Healthy To A Hundred: Dr David Katz of Yale University’s Prevention Research Center On 5 Things You Need To Live A Long, Healthy, & Happy Life
An Interview With Savio P. Clemente
Respect, trust and parity. Everyone wants, and generally deserves, respect. Trust is earned, but I believe it should be like innocence: presumed, in the absence of evidence against it. I believe in trusting people. And finally- the captain, famously, goes down with the ship. The captain of any team should be willing to deal with any and all difficulties that are asked of the crew; that’s parity. And that willingness to lead from the bottom up, rather than the top down, is, I believe, conducive to mutual respect and trust.
The term Blue Zones has been used to describe places where people live long and healthy lives. What exactly does it take to live a long and healthy life? What is the science and the secret behind longevity and life extension? In this series, we are talking to medical experts, wellness experts, and longevity experts to share “5 Things You Need To Live A Long, Healthy, & Happy Life”. As a part of this series, I had the distinct pleasure of interviewing David L. Katz.
David L. Katz, MD, MPH, FACPM, FACP is a globally renowned expert in disease prevention, health promotion, lifestyle medicine, and nutrition. The founding director of Yale University’s Prevention Research Center, and past president of the American College of Lifestyle Medicine, Katz has earned numerous awards for his contributions to public health, including three honorary doctorate degrees. Dr. Katz is also a Scientific Advisory Board member to ChromaDex, a global bioscience company dedicated to healthy aging and makers of the consumer supplement, Tru Niagen®, which supports healthy aging and promotes cellular energy, defense, repair, and vitality.
Thank you so much for joining us! Our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’?
My general interest in health and wellness began in my early teens with an interest in sports and fitness. Before long, it dawned on me that any high-performance body required high-performance fuel, and my interest in nutrition was born. My father is a cardiologist, only recently retired from clinical practice, whose interest in fitness helped foster my own- although in the case of nutrition, I led, and he followed.
As for the rest, I have a native predilection for patterns, how things come together i.e., the big picture. This is at odds with what science tends to reward — a riveted and reductionistic focus. There is value in both, obviously. In my case, that ‘big picture’ view caused me to think not only about individual patients for whom I was learning to care while in medical school and residency, but about the population of patients. I felt that I was learning how to be one of ‘the king’s horses and the king’s men’ engaged in the futile effort to put ‘humpty dumpty’ together again. For me, ‘together’ meant vitality fully restored and the fall from that wall were illnesses like heart disease, cancer, stroke, diabetes, dementia, aids, and so on. These diseases did not need to happen and even back then we knew how to prevent them, but we weren’t applying what we knew to any good effect. Knowledge isn’t power if you don’t use it as such. And so, my career in preventive and lifestyle medicine was born — striving less to learn what we didn’t yet know, and more to figure out how to use what we already do know in the service of adding years to lives, and life to years.
Can you share with us the most interesting story from your career? Can you tell us what lessons or ‘takeaways’ you learned from that?
There are several good candidates here. In the clinical realm I took care of patients for 30 years and there are at least three rather amazing episodes. One involved a young patient that the ‘standard of care’ was blithely killing. I saw the danger early, told my wife and then young children that they would be having summer without me and effectively moved into Yale New Haven Hospital to do all I could to save this woman’s life. I succeeded in that, but the deficiencies in the system exacted far too high a cost from her just the same. What did I learn? The ‘standard of practice’ is essentially the means of what is routinely done and by no means the best we can do. The standard of care is all too often substandard, as it was. I also learned that sometimes you have to fight the very system you have devoted your utmost effort to being part of.
A related case involved a woman with cancer who wound up in the ICU with multiorgan-system failure. At a certain point, her oncologist was ready to throw in the towel, but I wasn’t. He renounced her care, and I took it over. She made a full recovery and six months later, in remission, was vacationing in Florida. The lesson? When you know what’s right, you have to do it no matter who or what is standing in your way.
