Why food cravings are killing us, and how to stop them

Mark Schatzker on the biology of craving, the dangers of fooling the brain, and why food should be delicious.

WRITTEN BY

The Levels Team

UPDATED: 07 Nov 2023

PUBLISHED: 11 Feb 2023

🕗 28 MIN READ

Mark Schatzker is the author of Steak, The Dorito Effect, and most recently, The End of Craving. His work has appeared in multiple outlets, including The New York Times, The Wall Street Journal, and Annual Review of Psychology. He is currently the writer in residence of the Yale-affiliated Modern Diet and Physiology Research Center.

The Origins and Biology of Craving

Dr. Casey Means: I was blown away by your book, The End of Craving: Recovering the Lost Wisdom of Eating Well, which was particularly impactful to me for a couple reasons. One, it really made me think about things differently. It introduced me to concepts I’d never thought about or heard of before, like nutritive mismatch—which we’ll talk about—and what that means for our health, and for our obesity and chronic disease epidemics. Two, it’s filled with many amazing stories. 

Let’s start by defining and breaking down what cravings actually are. A lot of people have had that feeling of “I’m craving x.” For me, sometimes it’s dark chocolate and almond butter. But what’s actually happening when we feel a craving? What’s the physiologic response occurring in the brain?

Mark Schatzker: Craving is simply desire—desire at its most intense. It has a negative connotation. We think we’re victims of craving. To some degree, that’s true. But it’s important to understand this is a natural thing. It’s there for a reason. If you look at humans or animals in a natural context, it performs a very important task.

What do people do when they’re starving? They crave food. They become absolutely fixated with food. The same is true if you’ve ever gone on a long run on a hot day and you become really thirsty. You start to crave water. You feel it. It completely seizes your mind.

In high school, when we look at the journals of British sailors who were suffering from scurvy, we learn how they had these swollen gums. That’s true; they did have swollen gums. But the first symptom was a craving for fruits and vegetables. The craving is the brain saying, “I need you to get something that’s really, really important for survival.”

Craving comes from a good place. But that doesn’t mean, in our modern world, that it’s always a good thing. That is one of the focal points of this book, because one of the most interesting things about obesity is that we tend to think of it as a disease of pleasure, that people with obesity lose themselves in the pleasure of the moment, and just don’t know when to say enough is enough. That’s not what the neuroscience tells us. The neuroscience tells us that obesity is much like starving, in the sense that it is a disease of craving.

Imagine it’s time for a milkshake. Everyone thinks that when an obese brain takes a sip of that milkshake, it just loses itself. It lights up like a Christmas tree. That’s not what the neuroscience tells us.

What the neuroscience tells us is, upon seeing the milkshake—upon receipt of the cue, as the psychologist would say—the trim brain says, “That looks like a nice milkshake.” The obese brain says, “I’ve got to have that milkshake. That milkshake looks like the best thing ever.”

When it comes time to actually sip and taste that milkshake, in the obese brain, the pleasure response is blunted. It has this massive craving for a milkshake, and yet the milkshake isn’t actually all that fulfilling. Whereas the trim brain says, “That looks like a nice milkshake.” It takes a sip and thinks, “Wow, that’s a great milkshake.”

Craving really is a miserable condition. It is such a distorted and terrible relationship with food, because people are tortured by a craving for an expectation of pleasure that is never really fulfilled.

Dr. Casey Means: In the book you describe how, up until about 50 years ago, we were able to resist overconsuming food. We may have had an abundance of food, but we had to store food for winter at times, and we didn’t just go and eat all of it.

Now we’re in this situation where we literally can’t resist the food. There’s an insatiable craving, and you talk about how obesity is actually a disease of craving. What has changed over the past 50 to 100 years, so that we are no longer able to resist the food that is in front of us?

Mark Schatzker: That is the nub of the question. It’s interesting you say we’re no longer able to resist. But maybe we weren’t resisting 50 years ago. Maybe we weren’t tempted in the same way.

There’s this idea that we are wired to be obese, that we evolved in this environment where calories were unreliable, foods could be scarce. It just always made sense to eat a little bit more. And now in this modern food environment where we’re surrounded by all these calorie-rich foods, we’re sitting ducks. I don’t think that makes sense. It’s important to truly understand the nature of the brain and its relationship with food, because it’s the only way we can understand this problem.

For one thing, in an evolutionary environment, if you’re carrying extra weight, it makes acceleration less efficient and slower. It makes coming to a stop or turning quickly much less efficient. You’re less nimble. It’s going to be harder to catch prey, and you’re more liable to become prey.

If you are carrying around extra weight, let’s say 20 pounds of fat as energy insurance in case famine comes knocking on the door, that is a really inefficient way to go about your life. It’s like driving a very big car. What does a big car need? It needs more gasoline. Well, a big body is the same way. If you’re trying to navigate around a calorie-scarce food environment, if you’re carrying extra calories, you have to eat lots more calories just to maintain those calories. It’s a really bad strategy to use in a calorie-scarce environment.

This whole idea that we are forged by the Stone Age to be hungry ogres—that the appetite is dumb, permanently hungry, always turned on—is just wrong. We know this because of dieting. The brain controls our body weight.

When people go on diets, they work for only about six or eight months. This is part of the problem, because people think the diet is working. Then around the six- or eight-month mark, the pounds start to come back on and people blame themselves. They say, “The diet was working. I failed.” That’s not what is happening. What is happening is the brain is intervening and says, “I know you’re losing weight, and I want you to gain it back.” People snap back to their old weight.

But it also works the other way. When scientists do overfeeding studies, which they’ve been doing since the 1950s, it turns out that getting people to eat too much food is nearly as miserable as starving. 

The first scientist who did this was Ethan Sims. He tried to do it at college. Everyone thinks college students are permanently hungry. He couldn’t get them to eat too much food. They just didn’t want to. He had to go to a state prison. Even there, prisoners were dropping out of the study, it was so miserable. When that experiment came to an end, the pounds melted away. They snapped back to their old way, just as dieters do. There’s evidence that the brain has a pretty good idea of how much it wants you to weigh.

> There’s something wrong when a brain has made a decision to say, “I need to eat more food.” That is the question we need to ask. What could cause a smart brain to say, “I need to eat more food”?

We think of the sensation of eating, of flavor and sweetness and taste, as this frivolous thing. We think this gets in the way of nutrition, and takes us to a bad place. That could not be more wrong. It is your brain’s way of measuring the nutrients that come into your body. The brain is obsessed with measuring.

In the book, I talk about a study done by a scientist from the National Institutes of Health named Kevin Hall. He studied people taking a drug called canagliflozin. This is a drug that diverts sugar into the urine. It’s used for diabetics, and was diverting about 360 calories of sugar a day into their urine. He noticed that for every pound they lost, there was a commensurate uptick in their appetite, until they were making up for this loss of 360 calories by consuming an extra 350 calories. Talk about accuracy. But these people had no idea. They didn’t know if they were taking a placebo; they were just taking this pill. This all happened unconsciously.

This really reframes the idea of overeating and obesity, because this isn’t just us falling into our natural inclinations given to us by evolution. There’s something wrong when a brain that manages body weight, and is obsessed with measuring the nutrients that come in the body, has basically made a decision to say, “I need to eat more food.” That is the question we need to ask. What could cause a smart brain to say, “I need to eat more food”?

