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If you have the option of shopping at a full-service grocery store or strolling the local farmer’s market, then you should consider yourself lucky. Scratch that – you should consider yourself privileged. Many of my listeners can put themselves in this category. After all, you have the time to listen to this podcast. It’s important for members of this group to have their eyes opened to the experience of others, those that don’t have the same access where the closest place to shop for perishable foods is a dollar store.
My guest on this podcast episode is Dr. Mark Cucuzzella, a professor at West Virginia University School of Medicine. Dr. Cucuzzella has real, front-line experience in working with populations with limited resources. They may be several miles from the nearest grocery store, have limited kitchen tools, or live in poverty.
Mark has been instrumental in establishing programs that help to level the playing field for these folks. The WV FresHealthy Bucks is a program that doubles the value of participants’ SNAP benefits when used at farmer’s markets. Folks can purchase veggies, fruit, and MEAT – basically, anything that is normally eligible with SNAP.
Dr. Cucuzzella is also busy with clinical work, establishing low carb menus, and removing sugar-sweetened beverages at the clinic where he works. Plus, he is currently running a pediatric obesity study using the Obesity Medicine Association’s literature on low carb methods of weight loss to treat children in the West Virginia area.
Mark is a busy guy but he’s taken time out to chat with me about his work. Listen in to find out about:
- The health issues people in West Virginia face
- How to eat healthy at The Dollar Store
- The rise in fatty liver disease
- Long-lasting farmer’s market produce
- The risks of being obese as a child
- The anti-meat narrative and how it’s being presented to medical students
- Better ways to measure heart disease risk
- The importance of viewing science through the lens of evolutionary biology
Also, be sure to check out Dr. Cucuzzella’s book he co-authored with Kristie Sullivan: Low Carb on any Budget – A Low-carb Shopping and Recipe Starter. This guide has easy recipes with simple and available ingredients, all while being budget-friendly. You can download the PDF for free or view the online version.
Resources:
Sustainable Dish Episode 87: Dr. Mark Cucuzzella
Jefferson County Community Ministries
Sustainable Dish Episode 53: Kate Sillman on “HIP” benefits hurting local meat sales
Sustainable Dish Episode 178 & 64: Lily Nichols, RD on nutrition during pregnancy
Sustainable Dish Episode 191: Frédéric Leroy, PhD on the Global Burden of disease
Physicians Committee for Responsible Medicine (PCRM)
Coronary Artery Calcium (CAC) Score
Carotid Intima-Media Thickness Test (CIMT)
American College of Lifestyle Medicine
Sustainable Dish Episode 187: Melissa Urban on plant-based Whole30
Connect with Dr. Cucuzzella:
Websites: Dr. Mark’s Desk | Run for Your Life Book
Instagram: @markcucuzzella
LinkedIn: Mark Cucuzzella
Episode Credits:
Thank you to all who’ve made this show possible. Our hosts are Diana Rodgers and James Connelly. Our producer is Emily Soape. And of course, we are grateful for our sponsors, Patreon supporters, and listeners.
Quotes:
“It’s gonna take a long time before the top item purchased with an EBT card at the Dollar Stores is eggs because right now the top food purchase nationwide with your EBT card is soda.” – Dr. Mark Cucuzzella
“Fatty liver disease now, it’s the number one contributor to liver transplants. And there are not enough healthy livers anymore on the planet to transplant these livers.” – Dr. Mark Cucuzzella
“If something doesn’t make sense in the light of evolutionary biology, your hypothesis is probably wrong.” Dr. Mark Cucuzzella
“Kids who are obese, medically obese at age six, their odds of becoming a normal weight adult are slim, like slim to nil.” – Dr. Mark Cucuzzella
Transcript:
Diana Rodgers, RD 00:01
Welcome to the Sustainable Dish Podcast. I’m Diana Rodgers, a real food registered dietitian, author, and sustainability advocate. I co-host this podcast with James Connelly who was a producer on my film Sacred Cow. I also founded the Global Food Justice Alliance an initiative, advocating for the inclusion of animal source foods like meat, dairy, and eggs for a more nutritious, sustainable, and equitable worldwide food system. You can check it out and join me at global food justice.org. Thanks again for listening. And now on to our show.
Diana Rodgers, RD 0:39
Welcome back to the podcast everyone. Today I have with me Mark Cucuzzella. Did I pronounce your last name correctly?
Dr. Mark Cucuzzella 0:46
Sure did, first time.
Diana Rodgers, RD 0:49
So this is your second time on the show. And we met at some low carb conference or I don’t remember when it was maybe at the Ancestral Health Symposium or…
Dr. Mark Cucuzzella 1:02
Yeah. We met in Iceland. I think mostly on longevity. We connected there and that was a great trip. Pre-pandemic.
Diana Rodgers, RD 1:10
Oh. Right. Yeah. That was a great trip. That was super fun. Actually, I met Dr. Panda there. And I’m gonna see him in London at this health optimization. So another longevity conference actually. We’ll be among the older crew at that longevity conference with a bunch of 30-year-old biohackers.
Dr. Mark Cucuzzella 1:33
And Dr. Panda’s, I’m 55. So he may even be a little north of me, but he still looks pretty good. My Circadian Clock so look him up if any of you all are interested in Dr. Panda’s work.
