Priya Menon :  Good evening, everyone!  Hello and welcome to Cure Talk.  I am Priya Menon, Scientific Media Editor at Cure Talk, joining you from India; and I welcome all of you this evening to a discussion on making good food choices in an urban environment.  This is our 86th episode.  Nutrition and diet are a popular topic on Cure Talk; and today, we are going to explore and understand how our immediate food environment affects our food choices and attempt to tackle the question of whether consuming organic food can help us stay healthy.     To do so, we have with us two very distinguished panelists.  Dr. Sean Lucan – He completed his MD and MPH degrees at Yale before earning an MS in Health Policy Research as a fellow in the Robertwood Johnson Clinical Scholar Program.  He is currently on the research faculty in the Department of Family and Social Medicine at Albert Einstein College of Medicine and is a practicing family physician at the Montefiore Medical Center in Bronx.     Our next panelist is Samantha Heller, registered dietitian, exercise physiologist, senior clinical nutritionist of NYU Langone Medical Center’s Center for Musculoskeletal Care and Sports Performance Center, a SiriusXM radio host.  Samantha’s new book, The Only Cleanse: A 14-Day Natural Detox Plan To Jump-Start A Lifetime Of Health will be available starting May 26, 2015.    My co-host of the evening is Matt Goldman. Matt is a multiple myeloma survivor who is discovering nutrition and its nuances  in keeping healthy.  Towards the end of the discussion, we will be answering questions sent in via email by our listeners.  If you have a question for our panelists, please press 1 on your keypad to let us know and we will bring you on air to ask them.    The modern day city is designed for unhealthy eating.  The very system put in place to protect us are skewed towards  profitability, not nutrition, and the results are skyrocketing levels of obesity and chronic disease.  Its toxic for the environment, is a complex problem that requires reforming at all levels, from government and industry to local institutions and families.    Until that happens, its up to us to find solutions in the small choices and changes we can make in our own lives. In this discussion, Dr. Sean Lucan and Samantha Heller will talk about the modern food environment and deliver some practical advice to help us make healthier food choices.  With that, its over to Matt to begin with the discussion. Matt, you are on air. 

Matt Goldman :  Thank you, Priya, and welcome, Dr. Lucan and Ms. Heller. 

Samantha Heller :  – Hi! 

Dr. Sean Lucan :  Hi! Thanks for having us. 

Matt Goldman :  – Yeah.  Thank you.  Brian Wansink, Director of the Cornell University of Food and Brand Lab and an authority on eating behavior, mentions in his book about . Quoting him, he says, most food choices happen within five miles of where we live, our home, two or three most frequented restaurants, our main grocery store, at work, or in school.    We tackle that, we not only eat better but have a positive effect on our families, our neighbors as well as the 80% of people who don’t care what or how they eat.  So, our immediate food environment is important for us to make healthy food choices.     So, given that, today’s show is about how we make decisions about food and how our decisions are shaped by our food environment, but I…, I would imagine for many listeners and even myself, the idea of a food environment is a new…, is new information, its something we don’t know about.  So, Dr. Lucan, can you explain a little bit what a food environment is and how it influences the choices that we make? 

Dr. Sean Lucan :  Yeah, sure.  So, broadly, I think a food environment is just a context within which individuals make dietary decisions; and there are many aspects to a food environment, social, cultural, economic policy.  Recently, there has been a lot of interest in looking at healthy environment or, you know, actual food sources,    where people get their food, the sources of those food, and…, and what types of food are available from those sources.  So, a lot of interest is looked at, you know, restaurants and food stores, other aspects of the food environment like farmers’ market, street vendors, non-intuitive store, retail and all kind of selectively is…, is already reflected in the food environment. 

Matt Goldman :  Okay.  Thanks.  Ms. Heller, do we…, do we even stand a chance at making good choices in the…, in present day society?  We all like to think that we have, we will and if we choose what we eat, but how much…., how much of a choice we really have nowadays? 

Samantha Heller :  You know, that’s such a great question.  I…, I certainly have people who listen to me on my radio show on SiriusXM who call in and say, “I don’t want my food choices to be regulated, don’t tell me what to eat,” and then what they don’t realize is how incredibly manipulated they are by the big food companies.  Food ads are everywhere.  They are on television.  They are on billboards.  They are on your smartphone.  They are on your computer.     When you walk into a grocery store and you smell coffee at the Starbucks right there…  There is a Target near where I live and I was there today and the first thing you smell when you walk in is pizza and popcorn.  That’s not a mistake.  The way a food court in a mall is lit, the music, the color, all…, all effects are food choices. The number of ads on television…  If you watch TV when you are hungry, forget it!  You are just going to want to eat every ad that comes up because their job is to make you want to eat their food.    So, we are living in a food environment that…, that doesn’t support healthy eating in general and so what we want to do is create a food environment at least in our own homes that can help us eat more healthily and we can do that, for example, just by stalking our…, our pantries, our refrigerators with healthier foods because Brian Wansink, who you referred to before, in his research,   he has found that we will eat what is in front of us.  So, we will eat the first thing we see in the refrigerator, the first thing we see in the cupboard.  So, instead of having the cookies at the front of the cupboard, either don’t have them in the house or if that’s impossible, put them in a different cupboard or in the back of the cupboard.  Have some whole grain crackers there instead.    He did a study where they put the fruits and vegetables.  They took them out of the crisper bins and brought them up on the show where you could see them and people ate significantly more fruits and vegetables when they were right in front of them.  So, if we can change our own personal environment and understand the environment that we live in, when we get out on the street, when we leave our homes, is not necessarily conducive to healthy eating, then we can be more aware of the influences it has upon us as we go through our day. 

Matt Goldman :   Oh!  So, we do have free will, but we need to be a little bit focused and thoughtful about that free will, it sounds like.

Samantha Heller :  Absolutely!  I think…  I think we are affected in ways that…, that we are…, of which we are completely unaware and I think when we are really thoughtful about what we have in our homes and we become more mindful eaters, when we are consciously aware of what we are choosing to put in our food cart, what we are choosing to bring into our houses, what we are choosing to put into our mouths, then we can start taking a little more control. 

Matt Goldman :  Right.  Dr. Lucan, what…, what is an ideal food environment?  Does it even exist in western society or is it just a matter of bad, worst, and terrible?  Are…, are there any communities or neighborhoods or areas that we can look at as…, as models for having the ideal environment? 