Dr. Casey Means: That feels like the crux of the book, that this may actually be caused by something very different from what we conventionally think about as part of the obesity conversation. Maybe, with the advent of processed food and this completely new food environment we’re living in, our brain is really confused. This amazing measurer that is so finely tuned is not really sure what’s going on.

Nutritive Mismatch: Fooling the Brain 

Dr. Casey Means: We used to have these visual and sensory cues that gave it a good sense of what was coming in from the mouth and to the stomach, and now it’s completely lost. What’s going on there? What is happening physiologically, and what is happening with our motivation mechanisms that are causing us to overeat this way?

Mark Schatzker: Let’s first talk about the importance of this measuring of nutrients coming in. We do that with our nose and mouth. We experience it as taste and flavor. But to your brain, this is information.

If you think of your DNA as your instruction manual to make you, the thickest chapter is on making the nose and the mouth. That is how important nutrient detection is to the brain. Only recently have we started to mess around with those signals. They were always very stable. 

Let’s discuss an experiment done at Yale University by a woman named Dana Small, because once you understand this experiment, the pieces start to fall into place. She began the experiment by asking a simple but important question: Is it possible to create drinks that are just as rewarding as a sugary drink, but that pack fewer calories? 

This is the dream of things like artificial sweeteners: Can I scratch this itch I have for sweet things but not get that wall of calories in the gut? If that’s possible, wouldn’t that be great? We can go around drinking all the sweet, delicious things we want, but not pay for it in terms of all these calories that accumulate as body fat.

It’s an interesting question, but how do you answer it? This is what makes Dana Small such an interesting scientist. She devised five novel drinks. They all had a distinct flavor and color. They were all made equally sweet with an artificial sweetener called sucralose. They all tasted like they had about 75 calories worth of sugar.

Then she used a tasteless starch called maltodextrin to give each of these drinks a different calorie payload. She gave these drinks to subjects, and they went home and drank them. The brain, as I told you, is obsessed with measuring. Their brains drank, sipped, tasted, learned. And the brain doesn’t just measure what’s in the mouth; it also measures what’s in the gut. It’s called post-ingestive learning. The brain gets a case report on each of these drinks.

Then Small invited the subjects back to the lab, and stuck them in the brain scanner, where they sipped each of these drinks. How are these brains going to respond to these drinks? Are they going to like them all equally because they were all equally sweet, and the brain just likes sweetness? Then, if it tastes sweet, that’s all we care about. Or, is the brain smart, and is it going to measure these drinks and say, “I like the 150-calorie drink because I’m a calorie hog”?

Dana Small was expecting one of these two outcomes, and it turns out there was only one drink that really generated a big brain response. That was the 75-calorie drink. It just didn’t seem to make a lot of sense: the one right in the middle. Not the 150-calorie drink, not the zero-calorie drink. It didn’t really make sense. She did the experiment again, and it happened again.

Now she sort of kicked things up a notch, and she put her subjects in something called an indirect calorimeter. This is a device that measures what’s called the thermic effect of food. When you consume calories, the body starts to expend energy. We can measure that in terms of the heat that’s given off to process those calories. The more calories you consume, the bigger the thermic effect.

One day, a female subject in her early twenties comes in and drinks the 75 calorie-drink. There’s this beautiful little plume of heat, just exactly like you’d expect. That’s what the physiology textbooks say is going to happen. Everything’s going great.

A few days later, she comes in and drinks the 150-calorie drink. What do we know from physiology and how the body burns calories? There should be a bigger plume of heat. But there’s no plume of heat. The metabolic response is flat. This woman has consumed 150 calories, and it’s like she drank a cup full of air. What on earth could be going on? Dana Small is flummoxed.

Then it hits her: It’s the number 75, because all the drinks tasted as though they had 75 calories worth of sugar. But only one drink actually had 75 calories worth of energy in it. That’s the drink that was metabolized properly. That’s the drink that got the brain excited.

This tells us something very important: Sweetness isn’t just this frivolous sensation from the Stone Age that’s meant to pleasure us for no good reason. It is information, and the accuracy of that information is crucial. When everything lines up—when the sweetness matches the calories—the beverage is metabolized properly, and the brain responds to it properly. But when it’s mismatched—when the taste does not match the calories—everything kind of goes awry. It doesn’t get metabolized properly. The brain doesn’t respond to it. 

What happens to these calories? They’re floating around in the blood, and the brain almost isn’t even aware of them. This is kind of frightening, because you’re dumping nutrients into your body, and they’re not getting processed properly.

She did more experiments, and she found that this prompts symptoms in the body that are similar to metabolic disease. She did a study with adolescents. This is really important because adolescents are in a period of bodily growth. That’s why a lot of teenagers drink juice. They drink pop, they eat chips, they eat pizza. They can really pack it away because they’re in a period of growth. The body does need energy.

She found that when she gave these adolescents mismatched drinks, they actually had to bring the study to a screeching halt, because they drew blood from three subjects early on, and they were already looking pre-diabetic. 

This is disturbing, because we see that when you start to mess around with the sensory signals in food, it doesn’t get metabolized properly. But let’s ask a deeper question. Let’s talk about the fundamental nature of the brain itself. I told you how the brain loves to measure. Why does it love to measure? Because the brain loves to predict. 

A lot of neuroscientists are talking about the brain as a prediction engine. The reason we have the senses—the sense of sight, the sense of hearing, the sense of taste, the sense of touch—is so we can draw a map of the external world, and thrive in that external world. We draw a representation of it, which lets us predict what’s going to happen.

For millions of years, a crucial signal—sweetness—was stable. Sweetness meant calories. The sweeter something was, the more calories it had. Now we have this funny situation where maybe that’s not true. You could have a sweet drink on a Monday and get a bunch of calories. You could have a similarly sweet drink on a Tuesday and get no calories, or get a bit of calories. And then on Wednesday you have the same sweetness, and you get lots of calories.

This signal that was stable all through evolution has very recently become unstable. What is this? Psychologists call this uncertainty, or, more precisely: reward, prediction, error. It basically means the brain had a predicted reward in mind. That reward didn’t happen. How does the brain respond?

This is where things get really interesting. The brain responds with increased motivation. When the brain doesn’t get what it thought it was going to get, how does it respond? It’s almost like it gets a little ticked off. It says, “I really want that thing I didn’t get, because I thought I was going to get it. And this time I really want to get it.” It’s going to work extra hard to get it.

This is what evolution has given us. Evolution did not design us to want to stuff our faces, but it did design us to respond to uncertainty with excess motivation. Why? Because when something important like food becomes uncertain, that whispers that there’s a possibility you might not get it. And if that keeps happening, you’ll starve. You’ll die. We’ve created this environment where there’s a lot of uncertainty in our food.

I use artificial sweeteners as an example. But uncertainty is baked into so much of the food we eat. There’s not just artificial sweeteners, there’s fat replacers. Everybody knows about artificial sweeteners. Nobody knows about the multi-billion dollar fat replacer industry. Maybe you’ve scratched your head and wondered, “What the heck is light mayonnaise, anyway? What is a light salad dressing?” It is technology companies have created to create the illusion of rich, fatty calories in the mouth, and deliver just a dribbling of calories in the gut. 

