You are what you eat, right? If so, then our guest has a message for us: we’re “ultra-processed people.” In this episode, Abdul reflects on just how culturally-driven our food choices are and how big corporations use that to influence those choices and feed us food that’s…barely food at all. Then he interviews Dr. Chris van Tulleken, a physician and health researcher, about his book “Ultra-Processed People.”

TRANSCRIPT

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Dr. Abdul El-Sayed, narrating: Only 3% of eligible Americans have received a COVID 19 vaccine booster, a pandemic era low. Attorneys General from 41 states and D.C. sued META over features in their products they say are intended to drive compulsive use in children. More than 7000 people have died, including 3000 children in an escalating humanitarian situation in Gaza. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] It’s Halloween, which I have to admit has always been a bit complicated for me. For one, it’s my birthday, which, as anyone with a holiday birthday knows, kind of sucks. In this case, everyone’s generally more amped about the holiday where you get to arbitrarily dress up and get candy from folks then, well, my birthday. But also this holiday kicks off what I’m going to call the food end of the year. Every month features another food themed holiday. Halloween is all about the candy, of course. And then there’s Thanksgiving, which I don’t have to explain. And then the end of the year holidays, whether Christmas or Hanukkah or Kwanzaa or Diwali. All of them have their own food themes. And then, of course, there’s New Year’s Eve. To appreciate just how culturally determined our food choices are. I want you to think through the foods you associate with each of these holidays. I bet if I asked you what your favorite Halloween candy, you’d be able to immediately come up with two or three. And if they’re Reese’s Cups, you’re correct. And no matter which one it is, it probably brings back a warm, fuzzy feeling about a time you ate that candy. When I say Thanksgiving, I’m sure that conjures up a very specific meal, probably featuring Turkey or characterized by Turkey’s conspicuous absence. And of course, if I asked you what your favorite side was, I’m sure you could immediately name it. In our family, it’s scalloped oysters. Odd, I know, but delicious. The point I’m making here is that we often think of food as an individual choice that someone makes about what to put in their body. But food, like so much of public health, is a lot more about the environment, both the space, but also the time in which we’re exposed to it. Simply put, food is one of the most important ways that the outside world gets into our bodies. But as much as food is environmentally mediated, our preferences are still the final gateway. And here again, society and culture play a part. How many times have you heard you are what you eat or an apple a day keeps the doctor away. Or milk, it does your body good. It’s what our moms and dads told us when we were young. But then there was the stuff we heard from our third parent, the television. No one out pizzas the hut, Trix are for kids and, of course, [?], because there are literally billions of dollars to be made making sure that we lower our gates and let cheaply produced food in, the food industry spends billions trying to get us to lower these gates. Even at times making fantastical health claims about why we should. This won’t be the first time we’ve talked about food here, but given how big the topic is, we wanted to create some space to talk about it with some nuance. This is the first of several episodes we’ll be doing on food this season, and I wanted to start with the topic that’s a far cry from daily apples, milk or other raw ingredients from the old adages. We’ll be talking about something probably all of us have eaten, maybe even eat regularly, but that today’s guest at least would be hard pressed to consider food. And he doesn’t think you should call it food either. And that’s because it’s been processed beyond recognition. What starts out as a soybean or a kernel of corn is broken down into its constituent molecular parts until it’s simply a series of additives. Massaged and teased and refined to proffer a specific flavor, texture or shelf life to a product. All of this is designed to keep us coming back for more. Dr. Chris van Tulleken is a physician and health researcher at University College London, and he believes this ultra processed food is creating ultra processed people, which happens to be the title of his new book. He joined me to talk about food processing, its health implications and the companies that make billions doing it. Here’s my conversation with Dr. Chris van Tulleken. 

Dr. Abdul El-Sayed: Can you introduce yourself for the tape? 

Chris van Tulleken: I’m Chris Van Tulleken. I’m a medical doctor in our National Health Service. I’m an associate professor at University College London, where I study something called the Commercial Determinants of Health, how Big Corporations Affect Human Health. This is now uh the major cause of human health problems on planet Earth. And my argument at the moment, and it is an argument because all discussions of food are argument, is that the definition ultra processed food is the best and most evidenced way of thinking about the products that are driving a global pandemic of diet related disease, which is now the leading cause of early death on planet Earth, and a synergistic pandemic of um climate change and malnutrition. 

Dr. Abdul El-Sayed: This is going to be a fun conversation. And thank you so much for uh for for joining us, because I think you uh you are hitting a lot of a lot of the key ideas that we talk about on this this show. I want to step back. Um. Before we started recording, we were talking about the idea of ultra processed as a way to understand so much of human experience in this 21st century era where everything gets technologized before we consume it. But when you talk about ultra processed food, just to sort of set the stage for us about what this discussion is going to be, what do you mean by ultra processed? What what does that mean to you? And and how does that operationalize both in food but then, you know, applying the device uh beyond food? 

Chris van Tulleken: I love the use of the word operationalized is like this clue that we’re going to really get into things usefully here. So um for a long time, the problem with food has been defining food that’s good and food that’s bad. And we’ve known that there is food that’s harmful, but we’ve never had a formal definition of it. So we’ve called it junk food or we said processed food. But then also humans have been processing food for a long time. So in around 2009, a team from Brazil developed a formal definition. Now it’s very long. It’s housed on the United Nations Food and Agriculture website. It’s been used by hundreds of research groups all around the world. Um. It’s recognized by lots of governments. But it it boils down to this. If something is wrapped in plastic and contains an additive ingredient that you don’t typically find in a domestic kitchen, it’s almost certainly an ultra processed food. 

Dr. Abdul El-Sayed: Okay. And not not because I’m I’m an ordinary uh recovering academic, but because I really want to understand the term. So I started this morning and we’re taping given that uh Chris is in London and and I’m in Ann Arbor. Uh. We’re taping at 6:30. So of course, given the my my heavy caffeine addiction, I started the morning with a double espresso. That’s not something that you would find in most kitchens. It is processed and it came wrapped in plastic. Would that be an ultra processed food? 

