Dr Sandro: Margaret Chan very famously said, you know, when we were fighting malaria, the mosquitoes didn't have a lobby group to sue us. And when we started handing out bed nets, governments didn't start suing each other for for handing out bed nets and for eradicating mosquitoes. When you're trying to address child obesity, it's quite different.
Dr Rupy: Hi guys, welcome back to the Doctor's Kitchen podcast with me, Dr Rupy, where we discuss the most important topics and concepts in the medicinal qualities of food and lifestyle. Now, the Doctor's Kitchen is all about blending together the science with delicious recipes, inspired by cuisines from across the world, which is what you'll see in my first book, The Doctor's Kitchen, as well as the second book, Eat to Beat Illness, out now. It's on Amazon and in all good book stores. Today's discussion with Dr Sandro takes a slightly different path, but it's still very, very much related. We're going to be talking primarily about answering the question posed by the EAT Foundation, of which Dr Sandro is the CEO, can we feed 10 billion healthy people on a healthy planet? And the answer, luckily for us, is yes. And this is what we're going to be chatting about. Here on the Doctor's Kitchen podcast, we discuss the intersection between nutrition and lifestyle across the breadth of different medical specialities, and it's just as important to consider our environment, the sustainability of our food choices ultimately impacts the health of our planet. And this is why we're talking about diet and eating for the world today. A little bit of background for Dr Sandro Demaio. He is trained as a medical doctor in Australia. He's also done a Master's in public health, including some fieldwork in Cambodia. He completed a PhD at the University of Copenhagen focusing on non-communicable diseases, so that's things like diabetes and lifestyle related diseases. Sandro has also held a post-doctoral fellowship at Harvard Medical School between 2013 to 2015. And in April 2015, Sandro became the chief exec of EAT, the science-based global platform for food systems transformation. He also hosts the ABC television show, Ask the Doctor, which is available on Netflix. He wrote a book called The Doctor's Diet, which is available in the UK, and he established a not-for-profit foundation, Sandro Demaio Foundation, which is focused on improving the health and nutrition of Australians. You can find him at sandrodemaio.com and on social media, Sandro Demaio, Instagram, Twitter, all the links will be in the show notes. You're going to find this a fascinating conversation about systems innovation, food policy and how it affects every aspect of health and lifestyle. Let's get to the podcast. Sandro, you made it.
Dr Sandro: I did. You did.
Dr Rupy: Almost didn't.
Dr Sandro: Almost didn't.
Dr Rupy: No, that was cool. So you flew in from Oslo?
Dr Sandro: Oslo, yeah. Arrived this morning. Uh-huh. Despite the best, the best trials by a certain airline not to get me here.
Dr Rupy: You're in London quite a bit, you were saying, right?
Dr Sandro: Yeah, I, I mean, we try to travel as little as possible, but London is definitely one of the ports that we find ourselves in pretty often. It's, as you know, Rupy, you're pretty lucky to live here. It's one of those kind of global capitals. It's growing up in Australia, always when I was young, you see, you know, those sort of high-end fashion bags that I definitely couldn't afford. And it has like, you know, London, Paris, New York. It never had Northcote, Australia. So yeah, so I do find myself here quite often. A lot of our collaborators are here, which is really great.
Dr Rupy: Yeah, that's great. And so the first time I came across some of your work was actually via Hazel and we were both speaking at her conference last year.
Dr Sandro: It was awesome.
Dr Rupy: It was awesome. Yeah. I actually had Hazel on the podcast talking about it a couple of weeks ago. And it was fascinating. And I remember going to your talk and I'd read a bit about you. We'd interacted on Instagram and stuff, like mutual love for.
Dr Sandro: I'm a huge fan.
Dr Rupy: Yeah, yeah. And dude, I was blown away by your talk. It was, it was, I mean, clearly you've done it a couple of times and it was just pitched so perfectly, you know, your background and how food is intertwined with every element of our environment, our lifestyle, how it's related to conflict, how it's beyond just personal health. And that's why I just had to get you on here, man. And obviously talk about, you know, the EAT Foundation and all the other stuff that you're doing with your own nonprofits.
Dr Sandro: Cool.
Dr Rupy: Before we get into that, why don't we go into a little bit of your background? I did a little bit of an intro before you got here, but I feel there's so much stuff that you've done in your short lifetime.
Dr Sandro: I could be 90 and just moisturise.
Dr Rupy: So, yeah, why don't you give the listeners a bit of a background to you and where you come from? We know you're Australian.
Dr Sandro: Yeah, thanks, Rupy. Yeah, an Italian Australian. I always confuse people when they when they meet me, they hear, you know, Dottore Sandro Demaio, and they expect me to open my mouth and have like a Mario Luigi accent. And then I'm like, g'day, mate, how are you going? Yes, so I grew up, my name's Sandro. I grew up in Australia. I grew up in just near Melbourne. And I grew up in a big Italian family. So I have a dad who looks like he's part of the mafia. Um, sort of shorter, very hairy, darker skin.
Dr Rupy: I've got to put a picture of this on the show notes.
Dr Sandro: Yeah, no worries, no worries. And then, and then mum who, um, actually is Welsh background, both grew up in Australia. Um, amazing people. Dad's a doctor, mum's was an occupational therapist. So grew up in an Italian family, but with a big health focus and a big focus. My mum has volunteered for decades to various causes, mostly health-related, cancer-related. So strong community-focused family. I have two older brothers, they're both married. I have two beautiful nieces now, May and Wren, three and five. Um, I have a 95-year-old grandma, Bet, who's on Instagram.