> You’re fooling your brain, and your brain will have the last laugh. It’s going to say, “Don’t do that to me. I’m going to get what you tried to take away.” We have incited this kind of artificial state of excess hunger by tampering with the sensory qualities of food.

This is a great idea if your brain’s just a hungry moron from the Stone Age—fool that brain. If your brain is smart, and obsessed with measuring, this is a terrible idea. You’re fooling your brain, and your brain will have the last laugh. It will have the last word. It’s going to say, “Don’t do that to me. I’m going to get what you tried to take away.” This is what we see in neuroscience: excess motivation. People with obesity crave food too much. We have incited this kind of artificial state of excess hunger by tampering with the sensory qualities of food.

Dr. Casey Means: That is a mind-blowing explanation. One of the main points I’m hearing is that when there is a mismatch between what the brain thinks the stomach’s going to be getting based on taste and other sensory cues, and what it actually receives, it changes the way we metabolize the food.

The experiment you described is very interesting. In the book, you said that when the sweetness essentially equated to what 75 calories would be, the body metabolizes it properly. And all the cellular processes that break down carbohydrates and glucose, and process this, and form ATP—all this stuff—were working. But then when it was the same sweetness—we expected 75 calories, but it was actually 150 calories—it the metabolic processes inside the body post-digestion. The cellular physiology actually changed. Is that accurate?

Mark Schatzker: It just stops. It just comes to a screeching halt. It’s as if you invited 20 people over to a party, and you open the door and 50 people are there and you think, “Oh, my God. I don’t know what to do.” You just freeze. You freak out. You might think, “I’m calling the cops.” It’s something like that. It really seems to throw things into disarray. We don’t actually know why that is. That’s an area of further study that might have to do with the rate of gastric emptying. There’s so much more to learn here. But what we do know is that when the signal doesn’t match the nutrition, things don’t work.

I find it interesting how surprising we find this, because we’ve been so conditioned to think that taste and flavor is frivolous and unrelated to this important business of nutrition. Nutrition is always from the neck down. We always think of nutrients entering the body, entering the stomach—carbs, protein, fat.

It’s as though this experiential part that happens in the mouth is just frivolous and silly. But of course it isn’t. There’s a reason we have this experience, and of course it must mean something important for the way the body metabolizes and processes food. We’ve been so conditioned to ignore it that when we actually have really good evidence saying, “Hey guys, look at what’s going on,” It becomes such a surprise to us, which in itself is interesting.

Dr. Casey Means: Because we think of flavor as driving pleasure, we think we can really have our cake and eat it, too, by just getting as much flavor as we want, without considering the actual nutrients going in. It’s almost like an afterthought. We’ve decoupled these things. But you present this model of an integrated system of flavor, taste, and all the stuff that’s happening with the sensory cues of food as setting up a top-down series of downstream effects, which are related to how we process and metabolize that food. This is why the book was so impactful. We have really decoupled those things—to our detriment.

You essentially have the taste and what your body is predicting you’re going to get from a food. When that is mismatched with what the food actually provides, which is essentially the definition of processed food—it’s very much modified to be something it’s not—that is going to drive us to eat more. This is not necessarily about craving more of that flavor. It’s the fact that the brain is confused. There’s inconsistency between different iterations of what it’s getting. You might have a Diet Coke on Tuesday, and then a Coke on Wednesday, and a Diet Coke on Thursday, and a Coke on Friday.

It’s getting the same flavor, but different amounts of nutrients. It’s throwing the brain for a loop, saying, “There’s inconsistent nutrition coming in. This is a time of scarcity and inconsistency, and therefore I need to be driven to consume more and eat more.”

That is fascinating to me. I think you called it a reward prediction error, which could really be a link to the obesity epidemic and the processed food culture we’ve been living in for the last few decades. 

Uncertainty and the Signals Our Food Sends Us

Dr. Casey Means: One of my favorite parts of the book was the gerbil experiment with the seeds. Could you share that?

Mark Schatzker: It’s a great one. This really brings to light how uncertainty works. This was an experiment done with gerbils. They were put into a food environment. One was a very certain food environment, with a big bowl filled with seeds. Next to it was a bowl filled with sand, and there were seeds buried in the sand. It was paradise for the gerbils. They had all the seeds they could eat.

They didn’t really overeat all that much. It was kind of funny, because even though they could go to this big bowl and pig out on seeds, they seemed to enjoy digging around and pulling out the seeds from the sand, and eating at their leisure.

One day, they went from the certain condition to the uncertain condition. Now, the big bowl’s gone. There’s just the bowl with seeds, and there’s actually not that many seeds in it. The next day, while the big bowl’s there, there are only a few seeds. In the bowl with the sand, there’s hardly any seeds. Then it was moved to the left side of the cage. And things kept changing. The stability was gone.

What did those gerbils do? They really started to pig out. They didn’t seem to enjoy pulling the seeds out of the sand. If they could get a free seed out of that big bowl, they would go for what is called the most profitable bowl, the bowl that gives them the most for the least amount of energy.

In this uncertain food environment, we see this whisper of a loss. The world is whispering to the gerbil, “You might not get enough to eat.” What did they do? They freaked out and started stuffing their cute little faces.

Here’s the most interesting thing about that experiment: they always had too much food to eat. Even in the uncertain condition, there was more food than they could have eaten. But it was because of this change in the way their expectation of food was framed that it instilled this panic in them.

This might seem odd and unusual, but it happens to us. If I told you you’ve got to catch a flight at 5:00, and it takes an hour to get to the airport, and your watch says it’s 2:00, or your watch says it’s 3:00, it’s either an hour fast or an hour slow. What are you going to do?

Dr. Casey Means: Assume it’s early. 

Mark Schatzker: If I’m early, it’s no big deal.

Dr. Casey Means: Exactly.

Mark Schatzker: That’s right. Here’s another example. If your car fuel gauge was uncertain—it says it’s full, but you actually don’t know, it’s just not working—what’s your response?

Dr. Casey Means: Get more gas.

Mark Schatzker: You’re going to go to the gas station more often, because you think, “I don’t know how much gas is there.” And running out of gas sucks, right? You’ve got to call a tow truck. It’s a disaster. This is an emotional response we all have. This is a signal, an unconscious signal our food is sending us now.

It’s not just artificial sweeteners and fat replacements. Those are the two big ones, which is the industry trying to muck around with our sensory system. But there are all sorts of other things, like emulsifiers. There are things they add to ice cream so that it doesn’t form ice crystals. That’s good if you want to get a longer shelf life out of ice cream. But it also adds creaminess. Of course they’re going to use more of that if it makes it creamier. They put things in chocolate milk, for example, so that it doesn’t separate into the chocolate and the milk—because that’s unsightly. Nobody wants to buy that.

There are all sorts of things they add to food. They put stuff in microwave pizza so that you don’t get this oil puddle when you heat it up. These are called modified starches. There’s a massive industry in modified starches. I call them stealth carbs because they are carbohydrates that have no flavor. They’re just there to perform a functional role in processed food. You’re putting these calories in your body, and you can’t really sense them as they go in.