Dr. Sean Lucan :  So, I…, I think as Ms. Heller suggested, you know, an ideal food environment is one that puts real food in front of people, real whole food and makes it available, accessible, affordable, and makes it so that it becomes the default choice and something that people choose to eat over, you know, food that’s…, that’s not conducive to good health and unfortunately, in…, in    most of the…, most of the places where people live there is a lot of unhealthy food.  There is a lot of exposure to unhealthy food.  There is lot of exposure to unhealthy food marketing and, you know, those can be overwhelming for us as for many people, but, you know, the…, the context of the food environment has to be considered in the context of the individual and…, and the individual resources, so one environment might not be the same for two different people.     So, you know, access to healthy food depends a lot on people’s financial means, people’s access to transportation, people’s, you know, educational level and understanding and…, and where to get healthy foods, both understanding about cooking and food traditions and if they know what to do with whole food.  So, its a complicated matter.     I…, I don’t know that, you know, are…, are there communities that do it better?  I would say, you know, rural communities, more agrarian communities, communities that are, you know, more based on farming and cooking and kind of, you know, old traditional food ways, kind of have it more right than…, than…, than for these modern…, modern food environments that are, you know, largely as noted, you know, kind of very much pre-packaged, processed, less healthy food items.

Matt Goldman :  Umm…  And, doctor, how would…, how would you say, sort of building on what you just said, how would you say that the modern day food environment differs from previous decades or even centuries?  How has it changed over time? 

Dr. Sean Lucan :  Oh!  I think increasingly its become more artificial, more…, more refined, more processed, more pre-packaged, more convenience items, more fast food.  You know, we used to be an agrarian society and grow our food and there was a lot more knowledge about, you know, how to grow food and how to prepare food and cook food and share food that we made ourselves    and, you know, eating…, eating food that…, that came from whole food sources as opposed to industrial processing plants and I think that…, that really shook it a lot, you know, not even over the course of centuries but even over the course of decades, you know, its a profoundly different food environment today than it was, you know, even just years ago.

Matt Goldman :  Uhmm…  And…, and, Ms. Heller, you…, you touched on this already, but could you…, could you go into it little bit…, in little more detail in terms of what are some of the things that you recommend people do that so they set themselves up for success? 

Samantha Heller :  You know, as Dr. Lucan pointed out, its very individual with some people live in cities, some people live in areas where they don’t even have a grocery store nearby, some people have a lot of money and can have food delivered to their house or hop in their car and go to the grocery store.  So, what we need to do is we need to find out what…, what works best for our individual environment.  What…, what works best for you in the healthiest way possible?     If you live in the city and you don’t have a grocery store nearby, you can still possibly, you know, maybe plan ahead.  Planning is key.  Its key in being able to schedule out, carve out the time to get to the store, to lay aside the money you need to buy the food you want to, to be able to review the coupons you have, what’s on sale,    what’s available, what you can afford, you know, cans of beans, frozen foods, puffed rice, these are things that are pretty affordable and pretty healthy, even if you are in an urban, you know, environment where things are not as available as one might like, but to stop and think about what you want to do with your life.    I think people feel so overwhelmed with the amount of information that’s being thrown at them from every angle, the internet and television and newspapers and magazines, but they don’t really know who to listen to and…, and…, and what’s true and what’s not and I know…, I know I experienced this, Dr. Lucan, and I am sure you do.  Patients coming to us with all kinds of crazy information and ideas that they are hearing, that are expensive, that they think they have to do to be healthy and    really if we can just get people back to basics, back to really almost simple eating to start, maybe cooking at home a little more often because as our environment has changed even in recent decades, as Dr. Lucan mentioned, I have patients whether they are in the country or certainly New York City who just…, they don’t even want to boil water.  They don’t want to even have to cook at all,    so how can we accommodate those needs.  If they really don’t want to cook, how do we instruct them, educate them on what you can do to get healthy food if you are not going to be cooking or not going to want to cook a lot.  On the other hand, I would love to encourage people to cook more at home and…, and maybe if we tried that a little bit more often, occasionally, would realize its not quite as difficult as or time consuming as we think it is. 

Matt Goldman :  Right.  Its not as daunting as people think. 

Samantha Heller :  You know, honestly, I lived in New York City for a lot of years and when I moved out of the city a few years ago, I…, I basically had to learn how to cook.  I didn’t cook in New York City.  People use their stoves to store their sweaters.  I mean people…, the kitchens…  Most of the kitchens aren’t even usable for cooking.  So, when I moved to the country and I had to start cooking,    there is certainly a learning curve, but I actually almost never go out to eat now.  I really like cooking and…, and I really…, I can get home from a long day of work and whip together a pretty decent meal in…, in about 45 minutes and I think if you…, if you…, if you can kind of stock your pantry with those healthy, non-perishable things that you can throw together relatively quickly, its great for you and the family and in the long run, you save money. 

Matt Goldman :   Right.  Yeah, and I…, I think your statement about planning ahead makes…, makes good sense.  It just seems like we are all sort of programmed to go, go, go and everything needs to be instantaneous and so it seems like even with eating, you know, we just want to be able to eat right away and so planning ahead and have your pantry stocked and refrigerator stocked.   Its probably a good idea.  Dr. Lucan, what…, what correlations have we…, have you found in your research between our food environment and chronic disease or just disease in…, in general?  Are there populations that are most affected by a toxic food environment?  