Dr Rupy: Nonna Bet is on Instagram.
Dr Sandro: Yeah, Nonna Bet's on Instagram. Absolutely, absolutely. Um, and, um, and so, yeah, I grew up in this in in sort of a big Italian family. We have a a farm about an hour south of Melbourne, and food was always central to everything we did. Uh, in the summer, we would grow and make our own passata from our own tomatoes. Uh, the taste of bottled tomatoes, when you crack open that lid and the and the rush of of of summery homegrown tomatoes, basil, garlic comes, you know, wafting out in the middle of winter, it's like, ah, you know, so, so making those, making those bottles every year, preserving them.
Dr Rupy: I've got to know how you make your passata, man.
Dr Sandro: I'll send you the recipe.
Dr Rupy: You've got to give me the family secret recipe.
Dr Sandro: I can make it with you.
Dr Rupy: Yeah, let's do that.
Dr Sandro: We can do a masterclass with a, invite over a few people at the end of summer.
Dr Rupy: I'm going to hold you to that. Absolutely.
Dr Sandro: Done. So, so, and then we would also, you know, we had a, we have about 100 acres. Um, so we would also bottle our own, uh, pears and, um, peaches, make our own pickles. Dad would make his own prosciutto in the winter. We would kill the pig, one pig for the entire family. And from that we would make an entire year's, uh, food, you know, meat, salamis, uh, salsiccia, the sausages, the prosciutto, all the preserved meats. Um, it was a very happy pig. So you learn, you learn where food comes from. You from a very early age, you have an understanding and a respect for food. But you also understand how food starts to interact with your body, um, and the importance of food as medicine, as I know you're a great champion. Um, but ultimately also that food is the building block of life and and what what we put in our in our mouths at the end of the day has such a huge bearing on our health. Um, so as I as I got older, um, I went to medical school, I became a doctor. Um, still had a passion for for food, but they kind of diverged for a little while. I was doing emergency remote medicine. Um, had an interest in diabetes and chronic disease. And what I noticed, Rupy, was that, uh, regardless of where I was working, whether it was in the biggest tertiary hospitals in Melbourne, or whether it was in Sri Lanka after the boxing day tsunami, or in Cambodia in, um, providing health care in Buddhist temples, uh, or or in remote communities in indigenous communities in Australia, all of the populations that I was serving, all the individuals were coming in with the same diseases. And this was a group of highly preventable diseases, what we call non-communicable diseases, diabetes, heart disease, cancers, uh, chronic lung conditions, mental illness. Um, they were coming in with diseases that we knew how to prevent, we knew how to delay, we could keep these people healthy if we chose to as a as a collective. Um, and if we gave them the same opportunities that many of us take for granted, and in particular, if we improved their diet and allowed them to access affordable, nutritious, uh, wholesome food. And so I thought, well, if I'm seeing the entire, you know, from Mongolia to Sri Lanka, to remote Australia, to the wealthiest communities in Melbourne, if everyone is dying from the same group of diseases that we know how to prevent, maybe my role as a doctor is, you know, whilst I I have huge respect for clinicians, maybe my role actually isn't to work at the coalface treating the outcomes of disease, but maybe I need to find a way to stop the disease in the first place, to go up the the river, so to speak, and and see if you can exactly and see if you can, I always think of it as sort of a cliff, you know, rather than working at the bottom of the cliff and and taking, uh, the the those that have fallen to their peril to hospital, maybe there's a way we can go up and build a build a fence at the top of the cliff and and stop people from falling in the first place. So I spent the next three years doing a PhD, the next two after that doing a postdoc. I was in Copenhagen, uh, Mongolia, and then Harvard for two years. Um, I I did a lot of research looking at these different issues. I launched a few startups and, um, social campaigns. Um, and then I was lucky enough to spend three years working for the World Health Organization in Geneva at the global headquarters. I was a an expert advisor, um, what's called a medical officer on nutrition and and the same group of non-communicable diseases. And that was a huge privilege. I got to work with 193 member states around the world or countries to try and improve, uh, promote and protect health, uh, for vulnerable populations. And I got to see, you know, I got to see remarkably inspiring things. I got to see countries that were truly committed to improving the health of their populations. I got to see, um, the the the huge progress that we're making on reducing child hunger. Um, but I also got to see some really terrible, alarming things. I got to see industries that were blocking governments from, uh, doing what was best for their for their, um, for their, uh, populations, particularly young kids, because they wanted to make a profit. Um, I saw countries fighting or or intervening against other countries, uh, to try and stop them from protecting their own populations. I saw, um, you know, decisions that were being made on ideology and and, um, profit and and not, uh, based on, um, best practice or the evidence. Uh, and and I realized that whilst policy is critical and ultimately what what I believe is going to solve most of the big challenges we face is is far more responsible policy and responsible government. Um, I realized that we needed to be working at multiple levels and we needed to be working in multiple sectors. Uh, so when the opportunity came up to write a book, um, and then be the host of a television show on Australian television, which is now actually on Netflix worldwide in 300 country, sorry, 300 million people have access to. Um, I jumped at that and thought, gosh, if I can, if I can continue to work at the global policy level, but take those messages like you and Hazel do so effectively through social media and through the podcasts you guys are creating, if I can take those messages out to a wider audience, build the bottom-up movement, support those those that are trying to create this bottom-up movement for change, um, and empower our politicians to make the right choices, but at the same time work at the global level to give those politicians the right tools, the right solutions and help them to make those right choices. So if you can give them the support bottom up and the solutions top down, then maybe we'd be able to make a lot more progress more quickly. And so that's why in April of last year, I left the United Nations, my dream job, uh, to take an even more incredible offer, which was, uh, to be the CEO of a global foundation focused on transforming the world's food systems, uh, with my, um, Norwegian sister, uh, Gunhild Stordalen. And I've been there since.
