Episode 7: The “New Normal” with Dr. Kee Seng Chia


Dr.  Wendy Slusser  00:03

Dr. Kee Seng Chia is a professor and founding Dean of the National University of Singapore, School of Public Health. He played a key role in initiating the Healthy Campus Initiative in two major universities in Singapore, Nanyang Technological University and the National University of Singapore. Welcome, Kee Seng. We are so grateful that you’re here with us today to talk about what you’ve done in Singapore to deal with this new pandemic called COVID-19.

Dr. Kee Seng Chia  00:34

Thank you very much for having me. I would like to share with you, more in terms of how should we move forward. I think, I’m sure your audience is already very familiar with what’s happening around the world. But I think it is important also to have the right mindset, because we are going to be faced with a new normal.

Dr.  Wendy Slusser  00:57

Yeah, well, I’ll tell you, you already educated me about a new mindset a number of years ago, which was almost clairvoyant, in a way. And I’ve been quoting you over the last month or two, because you really introduce the phrase or saying to me, that we need to equate health with wealth. And in fact, I think, you and I would even say we need to raise health higher than wealth, because without health, you have no wealth. And we are seeing this before our very eyes. Tell me, what is it that you feel we have to look forward to as we move into this new phase of the pandemic?

Dr. Kee Seng Chia  01:34

So I think, because of these restrictions that we are facing, it’s very natural to kind of look forward to the time when things will be back to normal. We kind of feel that, yeah, you wish it, and that’s a very natural response. And very often we may be thinking more in terms of, oh, how are things actually being subtracted from our life right now. We can’t do this, we can’t do that. And we kind of hate this term, when people tell us that this is going to be the new normal. So I think, for us to be able to move forward with purpose, I’d like to suggest that we need to discard this subtracted kind of viewpoint, and put on ADD. perspectives, for us to add and not to subtract kind of mindset. And by “ADD,” I am referring to “A” standing for to accept the new normal, “D” to define a new normal, and the third “D” to delight in the new normal. So what I like to share is that we need to put on this ADD perspective and not a subtract kind of a mindset.

Dr.  Wendy Slusser  02:46

Well, you know, that kind of approach is really something that we’ve heard from other experts in regards to resilience, looking at things from different perspectives. And also, it adds to people’s sense of positive outlook, what you’re relying on people to pivot and be looking at this experience as one that should not be considered necessarily subtracting or taking from your life, but an opportunity to make something maybe different.

Dr. Kee Seng Chia  03:18

Yeah, so I meet many people, I say, don’t waste a crisis in that sense. But I think, you know, one way of not wasting this crisis is to help to accept this new normal, to define this new normal, and to delight in this new normal. Because what we’re facing is not going to be a transient phenomena. COVID-19 is not going to go away. Even if we were to find a vaccine tomorrow, we find a miracle cure tomorrow, these solutions, this magic bullets will need to be applied globally and equally. And to do that is going to take quite a while.

Dr.  Wendy Slusser  03:59

Just to ask you, why do you think it’s not going to go away?

Dr. Kee Seng Chia  04:02

Well, basically, because even if we do have a magic bullet today, it has to be applied globally, and it has to be applied equally. And essentially, that will take quite a while. So take for example, if you find a vaccine. Theoretically you need to vaccinate the entire world, 70 to 80% of the entire population of the world, before you could have sufficient herd immunity. And all you need is just one population who continue to not be vaccinated and continue to have those cases. And when they travel in this globalized world, it will just be seeding new outbreaks everywhere. And in a sense, that’s what you’re seeing in China, that they have locked down and controlled pretty effectively, but now they are faced with imported cases primarily.

Dr.  Wendy Slusser  04:58

So therefore what you’re saying about accepting is that this will be here.

Dr. Kee Seng Chia  05:04

Yep. Yeah, this will be here for a long, long time.

Dr.  Wendy Slusser  05:07

Sort of like smallpox was until we eradicated it, which was a long path before we got there.

Dr. Kee Seng Chia  05:15

That’s right. And so, I mean, a lot of people were hoping that like SARS, this will be kind of a V-shaped recovery. You know, especially those in the financial markets, they were hoping for a V-shaped recovery. But now they’re kind of accepting that it might be a U-shaped recovery, it’s going to take a long while before it comes back up. But I would argue that we need to be mentally prepared that be a L-shaped recovery. So that “L,” that horizontal arm is going to be that new normal. Right now, you see many countries basically going through a lockdown, because by the time they realize that this was a problem, there was already widespread community infection. So it’s like driving a car, and suddenly you see a truck coming at you, you pull the emergency brakes. Other countries, say, like in Singapore, when we were lucky to discover it early, we’re actually just tapping the brakes. So we do things progressively. And as things evolve, we change a strategy or we increase the number of measures. But eventually, all countries will have to come into this phase of tapping the brakes. You can’t be in a perpetual lockdown so you got to kind of unwind. But yet, you cannot unwind completely. Because even if you don’t have any more cases within your community, because you opened up again, for economic activity, you’re going to end up with new important cases. And then we see a new local cluster. So this is going to continue for quite a while. I’ll be quite happy if this continues for just a year, but it might even be longer than that.

Dr.  Wendy Slusser  07:06

And so what you’re saying is, we will see an economic downturn. And the “L” shape is what you’re predicting, because of the nature of this pandemic’s worldwide spread, which is defined by pandemic, right, that defines a pandemic, but also the nature of this particular virus, is that what you’re saying? It’s the combination?

Dr. Kee Seng Chia  07:32

Yeah, that’s correct. So this is a virus that is highly infective. Although the mortality rate is unlikely to be anywhere close to SARS, what we are more concerned with is that the proportion that may require ICU care, intensive care, may be quite high, anything from 10 to 20%. And it basically overwhelms the entire healthcare system. So it may not be the mortality rate that is the main driver, but the complication rate. But in large populations, even with a mortality rate of, say, 1 to 2%, the absolute numbers can be staggering.

Dr.  Wendy Slusser  08:21

And so with that degree of morbidity and mortality in large populations, the effort for the economic downturn to recover is just going to take a longer time because of the nature of the disease itself.

Dr. Kee Seng Chia  08:36

That’s correct. I mean, it’s going to impact on working life and therefore economic activity would have to be changed. Slow-down is inevitable. So that’s why the economic impact is also very high. But I think I’d like to highlight one point, which I think was very well-stated recently by our Minister who co-chairs our Onterim Ministry Task Force on COVID-19. He highlighted that the primary concern is actually health. And he made a very logical and candid point that the economic impact is going to be there. And you need to actually now put in measures that actually have health as the primary consideration and not economic considerations. So he was very clear that the health and well-being of the population has to be over and above economic considerations. And if you address these health and well-being factors, economic considerations will take care of itself. So here in real life, you see actually a kind of close link between wealth and health. And you see a real live demonstration of health in all policies kind of an of approach.

Dr.  Wendy Slusser  10:05

You know, what’s really remarkable is what you and I and so many others have always thought about how much your health is number one, you know, there’s nothing you can do without your health. And this is like a perfect example of how you can’t do anything if you’re not having a healthful well-being, life in the end. I mean, as a community, certainly. And this is, unfortunately, a great tragedy that has to sort of bring it to light to many people. What I’m finding is, what you’ve just said is, the acceptance of the situation is really an acceptance of that belief, right, that health is critical for a successful, thriving, vibrant community. So your next thing was to define the new normal? What is that?

Dr. Kee Seng Chia  10:53

Yeah, I think right now, when we think about a new normal, we think of all the restrictions and social distancing. And we kind of call that the new normal. Yes, I think those are components of the new normal. I think each and every one of us would then need to define specifically, what is the new normal for my life? And also contribute to this whole understanding of what should be the new normal in society. And especially, I think, the universities have a role to play. And we must be able to try to help society to define this new normal. So as you know, most tertiary institutions now would go for e-learning. And we basically have to find new ways of teaching for faculty to do that. But students also have to find new ways of learning. So this e-approach for teaching and learning is going to be very much part of the new normal. It has to be escalated very rapidly. I just saw a kind of joke in the internet, where they posted this as a MCQ question. And the question was, who is responsible for digital transformation in your company? And there were four choices. “A” was the CEO. That’s the wrong answer. “B” was the Chief Technology Officer. That is also the wrong answer. “C” was IT Department. That was definitely the wrong answer. And the correct answer is choice “D,” COVID-19.

Dr.  Wendy Slusser  12:37

Ha. Necessity is the mother of invention, is that right?

Dr. Kee Seng Chia  12:44

Yeah, so COVID-19 will drive and escalate the adoption of digital technology into teaching, into learning. And it will drive the transformation towards a smart nation. So I think one is that the universities will have to play a leadership role and set the example. I’m all dead wood in the university, hah.

Dr.  Wendy Slusser  13:11

I don’t believe that.

Dr. Kee Seng Chia  13:14

And I have my own favorite way of teaching. And I need to kind of discard all those old-style, old paradigms of teaching. The old paradigm is, we teach to impart knowledge and so forth. But actually, the new way of teaching is I need to teach to make an impact. So instead of teaching to impart, I need to teach to impact. So these new ways of thinking will have to influence the way I teach. And secondly, students also have to now take greater ownership for their own learning, as a result of this digital learning. In the past, at least among Singaporean students, their main concern is they want to learn to be able to pass a module. They want to learn to be able to pass the exams. And now they need to change and say, I need to actually be passionate about learning. So instead of learning just to pass, it’s to develop a passion for learning.

Dr.  Wendy Slusser  14:19

And why do you think this kind of learning on platforms will create that kind of mindset? What will make that different?

Dr. Kee Seng Chia  14:28

I don’t think the platform itself actually brings about that change. The platform itself would actually then hopefully, the more enlightened students and the more enlightened faculty start to think and reflect on how effective they are using these platforms. In fact, the platforms may show up that, look, there are going to be gaps if we just rely on technology-based teaching and learning. Then it costs the student to now begin to question why they are going through this. Why are they learning? What’s the purpose? I came across an article actually written by a Singaporean student. She was in the UK, I think, doing her International Baccalaureate course. So she came back to Singapore. And the college basically says that exams have been canceled. You will be assessed just based on your day-to-day performance over the entire course. And she wrote an article basically saying that if I knew that there were no exams, would I have actually went about learning in a different way? Would I be asking more questions, rather than memorizing what I need to pass my exams? So to me, that kind of demonstrated that as a result of moving towards a digital platform, students are starting to take greater ownership of the way they learn or what they want to learn, and to perhaps develop passion about learning.

Dr.  Wendy Slusser  16:11

Well that’s a very optimistic, I think, and positive outlook for a potential outcome for students and their capacity to embrace and become lifelong learners. That’s really great. So you’ve talked about accepting and defining, and explain to me what you mean by delight in the new normal? What do you mean by that?

Dr. Kee Seng Chia  16:35

So we tend to think of, what do we need to do when there’s a new normal. But the new normal is actually not about new ways of doing things. These new ways of doing things must be actually anchored on a new personal, as well as new societal, values. If it had just resulted in just a new way of doing things or different ways of doing things, it tends to be superficial, and we will tend to regress back to the old ways. So what I hope to see as a result of this crisis is that there’ll be new personal and new societal values. So one of which is something that we have always discussed and can talk about, it’s to value health just as much as wealth. Yeah, although right now we see the health seems to be more and we need to focus more on health rather than wealth. But I think in reality, they should be seen as equal because they kind of have a direct impact on each other. Wealth does promote health, and health definitely does promote wealth. So that’s why within our NUS campus, the National University of Singapore, our Healthy Campus Initiative is that we hope that the graduates in five years’ time, 2025, will be graduates who value health just as much as wealth. So we’re talking about an internal value system change. We’re not talking about something that’s just external, and doesn’t cause an internal change. And I think related to that is, the world has been going along the lines of greed is actually good. I think Milton Friedman in the 70s, in his Shareholder Doctrine, seems to emphasize that the sole purpose of a corporation is to generate wealth for its shareholders. And definitely shareholders love that. But the unintended consequence, I suppose, of that doctrine is that it caused a whole era of people who consciously or unconsciously practice this mindset and this value system that greed is good. That is changing, but it’s kind of changing rather slowly with global warming issues, with sustainability issues, with global security issues. But this pandemic, perhaps, would be a good trigger point, to make a quantum leap from this greed is good philosophy, to rather, growth is good. And by growth, I mean, growth in well-being, not just health, but in general well-being. So when I use the term delight, it means that this is something that we embrace, that we want to embrace that we value health just as much as wealth, and we value growth in our well-being. You know, that growth is good. So what I meant by delight in the new normal is a deeper internal change.

Dr.  Wendy Slusser  19:56

And how do you feel about how changing values is not easy. What do you think? Do you feel that this pandemic has created a pivot that will enhance this change in values? Or what do we have to do intentionally to work on promoting this value change?

Dr. Kee Seng Chia  20:16

Well I think change has to happen with young people. In a sense, the older generation, like myself, you can’t teach an old dog new tricks. And change must happen with the younger generation. And I would say, people who are 30 years and below, they must drive this change. They must take advantage of this crisis, to say that, look, society must change. And I actually have a lot of confidence and faith in this younger generation.

Dr.  Wendy Slusser  20:47

Me too.

Dr. Kee Seng Chia  20:49

You see the way that climate change has taken off?

Dr.  Wendy Slusser  20:53

That’s right. They’re driving it.

Dr. Kee Seng Chia  20:55

Exactly. They’re driving it.

Dr.  Wendy Slusser  20:57

And they believe in it, that we need to make changes because of what’s happening.

Dr. Kee Seng Chia  21:02

That’s correct. And I hope this pandemic will not cause them to react either in fear or in indifference. But they take this as actually an opportunity to drive a change in value systems in themselves, as well as in society.

Dr.  Wendy Slusser  21:23

Well, I do. I also have great confidence in our younger generation. And that’s part of why, I’m sure I don’t know for you, but that’s one of my drivers for why I’m so passionate about the Healthy Campus Initiative at UCLA, is really engaging the next generation of leaders. And we have this huge opportunity to support a group of people who are emerging as leaders of our country and the world. So I think we’re eternally grateful for those really working hard on so many issues, and this will be one of them. The health, equating it to wealth. And I really find your ability to communicate in a way that allows all of us to have some practical approaches to culture change. And I want to thank you for that, very much so. And Kee Seng, I’m sure, you’re considered a treasure at Singapore. But you also are considered one, in my opinion, for us at UCLA. And I’m really grateful for you to share these wisdoms and take the time in your busy day. Thank you so much for all you’ve done and offered us right now, at this time for us at UCLA.

Dr. Kee Seng Chia  22:38

Thank you for inviting me to join this, and you guys keep safe. And just remember that 80% of people who get infected only have very mild symptoms, so we don’t need to actually live in fear.

Dr.  Wendy Slusser  22:54

That’s a very good piece to leave us with. And we thank you for that. Thank you for tuning in to “Six Feet Apart,” a special series of the Live Well Podcast. Today’s episode was brought to you by UCLA’s Semel Healthy Campus Initiative Center. To stay up to date with the rest of the episodes in this special series, and to get more information on maintaining your mental, social, and physical well-being during COVID-19, please visit our website at healthy.ucla.edu/livewellpodcasts. Thank you and stay remote.

Episode 9: The Mind-Gut Connection with Dr. Emeran Mayer


Dr.  Wendy Slusser  00:03

Today I chat with Dr. Emerson Mayer, director of the G. Oppenheimer Center for Neurobiology of Stress and Resilience, and UCLA Distinguished Professor of Medicine, about the bi-directional communication between our mind, brain, and gut. We’ll answer the question of what the mind-gut connection really is, and how it may be affected during these unique times, and how we can improve our diet to foster a healthier microbiome.  Thank you for joining us today during this pandemic. A lot of us are facing changes in our eating habits, and sometimes drastic changes as our usual sources of food are cut off or limited. I’d like to focus today’s conversation on your area of expertise, the mind-gut connection, and how it relates to the current time. So to start off with, what is the mind-gut connection?

Dr. Emeran Mayer  00:59

First of all, Wendy, thanks for having me on the program. And to give you a brief answer, it’s essentially, first something that everybody has experienced, a relationship between what goes on in our brain, in our mind, and our emotions, and what happens in the gut and what we feel in the gut. This has been known to people for a long time, but has become a scientific discipline much more recently, particularly with these sort of the microbiome science that has made this a lot more exciting to people than it has been before that. So it’s a biological connection. It’s not just in our minds, it’s not just in our gut, it is multiple communication channels that mediates this. And the communication goes both ways. It goes from the mind, the brain, to the gut, and it goes from the gut to the brain.

Dr.  Wendy Slusser  01:48

So I think, to unpack what you just said, the first question I have is, can you define microbiome? Because when you first defined it, for me, it was kind of a wild thought to imagine the quantity and the age of them. And so could you sort of elaborate on that?

Dr. Emeran Mayer  02:06

Yeah, so it’s the numbers have gone, you know, the comparative numbers between human and microbial cells has sort of undergone some evolution, but as up to 100 trillion microbial organisms that inhabit, that live all the way really from the stomach to the end of the large intestine. The highest density by far is in the large intestine, then comes the end of the small intestine, and very few in the stomach. So in terms of what we know today, many from studies focusing on analyses of stool samples, we get a mix of all of these. So we can’t really tell exactly, you know, what we measure in a fecal sample, if this comes from which part of the GI tract, which is important, but we just don’t have the answer. Now, there’s about 100 trillion of these microorganisms. There’s just different types, there’s the microbes, the RK, the fungi. The area we know most about are the bacteria. So the number is about the same, rough plus/minus, it’s about the same as our human cells. So we are half-human, half-microbial, really, and it’s been called a holobiont, you know, because we live in such close synchrony with these organisms. But what’s even more informative is that we have about 20,000 human genes. And we have, you know, millions of microbial genes. So the capacity for these microbes to produce molecules that influence our human physiology, the gut physiology, and also the brain and this brain-gut communication is enormous. We just, at the moment, are scratching on the surface of understanding this. It’s really a rapidly emerging field with rapidly developed technology. But so we can say, because it’s also in evolution it’s been with us, with animals from the first primitive animals millions of years ago, to today, and has really become a blueprint for most animals, from the bees to mice to, you know, horses, humans. We all have a microbiome. There’s only a few species that don’t have that. So it seems to be a very important evolutionary design, in human life and in animal life in general. I mean, the connection to the brain is even more intriguing because many of these molecules that the microbes can produce are what we call neuroactive molecules. That means where they have homologues in the nervous system, means molecules that look very similar can act on the same receptors, and that can interact with our nervous system. There’s these neuroactive molecules and there’s also molecules like short-chain fatty acids that they produce from fiber that we eat, that have a positive influence on gut inflammation, for example. So really two different types of signaling molecules: some that act directly on our nervous system and others that can influence the nervous system indirectly through regulating inflammation in the gut, which then can spread throughout the organism all the way into the brain.

Dr.  Wendy Slusser  05:27

So these neuroactive homologues that they are producing, they get into our system? Is that what you’re saying?

Dr. Emeran Mayer  05:36

Yes, and we don’t know to what degree these different pathways are important. So one very important communication channel is the vagus nerve. You know, the vagus nerve innervates, amongst all the other nerves in the gut, particularly, plays a major role in the signaling from the gut to the brain. These nerve endings of the vagus in the gut have receptors that respond to molecules that are produced by the microbes. So that’s one communication pathway. There’s another one, the vagus nerve innervates cells in the gut that produce hormones, and serotonin, and these cells respond to signals from the microbes. So there’s an indirect step in between the microbes signaling to these hormonal cells, which then act on the vagus and then go to the brain. And then there’s some of these neuroactive molecules – people have, you know, speculated this – that actually are being absorbed, and get into the bloodstream and reach the brain directly, which, you know, if they can cross the blood-brain barrier, or if they reach regions that are outside of the blood-brain barrier, like the hypothalamus, can influence brain function and brain activity.

Dr.  Wendy Slusser  06:50

So you mentioned the serotonin, I understand, you’ve educated me on this, it’s predominantly produced in the gut. Is that right?

Dr. Emeran Mayer  06:58

Yeah, even though, you know, it plays such an important role and we know so much about serotonin, what it does to the brain, from mood, pain sensitivity, sleep, appetite, well-being. There’s very little of the serotonin that’s in the brain, in these nerve cells in the brain, just about probably less than 5% of our total body’s serotonin. Whereas most of it is stored in these, they’re called warehouses in the gut, these so-called enterochromaffin cells that, you know, produce serotonin, store it, and release it. And, probably too long a story for this conversation, but a lot of work that has come out of UCLA, particularly Elaine Chao, investigator of some of these pivotal studies, is a close interaction between the microbes in the gut and these enterochromaffin cells. So the microbes are responsible for the regulation of the synthesis of serotonin in our cells. So the microbes send signals to the cells to stimulate serotonin, to release serotonin. The serotonin cells, in turn, talk back to the microbes. So they release the serotonin not only inside of our body, but they talk back to the microbes. And to make that story more intriguing, the microbes have molecules that are similar to the serotonin transporter that we have in our brain and in our own cells, which are the target of antidepressants, of serotonin reuptake inhibitors. So the serotonin-microbe-brain interaction is a good example how intricate this relationship is between them. And I forgot to mention, obviously, the microbes and their activity to stimulate serotonin production is closely related to the amount of tryptophan that we ingest. So a close link between our diet, to microbial activity, to serotonin synthesis, serotonin influencing brain functions through the vagus nerve, and talking back to the microbes, telling them, well, we don’t really know what our serotonin tells the microbes, so that’s still an unresolved question.

Dr.  Wendy Slusser  09:14

I want to get back to the tryptophan, but before I do that, I think that what you’re describing to me really implies,, or suggests that what we put in our own mouths that gets down into the, what would be ultimately our large intestine which is where most of these microbes live, that even the small intestine is critical, or might be critical, for influencing these microbes to do their job. Am I correct in thinking that way?

Dr. Emeran Mayer  09:44

Yeah, absolutely. And to me, it’s sort of really been an eye-opener to realize. So I’m not trained in nutrition, but I’ve gotten fascinated with this topic because clearly, it has such an important influence of this key function of our brain-gut-microbiome axis, that not taking into account, for example, in psychiatric disease or in our well-being, is leaving half of the story out, you know. And I think this continues that we really don’t, I would say 99% of our medical students, have not heard about that story.

Dr.  Wendy Slusser  10:19

Yeah, we’re working on that right, you and I. It’s an important piece. Well, so, let’s talk about tryptophan, which you know, all of us know about tryptophan during Thanksgiving time, right? God, it puts us to sleep. Tell me, is when you’re saying tryptophan influences microbes, is it in a positive way? Or in the microbiome? Or is it a negative way? Or how, or is it more complicated than that?