Dr. Sean Lucan :  Oh, certainly.  My research is based out of Bronx, so, you know, I am a family doctor at a federally qualified healthcare center right in the city and so I take care of a population that’s predominantly low income and underserved and, you know, its that population kind of urban, low income minority that I think are just proportionately disadvantaged    by the negative aspects of the environment, so its generally in those types of communities that you see, you know, the greatest preponderance of sources of unhealthy foods, of fast food and convenience stores and, you know, outlets selling predominantly, you know, pre-processed and packaged industrial items and less in the way of whole fresh foods and…, and…, and sources of whole fresh food and, you know,     as Ms. Heller said, you know, there is a lot to be said about planning ahead and stocking your pantry and, you know, having healthy foods available, but, you know, a lot of my patients, as well meaning, as well intended as they are, you know, just are not in an environment where that is very conducive or very feasible or…, or even possible in some cases or takes an,   you know, an inordinate amount of planning and resources and, you know…, you know, just kind of more effort than a reasonable person is able to put in to access a lot of healthy items. Now, I mean, certainly there are…, there are ways around it, but…, but when you are up against, you know, an environmental context working against your best efforts to keep you and your family healthy, it…,    it can be very challenging and so, we know that, you know, communities like the ones in which I practice, kind of have a disproportionate amount of unhealthy food availability, a disproportionate amount of unhealthy food marketing.  You know, even within the community, I did…, I have done some studies, you know, just looking at food advertising in subway stations and, you know, the stations that are located in the,    you know, kind of the low-income, low-education, high-immigrant population that, you know, have the most amount of unhealthy food advertising and these are the communities where there is, you know, the most unhealthy food available too.  So…, so, those are the…, those are the populations that I think feel it the most and…,   and they are also the populations with kind of the worst health outcomes, with the worst diet-related disease rates, the worst rates of obesity, the…, the worst rates of, you know, issues directly related to food that…, that would benefit most from a change in that kind of environment. 

Matt Goldman :  Umm….  And…, and, Ms. Heller, continued on that topic, what are your thoughts about income influences on our decisions to eat or not eat well and…, and do you feel like that’s…, that its largely a low-income issue in terms of having access to good food? 

Samantha Heller :  Well, having access, I think, has a lot to do with…, with income and socioeconomic status and…, and studies are indicating that.  There was a recent study in the British Medical Journal, founding that, you know, increasing age, being male, living below the poverty threshold were, you know, big factors in eating a high-calorie, less-healthy diet and,    you know, people who had more economic resources ate a greater variety of food and, you know, had those options available to them, so certainly it makes a really big difference in terms of what you have available and…, and what you know and what you understand and…, and how you are targeted by the food companies, which Dr. Lucan alluded to as well     There are resources out there for people.  It…, Its hard to navigate the system when you are in a city, so that’s…, that’s difficult as well and we are really trying to encourage people to make healthier choices and…, and have those foods available at.., at all income levels.  I think, you know, I think its a bit of a mess that healthier foods are more expensive, as I mentioned before.  You can buy dried beans.    You can buy, you know, big bags of brown or even white rice.  You can buy, you know, large cans of soup and you can go to the box stores and get, you know, a lot of food for a decent price, but one of the…, one of the drawbacks to that is what I see when people go to some place like BJ’s or Costco’s or Sam’s Club, if they all look and say, “Wow!  Look, there are three cases of soda for a dollar 99.”    So, then in…, in some ways, they are more apt to buy less healthy foods because they…, they think they are getting a better deal.  So, you want to be able to afford it, but sometimes you are tempted by…, by things that are conceivably a better deal, but…, but really aren’t a better deal for your health.

Matt Goldman :   Right.  Right.  And, doctor, do you think that the…, the government should step in…, in and regulate the food environment any more than it already is and are there even places that we could look at that are taking some initiatives to…, to put regulations in place? 

Dr. Sean Lucan :  Well, certainly, New York City has been very progressive in terms of…, of regulation and policy and…, and, you know, policy solutions are certainly one tool in the toolbox, but, you know, as with, you know, any well-intentioned intervention, there is…, there are almost inevitably unintended consequences.     So, you know, we have to be really careful and thoughtful in thinking about how to regulate or how to legislate to make things healthier.  There have been, you know, attempts to, you know, address issues as diverse as zoning for fast food.  There was a study recently that I believe was from LA, that showed that a fast food zoning ordinance to try to limit the amount of fast food in neighborhoods didn’t really result much in the way of having a beneficial effect on dietary outcomes or…, or downstream health and that wasn’t very surprising.    There are other targets of legislation, things like, you know, trans-fat bands and sodium bands and I think some of the political attention to single nutrients can be misguided and I think single nutrient focus, in general, can kind of steer us in the wrong direction, I think, you know, really we want to be focused more on whole foods and broader dietary pattern    and I think, you know, a place where probably we could see good changes is, you know, driving demand.  So, rather than, you know, relying on the government to regulate or relying on policy makers to legislate, you know, excuse me…, trying to increase demand for healthy food and using some market dynamics to try to improve the situation.    So, you know, there is…, there are some advocates out there who would suggest to people that they should go with their forks or go with their wallets and, you know, choose to push industry to provide what people want and if people want healthy food, the industry will provide it and so, you know, there’s probably a combination of approaches that could be beneficial,    but I think in terms of government regulation, one has to be really thoughtful about policies that are put into place so that we don’t do more harm than good in…, in trying to implement those measures. 

Matt Goldman :   Uhmm…  Okay.  Once found only in health food stores, organic food is now a regular feature at most supermarkets and I…, I think that’s created a bit of a dilemma in the…, in the produce aisle, I know even in my household its a real dilemma.  You know, on one hand, you have conventionally grown fruit and vegetables; on the other hand, you have fruits and vegetables that are organic.     Apples, for example, you know, both are firm, shiny, red.  Both provide vitamins and fiber and…, and both are free of fat, sodium, cholesterol, you know, the so-called unhealthy stuff, so I guess the question becomes which one do we choose.  I have here the definition or organic food as it is mentioned in the USDA website.      It says that organic is generally free of synthetic substances, contains no antibiotics and hormones, has not been irradiated or fertilized with sewage sludge, was raised without the use of most conventional pesticides and contains no genetically modified ingredients.  So, building on that, doctor, what exactly constitutes organic food and what…, is there a difference between natural food and organic food? 

Dr. Sean Lucan :  Regarding organic food, I mean I think you just gave the USDA definition and organic is a regulated term that now has meaning through that definition so that…, that.., that, you know, those criteria basically describe what organic food means or at least what it means today.  I mean it used to just be that organic food is what your, you know, grandmother would have just referred to as food    and (laughter) this is all conventional today is, you know, would have been unheard of.  So, you know, its…, its kind of…, its kind of a big turnaround too.  It is actually that…, that the.., you know, the food that’s…, that’s considered conventional, the thing that’s considered kind of the…, the…, the, you know, the predominant model is the one that’s the least like what had been done historically, the one that…, the one that least resembles how our ancestors would have farmed and would have produced food,    but then its unnatural, that’s.., that’s a meaningless term.  That is something that industry uses and advertisers and marketers use basically just to confuse consumers or make them think that food is…, is healthy or desirable or has certain benefits for them or the environment, but it is…, its a completely meaningless term.  So…, so, organic is a regulated term that has the definition that you said or natural is a term that…, that basically has no meaning.  Basically… 

Samantha Heller :  Yeah, when my patients ask me about natural, I say, you know, dog poop and arsenic are natural, but it doesn’t mean you want to eat them. 