Chris van Tulleken: No, that that wouldn’t be so the way I think about it is there are three kinds of food. Essentially, um there’s whole food, which is like an apple or an oyster. There’s not much food that we eat that’s completely unprocessed, that isn’t cooked or isn’t isn’t chopped or ground or something. So that’s whole food. Then there’s processed food. Now, humans have been processing food for well over a million years. It’s shaped our guts, our jaws, our teeth. If you compare human beings to any other animal of a similar size, like a pig or another non-human primate, we’ve got these minuscule little teeth and these tiny jaws and a very short digestive tract. And that’s because we’ve extended our eating and nutritional apparatus outside of our body. So we chop food rather than chew it, we cook it, which makes it easier to digest. We get more energy out of it. So primarily female scientists invented modern cuisine, and they did it over more than a million years in caves, then huts, then domestic kitchens. And they did it to nourish their friends, their families and their communities. And so they created this very wide variety of modern diets, um all of which are associated basically with good health, whether we look at fish diets from East Asia, vegan diets from South Asia, Arctic sea mammal diets, Mediterranean diets, they’re all pretty healthy. We don’t, there were tiny exceptions to that we can get into. But broadly, traditional food is associated with good diet. What we have now is the third type of food that makes up most of the calories we eat. And it is arguably not food in the sense that I think we don’t have a legal or a scientific definition of food. But food culturally is about nourishment and the purpose of ultra processed food, part of that very long formal definition is it’s about profit and the system that makes it, it’s made by quite a small number of companies is heavily financialized. So all the incentives in that system are about creating more money. And there’s this, you know, financial axiom. If you show me the incentives, I’ll show you the outcome. If you make food essentially for pension funds and for financial growth, you end up with food that is made using extremely cheap ingredients and that has quasi or really addictive properties. So ultra processed food is a way of describing really a modern American diet. And I hate saying this to Americans because I love America. My my folks are from Canada, but I feel very North American. But we so we could define it using the long definition. We could define it according to the additives or we could say this is a way of describing industrial Western foods, the food, the industrial food that’s come out of the global north that is fundamentally extractive. If a food has a a list of ingredients, it’s probably ultra processed. If a food has a health claim like it’s low fat, high fiber, high in energy, high in protein, it’s probably ultra processed. If a food is made by a transnational food corporation, it’s probably ultra processed. 

Dr. Abdul El-Sayed: That’s really helpful because there are a couple of things in that definition that I think are really guiding to me in my thinking. The first is this point about end outcome. You know, you contrasted the incentives of a large corporation to make a lot of money on some food versus the incentives of uh a person to nourish their family from some food. And it’s like the it’s this place where we decouple the producer uh and the consumer. And when the consumer of the food isn’t also the producer, that’s one key point to think about. And then the second is to think about the scale of production and then the third is to think about the actual processing, how much breaking down and building back up and manufacturing goes into it. So my daughter and I, we have this habit of watching YouTube videos about how things are made. And so we’ll just take a random thing in the kitchen and you know, it’ll be like an Oreo, and it’s like how is it made? 

Chris van Tulleken: How old is she?

Dr. Abdul El-Sayed: And she’s she’s about to turn six so– 

Chris van Tulleken: Oh I’ve I’ve got a six year old. Yeah I’ve yeah we do a we do a similar thing. Yeah. 

Dr. Abdul El-Sayed: It’s a lovely age right. Because they’re like– 

Chris van Tulleken: Yeah yeah.

Dr. Abdul El-Sayed: –truly curious about the world but they also come to the world without preconceived biases. Of what of of what they think the world is or what they what they will excuse as normal. So she saw this point in Oreo production where they were making the cookie and the guy was using a shovel and there was this notion where she was like, it looks like dirt Baba. And I was like, Yeah, you know, that’s kind of what it looks like. And she’s like, he’s just shoveling it into this very big machine. And it was this moment of like, oh, wait, like, I think of my Oreo as this dainty little thing that somebody, you know, cooked for me with with kindness and love. And she sees this– 

Chris van Tulleken: They roll it out and got the little cutter. 

Dr. Abdul El-Sayed: Exactly. 

Chris van Tulleken: Yup. 

Dr. Abdul El-Sayed: And somebody like [kiss sound] kiss their kiss their fingers as they sent it in the box to us. I was like, no, this is how they make that many Oreos [?]. And she was like, well, I don’t know that I like that. And I was like, Yeah, neither do I. And this is why we tell you, you can eat so many Oreos. And so it was this natural of just just aversion she had to what processing actually entailed like this this man shoveling her Oreo into a thing. And it was it was like almost she picked up this metaphor of this is unnatural and food– 

Chris van Tulleken: We shouldn’t– 

Dr. Abdul El-Sayed: –shouldn’t be treated this way. 

Chris van Tulleken: We shouldn’t make food with shovels. [laugh] So I sit in this really weird space where intuitively and emotionally I entirely agree with your five year old. They are they are right. But because the book was published in April and it’s been very widely read in the UK and in the US and in Canada, um I’m now having an argument against the food industry every day and the argument takes many forms and shapes. But one of the things I try and do is not get too involved in the emotional long grass, because that’s a that’s a trap where they say, well, we’re feeding the world. How do you expect us to make this many cookies? Like, of course we use a shovel, but fundamentally our factory is just a really big kitchen. We just use bigger pots and pans. And so for me, the the technical argument that I lean on very heavily is much less an emotional critique, although although that’s really useful when I’m speaking to my my reader or the lay public, I do want to disgust them with this food. I think people should be disgusted. I think that’s useful for many people. It comes with a problem because this is the only food that many people can afford and the only food that’s– 

Dr. Abdul El-Sayed: Right. 

Chris van Tulleken: –available to them. But we can we can come on to that. So I try and do that without generating stigma. But when it comes to the argument with the companies, for me, the really important thing is not that they’re using a shovel, although that is using a shovel is a proxy for an industrial process that does not have your interests at heart. And so I’m doing I’m doing a really cool piece of work at the moment where my academic work shifted from doing molecular biology, from studying nutrition at a very kind of basic level to now I work with economists and one of the things that they’re the team I’m working with and they’re dispersed around the world. The main teams in Australia is they’re trying to prove using financial metrics that the food companies will say that they care about you, but they really definitely don’t. And we can demonstrate, for example, that when they make money, instead of using that money to reduce the price or using that money to make sure that they use higher quality ingredients or make the food healthier, what they do is to use the money to do share buybacks and drive up equity value. So if we using measurements like this, we can say, look, whether or not you use a shovel to make the food, if if my parents were going to cook a meal for a thousand people at some enormous wedding, they might well use a big tool to shovel ingredients into a giant pan. That wouldn’t actually be a problem. The problem would be the incentives. 

Dr. Abdul El-Sayed: Mm. Yeah. No, I really appreciate that. I want to ask you just, you know, you you um you teed off on America here, and I certainly agree with you. We’re a you know, we’ve increasingly become a much, much more self-critical, at least some of us have become much more self-critical in our country. There’s a lot to be critical about. I want to ask you, in an average American diet, just how much ultra processed food do we consume in a given day? 

Chris van Tulleken: So um it’s it’s around 60%. Um. 

Dr. Abdul El-Sayed: Wow. 