Dr. Emeran Mayer  10:48

It’s more complicated, like most things in the gut. So you know, tryptophan is just really the precursor that microbes then metabolize in multiple different molecules. And to stand out, you know, one is the serotonin that microbes themselves don’t produce. They can’t produce it so they use our enterochromaffin cells, to stimulate our cells to produce it, and then they take it up from the cells. But there’s also another one, another metabolite, called kynurenine. Nobody can remember that name, but it’s a pretty important molecule, probably at least as important as serotonin, because it can cross the blood-brain barrier. And it has been shown to have inflammatory and neurodegenerative effects on the central nervous system. So the ratio between kynurenine and serotonin is regulated, in part by microbes, you know, when we talk about diseases that are involved with what’s called neuroinflammation, so immune activation in the brain, kynurenine often comes up as a key signaling molecule that plays a role in this. But there’s many others, there’s the indoles, each of which has specific functions. Obviously it’s important to realize that only some of them can cross the blood-brain barrier and affect brain function. Others act on the gut, on the vagus nerve, on other cells in the gut. So the simple story is, there’s two of these metabolites: serotonin and kynurenine, both of which played very important roles, sort of in opposite directions, really. And what you say earlier about the tryptophan: so like all dietary items, or most dietary items, I would say the majority is absorbed in the small intestine. So we have very elaborate, specialized mechanisms, transporters that can take up these molecules. The exceptions are very large molecules, or molecules for which we don’t have enzymes to break them down. So the very large ones would be the polyphenols, people often mislabel as antioxidants, because there’s just one small function that they have. So these are too large to be absorbed in a small intestine, they all go down to the microbes. The microbes break them down into smaller metabolites, which then are being absorbed, and they’re the ones that exert their beneficial effects, incompletely understood, really, on the brain. The other one is the dietary fiber, that, particularly if it’s not processed,or cooked, we don’t have the enzymes to break it down so it goes down to the microbes. It’s actually the main food supply, the main nutrition for the microbes. So I always say it’s a very easy answer to the question, you know, what can you do for your gut health? So you got microbial health. Well, it’s eating a lot of plants with fiber, because that’s what they thrive on and that’s where they produce their one class of molecules, I mentioned earlier, the short chain fatty acids that have beneficial effects really on pretty much all the cells in the gut, you know, the epithelium, the lining, the anti-inflammatory, they stimulate growth of gut cells. They act on on vagal afferent terminals signal to the brain. Yeah, so coming back to the tryptophan, like many things, we know many nutritional things. Classical nutrition, the field has learned a lot about the stuff that we can absorb in the small intestine. But it’s really just beginning to understand the full potential of what cannot be absorbed in the small intestine, but that goes down to the microbes. And I do want to say, in my opinion, it’s not just the colon, even though there’s most of these microbes. There’s a lot of them in the end of these small intestine in the ileum. And even in the end of the jejunum. So many of these beneficial processes may well happen in a small intestine, but we don’t really know that for sure.

Dr.  Wendy Slusser  14:51

Just so we can summarize just what we’ve talked about so we can move on, to people who might be eating for comfort, that might not necessarily at this time be the kinds of foods we want to feed our microbiome with. Or maybe there’s a balance that we can come around to. But what you’re describing is eating a diet full of fiber that also has polyphenols and foods like that, or eat the rainbow of vegetables and fruits, that kind of diet, which we all have heard about. But if you go down to the granular, it’s really about sort of the diversity of the fruits and vegetables that are as as important as one fruit itself, right? You have to have a diversity because there’s differences in what they can bring to you. It’s that, kind of?

Dr. Emeran Mayer  15:47

That’s a very important point. So, you know, Rob Knight with the American Gut Project, they have found from their survey of thousands of fecal microbial samples from volunteers that have sent them in, that it’s really the variety of plant products that determines, that has an influence on the diversity and the richness of the gut microbes. And, you know, Rob, obviously this is his example, you can be a vegetarian and just eat pizzas. That will not give you an increased diversity of your gut microbiome. The more diversity that you can add to the vegetables and fruits that you eat, the better. And it’s makes a lot of sense, because there’s hundreds of different fiber molecules, and there’s thousands of different polyphenols. Each of these plant components requires a different set of microbes, different strains of microbes, to process them adequately. So by feeding this kind of a diet, you force the system to diversify. And so that’s really, you know, one of the key concepts. Even though blueberries and olives may have the highest concentration of beneficial polyphenols, there’s thousands of other molecules, polyphenols, in much smaller quantities, in all fruits. But talking about the gut microbiome, so there’s three things, I mean, there’s the plant-based oils and fats, there’s the fiber, and there’s the polyphenols. I would say that’s what plants can contribute. And if you satisfy that need for these, you will automatically get enough vitamins and trace minerals in your diet anyway. So it’s not that you have to monitor each of these, you know, health-promoting components of plant-based food. So it’s actually, in some ways, it’s fairly easy. The science is pretty hard; the practice is pretty easy.

Dr.  Wendy Slusser  17:44

Thank heavens for all of us non-scientists. I have to say, you’re also, besides being incredible scientist, you’re an incredible author. And one of your blogs that you wrote recently regarding how the gut microbiome plays a role in the individual response to the COVID-19 virus, I love this description that you wrote about the world of the microbiome, so to speak. And you say, “Far from being a peaceful world of coexistence, there’s a constant struggle between these microorganisms, using antibiotic molecules suppresses each other, and to preserve ecological niches. So viruses living in our gut prey on the bacteria and kill approximately 10% of the microbial population every day and the gut microbes fight back with a vast battery of antibiotic-like molecules.” It just sounds so hectic down there. I never knew there were things like that happening on a regular basis.

Dr. Emeran Mayer  18:48

Well, it’s just, you know, a miniaturized ecosystem. So if you look around in any ecosystem, you know, you look at Yellowstone, I mean, there’s a lot of non-harmonious things going on, you know. Species are being eaten, you know, the bears prey on some animals. The wolves, sort of one of the keystone species ,takes care on the very top of the system. So something very similar, but in a miniaturized form, you know, goes on within the gut. And the interesting thing about these antimicrobial substances that they produce, I mean, obviously, they can talk to each other, these microbes. That’s why they have these enormous number of genes and molecules that they can produce to communicate with each other. What this communication entails, we don’t really know but we do know that some of these antimicrobial substances they produce limit the growth of other species. So this elaborate system that’s pretty much stable throughout our life is not just something, it’s not static, you know. It’s a constantly evolving and, you know, generated system that requires a lot of work from from each of the participants and survival skills. We don’t know as much about the viruses in this game and the fungi. Obviously, you know, viruses and fungi play a huge role in the soil, another ecosystem that has a big microbial component. And we know more about this in the soil. We don’t know as much at this point. Well, we know about pathogenic viruses, you know, that can create havoc within the gut and kill off a large number of bacterial organisms.

Dr.  Wendy Slusser  20:34

Like rotavirus.

Dr. Emeran Mayer  20:35

Yeah, like rotavirus. And but the ones, the commensal viruses, we don’t know as much about, you know. What regulatory role do they play in? Are they ultimately responsible for some of these microbial differences that we see in different disease populations? We don’t have the answer for that yet.

Dr.  Wendy Slusser  20:54

So getting back to what’s going on now with COVID-19 and people, you know, basically sheltering-in-place, many of us have gone to some of our favorite comfort foods that might not necessarily be promoting our gut. And others might be going to comfort foods that do. And also the scarcity of certain foods are present. So what happens if you are not getting as much of a variety of fruits and vegetables and/or also increasing some of the more processed foods, or you know, simple sugar foods?

Dr. Emeran Mayer  21:32

Here, let me start. The simple component of this question has to do with, you know, what we typically considered the Western diet – high in sugars, refined carbohydrates, low in fiber, and high in animal fats. That diet clearly has been, I mean, it’s a large number of studies now, both, you know, epidemiological studies, but now most recently, also, intervention studies, that this diet has a negative effect on gut microbial diversity and relative abundances of health-promoting organisms. And also on the metabolites that they produce. So in this time, where people may not think so much about, you know, do I get my servings of fruits and vegetables every day, but sadly, you know, where a lot of people are struggling with getting enough to eat in general, which is sort of an incredible situation that we’re in. On the one side, the fruits and vegetables are being thrown away by farmers who can’t get them to the restaurants. On the other hand, you know, the consumers, particularly the lower socioeconomic populations, don’t get enough of those healthy foods. So it’s a strain and stress on the gut microbial health. On top of that, so the comfort foods, unfortunately high fat and high sugar foods, provide immediate comfort. So studies on that, they decrease the the acute stress response, you feel better, you release dopamine. So there’s a lot of things that in evolution have evolved to make us crave for these foods.

Dr.  Wendy Slusser  23:16

Cheesecake’s my favorite.

Dr. Emeran Mayer  23:18

Yes, and I should say, normally, you know, small amounts of these foods are not bad for you. But if it becomes a significant part of your diet, then yes, it will. It probably has contributed a lot to these changes, these negative changes we’ve seen in Western populations. So yeah, this will add, you know, this eating these comfort foods will add another, on top of regressing to a typical Western diet, then you add these things, it makes it even worse. So another aspect potentially may play a role. A lot of people you know, spend a lot of time watching Netflix in the evenings and snack during this time, so after dinner. There’s also a lot of recent science that has shown that time-restricted eating, meaning, you know, you don’t eat around-the-clock. You have something in your stomach, but you restrict the eating to six or eight hours, that if you break that time-restricted eating pattern that also has a significant effect on our gut microbes and the way they interact with our, you know, with our gut-based immune system. So there’s a lot of things just from the diet side here that are not good in this current situation.

Dr.  Wendy Slusser  24:35

Yeah, you’re referring a lot to what’s emerging as the whole circadian rhythm of eating.

Dr. Emeran Mayer  24:42


Dr.  Wendy Slusser  24:43

We’ll have to have a whole other podcast on that one because that’s super interesting. We’ve talked a lot about how a diet, maybe this sort of modern high-fat, low-fiber diet has been adopted by the American population in general, or the Western population. I understand now it can impact these microbiomes, make them less diverse or not as healthy, maybe. What does it do to your mood, or your brain?

Dr. Emeran Mayer  25:15

So we know now, you know, from some of these familiar epidemiological studies, that if you compare populations that are on a typical Western diet, and those that are on a largely plant-based diet, that for example, depression prevalence is significantly higher in the Western diet group, also the risk for Alzheimer’s disease, and probably other brain disorders. But it’s been probably best characterized, I would say, for depression. Recently, there has been studies in this field, what’s now called nutritional psychiatry, where people are doing interventions. So they take a group of people with depression and they are randomized to two types of diets, either plant-based diet or plant-enriched diet, and a typical Western diet. And they found that there are beneficial changes in the intervention arm with a Mediterranean-type diet, such as, you know, traditional Mediterranean, there’s also another acronym called the MIND diet, or the DASH diet, which will all share this property of being primarily was 75% plant-based. So there’s now several studies that just recently came out last week, two of them, which really show that this has a effect not just on the symptoms, but also on the relative abundances, in a beneficial way, of microbes and on some of the metabolites.

Dr.  Wendy Slusser  26:46

And I noticed, in your blog, you mentioned two that were really important anti inflammatory herbs: the tumeric and the ginger.

Dr. Emeran Mayer  26:55

Yes. It’s just the beginning. You know, even though I’m trained as a gastroenterologist, I obviously never heard about this until several years ago, when I got involved in this microbiome science. And it is remarkable, you know, these plants, the molecules in them are such large molecules similar to the polyphenols that most of it cannot be absorbed in the small intestine. So they stimulate our taste receptors in our mouth. So that’s why we, you know, we use them as vices. But then what happens after that, a small fraction is being absorbed, but the largest amount goes down – again, my guess is into the end of the small intestine – is being absorbed, transformed by microbes, then absorbed and then exerts its anti-inflammatory effects, which are so strong, you know, that there are studies, even, that they have been beneficial in the treatment of mild inflammatory bowel disease in a randomized study. So it’s not a trivial effect.

Dr.  Wendy Slusser  27:59

Well, they certainly have been used in traditional medicine My question for all of us, who might have been indulging a little bit more than we wanted to in, say, cheesecake, the recovery time, or your ability to maybe pivot towards these more plant-based foods that you’re describing, 75% being your goal, how long would you say the microbiomes would sort of come back to life, so to speak?

Dr. Emeran Mayer  28:28

Yeah, this is a very interesting question. So at some point, people said they will never come back to life fully. So our Western microbial ecosystem is definitely compromised. Many factors start early in life, probably during pregnancy, nutrition of the mother influences that to a certain degree, as well. So many of these microbes have been lost forever. So they’re like the extinct species or strains. And those are, currently with our current means, we don’t really have a way to bring them back. There’s some populations in the world, in Africa, that live sort of a prehistoric lifestyle, they oscillate depending on the seasons in what they eat between our type of compromised microbial composition and abundance. But in their case, they come back, you know, so they somewhere keep a very small number of these organisms that then, with the right diet, you know, come back to life. In our case, some of them have gotten extinct and, you know, some people have warned if this process continues, we’ll lose more and more of these species. And I like to take the more positive approach to that, or optimistic viewpoint, that if you switch, and this has been now shown in several studies, if you switch to such a diet, that they will come back. Even in these trials that lasted eight weeks, even in that time period, they came back. And these weren’t even diets that I would push, you know, that I would recommend to maximize the diversity of the plant-based foods that you eat. So these are just the regular Mediterranean diet in this study. So the short answer is, we won’t get back to where we were 100,000 years ago. We may not even want to get back there. But we can certainly improve the situation significantly with health benefits, with these dietary interventions, even in a two-week period.

Dr.  Wendy Slusser  30:32

Oh, that’s very helpful. I’ll go with your take on it. Makes me feel better. So looking at the list of foods that you mentioned in your blog: large amounts of fiber, the tumeric and ginger, foods that have healthy fats like olive oil and avocado, and fermented foods. Now, how can you guide people, for instance, to the yogurts that are fermented? Because I know that’s always sort of a head scratcher? But how do you identify fermented versus, sort of, overly processed yogurt.

Dr. Emeran Mayer  31:07

So this is a head scratcher. There seems to be a general small benefit for a lot of, you know, health-related issues. And so these studies contain a whole variety of different probiotic strains. And as you know, they’re all, you know, from the taxa of lactobacilli, and bifidobacteria. Yet, there’s very few others that you know, that are in commercial use. But there’s a lot of microorganisms that are involved in fermentation of a variety of foods, like in cultures, you know, the Asian cultures – Korea, Japan, China – a lot of things are being fermented, and plant-based foods, and fish, and eggs. Each of these probably has somewhat different types of microorganisms. We can’t really call those probiotics, because there are no studies that have demonstrated the health benefit. In general, the feeling is that, what has happened in our civilized world, hygiene has reduced greatly the microbes that we ingest with our food. So the way I look at it is what all these fermented food products do is they they reintroduce in a controlled fashion, external microbes into our ecosystem within our gut. And so based on that, I think, this was a recommendation to my patients, a large variety of fermented foods. If you rotate them, if you have preferences – some people don’t like kombucha or don’t like kimchi – you can either select the ones that you like, or you can rotate them It’s probably the most plausible way of contributing a health benefit to your microbes. So increasing diversity and relative abundance by external feeding of these organisms.

Dr.  Wendy Slusser  33:02

And I know that, for instance, one way to reduce food waste is to ferment the foods that you might not have quite gotten to when they were at their freshest. So it’s a skillset I’ve never yet mastered, but one of the things that maybe we could do while we’re sheltering-in-place.

Dr. Emeran Mayer  33:24

Yeah, that’s a good idea.

Dr.  Wendy Slusser  33:26

So there’s a few helpful pieces of advice that you’ve already just delivered to us. One is that if you have been heading towards those comfort foods more than you wished you had, or you feel that you’re ready to, sort of, take on a more healthful diet, it’s possible  and plausible that you can improve your microbiome which will then in turn potentially impact your mood. So moving towards this Mediterranean diet of fresh fruits, vegetables, nuts, seeds, healthy fats like olive oil and avocado, and fermented foods, that those kinds of foods, and it doesn’t have to be all that, right. You can still have your brownie or your chocolate chip cookie, just not overly abundant.

Dr. Emeran Mayer  34:15

Yeah, absolutely. And you know, if you travel in Italy, you’ll see there’s a lot of delicious sweets that they have. In general, the quantities, and there’s a big difference, you know,  traditional Italian, or traditional Mediterranean cuisine, is quite different from what you find there today. And also the regions are different, you know, Northern Italy, having a lot more ham and meat products or, you know, Parma, where our friend Professor Del Rio is from. So they’re not really the traditional Mediterranean diet or which was used in the 60s to do these pivotal studies on cardiovascular health. So, yeah, I would say there’s clearly a hedonic component to food and sweets, I’ll give you that. A small amount of that is definitely something that contributes to your well-being and will not have any detrimental effects. It’s, you know, coming back to the cheesecake, I mean, eating a gigantic portion of cheesecake is obviously different from eating a small chocolate that is delicious but is obviously a tiny quantity of the cake. So yeah, I’m not saying that you should stop. And in some ways you could say, it’s the same with meat, you know, somebody, there’s people that love red meat, my son being one of them. I think if you reduce this to a small percentage of your overall intake, it’s very not detrimental, you know. But what’s happening in the Western diet. I mean, this has become like a daily or twice-daily component of people’s meals. Hamburger, which is not just meat, but you know, 60% fat, the more fat the better tastes. I’m definitely, you know, supporting the indulgence of sweets with the Mediterranean diet.

Dr.  Wendy Slusser  34:18

You’re referring to what we’ve worked on at UCLA and other places, that having meat be the condiment, not the center stage, of the meal. So you can get the flavors. that that’s it.

Dr. Emeran Mayer  36:10

Yeah, that’s very wise. Yeah, and you could say this is true in general, you know, the flavors. Yeah, you don’t have to eat four bowls of ice cream to get the flavor. I mean, you could have one teaspoon of each flavor and get the same amount of pleasure. The rest is essentially driven by your mechanisms in the brain having gone wild, you know, because you, sort of, are teasing them with the teaspoons.

Dr.  Wendy Slusser  36:50

Right. So I’ll end with this question. What keeps you up at night?

Dr. Emeran Mayer  36:55

So at the moment, clearly what quite literally is I’m working on my second book, and I’m about two-thirds through and that definitely wakes me up at three o’clock in the morning, because I feel they don’t have enough time to finish. But I would say, you know, what keeps me up. So taking this as a more general question, I think what we’re  seeing now with the COVID-19 epidemic and these differential vulnerabilities of different populations, is something that I find really intriguing. And I’ve written something about it, a speculative piece, and want to explore that further. So what we have seen, you know, the most vulnerable group is the group that has the most, what we call, comorbidity. You know, with the metabolic syndrome and obesity and heart disease, depression, liver disease. I look at this disorders, these metabolic and metabolic-related disorders, as really one chronic disease of our time, this so-called non-communicable diseases. And, you know, as I’ve done the research on this on my book, so you realize there’s clearly a connection between the health of the gut microbiome and the prevalence of these diseases, and the most likely explanation is ultimately, that’s related to the food that we eat. And particularly, as I mentioned this earlier, low-income people or people on the low socioeconomic ladder, eat this predominantly. There’s also racial divides, because those foods, unfortunately, are cheaper than the fresh fruits and vegetables that we’ve been talking about. That somehow there is ultimately a relationship to the gut microbiome, there’s probably many factors that predispose people. But I mean, you can’t overlook this, that this is a problem that most of us are not affected by, probably less than 5%, at most. So you could really ask the question, are we more prone and more vulnerable to these kinds of diseases? And I’m sure, this won’t be the last pandemic that’s come across, you know, the world, have we become more vulnerable to these diseases, because of our diet, dietary habits, and because of the changes in the gut microbiome, with the decreased resilience and resistance to perturbations like that. So I think that’s something I’ve been thinking about a lot. And so obviously, there’s a lot of research going on now, including at UCLA, but I think it’s a big question that certainly, from a nutrition standpoint, and from a lifestyle standpoint, would be worthwhile exploring.

Dr.  Wendy Slusser  39:45

Well it’s just one more reason why we need to try to move towards a more healthful diet for all and really reduce these inequities in our health system and in our health of our population.

Dr. Emeran Mayer  39:58


Dr.  Wendy Slusser  39:59

It’s really unveiled another really big health disparity in our country.

Dr. Emeran Mayer  40:05

Yeah, when you think about it, the cost of this pandemic, you know, is several-fold higher as the cost would have been if you could have intervened early with healthy diets and, you know, lifestyle changes in these most vulnerable populations.

Dr.  Wendy Slusser  40:21

That’s right. Well, to leave on a positive note, there is a program that’s a CDC program called the Diabetes Prevention Program that was studied and published their outcomes in 2002. That does show if you are pre-diabetic, which often also might be the prelude to these other conditions, like hypertension, and obesity, and so forth, if you are pre-diabetic, and you participate in these group classes that are once a month the first four months, once every other week for two more months, then once a month for six months. So 22 sessions, if you even just participate in 10 of them, you will reduce your risk of getting diabetes by 58%. Better than the medication Metformin, which is also very commonly prescribed if you’re pre diabetic, or even diabetic. So there are ways and I think, and a lot of it is related to modest changes in your diet, and your physical activity. And then also there’s a sense of social well-being that’s promoted with these group classes over time.

Dr. Emeran Mayer  41:27

Yeah, that’s amazing. Yeah, I can only support that, I think, the education. And that’s really one of the reasons I’ve started to write books, you know, instead of talking to my colleagues, who often are not that particularly interested in the diet part of gastroenterology. I think it’s to reach as many people as possible and make them think about their diet in a rational way. Because there’s obviously lots of advice out there that’s really not evidence-based and, you know, has commercial reasons behind it. I think that’s the best thing that some of us in academia can do and promote this among students, you know, to start out with, but also amongst the general population.

Dr.  Wendy Slusser  42:09

Yeah, fantastic. Well, Emeran, you’re a real gem for not just UCLA, but for our country and our world. And I’m really looking forward to reading your second book. Your first book was amazing. And we’ll put all that at the end of this podcast so others can learn from your wisdoms. And they’re quite readable too, so don’t worry. He’s very knowledgeable, but he makes it very digestible.

Dr. Emeran Mayer  42:40

Well, thanks, Wendy. It was a pleasure, you know, to add this dimension to our ongoing scientific interactions. I’m really excited about this.

Dr.  Wendy Slusser  42:49

Great, take care.

Dr. Emeran Mayer  42:51

Okay, bye bye.