(Laughter)

Dr. Sean Lucan :  Agreed. 

Samantha Heller :  You know how it goes, yeah. 

(Laughter)

Matt Goldman :   Yeah and…, and, Ms. Heller, do you…, in that definition and what we just talked about, you know, we are talking about organic and…, and the doctor touched on it little bit a couple questions ago, how does…  You have organic, but how does nutrition fall into that?  Should nutrition be part of the discussion, sort of separately or specifically? 

Samantha Heller :  Well, you know, we…  There are studies that have looked at the nutritional content of organically grown fruits and vegetables or grains and compared with conventionally grown and some studies found that there was a difference, some studies found that there weren’t.  Overall, I think both are healthy in terms of their nutrient content, but…, but organic has…,   its really all about production methods and no antibiotics and hormones, pesticides, herbicides, fertilizers.  Its about the environment.  Its about animal welfare.  Its about the whole picture.  Its not just about whether your orange that’s organically grown has 5 more milligrams of vitamin C than the orange that was conventionally grown.    So, I think we need to look at the big picture.  While there may be some better value in terms of organically grown fruits and vegetables, maybe a little bit of a nutrient here or there, and again, the studies are conflicting and sometimes it depends on who is funding the study, what your results are.    Its the whole picture and…, and what we are finding in…, in the broad spectrum is when we are using pesticides and insecticides, we have…, or having bee colonies collapse, that’s going to affect the entire world and…, and we are so self-involved that we don’t pick up and…,   and lift up our eyes to look at the world and say, “My gosh, what I am doing in my little backyard can actually affect something thousands and thousands of miles away.”  The song birds in the state where I live in, Connecticut, the population is declining because they are eating insects that have been, you know, contaminated with pesticides and insecticides. 

Samantha Heller :  So, organic farming in the long run is better for the environment.  Its better for the planet.  Its better for animals that are raised for consumption or for their…, for the products that they produce.  So, we want to look at the whole picture.    So, its better for everybody and its certainly better not to, you know, I don’t want to have those pesticides and insecticides in my body and in the bodies of children or even my animals.  So, we want to do the best we can and if we can support organic agriculture or local organic farmers, that’s great.  We can’t always do that.    We can’t always afford to do that, so I don’t want people to think that just because they can’t afford an organic apple or organic bunch of broccoli that they shouldn’t eat it, they absolutely should eat it because they are still really healthy for us, but when you can afford to go organic in certain things, I think that…, that’s a great thing to do. 

Matt Goldman :  Uhmm…  And, Ms. Heller, how is…, how is certified organic food different than organic food, you know, if we are out shopping and we see that something certified versus something that just says organic.  What’s the difference there? 

Samantha Heller :  I don’t think they can say organic unless they are certified organic.  The USDA has a certification process that…, that distributors or farmers have to go through.  They have to be inspected.  They have to meet a whole number of criteria.    They have to pay to get that certification.  So, when you say that something is organic or…  Dr. Lucan, correct me if I am wrong.  I think…  I think it has to be certified organic if it says organic in the grocery store.  Is that true? 

Dr. Sean Lucan :  I believe that’s correct.  Yes. 

Samantha Heller :  Yeah.  So, but what that doesn’t mean is if you know…, if you have farmers who live nearby and they are growing foods organically and they say its organic, but they can’t afford to or haven’t gone through the process of being certified by the USDA, it doesn’t mean their food is not organic.    You know, when you are going to the farm stand or the farmers’ market, so one of the reasons we like to support our local farmers and go to farmers’ markets or the farms themselves, if you happen to have those available in your community, if you can actually talk to the farmers and find out what they are doing. 

Dr. Sean Lucan :  Uhmm….  Yeah and I would just add, I agree completely with that point.  I mean, knowing your farmer can mean a lot because as Ms. Heller suggested, I mean a lot of these farmers might have the…, might not have the means to certify as organic when they might be using, you know, methods in agriculture and food production that actually exceed or that are actually superior to the criteria needed to establish that bare minimal   and just because…, I should mention just because the food is organic, you know, does not necessarily mean that its…

Samantha Heller :  Healthy. 

Dr. Sean Lucan :  Yeah, doesn’t necessarily mean its healthy, certainly, but even, you know, to the point earlier about, you know, kind of sustainability issues in the environment and, you know, our impact on the planet and environmental concerns, which are all, you know, vitally important and critical,   you know, if you take like organic eggs for instance, so you can have chickens that are raised organically and are given nothing but vegetarian feed and raised in organic settings by organic means, but, you know, they would be raised in conditions that many people and many, you know, animal rights groups and many who are concerned about the environment and animal welfare would just be horrified by…

Samantha Heller :  Right, right. 

Dr. Sean Lucan :  So, I mean…, you know, even…, even…, you know, designations such as cage free, though that just means the chickens are without a cage, but, you know, it doesn’t mean that they are not, you know, housed in these, you know, giant sheds with overcrowding and little access……to the outdoors or the sun and they can be raised in really kind of unhealthy conditions that are unhealthy for both the planet and the environment and you, the consumer,    but still meet the strict definition of organic and, you know, kind of get a whole halo placed over that product.  So, you know, organic is as far, I mean its a good sort of simple, you know, one-word dichotomy that consumers can look for in the store, but its not an absolute guarantee of, you know, the…, the highest standard in, you know,    sustainability or farm integrity or food production.  So, there’s…, there’s more that goes into it.  The more you can know about your food, the more you can know your farmer, the more you can buy locally, the more you can know the source, the better for everybody. 

Matt Goldman :   Right.  And I guess this follows for…, for both of you.  Given that, where…, where can the consumer find out information about how chickens are raised or about how animals are raised?  Are there websites?  Are there private organizations?  You know, it seems like its…, you would have to do lot of research to figure some of these things out. 