Chris van Tulleken: The the way we collect the data is um uh flawed and it almost certainly underestimates the amount. So, you know, you have a national diet survey. We have the same one in the UK. We don’t collect the granular detail of if you say you ate lasagna for dinner, it’s not entirely clear on most of the surveys if you cooked that yourself or if you had it in a packet. So if you if you bought a ready meal lasagna that had flavoring emulsifiers, xanthum gum um uh lots of stuff you don’t have in your kitchen, it would be ultra processed. It would probably be coded as in in the studies, as not ultra processed. So we probably underestimated a typical amount for an American teenager or a or a child would be 70 or 80%. So we– 

Dr. Abdul El-Sayed: Wow. 

Chris van Tulleken: We know it’s much higher in younger people and of course, in already disadvantaged people, it’s even higher still. So if we think about um people with very low incomes uh and and the communities they come from, those people are essentially forced to eat harmful food. 

Dr. Abdul El-Sayed: I want to touch on that point because I don’t want to let that one go, which is, you know, I actually, incidentally, wrote my doctoral dissertation on the predictors of obesity in the UK uh and um thinking a lot about uh socioeconomic position and um and race as predictors. Um. But but really not not as much as predictors, but as metrics that we can use to identify processes of marginalization and food access. And one of the big differences between the UK and the U.S. tends to be access to whole foods, or we’ll just say processed foods. Um. There’s much more a culture of smaller and readily accessible um food venues in, you know, even in, you know, you talk about the lowest income parts of London and you tend to have large immigrant communities who tend to open up smaller uh fruit markets in effect, and they’ll have some, you know, traditional ethnic foods, but they’ll usually have green leafy vegetables and other kinds of cuisines. You go to um communities in the US. So, you know, just to compare like in Detroit and in Newcastle, which I think are a pretty pretty apt comparison and there’s just less access to um whole foods.

Chris van Tulleken: They’re both ex-industrial towns with high unemployment. Yeah. 

Dr. Abdul El-Sayed: Exactly. And you tend to have far fewer um accessible grocery stores. So I was talking and we talked about this idea of of a food desert, and I actually think probably the better term for it in the US is a food swamp. There’s–

Chris van Tulleken: Yeah. 

Dr. Abdul El-Sayed: There’s a lot of food. There’s just not the kind that is going to nourish, you know, a brain. Um. And and I want to ask you, you know, as you think about uh the process by which these corporations have almost dominated the food space, it seems it would seem counterintuitive when you actually explain the process. You’re like wait, ultra processing the processing itself should cost more money. How come the food that lowest income people in high income societies end up getting is ultra processed? Can you talk a little bit through that in the ways that corporations have been able to leverage their power to be able to make that the truth? 

Chris van Tulleken: Okay. So this let’s let’s deal with the sort of technical question first. Why is it cheaper to make an ice cream uh with 20 ingredients rather than just making it from cream, vanilla, sugar and some eggs? 

Dr. Abdul El-Sayed: Yes. 

Chris van Tulleken: So um one of the issues with dairy fat is you’ve got to grow a cow, milk a cow, feed the cow. Um then when you get the milk, you’ve got to pasteurize it, homogenize it, separate it out. Um. It’s extremely expensive way of making fat. Now, if you can take some of that dairy fat and replace it with a refined, bleached deodorized, hydrogenated and interesterified palm fat, it’s way, way cheaper. Palm, you don’t you don’t need to feed a palm tree anything. You just grow it. You cut down some virgin rainforest, you sell that lumber and you grow your palm on the Indonesian peat soil. It grows brilliantly well that it’s all fed by the sun. Um. And then by putting it through this RBD process, through an edible oil refinery, which looks rather like a crude oil refinery, you can create a fat with any melting point in any texture you want by changing all the bonds between the carbons. So if you can save a little bit of dairy fat, that’ll be great. Now, eggs are a nightmare. Eggs have salmonella in them. You’ve got to grow the chickens. They you’ve got to crack the eggs open and process them. Eggs are just a terrible thing for a food company to deal with. If you can replace the egg with a synthetic emulsifier, even 50% or better yet, entirely like mono and diglycerides or fatty acids, then you’re onto an absolute winner. Um. If you use real vanilla, it’s expensive. If you use synthesized vanillin flavor, public don’t seem to tell the difference. No one cares and you can still call it vanilla. So by replacing every ingredient, you sometimes need to use more. But each one is much, much, much cheaper. And a lot of the logic. So the industrial logic of UPF is some of the time it’s just essentially it’s made from five or six plants, right? We eat basically six plants and three animals. That’s that’s the human that’s the modern human American, you know, Northwest diet, we, we eat rice, corn, soy, wheat, palm and and some sunflower oil. And then we add to that some pork, some beef and some chicken, maybe a bit of fish, but we don’t eat much fish. So that’s our diet. And a cob of corn will spot you could buy a cob of corn. You can keep that in your fridge for a few days, maybe a week tops. If you get it early. Um. You’ve got to own a fridge, you’ve got to keep it in the fridge and then you’ve got to heat up water, boil the corn. Now if you’re a corn manufacturer growing a monoculture crop of corn, it’s very you know, people only eat cobs of corn once a week tops. If you can take your corn and you can turn it into bioethanol for running a car on, high fructose corn syrup, you can get the corn oil out of it. You can get a protein isolate out of it. You’ve now created with your high fructose corn syrup, a liquid that can be added to anything from soda pop to pizza to breakfast cereal. I mean, it is in everything. You can take the emulsifiers out of soy in the the soy protein. You can add it to everything. And those pastes, powders, and liquids have a nearly infinite shelf life. So you go from the logic of a commodity crop, which you mainly grow to fuel, to feed animals, soy, corn, and you take a little fraction of that and you turn it into you add it to the human food supply. So where there’s a way of thinking about this, which we’re really eating the waste that’s left over from feeding animals and you’ll see some ingredients already incredible. So whey protein is a great example of we used to spread whey protein on fields, right? It was it was waste. It was leftover from the cheese industry. Now we mix it with vitamins and flavoring and sell it to bodybuilders. We’ve increased the value four five orders of magnitude. I mean it, the added value when you can do that is incredible. You’ll see citrus fiber on a lot of your little nutri bars. If you if you work out and you buy those high protein bars, citrus fiber is an added ingredient. Now citrus fiber, and there’s nothing harmful in it, but it’s extracted from the peel that would previously have been thrown away when you make a can of grapefruit slices or you uh make orange juice and your left with all the peel. You can turn that that into a fiber which has some nutritional value. I suppose it’s fibrous, but it’s just a way of taking waste and adding it to the food chain. The same is true of all the fats, mango kernel fat, so that the industrial logic is take the cheapest ingredient and and and add it to the human food chain. 