Dr Rupy: And you must have left that organization, like you said, your dream job, with quite a heavy heart, but a lot of aspiration and expectation going into the EAT Foundation. And and just remind me, when you went in April 2018, how long had EAT been around for?
Dr Sandro: So EAT had been around for about three years at that stage. Uh, it had been, it had been an organization for about two. Um, the concept had been around for about three, three and a half. And I'd been on the advisory board right from the start. So I actually met Gunhild, um, back when I was in the US doing my postdoc. And we just clicked because we, you know, I I saw that we needed to really take a systems-based approach to solving many of these big, what we call super wicked challenges, climate change, obesity. These are these are big challenges that have multiple causes, but also require multiple responses, multiple solutions, multiple levers across different sectors simultaneously to to, um, actually address. They're not, you know, it's not like malaria, which is a complex global challenge, but at the end of the day, we have a solution. You know, bed nets and uh, and and uh, eradicating bodies of water and providing medicines. We can eradicate, we can eradicate malaria. It will cost a lot, but we can do it. Obesity is a much more complex global challenge. Um, you know, Margaret Chan very famously said, uh, you know, when we were fighting malaria, the mosquitoes didn't have a lobby group to sue us. And when we started handing out bed nets, governments didn't start suing each other for for handing out bed nets and for eradicating mosquitoes. When you're trying to address child obesity, it's quite different. And and and so it's that's really the space where uh, EAT works. We're a we're a not for profit. We're based out of Oslo. We're a staff of 40. Most of us are under uh, 35, though we do have some fantastic, uh, senior, uh, figures in our group as well. I'm very, I'm very honored to work alongside, uh, alongside them. Um, and and it's an organization that, uh, that really focuses on understanding, bringing the different sectors together, but then driving through from evidence, it has to be based in evidence. We live in a world that is less and less concerned with science and truth and fact, but actually science has to be the, you know, it has to underpin how we respond to these big global challenges. Um, and so we we we build the science, but then we also have uh, different ways of bringing about change through partnerships with some of the biggest UN agencies, through partnerships with some of the most powerful governments on the planet, and through partnerships with scientists, businesses, uh, civil society organizations through our global forum, uh, which which happens every June.
Dr Rupy: Yeah, yeah. I remember actually, I'll put a show note link, um, to the opening speech that that Dr. Gunhild, uh, made last year. I think it was last year, uh, on, um, at the EAT Foundation. Uh, she's had a quite an interesting past herself, right? So she is a a doctor turned, uh, advocate, uh, for environmental and sustainability. Um, and, uh, you guys met, so you guys met whilst you were an associate professor, was that correct?
Dr Sandro: That's right. Yeah. So I was in the US for two years. And, uh, and it was a funny story actually. So Gunhild, um, Gunhild has a few different hats. She's an she's an astounding, um, down-to-earth individual. Uh, she's a medical doctor. She grew up in the country. Um,
Dr Rupy: Actually, there's an interview that you've done on the first episode of your podcast that I'll put in the show notes as well where you talk to Gunhild.
Dr Sandro: Yeah, she's and she's a real kind of, what we call in Australia, a real larrikin. She's like, she's just a lot of fun. Um, she's, you know, incredibly down to earth and and and but at the same time, uh, kind of powerfully visionary in what she wants to achieve and and how she goes about it. Um, and so, you know, EAT really started with a question that Gunhild had, which was, you know, can we feed 10 billion people, a population that we're locked in to have on the planet in 2050? Um, can we feed 10 billion people, uh, that are healthy, that that have actually got, you know, that have achieved, we've achieved health for all. So, you know, left no one behind, which is the agenda of the sustainable development goals, the United Nations SDGs. Can we feed 10 billion people on a healthy planet? Um, and and to her surprise, there was no clear answer on on whether that's possible and how to achieve it. Uh, and so she formed EAT, uh, with science at its core, but then bringing in all of these different players, business, policy, civil society, uh, around the same table to say, well, is it possible to have 10 billion healthy people on a healthy planet by 2050? And if it is possible, then how do we achieve it? And it has to, look, let's be honest, it has to be possible because we live in a world today where 800 million people, more than 800 million, have no choice but to wake up with too little food and go hungry every day. On the same planet where more than two billion, that's B, are now, uh, eating too much of the wrong types of food, resulting in obesity, chronic disease, suffering, pain. Uh, so all in all, half the planet is now malnourished, while at the same time, the planet has never been richer before. We waste a third of food, and the food sector is the single biggest driver of climate change, of deforestation, of species extinction, of water use. So when you put all of that together, you know, we have to be able to feed 10 billion people by 2050. We can't continue on the path where we leave half the planet behind. That's just totally unethical, but also, you know, it's it we shouldn't even see that as a as an option. So the business as usual approach is not an option. So we have to achieve 10 billion healthy people. But I I want to be, I want to make sure, and I know you do as well, Rupy, I have a three-year-old niece, I have a five-year-old niece. They'll be my age in 2050. And I don't want them to be living in a world where we don't know if we're going to be the last generation to live on a safe, sustainable, prosperous planet. You know, the future looks pretty bleak at the moment, and we have to be in a position where in 2050, we're not only have we not left a billion people behind at the cost of billion, you know, two billion more. But we need to make sure also that the planet we're leaving behind when we come to our to the end of our lives is safer, is more sustainable and is more prosperous than we found it.