Dr. Sean Lucan :  So, there is a very strong interest by the food industry to keep you in the dark.  So, if people knew how most of their conventional or industrial food was produced, then I think they would be horrified and…, and, you know, discussed it actually and so there…, there is a very strong incentive to keep consumers from knowing the processes that bring food to the table.    So, its hard, especially when your food is produced by these, you know, giant multinational, you know, conglomerates.  So, I think, you know, getting back to Ms. Heller’s point about, you know, know your farm…, know your farmer.  By vocally, I mean if you can shake the hand of the person that, you know, produced your food and talked to them, I mean you can, you know, you can learn everything there is to know about how…, how the food is produced and, you know, you may even be able to see the farm.    You know.  In industrial…, in most industrial agricultural practices, you know, there…., there is…, there is discreet secrecy and I think, you know, resistance to the consumers knowing anything or seeing anything.  I think, you know, if you tried to walk on through a farm, you know, you might be escorted off by armed guards, whereas, you know, a local farmer, you know,    might invite you on to the farm and want you to see how their product is produced and want you to see the kind of, you know, high integrity methods that they use to…, to produce your food, which is, you know, again just harkening back to, you know…, you know, yesteryear and comments I made before.  I mean that’s what food was.  I mean, now we have to think more about our food and the food production because its been    so adulterated and so, you know, for lack of a better word, contaminated by these…, these…, these powerful influences, whereas in the past healthy food used to just be food and now its, you know, there’s a lot of really unseemly practices that go into what…, what brings your food to the table. 

Matt Goldman :   Uhmm…  So, again consumers really need to let…, make their voice be heard by how…, where and how they spend their money, but that’s the way to start making some bigger changes, it sounds like. 

Samantha Heller :  Yeah.  I mean Marion Nestle and I think, Dr. Lucan, you…, you kind of referred to her.  She has a book out, called, oh gosh, Its Eat With Your…, Vote With Your Fork and Vote With Your Vote….and she talks a lot about, you know, companies take notice when foods…, when they make money.  That’s…, that’s their bottom line if they want to make money and they don’t really care how they are necessarily treating the animals    and, you know, how the food is produced and…, and they don’t want you to know about it.  Michael Moss wrote a book called “Sugar Salt Fat” or “Fat Salt Sugar,” where he talks a lot about the…, the secrecy of the industry.  I am supporting basically what Dr. Lucan had just said.  So, you know, if its a big company, you can always call the company.    There…, there are smaller companies coming out where you can’t necessarily go to their headquarters and…, and…, and walk, you know, walk into their facility and see what they are doing, but the smaller companies tend to call you back.  You would actually get a human on the human who seems to be able to answer your questions.    So, that…, that may be a good thing that consumers can do is pick up the phone and call, say, I am…, I actually did this with a…, with a…, with a vegan margarine and they were using palm oil and I…, and I emailed and they emailed me back, so I said I am concerned about Malaysia, they are using child labor, they are destroying the forest.  They are destroying habitats, the orangutans, and they…, and they…, they emailed me back and said,     we are using sustainable practices.  We are trying to use more organic and kind of laid out what they were doing to…, to not do what cannot work in a way that I was concerned about, so I was pleased that they actually responded.     I…, I would like to assume they were telling me the truth.  I can’t say for sure that they were, but sometimes reaching out in the consumer voice, you know, sometimes these companies listen and we feel like we are screaming into the wind, certainly politically I do, but if you can call the smaller companies, I…, I do think they…, they listen to the consumers.     So, its good to be active and…, and…, and be proactive in what’s happening in your grocery stores and talk to your grocery store managers.  If you don’t have farms nearby, if…, if you don’t have local farmers, if you live in the middle of a big city and you can’t get out of the city, talk to your local store managers and…, and ask them where you are getting your food and do you think you can more local and…, and see what they can tell you about what they are bringing in to their stores for their neighborhoods. 

Dr. Sean Lucan :  It is true and just to piggyback on that point, I think, you know, some stores now even have rating systems or…, or these scales that, you know, talk about certain foods in…, in terms of their, you know, sustainability or the production methods or what went into raising them and so, you know, that can be a tool for consumers.    Another thing is, there are independent groups like the Environmental Working Group that have food score systems, that look not only at nutrients but also at the number of processed ingredients and the types of ingredients and production methods and…, and rate…, rate different products on that scale, but I would say the general rule, the more…, the more  health claims a product is making, the more its trying to advertise, the more, you know, kind of, you know, yellow and, you know, big font type on the front of the package, trying to get you to buy it, probably the more you should try to stay away.  

(Laughter)

Samantha Heller :  And…, and…, and its also…, again I think, Dr. Lucan and I really are on the same…, on the same page here is, it…, it also supports us to trying to buy more whole foods and less packaged foods.  Its not that you are not going to buy packaged foods.  I bought…  I bought a bag of…, of    organic corn tortilla chips today for a party I am going to be having and that’s a processed food, but…, but buy less processed foods.  Make more foods at home.  You know, instead of buying a…, a box of rice that has a flavor packet in it, buy some brown rice and add your own spices and herbs to it instead.  You know, make your own bread.  You can buy a bread maker and make bread at home that costs you a lot less    than it would than the loaves of bread in the stores over time and doesn’t have all of the fillers and…, and all of the chemicals in it.  So, there are ways you can actually do that and…, and save money, but it does take a little bit of thought and there’s a bit of a learning curve…..and if you are willing to do that, its certainly worth it. 

Dr. Sean Lucan :  Yeah, I agree. 

Matt Goldman :   Does it…, does it seem like consumers that were having a little bit of a shift and consumers are…, are getting smarter and making better decisions and starting to…, to vote with their wallet? 

Samantha Heller :  Dr. Lucan, I would ask you because you are up in the Bronx and you are working with a very specific population.  Do you feel like your patients when they come in are.., are…, are making better decisions or understanding a little more about what’s happening? 

Dr. Sean Lucan :  I…, I think it varies.  I think it varies very much by community.  So, I work in the……Bronx, but I live in…, you know, in an affluent neighborhood of New Jersey.  I would say, you know, the parents at my son’s school, absolutely.  I mean, they are voting with their forks, voting with their wallets.  My patients in the Bronx, not really high on their agenda.    You know, they’ve got…, they’ve got bigger issues to worry about and more pressing things on, you know, the hierarchy of needs.  So, you know, I am happy if I can get them, you know, to eat a few more fruits and vegetables, kind of regardless of what form they came in or where they came from or, you know, how they were raised.  So, you know, baby steps in.., you know, knowing the…, the resources and limitations of the…, the people that you are working with. 