Dr.  Wendy Slusser  42:58

Thank you for tuning into “Six Feet Apart,” a special series of the Live Well Podcast. Today’s episode was brought to you by UCLA Semel Healthy Campus Initiative Center. To stay up to date with the rest of the episodes in this special series, and to get more information on maintaining your mental, social, and physical well-being during COVID-19, please visit our website at healthy.ucla.edu/livewellpodcasts. Thank you and stay remote.

Episode 12: Diabetes Prevention Programs with Dr. Tannaz Moin

Dr.  Wendy Slusser  00:03

In the United States, every other person over the age of 20 either has prediabetes or diabetes. Today we learn about the story behind this alarming statistic with diabetes expert Dr. Tannaz Moin. Dr. Moin graduated from the University of California, Irvine with a dual MD and MBA degree. She completed an internal medicine training and chief residency year at Yale University, followed by specialty training in endocrinology, diabetes, and metabolism at UCLA. She has quickly excelled in her field. Currently, she’s an assistant professor at UCLA and core investigator at the Center for the Study of Healthcare Innovation, Implementation and Policy at the Veterans Association, Greater Los Angeles, where her research focuses on comparing the effectiveness of different interventions for patients with diabetes and prediabetes. What exactly is diabetes? And what are the risk factors for it? What can you do if you are at risk, or have diabetes? Join us today as Dr. Moin unpacks these questions and shares what a successful diabetes prevention intervention looks like. Dr. Tannaz Moin, it’s so wonderful meeting you here and talking about this incredibly important subject, diabetes prevention programs and your record speaks for itself in terms of what you’ve accomplished over your lifetime, your short lifetime, I expect a lot more in the future. And also having someone as talented as you in so many ways, not just as a researcher and an accomplished physician, but also ability to really cross into other different departments and working with various different people with different skill levels, and educating them, and working with them, communicating. I think it really speaks for the well-roundedness that you are but also how you’re able to work in this field of diabetes, which really is requiring a large, multi-talented, multi-disciplinary group to accomplish your goal. What is your goal, actually, what is it? What would you say?

Dr. Tannaz Moin  02:13

Well, thank you. I’ll start by just saying thank you so much for having me here today. And it’s been an absolute pleasure working with you as well, and other folks across the campus who are thinking about prevention and healthier lives, and for our students, for our faculty, for our patients. So it’s really an honor to be here. And you know, in terms of my personal goals, I think, you know, I realized early on in my training here as an endocrine fellow, so I was studying diabetes in particular, that we have the opportunity to be proactive about a lot of things with respect to our health and well-being. But I think the way medicine is delivered in the US is often reactive. So we’ll be talking about prediabetes. And I think that’s a great example of us really trying to get ahead and empower our patients to lead healthier lives.

Dr.  Wendy Slusser  03:06

Right, working upstream.

Dr. Tannaz Moin  03:07

Yeah, absolutely. Instead of waiting, again, for bad things to happen, and then stepping in. And as an endocrinologist, you know, I sometimes get some slack, or I used to, why why are, you know, preventing the one thing you’re supposed to be treating? I would love that. Yeah, there’s a lot of really kind of bad things that we can’t prevent. But, you know, we’re learning more and more about the importance of prevention, and that even though I’m a subspecialist who focuses on diabetes, that is my passion. And I think part of that stems from seeing the negative impacts diabetes can have on my patients’ lives and their families’ lives. So really just using that as a motivation.

Dr.  Wendy Slusser  03:55

Yeah I mean, what you’re describing really is secondary prevention, right? Because primary prevention would be preventing even the prediabetes. Secondary prevention is taking someone with something that’s the harbinger.

Dr. Tannaz Moin  04:07

Right. And when we talk about prediabetes, so yes, we are trying to prevent diabetes. But you know, we’re still at a point where we’re, in technical terms, trying to prevent those bad things that can happen with diabetes, like heart problems, heart disease, strokes, MIs. And so in that respect, we’re still doing primary prevention of those kinds of negative side effects. So, yeah, this is something I feel passionate about. And I feel very lucky to be in sort of a university setting where folks are forward-thinking about these topics, including, you know, yourself. And we’re bringing together individuals from, as you said, different sectors. And all of us have, you know, something to contribute. And together, I think we can get a lot farther and be much more impactful than any of us sort of working alone.

Dr.  Wendy Slusser  04:59

For our listeners, can you give a bit of a background on what diabetes is?

Dr. Tannaz Moin  05:04

Sure, I’d love to do that. So diabetes, we can think about it broadly as a condition where blood sugars or glucose levels are higher than they should be in the body.

Dr.  Wendy Slusser  05:14

And what’s normal? What is higher?

Dr. Tannaz Moin  05:19

So a normal blood sugar, if you were to fast overnight, and we were to do a blood sugar test in the morning, normal is 100 or less. And so diabetes is when, you know, in the morning, if we were to do that blood test, is 126 or greater. And the reason that diabetes happens is that there’s dysregulation of a very important hormone called insulin, which controls blood sugar levels in the body. Insulin’s released by the pancreas, and it’s essential for life. We can’t live without insulin. And so there’s two types of diabetes. Type 1, where folks are usually diagnosed at a much younger age, and the pancreas stops producing insulin altogether.

Dr.  Wendy Slusser  06:03

Younger meaning less than 20.

Dr. Tannaz Moin  06:05

Yes, yeah. And you know, they can be toddlers and into the teen years. We do have cases of adults who are also diagnosed with Type 1 Diabetes. But what happens on a sort of a pathophysiologic level is the pancreas, the islet cells, stop producing insulin.

Dr.  Wendy Slusser  06:22

The Type 1?

Dr. Tannaz Moin  06:23

The Type 1. So folks who are diagnosed with Type 1 Diabetes, require insulin replacement therapy right after diagnosis. And the second and much more common type of diabetes is Type 2 Diabetes, which means that the body’s actually still making insulin. It just doesn’t know how to use it correctly. And that type of diabetes is usually diagnosed older, in adulthood. And individuals with Type 2 Diabetes are almost always started on oral medications. And with time, many of them also may need insulin therapy. So there’s an overview of the two different types of diabetes.

Dr.  Wendy Slusser  07:06

And what does it mean to have prediabetes?

Dr. Tannaz Moin  07:09

So what it means to have prediabetes is that the sugars are above normal, but not yet meeting the diagnostic threshold to be diagnosed with Type 2 Diabetes. So fasting between 100 and 125, is considered prediabetes. So less than 100 is normal. 100 to 125 is prediabetes, and 126 or more is considered diabetes. And there’s also another blood test, Hemoglobin A1C. So 5.7 to 6.4% is considered prediabetes, and 6.5% and above is considered diabetes. And so what it means to have prediabetes is that you’re on this spectrum of the sugars are a little above normal, but you don’t yet meet the criteria to be, you know, considered to have full-blown diabetes.

Dr.  Wendy Slusser  08:05

That sounds very clear. Thank you.

Dr. Tannaz Moin  08:08

You’re welcome.

Dr.  Wendy Slusser  08:09

The thing that, I think, has blown my mind away is this sort of statistic of one out of two over 20-year-olds in the United States are either prediabetic or diabetic. And I know people say one out of three are prediabetic, but to me, this other data point is even more profound. 50% of our population. One out of two, right? And tell me more about it, I mean, like, how have we gotten here? Like, it just blows my mind. As a pediatrician, it blows my mind.

Dr. Tannaz Moin  08:39

Well, as an adult endocrinologist, it also blows my mind. The statistics are really alarming.

Dr.  Wendy Slusser  08:45

And what data is this?

Dr. Tannaz Moin  08:47

This data? So there was a study published in the New England Journal of Medicine, one of the highest tier kind of journals that we have. And it comes from data and investigators from the CDC, Centers for Disease Control and Prevention, who have a really strong interest in diabetes prevention these days. And yeah, it’s absolutely shocking. And I think there are a lot of risk factors for diabetes and prediabetes. Obesity being one of the biggest, and we know those rates are continuing to increase as well. So you know, and it’s not that every person with prediabetes or diabetes is obese. We have different phenotypes or body types, but definitely higher risk. Also, lack of physical activity, we know is a risk factor for both prediabetes and diabetes, and our lives have become more and more sedentary. You know, we sit behind our computers or when we get home from a long day of work, we’re not doing as much physical activity as we should be doing.

Dr.  Wendy Slusser  09:53

Yeah. And why is that? Why is physical activity so protective?

Dr. Tannaz Moin  09:58

So there’s a lot, you know, we understand and there’s some things we don’t fully understand. So obviously, weight maintenance or prevention of weight gain is one very important thing about physical activity. So we know as individuals age, they gain weight. But folks who are more physically active are less likely to gain weight, they also tend to have more muscle mass, which, when we think about the balance between insulin and glucose, or sugar levels in the body, is a protective thing. And there’s all these other factors like stress, which we know, you know, sort of there are stress hormones. Stress levels can increase blood sugar levels in the body, and physical activity is protective in that way as well. You know, there are again, numerous other risk factors, the ones we’ve talked about so far are what we call modifiable. So these are things that every single person has the power to change. I can eat healthier, I can be more physically active. There are some things, though, that are non-modifiable. So that might be our family history. So a parent, a brother, or a sister with diabetes, will increase your risk. And certain racial and ethnic groups. If you’re African American, of Hispanic background, Asians, all have increased risk. And those are things, unfortunately, none of us can change about ourselves. So it’s very important to focus on the things we can. And I think, healthier lifestyle is really the key here.

Dr.  Wendy Slusser  11:26

I want to go back to two things that you said just earlier. I’d like to debunk a myth, in the sense that, yeah, I think, as you age, you can gain weight. But I don’t know. It’s like, everyone says, oh, you know, going through menopause, you’re going to gain weight.

Dr. Tannaz Moin  11:45

Yeah. So it’s not that you have to gain weight. But when we look at population-level data, and this is not just one study, I mean, numerous studies have shown this. And part of this is our metabolic rate actually does decrease as we get older. So that plays into it. And so even if you’re physically active and kind of eating the same things, with age, you’re at increased risk. So I think the better way to phrase it is, with age ourpropensity to gain weight goes up.

Dr.  Wendy Slusser  12:14

If you don’t modify your diet and listen to your hunger cues.

Dr. Tannaz Moin  12:18

Yeah, and obviously stay physically active. Absolutely. So all of those. Again, the things we can modify the things we have power to potentially sort of be proactive about, as opposed to wait until something happens and then react after the fact.

Dr.  Wendy Slusser  12:32

Yeah, because I feel that one thing that I feel is a myth is the fact that, you know, women who go through menopause are going to gain weight. Whereas what you could really be considering as not denying yourself food, but just listening and being more mindful of your hunger cues. Yeah,

Dr. Tannaz Moin  12:48

Yeah, I just read a study about children and hunger cues. So you know, parents say, eat more finish your plate. And how, you know, sort of culturally, that can be, you know, a belief or a personal family sort of tradition that, you know, people clean their plates. And that we should, as parents, stop doing that because you kind of suppress those cues. And we should be listening, because oftentimes, we’re eating much beyond that hunger cue, and that, again, puts us at risk for all kinds of health problems.

Dr.  Wendy Slusser  13:19

Yeah. Well, actually, there’s research that shown, out of Penn State, Leann Birch did a lot of research on parents who are controlling over their child’s intake actually backfires, ultimately, and especially with girls, Caucasian girls. The data shows that they will actually be much more likely to be overweight later in their 7, 8, 9, 10-year-olds, period of age.

Dr. Tannaz Moin  13:44

Yeah, and I think there’s even some data about, you know, sort of, especially women compared to men, that the more controlling parents might be around food and intake, the propensity to have eating disorders in young adulthood. And we see that in our patients with diabetes, too, who are transitioning to adulthood and might have had lots of do this, don’t do that, eat this, don’t eat that. And that can definitely backfire as they get older.

Dr.  Wendy Slusser  14:08

So when we’re talking about diabetes, when we say one out of two people are either prediabetic or diabetic, we’re talking about Type 2 Diabetes?

Dr. Tannaz Moin  14:17

Yes. So those statistics, when the CDC, Centers for Disease Control and Prevention pulls the statistics, they’re pulling from different data sources, and they try as much as possible to make sure that it’s Type 2 Diabetes and prediabetes. But as you know, there’s another type of diabetes, Type 1 , juvenile onset, insulin dependent. Because from the get-go, the body has stopped producing insulin. The pancreas, the organ that’s responsible for insulin production. But what happens, you know, and my work is in large data sets, when you’re trying to tease out Type 1 from Type 2 Diabetes, sometimes it’s not a perfect science. But yes, when we talk about those statistics, we’re talking about prediabetes and most patients with diabetes actually do have Type 2 Diabetes. That’s a much, much, more common form.

Dr.  Wendy Slusser  15:07

And so the other thing that you were mentioning which is non-modifiable are your genes. And that’s when you referenced certain ethnic or racial groups have a higher tendency, right. It’s really related to the genetic makeup. Now there’s also this belief, of course, which you’ve talked about modifiable behaviors. So you can have genes but they don’t have to be your destiny.

Dr. Tannaz Moin  15:30

Absolutely. I’m a wholehearted believer. But it does mean that if you have those certain risk factors you should be talking to your doctor a lot sooner. Typically we start screening for Type 2 Diabetes at age 40 or 45.

Dr.  Wendy Slusser  15:48

And how do you screen them?

Dr. Tannaz Moin  15:49

So there’s very simple blood tests. The one that’s most commonly used these days is called a Hemoglobin A1C test.

Dr.  Wendy Slusser  15:55

And what does that mean?

Dr. Tannaz Moin  15:56

Yeah, so what does that mean? So this test measures the amount of glucose on red blood cells. It’s sort of a very plain definition of what the test is actually doing. It reflects the level of glucose that’s circulating in the body over three months’ time on average. And so for prediabetes, it’s an A1C of 5.7 to 6.4%. 6.5% and above is considered diabetes. So it’s a very simple test. You don’t need to fast or do anything different with respect to your diet but your doctor could simply order the tests for you and so you could know. And if you do have some of these other risk factors, it’s better to get screened earlier.

Dr.  Wendy Slusser  16:41

Yeah, earlier meaning 40?

Dr. Tannaz Moin  16:43

At a younger age, yeah, absolutely. If you’re overweight, if you’re not that physically active, you may want to get tested sooner as well.

Dr.  Wendy Slusser  16:54

Even if you don’t have a relative, is that it?

Dr. Tannaz Moin  16:56

Yeah, so you know, depending on the patient and their risk factors, we would even screen teenagers. And we’re doing more and more of that because there are more individuals who are overweight and at risk. So those are the the national guidelines that, sort of, are phrased that way.

Dr.  Wendy Slusser  17:13

Well and even, correct me if I’m overstating, but from what I understand is, if you do run a higher blood sugar level when you’re a teenager, you’re much more likely to accelerate your expression of Type 2 Diabetes because of growth hormones and the other hormones that are circulating?

Dr. Tannaz Moin  17:30

Yeah, absolutely. And I’m by no means, you know, sort of a research expert in that area but definitely, I think we’re seeing the onset of what we would call dysglycemia or sort of abnormal glucose regulation and slight elevations in the glucose levels at earlier ages. So decades ago, it was very rare, I would say, for someone who’s a teenager to be diagnosed with Type 2 Diabetes. Now it’s a lot more. You know, sort of, we’re seeing more cases of it. So there’s definitely things that happen, usually 6 to 10 years before you’re diagnosed with diabetes is when we start to see lab changes, physiologic changes. So this is a very long, kind of indolent process that’s almost completely asymptomatic, so you wouldn’t otherwise know unless you had the conversation with your physician and thought about getting yourself screened for diabetes.

Dr.  Wendy Slusser  18:25

So with prediabetes, you’re describing that there are effects on your body, even that aren’t negative?

Dr. Tannaz Moin  18:33

Yes, absolutely. So, you know, I like to think about normal blood sugar, prediabetes, and diabetes as a continuum. So we have sort of a slow progression throughout all of these different stages. It’s not like everybody knows, actually, about the bad side effects of diabetes: heart disease, you know, it’s the number one cause of kidney failure, blindness, preventable amputations in the U.S. and in the world. That’s sort of general knowledge. Most people are aware that diabetes is not a good thing, but it’s not like there’s an on-and-off switch, so you all of a sudden have this risk when your blood sugar reaches a certain threshold. In the prediabetes range, you’re still at risk, an increased risk, for those things.

Dr.  Wendy Slusser  19:16

And why is that?

Dr. Tannaz Moin  19:18

So we have yet to really fully understand the pathophysiology, I would say, of why increased blood sugars directly, you know, are related to cardiovascular events. But there’s some thought about glucotoxicity, so that the glucose itself is actually toxic, the sugar. And so in prediabetes, of course, your sugars aren’t as high as diabetes. That’s sort of by definition what it is. But it’s still above normal. And so all of those things that we worry about. Retinopathy, when vision is impaired by diabetes, also happens in prediabetes. The rate of it is lower, but it’s still a risk. So absolutely something to take seriously.

Dr.  Wendy Slusser  19:59

So one out of two over 20-year-olds are either prediabetic or diabetic in the United States. And I’m assuming that it’s less in the 20-year-old range and it’s sort of rises as people age?

Dr. Tannaz Moin  20:12

Absolutely. Because as you get above, sort of, in the fifth or sixth decades, so 50 to 60, absolutely, the prevalence even goes higher and higher. Because age, in and of itself, is actually a risk factor for diabetes. So as I was mentioning, most national, sort of, care guidelines would say, even in someone with absolutely no risk factors for diabetes, by age 45 they should have been screened for it, because age itself is a risk factor.

Dr.  Wendy Slusser  20:39

And another statistic that’s quite dramatic to me is the one out of ten do know. Only nine out of ten don’t know that they’re prediabetic or diabetic.

Dr. Tannaz Moin  20:51

Yeah so and this is where my work has focused, you know, sort of in the last five to seven years. I think it’s shocking. Every time I hear that, I’m not less shocked. I mean, it’s really alarming, especially because prediabetes is a time, I’ve always thought of it as, you know, the silver lining is even if you’re at risk you know that there are things, and we’ll talk about those, hopefully, but there are things you can do to prevent Type 2 Diabetes or at the very least delay the onset. Yeah, glass half-full is what I always tell my patients. But if you don’t know that you have this condition, how would you know to sort of do anything differently or to be proactive? And again, these statistics come from the CDC data, and they’re kind of now a decade old, so we’re hoping that with some of the national campaigns that are ongoing from the CDC, the American Medical Association, and I know when I give talks sort of anecdotally, I always ask people to raise their hand. There’s sort of more, I think, attention to the issue but yeah, I would say most patients and there are recent studies show that it’s maybe closer to 20 or 30% know. So we’re making headway, but that still means, you know, three-fourths of people have no idea.

Dr.  Wendy Slusser  22:11

Well yeah, you’re definitely making headway. I have a friend who, in her union, she got a newsletter this week that said one out of three Americans have prediabetes. So she couldn’t believe it. She, like, texted me, oh look at this, Wendy, and that’s what you told me and there it is! So I mean, that would be terrific, right, if our organizations that normally are dealing with other health and welfare issues could also telegraph this message.

Dr. Tannaz Moin  22:40

Yeah, absolutely. And I think you know, the old saying is knowledge is power. And so I think everybody has the right to know about their you know their health conditions, their risks. And some people may choose not to do anything about it. You know that’s not their priority right now. But I think giving folks the information to make those kinds of informed choices about their health is really important. And you know I have yet to meet a patient in all of my years of training and faculty that doesn’t care if they get diabetes. Yeah, who wouldn’t be motivated?

Dr.  Wendy Slusser  23:16

If they have had a relative that has had it.

Dr. Tannaz Moin  23:18

Yeah, so everybody you know most people are sort of, have some experience either through family or friend or colleague. And you know when we talk about prediabetes, if they’re at risk, again, I’ve yet to meet someone who says, oh that’s really not that important to me. Of course everybody’s motivated. And it’s interesting and it’s sort of a contrast to when I talk to patients about weight management. For some folks it’s not as important maybe to lose weight, or you know, but when we talk about in the context of diabetes prevention, it becomes a priority, usually.

Dr.  Wendy Slusser  23:50

Well I can understand that because it’s focusing on something that is a positive, you know, outcome that isn’t necessarily the values of how you look, which are different for different people. But your health, everyone wants to be healthy, right? Everyone defines it differently. That’s one of our Semel HCI values, you know. Everyone wants to be healthy but everyone might define it differently. So one thing that has struck me about this whole conversation about one out of two are prediabetic or diabetic, only one out of 10 know it, that we’ve known since 2002, a way to reduce your risk of developing diabetes if you are prediabetic. So tell me about that study from 2002. I mean, we’re almost two decades after.

Dr. Tannaz Moin  24:42

Yes, so well, that study, commonly referred to as the Diabetes Prevention Program or DPP study, was published again in that same New England Journal of Medicine, which is one of the highest tier journals, and was conducted in 27 centers in the US. Patients who had prediabetes and were overweight, were randomized to receive an intensive lifestyle intervention which we also now commonly referred to as the Diabetes Prevention Program or DPP, to metformin or to placebo, which was basically some informational flyers and “usual care.”

Dr.  Wendy Slusser  25:18

And metformin is?

Dr. Tannaz Moin  25:19

Metformin is an antiglycemic, it’s a diabetes medication.

Dr.  Wendy Slusser  25:24

The oldest one, right?

Dr. Tannaz Moin  25:25

Yeah. The oldest.

Dr.  Wendy Slusser  25:26

From the lilacs, from France.

Dr. Tannaz Moin  25:28

Yea, actually, it is. It’s derived from the French flowers. So it’s, yeah, and it’s one of the oldest, safest medications. And these days actually one of the cheapest, it’s pretty low-cost and low-risk. And so patients were randomized to these three arms and then followed over time, the intensive lifestyle intervention, metformin, or usual care.

Dr.  Wendy Slusser  25:56

And what was the intensive lifestyle intervention?

Dr. Tannaz Moin  25:59

So the intensive lifestyle intervention in this study was one-on-one, face-to-face weekly sessions over 16 weeks. And overall, these were conducted over 12 months’ time. So they could be, you know, biweekly, depending on the participant’s needs. And there were some very specific goals. 150 minutes of moderate physical activity. So everybody was aiming to do a minimum of that.

Dr.  Wendy Slusser  26:26

They could build up to it, though, right?

Dr. Tannaz Moin  26:28

Yeah, they could. And there was actually a run-in period of a couple of weeks before, to get folks sort of starting to be active if they’ve never been active.

Dr.  Wendy Slusser  26:35

So 150 minutes a week means 30 minutes a day for 5 days.