Two non-clinical stories: I lead a team of colleagues in the development of what, to the best of my knowledge, is the most robust and useful system ever devised to score the overall nutritional quality of individual foods and empower consumers to make informed choices at a glance. At its peak, it was deployed in 2000 US supermarkets, putting scores from 1 to 100 — the higher the number, the more nutritious the food — in front of 150,000 items. I looked on as the food industry fought it to death over the span of a decade. Lesson? Only the obvious — the status quo is mighty, and fights with its full strength to preserve itself.
Lastly, the invention that resulted in the formation of my company, Diet ID, and resulted in me leaving academic medicine to become an entrepreneur after 30 some-odd years. The idea that became Diet ID first unfolded in my mind like origami in reverse while I was working out one day. The idea was simple at first and then as I challenged it, took on the many facets of intrinsic complexity. These years later, it is a fully deployed solution to the long-standing problem of efficient, reliable dietary assessment at scale. Though the process has been arduous, the mission to make diet quality a vital sign is worth it. The lesson is to give any good idea the chance for its potential to make a positive difference in the world.
None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful for who helped get you to where you are? Can you share a story about that?
I have more than one potential answer, but I have to give this by a wide margin, to my wife, Catherine. First, we decided long ago to have a division of labor; she worked at home raising our five children, and I went out to spar with dragons in the world. We both worked hard, and both jobs were important, and neither of us could have done it without the other. There are many other practical manifestations of the love and friendship we share, of course. But perhaps most important is this: the world will inevitably make you doubt yourself and maybe make you doubt everything about yourself. When you are undone and not a reliable barometer of your own worth, you need someone who can step in and provide that measure for you. Someone you trust. Someone tough, but fair; loving, but willing to be brutally honest. Those times when I doubted I could keep on keeping on, and then did anyway- Catherine was invariably the reason.
You are a successful leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?
Respect, trust, and parity. Everyone wants, and generally deserves, respect. Trust is earned, but I believe it should be like innocence: presumed, in the absence of evidence against it. I believe in trusting people. And finally, the captain famously goes down with the ship. The captain of any team should be willing to deal with any and all difficulties that are asked of the crew, that’s parity. And that willingness to lead from the bottom up rather than the top down is, I believe, conducive to mutual respect and trust.
I don’t really have a good ‘example’ of each of these abstracts’ rather important principles, but I have one anecdote that might serve well here. Many years ago, I got a request to meet with a student about career advice. This particular request (this tale generalizes to some number of closely related anecdotes), came when I was swamped, and the last thing I needed was another meeting on my calendar. But I said yes anyway, because I thought, what if this were me reaching out to someone I admired? What if this were a door that could open for me, or slam in my face? How can I know just because I am older, was born earlier, am further along the course of my career and life than this person is right now that s/he doesn’t have the full measure of my own potential and more, to do good in the world? Given the choice between a false negative (saying ‘no’ when yes would have been right) and a false positive (saying ‘yes’ and then regretting an unproductive exchange), the false negative seemed the greater risk, because it risked…discouragement. Over the years, some of those meetings were pretty dubious, but some were spectacular. If the price of the spectacular meetings meant the opportunity to help encourage someone of exceptional vision and ability was the time spent in dubious meetings, it was a small price to pay as compared to the presumption of discouraging a young person who might just be working toward…saving the world.
Can you share with our readers a bit about why you are an authority in the fields of health, wellness, and longevity? In your opinion, what is your unique contribution to the world of wellness?
I chose to focus on nutrition, weight management, chronic disease prevention, and lifestyle medicine because this nexus was clearly the greatest opportunity to add years to lives, and life to years. My career was in fact, greatly influenced by a single research paper, entitled ‘Actual Causes of Death in the United States,’ and published in the journal of the American medical association in 1993, the year I completed my second residency (in preventive medicine/public health) and earned my Masters of Public Health(MPH). This paper revealed, as have many others since, and some few prior, that 80% or more of all premature death and chronic disease in the modern world could be eliminated if only we ate optimally, were active routinely, and avoided potent toxins such as tobacco. Acting on this became my career mandate.
As for being an authority, that is a decision made by others, of course. One leads only if others follow; one is an authority only if others decide you are. To the extent they have in my case, I greatly value the trust, and strive every day to be worthy of it.