Dr. Abdul El-Sayed: Hmm. [music break]

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Dr. Abdul El-Sayed: You’ve really helped us to understand and explain the way that extraction out of these few small. Or these few very, very, very large commodity crops um displaces a lot of the traditional foods that, you know, we’re we’re sort of making technological simulacra out of um, I want to– 

Chris van Tulleken: Technological simulacra. I’m going to use that at least twice today. That is my mission. I’m going to use that. 

Dr. Abdul El-Sayed: You know, hey that one’s, that one’s for you. Uh. [laughing] But like that’s what it is. I mean, really, it’s like I’m eating ice cream. No, you’re actually not. You’re you’re eating a whole bunch of, frankly, chemicals that have been fully extracted from a base commodity crop to the point where you actually from on a molecular level, almost can’t know where it came from. And then add mix together– 

Chris van Tulleken: You can’t. I mean, your sandwich will have 14 ingre– I mean, my my, the sandwich I used to eat for lunch has 42 ingredients. You, you, if you want to be an ethical consumer, you can’t keep tabs on all that. And nor do we know what they’re doing to the body. I mean you, so the the argument becomes devilish because many of these the definition focuses on the additives. And so I think a common misconception is it’s the additives that are harmful. And while we have very good data that, for example, the emulsifiers and the non-nutritive sweeteners and the flavor enhancers and some flavors are harmful, for the most part, the additives are just a proxy for the industrial process that’s about extracting money. I mean, you asked about corporate power, which is the more complex question. And there is this when we look at already disadvantaged communities in London. So if I go to South London, there’s this this paradox amongst our African and Caribbean communities that there are whole food markets with very traditional food, and there’s a generation of people who still buy that food and cook it. And you then talked about there is there is also a culture of using convenient, ready processed chicken shop, fried chicken kebab shops. There’s a there’s a culture of that. I would say there is not a culture of that. There is um the imposition of that food. 

Dr. Abdul El-Sayed: Right. 

Chris van Tulleken: In a predatory way by enormous companies. And something I worked very hard on in the book was to to go to those communities and understand from their perspective this kind of dissonance where people, you know, in in South London will be very defensive about fried chicken because you can’t live with the dissonance that you are being exploited and extracted from when it’s the only food you can eat. But the the voices in my book from I mean, particularly that the Black community were entirely clear that if you look at the ownership of the kind of major chicken shop chains, this is not um a culturally appropriate local food producer. This is a company owned by um, you know, shareholders in the Global North with that demographic that is extractive, not just of poor communities in London and people of color in London, but it’s also extractive of the global South. And we’re seeing the the the huge expansion of the major chains into Ghana, Kenya, into the sort of burgeoning middle class of western central Africa in a way that is kind of desperately harmful. 

Dr. Abdul El-Sayed: Yeah, I really appreciate that point insofar as there is this implicit blaming of people of color, low income people for, quote, “food choices.” And your point is a really good one, that it’s not actually about choices that people are making. It’s about the opportunity set that is increasingly being manufactured for them um around price structure. And we see a see a very, very similar thing that’s happened here in the US well, well before it started to happen, uh even in Europe. And certainly as you talked about in large capitals in, you know, sub-Saharan Africa, lower income Middle East countries, etc., I want to move um because you make a really important argument in the book that the the disastrous consequences of ultra processed foods go well beyond calories in, calories out. And that that’s traditionally what you were taught in medical school, what I was taught in medical school, that really it’s just about calories in and calories out. And if you have this calorie balance, then you know that that is that is just fine. It really doesn’t matter what those calories are. And your argument is that actually that’s that’s just not true. Can you tell us a little bit about why UPF are designed to be over consumed and then how they violate calories in, calories out? 

Chris van Tulleken: So one of the one of the kind of really cool ways that the industry messes up this discussion is by conflating weight gain and all the other problems of diet. So let’s just deal with the pandemic of increased body weight that has has happened in the States and is happening at an extraordinary rate around the world. And it’s certainly happened in the UK. Um there is, um I think, very wide agreement that the human body can’t violate the laws of physics and we burn a certain number of calories per day, and there’s not much that actually changes that number of calories per day. Inactivity is a very small part of the picture. And if you consume more calories than you burn, um you will gain weight. And so the the the food industry has put two really big emphasis on this discussion. First of all, they say, well, everyone has an individual responsibility to monitor their own calories, you know, and we are the only animal on planet Earth that seems to think that we can read a list of calories and then control our calorie intake. And so when we say to people, um uh when they’re surrounded by food that has addictive properties, well, just eat you know, you and I will use about 3000 calories a day. Just eat your 3000, keep tabs on it, do the maths on every single mouthful, and then stop when you get to 3000. It’s the same as saying to smokers, look guys, you know, one cigarette a week is fine, you just have to stop at one or to someone who lives with a an addiction to alcohol or illicit drugs of abuse saying, you know, we’ll just have one line of cocaine, have one shot of heroin, you know, and you won’t come to any harm. It’s the excessive use that’s doing you harm. So there is very good evidence that the food is addictive for many people, but there’s also very good evidence that it interrupts our ability to self-regulate. So food is abundant for many, many animals, including for human beings traditionally. And if you eat real food, your body has a very well evolved set of nerves and hormones inside it that when you have had enough food, your body will say, okay, you’re done. You can stop eating now. We know from a huge body of data going back to the nineties, I mean, it just we have so much science on this that when food is manufactured so that it is soft, it is energy dense, it is flavored, it is flavor enhanced. Those amongst many other properties get around that, that um ability to feel full. Um. So the other thing the food industry has very skillfully said is, look, if you do eat too much, go for a run. And so there is a very large body of credible looking literature that says if you do more exercise, you can burn off excess calories. And that frames the problem with the pandemic obesity as being kind of to do with this pandemic of inactivity. And that feels very I mean, that was the way I learned in medical school. You know, people could run off, you know, eat less, do more is the kind of maxim. In fact, the entire network of literature that promotes that and all the institutions that promoted it were funded by one company, the Coca-Cola Corporation. So exercise is medicine was a Coca-Cola program in the States, partnered with the American College of Sports Medicine. What we have, I think, very good evidence around now and this is published in very good journals, it goes back to the 1990s. There isn’t the lead, the sort of main author on this is Herman Pontzer, but there a are huge number of other scientists saying the same thing, which is that broadly, by increasing your activity in the way that most of us will like, we’ll go to the gym a couple of times a week, you know, by walking to work. That will be very, very good for us. It doesn’t seem to have a huge impact on the calories we burn. So this is really kind of food industry misinformation and the extent to which is a I mean, you and I, with Phds and medical degrees had our thinking influenced by this network of research is kind of extraordinary to me. But anyway this is you can sound a bit conspiratorial, but the you know, I put a whole chapter in my book about exercise is good for you, but there is very good evidence it will not really help you lose weight. It might help you keep it off as part of a kind of healthy lifestyle. But it it doesn’t seem to very much affect the calories we burn. 