Dr Rupy: Yeah. And I think, you know, one thing that the EAT Foundation was incredible at doing is getting it to the front page of all the newspapers over the last couple of weeks. And you really got to have your head in the sand if you didn't notice what was going on with the planetary diet. And I love the name of that. Um, but unfortunately, for a lot of people, it's just purely not on our agenda at all. I know when I'm working in A&E, um, and I'm talking to people about food, I'm talking about food from the perspective of their personal health. And even that is a challenge to take people that extra step further and talking to them about, yes, it's about your personal health, but it's also about the health of your environment and the health of your kids and the health of their kids as well and the future.
Dr Sandro: Well, and and the health of the people around us, because if we continue to consume food in the way that we do in the parts of the world where I'm assuming most of your listeners come from, in in wealthier parts of the world, if we continue to consume food in the way that we do, we are literally making a world where it's impossible to have everyone live healthily. So we in a way, the way we consume food leads to hunger and starvation in others. And when you think about it that way, we have a moral imperative to change the way we currently eat to be able to bring that extra billion people into the global food system. We currently, it's it would be like us you and I eating at a tent and one person sitting outside without food and we we're okay with that. And the way that we consume food results in them being in hunger. That's literally how it is because it's actually global hunger is on the rise due to climate change and conflict, which to a large degree are driven by our food system ironically. So hunger is driven by the production of food. But we're consuming too much of the wrong types of food in many parts of the world, including our own. But coming back to what you said, absolutely true. I mean, I was a, you know, I was a clinician, um, earlier in my career and I remember, you know, people, at the end of the day, humans want to take care of themselves. And and you know, it's it's around the hierarchy of needs. And and particularly for people who have a life much tougher than ours. We're very privileged. Um, people who have a life much tougher than ours and are more focused on where their next meal will come from, who will put a roof over their head that night, they're not going to be that much that focused on ensuring that the way they eat is good for the planet as well. The good news is that this diet, the planetary health diet is actually optimal for human nutrition period. So it's it's not we're not saying that if you want to eat for the planet, eat this way. We're saying if you want to, if you want to have the best nutrition, if you want to achieve the best health yourself as an individual, eat this way. The good news is that if you eat this way, you will also allow the 1 billion people on the planet who are currently locked out of the food system to come in and enjoy a healthier life. But you'll also, it will also result in us having to chop down less rainforest, use less water, use less nitrogen and phosphorus, which lead to leaching and and death of our oceans, and it will lead to less less uh global warming and climate change. So even if you're focused, if you're focused on global equity and ensuring that we don't leave a billion people on this planet behind, if you're worried about the future generations and the world they will inherit, if you're worried about uh simply your own health and living as long as possible and being as healthy for as long as possible, in all three scenarios, it's the same outcome. This is this is the diet that that 37 of the world's best scientists, including the World Health Organization uh representative recommend.
Dr Rupy: Yeah. And I I was really happy to see it uh and especially like you know the breakdown and the plate and stuff and it looks really aesthetically pleasing. Also, it's kind of in line with the way I've kind of come to believe how we should all be eating, plant focused, whole, colourful foods.
Dr Sandro: And it's how we ate not long ago. I mean, if you look at my my Nonna, I mean, so the modified or the Mediterranean diet, which is pretty much like the Bible of of good of good eating. And that doesn't mean that everyone has to start eating spaghetti and and risotto and and uh, you know, rappe tomorrow. I mean, they can because it's delicious. Let's be honest.
Dr Rupy: I wish we could get rappe here.
Dr Sandro: I'll bring some for you next time.
Dr Rupy: Yeah, you're going to have to bring like a massive suitcase just full of food. I don't know if you'll get through customs.
Dr Sandro: If I get if I get tasered at Heathrow, Rupy, I'm going to come after you. It's my problem. That's all right. Um, so we might we might have to do the next podcast in jail. Anyway. Uh, so, so, um, you know, it's about eating more more more fruits and vegetables, uh, whole grains, nuts. Nuts are such a an underutilized way to get healthy oils, um, to get, you know, protein into our diet, um, to keep us full, uh, for the afternoon, you know, add a few nuts to whatever you're eating. So nuts and seeds, healthy oils. A lot of confusion around oils, but you know, there are some really great healthy options. And then a smaller amount of, uh, chicken and fish, uh, even smaller amounts of red meat and a couple of eggs if you want to. Otherwise, you can substitute those for for plant-based options. But so first, first,
Dr Rupy: So overall, like, you know, it's an incredibly healthy diet. What I want to know is,
Dr Sandro: And and everyone's making this, you know, this palaver about the red meat. But but, you know, what what we're what what the what the science, it's not opinion. This is this is what, you know, two years by the world's best scientists tells us is the best for our health.
Dr Rupy: I think it's important to mention that actually, because I think people just think, oh, you gave this problem to a bunch of scientists and then they just came out with this answer. It's two years.
Dr Sandro: It took two years. I mean, they have trolled all of the available evidence. This is not, you know, oh, Rupy, what do you think we should eat and sort of stick your your your finger in the, you know, in the air and whatever way the wind's going. It's like, no, this was two years of, uh, rigorous analysis of all of the latest, the best quality evidence. Um, and they they basically come up with, so the first, the first thing is around the diet and and and shifting the diet. Um, with red meat, it's basically, you know, it's been sensationalized quite a bit in the media, but you know, the take home message is sort of a hamburger-sized piece of mince once a week or a steak once a month, which to be honest, I mean, it's not that extreme.
Dr Rupy: No, it's actually something I talked about in my first book. I I I have red meat probably once every fortnight.