We’ve been divorced from the importance of the sensory aspects of food. Everyone thinks it’s no big deal because nutrition starts with nutrients in the gut being diffused in the body. That’s not how it works. The mouth and the nose—that is the gateway. That is where it all starts. And we’ve ignored it. We think it doesn’t matter. I’m saying it’s actually the most important part of nutrition.

Dr. Casey Means: It can be perplexing because we think we live in this environment of crazy food abundance. It’s everywhere you go. You’re just surrounded. In most grocery stores, the shelves are full and shiny. That’s the problem.

But from your perspective, that’s not the problem. It’s not that there’s too much food around. It’s what’s happening to our brains—the way food is processed is actually signaling to our brain when we eat it that there’s uncertainty, and there’s potentially a survival risk. That is such a different paradigm, but it makes so much sense.

It gets at this insatiable desire we have. It makes sense that this is tapping this deep, visceral, dopamine survival neurocircuitry. Like you said, when you look at the brain scans, it’s not actually generating that much pleasure. And yet, we are literally killing ourselves by eating so much of it. To unlock this new way of looking at things—of this being the survival brain getting hijacked, in a sense, and then utilizing the dopamine reward pathways to co-opt us—puts a lot of the puzzle pieces together in a new and interesting way.

> We’ve been divorced from the importance of the sensory aspects of food. Everyone thinks it’s no big deal because nutrition starts with nutrients in the gut being diffused in the body. That’s not how it works. The mouth and the nose—that is the gateway. That is where it all starts. And we’ve ignored it. We think it doesn’t matter. I’m saying it’s actually the most important part of nutrition.

Much of what I think about and focus on as a physician, and with what we’re doing with our audience and members at Levels, is fundamentally trying to move people toward eating a more thoughtfully grown, whole-food, unprocessed diet, and to have a better relationship with this miraculous substance that creates our body and also dictates the functioning of our body.

Motivating people to eat whole foods can be challenging. But understanding what whole foods or unprocessed foods are physiologically doing to our brain is a new level of motivation. Understanding why it’s important could have a huge impact if people adopt and incorporate this message. I’m very grateful you’re putting this out there.

The Importance of Pleasure: Where North America Gets It Wrong

Dr. Casey Means: We think a lot about empowerment at Levels: How do we empower people to live their healthiest lives? I believe empowerment starts with understanding the reality of what’s going on. Why do you think that this perspective hasn’t really made it to the mainstream conversation? You’re bringing it to the forefront. Why do you think we’ve struggled to have this understanding of our brains and what’s happening to them when we eat processed food?

Mark Schatzker: It’s a really good question. It seems clear to me, and it’s been something that has sort of been calling out to me. I talked to a lot of scientists about this. Slowly, the consensus will start to move in this direction.

Part of the problem is that as North Americans, we are suspicious of pleasure. We think pleasure’s a bad thing. We’re conflating addiction with pleasure. We think things that taste good are actually addictive.

This is wrong. Maybe the most important aspect of addiction is that pleasure is gone. When heroin addicts talk about using heroin, or alcoholics talk about using alcohol, they are seized by cravings for it. When they’re in the grip of the craving, they’re convinced it will bring them pleasure. But it no longer delivers pleasure.

We talk about whole foods. I agree whole foods is the way to go. But there’s almost this idea that that’s boring. It’s like going to church, or community service. The food nature creates is the most delicious of all. Fritos, Lay’s, Pepsi, Coke—they don’t have anything on mother nature: strawberries, a great peach, an amazing steak, mushrooms… But we’ve been conditioned to think of healthy eating as boring, like it’s going to suck, like it’s going to taste terribly. That’s part of the problem.

When you look at the food cultures with the highest standards for food, the three I think of are Italy, South Korea, and Japan. These are countries where the food is of an incredibly high quality, and they’re very picky about what they eat. They are in far better shape in terms of obesity and metabolic health than we are. That’s telling us something really important that we’re getting wrong. Food needs to taste good. Food tasting good naturally is not a bad thing. It’s a very good thing.

Dr. Casey Means: You get into the Italians quite a bit in the book. When you look at the rates of global obesity, of course the US is right at the top. Then you’ve got Italy much lower down, with about 20% obesity. South Korea is way at the bottom near Japan, with around 5% obesity. These are also modernized, industrialized countries, with tons of access to products they want. What is going on? Where did the trajectories go awry between the US and these other modernized countries that love food, and yet have a fraction of the obesity we do?

Mark Schatzker: I focus on Italy because Italy is a Western culture. There are many Italian immigrants in North America. I love South Korea and Japan, but I think they’re culturally more different. 

The most interesting thing about Italy is it really explodes one of the myths about food, which is that delicious food takes us to a bad place. Italian cuisine is famous. I really focused on Northern Italy, in particular the city of Bologna. That’s where we get that kind of famous, maybe infamous, lunch meat. They call it mortadella. I would say it’s a finer creation, more of a crafted, artisanal product.

One of the biggest differences between the mortadella you get in Bologna and the bologna you find in supermarket shelves here is that in Italy, you see these cubes of white fat. They are not afraid of eating fat in Bologna.

They are obsessed with food. They have a repository in their chamber of commerce where they keep an official list of recipes that tell you how to make lasagna, how to make tortellini, which is that wonderful little dumpling filled with pork and prosciutto and Parmesan cheese. It must be served in a broth made with farmyard chicken. They are fastidious about it.

They have these two religious orders. One is the Brotherhood of the Tagliatelle. This is their favorite noodle. It’s made with the two nutrients we’ve been living in fear of, carbs and fat. It’s made with eggs and flour. And they make this fantastic noodle, which they use with their famous Ragu Bolognese. This is not the Mediterranean diet. This is not fish, this is not olive oil. This is pork, cream, pasta, butter. It’s really rich food.

If rich, delicious food is what makes us fat, then the Northern Italians should be the absolute plumpest people in the world. What is so stunning is that not only are Italians thinner by a long shot than North Americans, Northern Italians are skinnier than Southern Italians. 

The NHANES survey has been measuring obesity in the United States since the early ’60s. It has never been that low. We’ve never been as skinny as Northern Italians. And they’re eating this absolutely fantastic, rich, delicious, amazing diet. It’s so good that people travel by plane just to eat with their eating.

On the one hand, this is actually really hopeful. It is possible to literally have an amazing cake—the world’s best cake—and eat it, too. That’s really exciting. But then I wanted to understand what’s going on. What is it that makes Northern Italy different from us?

I started to turn back the pages of history. At one time, Northern Italy wasn’t much different as it was similar, specifically to the American South. This is going back a little over a century ago. In Northern Italy, there was an epidemic called pellagra, which means “rough skin.” The disease started with farmers’ wives, who would get a scale on their hand. It started in spring, and then went away in the summer. But then it would return the next year. Eventually it would overtake their whole body. Their hands would become these hideous appendages. They would get diarrhea. They would become demented and confused. Eventually they would die.

They had no idea what was causing this. Some people thought that if you lived too close to a river, spores would get into the blood and ignite. Some thought it had to do with eating rotten food. It’s hilarious, some of these old-time medical explanations.

In 1904, pellagra suddenly popped up in Georgia. Just as in Italy, it became an epidemic. It spread from state to state. It’s very much reminiscent of our obesity debate, because all these experts were pounding their fists on the table saying that they had the answer. Some said it was clearly a disease of infection—a virus or a bacterium. Some said it was spread by flies. There was a sandfly contingent, there was a mosquito contingent. They would argue with each other.