Dr. Abdul El-Sayed: And one mechanism of this that I just think is really important to be thinking about is that human hunger and satiety are centrally mediated. And like, we have a very, very large brain that beyond just saying I’m hungry or I’m full adds a lot of imagination to that. And so most of the time when you’re hungry or full, you’re not just saying, I would like to eat any calories, right? There are particular things that you’re craving. Those cravings take particular forms, and those forms tend to be the most delectable, most juicy things that you can potentially eat. So I know when I’m uh I walk into the house and I’m hangry um if I have Oreos or I have an apple, I’m picking Oreos. And the reason why is because, you know, the Nabisco Corporation is probably owned by some other corporation now um– 

Chris van Tulleken: It was owned. 

Dr. Abdul El-Sayed: –designed those things. 

Chris van Tulleken: Of course by R.J. Reynolds, the tobacco company. 

Dr. Abdul El-Sayed: Oh. Wow that is–

Chris van Tulleken: Yeah. Nabisco is so the tobacco companies bought Philip Morris and and R.J. Reynolds bought most of the major food brands in the states. So almost every ultra processed product you eat now, if it’s dates back to the eighties or the nineties was owned by one of those two tobacco companies. 

Dr. Abdul El-Sayed: So does– 

Chris van Tulleken: Just as an aside. 

Dr. Abdul El-Sayed: That says something really profound because because the experience of eating an Oreo for me. Right. Hits all of these nutritional erogenous zones in my mind. Right. Versus having an apple. And look, I like apples. Like apples are one of my favorite fruits. But they’re fruits and um and they weren’t manufactured right to specifically give me that kind of I hate to say it, that high right of having eaten uh this ultra processed food. So there’s this way in which right our psychological mediation gets tickled by these corporations that design their products just so so that they become the go to product. And and the other part that you talk quite a bit about in the book is just the chemical mediation of that. Can you speak to the way that they tend to get engineered specifically around those flavors that we can’t we can’t deny ourselves? And then also the way that chemicals get leveraged into sort of disrupting our biological processes? 

Chris van Tulleken: Yes. So there’s a really important finesse I want to add to what you’re saying. Which is that it’s easy to frame this food as delicious. I think the food is delicious in the same way a cigarette is delicious or beer is delicious. That first sip, the first puff, the first bite. Often you do get a some euphoria from it. It seems to satisfy some craving very briefly. But by the time you’re approaching the end of the burger or the bag of chips or the packet of cigarettes or the the fifth, the fifth beer, you’re no longer really enjoying it. And so there is a big difference in the human brain between liking and wanting and what this food and all these products, whether it’s booze or or drugs of abuse, they’re really good at generating, wanting, liking, not so much. That’s of very little interest to the food companies. And so I think it’s really important when you talk about this food when anyone talk– to to not frame it as delicious because actually the trial data is pretty clear that people don’t find this food delicious. They find it extremely palatable and unsatisfying. Um. But it’s very close to being disgusting for many people, which is why I put this invitation in the book to please eat as you read, because the food can very quickly go through that kind of uncanny valley where it becomes what was the word you used, simulacrum it’s a it’s fake. And once you realized that an Oreo is fake, when you start eating an Oreo and reading the ingredients and realize how little of it is food, um it can become very repulsive. So, yes. Okay. So how do they do it? The conversation we have in the UK is what the industry and their intermediaries want us to believe is that the problem with food, unhealthy food is high in fat, salt and sugar. Now it’s true that those molecules do drive appetite to some extent but they’re a relatively small part of the picture. What when it comes to obesity is the problem is when we eat too much. And so the ratios of fat, salt, sugar, sour and bitter are much more important than the absolute amounts. And if you think if you if you get a bowl of um, you know, UPF cereal, whatever your favorite one would be, you you could make it even more unhealthy by adding another three spoonfuls of sugar and adding a spoonful of salt. But because it would become repulsive, you wouldn’t eat it and it would actually become healthier. So a big part of what drives the food food’s unhealthiness is this palatability is how much we eat. So a really good example, I think, is to think about the construction of a soda pop. And these used to be called phosphate pops, or um they were served at phosphate bars because they all contain phosphoric acid. Now, if you take a glass of water, uh which I you know, I have an empty one here. Now, let’s imagine adding if we filled that with with water, if we added ten spoonfuls of sugar, it would become more disgusting, not less disgusting wouldn’t it? No one ever adds sugar to water. But if you add a few drops of synthetic flavor and you make it very bitter with caffeine and you add sourness from the phosphoric acid and the citric acid and you make it fizzy and cold, it then becomes addictive. And we understand a little bit about how this works. Part of it is because of the sourness, the bitterness, the coldness and the fizz. You can get all that sugar past your tongue because your your body should be saying that this is actually too much sugar. This is going to mess up my blood concentration and my water balance. If you can get if you can deliver the dose of sugar into the gut, it seems that you get that sudden reward, the nutritional reward. You link that reward to the flavor pattern, which is patented in the in the recipe. And that’s what brings you back to that soda pop wanting more. So there is so much more to the addiction of these drinks than just the sugar. If sugar was addictive, we’d all put we all eat sugar with a spoon or we’d, you know. But none of us ever, ever are addicted to sugar. We’re addicted to sugar mixed with emulsifiers, acid sourness and chewy weird textures wrapped in plastic, branded to us that in that context, sugar delivers a reward. So it’s kind of like speed balling, you know, with with there was a there’s a when I worked as a physician and you may have seen this in emergency rooms, patients will often take stimulant drugs like cocaine or methamphetamine, and then they’ll take sedative drugs at the same time like heroin or benzodiazepines. And the more heroin you take, the more crack cocaine you can take. And so you can kind of overdose on both but feel okay and get a high in two directions. And it’s a little bit like what’s happening. The more sour and bitter you add, the more sugar and salt you add. 

Dr. Abdul El-Sayed: Wow. No, that’s really helpful to understand. And it you know really gets to that, that notion that behind all of this is this very fine tuned technological manufacturing process that that really is designed to to to just load you with this stuff and to make you come back and want more. 

Chris van Tulleken: I mean, the weird thing is no one understands why the Diet Colas are addictive. So we know they are many people watching or listening to this may be people who drink seven or eight cans of it a day. They will they will find it very hard or impossible to stop. And there was some amazing research done at Yale by a fantastic scientist called Dana Small, and it was funded by Pepsi. And Dana discovered that the Non-nutritive sweeteners seem to have this very weird effect where they they would drive excess consumption, but they they caused a lot of metabolic imbalance. So we we would the food industry argues that, well, we can make ultra processed food healthier by taking out the sugar calories or the fat calories and replacing them with gums or non-nutritive sweeteners. The non-nutritive sweeteners seem to cause this real metabolic confusion, and somehow they can be addictive too, without any calories. So we don’t. The only research ever been done, funded by Pepsi, once Dana tried to publish it, um you know, Pepsi got quite unhappy. Some of it is out there, but we barely understand how this stuff works from an academic perspective. 