Dr Sandro: I do too. And and particularly, I mean, there are incredible products now where, you know, burger burgers that are, um, that are mince mushroom mixes. I know you've you've done some stuff with that as well. I mean, you know, mixing, um, different things in with your chili, like lentils, other things to kind of make the meat go further. Amazing, like super, super tasty. Um, the second, so the first part is around shifting the diet and and and rethinking what you're eating in a way that's good for your body, best for your body and and also good for the planet. The second is then voting with your note, because ultimately, as you said before, our food system over the last 30 years has moved in the direction driven by consumer demand to a large degree, but also consumers have been kind of driven by marketing and all sorts of, um, all sorts of financial incentives, uh, in in the direction of eating more meat that's poorer quality, of eating fewer types of vegetables, um, and eating vegetables that because they're we want them available all year round, they can sometimes be less nutrition, nutrient dense. So the second thing is about voting for your note and actually using the money that you spend, thinking about every time I spend a dollar in the food system, I'm making a statement about the type of food system I want. So every time you buy slightly better quality meat that was given a better life, that didn't need to be treated by antibiotics because it wasn't subjected to a horrendous, uh, existence, that was killed in a reasonable way, that was, um, you know, where where the butcher was given a good livelihood, um, and, um, and where we where we, uh, and also where it was actually produced in a more sustainable way, because there's huge variation depending on how you produce meat in its in the, um, ecological footprint it has. So every time you buy meat that's just slightly better quality than you did before, maybe you're buying slightly less, but slightly better quality, so the price is the same, you're shifting the market in the right direction, because then meat producers will think, okay, people actually are willing to pay for a slightly smaller portion, but of better quality beef or chicken or lamb or fish. You know, they're willing to pay for fish that we know is sustainably caught, that has been certified, that has a cost associated with certifying it, with catching it in a country where there are controls to make sure that, you know, the fish will the fish stocks are are treated with respect and will still be there in 100 years. If you're willing to spend that little bit more or even just take the time, maybe it's not even about the money, it's about taking the time asking the question, where did it come from? You know, how was this caught? How was this grown? Um, and then and then voting with your note each time to make sure we move the the food system in the direction we want.
Dr Rupy: Totally. I I I totally believe and it's something I wrote about in the first book that we have immense power, uh, using our our dollars, our pounds to shape the future food landscape. Where I feel that I I I think perhaps there's a role more for government and economic nudges, as they like to call them, uh, is the average Joe that's not going to be listening to this podcast, that's not invested in the food, that is blinded to the analogy of us in a campsite with a tent next to people who are sleeping rough and don't have enough food to eat, because we are, there's a massive curtain between that. People don't understand the relevance of even within their own community about how, you know, me choosing fish that comes from over fish stocks or me choosing beef that is cheaper and therefore my family can afford it, um, but it's going to lead to increased antimicrobial resistance. Um, all these different things. How do we get those people on the ground, on the the average Joes who are not interested in food, who have no interest in this, to adopt a diet that ultimately leads to the salvation of a human population?
Dr Sandro: That's a tough question. I know it's a tough question. No, no, no, it is, it is tough. And and and I mean, I think, I think again, it comes back to, um, you know, the hierarchy of needs. So I think most people are interested in ensuring that their family is healthy, that their community is healthy, and that ultimately the planet is healthy. But they have to, they they will put their family and them, you know, they'll put their family first. And that's pretty reasonable. Anyone would. Um, I think, you know, to a large degree, if those of us that can vote with our note, and also vote with our vote, it's not just forgetting, you know, next time the the it's time to actually vote in an election, vote for politicians, you know, this is not in the EAT-Lancet Commission, this is now me speaking personally, but, um, you know, it's about actually thinking, you know, who who is going to represent the future and the food system of the future that that I believe in and and it's also about actually just voting with your vote. Um, because it will take, you know, I I come from a background in policy and I'm a strong believer that until the price of fruits and vegetables are brought down, until it's uh available and accessible, until we're able to deliver food and nutrition education to all kids, regardless of their background, not just in the wealthy hipster schools, but across all socioeconomic incomes. Until kids are growing up understanding how to, um, how to use food, and then they have access to it, it's affordable, and importantly, they're not being marketed to on every single corner and on their electronic device that they spend 10 hours a day staring at from fast food companies, big soda companies, you know, all of the wrong types of foods. Until we have government step up and say, marketing junk food to kids and having super cheap soft drink that's actually cheaper than a bottle of water and having a situation where meat is cheaper and easier to feed your kids than fruits and vegetables. Until that changes, and that takes government, then we're not going to solve the problem. But a big step in the right direction would come from individuals voting with their note and individuals being cognizant of it the next time they vote in an election. And having these issues on their mind, because we we have, I believe we do, you know, for those of us who are privileged enough to, um, you know, to to, um, be able to choose better quality food and vote for a food system with our with our money, um, you know, I believe we have a responsibility to do that. And we will actually start to shift the market. And you know, it's simple economics. If if we, if half of the population or a portion of the population who can afford to starts to buy more organic or more locally produced or more, uh, seasonal or even just more fruits and vegetables, it increases demand, but that will bring greater supply to the market. The market will respond and we'll start to produce more. And we've seen this around the world.
Dr Rupy: That's true. We're seeing that in most local supermarkets will offer a vegan range now. And the same thing with free from aisles, like the free from aisle used to be the bane of most supermarkets, like a tiny little shelf. And now people are fighting to get into that aisle because there's such a demand from, you know, the health conscious sort of.