One day, an epidemiologist named Joseph Goldberger got sent to a sanatorium in Tennessee. Everyone thought this guy was nuts. He said things like, “Don’t clean up the puke on the floor. Don’t change the bedsheets. Keep everything as it is. I just want these people to eat different food.” They start eating beans, cheese, milk. Everyone thought, “This guy is a total lunatic.” But it worked. He got in during the fall. By the spring, there was one case of pellagra left. But nobody believed him. 

Then he went to a prison in Mississippi and created pellagra. He got permission from the governor. He said, “If I can do this experiment on these prisoners, will you let them go free?” The governor consented.

Goldberger gave them what’s called the pellagra diet. They ate a diet of grits—corn meal—which is what the Italians were eating, polenta. They ate pork fat and molasses. And then he induced pellagra. Eventually, people started to realize that this guy knew what was going on. This led to a very important discovery, which is that of vitamins. Goldberger wasn’t the only one, but his research helped us understand that food isn’t just food. There are vital elements within food that are necessary for the continuation of life. If you don’t get these elements, you die.

Early on they were called vital amines. We now call them vitamins. The American government responded to pellagra differently than the Italian government did. The American government put on their lab coats and said, “If people need niacin, let’s give them niacin. Let’s put niacin in white bread. Everybody eats white bread. Let’s also do thiamin and riboflavin—two important B vitamins. Let’s also do iron.”

That’s called enrichment. It started with white bread, and it spread to pasta. Now it’s in everything. It’s in donuts. It’s in basically all our processed carbs, also in breakfast cereals. It worked beautifully. Pellagra just fell off a cliff.

Over in Italy, the response was almost medieval. They could have added niacin to polenta, but they didn’t. They said, “We should bake bread in communal ovens. And you know what poor people should do? They should raise rabbits, because rabbits are an economical form of meat.” Some people said that if you had pellagra, you should have a glass of red wine, which is just so Italian. It’s funny. They have a nutritional deficiency, and they say to have a glass of vino.

It wasn’t bad advice, though. Not that anybody knew it, but the wines back then weren’t well filtered. They had lots of yeast. And yeast is loaded with niacin. If you got pellagra, red wine  was a really good idea. The Italian method also worked. It didn’t work as quickly, but Italy ate its way out of a nutritional epidemic.

Let’s fast forward to the present, because these two regions could not be more different. Northern Italy is the seat of Italian culture, fashion, Ferrari, Maserati. Northern Italy is this amazing place. The food is incredible.

The American South graduated from one nutritional disaster to another. What was once upon a time the pellagra belt is now the obesity belt. It’s also called the diabetes belt. If you look at the Southern US, it confirms our deepest fear about food, which is that you are either going to starve, or you’re going to eat yourself to death. But Northern Italy says, “No, actually you can have this great relationship with food.”

Then I asked, “Could enrichment have had something to do with this? Could putting vitamins in processed carbs have had something to do with this?” I’ll be the first to say this sounds wacky. We’ve had every theory of obesity in the world, except now there are idiots coming on saying it’s vitamins? There are no calories in vitamins. You can have one ton of vitamin C. There are no calories. What could the connection be?

> Food needs to taste good. Food tasting good naturally is not a bad thing. It’s a very good thing.

Here’s where things get interesting. Remember that diet that Joseph Goldberger created in that prison? What were they eating? They were eating grits—which is cornmeal—pork fat, and molasses. Carbs, fat, and sugar. It’s really hard to imagine a more calorie-dense diet, yet these people were starving. How is that possible?

That tells us our concept of calories equaling energy is wrong. We think of calories as putting gas in your car or plugging your phone into the wall socket to get energy. Calories don’t equal energy. For the energy and calories to be released, they have to be metabolized. To be metabolized, you need certain vitamins, certain B vitamins like niacin, thiamin, riboflavin.

I became convinced when I looked at 1950s pig farming. This was when things really started to come together. The goal of the pig farmer is to get pigs big and fat as quickly as possible. The faster they can turn over their pigs, the more money they can make. In the early 1950s, pig farmers knew that if you wanted to get your pig big and fat really quickly, you gave them a diet of corn with some soy. That just packs on the pounds. But if that’s all you give them, they die. Their hair starts to fall out. They get diarrhea, they crater, they lose weight. They’re basically getting something like a pig version of pellagra.

They knew that the diet was unbalanced. They didn’t really know why, but they said it was important to send your pigs out to pasture, where they would munch on alfalfa. Back then, all pigs were pastured pork. That’s trendy and more expensive now. But that’s the way all pork was, once upon a time. They knew that alfalfa was essential to balance the diet.

The discovery of vitamins changed everything. We talk about confinement farming. Vitamins made that possible. Now you could take your pigs, crowd them together in a barn, and give them that rocket fuel feed of corn and soy, and then dust in these B vitamins. They didn’t need to eat alfalfa anymore. Now their rate of gain took off.

I found pamphlets from the University of Iowa from the late 1950s that said the pig has a reasonable ability to balance its own diet, but there was now a better way. There was now optimal weight gain. What was that? It was giving pigs corn and soy with the B vitamins dusted in.

If you want to get your pigs big and fat quickly, that’s the way to go. But the problem we have as humans is that we get big and fat too quickly. What did we do to our diet? We did something that resembles what we did to the pig diet, and the chicken diet, and the cow diet: the confinement diet, which is to say, “Give them processed carbs and dump in the B vitamins, and they will rapidly get big and fat.”

Dr. Casey Means: Oh, my gosh. There are many fascinating elements of it. One is that it’s a case of  good intentions going awry. I could totally see the reasoning at the time. They’re fighting pellagra and thought, “Let’s enrich our flour, and these staples, and maybe it’ll help.” Now we are potentially paying the price for this. It’s hard to dig our way out. It’s fascinating to hear the full story.

The book got me reflecting on something I talk a lot about with metabolic health in our community, which is the importance of micronutrients for optimal metabolism. When I go to the grocery store, I’m on a micronutrient high—micronutrients being vitamins, minerals, antioxidants, etc., that serve multiple functions. They can be lock-and-key co-factors for enzymatic processing in the body. They can act as antioxidants. They can be incorporated into proteins like selenoproteins. All these things are really important for our cells to function properly. 

For our metabolic machinery to function properly, we need proper micronutrients. We’re also living in this funny time where we are fortifying food with some vitamins. Our whole foods are becoming less micronutrient dense, as our soil becomes depleted, and our farming practices become worse, especially with our monocropping agriculture. The average American is deficient in at least one key micronutrient.

That seems to be a big problem related to the fact that we’re not eating diverse, omnivorous, nutrient-dense whole foods, and we’re stripping a lot of our foods of different things.

I’m trying to put this together in my head, of how enriching foods with B vitamins is actually helping our body store it as fat more quickly, versus this other reality, where people are becoming vitamin or micronutrient depleted because of our processed food diet and our poor soil. How do you think through those different things going on?

Mark Schatzker: I was tortured by the same thought. The American approach is to say, “We’re dumb. We don’t know what’s good for us. Food is by its very nature incomplete because it doesn’t always have what we need. We will take the God-like hand of science to intervene, and we’re going to put in food what needs to be in there.”