Dr. Abdul El-Sayed: Hmm. I want to I want to move to thinking a bit about interventions here. Um. First of all, it’s tempting to think that we as consumers can just choose our way out of the problem. And in some respects we can. And if folks listening today say, you know what, I really want to take ultra processed foods as far out of my diet as possible. What are some of the things that they can do? 

Chris van Tulleken: So I relentlessly refuse to give anyone advice about what to eat. And I do that for two reasons. First of all, many people want to look different, and I don’t want to endorse that perspective. So a lot of people come to me and say I want, want to be thinner. And I I feel, well, you’re you know, I don’t think that anyone needs to be thinner. I don’t think that people will look better. They may not even feel better. Most of the harms of excess weight come from the fact that doctors marginalize and abuse patients and stigmatize patients who live with excess weight. Living with excess weight does have some health problems, but but most of it is probably the health problems that come from the diet that drives excess weight rather than the weight itself. So I don’t feel anyone should look different and I don’t judge anyone for eating this food. We eat the food that’s around us. Um. I do think that people who live with an addicted relationship may find that abstinence is much more helpful than trying to reduce. And I think the the evidence around how to become abstinent is that I draw on is the evidence around that this famous book, The Easy Way to Quit Smoking. And it’s it’s the only self-help book that is recommended by the World Health Organization. And the proposal in that book is you smoke while you read the book, and there’s loads of randomized trials on it versus nicotine gum and other behavioral interventions. And it works really, really well. So if you live with addiction, learn about ultra processed food, see if you can shift to being disgusted. But my caution will be is your life will become inconvenient and expensive. Eating real food is incredibly expensive because we we subsidize ultra processed food in in all kinds of ways like direct crop subsidy and all the external costs of climate change and the cost to our health. You know, you’re going to pay those costs at some point, but you’re not going to pay them when you pay for the food. So the food is artificially cheap. Um. And for someone who just wants to align their groceries, you know, if they’re feeding, I mean, I’ve got I’ve got the six year old and a three year old and my wife’s pregnant and I don’t want to eat this stuff, but I also want my kids to be normal. I want, you know, food binds us to the people around them, all their friends eat this stuff all day. So I don’t ban it, when they go to parties they can eat anything they want. We don’t have much in the house. So a big deal is it’s like cigarettes if you have them in the house or if you have booze in the house, you will tend to smoke or drink it. So not buying it and not having it in the house is useful or treating it as as exceptional. You know, we’re all allowed indulgence and many people can enjoy two cigarettes a week, a glass of wine on a Friday night. You know, that can be a perfectly healthy part of a lifestyle. The problem with that stuff is that many of us find it hard to not experience the mission creep where you are enjoying that stuff at 9 a.m. on a monday morning. 

Dr. Abdul El-Sayed: And I know from the book that the real intervention has to come at the level of policy. So what are the things that we should be driving our policymakers to be doing around reducing this in our environment? 

Chris van Tulleken: The most important thing is that we frame this using the language of the free market and the political right. So I my private politics, I keep close to my chest. I don’t talk about the party I vote for. You can probably make guesses about them. I’m a humanitarian doctor and I do work in our public NHS service. So what I advocate for and what the charities I work with advocate for is not we’re not taking away anyone’s fun. We don’t want to ban anything. I’m not even proposing taxes on anything. What we want is people to have increased freedom and increased choice. We want them to have freedom from misleading marketing. Freedom from aggressive packet claims. Freedom from misleading pack claims. Um. And and to be able to afford real food. Because we know that when people with low incomes get money, they buy real food. There is the gulf between what rich people eat and what poor people eat. It’s not because poor people don’t have information. It’s because–

Dr. Abdul El-Sayed: Yeah. 

Chris van Tulleken: When people have lots of money, they want to buy healthy food. So um it it we have to use that language. And the other thing is not to allow it to be framed as neo-Marxist, as anti-capitalist. We’re talking about regulating an industry that is the leading cause of early death on Earth. Right. This isn’t this is not controversial. We did it with tobacco. We did it with seatbelts. We did it with leaded petrol. You know, light touch regulation works fantastically well. The companies can deliver fantastic growth to their shareholders. Everyone can remain employed. We’re talking about bringing in some regulation that will incentivize the companies to produce really good food. So I, I refuse to be pigeonholed as an as an anti-capitalist. This is this is all, you know, can all be done across the political divide, because I think we all agree that children should be able to eat healthy food regardless of the household they’re born into. 

Dr. Abdul El-Sayed: Yeah, no, and I really appreciate that focus on the inequities that are driven by the food environment. Are there are few specific interventions that you would really point to as being these are the ones that are most important right now? 

Chris van Tulleken: Yeah. So the first thing is the acknowledgment that ultra processed food as a formal definition is useful for policy and we need to put it in our national nutrition guidance in the UK and in the US that this food is um has been associated with a long list of negative health outcomes. Regardless of whether you gain weight, it drives dementia, anxiety, depression, cardio metabolic disease, inflammatory disease. There is a long list of conditions. Cancer, early death from all causes. So with this needs to go in the national nutrition guidance. Now that sounds a bit finickety and technical. No one ever reads that, but that is the lever that then allows you to to do other steps. And that’s what the food industry are resisting. We need to take all the cartoon characters off the packs. That’s completely obvious. We did it with cigar– you know, cigarettes were aggressively marketed to kids, all the cartoon characters off the packs. And we need to follow the example of Chile, Colombia, Brazil, Mexico, Argentina. If you buy a can of cola in Argentina, the warning labels are bigger than the logo of the manufacturer and that’s how fizzy pop should be sold. Pretty obviously we have absolutely irrefutable evidence that fizzy pop drives all kinds of terrible harms to children and adults, and it should have a great big warning label on it. Same of the breakfast cereals. Um. And then we change institutional food. So this is start just as the food companies are using the tobacco industry playbook to spread misinformation, to fund policy makers, um we need to use the regulatory playbook that we use to regulate tobacco, limit the marketing and and perhaps more than anything else, industry money is dirty money. You cannot be a food charity or a food policy organization and take any money from the companies who profit from creating the problem you are trying to solve. In the UK, the situation is just terrible where we we get these supposedly independent groups who are all funded by Kraft, Heinz, Pepsi, Lay, you know, Coca Cola, McDonald’s, Cargill, um and they they have huge sway over policy. So if perhaps if there’s that, that is my second to the top is stop the conflicts of interest. And the absolute number one thing is reduce poverty. If all you do is get rid of poverty, then people with money buy healthy food. They can all afford refrigerators and cutting boards. And they all have time and they they buy good food and the market will correct itself. So perhaps that’s that’s the number one thing. And I think poverty is a is a political choice. It’s not a natural state of people. 