Dr Sandro: And and you look, so one example is gluten-free. I'm not gluten-free and and and as you know, um, many people, um, choose not to eat gluten and and I think that's great if that's what they want to do. And, um, there's been this huge interest in gluten-free over the last sort of 10, 15 years. And the result of that is that there are almost every product on the market now has, you know, gluten-free used to be like two things in aisle four. Now it is aisle four. And that's a good example of like where and and that aisle four is not just for one part of society. You know, yes, some of those products are more expensive, and that's an issue, and that's something the government needs to intervene in. It needs to take up the price of unhealthy foods, it needs to reduce the price of healthier foods, it needs to make sure that they're available in the poorer suburbs, and that the poorer suburbs where we know there is a saturation of junk food and fast food and takeaways and very often a total paucity of access to fresh foods. We need to fix that and government needs to step up and do that. But by us buying and voting for a better food system, we can actually, you know, aisle four might be gluten-free, but aisle five, six and seven might be the food of the future, the food that is actually driving our food system in the right direction, a food system that brings that other billion into it, allows them to enjoy a happy life, that treats animals with respect and that sees us enjoy a healthy life, those around us and also passes on a healthy planet to future generations.
Dr Rupy: Absolutely, yeah. And I I loved uh some of the uh elements of your of your talk that I had the privilege of being at where we actually talked about where you talked about um how food and the choice of food is related to migration, conflict, antimicrobial resistance, which is not on a lot of people's minds right now. Although in the in the UK here, we've uh had a few advertising campaigns trying to reason with people about asking for uh antibiotics from the doctors and how during the flu season that that like rockets right up there. And I have discussions with patients all the time about how viruses are not treated by antibiotics, etc. But our food system is responsible for a huge proportion of that, the biggest.
Dr Sandro: And and again, it comes back to this this kind of demand that that we've created, but also the market has kind of forced upon consumers in many ways of, um, you know, cheap, rapid, poor quality, you know, quantity over quality. And so, you know, meat in particular, it's a huge use user of resources. Uh, it's a huge emitter of carbon dioxide and greenhouse gases in general, methane as well. Um, but it also uses about 70% of global antibiotics. So, you know, three in 10 antibiotics used on the planet are used in animals, not in humans. And to a large degree, because we actually we actually did a story on this on Ask the Doctor. Um, a big reason why we have to use so so many antibiotics in animals is because we have them in such revolting conditions. You know, to keep them well when they're penned in in a tiny space living in total squalor, which is hugely disrespectful to animals, the animals that we're eating. And at the end of the day, you know, where do you think those antibiotics go? They either go into the animal waste and back out into the environment, terrible situation for the environment, or we eat them and congest, we ingest them. And and yes, it's it's a major challenge then for resistant organisms that we're actually ingesting a huge quantity of antibiotics and antibiotics are entering our food system and and ending up somewhere.
Dr Rupy: I've witnessed this on a personal level. One of my friends, um, his father had to go in for an operation, just a routine elective operation for his knee. And he told me he was given a particular antibiotic, um, that when I was a junior doctor in 2009 was third line and I had to call the microbiologist and beg for like, you know, can we please use this because we've used XYZ. And now it's been given routinely. And I was like, wow, it's been 10 years. And we've literally skipped through a whole bunch of.
Dr Sandro: Well, scientists are worried about us running out of antibiotics. And and we don't realize that actually by us eating, you know, cheap and nasty meat basically, um, that there I mean, think of all the flow on effects. We're eating more than we probably should. That has diabetes, cardiovascular disease and bowel cancer risks. Then we're the environmental, you know, it uses more water, it emits more carbon. Uh, it in turn uses more, so, you know, you need to feed the animal something. It's a very poor, uh, it's a very inefficient way of making calories for a global population where 800 million people are still hungry to use food to feed an animal and then use the animal to feed a human. You know, yes, animals, I'm not again, I'm not vegetarian or vegan. I eat meat, but by when when we demand a lot of it at a very poor, at a very low cost, we find ways, the market finds ways of making it as efficiently as possible. So it ends up being, you know, feed lots with grain fed, um, where the grain is coming from land that used to be rainforest. It takes a huge amount of energy to produce and ship uh the grain and then you end up feeding it to animals that live a poor life. Uh, and then getting it to market only to be overconsumed and cause disease, I mean, in in humans. And the only way you can get it to market and keep the animal healthy for long enough is to give them a whole bunch of antibiotics in the process. So, you know, that seems like a crazy, a crazy, you know, that doesn't seem a very sustainable way of of of approaching animal source food consumption.
Dr Rupy: And this is what happens when market forces essentially dictate what the demand is and what's available. I mean, like, you know, we've been taught to have meat in our diet as part of, uh, a healthy diet, yes, but also it's associated with wealth, which is why in, uh, growing economies like India and China, they have increased meat consumption. What I found interesting about your talk is, uh, one of the observations that we in the West, for one of a better term, uh, eat too much meat, but there are populations around the world that eat too little. How do we actually readdress that balance? It's not as simple as like, okay, well, the meat that we're consuming, we send over to wherever they need it. What how do we, was that something that was included in the report?
Dr Sandro: It is, absolutely. So the recommendations in the report are again, dramatic reductions for parts of the world like, you know, UK, Australia, the US, where where consuming four, five times. Australia, for example, I was there just last week and, you know, we're consuming uh about five and a half times what is recommended in the planetary health diet. Um, even about 20% more than the national dietary guidelines. So, I mean, Australians are eating half a kilogram of meat of red meat a week. I mean, that's that's crazy. I mean, that's five hamburgers a week. Who is eating this much? I'm not eating this much. You're not eating this much. Someone's eating this much.