The Italians took a different approach. They didn’t see food as the problem. They saw food as the cure. They said that the problem with these poor farmers was that they couldn’t afford good food. That’s why they said to grow rabbits. They said they needed to eat meat, drink wine, eat all these good things. It has this folksy, old-world quality, but they were right.

The difference comes down to complexity and simplicity. Nature is complex. There are many compounds in whole foods. We talk about ingredient lists being long. If you look at the ingredient list of all the compounds in a strawberry, it would be from here to the moon. There are tens of thousands of compounds.

The idea that we could enrich food to make it healthier is well intended. The problem is we are simplifiers. We just do a handful of things we think are important. We can’t come anywhere close to achieving the complexity and nuance nature does.

This is why I’m such a critic of things like plant-based meat, because there may come a time when we can equal the complexity of nature and create food that communicates with our body the same way actual food does. But we are far away from that, and part of that is because of our simplistic thinking.

When we do things like enrich and fortify food, we’re not trying to mimic the complexity of nature. People say that we enrich food to replace what’s lost in processing. That’s not true. The nutrient profile that’s lost in processing is nothing like what we add in enrichment. When we think of all the vitamins and minerals we need, not to mention all the phytochemicals and antioxidants—all the stuff companies are dumping into Rice Krispies or Multi-Grain Cheerios—it’s nothing like what you actually see in a plant. It’s not even a vague resemblance.

> Clearly, we’re getting the vitamins we need to process those calories into fat. But we’re not getting a truly nourishing diet. The diet we’ve created in no way fills in, or can in any way equal, what nature does when nature creates food. Maybe one day we’ll do that, but we’re not doing it now. I don’t even think we’re trying, to be honest. It’s a quick fix meant to make people think food is healthier than it is.

One of the reasons companies do this is because, unfortunately, they have the advantage that most of us don’t know a great deal about nutrition. A parent looks at the side of the cereal box and says, “Look at all those vitamins. This must be healthy.” What we’re getting wrong is it’s not in the right amount, not the right diversity, not the right nuance. It’s tilted a certain way.

A lot of people say there are too many empty calories in our food. If you think of something like sodas, that’s just empty calories, right? There’s just sugar. But if we were really eating this empty calorie diet, we’d be just like those southerners. We’d have pellagra.

Clearly, we’re getting the vitamins we need to process those calories into fat. But we’re not getting a truly nourishing diet. It’s lacking in all sorts of ways. We’ve torqued it this way and that. But the diet we’ve created by doing that in no way fills in, or can in any way equal, what nature does when nature creates food. Maybe one day we’ll do that, but we’re not doing it now. I don’t even think we’re trying, to be honest. It’s a quick fix meant to make people think food is healthier than it is.

Eat Real Food—and Enjoy It

Dr. Casey Means: It can seem pretty overwhelming—our motivation circuitry at the most fundamental level is being hijacked by our food environment. What is your personal framework for how we should be approaching our diet and our food, on the individual level, and on a systems level?

Mark Schatzker: Everybody’s after a quick fix. And there is no quick fix. We’ve gotten ourselves into a bad place with food. It’s taken time. It’s going to take us time to get out of that bad place.

On an individual level, I’m one of those very lucky people. I eat what I want, and I maintain a healthy body weight. I don’t diet. I weigh myself, and one day it’s a couple pounds up, one day it’s a couple pounds down. I realize how lucky I am. But the relationship I have with food should be the normal relationship everybody has with food. The question is, how do you get back to that?

When people say eat whole foods, eat real food, eat foods your grandmother would recognize—that’s true. But what I would add to that is, eat like an Italian. Eating food isn’t doing community service. Nourishing the body isn’t meant to be boring or painful. It’s meant to be joyful. Food tastes good for a reason, because it’s providing nourishment. Every meal should be an opportunity to indulge and enjoy what nature gives us.

Eating like an Italian means valuing food the way Italians do, which is honoring the goodness we get from the land and the sea. Italians have all these food rules. If you want to call a San Marzano tomato a San Marzano tomato, for example, it must be a certain type of tomato grown in a certain place.

The reason they’re saying that is because that’s their guarantee of quality, because they know when they grow this tomato, this variety, it tastes really good. They have all sorts of rules like that.

We’re nothing like that. I think things are improving. You can look at some things, like how we’re developing a more sophisticated wine palette. You look at the growth of artisan cheeses or craft beers—things are getting better. But we have to make a big deal over flavor, and celebrate it, and be willing to spend a little bit more money on food that really tastes good, in the right way—not by cheating.

Eat food that tastes like what it is. If you actually start to look at what’s in the ingredient list, you see things like artificial flavors and natural flavors, and you see artificial sweeteners and fat replacers. These are foods engineered to create a flavor image that deviates from what they’re sending to your stomach. Eat food that tastes like what it actually is. That will do your brain a big favor. By doing that, you’re eating foods that are automatically healthier.

We also have to develop a more sophisticated language around pleasure. I visited a clinic in Germany, and spent some time with a scientist there named Anja Hilbert. She does what’s called hedonic therapy. That means pleasure therapy. In science, hedonics means pleasure.

> Nourishing the body isn’t meant to be boring or painful. It’s meant to be joyful. Food tastes good for a reason, because it’s providing nourishment. Every meal should be an opportunity to indulge and enjoy what nature gives us.

She let me take part in this therapy. It made me realize how our brain can respond to food in two different ways. One of the first things she did was an exercise in making me experience this craving circuit that can take us to a bad place. She started with a cheese-and-onion-flavored bag of potato chips. 

She said, “Open the bag. Look at the bag. Look at the picture.” She opened it. It made a pop, and there was this woosh of aroma. “Just smell it. Inhale it deeply,” she said. “Take up two chips. You can nibble them, but you can’t munch them.” Then she instructed me to, “rub them together.” I thought that was weird, but I rubbed the chips together.

It was really, really odd. I was absolutely seized by an almost angry desire. I wanted to eat those chips. Then she said to throw them out. I thought, “Are you crazy? These two beautiful potato chips?” I threw them out, and then took these two new pristine potato chips. I did it again, and this craving washed over me. I wanted to eat them so badly. I’m someone who has a good relationship with the food, but I was brought to this place of total craving. I was angry. I really wanted these chips.

Then we did a different experiment. This was opening my mind’s eye to the pleasure circuit, which is different from dopamine. Dopamine is craving. Dopamine is desire. Pleasure is mediated by the opioid neurochemicals. This is true pleasure.

She gave me this little square of dark chocolate and said, “Just put it in your mouth and let it start to melt.” Nothing really happened at first. I thought, “Whatever.” And then there was this warmth, and this cocoa aroma started to fill my mouth. It started to melt. The drop turned into a pool, and I crunched through this biscuit center.

This was such a different experience, because a few minutes earlier, I was hopped up. I was aggressive. Everything was going quickly. Then all of a sudden everything was going slowly, and I was like the passenger in a boat. This chocolate was taking me on a journey. Tthat is what true pleasure is.

There’s a reason we call junk food junk food. We intuitively know it is crap. We know it is taking us to a bad place. Everyone eats potato chips. No one ever talks about this legendary bag of potato chips they had on their honeymoon, or their first trip to France. We talk about other things. We talk about mushrooms, or great steak, or great soup, or a great glass of wine. That is how food is meant to pleasure us. When food pleases us in that way, it communicates to our body in a different way.