Dr. Abdul El-Sayed: I really appreciate that sentiment. One thing I notice that you didn’t talk about was subsidizing some of these commodity crops. So in the US, you know you talked about conflicts of interest and the role of food money in the running and operations of these charities in the U.S. We have a political system which is porous to that money as well. And so you have these corporations spend hundreds of thousands of dollars–

Chris van Tulleken: It’s not just tourists, it’s fueled by it. 

Dr. Abdul El-Sayed: It’s it’s yeah, exactly. That is decidedly true. And so you can get elected by getting, you know, PAC contributions from, you know, huge food companies who then, you uh, who’d have though it, not regulate when you’re actually in office. And in fact, not only that, but direct huge sums of government money to subsidize. Right. You look at the agricultural industry in the United States. It’s largely um gigantic agro corporations that are funded by government incentives to grow really, really artificially cheap corn uh or soy or some of these other commodity crops. And– 

Chris van Tulleken: Yeah. 

Dr. Abdul El-Sayed: That tends to create an artificial setting where, you know, these food prices are artificially low, which allow them to undercut– 

Chris van Tulleken: Yeah. 

Dr. Abdul El-Sayed: –some of the wholer foods that people could otherwise be eating. And I I you know don’t want to paint all farmers with broad, broad brushstrokes. There are some heroes out there, small farms who are are still growing whole foods. But, you know, if you just look at the sector and you analyze it by size of farm, it has been consolidated. Like so many of the other industries in our society– 

Chris van Tulleken: Yeah. 

Dr. Abdul El-Sayed: –have been. And I want to ask you, you know– 

Chris van Tulleken: There are six companies that make around 75 to 90% of the world’s calories. 

Dr. Abdul El-Sayed: Yeah. And that that itself–

Chris van Tulleken: There are four, four that make most of them. Yeah yeah.

Dr. Abdul El-Sayed: And that itself is a function of of public policy, largely American public policy. 

Chris van Tulleken: Yeah. So you’re completely right. At no point in the book did I go we need to sort out US food subsidy systems. And that was partly because that is a whole separate book. Um. And um partly because I think when it comes to the granular detail of those policies, so I am very good on like how we need to label a pack, how we need to warn people. Um. I think when it comes to the long term effects of food subsidy, it requires really, really nuanced technical input. I mean, basically, yes, it’s disgraceful and disgusting. And we have a very similar situation that’s slightly less exaggerated or we’re just ten years behind you in the UK. Um. So changing those subsidies. I don’t have an immediate mechanism for interrupting that corporate power other than I think the there needs to be before they can before politicians can start saying uh we are going to tackle a problem, you need a grass roots momentum to say, you know what, we’re sick of eating this garbage and we want the system changed. And I do have some faith that the food system that many of those small producers could meet demand. But look, look, basically, you’re entirely right. And we need a revolution in the way we grow, produce and process food. And for me, the place to start is with the the the human being, the voting public going I really don’t want to eat this. I’m fully aware of the harms. I want this taken away from me or I want this. I want to be warned about this. And I I demand that real food is available. And so that’s that’s my starting point. Because until you have a population asking that, I think the politicians are stuck because they they’re industry funded. And if the voter isn’t saying, please help me here, then then they are stuck. Does that–

Dr. Abdul El-Sayed: Yeah. Well-

Chris van Tulleken: Is that a cop out? 

Dr. Abdul El-Sayed: No, no, no. I appreciate it. I also um I fully appreciate why in a book about ultra processed foods, your conclusion wasn’t what wasn’t we need to change the American campaign finance system. But that’s that’s in [laughter] large part what we need to do around so many problems that we talk about here. And you know–

Chris van Tulleken: I mean you, you are so yeah. And what you’re saying is really kind of powerful to me that you’re explaining so elegantly. You we are all going to pay for this food, right? Like we’re you’re going to pay you pay you and I. Well, you anyway, through your taxes, pay for the corn subsidy. You then pay all the health insurance costs. You pay the environmental costs. Like we’re constantly paying for it. We pay for the lawsuits they bring against our governments when the governments do attempt regulation. So, yeah– 

Dr. Abdul El-Sayed: And that’s the thing. This this point–

Chris van Tulleken: Never think that this food is cheap. 

Dr. Abdul El-Sayed: –is is actually spot on. Right. Is we pay for the subsidies for the food that makes us sicker. Then we pay for the insurance system that allows somebody to take money off the top for the health care we then need. Then we pay both for the research and development of the drugs that we take to address the challenges that we should not have had because of the food we ate. And then we pay on top of that because we’re not allowed to negotiate for the prices of those prescription drugs. We subsidize our own unhealthy in a profound way, largely because of the mechanism of our politics. And and that’s the thing is it’s beyond the scope of a book. And I I I deeply appreciate the the you know profound, um immense work that you put into educating consumers on both sides of the Atlantic and frankly, around the world about what this food is doing to us. And that is the work. But, you know, in our country, it’s just so frustrating to know that this is part of our global export. You know, when when people think about the impact of America on the world, we don’t take it back to the notion that these corporations that are our our pensions, if only we had pensions, our 401Ks uh are invested in. Right. That that they are incentivized to drive our government to allow them to make shit that we then sell all over the world making people unhealthier and we end up bearing the cost on every side of it. And so, you know, it’s important that that that folks really take this. And I what I’m what I’m going to ask, given that, you know, we’re going to be talking about this right up to Thanksgiving, which traditionally is a moment where people actually do eat whole foods uh for like the one meal of the year, maybe the other one is at is at Christmas and as you’re as you’re talking to your your auntie and your uncle and your cousin about the things you’re thinking about, I hope this is one of them, right. Because, look, you’re eating a delicious turkey and that turkey was probably fed on corn that was itself subsidized so maybe not perfect, but like, close. 

Chris van Tulleken: Let’s not let’s not sweat about it too much. 

Dr. Abdul El-Sayed: Yeah. 

Chris van Tulleken: Yeah yeah yeah. 

Dr. Abdul El-Sayed: You know, at least it’s a turkey, like you can see, it’s it’s actual bones– 

Chris van Tulleken: Yeah. 

Dr. Abdul El-Sayed: –and sinew. 

Chris van Tulleken: Yeah. 