Diana Rodgers, RD 1:44
Not only is he fascinating, he’s just so nice. It was really fun. Like it was a fun group of people to go to the Blue Lagoon with and stuff, you know. So Mark…
Diana Rodgers, RD 1:54
He was way off his circadian. He was in LA
Diana Rodgers, RD 1:55
I know. I know.
Dr. Mark Cucuzzella 1:58
And here he is, like, one day later having dinner in Iceland, so it was the middle of the night for him I have to figure out his strategy. How did he pull that off?
Diana Rodgers, RD 2:07
Yeah. And you and I are east coast, but he was coming all the way from wherever San Diego or wherever he lives. And he was such a lovely dork about his lightometer little app that he had on his phone and like measuring the flux at different airports. And it was really funny.
Dr. Mark Cucuzzella 2:26
He convinced me to get a lightbox. I have a lightbox now buy my laptop in the morning, you know. So when it’s dark, and you’re waking up and clearing in your inbox, you’re getting that 10,000 What is it? 10,000 lumens. It costs about 30 bucks now on Amazon. They used to be very expensive. These little lightboxes,
Diana Rodgers, RD 2:42
You know, I had one, but it really irritated me a lot. It was very blue. Like when they first came out. It was just the most… I just found it very, like irritating and frustrating to have this like blue light at me. But now I think they’re a little more yellow. And that’s okay. Or I don’t know, what’s the hue of the light?.
Dr. Mark Cucuzzella 3:03
It looks like a little picture frame and it’s white. This is the one to wake you up to set morning, not the one to help you go to sleep, like the blue blockers I guess. But no, it’s looks pretty much like a white and it’s not so bright. And you can adjust it a little bit. That and a cup of coffee, I think starts the day pretty well. I think the coffee is doing more than the light. That’s my N of 1.
Diana Rodgers, RD 3:28
It could be you have a super interesting background. I would love for folks to just learn a little bit. It’s been quite a long time since you’ve been on the podcast. You’re down in West Virginia where I mean, the health issues that you see are much different than what I see here in the Boston area. So give folks a little bit more context of what you do and the populations that you work with.
Dr. Mark Cucuzzella 3:55
Yes, I’m a professor at West Virginia University School of Medicine. So working in the state with either number one or number two obesity, and that’s childhood and adult which translates to number one or number two diabetes. So it all travels together. Plus we’re like the least active state and you know, global happiness scales that are one of the most unhappy places. A lot of poverty, Appalachia. So there’s a lot of social determinants of health working against people. A lot of people on SNAP dollars trying to feed their families. You know, so you name the barrier to getting well it’s present in our state, but probably not uncommon to any other rural community. You could be in rural Massachusetts, rural Maine, even the urban areas, you know, if you have economic disparities, and we’re trying to help. I work in a clinic that takes all comers. You know, we have a lot of Medicaid and have a lot of Medicare patients. We have some insured, pretty well-to-do patients. So it’s a mix, but the strategies are pretty similar. We started a lot of unique things here. We started low carbohydrate menus in our hospital about 10 years ago because in the hospital setting, you know, if you have diabetes, they feed you the ADA diet of 60 grams of carbs and it blows up your blood sugar. So that was one of our first changes was just an option, we can not feed you that stuff. We can feed you double eggs, double meat, extra salad and not give you a side of insulin with your meal. I mean, it kind of makes sense. And we published a paper on that with both of our good friend Adele Hite was part of that paper, you know, who just passed this week, you know, tragically sad. Great partner and innovative thinker and all of this. We got sugar drinks out of the hospital, and that was about four years ago, and the revolt has not happened yet. I think we’re good. They opened a clinic that allows me to do low carbohydrate because there was a kind of a fear that where are these patients going to go in the hospital when you start taking medicines away. And, you know, so we have a clinic now that allows me to advise people to come off of carbs and reduce medications. And we published a paper last year, on the protocol of how to do this in a primary care clinic. We had like 30 authors from five continents on that paper. because this is a worldwide movement. Your movement, farmer markets, you know, so we want to attach people to local foods. So we’re at about year six, now, Diana of a double SNAP program at our farmer’s markets, that’s where people can use their EBT cards, which are food stamp cards if you don’t know the modern language of that, and it doubles it. So you can take that go to your local farmers market, we have three farmer markets here, with amazing local food. You can get meat, eggs, cheese, or you can get vegetables and fruit. Just something that was real, grown locally or raised locally. And that doubles. So it kind of makes that bar a little more equal as far as cost, because yes, it is more costly to buy better quality stuff. But they meet a farmer and they learn a little bit about the food. And I think when people learn like wow, like, learn where your chicken came from, you know, or your cow, I mean, I have CSAs with a number of these farmers, and you know, trying to teach kids you know, like this chicken lived a good life. And this is part of the cycle and versus, you know, maybe a Food Lion rotisserie chicken, which Food Lion would be a big grocery store, whatever the one is near, you know. But these are the people that come to the market. So that was a nice stride and it’s still going. We keep raising money for those projects through grants. And we’re starting and I enrolled two patients today. We’re starting a pediatric obesity study here in the literature. If you look at what’s effective for pediatric obesity in the OMA’s (Obesity Medicine Association) own literature, the only method that’s actually shown moderate to good effect on obesity as low carb, but yet it’s not promoted. So all we’re really doing in this trial is the standard of care. So, but it’s hard. We have an RD, just like yourself, we have an RD attached who’s the main person in our study, who’s going to be kind of the companion coach. Because it’s hard. You know, the two families today, you know, okay, how are you going to keep this 12-year-old, you happy eating eggs and meat and salads. Gotta make it interesting. You know, I had one family this morning, enroll who lost their home to a fire. So they’re trying to do low-carb living in a hotel with a fridge and a microwave. So maybe you have some ideas. And that’s a challenge right there. They have a little stove like a little… They have to hide it because it’s against, I guess, standard hotel. So you got to sneak in a little burner that’s plugin. They have an outdoor grill. So in the summer, there’s a little outdoor grill, which is like a sure grill, but they’re dealing with that until you know until their home gets built. So everyone’s got issues, right. Everyone’s got barriers, but what we want to do is be able to help people overcome these barriers.