Dr. Tannaz Moin  26:39

Yes. And moderate means, you know, you don’t have to go run marathons. We’re talking about brisk walking. So you sort of can still carry on a conversation, but feeling a little bit, sort of, out of breath, but could still speak a full sentence.

Dr.  Wendy Slusser  26:55

It wouldn’t have to be all at the same time. It could be, like, ten minutes, ten minutes, ten minutes.

Dr. Tannaz Moin  26:59

Yeah, and it’s actually better.

Dr.  Wendy Slusser  27:01

Isn’t it also better to exercise after you eat? Or walk after you eat?

Dr. Tannaz Moin  27:07

So yeah, it’s great in terms of, you know, digestion. I think there’s some data about sort of being able to digest food. But also after you eat is when your blood sugar levels tend to rise and activity helps reduce blood sugar levels.

Dr.  Wendy Slusser  27:20

How does it do that?

Dr. Tannaz Moin  27:22

So activity, one, you’re burning calories, I think that’s a very sort of straightforward way of thinking about it. So you’re burning calories, and you’re burning kind of the food that you’re taking in. It’s one of the main ways, yeah. So those muscles are working, and they need glucose, right? They need to take it.

Dr.  Wendy Slusser  27:37

So the glucose will be out of the bloodstream. So the insulin doesn’t have to be doing it as much.

Dr. Tannaz Moin  27:43

Exactly. Well, the insulin helps, yeah. So when glucose goes up, insulin goes up. And when you don’t have diabetes, there’s sort of a perfect match of the insulin and glucose. So all that extra sugar is taken up. When you have diabetes, that balances off, so insulin may go up, but it’s not being used appropriately, and the sugar levels stay up. So 150 minutes of moderate physical activity a week, and then in the original trial, it was 7% weight loss. So the actual amount of weight loss varied at one year. It varied depending on the person’s starting weight, but it was to aim for 7%. And the third part of this intervention was really reduction of calories to be able to meet that 7% weight loss goal. So actually, they followed these participants for three years. But at the end of the study, they looked at, you know, weight loss in the first year, which was on average, about 5%.

Dr.  Wendy Slusser  28:41

On average, so some people lost ten percent, some lost one percent.

Dr. Tannaz Moin  28:46

Yeah. And what they found in this study was that that amount of weight loss, we’re talking about 5%, in those first 12 months, was correlated with a 58% relative risk reduction for progression to Type 2 Diabetes, as compared to the placebo arm. And the data we have on prediabetes that comes out of some studies that were done in China, is over the lifetime, prediabetes represents about a 70% risk of progressing to Type 2 Diabetes. So not every single person who has prediabetes is going to get diabetes, but you know, the lifetime risk is actually pretty high. And you know, so we talked about all these risk factors. And so you know, if someone’s overweight and doesn’t lose the weight, or if they are from certain racial or ethnic groups, their risk might even be higher.

Dr.  Wendy Slusser  29:41

Yeah. And so getting back to preventive medicine, which I think is really a unique characteristic of your work, because it is true as a specialist, even in this day and age, a lot of medical doctors are still not devoting the amount of time that they’d like to or they even have the skills for. So why is it so important for long-term health for your patients or our community overall? What’s driving you to focus on this?

Dr. Tannaz Moin  30:06

Yeah, I think for me personally, it really has been what I see in my everyday sort of clinical practice of with respect to diabetes, sort of the negative impacts. And so at the same time, so you see all of these negative things that can happen, and it’s physical, a whole change of life. Yeah, absolutely emotional. And, you know, living with diabetes is, you know, something that folks can do very successfully. But it’s a whole added bunch of thing you have to do. Check your blood sugar, you know, I mean, there’s a lot of other things that come with that.

Dr.  Wendy Slusser  30:39

What is it, what comes with it?

Dr. Tannaz Moin  30:42

Checking your blood sugars, medications that you’re taking. And in some instances, you know, usually we start with oral medications, but often, might be insulin, and that’s multiple daily injections that someone’s giving them. And so you can think about, we can think about the average working person and how much of a disruption something like this can be to their life. And so you know, if we’re in a position where we can, again, prevent, or at the very least, we can delay the onset by years, I think we’re doing so much for, you know, quality of life, really, more than anything else. And, you know, in terms of our healthcare costs, and from a societal perspective, prevention is key. As most of our healthcare spending happens, in a reactive fashion, people are hospitalized, you know, sort orf fo these diagnoses and complications from the diagnoses. So in the US, one out of every seven healthcare dollars goes to diabetes-related care and complications. One out of every seven.

Dr.  Wendy Slusser  31:44

Wow, what is our health care spending, do you know?

Dr. Tannaz Moin  31:48

So in terms of diabetes-related healthcare spending, we get great estimates from the American Diabetes Association, which are published about every five years. In 2017, the ADA estimated that we spent $327 billion on diabetes-related healthcare in the US. In comparison, in 2012, we had spent $245 billion. So in the span of just five years between 2012 and 2017, diabetes-related healthcare spending has increased by 26% in the US, so from an individual quality of life perspective, it’s critical that we try to prevent diabetes, but also from a societal and sort of big picture, also really, really important that we prevent.

Dr.  Wendy Slusser  32:39

Yeah. So what what are the makings of a successful diabetes prevention program?

Dr. Tannaz Moin  32:45

Sure, that’s a great question. And I think we’re fortunate that we are in a time that we have very clear guidelines about how to do diabetes prevention program delivery and how to do it well. And we have national guidelines on what the makings of a successful program are. And all of that is informed from the trials, the randomized control trials and all the studies that have been done over the last two decades. So critical things are that the program is vetted by and sort of recognized by the Centers for Disease Control and Prevention or CDC. There’s a national registry that’s publicly available, a website that you can go and look up programs by your city, by your state. So that’s key. And and the reason that’s key is all of the programs that are in that registry follows some very basic standards for delivery, based on the research. And the coaches are certifiedl they’re trained the curriculum.

Dr.  Wendy Slusser  33:48

And they don’t have to be college educated.

Dr. Tannaz Moin  33:50

Absolutely not. But they have some training to do what they’re doing. The curriculum is, you know, again, informed by the original research studies. And also, it’s an intense program that’s delivered over time. So we know the more sessions that are a part of the program, the better in terms of someone’s ability to lose weight. So the programs are all at least a year long, 12 months, and at least 22 sessions in those 12 months, and some programs offer more. And when we talk about those numbers, it can be a little overwhelming. It doesn’t mean that you have to come to every session. But the idea that, you know, when you’re making healthy lifestyle changes, it’s not overnight. You’re doing it slowly and over time, and that any of you do it in that way are more likely to succeed.

Dr.  Wendy Slusser  34:38

Well I remember, you said the sweet spot’s 10, right?

Dr. Tannaz Moin  34:41

So we know, sort of, 9 or 10 is critical, you know, dose and again, every sort of study that’s looked at this, the more sessions, the more lasting and the more the actual amount of weight loss. Yeah. Part of that is because more motivated, you know, individuals might be self-selecting. Yeah, but that session attendance and the number of sessions is highly correlated with weight loss, for sure.

Dr.  Wendy Slusser  35:11

Yeah. And so, tell me long-term outcomes, like you’re telling one year. What’s the sort of return on the investment, so to speak?

Dr. Tannaz Moin  35:21

Yeah, so the Diabetes Prevention Program study that was published in the New England Journal in 2002, you know, they’ve published their 10-year outcomes, their 15-year outcomes, and that cohort of patients is still being followed. So under sort of the auspices of NIH that sponsored the trial. And you know, so what it looks like is that the protective sort of risk-lowering effects of intensive lifestyle intervention, and also the m metformin, which was one of the other arms of the study, and

Dr.  Wendy Slusser  35:50

What was that reduced risk?

Dr. Tannaz Moin  35:52

So in the first three years, it was 31% relative risk reduction. But that protective effect, or the risk-lowering effect of both the intensive lifestyle intervention and metformin, are lasting to 15 years, so they decrease over time. But there’s still a significant degree of risk reduction. Even 15 years out where a lot of folks have regained the weight they lost in the original intensive program.

Dr.  Wendy Slusser  36:18

Their diet must have changed, or their activity levels.

Dr. Tannaz Moin  36:22

Yeah, what we know from this study is that, you know, again, even if you can do the intensive lifestyle intervention, or even with respect to the metformin, even if you did it for a period of time, it’s somehow protective for 15 years.

Dr.  Wendy Slusser  36:34

It gave your pancreas a break or something.

Dr. Tannaz Moin  36:36

Yeah, again, the pathophysiology is yet to be fully clear. That is the largest cohort of patients with prediabetes who’ve been followed over time in any, you know, study conducted anywhere in the world. But there are also large studies that have been conducted in China and Finland, where patients have been followed over time and showing, again, sort of this protective benefit that lingers even years after the trial is completed.

Dr.  Wendy Slusser  36:37

Well, you know what, it makes me wonder, and it’s something that I know you’re going to be looking at, in our groups that we are having here at UCLA. But I’m wondering, the sort of other secondary outcomes, not just related to the physiologic changes, but this social cohesion or social connectivity, that might be a result of these group classes, which were up to only 20 people in class.

Dr. Tannaz Moin  37:30

Right. So it’s sort of a small group environment is how the DPP is delivered. And again, that’s another aspect of a successful program to look for. You don’t want to be in an auditorium with 100 people trying to sort of take the course.

Dr.  Wendy Slusser  37:45

Are there some courses that are taught that way?

Dr. Tannaz Moin  37:47

I’m sure there are. They won’t be CDC recognized, but there are and so, you know, I mean, the day and age we live in, if you go onto Google and say, you know, diabetes, there’s a whole series of things that might come up. And not that sessions like that aren’t helpful and refer you to get more information and, you know, sort of an overview. I’m a big supporter of the more, sort of, information is a good thing. But in terms of the Diabetes Prevention Program, you know, we have some really kind of very clear guidelines on how to do that program and do it well, based on the research. So that’s important to sort of keep in mind. And in small groups, so we’re talking about 20 or fewer participants, and there’s a coach who shares information from the curriculum, but folks are coming together. And they’re supposed to share their shared, you know, challenges, and also their successes. And, you know, there isn’t a lot of data that we’ve seen in terms of when you bring people together around this topic of prediabetes. We know there’s group cohesion over time, right? So you’re meeting with the same people and the same coach. And you would think that that hopefully, is a motivating force for individuals. And in studies we’ve done and the VA particpants, the Veteran’s Association, talk about accountability. So I know when I’m going to my group, you know, I am accountable to myself for these promises to live a healthier life and be more physically active. But, you know, I’m also accountable to my group members. And that’s another form of social support. So, yeah, we’re really excited to look at these things and see, you know. We know quality of life improves with the DPP, an intensive lifestyle intervention that’s been shown, but it could be because of social support.

Dr.  Wendy Slusser  38:03

And how do you measure quality of life?

Dr. Tannaz Moin  39:40

So there are different survey instruments that can be used in studies and the original cohort of patients who was in that DPP study from the New England Journal is still being followed, as I’ve mentioned. Then they’ve had standardized assessments, measurements of how they rate their own quality of life. And with the folks who were in the intensive lifestyle intervention, they are rating higher quality of life, again, whether or not they were able to lose weight, whether or not they were able to stick with the intervention. Their quality of life over time seemed higher. We didn’t see that change with the metformin arm or with the usual care arm.

Dr.  Wendy Slusser  40:18

That’s very interesting and it will be interesting. Hopefully you’ll have some data for social well-being since we know that’s a big predictor of health and longevity in other studies around just aging Americans. You mentioned your work at the Veteran’s Association, and you mentioned earlier the diabetes prevention seems to be more motivating than weight loss. Your studies that you’ve published, too, have shown that kind of data or observation is played out.

Dr. Tannaz Moin  40:51

Yeah so I spend, you know, part of my time in the VA and actually some of my initial interests around diabetes prevention are based on work I did really many years ago with veterans. And part of the issue or the challenge with veterans is the rates of obesity are even higher than the general population. And the VA has always had what we would call a standard-of-care weight loss program known as the MOVE! Program that’s delivered actually at 150 VA medical centers everywhere. But it’s sort of delivered in different ways based on the site so we were really interested, now this is going back to 2012, to do a comparative effectiveness trial, to compare DPP, which is a much more intense diabetes prevention program, meaning more number of sessions and you know certified coaches, same group, that group accountability kind of cohesion we were talking about, to compare outcomes and patient experiences with the DPP as compared to MOVE!.

Dr.  Wendy Slusser  41:57

Which doesn’t have the same, like you don’t have to go to the same group.

Dr. Tannaz Moin  42:01

Right it’s sort of a come-as-your-schedule-allows, your goals are not, you know, the same. I might want to just be more physically active, you might want to just eat healthier. Whereas the Diabetes Prevention Program has standardized goals so everybody in the group is working towards the same goals. So we did this study, initially we started with just an in-person version of the DPP, which is the way it’s traditionally delivered, compared to MOVE!. And we saw that around six months there tends to be more weight loss with the DPP as compared to MOVE!.

Dr.  Wendy Slusser  42:38

Even though MOVE! was a weight loss program.

Dr. Tannaz Moin  42:40

It is. And this is a really active comparitor. We’re not comparing patients to usual care. And by 12 months, though, the weight loss seem similar between the two groups or it was approaching the same. And part of that is regained, so what happens is the program went from being very intensive to less intensive, the Diabetes Prevention Program. But patient satisfaction was much higher with the DPP. Participation tended to be higher so veterans were coming. They were more likely to come to a DPP session than they were to a MOVE! session and as this study started getting underway, we actually decided because at the time there was a lot of interest in technology and how we can deliver DPP differently, we actually added on an online or virtual group form of the DPP. And those results were really kind of interesting because then we were doing a three-way comparison and it seemed like online and in-person DPP, you know, they’re very similar in terms of the amount of weight loss that they resulted in. We’re talking about around four kilograms. And and the MOVE! participants were kind of hovering around the same weight over the 12 months.

Dr.  Wendy Slusser  43:54

They didn’t gain weight but they didn’t lose weight.

Dr. Tannaz Moin  43:56

Right and so, you know, it was really interesting to see that, you know, you could deliver a traditional face-to-face program, maybe using a web-based platform that might provide some convenience and flexibility.

Dr.  Wendy Slusser  44:10

So it’s another option that might be available and acceptable to some people. So the social learning aspect. Was that maintained in the online, like there were forums for the groups?

Dr. Tannaz Moin  44:24

Yeah. And online DPP is delivered in different ways and by different vendors. There’s a lot of them out there and, again, I would encourage our listeners to reference the CDC lists because they tend to vet the programs.

Dr.  Wendy Slusser  44:37

So just go to cdc.gov and search for “diabetes prevention program.”

Dr. Tannaz Moin  44:42

And you can see a registry. But yeah, usually the way online DPP programs are delivered is asynchronously, which means I can log in at 2am and you can log in at 12am, you know, or 1pm. It’s not a group time, it’s not like a Skype, you know, or a WebEx or something. There are programs that do it that way. But most are providing some educational materials and it might be through videos or other sort of interactive means. But I can sort of go through those materials at a time that works for me. And then I have sort of access to what’s happening with other people in my same group. So I log in and imagine kind of a Facebook group. And so I can see their pictures, they can see my pictures, they can see how I’m doing in terms of my goals, and I see how they’re doing. We have a coach, we can send each other messages, we can post to the group site, and we all have wireless scales. So we’re weighing ourselves instead of driving in for an appointment, you’re kind of doing that conveniently at home. So that’s a more multifaceted kind of way of thinking about online DPP.

Dr.  Wendy Slusser  45:53

So you could still get support, but in a non, like, live situation, or ideas from other people, because that’s what I find that social learning is so useful for people to say, hey, you know, I couldn’t fit in the walk.

Dr. Tannaz Moin  46:08

And that’s what we saw. We actually did a study where we looked among women veterans who tend to be more reluctant to participate in any of the in-person weight loss programs in the VA. I think the number was an average of 70 posts, you know, over the first couple weeks of the program. So it takes effort, you know, it was very interactive. And we did interviews with these participants and I was really surprised to find out that they still felt accountable to their group. And they felt like they were part of a group, you know. This wasn’t, you know, sort of a random set of people that they, you know, had no interest in getting to know, and some of them actually even formed, if they lived close together, were interested in forming walking groups. So again, there is that social component. And the coach, any successful online program should have a live coach, you know, there should be someone that you can talk to by phone, or would even call you if you haven’t logged in in a week to say, hey, is everything okay? And that’s a real important piece of success. We had that, and any program that, you know, someone’s looking to sign up for should have that.

Dr.  Wendy Slusser  47:18

And so if you were to say, a 40-year-old, you’re a specialist, so you wouldn’t see a 40-year-old that was just coming in for a checkup, but say you’re like supervising internal medicine resident in clinic, and there was a 40-year-old coming in who looked like they had a healthy weight and no family history of diabetes, what would you do? For a checkup?

Dr. Tannaz Moin  47:43

For a checkup? Yeah, it’s been a long time since I’ve done general primary care. There are other age, you know, appropriate screenings. I think I would talk with them, I would, you know, even if their weight was normal, I would talk about the importance of avoiding weight gain, because, as we talked about, as you get older, your risk of potentially gaining weight goes up. And I would also ask a lot of questions about the other potential risk factors. So in someone who’s 40, I would ask about, if they’re a woman, you know, how much weight they gained during pregnancy, if the baby was over nine pounds. That’s a risk factor for diabetes, and really try to make sure that we, you know, aren’t missing any other risk factor.

Dr.  Wendy Slusser  48:28

Even though they had a normal glucose tolerance test?

Dr. Tannaz Moin  48:31

Yeah. So baby over nine pounds at delivery is a risk factor for future diabetes development. So some women have a known diagnosis of gestational diabetes, where, you know, the glucose isn’t normal during pregnancy. But on a baby that’s large for the age or the mean, is also a risk factor.

Dr.  Wendy Slusser  48:53

Even though they pass their glucose tolerance test? Oh, that’s interesting. It’s not a perfect science, is it?

Dr. Tannaz Moin  49:00

Not a perfect science. And that’s why there’s great screeners, and that might be something else I would do or encourage our residents to do, share that information with patients. There’s nine questions and there are different versions of this screening, but it literally takes 30 seconds. And the questions are about your age, your physical activity or family history. You know, if you’re a woman, whether or not you had gestational diabetes, a baby over nine pounds, and it can give you a risk score.

Dr.  Wendy Slusser  49:26

Without having a blood test?

Dr. Tannaz Moin  49:28

Without having a blood test. And if your risk score is elevated, the data, the research and the national guidelines would say you should be thinking about being checked and participating potentially, in a DPP program.

Dr.  Wendy Slusser  49:42

So if you were, say, maybe you just want to prevent or you want to institute healthy lifestyle, and you are less than 40 and you’re not in any of the risk categories, what would you do? First of all, I think that the Diabetes Prevention Program, I’ve heard people really enjoy and totally talk about how it changed their life in terms of just socializing with their family and feeling better, and being able to hike and all this stuff. So I always like to sort of, I’m sure you do, to like gear people towards the positive and not like, oh, you have to give up this or that. But what’s your standard, kind of, coaching that you’d like to see people to do in their in their day-to-day life? Like, what would you recommend?

Dr. Tannaz Moin  49:42

So I think simple and small steps are really important. So obviously, I’m a huge proponent of the Diabetes Prevention Program, but that’s a big commitment and it’s hard, you know, for some folks maybe to commit to doing the program. But there are little things you can do, and goal-setting, and thinking about, you know, one thing you can change. I think, it’s something that’s reasonable, it’s feasible, it’s something you can do. You know, there are all these fad diets, and you go on these sort of crazy calorie restriction, but if it’s not something you can maintain, chances are, you’re going to do the sort of the yo-yo, the up and the down weight cycles that we try to avoid.

Dr.  Wendy Slusser  51:11

What happens if you are a healthy weight already, like, a 20-year-old? What would you say, not to give up or change? But what do you should be done? Where should people go, what direction?

Dr. Tannaz Moin  51:23

So one thing I actually do talk to patients, and actually friends and colleagues about is this concept of self-monitoring. So I think, especially with diet. We often aren’t thinking about what we’re eating, and not just calories, but the sort of the nutritional component. I think someone who’s at a healthy weight probably is doing that and obviously is lucky in terms of the metabolic rate and things like that. But I would encourage them, you know, to do a food diary, and you can do it with a good old journal and pen. But there are all these really neat apps and kind of things that are available. And to really take a look at the foods they’re eating, and both in terms of calories, but the nutritional component. And even if you’re a healthy weight, there’s always things that you might be able to improve in terms of your health. And then of course, physical activity is huge.

Dr.  Wendy Slusser  52:17

And walking. Just plain old walking.

Dr. Tannaz Moin  52:20

And walking. Just park a little farther. You know, so I think that’s something again, that we could all do more of. And it’s not easy. It’s hard to do, but something for folks to think about, yeah.

Dr.  Wendy Slusser  52:33

And so for, like, the foods that you would suggest are good foods, period, but also good if you are prediabetic. I know fiber, high-fibrous foods.

Dr. Tannaz Moin  52:44

Yeah. And we are, you know, learning more and more about the ideal dietary makeup for someone with prediabetes. It’s sort of relatively speaking, still a newer, you know, concept in the last decade or two, I think fiber and sort of complex grains are really important. We also are hearing more and more about the Mediterranean diet. So nuts and you know, sort of the olive oil and fish, and kind of staying away from heavy meat products, I think might be something else to think about. But the idea is to eat a balanced diet, try to avoid processed foods.

Dr.  Wendy Slusser  53:30

And sugar really sneaks into all foods, even mayonnaise has sugar.

Dr. Tannaz Moin  53:35

Everywhere. And that’s why I like these apps a lot. I mean, the one I’ve personally used is MyFitnessPal. But there’s a million out there, but it actually gives you, once you put in sort of the food item, it shows you everything, not just calories, but how much salt, how much sugar, you know, and that’s eye-opening.

Dr.  Wendy Slusser  53:52

And that’s much more important to me. I mean, I think carbohydrate content is much more important than the calories.

Dr. Tannaz Moin  53:59

Yeah. So it’s really amazing. And, you know, again, physical activity is so important. But, you know, I tell my patients, when I see them in clinic, you know, I can be on the treadmill for like an hour and I burn maybe 400 calories. In a minute, you can, you know, consume something and you’re just not even sort of thinking about it. So self-monitoring, you know, someone who’s at a healthy weight and has made lots of good decisions so far, I think that might be something they could do to see, gosh, you know, what am I eating?

Dr.  Wendy Slusser  54:31

Yeah, that’s been proven in both just healthy maintenance, but also weight loss.