Dr. Abdul El-Sayed: Uh have that conversation because it really does ultimately often go back to that in you know this is the purpose of of your work Chris, is that you’re trying to remind us that the stuff that we eat every day, often mindlessly as we consume other garbage through our eyes and our ears. Right. That that that this stuff has a real impact and it shouldn’t have to be that way. Um. I just really appreciate the the work uh that you’re doing and uh appreciate you you coming on uh today to share it with us. Our guest today was Chris Van Tulleken. He is both an infectious disease doctor and he is associate professor at University College London, where he studies the impact of corporations on health. Chris, thank you so much for taking the time. 

Chris van Tulleken: Hey thank you so much. This was literally the most interesting conversation I’ve had in a long time. [music break]

Dr. Abdul El-Sayed, narrating: As usual, here’s what I’m watching right now. To this point in the fall, only 3%, yeah 3% of Americans have gotten their COVID 19 boosters, and that includes only 7% of nursing home residents. You know, the most vulnerable people to COVID. Those are both pandemic era lows, and that should be astounding to all of us. This problem has two main causes. The first is that the rollout of the 2023 vaccine, as I predicted, has been let me find the technical term, hot garbage. Remember, this is the first year of commercialization, a fancy word for saying that the government is now focused on making sure that the corporations that manufacture these vaccines can make more money off of it than they are in making sure that people actually get the vaccines. So rather than anyone being able to get any vaccine anywhere vaccines are offered. Instead, there is a piecemeal approach to who can get vaccines where. If you’re insured, don’t bother going to your local health department. Their supplies relegated to uninsured and Medicaid eligible people. But if you’re uninsured or Medicaid eligible, then don’t bother going to the local pharmacy. You can’t afford it. See the problem here? What’s even worse is the fact that many nursing homes can’t crack the absurd bureaucracy this created, meaning that only 7% of the country’s most vulnerable people to COVID have gotten the booster for it. It’s a perfect demonstration of just how broken health care incentives can be. We’ve made it harder to get a vaccine that for years we’ve been saying is absolutely critical, simply so that the manufacturers can make more money. And you know what the outcome will be. Not only won’t the vast majority of Americans get their booster, but the companies won’t make much money either. And you know what? It serves them right. The second issue, though, here is simply apathy. Look, we’re just not experiencing nearly the number of cases that we had been at this time last year, or certainly not the few years before in 2020 and 2021, but 3% coverage? That’s a real problem, considering that we simply don’t know where this virus is headed and there’s still the risk that it’s got one last evolutionary gasp inside it. And that, I don’t have to tell you, could be catastrophic. So, look, if you’re one of those 93% of Americans who are eligible, who have not gotten vaccinated, what are you doing? Go get your booster, please. Thanks. In other news: 

[clip of unspecified news reporter] 42 states led by California’s attorney general, have filed a major lawsuit against the parent company of Facebook and Instagram, META, accusing it of damaging the mental health of their youngest users. 

Dr. Abdul El-Sayed: They allege that META, you know, the purveyors of Facebook, Instagram and WhatsApp knowingly, quote, “designed, psychologically manipulative product features to induce young users compulsive and extended use.” Those features include things like push alerts, infinite scroll and disappearing stories. Make no mistake, the fact that social media is deliberately designed to be addictive is not in question. I mean, talk to any adult that, you know who uses the stuff. That’s the whole point of these platforms after all. To own more market share of your eyeballs and eardrums, to push you ads to sell you stuff. That’s the business model. But there are ultimately two questions that the attorneys general have to prove. That META specifically and knowingly targeted kids and that there was demonstrated harm. The harm part is where I want to focus here. As we discussed in an episode on this topic a few months ago, American teens and to a less extent teens around the world are facing a mental health crisis. And while it’s en vogue to blame the pandemic, it started far further back. Rates of depression, anxiety, isolation and suicidal thoughts began to hockey stick upwards in the mid 20 tens. Just as teen social media also began to skyrocket. And it’s not just individual use. It’s the way that social media has fundamentally reshaped the circumstances of teen social dynamics, pulling more and more of their lives into the online simulacrum. I’m glad that government leaders are pushing back. I just wish that instead of 42 attorneys general that, well, the federal government could get its stuff together and move on this. And finally, as of this Sunday, more than 7000 people, 3000 of them children, had died in Israel’s aerial assault on Gaza leading up to their ground invasion over the weekend. Every single life deserves its dignity. And that’s why I condemned and will continue to condemn Hamas’s brutal attacks on Israel on October 7th. It was vile and wrong. But what of the lives of innocent Palestinians? Hamas’s attack took 1400 lives. Even before the ground invasion, Israel’s attacks took 7000. Five times as many. The only way the loss of a life justifies the loss of five others is if you devalue those five others. And I’m afraid that as these bombardments have taken place, the conversation that’s been had about them has done just that. I’m particularly ashamed by the way our leaders have engaged in this. 

[clip of President Joe Biden] We just have no notion that the Palestinians are telling the truth about how many people are killed. 

Dr. Abdul El-Sayed, narrating: Question the body count is to devalue the people underneath it. And yes, it’s true that Gaza’s health ministry operated by Hamas, keeps the body counts. Ideally, we’d have independent entities like the U.N. or independent media on the ground to verify them. But you know why we don’t? Israel has either driven them out or attacked them in their indiscriminate destruction of Gaza. Since October 7th, Israel has killed 57 U.N. staffers and 29 journalists. In any other circumstance, you’d probably have heard about this already. Chances are this is the first time you’re hearing about it, or the 500 American citizens that are stuck on the border with Egypt that cannot get out. And if you’re outraged by it, there’s one answer that we should be calling for a cease fire now. This is a public health podcast, and I try to leave the international affairs work to folks like Tommy and Ben, who are far better versed on this than me. But I’m a doctor and a public health official, and I have to remind us all that war is the single most frustrating public health problem because it almost always can be avoided. And it should be. And it must be. And if we have a voice, we have a responsibility to call for its avoidance. So it’s shocking and shameful to me that our leaders seem to be walking us into yet another Middle Eastern war with no end in sight. It could cost us tens of thousands of lives, decimate what’s left of our reputation abroad. It could even cost young American servicemen and women their lives. We don’t have to take it. We could choose another way. And that’s why we need a cease fire now. If only our leaders had the courage to call for it. And that’s it for today. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producers are Tara Terpstra and Emma Illick-Frank. Vasilis Fotopoulos mixes and masters the show. Production support from Ari Schwartz. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sarah Geismer, Michael Martinez and me, Dr. Abdul El-Sayed, your host. Thanks for listening. [music break] This show is for general information and entertainment purposes only. It’s not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests and do not necessarily represent the views and opinions of Wayne County, Michigan, or its Department of Health, Human and Veterans Services.