Diana Rodgers, RD 8:54
Yes, well, when I was… when I was starting the film, Sacred Cow, we actually did a lot of filming with Dr. Sarah Hallberg. Dr. Hallberg who also unfortunately recently passed away, then, as you know, has a great study on low carb and we actually followed a bunch of her patients and what the folks in Lafayette, Indiana were dealing with was much more intense than what a lot of the clients that I work with here in the Boston area deal with and so we had a kid who was 16 years old, no mom in the house, lived with his dad and his grandfather who kept on buying doughnuts even though they knew that this kid wasn’t supposed to eat them. They wouldn’t stop eating them. So they ended up buying a locked box to keep their food in to lock it away from the boy and that was just a side story that was pretty shocking. And then this kid, you know, qualified for free school lunch. But of course, it was so full of sugar. They would do the, you know, the breakfast for lunch with the waffles and the syrup and all that kind of stuff. And so we actually followed him into Walmart and watched him buy the things he needed to buy on a low budget just to keep himself on a low-carb diet. And so, I appreciate so much the work that you’re doing in the community that you’re working in. Because when I interface with people in the regenerative ag movement, who say, it needs to be grass-fed or nothing, or, you know, we need to go more plant-based. If you can’t afford grass-fed meat, you should eat, you know, beans and rice. What they’re not understanding is your reality and my reality of trying to help people just get healthy. And so if it’s just the Food Lion chicken, that’s still going to be better than all of the other options.
Dr. Mark Cucuzzella 11:06
They are better than the Food Lion chips. You name, like anything in there, but no 100%. Kristie Sullivan and I, we could share it in the show notes. But we wrote a book low carb on any budget, which I give out to patients. It’s awesome.
Diana Rodgers, RD 11:22
Yeah, I’d love to see that.
Dr. Mark Cucuzzella 11:24
And you can do this at The Dollar Store. The purpose of… I would say in my state, half of the people, their first access to food is The Dollar Store because they’re living in these food deserts. You know, there’s no real grocery store more than 60 minutes to get to a real grocery store. So they make it once a month to the real grocery store. But everything else is at The Dollar Store. And you can get eggs, you can get meat, you can get frozen vegetables. I mean wherever you are, you can get that stuff. And it’s supply-demand. The more people start purchasing those products at The Dollar Store, you know, they’re just going to keep getting more of that. So it’s gonna take a long time before you you know, the top item purchased with an EBT card at the Dollar Stores is eggs because right now the top food purchase nationwide with your EBT card is soda. Because it’s allowed. It’s terrifying, isn’t it? Yeah, like this is endorsed by our government that you can use your federal dollars to buy soda. It’s the number one item purchase. So we’re dealing with policies that now you could look at cigarettes, right. It’s hard for a teen to smoke, you know. It’s not affordable, it’s not acceptable. And it’s not accessible. These kids, Diana that are enrolling in the study, they are not allowed to eat school lunch. I mean, that’s really sad. Like it’s a hard stop because our goal is less than 30 grams of carbs a day. And they get and I can show you links to the menus because they actually post the macros. They get 200 plus grams of carbs, and it’s all processed in breakfast and lunch. And these are like first graders. And you’re like, Whoa, that’s for an adult. This is a first-grader getting, and then they go home to pizza and Mountain Dew. So this is just school breakfast and school lunch. 200 grams of carbs, right there. These kids will never, ever, ever be healthy people because, you know, we’re subsidizing it. We’re directly giving them the toxin. And why that is so confusing to people or creates so much controversy is beyond me. The science is, you know, it’s solid. 100%. Right. My other partner in the study, you know, the one who sees the canary in the coal mine. So it’s a collaborative study. I have a pediatric endocrinologist and a pediatric GI doc. Because what’s the first organ affected by the fructose? The liver. So yeah, like her clinic is filled with fatty liver disease is not a disease. It’s a syndrome of fructose and sugar toxicity. And we call it a disease. And then I think in the medicalization of the world, people think, well, this is just a disease like you get it like COVID or something.
Diana Rodgers, RD 14:06
Yes. Progressive, incurable, yeah
Dr. Mark Cucuzzella 14:10
Well, I just got this disease. You know, it’s no, it’s the same as Type 2 diabetes. It’s a syndrome of your body’s inability to handle the amount of carbohydrates you’re throwing at it. But there’s not enough livers to transplant all these livers. I mean, I know that’s kind of a morbid, morose thought. But, you know, fatty liver disease now, it’s the number one contributor to liver transplants. And there are not enough healthy livers anymore on the planet to transplant these livers. So like, when is the Armageddon coming? It’s like you and I both right, with the agriculture. It’s like this. You’re like Chicken Little. You’re like the sky is falling, the sky is falling. The sky is falling. It’s falling. It’s already fallen. It’s here. It’s like no one sees it. But you just keep shouting from the mountain. Right? All right, die on the hill. You know, that’s all you could do.