Dr. Tannaz Moin  54:37

Yeah, absolutely.

Dr.  Wendy Slusser  54:38

Well, so from your perspective as an endocrinologist, what’s the number of grams of sugar that you would recommend a prediabetic, in percent of their caloric intake?

Dr. Tannaz Moin  54:49

Oh, that’s a tough question. Yeah. I don’t know that we have a prescription for something like that. You know, for our patients with diabetes, there’s been a lot, you know, more studies and I think if we follow the general guidelines for diabetes, they’re  about 60 grams of carbohydrates per meal. Not more than though, per meal, three meals a day. But that’s still, I mean, if you think a slice of bread is about 15 grams, if you had a sandwich, that’s half, and then you might have an apple, which is another 30 grams. So that’s generally the recommendations for someone with diabetes. For prediabetes, we don’t have clear, set guidelines like that, but that might be sort of a framework to think about.

Dr.  Wendy Slusser  55:30

So would you recommend for like a prediabetic, well, obviously diabetics do, but to actually, in terms of self-monitoring, monitor their carbohydrate intake?

Dr. Tannaz Moin  55:41

Yeah, so carbohydrate intake. And again, it’s not just about the calories and the carbohydrates, but making sure they’re getting balanced intake from sort of a nutritional perspective, too. So if we think about, you know, the My Healthy Plate, you know, the idea is half is coming from salads, and green vegetables and things. And so to be thinking along those lines of eating balanced meals, is really important. And of course, avoiding high-sugar drinks and kind of any sugar sweetened beverage, you know, eliminating that altogether.

Dr.  Wendy Slusser  56:19

Which includes sugared sodas. And also what about the sodas that are artificial flavors? Or artificial sugar?

Dr. Tannaz Moin  56:30

Yeah, so this is where, you know, I don’t want to say the jury’s still out. But I’m, you know, not a basic scientist, but there are basic science studies that have been done, you know, using animal models, showing that animals that are taking in high levels of these artificial sweeteners are more likely to be at risk for diabetes and weight gain.

Dr.  Wendy Slusser  56:54

And what’s the pathophysiology behind that?

Dr. Tannaz Moin  56:56

So, you know, it’s not one that I’m familiar with, but you know, in my own sort of thinking about this, I’ve thought it’s like, you taste sweet, but the sugar isn’t the sugar that your body’s expecting. So maybe there’s some kind of hormonal dysregulation, and that might be happening, but we don’t have human studies. We don’t have large trials that have been done, you know, in adults or obviously not kids that have looked at this. So the data about whether it’s good or not really comes from animal studies. And it’s hard to extrapolate that to humans, but there is some indication that, you know, maybe it’s not a healthier choice.

Dr.  Wendy Slusser  57:36

Right. And do you know anything about, I know, there’s herbs that are considered moderating, like cinnamon?

Dr. Tannaz Moin  57:46

Cinnamon, and actually tumeric is another one.

Dr.  Wendy Slusser  57:49


Dr. Tannaz Moin  57:50

Yeah, not my area of expertise. But, you know, I do get patients who ask about this. And I’m always of the thinking that, you know, to try. A lot of these things are sometimes advertised as supplements and so it gets into this sort of gray area. But I think, again, thinking about what we’re consuming and why, is an important thing for all of us to be doing.

Dr.  Wendy Slusser  58:13

Right. And certainly, those particular herbs make things taste better. So that’s important.

Dr. Tannaz Moin  58:19

Right, so cinnamon’s a favorite and tumeric, we use a lot in, I mean, Middle Eastern foods. I think, yeah, try it and, you know, see how it works.

Dr.  Wendy Slusser  58:31

It’s good for your gut health, as far as the data that’s out there. So, to wrap up, I want to leave our listeners with some resources to go to if they’re seeking to improve their health and live a healthier lifestyle. Do you mind sharing some resources, both nationally, and within California? And even here at UCLA?

Dr. Tannaz Moin  58:53

Sure, so I’ll start nationally, I think there’s a lot of really incredible information on the CDC website. And those, again, you can just go Centers for Disease Control and type in “diabetes” or “prediabetes” on Google. And there’s really helpful information about what diabetes is and what prediabetes is, and, you know, even some questions about pathophysiology, but really national statistics, what the trends look like. And then the CDC also has, what we had mentioned, this national registry of DPP programs that are certified. So that would be one of the main sites I would send folks to to get more information about the clinical side, but also some potential resources.

Dr.  Wendy Slusser  59:40

And if you wanted to start a program on your university campus, you could also get information from them about that?

Dr. Tannaz Moin  59:50

Yeah, the standards for delivery. So the metrics that they expect if you’re going to deliver a program and that process, absolutely. And I think the American Medical Association also has a prediabetes STAT, which stands for a Screen Test Act Today site. And that also has patient-facing materials, it has provider-facing materials that are helpful for thinking about how to screen, who to screen. You know, it’s geared at both providers and healthcare organizations. So that’s a great resource. And locally, so obviously, we’re so proud to have our local campus, UCLA-based Diabetes Prevention Program, which is open.

Dr.  Wendy Slusser  59:55

One of the firsts, right, on a university campus.

Dr. Tannaz Moin  1:00:37

Yeah, which we’re really proud of, and it’s offered through Campus Recreation. And in addition to the Diabetes Prevention Program, our campus offers other classes and group-based weight management programs and things that folks would probably be interested to learn about. And that program, our UCLA DPP program, is now a model for the other UC campuses. So if someone’s listening, and they’re on another UC campus, there should be a DPP even closer to home that they can reach out to. So yeah, lots

Dr.  Wendy Slusser  1:01:12

Campus staff are able to use that for free. And here at UCLA, students as well.

Dr. Tannaz Moin  1:01:18

Yeah, absolutely. So it’s a program that would normally cost around six, seven, maybe, you know, $100. But it’s offered free for faculty and staff and students on the campus. That’s a huge benefit. Yeah. And hopefully more people learn about it. We do have waitlists. So I mean, we’re, again, very excited about the program.

Dr.  Wendy Slusser  1:01:18

Oh, we have waitlists now? Oh my goodness.

Dr. Tannaz Moin  1:01:43

Yeah, we have waitlists. So, we don’t want to turn anyone away. But you know, we are trying to accommodate.

Dr.  Wendy Slusser  1:01:51

We want to keep it at 20 participants.

Dr. Tannaz Moin  1:01:53

The smaller group, yeah, because you’ll get more out of the program in a smaller group. So yeah, we’re really excited about our campus leading the charge here.

Dr.  Wendy Slusser  1:02:04

Well, so we’ll end this with some questions. I haven’t covered anything. But also I’d love to know, like, what’s your home kitchen look like?

Dr. Tannaz Moin  1:02:12

Oh, well right now we’re in temporary housing, but my home kitchen is relatively small. But it often includes the kids and I cooking together, we sort of tend to do that as a family.

Dr.  Wendy Slusser  1:02:28

And how old are your kiddos?

Dr. Tannaz Moin  1:02:29

So I have a six and an eight year old, so they’re kind of stove-safe at this point. They  want to help. But you know, we’re really trying to do balanced meals at home. But you know, that can be challenging sometimes after school, and it’s a rush.

Dr.  Wendy Slusser  1:02:46

How do you overcome that challenge?

Dr. Tannaz Moin  1:02:50

Yeah, so some days are better than others, but, you know, even if it means, we’re rushed, even if it means taking some vegetables and doing a steam quickly and sort of having them on the side. We’re trying and I have help at home so that really does make it easier. The other thing I’m trying to do is, and this is a personal thing, less frozen stuff. We tend to like freeze everything. And I know in Europe, the refrigerators are smaller, and you’re trying to eat fresher, but that’s also challenging, so something we’re working on.

Dr.  Wendy Slusser  1:03:27

Well, frozen vegetables are considered to be almost even more nutritious.

Dr. Tannaz Moin  1:03:32

Absolutely. And I have a whole stockpile of them for sure. But yeah, trying to think about all of us. But no juice, you won’t find any juice in my house.

Dr.  Wendy Slusser  1:03:41

So making a healthy choice, the easy choice, right? And the less healthy choice the not-so-easy choice.

Dr. Tannaz Moin  1:03:47

Yeah. And that’s the way I sort of grew up too, you know. I don’t remember soda. I don’t remember chips, you know, in my household.

Dr.  Wendy Slusser  1:03:57

And you don’t make them forbidden foods. If they’re at someone else’s house, it’s not like oh, they can’t do that. Yeah. Yeah, that’s always the hitch in certain circumstances. It’s no question. Was there anything that we haven’t covered that you’d like to share?

Dr. Tannaz Moin  1:04:04

Yeah. And it’s not like, I mean, we definitely have our days when we will eat out. We have our days where things aren’t as ideal as I’d like them to be. But, you know, I think one thing is this hunger cue. And that’s something culturally for us and for my family. It’s always about like, finish your plate, you didn’t eat it. And you know, so that’s something we’re really trying to work on at home so that when you feel full, it’s okay to be excused. You don’t have to keep eating for the sake of eating. So that is something we’re trying to work on, with the grandparents especially. No, just thank you so much for this opportunity. Thank you for your leadership on the campus. I don’t think any of this, what we’ve accomplished with the UCLA DPP program, and a lot of other really exciting things that are happening on campus, would have been possible without you, Wendy.

Dr.  Wendy Slusser  1:05:05

Well, thanks Tannaz, we’ll stay tuned. We’re going to do more, onwards and upwards.

Dr. Tannaz Moin  1:05:10

Thank you.

Dr.  Wendy Slusser  1:05:11

Thank you so much. Thanks for your valuable time.

Dr. Tannaz Moin  1:05:14

Thanks so much.

Dr.  Wendy Slusser  1:05:14

On all of this work that you do. Thank you so much for tuning into Live Well. Today’s podcast was brought to you by UCLA Semel Healthy Campus Initiative Center. During these extraordinary times of the COVID-19 pandemic, UCLA’s Diabetes Prevention Program has transitioned online, and demonstrated that it is possible to create a strong sense of community virtually. Many participants have shared that this program has enhanced their current life in providing a strong social support network. We’re learning how to stay connected during this new normal and invite you to learn more about how you can become involved in the Diabetes Prevention Program. For more information on Dr. Tannaz Moin, and the DPP, please visit our website at healthy.ucla.edu/livewellpodcasts.

Episode 1: The Neuroscience of Music with Dr. Bob Bilder


Dr.  Wendy Slusser  00:00

Hello, my name is Dr. Wendy and here at the Semel Healthy Campus Initiative Center at UCLA. We’re on a mission to change the culture of health and make the healthy choice the easy choice. Starting in our own backyard, we’re implementing evidence based changes right here on campus. Welcome to our center’s podcasts, LiveWell. Join us as we interview leading experts and discover new perspectives on health and well being. Each episode, we will bring to you scientists and world class operators, who will share with you the never before broadcasted tips to live a more healthful and wholesome life for yourself, community, and ultimately our planet. What are the origins of hearing or what is the evolutionary benefit of music? And why do we get chills when we listen to certain songs? Today we will talk to UCLA neuropsychologist expert Dr. Bob Bilder, about the neuroscience behind music and its benefit for our health and wellness. Bob is the chief of neuropsychology at UCLA Semel Institute for Neuroscience and Human Behavior, and director of the The Tennenbaum Center for the Biology of Creativity. Do we have your interest now? You might even be interested in his research, which is focused on the links between brain and behavior using tools spanning genetics, neuroimaging, cognitive, and other assessments of human behavior. I think my brain just did a little gymnastics. Bob has been studying the brain basis of creativity across species, and identifying brain and behavioral traits associated with exceptional or Big C creativity in humans, which we will discuss today. He is particularly interested in studying dimensions of brain function to help eliminate artificial boundaries between mental illness, between health and disease, and between the brain mechanisms involved in exceptional and everyday creativity. He also directs the MindWell pod within the Healthy Campus Initiative Center at UCLA to concentrate on how we can support resilience, well-being, and creative achievement at UCLA and beyond. Please join us in today’s conversation. Dr. Bilder will discuss the relationships between music and the brain. What is happening in our brain when we listen to music? Can music help with addiction? What are the differences in our brains between highly creative individuals, protegees, and the regular person? And what does Herbie Hancock have to do with all of this? Thank you so much for being here, Bob. I mean, I’m so excited to hear your answers for these questions I’ve been putting together with the UCLA students, staff and faculty. This is our UCLA Semel Healthy Campus Initiative podcast series, and we’re focusing on healthy mind and healthy body. Who’s better to talk about that, but you Dr. Bob Bilder, you know, you’re a neuroscientist, you’re a musician, you research creativity, and I think Herbie Hancock is going to be entering into this conversation as well.


Dr. Bob Bilder  03:43

if Herbie’s doing anything you got to listen to it, if he’s involved, it’s going to be good.


Dr.  Wendy Slusser  03:45

Right? Well, let’s get to Herbie then right away. He was a guest lecturer at this presentation at the music school here at UCLA and the professor fainted or nearly fainted on stage. And I was called into action with had to put my physician hat on and I rushed up and took care of him. And as the ambulance left, Herbie and I had a conversation, he learned a little bit about the Healthy Campus Initiative. And so a little while later, he approached me and asked me if I knew anybody that could speak to the neuroscience of music and its relationship to health and well-being as well. And so of course, you came immediately to my mind, and the reason I didn’t realize was even more apparent once you explained to me that not only do you study creativity in your day job, you also in your weekends, you have a dad band, tell me what a dad band is. It’s the first time I’ve heard that phrase.


Dr. Bob Bilder  04:50

Yeah so there were a bunch of guys, we got together. We were all dads at the UCLA Lab School. We were lucky enough to have our kids go to the UCLA Lab School, which is a fantastic place and sitting around at some school that we started talking about music and we realized that at least three of us all shared an interest in one particular kind of music, which was music from pretty much the 70s and has been referred to as progressive jazz or Sophistafunk and among the artists that each one of us had followed, Herbie Hancock was the main man in some of his albums from that period, including The Headhunters album and Thrust. And this was like our standard go to stuff. So we as dads got together and tried to play some of these songs, which were way over our head. Another friend of mine who used to be a drummer in our band in high school, I sent him our playlist, and he said, “No sane musician would attempt to play that playlist.” So we’re not sane musicians, we’re just dads. It’s fine, we have a good time.


Dr.  Wendy Slusser  05:51

That’s why you keep the title Dad’s Band just to bring everyone down to reality. But Herbie, if you ever hear this, we need a keyboard player. First of all, you must have cleared the decks from your schedule, because it’s so packed.


Dr. Bob Bilder  06:05

I’m so excited. How many times does somebody call me up and say can you come and give a lecture to Herbie Hancock’s class? This is crazy.


Dr.  Wendy Slusser  06:12

And not only was it for Herbie, it was for his elite musicians who were recruited from all over the world studying the Monk jazz program in jazz, right, so only one of two in the whole country.


Dr. Bob Bilder  06:25

That’s really an amazing thing to try to talk to that group about music. It was also very intimidating. You mentioned that another professor who was giving a lecture fainted, well, I think I was probably close to fainting a couple of times. Oh, my God, you know, to talk about music to these musicians is very difficult. And my familiarity with it is you know, only in passing, and trying to understand you know, how the brain could produce music, come to enjoy music, and all that kind of good stuff.


Dr.  Wendy Slusser  06:53

Can you tell the listeners what you taught me, which was so sort of revealing about the neuroscience of music and the origins of music in the brain, like the relationship.


Dr. Bob Bilder  07:03

One of the one of the really fascinating things that I learned and trying to understand the neuroscience of music is how hearing came to be in the first place. If you think back through evolutionary time, and back to single celled organisms, they don’t have any ears, obviously. But you know, those even those simplest of animals, ones that really had just one cell, and maybe a tail that could help them wiggle and move in the waters where the light was, so they could get more food and nutrition. Even those animals had some kind of sensory function. So they would sense what’s on the outside of the cell and that would help to drive their little tail.


Dr.  Wendy Slusser  07:38

They could sense vibration, or


Dr. Bob Bilder  07:40

Well, they were more sensitive to light and chemical environments. But over time, and as we developed into multicellular organisms, then sensitivity to vibrations became important. Now first, that was just embedded in the body of the animal. And right now, all of us can experience sound, if you take a tuning fork, and hit it and then put it against your skin, you can feel the vibrations.


Dr.  Wendy Slusser  08:03

That’s right. Well, that’s what doctors do, we learn to do that on your head to see if you can sense the vibration on either side.


Dr. Bob Bilder  08:10

That’s right. Yes, you guys call that bone conduction, versus conduction through the air. But then over time, what happened is, animals began to develop these very sensitive membranes and parts of their skin surface or their body surface that were much more sensitive to vibrations that are conducted through the air, the sound vibrations, and then those ultimately evolved from being just little thin membranes on usually the sides of the head into real ears that help to amplify the volume and then in humans, there’s a special apparatus that helps to segregate the high frequency sounds from the low frequency sounds. And a lot of brain has been dedicated to unpacking the auditory signals and the vibrations that come into our ears, interpreting that in the brain and classifying different vibrations as different notes, different frequencies, picking words out and identifying meaning all these functions the brain has evolved to enable us to process. Then there’s some other really interesting things that have to do with the possible impact of music and other rhythmic sounds on group cohesion, and social functioning. Really fascinating theories have evolved, they’re very hard to test because we can’t go back in history. But it’s been hypothesized that there might be something about having shared rhythms that enabled people in early times in human evolution, to work together, to hunt, synchronizing their steps in ways that didn’t alert other animals in the environment that they were coming so they could successfully hunt, they were quieter and coordinated. There may be other aspects of shared experience that helped to bond social units. So one of the things about humans and certain other species is that they tend to hang together in social structures.


Dr.  Wendy Slusser  10:03

That’s what you’re describing as the evolutionary basis of music is that there was a connector


Dr. Bob Bilder  10:09

That’s right, that is one of the ideas, it’s that it helped us to share experiences and bond together and because when you are listening to music you are sharing a common experience and are brought together by the rhythmic and melodic structures.


Dr.  Wendy Slusser  10:24

I know in that talk that you gave you talked about the four f’s in the limbic system, and can you elaborate on that?


Dr. Bob Bilder  10:31

Sure. It comes right back to what we were talking about in terms of evolutionary significance. You know as the brain evolved from its most primitive levels up to the fancy brain that we have now as humans but this limbic system has been described as mediating and supporting the four f’s functioning in humans which we can identify as feeding, fighting, fleeing, and reproductive behavior. So those are very key paths that we take to identify behavior.


Dr.  Wendy Slusser  11:01

That gets a big laugh usually when I see you speaking to the students, undergrads.


Dr. Bob Bilder  11:07

That is one way people will remember this stuff, right?


Dr.  Wendy Slusser  11:08

I know, actually I remember the four f’s more than anything else about the brain.


Dr. Bob Bilder  11:15

It’s clear how each one of those directly relates to our ability to survive as a species. If you’re missing any one of those then you’re likely not going to survive as well as other animals.


Dr.  Wendy Slusser  11:27

I remember you did this limbic system and the four f’s getting back to sort of the more primitive area was also an area that lights up with music. Are there other sort of feedback loops that go on that are in that primitive area?


Dr. Bob Bilder  11:40

Yes, that first we want to recognize that you know when we experience music, it’s hitting all parts of our brain. Some aspects of musical expression could only be interpreted by the highest levels of our brain where they carry certain nuanced meanings that in the same way that language communicate certain meanings, music can also carry certain meanings. Indeed some of the regions of the brain that are language processing zones also can be engaged by music and some music of course is very representational or has very sophisticated layers of meaning that go beyond it’s emotional impact, but all that being said, i think that one of the things that we love about music is that it does hit also these more core and limbic brain functions. Cyanic connects in some ways more directly with some of these emotional centers and i think that’s you know a fascinating aspect of music appreciation. I mean a great example is the experience of chills when we’re hearing certain musical expression and it seems like that kind of experience which has been referred to by some people as a skin orgasm but seems to be found when there’s a certain surprisal to the music following a period of expectation. So i think that if you can think to those elements of music that may have given you chills often it’s the result of you following the thread of the music through some kind of expectancy and then suddenly the expectation is either satisfied or there’s a complete surprise just an example would be a chord progression that deviates from what you expect but then it resolves to a harmony or a melodic element that you already had implanted in your expectations. It is this kind of resolution that seems to result in this big shift and this experience of chills.


Dr.  Wendy Slusser  13:43

That’s considered to be more in their primitive brain to relay that response?


Dr. Bob Bilder  13:48

Yeah, while a lot of the setup for that and how you expect things comes from higher brain centers, the bottom line of many of these kinds of experiences probably extend from our reward system which is baked in at a pretty primitive level in our brain, in the brainstem and limbic levels. So when we experience something that’s better than what we expected, we get a positive surge of dopamine in the nucleus accumbens. If something is not as good as what we expected, then there’s actually a decrease in that same signal. This has been referred to as prediction error; our cells, our brains are constantly predicting what is going to happen next. We have expectations all the time, so if what actually happens is better than what we expected, then we get this positive production of a surge of dopamine in the nucleus accumbens and then through a whole bunch of other connections that increases the likelihood that you’re going to do again whatever it was you were doing when you had that surge. In contrast, let’s imagine that you’re expecting something good to happen and nothing good happens or something bad happens. The brainstem is going to quiet down and not send any dopamine up to the accumbens and you’re going to become less likely to repeat the same actions that led to that problem. This is how learning actually takes place; how we develop habits is usually by having some reinforcement through reward. 


Dr.  Wendy Slusser  15:15

That leads me to this question: the four f’s, we don’t have to be really aspiring to meet any of those who any major extent these days at least in our current setting. Would it be too much of a reach to say that we could make a list of what you’re describing as the positive reinforcement? Music would be one, I would imagine, and could there be other things that you could say, okay if i’m conscious of these habits that do give me that positive feeling that are positive for my life that you could then enhance that and then look at the areas that are negative and sort of remove those? Is that a methodology that people utilize based on your neuroscience description of the brain?


Dr. Bob Bilder  16:07

I think it is, that’s one of the real bases of modern psychotherapies to do pretty much exactly this to help people identify what are the things that are important and valuable to them and then helping them align their actions with those high level values and goals. In that way, if people can begin to select their actions based on what is valuable to them, then they’re going to find that those are going to be more satisfying because it’s actually connected to things that are very valuable and potentially very physical. It can help to overcome distractions or overcome bad habits, things that we don’t want to do that might be suggested to us, like eating that extra bowl of ice cream.


Dr.  Wendy Slusser  16:49

So it could act as a deterrent for that because you can replace that extra bowl of ice cream if you’re bored or something with listening to music. Is that what you’re suggesting?