Anja Hilbert has patience with binge eating disorder. These people are absolutely consumed by cravings. They eat themselves to the point where it’s painful. When they get these cravings to stuff their faces, she says, “Just take a really fine chocolate and let it melt in your mouth.” What she has found is that the pleasure that chocolate can deliver can extinguish the craving. That’s telling us something. When you choose to eat food that delivers true pleasure, you start to develop a different relationship with food.

Dr. Casey Means: Is food that delivers true pleasure going to be more beautifully grown, natural foods filled with all the phytochemicals that are supposed to be in there? What would be defined as food that generates pleasure?

Mark Schatzker: Dark chocolate’s a really good example. I talked to one of Anja Hilbert’s patients, who said dark chocolate was a transformative food for her, because she didn’t like it at first. She found it bitter. But then she started to eat it, and to develop a taste for it. One day she put a square of milk chocolate in her mouth. She thought, “I can’t believe I was ever eating this. It’s sickly sweet.” She also said you can’t eat it too quickly. You would never stuff your face with dark chocolate. It’s something that is meant to be slowly savored.

You talk about things being beautifully grown. When food is beautifully grown, there’s a complexity that our brains can perceive. That’s why the Italians care about the way their tomatoes taste, and about the varieties of grapes. They know that’s where the real joy is.

Dr. Casey Means: It resonates with my personal food journey. I was very overweight in my early teenage years. I ultimately was able to lose a lot of the weight and keep it off by learning how to cook, learning about food, moving away from the standard American diet toward more of an unprocessed diet, and also appreciating food more.

When I was in college, what really got me fascinated with the biosciences was the study of nutrigenomics, how food compounds change gene expression. It feeds into what you’re talking about, which is a sense of awe and reverence for what food can do. 

My journey was a combination of wanting to lose weight and this more science-based sense of awe over the power of food and what it can actually do. For me, that was learning how to cook, learning how to prepare foods, and engaging with food much more than I had as a child, when you’re just wolfing down food. It was slower and took more time, and I appreciated the food more because I was actually cooking it. All these things together set me up for a long-term, sustainably positive relationship with food.

I’ve been on both sides of this. I know how severe a craving can be. As a child, I literally hid Nutella containers in my closet. I very much get it. But I have no risk for that right now. Pleasure has overcome that in a lot of ways. Now, I think about and dream about healthy foods, like a cauliflower rice stir fry, or something I’ve taken an hour to cook, or something like that. I think, “Oh god, that sounds so good. I’d love to eat that.” 

Before reading your book, I thought that I had somehow changed the dopamine reward circuitry in my brain to want healthy food. But what I hear you saying is that it might be more that the pleasure associated with that stuff, which maybe is more opioid driven, is actually stifling some of the other cravings that could be there. I’ve replaced one craving with another. How do you think through that?

Mark Schatzker: I think it’s both. You do kind of overwrite those cravings. You do get hungry. You do want to eat. I’m similar to you. As a teen, I would crave crappy pizza or McDonald’s or something and those cravings are gone for me now. They’re foreign to me. If on the rare occasion when I’m stuck in an airport and I eat that, I think, “Wow, this is just hot grease. There’s nothing there.”

I was actually really proud today. My daughter got braces and said, “Daddy, can you make chicken soup?” I said, “I’m really busy. I’ve got a podcast. I’ve got to prepare.” I found a can of Campbell soup. She said, “No, no. I don’t want that. I want you to make chicken soup.” And I said, “You’re right.” So I made her chicken soup.

She followed along with me, and we got herbs in the garden, and we got a shiitake mushroom because it has this beautiful kind of umami. I thought, “This is great.” I’m not trying to congratulate myself or anything like that, but this is how you do it. I’m glad she caught me. She didn’t let me take the easy way out.

People also don’t realize the degree of processing. People don’t realize how much is going on. If you look at the whipped cream topping you get in coffees and things like that, everyone thinks it’s whipped cream. Most of the time, it’s not. It’s these confected, fake whipped creams that have fewer calories.

> No one ever talks about this legendary bag of potato chips they had on their honeymoon. We talk about other things. We talk about mushrooms, or great steak, or great soup, or a great glass of wine. That is how food is meant to pleasure us. When food pleases us in that way, it communicates to our body in a different way.

It’s everywhere in the food environment. I don’t want to be one of these weirdos who says, “If it didn’t come out of your garden, don’t eat it.” But it does frighten me when I see what my kids are up against. My other daughter brought home an energy drink from Starbucks. It had sugar and sucralose in it. It was like a Dana Small experiment. It also had 200% of vitamin B6. I sat there thinking, “Why would anybody need 200%? Nobody does.”

But in our silly way, we think, “If 100% is good, 200% must be really good. It’s packed with nutrients.” The way we’re designing foods screw things up. It’s more important than ever to eat real food.

Dr. Casey Means: The part of your book around all the stuff put in our food was mind blowing. To make something taste like fat, we’re actually using microparticles of protein globs. It’s revolting.

Mark Schatzker: It is. But here’s the best part. I’m Canadian. That product was discovered in Canada, by a scientist working for a brewery. In the 1970s, he tried to turn whey into a gelatin, and he got this styrofoam-like thing that sort of tasted like cheesecake or cream cheese.

It was eventually sold to NutraSweet. It was a microparticulate protein, tiny balls of protein that tickled the tongue, which created this experience of fat, even though it wasn’t fat. When they put this stuff in a product, if you look at the ingredient label, you don’t see microparticulate protein. You’ll see whey protein or milk protein. That doesn’t sound bad. This is concentrated milk. That sounds great. 

Scientists aren’t studying that. I talk to all these sensory scientists studying artificial sweeteners. They don’t know about fat replacers, because they’ve also been fooled. The fat replacer industry has been really smart. They lurk in the shadows. They put the stuff in your food, but they give it all these nice-sounding names. People don’t realize this stuff is getting put into everything. But it brings the calorie count down.

One of the reasons this is happening is because of the nutritional information panels. Everyone turns over the package, they see calories. They’re always picking the one that has fewer calories. The companies are saying, “We’ve got to lower calories. Let’s use artificial sweeteners. Let’s use fat replacers. They bring that calorie count down.” Every time we do this, we’re baking uncertainty into our food. It’s spreading, which is the scariest thing for me.

Dr. Casey Means: Just by baking uncertainty into our food with these replacers and ultra processing, we’re literally driving our motivation to eat more.

Quality and Simplicity

Dr. Casey Means: Italians eat a lot of pasta. You talk about pasta a lot in the book. Pasta is not found in nature. It’s ground grain, water, and maybe egg and stuff like that. It’s a combination food. The brain doesn’t really know what that’s going to do to the body. How do you look at something like that, a somewhat processed food that Italians seem to be doing fine with? How does that not cause a mismatched situation? 

Mark Schatzker: We’re not born with a hardwired menu of things. We have a brain that’s capable of learning. The brain learns what pasta is, and it learns that it contains carbohydrates. If you’re eating Italian pasta, it learns that it might contain some fat. It’s really smart that way. Italian pasta isn’t enriched or fortified. That’s also a big difference.