Diana Rodgers, RD 15:03
Yeah. And so when we talk about, you know, hoping that people buy more dollar store eggs and things like that, I’ll often get accused of well, she promotes CAFO chicken Dollar Store eggs, how evil. It is still 100% possible to advocate for sustainable local, regional food systems and want people to eat Dollar Store eggs if that’s all they can access. It’s gonna be better.
Dr. Mark Cucuzzella 15:30
If it’s all they can afford.
Diana Rodgers, RD 15:31
You know, we followed one clinic patient of Dr. Hallberg to a food bank. And the challenges of being low carb in that environment are really intense as well. You know, trying to get protein from a food bank is really hard.
Dr. Mark Cucuzzella 15:47
We work really close with our community. We call it Community Ministries here, which is the food bank and the director is a huge advocate of low carb, so he actually keeps a freezer for the like the diabetes patients because, you know, the only – everything else and there’s a nonperishable, you know, out of the kindness of their heart donated by Boy Scout groups and such like that, you know, but everything’s all these food drives. It’s actually like, Well, you look at what people are getting rid of, you know, everyone kind of feels good about that. But the person on the other end of that you know. Just know that you have to be careful who you give those toxins to because they are… Some of our markets here, larger supermarkets are starting to not display… they throw away sell-buy vegetables, right, so we’re trying to make some partnerships with Walmart and a couple of the other larger, Martins is another one that… that you got to turn that stuff pretty quick, right? Like, if it’s about ready to go, you know, and they’re gonna throw it out when maybe they can get the asparagus to the food bank, right. But they got to get rid of it in a few days or else. And then you need fridge space. There’s a lot of issues with trying to get real food. That’s, you know, vegetables go to waste and fruit goes to waste. Tons of meat and eggs tend not to go to waste. I mean, think of have you ever thrown away meat or eggs from your directly from your freezer in your life?
Diana Rodgers, RD 17:15
I personally absolutely do not.
Dr. Mark Cucuzzella 17:18
It gets eaten. That stuff stays pretty good. As long as you know, you keep it frozen, and then or the fridge for the eggs. Veggies go fast.
Diana Rodgers, RD 17:28
You know, another thing you brought up that I thought was really interesting is the double EBT. I did a podcast with a meat farmer here in New England who was really feeling frustrated because in Massachusetts, there was a program called HIIP and it was basically doubling the dollars, but only for produce. So you know, your $6 pint of organic raspberries, you could get but not you know, the local liver or ground meat that is less perishable, healthier, cheaper per pound and by nutrient by far, but the meat was not included in the program, only the $10 bag of organic green mescaline mix and the raspberries, you know. So we did a whole show about that.
Dr. Mark Cucuzzella 18:26
Was that an issue? Some of the states Diana who double there’s all these different programs now and sometimes the funder of that makes that a stipulation. Ours, we raised our own money so we could make our own rules, which was kind of good. But maybe that was part of that. I don’t know. Was it a matter of like that state’s Food and Farm Coalition was only doubling the produce?
Diana Rodgers, RD 18:47
I don’t know who was in charge of it. But yeah, we were quite critical of it. Let’s talk a little bit more about kids and how the work that you’re doing, like the study that you’re doing. And also just the unique challenges with children in their food and, you know, kids environment, right, because it’s so normalized. I mean, I have teenagers, for the most part, they’re pretty healthy, but they have a vehicle they can go, you know, as teens, they can go get their own food. They feel less impacted. They’re less connected to the fact that they might develop something down the road, you know, I mean, Type 2 diabetes isn’t something that’s necessarily going to happen to you in a month. Right.
Dr. Mark Cucuzzella 19:34
Exactly. I want to just mention one other thing about the farmer’s market produce, which is very interesting. So on Sunday, I cooked a frittata, and I was throwing all my leftover vegetables. And I had some kale that was cut over a month ago from a local farmer. And it was still pretty damn good. It was perfect. A little brown. But the stuff that’s local, like by the time that if I’d gotten my grocery store kale, and it was probably already a month old. But if you’re out there listening, and you’re like, oh, it’s gonna go bad. The farmers market produce, like I’ve had bags of spinach, you know, as long as it’s kind of like tied up, like sit in there for like six weeks. And it’s still pretty good. Yeah, it’s the stuff lasts like a crazy long time when it’s cut, like that day,
Diana Rodgers, RD 20:21
I can totally attest to that having eaten that way for the last 18 years, for sure.
Dr. Mark Cucuzzella 20:28
It lasts through the summer, but not maybe not that long. But…
Diana Rodgers, RD 20:32
It also just makes you appreciate it, and it feels good to buy directly from the person,
Dr. Mark Cucuzzella 20:39
And you’re not going to throw it out. Because unless you forget about it in the back of your fridge. And that’s happened before, you will eat it. And even if you have to throw it in an omelet, you know, if it’s not servable to guests. You know, you just sauteed a little bit, throw it in your omelet, and it’s delicious, you know, and adds those nutrients, you know, all those micronutrients in the dark veggies is really powerful. But yeah, so the kids, you know, so they’re already starting life, you know, in their own endzone, so to speak. You know, you talk about how you get ahead in life, you know, you want to be at least starting on your own 20. You know, maybe moving forward. So and Lily Nichols, I think, you know, Lily, and maybe
Diana Rodgers, RD 21:17
I’ve had her on a couple of times.