Dr. Bob Bilder  16:59

Exactly. In fact that replacement is a critical thing. Punishment doesn’t work. Punishment only leads to the delay in the behavior occurring again.


Dr.  Wendy Slusser  17:10

or feeling like you’re deprived.


Dr. Bob Bilder  17:12

That’s right. I think the one thing that is important that just struck me while we’re talking is that we don’t want to ignore our limbic systems. We could use our frontal lobes, the highest levels of development of the neocortex, to try to dampen and shut down that limbic system, but i think that would lead to all kinds of problems. I think what we want to do is have a good balance and have…


Dr.  Wendy Slusser  17:32

Wait, what’s the problem if you ignore your limbic system?


Dr. Bob Bilder  17:35

Because then it will it will express itself in one way or another. It will end up controlling the rest of the body in unusual ways or it’ll bleed out into the other parts of the brain and mess up the higher level functions.


Dr.  Wendy Slusser  17:48

You mean that if you don’t satisfy the fighting, fleeing, feeding, and reproduction.


Dr. Bob Bilder  17:55

That’s right. That dynamic balance has to be maintained so that the limbic system is still functioning. If various forms of expression can connect to the limbic system and enable it to be expressed, and if the is experiences of lust are converted and expressed through love, then that may provide a good avenue for expression. But if there aren’t love options and the lust is repressed, then it could lead to explosions of lusty behavior in an inappropriate context.


Dr.  Wendy Slusser  18:26

Yeah, which you see sometimes when people are completely deprived of anything, right?


Dr. Bob Bilder  18:30

That’s right.


Dr.  Wendy Slusser  18:32

Well feeding, you have to feed.


Dr. Bob Bilder  18:34

That’s right, and you have to feed, but some people control their feeding too much. You’re familiar with one of the deadliest diseases, is anorexia and bulimia, that leads some people to over control those limbic centers in ways that are dangerous.


Dr.  Wendy Slusser  18:48

Fighting and fleeing, how can you satisfy those?


Dr. Bob Bilder  18:51

Yeah, a play. It’s an interesting thing that some people would suggest that play is something that has evolved in connection to fighting and fleeing. You ever see dogs play?


Dr.  Wendy Slusser  19:01

Oh sure yeah, sometimes it scares me but you’re right it’s not really fighting it’s playing. But it looks like fighting.


Dr. Bob Bilder  19:10

And a lot of chasing. And who’s chasing whom…


Dr.  Wendy Slusser  19:13

So tag’s a great–


Dr. Bob Bilder  19:13

–perfect example. I think that is a neat re-expression and highlights the value of play because we don’t have opportunities to fight and flee in exactly the ways we used to.


Dr.  Wendy Slusser  19:25

What else lights up there besides the four f’s and the music?


Dr. Bob Bilder  19:29

Whole lots of other centers in the brain that are specialized for what we call semantic processing or extracting meanings out of these elements. Language is a perfect example. Language is a kind of music that involves sequentially organized in time changes in the frequency of sound. Now our brains and human brains have developed an incredible lot of brain territory dedicated to this processing of language so that we can detect the differences between very, very subtle sound differences. For example, if I say the words, Ben and Kim, does it sound like the same word repeated twice or two different words?


Dr.  Wendy Slusser  20:14

Two different words.


Dr. Bob Bilder  20:15

It’s possible to distinguish those because you can tell the difference in what’s really occurring just in like the first 50 milliseconds, that utter in “b” versus “p.” The only difference is “b” has a gentle closing of the lips, where “p” has a plosive, or rapid separation of the lips with the sound and letting the air escape in that way. This is a very subtle difference yet, you can resolve it with 100% accuracy. That’s a real tribute to how much the part of the brain, usually in the left temporal lobe, gets overdeveloped. Sometimes the territory there can be seven times larger than the comparable brain region on the right hemisphere, dedicated to this processing of sounds for speech. Now, in music, we also extract meaning from the sequentially organized in time fluctuations in the frequencies of the sound, but it follows different rules. We actually can see that as people get more training in music, they transfer some of the processing capacities from the right hemisphere to the left hemisphere, as they learn the rules that are associated with musical processing. So if you have novices attend to certain musical tasks, they will show this right hemisphere preference and it will be more widespread in its brain activations. Whereas a skilled musician will analyze it immediately and classify it in its left hemisphere modules, which is more like language.


Dr.  Wendy Slusser  21:48

Which is so cool about the brain, isn’t it that we now are knowing that it’s so elastic, and you can do these connections even at a late age, by learning new languages and different sports,


Dr. Bob Bilder  22:02

and playing instruments is something that’s supposed to be good for your brain as well.


Dr.  Wendy Slusser  22:03

Yeah, picking up a new instrument or learning a new song on an instrument. And that really touches on what we were talking about earlier about how the brain is much more complex than this description of all the different sort of anatomic areas that we’ve been spending a lot of time on that there’s a lot of connectivity between back and forth, up and down, sideways. You talked about language and I remember in the talk that you gave with Herbie, that music came before language, can you elaborate on that?


Dr. Bob Bilder  22:37

I think that there’s not really enough information about exactly what the timeframes were for developing language and music. But it looks like there were certain shared rhythmic patterns that occurred in social groups before language even developed. Now whether that’s really music? Certainly it’s not like Watermelon Man, but it gives us a broad definition of music in that way. Probably those shared soundscapes were important to humans, even before formal languages developed. We can also identify that those are simpler than some aspects of language. However, there are probably other aspects of language that were developed very early. If I say, “Help!” then you know that I’m in distress, right?


Dr.  Wendy Slusser  23:23

Yes. No matter what word you say.


Dr. Bob Bilder  23:27

Other species are capable of these kinds of vocalizations. Another interesting vocalization which is also very primitive, is the infant cry. There’s a key part of the limbic system that’s known as the cingulate gyrus that is particularly sensitive to these infant separation cries and is particularly well developed in mothers. If that territory is damaged, then mothers will stop showing a sensitivity to infant cries and neglect their offspring. That, of course, has bad evolutionary consequences. We see variations on that all the time.


Dr.  Wendy Slusser  24:06

In mostly developed countries, but now developing countries. But now developed countries take a form of what’s called kangaroo care where it was developed in Colombia, the country where they didn’t have enough incubators for preemies and newborns that needed to be in an incubator. They would put them skin to skin to the moms and wrap them around. Moms would act like incubators. The child’s temperature dropped, their temperature wouldn’t rise and maintain the temperature of the these preemies, except for drug addicts. They didn’t have that kind of communication emotional communication to be able to incubate their babies. It might be explained through some of the potential damage or interruptions of this limbic system. It’s possible. Anyway, they found that that was a key difference between mothers who were more in tune with their babies and mothers who were disconnected mostly because of habits that were addicting–bad habits. I want to get back one more time to this question because I feel that these negative behaviors that are routinely cited as ways to feed the reward system, like drugs, nicotine, but also gaming–the smartphone is now looking to be quite addicting– gambling, what do you think can be beneficial to make a living, I mean what other things besides music or other things that you might observe yourself that help feel positive for your reward system, what do you know that lights up in the limbic system that would be something to give people ideas about that they could try?


Dr. Bob Bilder  25:49

I think when we see all these kinds of problems emerging it usually comes from some root cause. Some of the root causes that we know are relevant are anxiety and the lack of social connections support. Those two features can be worked on usually in psychotherapy and also through other positive psychology activities and just focusing on the relationship building and building the other tools that support resilience. I think that’s something that is part of our work in the Healthy Campus Initiative; we’ve been trying to work on identifying first how to make sure that people don’t feel the stigma associated with problems like anxiety that can lead to seeking out other ways to get reinforced like drugs or alcohol. Alcohol was the first drug ever identified and it does a great job of going and dampening certain aspects of this anxiety system in the brain.


Dr.  Wendy Slusser  26:50

Which is where? Where is that anxiety system?


Dr. Bob Bilder  26:53

Interestingly there’s this great additional cocktail party lingo, what’s called the septohippocampal system. There’s a loop that’s part of the limbic system that goes from the septal nuclei and projects to the human hippocampus. In that hippocampus really seems to be some of the key brain systems that help to stop ongoing behavior in a sort of a freezing reaction and help us be alert to things in the environment that might be threatening. The cause of anxiety is often felt to be an increased sensitivity of that system so that it may fire under relatively not threatening circumstances, maybe hyper attuned and thus we end up feeling threatened even when we’re not really being threatened and engaged that circuitry now if you then experience that as experienced as being quite unpleasant as anybody who’s ever been anxious, which is everyone and recognizing…


Dr.  Wendy Slusser  27:50

Sometimes a little anxiety is a good thing too.


Dr. Bob Bilder  27:53

There is the whole Yerkes-Dodson law. We’re getting all kinds of great stuff to bring up at the cocktail party. Yerkes-Dodson law, that’s the law that is the inverted u curve so that it defines, when you put anxiety there, there’s a certain peak level of anxiety which your performance is the best, but if you get more anxious than that then your performance deteriorates. But if you’re not anxious at all, if you’re too laid back, then you’re not going to perform your best either yeah. An interesting thing is that the more you practice something, the higher you can push up that anxiety function and still be performing better. That’s why world class musicians, world class athletes, will often turn in their best performances under situations where they are performing in front of thousands or millions of people because they can push it to that level. They can get there and without a deterioration in performance. Others like me, if i’m asked to play a bass solo, I fall apart immediately. Just the words make me scared. Some of the people resort to alcohol or drugs in order to get out of that bad feeling. The question is how can we then treat that with more advanced forms of psychotherapy? We try to get to well what are the roots of that problem? They go back to earlier trauma that one has experienced etc. There are also behavioral ways to try to get past that to desensitize people to anxiety-provoking stimuli and then find other behaviors that aren’t using alcohol or drugs that can be substituted.


Dr.  Wendy Slusser  29:25

Like running for me. I run every morning for that reason.

Dr. Bob Bilder  29:29

Do you feel good?



Dr.  Wendy Slusser  29:30

Oh yeah, it moderates my anxiety.


Dr. Bob Bilder  29:33

It has a lot of other beneficial effects.


Dr.  Wendy Slusser  29:35

I get my best ideas when I run.


Dr. Bob Bilder  29:38

There you go, it’s good for your brain.


Dr.  Wendy Slusser  29:40

That’s right, that’s what I hear, am I right?


Dr. Bob Bilder  29:44

Yeah of all the work we’ve been doing trying to understand what are the positive things you can do for your brain, among those positive things you can do for your brain, physical exercise is certainly one of the best.


Dr.  Wendy Slusser  29:54

Even brisk walking, I’m assuming, right?


Dr. Bob Bilder  29:56

Even brisk walking.


Dr.  Wendy Slusser  29:57

I think that says a lot. You’ve explained getting to the root cause is critical of what might cause you to lead you to poor behaviors, and then replacing it with healthier behaviors.


Dr. Bob Bilder  30:12

One thing I didn’t mention, which just comes to mind is, when you’re talking about the problematic use of mobile phones, which is a product I’d love to work on here on our campus.


Dr.  Wendy Slusser  30:22

Me too, there’s no question that we’re going to see a social well-being–poor social well-being epidemic.


Dr. Bob Bilder  30:29

This is also an evolutionary throwback. Before we developed all those frontal lobes, it was certainly wise to go for the bird in the hand. In ancient times, if you let go of the bird in the hand, you’re not going to get the bird in the bush. Immediate gratification is built into our brains, it’s really baked in. It’s only through having this extra cortex that we’re able to delay gratification over longer periods of time, and make more rational choices. When we do plot out these so called discounting functions to see how much is a reward now valued relative to awards you could get at some later point in time, we discount the stuff that’s further away in the future. So, from investments, imagine I give you this alternative: I’ll give you $100 now or I’ll give you $200 in six months, which would you take?


Dr.  Wendy Slusser  31:25

Well, I would take the $200.


Dr. Bob Bilder  31:27

You see, you’ve got very strong frontal lobes.


Dr.  Wendy Slusser  31:30

I don’t need the $100 now, right? See, if I needed it, maybe I would take it.


Dr. Bob Bilder  31:35

You’ve engaged in a very rational process that illustrates the power of your frontal lobe. However, that exact example is just about at the average place where people think it’s about the same. However, in reality, nobody has an option to double your money every six months. That’s about the steepness of the typical human delayed discounting curve. We often make choices. That’s one of the reasons why cigarette smoking persisted for so long, so you get the immediate reward. Most people knew that you got a risk of cancer in less than 20-30 years. But people didn’t think about, well that’s in 10 or 20 or 30 years, and it’s only a partial risk, it’s not a sure thing. In the face of those probabilities, people continue to do the thing that provided the immediate gratification. It’s a matter of connecting up the immediate actions with the longer term values and rewards that is the key to overcoming a lot of these problems.


Dr.  Wendy Slusser  32:32

That’s right, or doing the opposite, where you can have the rewards in the primitive and the more cognitive areas. Going back to music, playing music could satisfy everything.


Dr. Bob Bilder  32:48

That’s right. It can light up the whole system. Brainstem up to the…


Dr.  Wendy Slusser  32:54

Just getting back to your time here, you’ve been here at the UCLA Semel Institute for 16 years. But before that you’ve had a distinguished career in researching mental illness at Columbia, Albert Einstein Hillside Hospital and Nathan Kline Institute. How did these previous roles prepare you for your role at Semel Institute, the leader of MindWell pod and researcher of Creative Minds?


Dr. Bob Bilder  33:20

I’ve been super, super lucky. In those earlier experiences, I was able to do a lot of different things. I’m trained as a neuropsychologist, so typically, neuropsychologists get into how to measure behavior to understand how the brain is functioning. But then in our research, we come back to my dissertation, I started getting into neuro imaging. At that time, we didn’t have MRIs and CAT scans. I used to trace the size of different brain bits on her scans directly. It was really difficult because the little measuring thing would skip. It was not fun. I had to do it again, and again, and again. Now, I got computers, that can do all that for you automatically. I learned to do brain imaging of brain structure and then imaging of brain function. Subsequently, when the functional MRI came along, I was able to get involved in doing that. I was lucky enough to be involved in a center where we did what are called neurophysiology, basically gathering brainwaves and studying the electrical activity of the brain. So as you know, another discipline called neurophysiology, and then I was able to start looking at genetics as well, because over the last 20 years, we’ve developed these tools that let us look at the human genome in amazing ways. When we started, we sort of picked off certain candidate genetic markers that we thought would be useful. Then we realized, well gee, that’s not as informative as looking at all 3 billion base pairs, but that was prohibitively expensive. Now, we can do that and it probably will be done soon in every human, whole genome sequencing, as it’s called. It is going to happen that we’re going to be able to connect the genetic risks all the way up through the proteins and the cells and the functioning of the brain to the expression of human behavior and see how everything is connected together. One of our NIMH directors referred to it as that genetics is providing the edge pieces to the puzzle of the human mind. It’s become sort of a scientifically tractable problem to figure out how all of this biology works to produce this incredibly complicated human experience. I’ve been lucky to be involved in a lot of different aspects of that. I probably don’t know anything in much depth, but a lot of breadth. I had the opportunity to do and then after coming to UCLA, I have increasingly been thinking, what could I do that would be really good for people. I had been studying schizophrenia for a long time. I had a very sobering experience once giving a talk to a group of people, families of people with schizophrenia, and a person says, “Of all the things you’ve done, Dr. Bilder, you’ve published, you know, hundreds of papers, and given, you know, hundreds of talks, what do you think has been of greatest benefit to the people who have schizophrenia?” As I searched the things I’ve done, I’ve thought, not much! Most of the work I had done, it was really related to more basic scientific issues, which may have a payoff in the very long term, but it didn’t have as much immediate impact. I’m really starting thinking, what would be, just as we’ve been talking about how to line up your high level values with your immediate actions, what can I do that would actually help people now and that’s where it was so great to have Jane Semel as the key benefactor of our Institute for Neuroscience and Human Behavior. She changed the title of it from the Neuropsychiatric Institute to the Institute for Neuroscience and Human Behavior, specifically to help bridge the gap between those people who were identified as having mental illnesses and the rest of us, which I don’t identify as being different from the people that have mental illnesses. I’ve always been interested in seeing how can we overcome the stigma that’s associated with mental illness? How can we identify those things where we are all the same? We’re really sharing these dimensions of well-being and not well-being.


Dr.  Wendy Slusser  37:13

You’ve always told me it’s just sort of a spectrum or you can move in or around it in terms of the definitions of well-being and emotional health and challenges.


Dr. Bob Bilder  37:27



Dr.  Wendy Slusser  37:29

When you do your studies on creativity, I know people also do studies on creativity with people with schizophrenia, right? I would love to know what have you found in terms of who are these creative people and what have you learned that distinguishes people that are creative? Because this is sort of the positive side of emotional well-being because a lot of people who are considered diagnosed with mental illness are actually among the most creative.


Dr. Bob Bilder  38:00

It is certainly true, but I think that there’s a popular misconception that that’s a good thing about mental illness. I think that what most of the research is pointing to now is that, yes, there are certain things about pushing oneself to the edge of certain dimensions that help creativity. But we developed the idea which we refer to as the the edge of chaos. It’s actually a model that comes from systems theory. It can be used to talk about the origins of life, economic systems, and all kinds of complex systems. But what we think is probably the case in humans for creativity, is that there’s a certain envelope that you can push to the novel, if you go too far. It’s not going to connect to the rest of the world, and it’s not going to be perceived as being creative. So there’s novelty up to a point, before it starts just being considered weird by everybody else. That’s called the edge of chaos.


Dr.  Wendy Slusser  38:56

What defines weird?


Dr. Bob Bilder  38:57

It’s defined by the community, unfortunately. That means that something that is considered weird today might be considered perfectly normal tomorrow. Yet, that is important for the survival of those ideas, they have to somehow make it past the current domain or the current culture in order to be preserved. So like Herbie Hancock was playing some pretty crazy stuff back in this hard, bop era into the funk era, but more than much other jazz music, it really connected to people in a way that was unique. I think that’s why some songs really stuck. It was new, totally new, different from what went before but connected in certain ways to people that ended up preserving it. I think the same is true in the creative arts. We’ve been finding that again, here. How lucky is this? We received support to study what we call Big C or exceptionally creative visual artists, exceptionally creative scientists, and then exceptionally creative musicians. One of the things we found is that in each of those groups, not so much the scientist since they’re a bunch of academics, tends to prune out certain problems that people have…


Dr.  Wendy Slusser  40:09



Dr. Bob Bilder  40:10

I know, I know! We need to support more of that. But it’s interesting that when we look at measures of what we call psychopathology, things that have been referred to as schizotypy, which basically means entertaining really unusual ideas. Well, it’s not that big of a surprise to know that the visual artists, and the musicians actually were high on some of those scales. They weren’t up in the range of people with diagnosable mental illnesses, but they were higher than the typical person. So they were more likely to entertain unusual ideas.


Dr.  Wendy Slusser  40:44

What are unusual ideas?


Dr. Bob Bilder  40:47

That other people can read your mind or that you could put your thoughts into somebody else’s mind, that other things that are going on in the world are actually about you or they have special meaning. You ask a scientist these questions, but nah they say that’s not really true. But you ask a visual artist, we ask our friend Cathy Opie here at UCLA, a great photographer, Doug Aitken, another amazing artist here in LA, well yeah, maybe! They’re very open minded. When we look at personality characteristics, that’s one thing we find, that openness to new experiences is very high, and people who have creative temperaments and are high in creative achievement. There’s also another fun finding that we observed in a group of healthy people, that the ones who have more creative achievement tended to also differ on another personality characteristic known as agreeableness. Some people were more agreeable than others. The ones who had higher creative achievement were less agreeable, they’re more disagreeable. We think that that’s reflecting their tendency to challenge the status quo. Some people just don’t accept things because somebody else said it’s true. An agreeable person might say, “Oh, that’s fine.” But the disagreeable person would say, “Oh, I’m not so sure. What’s the evidence that supports that?” I think that prides, some meat in creative science and and other other domains.


Dr.  Wendy Slusser  42:13

That’s a real juxtaposition. Open minded, but not agreeable.


Dr. Bob Bilder  42:18

That’s right.


Dr.  Wendy Slusser  42:18

It’s interesting. But that sounds like something that people could adopt if they were trying to build their creativity. They could work on being more open minded and also challenging perhaps the status quo.


Dr. Bob Bilder  42:32

That’s right. One of my favorite quotes about how to promote creative expression comes from Mihaly Csikszentmihalyi, which I love to say, because I feel like I’m pronouncing…


Dr.  Wendy Slusser  42:41

You’re so good at it.


Dr. Bob Bilder  42:42

Yeah. Less people call him Mike.


Dr.  Wendy Slusser  42:47

Oh, that’s good for me.


Dr. Bob Bilder  42:49

But he’s the guy who has written literally the books about creativity that are some of the best in the world. He also is the individual who brought to light the ideal flow, that state of effortless productivity and creativity that, we all see. One of the things he said if you want to promote creative expression, he says, “You should surprise someone else every day.” He also said, “You should surprise yourself every day.” I think that this process of seeking surprise, is one of the key activities that you could engage in to promote creative achievement.


Dr.  Wendy Slusser  43:27

That’s sort of like what you were describing with the music, if you got surprised by something at the end, that was satisfying or exciting.


Dr. Bob Bilder  43:37

That’s right. And those people who love jazz, I think that whole process of being taken out very far from where you started, and then suddenly having a comeback to the head…melodic line, where to have it all resolved, that is just an amazing thing.


Dr.  Wendy Slusser  43:52

That makes you feel good. I remember you saying in your lecture about music, that there’s some relationship to health in terms of impacting people, for instance, in intensive care units or other settings. What do you attribute that to?


Dr. Bob Bilder  44:11

I’m not sure. I mean, it’s sad that there hasn’t been more thorough scientific study of these kinds of processes. We know that there is a beneficial effect of music in medical settings. It’s not known whether that’s mediated pretty much all through relaxing effects, or whether there’s more to it than that. There also could be more trivial explanations. For example, one of the key sources of problems in medical settings is the ICU environment. There’s lots of flashing lights and sounds. And ironically, there you have people where they’re there to rest, yet they’re woken up every four hours in order to have vital signs. How crazy is that?


Dr.  Wendy Slusser  44:51

So crazy.


Dr. Bob Bilder  44:53

Rather than letting a person sleep and rest, which would probably have a much greater beneficial…


Dr.  Wendy Slusser  44:56

Which will be another topic of our pod. We have to do sleep.


