09/10/2014 01:02 pm ET Updated Nov 10, 2014

HOW to Eat Well

In the midst of last week's rather copious flow of verbiage regarding what foods are good for us, I received a comment in my Twitter feed that we know WHAT; what we need to focus on is HOW. Frankly, I hope for that every day. Let's break it down.

First, whether or not "we" know WHAT depends on who is and who isn't part of "we." Clearly, it has to exclude all those inclined to propound, publish, and peddle fad-diet hooey and conspiracy theory nonsense anew every day. Although in fact, these folks may well know "what" -- they just prefer the money to be made by pretending not to know. Moving on.

Just as clearly, "we" must exclude the gullible masses of us, high on pixie dust, eager to reach for our credit cards every time a new dietary scapegoat is dragged out, or a shiny new silver bullet seems just right to fit our gun.

Given those exclusions, and assuming there is anyone left -- then yes, we do indeed know WHAT. We are not confused, certainly not clueless. The evidence is compelling, consistent, clear, and robust.

It's just not sexy. The evidence supports a theme of healthful eating, and you really can't market the hell out of a theme. The military-industrial establishment, and Madison Avenue in particular, will go with perpetual confusion, and an endless parade of "my diet can beat your diet" beauty pageant contestants every time, thanks just the same. There's gold in perpetual confusion, because you can sell a new answer every day.

So maybe "we" really do know what, but if so, our culture just won't swallow it. That needs to be fixed if what we "know" is to relate in any particular way to what we "do." That needs to be fixed before knowledge can be power.

But let's assume for the moment that there are a few of us in the group that actually does know WHAT. Or let's be even more optimistic and pretend that the morning shows don't mind offering the same, honest and reliable diet advice every week, that publishers stop looking for the next fad diet to refute everything in the last one, and that we the people stop holding out for some magical combination of foods, fairy dust and moonlight that will let us eat limitless calories while watching TV yet still earn our living as underwear models.

Well then, I agree entirely -- the real challenge is indeed HOW. And that's the very challenge to which my career has been devoted for roughly 25 years. And although the going has been tough every step of the way, I still believe! I think we can get there from here.

HOW requires being able to find, access, identify, afford, care, prepare, and share. There are challenges in every case, but those challenges can be overcome.

While discussing the already notorious low-carb vs. low-fat diet study of last week on Boston Public Radio, my fellow discussants and I were asked to address the challenges of someone who shops in a mini-mart and simply can't find fresh fruits and vegetables. Dr. Dariush Mozaffarian opined, recommending taxes on poor quality foods. We ran out of time, and I never got to weigh in.

There are arguments for and against taxing poor-quality foods. Personally, I favor carrots over sticks whenever possible, and have made that case before -- including how it might be used to help poor people choose something other than poor food, and wind up with something other than poor health. But I don't really think that topic pertains to the question at hand. The issue here was access to produce, not cost.

So here, my answer would have invoked the many models of community activism encouraging former mini-mart shoppers to be gardeners. A garden can grow in an urban setting, or on a rooftop. It's not a one-size-fits-all answer; nothing is. But if the issue is: I can't find any fresh produce where I shop, then "maybe try growing some" is a not just a retort, but a widely validated model.

That said, I do like the idea of financial incentives for more nutritious foods, directed at both the supply and demand. Maybe carrots rather than sticks, in the form of subsidies or tax credits, could encourage bodega and mini-mart owners to sell more carrots. And yes, the carrots would qualify for the incentive so the buyer wins, too.

There are ways to make produce more accessible, and affordable; although obstacles remain to increasing vegetable and fruit intake. While working to overcome these, we should also work to improve all the other food choices people make. We have evidence that trading up the nutritional quality of groceries from soup to nuts is associated with a reduced burden of chronic disease, and a reduction in the rate of premature death from all causes.

So we can, and should, provide at-a-glance guidance for just such trade-ups where people purchase their food. We can and should educate our children to care about, and identify, more nutritious foods. We can and should provide user-friendly guidance to the more nutritious options in popular restaurants.

We need to work on the skillpower required for food preparation. My lab is currently exploring the use of church kitchens to teach whole communities how to prepare wholesome, delicious, convenient, economical, family-friendly meals. We call the project FICS, which stands for "faith in cooking skills."

But there is no need for you to wait. My wife recently launched a website that makes Katz family favorite recipes freely accessible to all. Help yourself.

And yes, helping ourselves is part of the formula. I recognize the important obligations of the body politic. But at some point, the care and nurturing of our own bodies and those of our family members is something to which we must commit ourselves. The body politic can help pave the way, but we still need to walk it. We still need to care. How to eat well begins by truly caring about getting there from here.

Then, it requires knowing where there is. To get to the relevance of "how," we must overcome the spurious debates about "what." You certainly can't get there from here if you can't acknowledge where "there" is. We do know, but our culture needs to admit that we know. The profitable market for pixie dust needs to disappear.

Then we can unite, and devote our unified strength, to the genuine challenge of "how." I hope we do just that.


David L. Katz, MD, MPH, FACPM, FACP

Author, Disease Proof

President, Turn the Tide Foundation