Dr. Mark Cucuzzella 21:20
Right? So, that the mother who is insulin resistant obese creates a child, intrauterine who’s already insulin resistant, obese, right? Those children are born with macrosomia hyperinsulinemia. They get hypoglycemia. So these kids already have about, you know, depending on what you read, maybe a 6x risk of developing Type 2 diabetes as an adult, so they’re already starting in trouble. That children, their brains are wired for the processed food and sugar, even more so than the adults. So when the food industry, which really controls the advertising, almost all first foods for kids are processed foods, and most of them contain added sugar. And I don’t think that’s by accident, you know. These kids’ brain starts to ping, like, and that’s what they want. They’re irritable, they crave the stuff, you know, when they can use words they asked for it. But it’s rarely encouraged by the food industry because it’s all kind of greenwash. Right, like, you know, a Go-gurt yogurt will say, you know, how the front of the label, you know, honey nut cheerios, and then the how many teaspoons of added sugar are in there. It’ll say whole grains. I mean, it’s everything you talk about, like the front of the package is a warning label, right? If it says heart-healthy, organic, you know, whole grain. You just gotta look, flip it over, and look at the actual ingredients of that. But it’s not just the carbohydrate, it’s the added sugar too. You know, kids are starting and even the AAP came out and had to acknowledge that we shouldn’t be feeding kids juice. So, okay, they can have fruit. I mean, they used to encourage juice that like six months of age as a healthy thing, but it’s the same thing as soda. So now they’re discouraging juice, at least until after a year. But I would say like, why would you ever give a child juice? Right? There’s nothing in that is going to help that child right? You might as well give them Mountain Dew. It’s very similar. Just I mean, you can have the kids have some fruit, chew it, get the fiber. But yeah, and a couple other just sad facts. You know, I did a couple of talks on peds obesity recently, because I’ve done a lot of prep to write this grant. Age six tends to be like a deflection point. Like kids who are obese, medically obese at age six, their odds of becoming a normal weight adult are slim, like slim to nil. Because many things are happening metabolically, endocrinology, endochronologically. Is that right?
Diana Rodgers, RD 23:46
I know what your intent is with that word.
Dr. Mark Cucuzzella 23:49
Their hormonal dysregulation is happening very early. And when kids have these rapid growth phases, you know, the adipocytes, the fat cells can undergo hyperplasia, meaning they multiply or they hypertrophy. So these critical times is you know, you’ve got kids, right, they just, they’re growing like crazy. And they’re eating like crazy. They’re not growing because they’re eating, they’re eating because they’re growing. But there’s this rapid growth phase, you know, when like, right before age six, and then again, adolescence, like that six-year-old timeframe. If you’re a kid who’s normal weight at age six has pretty good odds, even in the modern world, of being a fairly normal weight adult. That kid is overweight at age six, is in trouble, that kid’s going to struggle. And then these, like every kid we’ve enrolled so far in this trial, they’ve all been heavy, since early age, so we don’t know… I mean, we could really do everything we can to keep these kids on, you know, the Virta food list, right? So it’s all the “eat plants and animals, mostly animals” you know because plants have carbs other than the leafy greens. You know, so even when kids stay with this, you know, I think there’s gonna be some kids, it’s like, okay, they’re just still not moving. We’re going to be using breath ketone meters. There’s a device called Biosense. And they were kind enough to contribute their devices for the kids that want to use them to kind of gamify it a little bit. So if they’re not blowing any ketones, then we got to, you know, dig in a little bit. Like, where are those hidden carbs? You know, they’re probably getting something somewhere. These are kids. So yeah, if they’re blowing some level of ketones, they’re probably at least somewhat sticking with it. So right, you’re trying to give them tools to empower them. Make it fun. And like you’re saying that you know, when we consent the children for this study, we consent the children, as well as the adults in the room because they have to, the parents have to assist right? They can’t be a saboteur. But the 12-year-old does not even know what Type 2 diabetes is. Right? They have, they don’t care at all about that. So there has to be something in it for them. Like, why would you want to ask this to every child, whether they’re enrolling in a study or not? Oh, yeah, why do you want to do this? I don’t want to be picked on, you know, I want to have more energy, I want to be better and say they’re a football player, you got to somehow figure out, because they really don’t care. They don’t even know what the term obesity means. They kind of know it because some of them are picked on. But they don’t know all the fatty liver stuff. They don’t see that or the diabetes, they have to have something tangible to make them not want to eat a Chick fil A sandwich with a roll later tonight. Right? Yeah, none of us have figured it all out. But the intervention is powerful. When it works short-term studies in kids, the only method of weight loss that’s effective is carb reduction. Because like nothing else hormonally works because it’s hormonal dysregulation, and we don’t want the kids hungry. So there’s things that go against a lot of traditional dietary advice, which children still get, you know, so they’re not counting calories. They’re not weighing food, and they’re not going to be hungry. And we promise them that. Look, if you’re hungry, here’s some things you can snack on. Which of these look cool? Oh, I like cheese, you know, salami stick, you know, like, maybe they’ll learn to like some veggie sticks, but like, we don’t want them hungry, because they will eat.
Diana Rodgers, RD 27:14
That’s the biggest. That’s the biggest driver for even in my practice.
