Association of Diabetes Care and Education Specialists
Association of Diabetes Care and Education Specialists
August 04, 2017
3 min read

The real secret behind healthy eating: Feet, forks and fingers

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David L. Katz

INDIANAPOLIS — The “hottest” controversies in nutrition today, including questions about the health effects of saturated fat or claims that the harms of sugar have been hidden for years, are “all smoke, no fire,” according to a speaker at the American Association of Diabetes Educators annual meeting.

Speaking during a keynote address on obesity management and prevention, David L. Katz, MD, MPH, FACPM, FACP, founding director of Yale University’s Yale-Griffin Prevention Research Center, said today’s trendy claims about the “secret” health effects of certain foods are, usually, new spins on claims that have been around for decades.

“The truth about diet for diabetes prevention, diabetes management and overall health promotion is simple, clear and predicated on massive evidence and global consensus,” Katz told Endocrine Today before his presentation. “It is all the ‘lies’ obscuring that truth that are complicated and confusing.”

“I suppose the surprise, when you really do look at nutrition from altitude, is how unsurprising the conclusions turn out to be,” Katz said in an interview.

An insatiable pop culture fascination with what Katz called “scapegoats and silver bullets” distract many patients from the well-known fundamentals of healthy eating, Katz said. A public obsession with fad diets, he added, forestalls the advances in public health that can determine whether patients turn what they already know into what they do every day.

The solution, Katz said, is simple: Lifestyle as medicine.

“Study after study shows us an 80% variance in the risk of premature death and all chronic disease by changing what we do with our feet, our forks and our fingers,” Katz said during his presentation, conducted via video conference due to a flight cancellation. “This does pertain directly to diabetes. We have the stunning evidence of the Diabetes Prevention Program. A combination of a moderate, sensible diet, routine physical activity and fairly moderate weight loss resulting from that combination was twice as good as one of the best drugs we’ve had [metformin] at preventing incident type 2 diabetes in high-risk adults.”

Knowing what you know

The challenge before diabetes educators, Katz said, is to translate what is already known into routine action among patients. To prevent development of incident type 2 diabetes and obesity, Katz said, eat less of highly processed foods and consume more fruits and vegetables, more whole grains and more seafood in place of animal proteins.

“Everything we thought we knew — before we talked ourselves into the thought that we don’t actually know anything — we do know,” Katz said. “We are not clueless about the basic care and feeding of homo sapiens. This idea that somebody discovered the harms of excess sugar in his garage last Tuesday is baloney. We’ve been talking about sugar all along.”


The challenge confronting patients, Katz said, is the barrage of highly processed foods and the accompanying advertising, often claiming some of these foods are healthy or “part of a complete breakfast.” Patients should understand the forces behind the processed foods they consume, he said.

“Michael Moss’s book, Salt, Sugar, Fat, lays it out beautifully,” Katz said. “Every large food company has teams of PhDs, and they give them a functional MRI machine and marching orders to design food we can’t stop eating, and they work until they have the hypothalamus lighting up like a Christmas tree. Then they start selling us products and telling us, ‘Bet you can’t eat just one.’ That is a threat. That is a threat we should take seriously.”

Consumers, Katz said, have difficult choices to make, and many are confused because of the range of foods and dietary fats available. The key, Katz said, is to focus on a lower intake of saturated fats and a higher intake of unsaturated fats, along with more plant-based protein and reduced consumption of animal-based protein. The results, he said, are clear — lower rates of premature death.

“Lifestyle is the best medicine, and we need to get the medicine to go down,” Katz said. “The last thing we need, though, is more spoons full of sugar. So, how do we do it?”

Culture, Katz said, is the “spoon” to spur positive changes. Diabetes educators can help, he said, by empowering patients to make common sense choices and become educated consumers.

“For far too long in our culture, we have let health languish along the road not taken,” Katz said. “Together, and only together, do we have the strength to shift that to a path of lesser resistance, to turn what we have long known about lifestyle medicine into what we do routinely, not just in our clinics, but at the level of our culture. It is a tantalizing opportunity to add years to lives and slash rates of diabetes by 90% to 95%. Most type 2 diabetes does not need to happen.” – by Regina Schaffer


Katz, DL. Knowing What to Eat, Refusing to Swallow It. Presented at: American Association of Diabetes Educators Annual Meeting; Aug. 4-7, 2017; Indianapolis.

Disclosures: Katz reports no relevant financial disclosures.