As for unique contributions, in general, it relates to seeing and defending the big picture. There are clear, fundamental truths about healthful, sustainable living and eating — good for us, good for the planet — that are incontrovertible. Yet so much of our dialogue is about only marginally important details. I have consistently emphasized the confluence of science, sense, and global expert consensus regarding the fundamentals that matter most. I have done this in many ways, from studies, to commentaries, to op-eds, to interviews, to books, to conferences, to founding a non-profit organization, The True Health Initiative, all about this very mission. The signal of science, sense, and global expert consensus has by no means won out over the noise of nonsense, so this all remains a work in progress! Miles to go before I sleep…
More specifically, I think the breakthrough innovation in dietary assessment that has been developed and deployed at Diet ID is my signature, and I hope, legacy contribution to public health. Diet quality, objectively measured, is the single leading predictor of premature death and chronic disease in the modern world according to the global burden of disease study. It should accordingly, be treated as a vital sign because that’s what we call the most important measures in medicine, recognizing that we only manage what we measure. At Diet ID, we have an approach to the measurement of diet that can make it the vital sign it deserves to be, a measure in every health record. If we can get there, and I believe we will, it will forever change and elevate the standard of clinical care. That will be a proud achievement and will help me ‘go gentle’ in the fullness of time, when the good night calls my number.
Seekers throughout history have traveled great distances and embarked on mythical quests in search of the “elixir of life,” a mythical potion said to cure all diseases and give eternal youth. Has your search for health, vitality, and longevity taken you on any interesting paths or journeys? We’d love to hear the story.
Well, we might say in response to this that I’ve traveled to Ikaria, Greece; Sardinia, Italy; Okinawa, Japan; Loma Linda, California; and the Nicoya Peninsula in Costa Rica. But other than Loma Linda, I haven’t been personally to any of these places, rather I’ve been transported there by the writings of Dan Buettner, founder of the ‘Blue Zones.’ These 5 blue zones are the world’s populations known to live most routinely to 100 years or more, and largely with intact vitality, free of chronic disease. And when their time does come, they often die in their sleep at home, rather than in an ICU. These blue zone blessings — living long, prospering with lasting vitality, going gentle in the fullness of time — are the product of the most compelling ‘elixir’ I’ve encountered, namely, lifestyle as medicine. These populations eat variations on the theme of an optimal diet (real food, mostly plants), they are physically active routinely, they tend not to smoke, they get enough sleep, they don’t get too much stress, and they have strong social ties to one another. There is more, but that’s the gist. They have health courtesy, not of clinics, but of culture, that makes the fundamental requirements for a long, vital life norm rather than the exception.
Here in the US, those requirements are very much an exception. As a result, my ‘journeys’ have taken me into relationships with diverse entities working on ways to help people ‘get there’ from ‘here.’ Currently, one of those is a company called ChromaDex where I serve as a science advisor. ChromaDex is the creator of Tru Niagen, which features a unique form of niacin known as nicotinamide riboside (NR) and is a novel NAD+ precursor, an essential coenzyme known to figure in many of the body’s key pathways of energy generation and aging. This product is a supplement of course, not a substitute for the benefits of getting lifestyle right. But people living in a culture that conspires against health the way ours does often need a cellular boost, and this kind of ingenious ‘biohacking’ can help provide it.
Based on your research or experience, can you please share your “5 things you need to live a long & healthy life”? (please share a story or an example for each)
For a lifestyle medicine expert, this is too easy! We speak routinely of six domains or pillars, that I have long summarized as: feet, forks, fingers, sleep, stress, and love. By these I mean: eating optimally (forks); being active as a matter of daily routine (feet); not bringing toxins such as cigarettes to our lips (fingers); getting enough sleep; mitigating stress; and cultivating strong, social connections that fulfill us, and give life meaning. That is six, rather than five.