Dr. Mark Cucuzzella 27:19
Yeah. Everyone that’s hungry will eat. 100%
Diana Rodgers, RD 27:21
Yeah, well, I know, we also wanted to talk briefly about some of the plant-based bias and the anti-meat stuff, which is really harmful to our overall goal, your goal and my goal, which is to you know, the protein and healthy fats and meat are what these folks who are metabolically broken need, right? And so this anti-meat, and all we need to do is just eat more plant-based. It’s not just something that you know, I post, often social media memes and stuff from Vox from The Economist, from the New York Times – those are just the three massive ones that are the highest offenders. But we’re seeing this with the Global Burden of Disease. I did a podcast recently about the researchers not showing evidence for why meat is all of a sudden, 36 times more likely to kill you. But you’re seeing this also in some of the guidelines and in some of the supplements of the journals. And so I did want to make sure we have time to talk about some of that stuff.
Dr. Mark Cucuzzella 28:29
Yeah, that’s a great observation. I’m on the front lines of what gets fed to medical students, medical residents. I’m a family doctor, general practitioner, you know, most of us are so busy everyday and just trying to clear the electronic medical record inbox. So we really can’t look at the methodology of observational studies versus randomized controlled studies. You know, what is the or does it meet Bradford Hill criteria of causation? All that stuff like red meat causes cancer? It’s like, Wait, this was like 1.2. And this was in the context of highly refined processed things and processed diet. Like no one… they get that it’s evidence-based therapy, right? If some authority figure you know, some organization, the CDC, you know, the USDA, if someone sounds authoritative, and they’re giving a consensus recommendation, you know, we’re actually beholden… Like, I’m actually studying for my every 10-year boards, which I take next week, and I’ve got to unlearn so much stuff because every answer is what does the US Preventive task forces, the CDC, the American Heart Association. So basically, the correct answer is what these organizations state in their consensus statements, but what you see kind of fed to the medical students and the residents because they don’t know it. These organizations sound legitimate. You know, so I think we shared the PCRM the Physicians Committee for Responsible Medicine, so they’re giving away to every medical school this blue book clinicians guide to nutrition – nutrition guide for clinicians, you know, it looks pretty legit. It’s got a bunch of…
Diana Rodgers, RD 30:05
Nice and thick and it goes through these disease cases and how each one is caused by meat.
Dr. Mark Cucuzzella 30:11
Yes, yes. And the plan for each disease state and its whole food plant-based diet,
Diana Rodgers, RD 30:15
Every single one.
Dr. Mark Cucuzzella 30:16
Yeah. And I actually had to intercept this because they showed up at our dean’s office, and I was giving a talk to the students. And okay, here, I know you’re into nutrition, can you give them this book? It’s a free book, and I look at it, I’m like, hold on. I’m not giving them this book. But anyone else wants to just give it out? Right? And if it’s given out by your institution, it’s legitimate. So and another organization, and I think, you know, people can go to their website, right, people can go to the PCRM website, see, see who sponsors them, see, you know, what their conflicts of interest are, what their agenda is, and who their members are.
Diana Rodgers, RD 30:56
Right and I’ll just say this, because I’ll get in less trouble maybe than you. But they are neither physicians nor responsible for the most part. And they are largely funded by PETA. And so that’s who’s sending free nutrition booklets to medical students. And let’s face it, medical students, and this is not a secret, medical students don’t get a ton of nutrition, no education in school. And so this handy little booklet with every disease state and how you can fix it with the whole foods plant-based diet could be handy to somebody who doesn’t know.
Dr. Mark Cucuzzella 31:33
And they’re very eager learners. They’re like, Oh, no, because they all are very passionate about health, right? That’s how they got into this and like, oh, wow, here’s a tool, I can help people not get sick, right. But they don’t know the biology, and they don’t have clinical experience yet. So I think people need a lot of clinical experience before you can, I mean, it took me years of doing things wrong. You know, when we were all taught the same thing. And I had to end up getting kind of sick myself, I have a condition called MODY maturity-onset diabetes of youth where I barely make insulin. And I needed to keep my military commission. So I had to turn the food pyramid upside down. And like 72 hours after wearing a CGM, and seeing what was happening, I was like, oh, I need to like, fix this immediately. And I’d read enough on obesity and low carb working with the Air Force’s fitness program that I knew that it was a safe way of eating, and I just needed to adopt it. myself. I had no fear at that time that I could eat five eggs a day. I’ve eaten that way for 12 years, and my calcium score is still zero, and that’s the coronary score. So anyone who’s saying, you know, eating that many eggs puts plaque on your arteries, everyone’s an N of 1, right? So we’re an N of 1 experiment.
Diana Rodgers, RD 32:47
Oh, will you back up? And just so people who come to me freaking out about their high cholesterol, their doctors put them on a statin? And I tell them go get the CAC. Yeah, so will you please explain a little bit why that is the marker and what that test is all about?