Samantha Heller :  Yeah.  Its…, its…  The thing is and Dr. Lucan and I would say, I am not speaking for you, but you have to meet the patient where they are or the person or the student.  I have people call in to my radio show and say, why…, why can’t you just tell everybody they have to eat more plant-based diets and this and that and I would say because if I have a patient who comes to me and all they eat is processed food and they eat at the diner, they eat breakfast at the diner every morning and they go to    McDonald’s or Burger King or Popeyes for lunch every day and then at night they have a frozen meal, you know, I will be lucky if I can get them maybe to have oatmeal in the morning instead of the…, you know, bacon-egg-cheese-sausage thing. So, you…, you need to meet people where they are and…, and, you know, baby steps is a good word, a step by step, just…,    just maybe not buying soda, maybe… maybe trying some salts or some water instead.  Some…, you know, the…  Making these behavior changes is very complicated and people’s relationships with foods are based in a lot of emotional and psychological relationships as well as financial and…, and environmental  and…, and as research is suggesting and some books are suggesting, you know, the foods are actually formulated by food scientists and psychologists to make…, to make people crave those foods, even more those processed and less healthy foods.  So, its…, its even harder to get people to make that sort of shift in their taste and their preferences.  

Matt Goldman :   Uhmm….  And.., and what about schools…, schools in terms of both the…, the toxic food environment that…, that students are experiencing but also as a way to educate kids as well?  How…, how are we doing there? 

Dr. Sean Lucan :  Its an interesting question.  I…, I…, I actually just had a piece come out in the Huffington Post last week regarding school and school education.  Jamie Oliver is kind of a celebrity chef who had this whole food resolution day campaign to try to, you know, bring food education back into the curriculum and, you know, bring some of those lessons that we talked about earlier about, you know,    food growing and food procurement and food cooking and food sharing and I think most of the focus on food in schools has been around the lunchroom, but the point of the…, you know, the piece that I put in the Huffington Post was that, you know, the food exposures at school extend far beyond the lunchroom and include, you know, class parties for, you know, birthdays and holidays    and other celebrations that include, you know, bake sales and fund-raisers, that include vending machines, that include, you know, treats that teachers bring in to reward students, that include, you know, after-school programs and sporting events and in all of these venues, it seems like the predominant food source are again these…, these highly processed pre-packaged industrial item with less focus on, you know, whole, fresh,    you know, sustainably produced real food like actual supplements…..and I think that works very much to the disadvantage of our kids, you know, not just in terms of reinforcing, you know, unhealthy habits and behaviors in taste and preferences which can last, you know, with them throughout…, throughout their years and.., and, you know, into adulthood,    but also just in terms of immediate consequences, in terms of, you know, physical and mental performance and, you know, risk for chronic disease.  So, I…, I think its a big issue and I think its something that needs to be addressed and I think its something that, you know, parents have to play a bigger role and the physicians and, you know, nutritionists and dietitians should be a part of that conversation    and its.., its something that we should really focus on as something that’s not separate from the rest of the curriculum but integral to the…, the other curriculum so that…, that kids can be successful.  I think schools should be in the business of building healthy kids and I think we haven’t done a great job with that. 

Samantha Heller :  I…  I love that its part of the conversation now, though. I love that, you know, Jamie Oliver at least got on television to talk about it.  I love that they showed the pushback he got from the lunch ladies.  I love that…, that we are having the conversation now because its a big deal, but last fall I was asked to review a local after-school program snacks for kids.  I think they were 5 and 6 years olds and they sent me the menu    and what they give these kids after school and it was grape soda, Rice Krispie Treats, Skittles, brownies, chips and I was…, I was…  I shouldn’t have been surprised, but I…, I was surprised and so hugely disappointed and I wrote back and I emailed them back and I said, “Can’t you have yogurt for them?  Can’t you have some fresh fruit?  Can’t you just have some sunflower seeds if you can’t have nuts in the room?  I mean,    do you have to have Rice Krispie Treats?”  And again, as Dr. Lucan had suggested, it affects their performance.  Its affects their weight.  It affects their mood.  It affects their energy.  So, I was not, you know, disappointed.  Its a lower income area,    very blue collar where…, where they don’t have a lot of access to financial support, but I said, “Still you could…, you could…, the money you are spending on the grape soda and the rice crispy treats, you could certainly buy some yogurt,” and I am…, I am hoping they made some of those changes. 

Matt Goldman :   When you do ask that question, Ms. Heller, what…, what answers do you get or how much pushback do you get? 

Samantha Heller :  Well, I didn’t…  They…  I didn’t get much of an answer.  They…, they just…  Really, they just needed a dietitian’s signature on…, on a piece of paper for…, for some state to, you know, to meet some state requirement, but I did write back and they said, “Well, you know, we’ll talk to the people we are getting the food from and see if we can make some of these changes,” but I…, I don’t know if they made them or not.  I hope they did.

Dr. Sean Lucan :  Uhmm…  I can…, I can say as a parent, you know, my…, my son attends a private school and I know, you know, parents at other private schools have had similar conversations and I am, you know, been…, you know, been in discussion with teachers and administrators at my son’s school and, you know, its an issue that’s important to me and I think, you know, important for the school in general    and I…, I think there’s been a lot of receptiveness, but its not a public school and so, I think the conversation is different when you are talking about an…, an entire school system rather than a…, you know, a single…institution and so, you know, I…, I also was glad that this…, this issue got some press and that’s its on the table and that people are thinking about it and hopefully, you know,    would bring more attention to it because I think its…, its vitally important.  I…, I don’t think that the healthy lessons that we try to teach at home should be undermined when, you know, kids leave school…, leave home and go to school where…, where a lot of these unhealthy foods are not only endorsed but often celebrated.     You know they are often given in the context of these, you know, parties or special events.  There are other things, so its not just that the…, the healthy food is made available, but its…, its…, its…, its something that’s…, that’s special and, you know, kind of sets kids up on healthy habits, behaviors, and tastes and preferences for the rest of their life. 