I can’t really think how to give ‘examples’ for these, so I will leave it at that with just one addendum. It occurred to me at some point many, many years into my career that I was killing myself in the service of making others healthy! Not literally of course, but figuratively in the sense that I was working relentlessly, often under tremendous stress, and making little to no time for my own recreation. I changed this in rather dramatic fashion by getting a horse (I now have two). I am a passionate equestrian and having a horse was both an opportunity for the recreation I love best and all the obligations that come with an important relationship. The obligations made me honor the opportunity as I otherwise might not have, and the rest is history. I have made time in the saddle, which is physical activity, stress reducing, and the cultivation of an important social connection, albeit with a quadrupedal friend, a routine priority.
Can you suggest a few things needed to live a life filled with happiness, joy, and meaning?
Yes and no because I don’t think there is a universal answer for everyone. Only you can decide for yourself. But if I were to pick the most universal answer, it would be love or passion aligned with service. Find where these reside in you and follow them no matter what. This love may be for someone or something. This passion may be for a friend, a spouse, or a vocation, or all of these. But fulfillment resides where our efforts, our hours, and our passions converge. How we spend our days is how we spend our lives. I believe the need to feed passion is universal, but what sustenance is best is highly personal.
Some argue that longevity is genetic, while others say that living a long life is simply a choice. What are your thoughts on this nature vs. Nurture debate? Which is more important?
Both are important, but we are now well into the epigenetic age. The epigenome makes up 95% of our chromosomal real estate, with genes making up only the residual 5%. The epigenome is a vast system of ‘levers and switches’ that turn our genes up or down, on or off. The epigenome is highly responsive to our lifestyle and health and is modifiable throughout life. So with rare exception, nurture prevails because while we can’t change the genetic hand we are dealt, we can greatly influence how that hand plays out.
Stated differently, nature and nurture are not truly distinct because we can nurture nature, we can alter how our genes express themselves. While lifestyle behaviors are arguably the most potent way to do this, they are not the only way. As noted above, NAD+ is vital for cells to function optimally and stay resilient in the face of life’s many stressors and the levels of this critical compound can be influenced with supplementation. Tru Niagen, mentioned earlier, is a novel and highly effective NAD+ precursor backed by rigorous science. Levels of NAD+ reverberate through many key aspects of metabolism so if we can give ‘nature’ a bit of support with critical and vulnerable pathways, I am fully in favor.
Lifestyle and the social factors that influence it (even causes have causes), matters more. Zip code is apt to say more about health and the opportunity for it than genetic code, again, with very rare exceptions.
Life sometimes takes us on paths that are challenging. How have you managed to bounce back from setbacks in order to cultivate physical, mental, and emotional health?
I am truly blessed to have love in my life — friends, family, five grown children, my dogs, my horses. And above all, my wife, my partner in everything. I have sought strength I could not otherwise muster, again and again, in the solace and redemption and reality check of that love. As John Donne told us, no one is an island. We have all been lost at sea at one time or another — I most certainly have been- and when that happened, I have clung to the love in my life, and been rescued by it. The best personal flotation device — ever!
Can you please give us your favorite “life lesson quote”? Do you have a story about how that was relevant in your life?
For my career, ‘the best way to predict the future is to create it.’ For my personal life, ‘how we spend our days is how we spend our lives.’
The former is most often attributed to Peter Drucker; the latter to Annie Dillard.
If you could start a movement that would bring the most amount of good to the most amount of people, what would that be?
Years ago I thought of launching an organization: lovingparents&grandparents.org. I thought, what could bring us together past our divisions? What could help us see that we are all in this together? What could help us act in common cause for what matters most? What could get us to perceive past the veil of superficial differences to our common, human connections? Every answer is the protective love all decent adults feel for vulnerable children. So, imagine an organization that simply asks of us all to defend, protect, and promote what would make the world better for our children. We might not agree on everything, but past the trivial differences of party, religion, and ideology, I think we would agree on a lot! I recently watched the movie 13 lives, the true story of the rescue of a youth soccer team trapped in a flooded cave in Thailand, and it seemed to me an emphatic validation of this concept. We are, truly, just one extended, globe-spanning family. We all love our children in much the same way. If that were our lens, how would we see the world? How would we act in it?
What is the best way for our readers to continue to follow your work online?
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This was very inspiring. Thank you so much for the time you spent on this. We wish you only continued success.