Pasta tastes like what it is. It’s not trying to fool you. The Italian version isn’t torqued with B vitamins the way ours is. You could say the same thing about rice noodles in Japan. Cavemen didn’t eat rice. Cavemen certainly didn’t eat sushi. I like sushi, and I don’t think it’s driving people into a bad relationship with food the way processed foods are.

There’s an important distinction between processing and ultra processing. All foods are, to some degree, processed. Raisins are processed. Wine is a processed food. When you cook food, you’re processing it. It becomes a problem when sensed nutrition deviates from actual nutrition. You don’t see that in something like pasta. What you taste is what you get—if you’re eating real pasta, and that’s the pasta you grew up with. When you start to tinker with things and try to fool the brain, that’s where we get into trouble. It’s when we try to fool the brain**.** If you had the flavor and sensory experience of pasta, but half the calories, that would be a bad idea.

Dr. Casey Means: That makes a lot of sense. The same would be true of bread, because there are so many different varieties of bread, at this point. We’ve got what bread used to be—flour, water, and salt—and then what bread is now, many of which have sugar and sucralose in them. We’ve got all these modifying things in there, and it’s 15 ingredients.

It’s actually quite a liberating point. Some people think, “Oh gosh, can I never eat pasta again? Can I never eat bread again?” What I’m hearing is to really focus on simplicity and quality of ingredients. 

A lot of what we hear from our community is, “Where do I start? What’s the first step? I am eating a lot of this stuff, and I have a huge craving for it. What am I supposed to do? I’m not just going to become a whole-foods, regeneratively grown meat person tomorrow.”

One tip you mentioned was to take something like dark chocolate—or a gorgeous strawberry, or a beautiful heirloom tomato from the farmer’s market—and sit with it. Put it in your mouth and just chew it. Let it melt. Start to engage with some of those pathways. Is that a technique people should do?

Mark Schatzker: Yeah. The palate can change. I used to drink soft drinks, like most teens did. I used to drink Coke. If I drink it now, it’s just bubbly syrup. I think, “I can’t believe I ever drank this.” The palette can change. It takes time.

This all started with wanting to eat good food. This was not a nutrition thing for me. I wrote a book about steak. That’s where it started. I love to eat steak. I love to eat good food. Right now, the plums are in season. I’m in heaven. Nature can please in a way the food companies can’t. They’re centuries away from doing what nature can do.

Dr. Casey Means: In the book you talk about really experiencing meals. Trying to build cooking into our lives can help with that because you start to have a more complete sensory experience with food. 

Mark Schatzker: I love to cook. But many people are afraid of cooking. You’re going to screw up. Don’t beat yourself up. No dish is ever perfect. Every time you cook something, you learn something new about that dish. I’m always making notes. People shouldn’t be afraid to cook. You’re probably going to screw it up your first time. And if you have a dinner party, don’t cook something you’ve never cooked before**.**

Dr. Casey Means: Good life lesson right there.

Rapid Fire Round

Dr. Casey Means: People taking vitamins. Yay or nay?

Mark Schatzker: If your doctor told you to take B12, take B12. As we get older, we don’t absorb vitamin B12 efficiently. But to just go and buy vitamins and take them—no. Get your vitamins from food. That’s where they should come from.

Dr. Casey Means: What if people are eating an ultra processed diet where they’re just getting the B vitamins and the fortified vitamins, but they might not be getting any zinc, selenium, manganese, chromium, or choline? 

Mark Schatzker: If they realize that, the solution is to change their diet. I don’t think taking vitamins is a wise course of action.

There’s some evidence I talk about in the book that vitamin supplements could actually be contributing to the fact that so many pregnant women have difficulty losing the weight they gain in pregnancy.

Vitamins are the forest elves of nutrition—they always do good, they’re pure and wonderful. Nothing is that simple. You can poison yourself with water. We have antioxidants because oxygen, which is necessary for respiration, also can cause cellular damage. Biochemistry is very complex.

Dr. Casey Means: It is. There’s a very specific type of supplementation for which there is some clinical backing. But again, it’s in conversation with the doctor. For hypothyroidism, for instance, 200 micrograms of supplemented selenium has been shown to be helpful for certain patients with autoimmune hypothyroidism.

Mark Schatzker: I have no issue with that at all.

Dr. Casey Means: But it’s just like what you’re talking about. That’s a clinically indicated discussion. You’re using a potentially therapeutic, or super therapeutic, level to drive a particular outcome. 

Next rapid fire topic: Alternative meats—things like Beyond Burger, Impossible Burger.

Mark Schatzker: Hard no. That to me is the absolute apotheosis of this kind of North American idea that we can do better than nature. The entire purpose of these foods is to fool you. We are taking something, and trying to make you think it tastes like something it isn’t. On some level, it’s well intended. But I don’t think it’s the way to go.

I don’t like people calling them “plant-based,” because it makes it sound as though they have all the things in plants that make plants good—the fiber, the micronutrients, the phytochemicals. They have none of that. If plant-based meat is plant-based, Coca Cola is plant-based, Doritos are plant-based, potato chips are plant-based. It’s misleading people.

Dr. Casey Means: There’s a company called Actual Veggies which is trying to fight back against this. It packages its food in very similar containers as the Impossible and Beyond meats, down to the shape of the plastic insert. But it’s basically just vegetables that have been blended together. It’s still not a whole food, but the company is certainly trying to do something a little different than Beyond Burger.

Last rapid fire: The entire category of non-nutritive sweeteners. Yay or nay? A lot of people will talk about aspartame, sucralose, sugar alcohols. Some of them are worse offenders than others. 

Then you often hear about monk fruit, stevia, and allulose being put in a category that is better and okay, because they don’t seem to cause an insulin response. They don’t seem to perturb the microbiome. They don’t seem to change digestive or satiety hormones. 

But after reading your book, I thought, “I can’t imagine Mark’s going to say these make sense, because they’re a total nutritive mismatch.”

Do you see a difference within the category? Or is it all a problem because of the way they fool the body?

Mark Schatzker: Anytime you’re trying to pull a fast one in your brain, it’s probably not going to work out. Yes, these things are different. There was a study in Cell that looked at the microbiome. They looked at aspartame, sucralose, stevia, and saccharin. They had different effects, but they all had an effect.

A lot of the RCTs don’t look that bad. But they never look that good, either. They seem to show that people lose half a pound or a pound. It’s nothing.

It’s the wrong direction to go. I think the direction to go in is real food. If you have a tortured relationship with sweet foods, maybe just get away from them for a while and reintroduce yourself to sweet fruit, or things that are kind of sweet in the old fashioned way. Repair your palate rather than to further deceive it. That would be my approach.

Dr. Casey Means: Any final words of wisdom or anything else you’d like to share that we did not cover?

Mark Schatzker: We covered a lot. We’ve gotten to this point where food is almost like a poison. And I think food can be wonderful. It nourishes us and pleasures us. We can get back to that. There’s reason to be hopeful. We can get back to a good place.

Dr. Casey Means: I love that. Where can people find you?

Mark Schatzker: I’m on Twitter. I’m on Instagram. I’m not all that active on social media. The reason I wrote books is because if you have an important message, a book is the best way to express it. I would encourage people to read the books. And if they ever want to reach out to me on any social media platform, they’re welcome to.