Dr Rupy: A lot of people really like they have this misconception of Australia just being Sydney and Bondi and like, you know, everyone's healthy and it's got like the LA style lifestyle and everyone's eating like, you know, Buddha bowls.
Dr Sandro: But it's the same in many, it's the same in many, you know, in many high-income countries. And and that's for a whole number of reasons, you know, urbanization, westernization, the influx of of global corporations, you know, influencing our food system, the so-called kind of westernization or McDonaldization of our of our diets. Um, but the reality is that there are still, as I said, you know, 830 million people who go hungry, and there are still hundreds of millions of of particularly young women who are anemic, who don't get, who who would benefit enormously from having a little bit more, uh, meat and animal source proteins in their in their diet. And kids as well. Um, you know, there's a critical period of growth, the first thousand days, but also, you know, early in in life when children really benefit from having eggs and a small amount of of meat, high quality animal source, uh, foods in their diet. It helps their brain to develop, it helps, uh, in general nutrition, lay down the foundations for a healthy life. But the way that we're eating in the West, quite frankly, takes away that opportunity for hundreds of millions of kids living in poverty worldwide. So, and particularly in the context of climate change. And again, this sad irony that, you know, the way we're eating is driving to a large degree a change in our climate. The change in our climate is driving is increasing hunger after decades of reductions. It's once again on the rise. Like that is a sad indictment on our planet that after decades of reductions, you know, global hunger is once again on the rise due to climate change and conflict. And conflict, you look at, you know, when have been the major conflicts over the last 10 years, many of them, even the last few decades, many of them are linked with rises in food prices, because food, you know, when people can't access food, again goes back to what we were talking about of the hierarchy of needs. When it goes back to, uh, I can't put food on the table for my family, then of course people are going to worry about their family before they start worrying about their community and before they start worrying about the planet. So whether it's for the planet or whether it's for the individual, we actually need to find a way, you know, of of sustainably feeding the entire global population. And that will involve actually increasing the amount of meat and animal source proteins that hundreds of millions of people across the planet are eating because they're eating too little, resulting in disease and malnutrition. But to make space for them to be able to achieve optimal health on a limited planet, the planet seems big, but actually we've only got one of them. And if you use a resource in one place, you can't use it in another. You know, we we we have used half the planet's land space to grow food. That that's where we're at now. We use half the planet. We can't use any more because we need the rest of it to maintain biodiversity, to maintain important ecosystems, to provide energy, to provide all of the other, you know, services that that our that our ecology and that our nature provides to human beings and to the planet itself and to safeguard the planet. We can't use any more space to grow food. So we need to find more efficient ways of growing food. And if it's hugely inefficient and damaging to produce certain types of foods in a certain way, and they're the same types of food that are most hazardous for our health, then it makes it kind of just makes a lot of sense for the yeah.
Dr Rupy: This is where I see like almost the behavioral side of things coming into play here because we have been tricked into believing that meat does cost this much now because of whatever market mechanisms, we've been able to massively reduce the cost of meat, uh, through industrial processing, uh, intensification of labor. And, you know, we almost have to like reverse that and go back and say, actually, you know what, you can get it very cheap here, but you shouldn't. Uh, because you are essentially contributing to massive environmental, uh, issues as well as a health issue as well. And I've gone into that in another podcast.
Dr Sandro: And there are, you know, there's there's very strong evidence around the links of over consumption of red meat with, you know, heart disease, diabetes, but also obviously bowel cancer. Um, and and it's again, it's not to say that we shouldn't, you know, if you choose to be vegan or vegetarian, kudos to you and I think that's awesome. Um, I'm not, I'm not vegan. I'm vegetarian most days, but I also eat a bit of meat. But the meat that I do eat, um, I really enjoy and it's something that's seen as a privilege because it is ultimately eating another, you know, animal, uh, it's a huge privilege. So the planetary health diet is, I think if you think about it in sort of three domains, um, that that we at at home can take on board and and put into our everyday lives. The first is, you know, shifting our diet to something that is better for our body and better for the planet. So that's more plants, at least half the plate, uh, whole grains, so delicious. Like, I mean, if you start with 100 or 200 grams of barley or lentils or chickpeas, I had the most amazing chickpeas from the Ord River. Really? You probably don't know where the Ord River is. It's this like place in, uh, in in outback Australia. But the chickpeas, I mean, good quality chickpeas. I have no idea. I've never heard of that. So tasty. So I'll bring some for you next time. We can have the rappe. Actually, rappe and chickpeas is a great combination.
Dr Rupy: Okay, we're going to wrap up with some rapid questions. You're up for this?
Dr Sandro: Sure.
Dr Rupy: All right, these are questions that people have just shouted in because they want you to offer some quick advice or quick sort of like opinions on them. Don't worry about it. It's cool. It's cool. Uh, okay, what does a typical planetary diet day look like? Let's just give one meal example. Go for it.
Dr Sandro: So, uh, my homemade muesli, uh, some natural yogurt or some soy yogurt and some seasonal fruit.
Dr Rupy: Brilliant. Are there particular vegetables that wouldn't be suitable for us in the UK to eat from a planetary environmental standpoint?
Dr Sandro: No, the world will continue, will need to continue to trade and be one food system. Uh, the only thing would be poor quality, uh, meat.
Dr Rupy: Great. And so that answers the second, the other question, should I stop buying bananas?
Dr Sandro: No. The the the actually the efficiency of trade, if it's if it's shipped on a on a ship and not in an airplane, the the carbon intensiveness, so it actually takes more energy to grow a banana here in the UK than it does to ship it from South America or wherever. Um, so, you know, as long as we're eating food that has been shipped on a by a ship and not an airplane, we're not eating wagyu beef or sashimi that's been flowing in overnight, you're pretty safe.
