversing heart disease that we developed. And we're expanding it to diabetes and early stage prostate cancer, which is great because if you change reimbursement, you change medical practice and medical education. We partnered with a company called HealthWays. We're training, we're trying to create a new paradigm of health care because at the same time that the same scientific studies are showing that the drugs and surgery don't work nearly as well as we once thought. I mean the studies have shown the meta-analysis of stents and angioplasty that they don't work in stable patients. They don't prevent heart attacks, they don't prolong life, they don't even reduce angina. And the same is true for bypass surgery, except in a very small percentage of people who need it. Getting your blood sugar down with drugs doesn't prevent the horrible complications of diabetes. You know, the blindness and... We got to stop here. Is it just not correcting diabetes drugs work? No. Heart disease drugs work. Surgery saves lives for heart disease. What are you saying? There was a meta-analysis in what's now called JAM internal medicine. Let me finish, please. What was then the archives of internal medicine? They reviewed all six, now eight of the randomized controlled trials of angioplasty and stents in stable patients, including the courage study, a $39 million study in the New England Journal of Medicine. And they all showed the same thing. They didn't disable patients. They don't work. That was the conclusion. I suggest you read the article. And likewise, it's not to say that people with diabetes shouldn't take drugs, getting your blood sugar down with drugs. The navigator study, also in the New England Journal of Medicine, two drugs to lower blood sugar, thinking that will reduce the complications of diabetes. It actually didn't. The editorial by David Nathan, who did the diabetes prevention program 10 years earlier, also found that lifestyle changes work better than drugs. It's not to say that drugs don't have benefit, but lifestyle changes work better. I'm not going to treat cancer anymore. I'll just go on nutritional therapy and it'll cure all cancer. It's great. I'm not saying that. Don't put words in my mouth. Well, it doesn't prevent prostate cancer. There's no data that it will slow the growth of indeloprostate cancer at all. That's not true. We did a randomized control trial with Peter Kelly and Bill Fairwell. If I could make a suggestion. I think, yeah, I think a thing that often happens in science is that there are different studies and different conditions with different people. And we find different things compelling. And the arc of time is where we find the truth. So I want to remind the audience that these are experts who are on the stage. They are talking about things that they have deep knowledge of. If you feel a little confused right now, I don't blame you. A thing that I always go with is what do we see over time? Because one study might say coffee good, one study might say coffee bad. They're not wrong that they said that. But under those conditions, those were the results. So just remember we're talking about an arc over time. But in that same spirit, Mary, the idea that fruits and vegetables are the healthiest way for most people to eat in their natural forms, I think, has stood the test. So, Dean, let's push on the diet point for a minute. I saw there was another question over here, and I promise I'll let you ask that in just a minute. Please, Steve, go ahead. That's something. I think there's now a push toward diet-based dietary guidelines. Thank you. I was just going to ask that. Yeah, which I think is actually a very good approach because that's what we need to do. It's food that we eat and we need to have that. Rather than diet recommendations, we need those, but diet-based guidelines are, I think, what we need to have and we need to have them globally based on the public health needs of particular areas. So each country needs to have their own diet-based guidelines because that would need to be based on their own needs and might be very different in the U.S. than might be in some other countries. There are some basics that everyone follows. You don't need to be eating too much sugar or too much salt or too much fat, but then there are specifics that each country needs to determine based on their own public health needs. And could we make a recommendation because it is complex, because the studies are evolving over time. We're seeing things that are patterns or some things that might be a little confusing. How do we recommend to policy leaders how to get to dietary guidelines that are reasonable and good for their country or their people's particular issues? Go ahead, I'm sorry. I mean, I refer there was a very nice panel that was put together by WHO that actually looked at that. And there's a nice article that I can't remember their reference to, but be happy to provide to people. But they actually had a very nice way of saying, how do you go about setting dietary, you know, diet-based or food-based dietary guidelines and what are the different steps that you need to be taking? And I recommend people to read that. And they also have very, I thought, sensible and easy to follow suggestions in terms of what are some of the basic things that need to be, people need to be following and be happy to provide that reference to whoever needs it if they contact me later. Could you, yeah, or could you tell them how to Google it or something? So I think what the basics is not very far from what Dean was saying is that, you