Dr. Bob Bilder  45:02

Yeah. So you know, the mechanisms through which music helps people’s health remains unknown. Yet one of the things that’s interesting from a health perspective is true for music and probably true for other things as well, is the sense of being away. When people looked at environmental factors that contribute to well-being, one of the things they found is that, the more you can help people feel that they’re in a different place, that may be beneficial, that it inspires their sense of all and provides a feeling of connection to something larger, that may be beneficial. I think music can have that impact. People can be immersed in it and be taken away from where they are right now and have a real sense of being in a unique space.


Dr.  Wendy Slusser  45:49

Getting back to creativity, is there anyone that inspires you that you would identify as someone that has been creative?


Dr. Bob Bilder  45:57

Yes. I can’t not mention Herbie Hancock.


Dr.  Wendy Slusser  46:02

You’re right.


Dr. Bob Bilder  46:02

Every time I listen to those songs…I sort of focus on the baselines. But then, when I listen to what he does, playing keyboards, it’s just unbelievable how he ever came up with the ideas to play what he’s playing when he’s playing it. It really gets me every time.


Dr.  Wendy Slusser  46:23

That’s why you would like to image his brain. So tell me about that, the imaging of brains? What’s the difference? Are you seeing anything among those that you are imaging?


Dr. Bob Bilder  46:32

We have, I mean, some of the things are interesting, but not very surprising. For example, visual artists, we see have parts of their brain structure in visual cortical areas that are bigger. Now you could say, oh well maybe they decided, this part of my brain is bigger, I’ll go and become an artist. Maybe it’s easier for them if they were born that way, but I think it’s more likely that they exercise those aspects of their brains to such an extent that it grew. We know that there’s through what we call experience dependent plasticity, the capacity for the brain to grow a lot in response to exercise of certain cognitive functions. We know that doing cognitive exercise can grow these bits of brain. It was surprising to me that we would actually see it in these visual areas from people who are visual artists, they didn’t do that much exercise, perhaps. So that’s interesting. Then there’s another interesting thing that we see that links together different creative groups with the artists and scientists show a pattern of functional connectivity in their brains. That’s unique. When we look at the functional connectivity in the brain, it’s sort of like looking at those maps of airline routes, that you see in the seat back pocket, right? If you look at each airport as a node in a graph and then every airport is not connected to every other airport.


Dr.  Wendy Slusser  48:00

That’s right.


Dr. Bob Bilder  48:02

LAX connects to New York. And then LAX connects to other regional centers in the Southwest. But you don’t see flights from LaGuardia to Burbank, you don’t see everything connected to everything else as a more random pattern. Instead, the airline pattern is very efficient and spanning long distances with a few routes, and then having lots of local routes to get everybody where they need to go. That’s called the global efficiency. When we look at those kind of metrics of how the brain areas connect with each other, because we can map that, when people are at rest in the scanner, we can look at which patterns of brain activity are correlated with each other. We can basically say, “Where are the planes flying in the brain?” and make a map of that kind of a route map of the human brain at work. What we see is that these Big C creatives are actually showing a pattern that’s more random, with other stuff connected randomly to other stuff. Maybe you can go from LaGuardia to Burbank, if you’re a Big C creative.


Dr.  Wendy Slusser  49:07



Dr. Bob Bilder  49:09

I was really impressed that we saw that across two different groups, scientists and artists who couldn’t be more different in some ways, yet share this spark of creativity.


Dr.  Wendy Slusser  49:19

And again, is it the chicken or the egg? Right? Did they have it before or is it something that they built up over time?


Dr. Bob Bilder  49:26

That’s right, this is something that we need to do more research to find out. An amazing finding, just published, it’s hot off the press.


Dr.  Wendy Slusser  49:35



Dr. Bob Bilder  49:36

Yeah. Go pick up your copy of Neuropsychologia today.


Dr.  Wendy Slusser  49:42

We’ll definitely post it on as a link. We have to, your description of the circuits in the brain and comparing it to a map of an airline is very understandable. For people like me and my brain. Very helpful.


Dr. Bob Bilder  50:01

You have an amazing brain as you’ve already proven.


Dr.  Wendy Slusser  50:03

I hope so, I haven’t been recruited for the Big C though. That’s gonna be something I’ll have to aspire to. Can you explain what Big C creativity is?


Dr. Bob Bilder  50:13

When people talk about creativity, they sometimes talk about every day creativity or Little C creativity, as distinct from creative genius, transformative creativity, or Big C creativity, creativity with a capital C. So that’s been called Big C creativity. A lot of studies looking at creative achievement will grab what I refer to sometimes as free range humans, not selected for creativity and study a bunch of them, and you can rank them in terms of their creative achievements. Like in Visual Arts, I once painted something when I was in high school that I hope no one will ever see. But that was my greatest artistic achievement. That gives me a one or a two on the scale that goes up to seven. But our artists that we recruited for the Big C project, had multiple international exhibitions, and so they’re in a whole other stratosphere of artistic achievement. The typical person doesn’t get above a three. So the Big C individuals are those who’ve made clearly landmark achievements within their respective domains. People always wonder, when we do studies of Little C creativity and find dimensions that are associated with creative achievement, well what about the Big C creativity? How does that explain Picasso and Mozart? In the Big C creativity studies, we try to go out and find those people who are one day going to be seen as the Picassos and Mozarts of our era.


Dr.  Wendy Slusser  51:36

Do you see a difference in their brains, Little C and the Big C?


Dr. Bob Bilder  51:40

Well, there we haven’t compared enough of Little C’s who could be matched on creative achievement to the Big C, it’s a sort of definitional problem. That study is hard to do, what we’ve done is compared our Big C’s to what we call smart control group. One of the first things we realized when studying Big C creativity is that we would face scientific criticism, because people would say, “Oh those Big C creators are just smarter than everybody else, they just have higher IQs, etc.” Especially when we’re looking at Big C scientists, they all got doctoral degrees. Some of them several doctoral degrees. They’re hyper educated. Even our visual artists were quite educated and very intelligent. If we just studied an average group of people, people would say, “Well, but they differ in all these other properties.” We found a smart control group of people who were very high in intellectual ability. In fact, not significantly different from our Big C groups in estimated IQ. So in that way, we’ve looked at really smart people and the differences I talked about, this more random pattern of connection seems to be a big difference. It also looks like in that paper that’s in Neuropsychologia, what we found is that the Big C people didn’t need to work their brains as hard to get the same results in tasks that require divergent thinking. If I asked you to say, what are the unusual things that you could do with this water bottle? Then you might think, well, I could use it to water the plants. That’s not a very unusual idea, right? But what if you said, I could use it to practice my balance, I could put it on my head and practice walking with it as a posture. Now that’s a little bit more creative, right? We have tasks like this, where we ask people to produce as many unusual uses effect as they can. And it turns out that our Big C people didn’t have to exercise their brains as much. They didn’t show as much activation as the smart controls did when performing that kind of task. They got about the same amount of stuff, same amount of production in that task, but didn’t have to work as hard.


Dr.  Wendy Slusser  53:48

Wow. Because they were so probably revved up.


Dr. Bob Bilder  53:52

I think that maybe they’re used to doing that sort of thing.


Dr.  Wendy Slusser  53:56

That too, but maybe the connections too well, going from LaGuardia to…


Dr. Bob Bilder  54:02

that’s right going from LaGuardia to Burbank. Maybe it’s easier for them to make those remote…


Dr.  Wendy Slusser  54:10

I’d like to end this wonderful conversation with one question, especially since it’s been mostly about music. I’d love to know who your favorite artist might be and what’s your favorite playlist that will make you feel nostalgic.


Dr. Bob Bilder  54:26

I’m really tied to this whole 1970s Sophistafunk era. Herbie Hancock is front and center in that group. I also find to be very transporting, John McLaughlin was playing what they said is his last concert, and they’re playing the music of Mahavishnu Orchestra, which I heard in 1972 in Keene, New Hampshire, when I was a high school student. Yeah, we escaped from the school.


Dr.  Wendy Slusser  54:55

You mean you played hooky?


Dr. Bob Bilder  54:59

I think it was against rules. It was a boarding school. I think we weren’t supposed to leave campus. I went with my buddies up to see John McLaughlin and the Mahavishnu Orchestra.


Dr.  Wendy Slusser  55:09

You’re quite creative because you pushed the envelope there. So go for it.


Dr. Bob Bilder  55:16

He was quite an incredible musician. I mean, not only is he a legendary guitarist and guitar virtuoso, some people say without parallel, but the kind of music that he invented was really unique, really playing with novel time signatures, totally unique melodies and harmonies that no one else would think about. Remember, Miles Davis commented about John McLaughlin when he was playing on one of his albums, he goes, “Man, that is right off. Yeah.”


Dr.  Wendy Slusser  55:49

Wow. If you get somebody like Miles Davis commenting.


Dr. Bob Bilder  55:54

Yeah, yeah.


Dr.  Wendy Slusser  55:55

Did he meet your expectations, even this many years later?


Dr. Bob Bilder  55:59

Unbelievable. I can’t imagine because he’s, what’s the word, not a spring chicken? He must be in his 70s, 79… To be able to play, it’s very physically demanding. It’s unbelievable, he’s known by many for the rapidity with which he can play. I just can’t imagine how his brain and muscles can still move at that rate with precision. But anyhow, he’s just an incredible guy.


Dr.  Wendy Slusser  56:27

How did you feel, like physically?


Dr. Bob Bilder  56:30

Yeah, we were talking before about free song. So I had multiple experiences of free song during the course of that.


Dr.  Wendy Slusser  56:36

That’s like the goosebumps.


Dr. Bob Bilder  56:38

That’s right, because these melodies were so ingrained in my psyche, you know, over the last 50 years that to then hear them live and to see John McLaughlin there, and to have it resonate with this entire experience of wow, that was 50 years ago where I heard that same song by that same musician.


Dr.  Wendy Slusser  56:57

Live, which also has such significance.


Dr. Bob Bilder  57:01

With friends who really appreciate that music as well.


Dr.  Wendy Slusser  57:04

So you remembered your friends too. That brought some nostalgic memories. It shows that exposing your kids even maybe even in utero to music could have this kind of imprinting that potentially could bring back these wonderful feelings of contentment or histologia.


Dr. Bob Bilder  57:26

Could do in theory. I like the idea, but you have to show me the studies that people have done.


Dr.  Wendy Slusser  57:33

Yeah, I don’t know. I think it’s all theory, as you said.


Dr. Bob Bilder  57:38

We’ll do the studies.


Dr.  Wendy Slusser  57:39

Hey, that’s a good idea.


Dr. Bob Bilder  57:40

We can get together between the brain science and the pediatrics.


Dr.  Wendy Slusser  57:46

I like that a lot. Yes. Very positive too, creative! Maybe we just flew from LaGuardia to Burbank. We created a connection with our own brains. Thank you so much, Bob. You’re amazing. You’re such a jewel for our campus and I’ve learned so much from you over time about breaking down stigma around emotional well-being issues and music, just laughing and knowing that, you know, you can pursue a lot of different areas of science and still be a scientist. Meet lots of famous people along the way.


Dr. Bob Bilder  58:25

Well, it’s so nice. I’m so honored that you would speak to me about these things. You’re really a great force for the greater good here on our campus. It’s really wonderful.


Dr.  Wendy Slusser  58:34

Thank you Bob. That makes me feel good.


Dr. Bob Bilder  58:36

…leading the way. You always say onwards and upwards.


Dr.  Wendy Slusser  58:41

Onwards and upwards. It’s a group effort, it takes a university. Thanks again. All right. Bye. Thank you for tuning into LiveWell today. Today’s podcast was brought to you by UCLA’s Semel Healthy Campus Initiative Center. For more information on Bob’s new study on brain circuits, please visit our website at healthy.ucla.edu/livewellpodcast. To stay up to date with our latest podcasts, make sure to follow our Twitter and Instagram @livewellpodcast.

Episode 8: Resilience with Dr. Chris Dunkel Schetter



Dr.  Wendy Slusser  00:04

There’s no doubt that we’re all being challenged in our adjustment into a new way of life. However, as Dr. Chris Dunkel Schetter puts it, building resilience in this moment will make us all more adept to face the rest of life’s challenges. Join me as I chat about the importance of perspective and optimism today with Dr. Chris Dunkel Schetter, who is the UCLA distinguished professor of psychology and psychiatry, and co leader of the Engage Well pod. Chris.


Dr. Chris Dunkel Schetter  00:36

Hi, Wendy.


Dr.  Wendy Slusser  00:36

Thank you so much for coming on to our podcast for this new series. I want to talk about one of your favorite subjects, resilience, and hear about what we can do, now, during this pandemic, and what we can do in the future to prepare for future disasters and pandemics like we’re experiencing now.


Dr. Chris Dunkel Schetter  00:56

Sounds good!


Dr.  Wendy Slusser  00:57

I guess the first place to start is, what do we mean by resilience?


Dr. Chris Dunkel Schetter  01:01

Well, resilience has been studied and written about extensively. And there are many definitions out there. I’m especially interested in resilience in tough times, ongoing crises and disasters, and chronic stress, not quick things are acute stressors. So in the context of chronic ongoing stress, like we’re experiencing now, I think you can think of it as a process. And that process involves the ability to withstand and cope with ongoing or repeated demands, and maintain healthy functioning in different life domains. And that process could take place at multiple levels: it could take place at the community level, that a community could be able to withstand and cope with the ongoing demands of the virus, for example, and then chain functioning. Or the definition I gave you might be seen as more appropriate individuals: a process whereby individuals are able to withstand in cope and maintain healthy functioning in different parts of their life.


Dr.  Wendy Slusser  02:10

So, I guess parsing that out for community that’s functioning in a healthy or somewhat functional way. I could see in my neighborhood, there are grocery stores still open,  they’re still picking up the garbage, there’s still safety personnel out there, hospitals, all the basic needs are available, maybe not accessible, but at least available to all of us. And what about the individual, how do they maintain a form of health and functionality when they aren’t necessarily used to staying inside or even within the perimeter of where they live?


Dr. Chris Dunkel Schetter  02:48

While there are lots of ways that people can maintain functioning, and they tend to be organized around different themes. So there are themes that have to do with what kind of personal characteristics you have: your personality, your dispositions, there are themes that have to do with your social approaches, your orientation and your social connections, there are themes that might have to do with your worldviews and your culture, how you view the world. And then there are skills: behavioral and cognitive skills in coping. There also are other resources that are important and not always something, there’s something we can influence, as you know, but our health, for example, is something that’s a resource that we can draw upon. Staying healthy is a resource we can develop to enable us to be more resilient. So it’s a full gamut of things that are relevant to being resilient. And one way to look at it is to look at what the American Psychological Association has said, are 10 ways to build resilience and I would boil them down into fewer. The first one they mentioned is social, and that is to make connections. That’s all they say, make connections but we could broaden that to say maintain connections, create connections, nurture those connections and so on. But being connected right now is critical and people are finding new ways to do that which is pretty exciting. In the health and well being way that Healthy Campus Initiative has already talked a lot about taking care of yourself, focus on yoursel, yourself first, and on others second. Help others when you can, but not to your own detriment. So for the Coronavirus, of course, this means social distancing, and whatever you you like to do and can do and have been encouraged to do to maintain your well being your point of view your state of mind.


Dr.  Wendy Slusser  04:45

And I can say something, though, with social distancing is that actually that’s also helping others, right.


Dr. Chris Dunkel Schetter  04:51

That is a way of helping others, helping the community. Exactly. You know, when you have a situation like this one where we’re part of a common group and your individual actions affect the common good, then everything you do can harm or hurt the common good. So it’s a, sometimes we think of it as the dilemma of the commons in social psychology, where it might be to your personal benefit to go out and about and do whatever you like. But it’s not to the community’s benefit. And in the end, it may not be your own.


Dr.  Wendy Slusser  05:23

Right. So I think that’s important too, because I think that your point about taking care of yourself, and then others, if you can, really are one of both are the same, really, in this situation in a pandemic?


Dr. Chris Dunkel Schetter  05:37

Yes. So other things we can recommend are some ways of coping. And it’s easy to say these and harder to do but three things to avoid seeing crises as insurmountable problems,


Dr.  Wendy Slusser  05:51

How do you do that?


Dr. Chris Dunkel Schetter  05:52

It’s a perspective, I’ll read you the other two: accept that change is a part of living. So this is one of the many changes we will experience in our life. And if we learn to avoid seeing difficult times like these as insurmountable, then we’re going to be a lot better to keep them in perspective, which is the third: keep it in perspective. Now, how do we do that? I think that takes a lot of practice, and role models and social connections that you can talk to about how to do that. And sometimes it’s also based in your personality of being someone who is more optimistic and keeps a hopeful outlook. But what we’re learning, little by little, about resilience is that optimism can be taught, hope can be encouraged and right now, the many resources are being provided like mindfulness, meditation, exercise, walking by even by yourself in nature, all the things that HCI has been promoting, and that we know are healthy can be ways to help you try to avoid seeing this as insurmountable. Understanding it as just one series of crises or changes in life. And that’s part of living, which has many positives and some negatives, and keep it in perspective. And for younger people, that’s sometimes harder than for older people. Because older people, think about it for a minute. We have World War Two vets, we have people you know, who’ve been through a lot in their lives. And if you’re in fear, or World War Two vets, but we have veterans who’ve been in combat and all kinds of other situations people have faced so that if you’ve had adversities in life, you may already be able to see this as an adversity, but like rather is one that that is part of living and that can be managed, and maybe we’ll and in this case will change.


Dr.  Wendy Slusser  07:45

How do you teach optimism?


Dr. Chris Dunkel Schetter  07:47

That’s a very good question. Optimism and positive expectations go hand in hand. So thinking about expecting some positive things, having positive expectations, for example, that you will be able to take live classes again with professors that you and your friends will be able to socialize, that you as a faculty member will be able to teach in the classroom and get the enjoyment of that that you’ve had. And these sorts of things are ways to think of the positive expectations as well as the negative. Optimists have more meaningful lives. Meaning is something we also know we create through certain interventions like mindfulness. So there are a lot of different aspects to being an optimist, and, and consequences of it that we can cultivate. And there’s even some neuroscience in that area. It’s a very, very good topic. But what we know is that optimists and pessimists see the world differently, interpret events differently. And here are four little tips. I’m not big on little tips right now in the crisis, because it’s just giving people more stuff to be upset about. But a lot of scientific evidence would point to four ways to increase your optimism. Focus attention on the positive things around you. Go outside, I do in the morning and listen to the birds. Appreciate the wonderful family and friends you have that are connecting with you and that you maybe didn’t talk to as often. The second thing is to intentionally think positive thoughts and not dwell on the negative. This is something most people have probably either done well or not done well. And if you don’t do it, well, it’s something that can be treated in therapy. It is something that therapeutic resources may be needed for unhelpful for now in the past or in the future, but intentionally tried to think positive thoughts and not dwell on the negative–that would be a second way. The third is reframing negative and interpreting events in a more positive light. So I’ve already heard friends of mine who are quite resilient people saying, now every day I talk with my family, and I didn’t before this, and it’s so wonderful that we’re more connected. It could be that you have an entirely different kind of life as a student or grad student, one of my grad students might say, being home with my family is great and I’m getting more done on my I research than I would be if I was going to classes on campus. So reframe the negative and interpret events in a positive light. That’s a real hallmark of resilient person. Long, long ago, I did work on cancer. And at that time, Shelly Taylor and Mary Tele from UCLA was a person who studied women with breast cancer and found that the women with breast cancer who did the best were people who found ways to reinterpret the cancer in a positive light. They did exactly the kinds of things I’m talking about. Now they said things like, compared to other people with cancer, I’m so much better off. I feel really fortunate. Even in situations that we often might have thought of as quite dire. And we have lots of great evidence over many years that people can reframe things, and interpret events in a positive light. And that’s again, a hallmark. One of the books on resilience is called “Trauma and Transformation.” Great book by Tedeschi and Calhoun that I’ve used in classes, and transformation is referring to how you can let crises transform you and make your life different in a positive way. And Holocaust survivors. Virtually every group that trends with serious war combat and PTSD experiences, all of the groups we’ve studied, show the ability to reframe, reinterpret, look for benefits, find meaning, the Finally, the fourth way is behave and take action and ways to build positive feelings. So if you’d like to cook, go cook in the kitchen. If you love to walk, use your extra time to do more walking. Those are a few of the ways I’m seeing that people can creatively invent a whole lot more. So focus attention on the positive things around you intentionally think positive thoughts and don’t dwell on the negative, reframe the negative and interpret events in a more positive light and behave and take action in ways that build positive feelings. These are insights from two of the top resilience researchers Steven Southwick, and Dennis Charney, from their book “Resilience, The Signs of Mastering Life’s Greatest Challenges.”


Dr.  Wendy Slusser  12:07

Well, you know, I have to say that those tips are really useful, because right now you can implement them and build your resilience. Because often I think of resilience as something that you build, and then you’re confronted with a challenge, and then you get through it more easily. But in fact, what you’re offering us is something that you can do now, probably in a little bit of a different way, and in a more a simpler way. Because you’re more in your own space, wherever you’re living. So this is really useful. Very!


Dr. Chris Dunkel Schetter  12:43

Well, I think our social connection are opportunities for social connection are different, and sometimes in some ways richer right now. But in addition, I think you were alluding to that this is an opportunity to develop your coping skills to grow in your resilience capacity. Exactly. So many of us might say, we can’t come out of this, or we could hope to come out of this stronger, more resilient with a stronger capacity for the next thing. And there’s evidence of that, too, that people who go through difficulties often become more resilient and more capable for the next things they face in life.


Dr.  Wendy Slusser  13:20

One of the things that you mentioned about this tendency that many might be catastrophizing, right? That people are thinking this is the end of life as we know it and and concerned about the future. It related to that during our life skills course that we teach our students is one of the many sort of cognitive distortions that many of us practice on a regular basis. In our life skills course, we have weekly logs where people will identify behaviors that are related to cognitive distortions, like catastrophizing, or what ifs or should have, or mind reading, like people aren’t responding to my texts, which might be happening more right now. Because people are only communicating electronically. And they might think, Oh, this person doesn’t like me, because they’re not getting back to me in 10 minutes, or whatever it might be. We create a list of these cognitive distortions that people that are commonly practiced by most of us in our lifetime. And then we have a table where they, people can say, so what can you do to make yourself feel better related to that cognitive distortion? So are you suggesting that for this situation, this catastrophizing-like behavior or distortion of thinking of the future, that some of these other resilient tips could help you get through it? Is that partly what you’re saying?


Dr. Chris Dunkel Schetter  14:54

I think that that what you described is of a version of, a portion of, what cognitive behavioral therapy is. It’s identifying cognitions that are not adaptive and trying to examine them, identify them, reframe them. And doing that in a class is a very interesting and good idea. We also have web-based programs that help people with cognitive behavioral therapy techniques like that.