Matt Goldman :  Uhmm…  And… and…, and let me ask you this, doctor.  Do you see kids getting diseases that…, that in the past maybe kids didn’t get…..that they are starting to…, to get things that they didn’t used to get, if you will? 

Dr. Sean Lucan :  Well, you know, so I have only been a physician for, you know, just over 10 years.  So, in my practice, I mean…, so, I don’t know that I have seen a change, but I certainly see diseases today that physicians years ago did not.    So, you know, diabetes is the classic example.  We see, you know, what used to be called adult-onset diabetes now in children and that’s a consequence of obesity, that’s highly correlated with, you know, increased adiposity or increased body fat.    You know, we also see, you know…, you know, diseases or…, or risk factors like…, like hypertension and, you know, vascular diseases which were unheard of, you know, years ago.  Its just something you would not see in…, in…, in pediatric patients or in…, or in youth    and now, you know, its not even…, you know, and it would have been like a rare event.  It would have been a case report, but now its, you know, become…, it becomes less of the…, the unfamiliar event.  It becomes something more the norm.  Its some…, something that’s less outside the scope of what you might encounter in general practice and I am, you know, I am a family physician.  I am not a specialty cardiologist, but I have kids with, you know, hypertension.  I have kids with diabetes.  So, you know… 

Samantha Heller :  Its heartbreaking. 

Dr. Sean Lucan : Yeah, it really is.  It really is. And because its so avoidable. 

Samantha Heller :  Its avoidable. 

Dr. Sean Lucan :  When you…, when you see trends, it means something must be going on. 

Matt Goldman :   Ms. Heller, you…, you recently published a book about how to detox by the food environment that we live in.  Can you…, can you tell us a little bit about your book and maybe…, and I know you have given some already but some throw-ups and tips for folks for staying healthy and maybe keeping their immune system up? 

Samantha Heller :  Oh, sure.  Its called The Only Cleanse and really the only cleanse you need is the one you were born with.  Your body is detoxing and cleansing itself 24/7 and that’s how we stay alive and the mission of our…, our body is to keep us alive.    So, what we want to do and what we …, what we should do, since we…, since we have these amazing phenomenal bodies that we inhabit, its just a part of the body’s natural ability to keep us healthy.  So, our livers and our kidneys and our lungs and our mouths and our skin are, you know, are keeping us healthy all the time.    So, the book is about what we can eat and how to live to help support our body’s overall health.  Its about eating healthy food.  Its about managing mental and psychological stress.  Its…, its about…     Again and then I actually talk about changing your food environment, you know, literally rearranging your kitchen and your refrigerator, you know, moving your food from one cabinet to another because when you want to change habits, a new environment can be really helpful that way.    I go into some of the history of detoxes and cleanses and I deconstruct a lot of the crazy notions on, you know…, you know, enemas and fasting and juicing and all kinds of things that…., that people have been doing literally for centuries and…, and talk about really what’s down to earth, practical, and sensible, which is, you know, eating really a healthy, more plant-based diet.    I do have a 14-day plan to help people stop eating all the processed food, stop eating, you know, all of the sweets, all of the soda, even alcohol, just for those 14 days so that they can kind of reset their mouth expectations and how food will taste and…, and really enjoy the taste of real whole food and its got recipes that are relatively easy and…, and doable.    Its all evidence based, probably almost 300 references in the scientific and medical literature.  So, the only cleanse you need is…, is the one you already have.  Its sort of like Dorothy and the Wizard of Oz.  She always had the power to go home, she just didn’t know it.  So, we don’t need to do anything special to cleanse our bodies except to support our body’s natural ability to do that. 

Matt Goldman :  Are 14 days enough for…, to…, to get your body to not have certain cravings and to…, to change what you are used to and what tastes good and what doesn’t taste good? 

Samantha Heller :  Oh, you know, it takes about three to four weeks to create a habit and about three to four weeks to break a habit, but there is research to suggest that in 14 days you can actually start to feel better, start to have more energy, and…, and feel the differences of…, of a change in not only diet but lifestyle where you are managing stress, you are getting some exercise,    you are being well hydrated, you are eating healthy foods, and the research suggests that really in 14 days you will start to feel positive effects of this kind of a lifestyle change.  Now, it…, it does take a while to have it become part of your life and…, and…, and I do have a plan called the after cleanse, which…, and I know cleanse and natural detox are buzz words, but, you know, my publisher thought that that would sell the book……but the after cleanse,    to be honest, is really just say okay, so now that you have done this, you know, if you want to, its a vegan program with the exception of yogurt and honey just for those 14 days because I have a lot of people say, “I don’t know how to…, what do you mean, I can’t be a vegetarian, eww!  I don’t want to just eat sprouts,” and I am like, you know, these are… you are eating healthy fabulous food, there is puffed and beans and vegetables    and rice and tofu and all kinds of delicious recipes and foods and its just sort of to…, to hold your hand, to take you in a step by step process, so you can learn that these foods really do taste good and really don’t take that much time to make and afterwards if maybe you can manage to stick with, you know, meatless meals a few days a week like the Meatless Monday campaign that started down in John Hopkins, down in Baltimore.    That’s a great thing if you can remember to manage your stress and take some deep breaths during the day and drop your shoulders and relax your forehead and your jaw. If you can manage to look at your day and try to be grateful, you know, a few times a day and look at…., and look at the positive things that are happening in your day so we can come back from the negativity that we are confronted with on a daily basis.  That can help your body, your health, your mind.  So, there’s lots of pieces to…, to the puzzle that we can continue to do.

Matt Goldman :   Uhmm….  And, we are running really close to the end of…, end of time here, but just real quickly, doctor, when you…, when you talk to your patients, do you talk to them about what…, what Ms. Heller was talking about, sort of approaching…, being healthy holistically, you know, that its not just food, but there are other things that we need to do? 

Dr. Sean Lucan :  Yeah, absolutely and…, and, in fact, you know, the…, the…, the marketing terms that I get the editors in terms of detox and natural and cleanse, you know, I…, I think would be useful in selling the book and, you know, those are the kind of terms that, you know, I reacted to it, you know, kind of bristling. 

Samantha Heller :  Right.  I do too.  I bristle at those terms as well. 