Dr. Mark Cucuzzella 33:06
Yeah, there’s two… So cholesterol doesn’t cause heart disease and it’s at the scene of the crime, but it’s not the murderer. And these are the small BB size LDLs, not the big beach ball LDL. So LDL is not bad cholesterol. It’s… there’s good bad cholesterol and bad cholesterol, but you need some level of arterial damage. Right. So that is the root of it – some level of arterial damage. And that could be smoking, it could be metabolic syndrome, pre-diabetes. It could be air pollution, there are some genetic variants, could be stress. So if something is creating some inflammation in the arteries that allows the opportunity for these smaller dense LDL to penetrate the endothelium. There’s other markers that are better, like ApoB, which is another whole talk. And genetic markers such as LP little A so it’s like everyone that comes in is like a puzzle. The bottom line is don’t get heart disease. Now, if you’re 25, you’re probably won’t have any calcium on your arteries yet, even if you’re destined to get heart disease because you’re too young. The progression of atherosclerosis is soft plaque, and then you get little plaque ruptures and then you develop these little scars, which is calcium, so it takes a bit of time before someone’s going to get these scars. But if someone walks in at age 60, you know who’s had high cholesterol their whole life, man or woman who’s otherwise looks really well their HDL is high, their trig is low, but they have high LDL, you know, the deal breaker, the tiebreaker of do you need a statin or not is a CAC score – coronary artery calcium. If their score is zero, meaning absolutely no plaque on their arteries, their odds of a plaque rupture are near zero. And even the prospective studies show there is no benefit from a statin because their odds of a plaque rupture is near zero, so you can’t make that odd any better. Now, if they for some reason, have a ton of plaque on their arteries, then you got to dig into it a bit more. So there might be a role for a statin in that group. But you better figure out why they have plaque on their arteries, right? Treat the fire, not the smoke. If they’re diabetic, pre-diabetic, smoking, stress, circadian. Dr. Panda, I mean, there’s just crazy stuff that can figure out why they have plaque on the arteries. Lock that down and maybe with shared decision making, right, that’s what we do with patients. You know, I just got a CAC score back on a 50-year-old patient today who has an LDL of 500. But she’s uber-well, she’s pretty much eats a carnivore diet. Her CAC is zero, which is good. Yeah. And she’s uber-well, I mean, she is probably one of those lean mass hyper responders that she may even enroll in Dave Feldman’s trial because she meets all those criteria: super high LDL, super low triglyceride, eating a low carb diet, and lean, strong, fit. And LDL was like off the rails terrifying because we don’t know yet like is that over the course of 20 years nefarious? Clearly right now score zero, she’s pretty good. But what we want to know is, okay, is there some early markers? The other test that you can do is called a CIMT, which is carotid intimal, medial thickening, blah, blah, blah. That is, it’s an ultrasound over your carotid. But that one will actually show some soft plaque, which, in addition to the hard plaque, which is more downstream, that’s a scar. So the earlier changes are going to be changes in the soft plaques. For a younger person, if you want to follow them for two years, three years, you might want to consider that test. You know, if you’re listening and you’re 30 years old, and your doctor wants to put you on a statin, certainly like if your CAC scores above zero, figure that out, but even at a zero, you might want to make sure that other test is fine.
Diana Rodgers, RD 36:45
Hmm. Interesting. There was one more study that you had pulled up on your computer that you wanted to talk about really quickly. So I’m gonna let you do that.
Dr. Mark Cucuzzella 36:57
There’s not really a study, it kind of is in line with the influencers to all the hundreds of 1000s of general practitioners out there, the ones kind of churning and burning in the clinics. They don’t have time to dig deep in the literature. So we rely on some of these trade journals on most, you know, Journal of Family Practice, American Board of Family Practice some of the bigger name trade journals. And there was a supplement to the Journal of Family Practice about three months ago. You know, so that it comes in a little wrapper, you know, almost like your junk mail ads, right. It comes in a little wrapper, so you have the journal and then there’s an addition to that. There’s a supplement. And it was all on lifestyle medicine. And I was like, this is curious. And, you know, it’s flipping through and everything was plant-based way of, Type 2 diabetes plant-based way of heart disease prevention. You know, it’s like, this is really curious. There’s not a single thing sharing what is consensus in the literature now, even from the American Diabetes Association, you know, and then the American Heart Association, right. So their journals have said, “Okay, we’ve exonerated saturated fat.” So it’s pretty much opposite. Everything that’s been out in the main journals from these specialty groups, you know, they’re acknowledging low carbohydrate now. And then I’m kind of like who’s writing this and kind of up in the upper left corner is the supplement was sponsored by the American College of Lifestyle Medicine. So basically, these things look like medical journals. They look legitimate, but it’s an advertorial. You know, it’s basically it’s sponsored, so they have their arm and the American College of lifestyle medicine, similar to the PCRM, it sounds pretty good, right? They sound…
Diana Rodgers, RD 38:42
That sounds like a great thing, lifestyle medicine.
Dr. Mark Cucuzzella 38:46
I’m into that. Like, I run and I get people outside.
Diana Rodgers, RD 38:49
Yeah. I eat well, healthy. Yes. Sunshine, sleep. It’s good.
Dr. Mark Cucuzzella 38:54
Yeah. And all anyone needs to do after the show is just, like, look up their website, look who they are. It’s a Seventh Day Adventist group. It was founded by them, funded by them. There’s not a single animal product on the entire page. And then you look at their research, they’re pulling small observational trials, you know, things that don’t meet any clinical significance. You know, so unless you make diabetes go away, as our good friend Sarah Hallberg did and publish, not like make it a little better, you know, make it go away. You can’t say it’s helpful because you got to make it go away.