Dr Rupy: Okay. Do the vegans think this is drastic enough or do we need to go vegan to save the planet?
Dr Sandro: We don't need to go vegan. If you want to be vegan, you can be perfectly healthy. There will be people on both sides who say that they want to see less meat and they want to see more meat. This is based purely on science.
Dr Rupy: Great. We've answered this question, I think. Is it sustainable from a health perspective, the planetary diet?
Dr Sandro: It is.
Dr Rupy: Good, rapid answer. What are your thoughts on organic food and organic agriculture?
Dr Sandro: Love it, if you can afford it. Uh, we need to make sure it's affordable for all. And we need to understand that it's not about necessarily the food being healthier or more environmentally sustainable, but it comes then to a different issue that we haven't talked a lot about, which is pesticide use, uh, which is a whole other kettle of fish.
Dr Rupy: Yeah. Do you think we have to go organic, um, or that's what we should be aiming for as a food landscape for environmental reasons for for over pesticide use, do you think?
Dr Sandro: I think, um, moving towards more organic methods, yeah, it makes a lot of sense for the planet. Uh, it's not a recommendation from the EAT-Lancet, but, um, you know, if we can find ways of producing just as much food without pesticides, it would be a much better situation for the planet. Absolutely.
Dr Rupy: I believe that. Um, meatless meat. Do you think meatless meat has a place in the planetary diet? So we were talking about like the impossible burger.
Dr Sandro: It absolutely does, but there are lots of things that we can do without having to grow meat in a in a lab, which will, you know, entertain Los Angeles and feed hipsters in London, but is unlikely anytime soon to solve the global food crisis. So, um, instead, what we can be doing is, you know, eating slightly less, eating better quality, driving the market in the right direction, looking at plant, um, animal mixes. We talked about like the mushroom beef burger, but also looking at just totally vegetarian options or vegan options. I mean, some of the veggie burgers out there are super delicious. You don't you don't actually need to grow meat on a petri dish. You can actually just use, um, plant-based proteins.
Dr Rupy: Yeah, I totally believe that as well. If there's one thing you'd change about my diet, what should it be? What extra ingredient should I be having in my diet?
Dr Sandro: Just, I think starting with plants, starting with vegetables. I think if you, if you begin the meal with how am I going to make veggies the hero of this dish and then build out from there, even if meat ends up being, you know, uh, a last sort of, uh, condiment, start with veg, build out from veg, you can't go wrong.
Dr Rupy: What's your veggie hero?
Dr Sandro: Eggplant.
Dr Rupy: Nice. I like that. Have you seen the graffiti eggplant?
Dr Sandro: I thought you're going to ask about the emoji. I thought, oh god, here we go. We're going to get ourselves into trouble.
Dr Rupy: No, no, graffiti emoji, the graffiti aubergine.
Dr Sandro: No, I haven't seen it.
Dr Rupy: Oh, it's amazing. It's just like this amazing like.
Dr Sandro: I'll give you that in in in exchange for some rappe.
Dr Rupy: Done. Nice.
Dr Sandro: And some Ord River chickpeas.
Dr Rupy: A passionately informative podcast there with Dr Sandro. He really is an inspirational character. I can't believe the number of things he's done and I really hope you found that informative and useful. I think we all have a responsibility, yes, but also it's very actionable. And I and I hope just from my conversation, uh, you you understand how easy it can be to look after our own health and our planetary health as well. Yes, it is controversial. Yes, uh, we're always going to have caveats with any research we do in nutrition, but we have to do the best we can with the resources we have and the tools at our disposal. To summarize, the transformation to healthy diets by 2050 will require a big shift in how we are currently eating, which is largely meat focused. But really increasing the consumption of fruits, vegetables, nuts and legumes, things like chickpeas that we talked about a lot, but also broad beans, adzuki, black beans, whatever types of beans that you like, would need to increase by double. And fortunately, my book, The Doctor's Kitchen, and the new book, The Doctor's Kitchen Eat to Beat Illness, will encourage you and give you actionable ideas on how to do this. The consumption of foods like red meat and sugar will have to be massively reduced, and this is for not only our personal health, but also from the perspective of our environmental health as well. As stated in the EAT-Lancet report that I will link to in the show notes on the doctorskitchen.com, global food production threatens climate stability and ecosystem resilience. It constitutes the single largest driver of environmental degradation and transgression of planetary boundaries. Now, this sounds super, super scary, but really eating according to the principles of healthy eating that I discuss in my books and and also in the planetary diet is something that's very actionable for a lot of people and you could be doing a lot of good for environmental and personal health standpoint. Make sure you check out Sandro Demaio on Instagram at Sandro Demaio. The doctorsdiet.com.au is a link to his book and it's out in the UK too. eatforum.org is the EAT Foundation and his own foundation, Sandro Demaio Foundation.org is another link on the show notes on the doctorskitchen.com. You can also check him out on ABC or on Netflix on the program Ask the Doctor. And if you didn't know already, Eat to Beat Illness is out now. You can check it out on Amazon and all good book stores and it has tons of ways in which you can eat according to the planetary diet principles. If I was to recommend one recipe that will round up exactly what we've talked about in today's podcast, it would be the Ethiopian Berbere curry with tomato, different sorts of greens, lots of plant-based foods and tons of flavour. You're going to absolutely love it. It's on page, I can't remember, but it's definitely in the book. So make sure you go get it. I'll see you next time.