know, you need to be reducing, you know, simple sugars, more complex carbohydrates, whole grains, salt in moderation, you know, reducing that, reducing the total amount of saturated fat and total amount of fat in the diet, drinking a lot of fat, I'm sorry. And red meat as well. And yes, yeah, having that, you know, lean meat and more of the whole grains, more of the foods and vegetables, a lot of water to drink as well. And then also, I think something that we always forget when it comes to food is food safety, making sure that the food that you consume is safe and doesn't, is not contaminated. And there are a whole set of other recommendations that they have, but I found it very easy to follow, you know, very, and not confusing. And I think it made sense at least to me. You know, the problem is most of those are just not that data driven. So there are populations in Africa who only eat blood and milk. And they live a very long life without much heart disease and much cancer. And so I think we have to be very simple when we, when we get these declaratory statements, eat some three courses of vegetables and three courses of this, it's not most of the time really data driven. There are a lot of ways to achieve a goal. And many cultures have different ways of doing it. And they're all right in the right context. But that's what I first said. Right. That each country needs to use their own public health problem and come up with the dietary guidelines. But in general, I mean, those are exceptions. But in general, there are not many people who just drink blood and, you know, do that. Well, there are whole populations in Africa that do it. But I think, yeah, but I think that it's important for each country and for each ethnic background to know what is the problem that they're facing. I mean, there's a good example, for example, and this is true a few years back. I don't know if it's true. The amount of calcium that Chinese consume is less than what Americans consume, which both of them is less than the recommended level. But Chinese don't have as much osteoporosis problem, right? So maybe there are other things in their diet that is important. Well, you know, for example, I mean, it's not necessary to recommend Chinese to increase their calcium, but it's necessary to do it in, right? There's a context. But as you know, when you eat a lot of animal protein, your body excretes calcium with the protein. So drinking milk to raise your calcium may be self-defeating. If you're on a plant-based diet, even though you may have less calcium intake, you have lower osteoporosis. So we have to be careful. I mean, number 26,000 women in the women's health study, calcium of vitamin D versus placebo, no effect on bone fracture rate. Taking some of them. Well, there are other studies that do not show that, actually. I think that's not really true. Before we go study to study, we have five minutes left. I'd like to let the audience ask one or two other questions if possible. So I'm back here here. Can you wait for the microphone? I'm sorry. Thank you. I'm Marcel Escobarie. I work at Harvard Center for International Development. You talked about these techniques about how to cook food. I'm interested in what matters for health and how you grow food. Because I mean, I grew up in Bolivia, and I remember coming here and seeing in the U.S. seeing the apples, and I was like, these must be plastic. And I buy, you know, free-range organic eggs, and they don't taste like the eggs here or the tomatoes. So I love to to hear what we should learn about that. And does organic taste better? And does organic taste better? Yes, I mean, that's really important. And it's important because, well, I think we all agree, ultimately, it's the question of common sense. You just need, well, you need to take a common sense, a common sense approach to your diet. People pretty much know within the context of their culture what's healthy and what's excessive. But your question is a fundamental importance. The way that we grow food needs to be respectful. We need to preserve biodiversity. We need to make sure that we don't lose foods from the world. It's important also to have a varied diet. We shouldn't just restrict ourselves to four kinds of apples. There are many, many different kinds of apples, and we need to appreciate and cultivate that biodiversity. And in Catalonia we, the chefs, have become aware of the fact that many young people are going back to the land and treating it in a respectful, indeed even loving way so that they are growing foods which are fundamentally more healthy. That's a very important trend, something that we can contribute to, pay attention to, because otherwise we will see the detrimental effects of loss of biodiversity due to single crop growing and a kind of mass approach, mass market approach to agriculture. So we need to have a dialogue with scientists, but also with small farmers so that we can ensure that our products are as diverse and authentic as possible. Thank you. I actually think we have just one minute left, so I think I'm going to need to wrap up. One interesting conversation I think we talked about how food can nourish us and please us, how it can maybe prevent disease and support us when we're suffering from some disease states, and it's a pleasure that touches memory and creates many joys, and that the continuing dialogue and an evidence-based data-focused approach probably will be the best way forward over time, and I want to thank everybody so much for their time and for the terrific conversation. Thank you. Thank you.