Diana Rodgers, RD 39:31
Right. And so there’s no interventional trials at all showing that a whole food plant-based diet…
Dr. Mark Cucuzzella 39:36
No. Makes it go away. No, no, no,
Diana Rodgers, RD 39:39
But yeah, a low carb high animal diet…
Dr. Mark Cucuzzella 39:44
Yes, it can. Yeah. And we published a study here. A pilot study with new diabetic patients in 2/3, in four months, no medications made their diabetes go away. So yes, whether they’ll sustain that for the rest of their life, they can, I believe, that they eat that way the rest of their life. But you know, there’s going to be forces against them. But yeah, I think you have to trust but verify maybe. Isn’t that Donald Rumsfeld way? Like when you see something, you got to really look, even reading journal articles. They’re all funded by pharma, you know, all the studies say who stands to gain? You know who’s behind this study or the supplement, this textbook? You know if it goes against evolutionary biology, right there you got to hold caution.
Diana Rodgers, RD 40:31
Exactly, exactly. I mean, it really all comes down to… And that’s what’s so nice about everybody who’s interested in the worldview of evolutionary biology, because that sets the tone, then for everything else moving forward. And if it doesn’t fit, it doesn’t even make sense within the circle of evolutionary biology, then it’s likely hippie science.
Dr. Mark Cucuzzella 41:00
Yeah, that’s hard to find evidence… if it goes… Yeah. Evolutionary Biology is really – nothing makes sense, except in the light of evolution. I’m trying to remember who said that quote, it’s like a world-famous quote because that really is the foundation of science. Right? If something doesn’t make sense in the light of evolutionary biology, your hypothesis is probably wrong. And you better have a really good experiment to prove that your hypothesis is right. Because that’s why we do science,
Diana Rodgers, RD 41:26
Not just an observation. Yeah.
Dr. Mark Cucuzzella 41:29
You can just eat plants and live long and well, you know, but, you know, back to the kids, you know, that. if this trickled down, maybe you could take an adult, you know, who’s been eating omnivorously, too many carbs, fully obese, and get rid of junk food, right? Like a Whole 30. Right, just get rid of all the junk, they’ll do better than…
Diana Rodgers, RD 41:47
Even a plant-based whole 30. Whole 30 has a plant-based Whole 30 that I fully endorse for folks that are absolutely not willing to eat meat And I had Melissa on the show, we talked about it. We talked about why I endorse it, you know, I get why…
Dr. Mark Cucuzzella 42:02
100% It’s very helpful.
Diana Rodgers, RD 42:03
Right. Right. But the whole foods piece is critical
Dr. Mark Cucuzzella 42:08
And a lot of protein in that you know
Diana Rodgers, RD 42:11
Right there’s, no reason why then adding animal source foods would make that in any way worse. Right? Like it will only enhance a whole foods diet to incorporate some fish or beef. Yeah,
Dr. Mark Cucuzzella 42:26
But kids, I firmly believe, kids need animal products. Because they’re growing, right? They need all… they need the B12. They need the full plate of amino acids and essential fatty acids, right? They don’t have say in the game, right? They don’t have… they can’t make a conscious decision that, you know, ethical, religious, whatever people want to make later in life that they don’t believe animal agriculture is good for the planet. People can have their own opinions later in life, but a child should not be subjected to that. It has to be scientifically pure. When you’re in the room with a child and get every other bias, belief, religion, environmental argument that has to be out of the room at that moment.
Diana Rodgers, RD 43:12
I 100% agree firmly on that as well.
Dr. Mark Cucuzzella 43:15
They don’t have capacity. You know, they’re not emancipated yet.
Diana Rodgers, RD 43:19
And they absolutely have the birth rate to an evolutionarily appropriate diet, which absolutely includes animals sourced foods.
Dr. Mark Cucuzzella 43:28
And then when they get, after high school whenever, then they can get influenced by whoever they want. You and I try to make that influence, scientifically based, but they’re gonna see everything. Well, I know you have to go.
Diana Rodgers, RD 43:44
I know. I have a kid I have to bring to a game right now. It was so nice to… I hope to run into you at another conference soon. And, you know, thank you so much. Ping me in the future.
Dr. Mark Cucuzzella 43:57
Say “Hi” to Dr. Panda.
Diana Rodgers, RD 43:58
I know. I will say hi to Dr. Panda. And you have a great day. And how can people find out more about your work real quick before we go? They can find you… You’re on Twitter, right?
Dr. Mark Cucuzzella 44:07
I’m not on Twitter. I have a website Dr. Mark’s Desk.com, which links to – I wrote a book called Run for Your Life has a lot of stuff in there on health. That’s another website Run for Your Life. book.com. I can send you those links with the link to the low carb on a budget book.
Diana Rodgers, RD 44:26
Oh, yes. I want to see the low carb on a budget book. That’s right.
Dr. Mark Cucuzzella 44:29
Download it, share it. It’s on a tiny URL, so it’s like a PDF. And Kristie Sullivan, who you’re probably familiar with, is wonderful. She’s from North Carolina and knows how to cook this way on a budget. The recipes have been tested on her kids.
Diana Rodgers, RD 44:45
Oh, fantastic. Okay.
Dr. Mark Cucuzzella 44:45
They’re legit. All right.
Diana Rodgers, RD 44:49
All right. Have a wonderful day.
Dr. Mark Cucuzzella 44:53
Enjoy the New England day.
Diana Rodgers, RD 44:53
Thank you. Bye-bye.
Dr. Mark Cucuzzella 44:54
Bye.
Diana Rodgers, RD 44:57
Thank you so much for tuning in to the Sustainable Dish Podcast. If you enjoyed the show, please leave us a review on iTunes and check out my website at sustainable dish.com where you can sign up for my newsletter, catch up on the latest blog post, and check out my courses and favorite products. See you next time and thanks again for listening
