Per my title, this is an open letter to, and bet with, my fellow nutrition experts worldwide.

I hasten, though, to append the relevant provisos. I mean actual nutrition experts- not everybody with an opinion. I don’t mean what’s left after our culture gets donebeating expertise to death. I do NOT mean every Hollywood celebrity with a pet theory and a beautiful body, courtesy of youth, privilege, and mountains of cash to spend on personal pampering, from the spa to the gym to the kitchen to the cosmetic surgery suite. Sorry, gang- I may enjoy your movies, but I do not mean you.

I do, however, mean all legitimate experts. I mean dietitians, and diabetes educators; I mean epidemiologists, and endocrinologists; I mean health writers, and health coaches; science writers, and food scientists; physiologists, and nutritional biochemists. I mean everyone who has put in the proverbial 10,000 hours or at least a sizable portion thereof before presuming to opine.

My letter and bet are directed to all of YOU. So let’s get on with it.

The bet is that I can predict the answers to the questions that follow with a very high degree of fidelity. If anyone can prove me wrong about my predictions, I will eat a copy of the new (and thus, particularly copious) edition of my nutrition textbook, while dancing the Hula in traditional island garb. If I’m right, however- well, we’ll get to that.

Question 1: The typical American diet would improve the most by ADDING which of the following as a routine component?

A) pure, whole vegetables
B) pure, whole fruits
C) pure whole nuts
D) pure, natural meats
E) multicolored marshmallows as part of a complete breakfast

My prediction: most of you picked A, some of you picked B, C, or D- but NONE of you picked E.

Question 2: The typical American would improve the most by ELIMINATING which of the following as a routine component?

A) pure, whole vegetables
B) pure, whole fruits
C) pure whole nuts
D) pure, natural meats
E) multicolored marshmallows as part of a complete breakfast

My prediction: you all picked E.

Question 3: Which of the following diets is the BEST for human health?

A) prototypical Mediterranean diet
B) prototypical vegan diet
C) prototypical Paleo diet
D) prototypical American diet

My prediction: Some of you picked A, B, or C- and some of you wanted to pick something not on the list; but NONE of you picked D.

Question 4: Which of the following diets is the WORST for human health?

A) prototypical Mediterranean diet
B) prototypical vegan diet
C) prototypical Paleo diet
D) prototypical American diet

My prediction: You all picked D.

Now, to my real point. We have an incredible opportunity to take action based on our agreement. Yes, I know- it can be a bit embarrassing to link arms and sing Kumbaya- but there are lives at stake, and we need to get over it!

I wrote a column yesterday for US News & World Report to make the case that we have long known enough about the fundamentals of lifestyle as medicine- including, critically, dietary pattern- to prevent fully 80% of all chronic disease and related premature death. I wrote that column yesterday so I would not need to reiterate all of that today.

Today, given that we know what we know- I want to focus on how to put it to far better use.

We can start by getting a bit personal. What does a great diversity of the world’s multidisciplinary nutrition experts actually eat?

I obviously don’t know everyone in this category all around the world- but I know a sizable sample. Included in the group are some who don’t practice what they preach at all- and frankly, they don’t interest me all that much, and probably shouldn’t interest you. If advice cannot be applied even by the expert offering it, how good or useful is it likely to be?

Then, there is everyone else- who both preaches, and practices accordingly (more or less). Included in this group are some with whom I seem to agree about just about everything, and more interestingly, some with whom I seem to disagree about just about everything.

But as my quiz above highlights- we agree even when we are seemingly disagreeing. We all know that a diet of hyper-processed, glow-in-the-dark junk is both the worst of all diets, and the prevailing status quo in the U.S. It is also the diet we are effectively exporting to the rest of the world- along with the chronic diseases that follow. Tell them what they’ve won, Johnny!…

My vegan colleagues will want to focus on vegetables and fruits, whole grains and legumes; and my Paleo colleagues will want to focus on venison, or bison, or wild fish. But in both cases- whether it’s pure plant foods for us to eat, or the flesh of freely ranging animals in turn derived from the wild plants of their native diets- it’s pure, minimally processed food, direct from nature or nearly so. Multicolored marshmallows are nowhere to be seen. Nobody is running on Dunkin’. There is a decisive absence of soda, fruit-free fruit rolls, and toaster pastries. There is real food.

And while my questions above were limited to human health, we might reasonably extend the conversation to include issues of environmental conservation, ethics, sustainability, and hunger. I think most of my Paleo colleagues would agree that whatever the potential health virtues of eating a genuine approximation of our Stone Age diet, there is no space on this planet for >7 billion hunter-gatherers. A diet of mostly plants becomes common ground when we consider the common ground of our planet, and the modern population density of Homo sapiens on that surface area.

But even ignoring that, my case is this: assuming all concerned are truly expert in nutrition and practicing their choice well, the diets of the vegans and the diets of the Paleos are more like one another than either is like the diet all around us that is taking years from life and life from years, and consigning our children to a bleak future awash in diabetes.

And I am betting that you all care about that just as much as I do. After all, we, too,have skin in this game.

The public only hears about our disagreements- because those are provocative, and titillating. Our disagreements are the stuff of morning show teases, and best-selling books.

Our disagreements are also home to legitimate uncertainties, and the need for new studies to elucidate what we don’t yet know.

But what we DO already know- and have known for more than two decades at least- is enough to prevent 80% of all chronic disease. It is enough to add a bounty of years to lives, and life to years.

And so, my friends and colleagues, collaborators and combatants- we come to it. I am making a plea.

Let’s tell the world that the basic care and feeding of ourselves and those we love makes us more like one another than like the broken cultural default all around us. Across the full spectrum of competing dietary priorities, we are really more alike than different. It’s as if we were debating who has the best pyramid across a very narrow expanse of common sand, while overlooking the fact that the public is lost somewhere in the dunes, nowhere near any of us, dying.

People truly are dying, prematurely and unnecessarily, for want of knowledge about… our common knowledge. The perennial focus on only the disagreements among us lead much of the public to doubt us all. Any of us doubting the cost of this needs only look around. We are losing. Big Food is winning. People are dying.

We are all more alike than different. But only our differences are on display. If we changed that, our collective credibility could rally the public to the basic theme of healthy living we share, even while allowing for everyone to choose the variant on the theme they like best.

What we know and mostly practice in common is enough to prevent 80% of chronic disease and premature death. With differences on dizzying display and commonalities concealed, we have failed to get much of anything done with that knowledge for literal decades. We look on at the blessings of the Blue Zones, born of diverse practices on a common theme- and all we manage to do here is get blue in the face, shouting into the din.

I say: enough is enough. I’m betting I’m in excellent company.

If I’ve won my bet, it’s Kumbaya instead of Hula. Grass skirts are optional.


David L. Katz, MD, MPH, FACPM, FACP cuts a dashing figure in a grass skirt. Those who have seen his version of hula, however, tend to recommend he stick to his day job.

Director, Yale University Prevention Research Center; Griffin Hospital
President, American College of Lifestyle Medicine
Editor-in-Chief, Childhood Obesity

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Author: Disease Proof