Dr. Sean Lucan :  Yeah.  So…, so, you know, I was…  Its really, I mean, refreshing to hear you talk about it.  I think, as you said before, I think we are, you know, globally on the same page and I was, you know, when I, you know, saw the title of the book, I thought, “Oh, this is…, this is going to be one of these conversations where there is some tension here, but I…,    I think we are…, we are absolutely speaking the same language and I absolutely talk to my patients about that.  I mean, you know, its not about single foods.  Its not even about, you know, die in isolation.  I mean, its…, its all about lifestyle, right?  So, its about the whole package, right, about how, you know, its…, its about stress reduction, its about getting enough exercise, about avoiding toxic substances, particularly tobacco.    And its about making, you know, healthy dietary decisions and those things alone, you know, just those simple things that we can do have an enormous effect on our longevity and our quality of life, you know, for stalling chronic disease or…, or preventing chronic disease in the first place.    I just had a paper come out recently and American family physician might talk about dietary myths and healthy nutritional advice or clinical providers and we talk about just that idea, that its about, you know, overall dietary pattern and about, you know, reinforcing the idea of whole foods and…,    and going beyond that, you know, not just whole foods but whole meals and, you know, sharing a meal with family, enjoying cooking, you know, with friends and…, and…, and…, and, you know, really enjoying some of the…, the social aspects of eating and not just, you know, focusing on the…, on the…, the nutritive aspects. 

Matt Goldman :   Right.  Awesome!  Well, I want to thank you both for a…, for this fantastic discussion.  I think we could go on and on for quite a while, but I…, I need to turn it back over to Priya and she may have a couple more questions for you if we have time, but again, I really want to thank you both for your time and with that, I…

Samantha Heller :  Thank you. 

Dr. Sean Lucan :  Thanks, Matt. 

Matt Goldman :  Yeah.  I will give it back to Priya. 

Priya Menon : [start=57:20,57:45,Priya Menon] – Thank you, Matt, and that was a wonderful discussion, Dr. Lucan and Samantha Heller.  We have quite a few questions, but I think we are running short of time, so I will just quickly go over maybe a couple of them.  Dr. Heller…, I mean, Samantha Heller, this one is for you.  What are the super foods for the heart that you recommended?

Samantha Heller :  The super foods for the heart…  We love super foods.  I am sure, Dr. Lucan…  What is the one food I can eat that will make my heart healthy?  Well, I can tell you the more plants you eat, the better it is for your heart.  So, if you can make half of your plate vegetables, whether its broccoli or zucchini or tomatoes or peppers or egg plant or lettuce or mushrooms, that’s  going to help replace some of the foods that are bad for our heart or affect our heart badly, that are high in sodium like the processed foods.  We want to eat as little red and processed meat as possible.  You choose olive oil instead of butter, have nuts and seeds, you know, instead of…, instead of some of the other, you know, instead of cheese, for example.  So, the…, the plant foods are so fabulous for your heart.  Also, managing stress is a great way to keep your heart happy as well.  

Priya Menon :  Thank you, Ms. Heller.  Dr. Lucan, the next one is for you.  Do you think some of the forms of supplements are necessary even for a person eating a balanced diet? 

Dr. Sean Lucan :  I am sorry.  I missed that.  Do I think…  Can you repeat that?

Samantha Heller :  Supplements. 

Dr. Sean Lucan :  Do I think supplements are necessary? 

Priya Menon : Yeah.

Dr. Sean Lucan :  Well, so supplements is a…, is a little hard to tease apart.  I mean, certainly, I…, I think there has been a number of reports that have come out recently suggesting that supplements are probably not beneficial for preventing some of the chronic disease states that people are…, are concerned about, the things like cancer and cardiovascular disease,    probably not, but I don’t think there is clarity in the literature about, you know, people don’t necessarily take supplements to ward off disease.  Often times, people take supplements to…, to…, to just feel better, to have more energy, to feel more vital, and so I don’t… I don’t think there is a clear answer there.  Myself, I don’t…, I don’t take supplements.  I don’t prescribe supplements for patients.  If they want to take them, I try to counsel them towards good sources,    but I think that if you have a healthy balanced diet, you can get everything that you need, you know, from…, from…, from food and from the sun and from, you know, just a healthy lifestyle in general and I don’t think that you need to take pills on top of that.  That said, if people want to take pills or are taking pills, I can’t say that that’s necessarily a…, a bad thing.  Its an individual decision, I think. 

Priya Menon :  Thank you, doctor.  Ms. Heller, the next one is for you.  The issue of dieting is so prevalent in our society, our culture, and our media, from Paleo to Wheat Belly to a growing interest in vegetarianism.  Many people are either on a diet, off a diet, or thinking about a diet.  What is the healthiest choice? 

Samantha Heller :  (Laughter)  I know, isn’t it crazy?  So many people are dieting and, you know, the word “diet” I think just makes you want to go out and eat ice cream.  Just thinking about it freaks people out and…, and I don’t blame them.  So, I…, I don’t like the word “diet” in terms of, you know, going on a specific diet.  I mean, I do have a plan in my book.  Its to help people.  Really, its not a diet, its…,    its just a shift in learning how to make healthier choices and to understand that the fads and the transit are happening are exactly that.  They are fads in transcend and…, and we want to focus on being healthy and not being skinny and…, and so depending on your reason for “going on a diet,” having your health is everything and any of us who have been sick or have friends who have been sick with…, with any kind of disease, all you want to just do is feel good and be healthy and being healthy    can be accomplished by making healthy lifestyle choices.  So, you want to do something you can keep for the rest of your life and isn’t just going to take three days where you starve yourself, you take some crazy supplement, or you do some crazy kind of diet and…, and seek the advice of really intelligent, well-educated, qualified professionals to help you, like registered dietitians or like your physician. 

Priya Menon :  Thank you, Ms. Heller.  We have almost come to the end of our time.  Dr. Lucan and Samantha Heller, thank you very much for being with us today. 

Samantha Heller :   Thank you for having us.

Priya Menon :  Matt, its always a pleasure.

Dr. Sean Lucan :  Yeah, thank you.

Priya Menon :  Matt, its always a pleasure to host with you, and the talk and the transcript will be made available on the Cure Talk website.  Please visit curetalk.com for details on our upcoming talks.  Thank you very much. 

Samantha Heller :  Thank you.

Matt Goldman :  Thanks, again.  Have a good one.

Dr. Sean Lucan :  Thank you.