Dr.  Wendy Slusser  15:23

So those resources are available right now and can be used and tapped into by our students and staff. Right? The Grand Challenge.


Dr. Chris Dunkel Schetter  15:34

Yes, I, if I’m not mistaken, available through CAPS to students, and through HR would be connections to the Grand Challenge and to other methods, other methodologies for adult for getting this kind of help.


Dr.  Wendy Slusser  15:48

That’s really helpful. So for those that are listening, practicing some of the resilient steps that Chris has suggested, can you repeat them one more time, so everyone can…


Dr. Chris Dunkel Schetter  16:02

So you asked me about ways to become optimistic, but the ways to build resilience are to make social connections, take care of yourself, cope by avoiding seeing a crisis is insurmountable. Instead, accept that change is part of living and keep things in perspective. I don’t know if I mentioned it. But it is a good idea in this crisis to move toward your goals and take decisive actions that would, in the case we’re going through now, it would be a stay involved in your classes, decisively sign up for office hours, show up for those live classes, do your reading, take decisive actions in the direction of your goals. If you’re looking for the job after you graduate, keep doing it. If you’re looking for a summer job, keep working on it. Don’t give up on that. So goal orientation is real important. Self view is another area look for opportunities for self-discovery and nurture a positive view of yourself. So again, think about, what can I do to learn about myself in this situation? And what can I look at that’s really good about how I’m doing, how am I fortunate? How am I coping well. And then we talked about maintaining a hopeful outlook or optimism.


Dr.  Wendy Slusser  17:16

Incredibly helpful, Chris. So before we end this podcast, I’d love to hear from you. What are you doing to to get through this as a faculty member and leader of one of the Engage Well pod Healthy Campus Initiative, and as a mother


Dr. Chris Dunkel Schetter  17:37

Many things, many things. I’m busier than usual, somehow, when I gave up commuting, I filled every minute of commuting, and I can barely get out to take my daily walk. But some of it is relaxing. It’s not all work.


Dr.  Wendy Slusser  17:50

Fantastic. Well, those are, I think that you know, wearing my pediatric hat, I think that that’s something that parents really have to be cognizant of instituting at home now that there’s no school in session. So I think that for all the parents that might be listening as well, be sure to keep those routines going, because they’re not only important for your physical health, but they’re really comforting for people and make people feel like there’s some normalcy in life. So.


Dr. Chris Dunkel Schetter  18:21

Very good for kids.


Dr.  Wendy Slusser  18:23

Incredibly good for kids, no matter what situation you’re in. Exactly. So thank you again, Chris, you’re just the best. You’ve got so much to contribute. And I look forward to learning more about this, the building of resilience in light of the pandemic but also how we can make sure we nurture our community as we recover from this pandemic as well. Thanks so much.  Thank you for tuning in to “Six Feet Apart,” a special series of the Live Well Podcast. Today’s episode was brought to you by UCLA Semel Healthy Campus Initiative Center. To stay up to date with the rest of the episodes in this special series and to get more information on maintaining your emotional, physical and social well-being during COVID-19. Please visit our website at healthy.ucla.edu/livewellpodcasts. Thank you and stay remote.

Episode 33: How does a University respond to COVID?


Dr.  Wendy Slusser  00:02

On March 10, 2020, UCLA students, staff and faculty received an email stating in-person classes would be suspended the next day in response to the concerning COVID-19 outbreak across the nation. What University administration thought would be a short-term closure, ended up being much longer than anyone would have predicted. To address the ever-changing challenges over the course of the pandemic, UCLA leadership created the COVID-19 Response and Recovery Task Force. Consisting of 12 workgroups, the Task Force focused on a wide range of subjects from the logistics of maintaining research, to supporting the well-being of our Bruin community, to COVID testing. The staff, faculty, and student workgroup members from across the campus and UCLA Health work tirelessly to ensure UCLA continued to meet its mission to educate, research, and provide service to others. Join me today for a special conversation with Co-chairs of the Task Force, Administrative Vice Chancellor Michael Beck and immediate past chair of the Academic Senate, Dr. Michael Meranze. Please keep listening to learn about what happens behind the scenes at a university with over 80,000 community members when faced with a pandemic. Okay, well, Michael and Michael, we call Michael’s sometimes. It’s a pleasure to have you both on our podcast,  and we’re so grateful that you’ve had the time to chat with us about your leadership at the UCLA’s COVID-19 Response and Recovery Task Force. And I’d like to start for listeners to have you explain, firstly, what was the impetus of the COVID-19 Response and Recovery Task Force, and what were both of your roles?


Michael Beck  01:53

I can go ahead and start. The real impetus was to make sure that we had a coordinated effort across the campus to respond to the risks associated with the COVID-19 virus and the corresponding impacts to the campus and provide a way in which we can effectively debate the issues and provide recommendations to mitigate the spread of the virus to the campus community. Ultimately, consider what ways in which the campus needs to be prepared and respond to the changing dynamics of the virus and then incorporate principles of equity, inclusion into the decisions and recommendations that are ultimately made; and ultimately prepare and recognize that it’s a sustained challenge. This crisis was not a week, a day, or a month, but we’re going into the 19th month of the pandemic, and so we need to be preparing for responding to both the short-term realities but also responding to the long-term impacts.


Dr. Michael Meranze  03:04

I would underline, just in support of what Michael was saying, the importance of the sustained nature of the challenge. And when that campus first reduced its physical presence, there was some hope that COVID would simply be a problem for a few months, and that it might be brought under control relatively quickly. But it became apparent in the summer of 2020 that it was a longer haul challenge and that the campus needed to be prepared to respond in a way that allowed people to sustain that challenge without burning themselves out; without, you know, losing contact with what was important; and that the Task Force needed to think, not simply in terms of an emergency response, but in terms of an ongoing response. And the Task Force was set up to help provide recommendations and discussion, keeping in mind that it was a sustained and long-term problem.


Dr.  Wendy Slusser  04:00

So Michael Meranze, you just mentioned a timeline, in terms of when we started shifting from what was apparently, originally an emergency response to more sustained emergency response. This Task Force was started when?


Dr. Michael Meranze  04:14

It took shape in September of 2020. Discussions began in August; there had been a prior Task Force known as the Future Planning Task Force that had focused primarily on preparing the campus for how to handle the fall term of 2020. And originally there were certain expectations. It became clear, as Michael probably remembers, in August when the county numbers and the national numbers of cases began to dramatically increase, that we would be unable to offer as robust an in-person teaching program as we had originally hoped and that there were challenges for research and other areas; and that in light of that rising challenge, we needed to establish mechanisms to guide and recommend action for the campus at least over the next year. And so the task force was established, and alongside the Task Force was established a series of working groups that were more in line with subject expert who would meet and focus on particular problems to make recommendations to the Task Force itself. And then the Task Force could make recommendations to campus leadership, so that there was a wide range of input.


Dr.  Wendy Slusser  05:33

Yeah, so that seemed like where you were really realizing this sustained effort that needed to be elaborated on, like you said, with content experts. And I remember, early on, Vice Chancellor, Michael Beck, you were also, like in January of 2020, you were meeting with some regular content experts more related to, I believe, is more infectious disease, public health – is that correct?


Michael Beck  06:00

Thank you, Wendy. We were actually monitoring the Coronavirus, and as it was developing in China, we were monitoring that. We actually had, in February, the Chancellor’s cabinet actually go through a pandemic tabletop exercise, which was actually centered around COVID, as part of our regular emergency planning but in preparation for, what might have been – what we were contemplating at the time – that might be a pandemic; which, of course, certainly became a pandemic. And so we were working with infectious disease specialists at UCLA Health, in particular, to help us understand how the virus was spreading and what the likelihood of what would happen if it came to the United States and then ultimately to the campus, and what would be some of the implications associated with the environment that we currently know as UCLA. So we were looking at these, and at the very early stages, and as Michael Meranze mentioned, we did anticipate that this was going to be sort of a short-lived emergency; that we would have high case rate, and then it would burn out quickly. That, of course, didn’t materialize, and so we’ve continued to evolve our thinking based on additional information that’s being developed and made available through the medical and scientific community, as well as our own experience, and the way in which cases grow and plateau in the campus environment.


Dr.  Wendy Slusser  07:35

So thinking back then – which is hard with a COVID brain sometimes – but thinking back to the January/February of 2020, Dr. Michael Meranze, you were the head of the Faculty Senate; Michael back is the Vice Chancellor of Administration; and you’re relying on these infectious disease specialists, public health specialists, but you’re also thinking we have over 85,000 people, so you’re also in charge of a mini city, in a lot of ways. And many of those students are living on campus, and of course, most of the workers are either working on campus or on another UCLA property. So when you were thinking of all of that, during the process of this infectious disease discussions, were you also thinking about what might have to happen with those populations if we were to have a pandemic in that life scenario in February?


Michael Beck  08:29

We did. One of the things that we’re looking at is the idea of obviously ramping down and turning remote, which we did in March, but also the reality that a significant portion of our operation can’t be done remotely. And so really trying to make sure that we have to continue to operate, as you said, Wendy, is that we’re a small city. And so cities just don’t roll up the streets because there’s a pandemic and close – and that’s the exact same situation with the University. We have animal research, we have patients in our hospitals and medical centers, we have students that their only home is UCLA; and we have, you know, 419 acres of property and some 30 million square feet of buildings that all have to be maintained and their systems have to continue to operate. And so that is where we spend a lot of our time because it’s – even as difficult as it is, it’s relatively easy to send people home; it’s harder to have people continue to work in an environment where there’s known risks, and you’re trying to mitigate those risks while continuing to operate.


Dr.  Wendy Slusser  09:38

Yeah, I was really impressed, Michael Beck. I remember you talking about how you had PPE masks stored in case of something like this happening is that –


Michael Beck  09:48

Right. So part of our emergency planning for the hospital and for the campus is that we store significant amount of supplies for certain emergencies, and because of the fires that we’ve experienced in the last few years and the corresponding smoke, we’ve actually stockpiled – I don’t remember the exact quantities – but tens of thousands of masks, either N95 masks, which are referred to as respirators, or surgical masks. And then the hospital, because of the nature of their operation stockpiles, is substantially even more. So we did have a very significant inventory, which was very helpful for the campus. So we didn’t have a mask problem when this first came out for our healthcare workers, as other campuses did. UCLA Health actually lent N95’s and surgical masks to other campus medical centers that didn’t have that level of inventory and stock that they could actually utilize when the virus started hitting the campus; and we’re trying to quickly increase all of the hand sanitizer machines all over campus, which of course, we didn’t have; and we’re doing this in the same time that everybody else in the world is trying to do the same thing. Again, it was the fact that we had some supplies in reserve, and the hospital and their organization had substantial supplies of both the equipment, the devices to disperse the materials, the dispensers, as well as the supplies – backup supplies – to be able to refill the equipment, because that was one of the biggest challenges we had. But because of the fact that both the campus and the health system had a system in place to stockpile these type of materials, we were in a much better position than some of the other campuses or worksites.


Dr.  Wendy Slusser  11:47

So what you’re really bringing up, in which I really give my hat’s off to you, is how prepared we were for that, at least, at that stage. And that’s really what, in most emergencies, that’s what’s so important, is to be prepared. And I’m wondering, Dr. Michael Meranze, you were the head of the Faculty Senate – how do you think some of these faculty were prepared, and also how did you manage the pivot, because you were the leader of that group? I’d love to hear.


Dr. Michael Meranze  12:13

Well the Academic Senate is the collective body of faculty at UCLA, and the Academic Senate is its institutional voice – various committees, positions – it has oversight over courses and curriculum, makes recommendations on a whole range of other issues that, I think, the chronology for me was slightly different. Michael is talking about January and February of 2020, and although I was brought into some of those discussions late in February, as the Senate Chair, my role really kicked in in March when the campus had to decide, first, whether it wanted to pivot to remote activity, which was ultimately the Chancellor’s decision, because the Chancellor declares the state of the campus and then how were we going to manage the transition, especially to remote education. And in order to make that possible, the Academic Senate had to move very quickly in order to authorize remote teaching for the time period in order to provide temporary suspensions of various regulations having to do with finals and the shape of finals; and also in order to work with the administration in order to help to get resources to faculty, so that the actual remote teaching could take place; and finally, to determine which courses simply couldn’t be suspended from in-person, but we we did our best to move as many classes as possible to remote. I mean, I think the faculty last spring and across this year did a really fabulous job of responding to the crisis in terms of their willingness to provide courses in a remote setting. I don’t think anyone was fully satisfied with how it turned out. I mean, there were various issues with remote about access, about equity. There are all sorts of issues that come up in the remote environment, but the Senate very quickly moved to authorize the necessary changes to regulations. And the faculty, I think, responded very dramatically and put other things aside in order to enable their students’ education to continue.


Dr.  Wendy Slusser  14:34

So what it sounds like to me is you had some very strong systems in place, in terms of governance in the faculty that were able to be operationalized very quickly during this event in March where we all had to shelter at home, and it worked.


Dr. Michael Meranze  14:50

And the committees and the Legislative Assembly were very responsive and responsible.


Dr.  Wendy Slusser  14:54

Yeah. And you lead that, which is really tremendous. So it sounds like in the spring, and what I’m hearing, and what I experienced, and what you’re describing, and what I remember, too; it was really a well-thought-out, well-systematized – some hiccups, of course – response. And then as we saw that this pandemic was going to be going on for longer, which none of us expected, you’d set up this working group and you led the COVID Response and Recovery Task Force. And I was very grateful that the Wellness and Work Expectation Workgroup is identified as a priority. And I’d like to know, between the two of you, how did you decide which subject matters you thought were important? And that would have been in September of 2020.


Michael Beck  15:42

Right. And ultimately, it evolved, because we started with the different elements of the campus that needed to have a have a focus. And so the different committees included, you know, an Education Committee, which was focusing specifically on how do we deal with courses, and which courses are going to be in-person, which courses are going to be remote – how do you deal with the different elements associated with the delivery of courses in this environment? Then there was another working group associated with really reviewing all the different plans that are being developed, and documentation associated with the protocols, and making sure that those were consistent with all the Cal/OSHA requirements, and university policy, and other governing documents. And then, of course, infection control and our operations team – we have to remember that we have a pre-K through 12 program and two schools on campus – and so we created one specific to that group. Because we – normally when we get in an environment, we’re obviously thinking mostly of the university environment, and so that is very different than having minors at, you know, less than one years old up to 12th grade; their needs are very different than the needs, in some cases, of what the campus community, the University community need. And then public health and compliance – we need to make sure that we were looking at the protocols to be able to ensure that the safety measures and mitigations that were being put in place, there was appropriate compliance associated with that, and appropriate instruction and communication to the community, so that they understood what needed to occur and providing reliability and ensuring that those mitigations are being put in place. And then recognizing the fact that this might create an environment for us to change the way that we see the workplace in the future as it relates to telecommuting. The EVCP, Executive Vice Chancellor and Provost, Carter, created the working group of Reinventing the UCLA Workforce of the Future, and that was set up specifically to look at sort of the longer-term opportunities associated with what we learned during the pandemic. And then research has its own unique environment, particularly laboratory research that in many ways needed to continue, and in some ways ramped up because we were doing COVID research that needed to be done as safely as possible. And then recognizing the fact that we’re still operating a campus with 47,000 students, some still living in Westwood, some on-campus and off-campus housing, and a large number of the students living remotely and still expecting to have some type of student life experience, even if it’s done in a remote environment. There was a Student Life and Housing Working Group established, and then with the vast amount of symptom monitoring and testing, and ultimately vaccinations that we needed to do, we created a working group to deal with that; then there was also the Teaching and Learning Working Group, which continued from March, when we put together that particular group to deal with the sort of the technological and the actual support mechanisms for faculty within the classroom for remote teaching, on how they could have additional tools and resources to be able to pivot from in person to remote; and then, last but not least, Dr. Slusser, was your working group, which was the Wellness and Work Expectations, and Michael Meranze will refer to this a little bit because there was two things: one, we were concerned about the mental well-being of the employees themselves and the students in our environment coping with the pandemic; but also the reality that the employees themselves were being pushed in different ways in which they had been pushed before. Many of them are working remotely – less separation between their work life and their home life, and in fact, with their computers in their bedrooms and kitchens and family rooms, it had the opportunity to interfere with their personal life in a way that hadn’t happened in the past. And there was concerns that employees would overwork themselves because they were so motivated to keep the University running and keep moving forward; and faculty trying to teach in modality that they’re not familiar with, and trying to manage their course in a remote environment, when probably their entire career was based in-person; and so those issues and concerns were put into that working group to make sure that we were putting together practices and workshops and things that would support the mental well-being and help managers understand the expectations that a pandemic brought to the equation created additional stressors in individuals’ lives, and how we could create spaces like encouraging people to, you know, take walks around the block, at the end of their normal day when they would normally get out and get in their car or a van pool and drive home and create that disconnect. You’re not – you don’t have that same disconnect when you’re at home. And so the idea is, again, that you’ve got to create a way of separation. And so this idea of including some type of physical activity associated with the transition can be supportive. So, anyway, I went on way too long, and I’ll let Professor Meranze add where I’ve left out or abbreviate it in a better way.

Dr. Michael Meranze  21:34


And what I would say – we try to identify areas of focus and problems. And I think, in part, what we were trying to avoid was things being done simply by inertia. You know, universities are spaces for inquiry, and we wanted as best as we could to create these working groups that could take up problems that were being posed and actually think them through, rather than simply going on as things have been done or simply adding onto things that had been done. And so, you know, we tried to include administration, staff, students, and faculty in these working groups. And we tried to have them recognize that the pandemic posed a lot of additional challenges that could not simply be added on to the normal way of doing things; under these conditions, needed to be perhaps modified or rethought in some way. So we can see these working groups as places to think through the problems that different areas of the campus would face under the strain of a pandemic. And Michael and I basically, along with the Executive Vice Chancellor and Provost, discussed and then came up with a series of areas that initially we thought were the most likely to be pressing, and then as he says, there are some that emerged across the year.


Dr.  Wendy Slusser  23:01

It’s really great to hear the thoughts behind the decisions, because we are a university and that pursuing inquiry and really thinking deeply is part of our mission. And so this focus on different topic areas and finding a diverse group of people to contribute was tremendous. And I have to say, I asked across the UC’s about the particular working group that I ran, the Wellness and Work Expectation Group, to see if other UC’s had done that and they hadn’t. So it’s another, I think, really strong – it shows how strong your leaderships has been in terms of thinking holistically about this effort. Most of these working groups have wound down, and I’d love to hear from your point of view – what are your lessons learned from this period of time working on this challenge?


Dr. Michael Meranze  23:53

You know, I think that, you know, the successes of the Task Force in the process came about because of treating them as a shared endeavor between different parts of the University and trying to bring together a range of perspectives. You know, I do think that within the UC system, this was a fairly unique exercise. I don’t think there’s an equivalent structure that was set up on any of the other campuses. And I thought that there were always stresses and strains, and there are people that weren’t happy with various decisions, and I’m sure Michael and I can think of things that we would do differently; but, you know, I think the lesson that’s learned by this is that if you are faced with a challenge like this, you need to confront it in as open and thoughtful and inquiry-driven ways.


Michael Beck  24:50

Yeah, I would say that the lesson learned or reinforced through this is that you can’t be overprepared, and that we also need to rely on the individuals that have expertise in specific areas. The nature, certainly from my position, is that we’re dealing with crises that need immediate decisions. And I’ve unfortunately, or fortunately, dealt with a number of crises in my career, and so I feel very comfortable making immediate decisions. And this was a really good example of, as Professor Meranze described, as this was really a shared governance approach, right? I mean, this was not the Administrative Vice Chancellor making decisions on behalf of the campus without input from a significant number of people, and it wasn’t me making decisions or recommendations. There were literally 100+ people engaged in this process, across the campus. And, you know, I appreciate that the attention is on, you know, Professor Meranze and myself, today; but we didn’t do the bulk of the work. The bulk of the work was done by, you know, the people, Dr. Slusser, and others that were on these committees, and there were some really amazing superstars that really stepped up to the plate, which we could not have gotten through the pandemic without them. And so, I think, you know, we need to recognize the fact that the campus came together to work through and have the campus get through the pandemic in a way in which I think the campus should be proud – doesn’t mean it was perfect. But I think we did very well as a campus because we came and addressed this from a campus perspective.


Dr. Michael Meranze  26:37

To follow up on that, I mean, I completely agree with that. And, you know, Michael and I have talked about this; not just in this context but in others. You know, we have a university that is filled with enormous numbers of very knowledgeable and thoughtful people; and the more that the campus is able to draw on them and listen to them and mobilize them for common problem solving, the better I think the campus will be. And I think UCLA, given that it’s in L.A., faced some problems that some of the other campuses didn’t face but had a very wide range of people, faculty, staff, and students who brought deep knowledge – sometimes of their local circumstances, sometimes from below, sometimes a perspective from dealing with, you know, large issues around Cal/ OSHA that made all this possible. And going forward, I think the campus will be best as it draws on that reservoir and builds on these sorts of endeavors.


Dr.  Wendy Slusser  27:37

Yeah, I think, you know, Dr. Meranze and Vice Chancellor Beck, you’re both really putting a finger on something that I’ve observed, as well – is actually, this pandemic, I think, brought our community even more together and more cohesive, and some people in the past have told me it’s like a treasure hunt at UCLA. You keep discovering these incredibly talented, thoughtful, deep thinkers – whether they’re the students, staff, or faculty – and I feel that this pandemic has just created that kind of setting where we’ve even been able to mobilize them, like Dr. Meranze is describing, which is tremendous. And a culture of shared governance and a culture of openness has to be coming from the top, and that is no question. So to wrap up, I’d like to ask you a couple of questions. One is, now that vaccination rates are rising, and we’re really now in more of a recovery mode, I’d like to know what your thoughts are in terms of what you’re looking forward to? And what experiences have you garnered now – which I hear, you know, I heard one, which is hoping that we continue this collaborative, shared governance kind of approach to solving problems – but what other things would you like to move forward on? And also, what are you concerned about as we recover or reopen?


Dr. Michael Meranze  28:58

I think we’re both concerned about the Delta variant.


Dr.  Wendy Slusser  29:01



Dr. Michael Meranze  29:01

You know, I mean, I think – not to end this in a downer-sort-of way – I think had we done this podcast two weeks ago, Michael and I would probably have a somewhat different perspective than we do now. And, you know, we are concerned about the spread and the cases in L.A. County, the slowing down of vaccinations in the country – how that actually will play out on campus remains to be seen. You know, we’ve turned a lot of corners, but I’m not sure we’re at the end line yet. As a matter of fact, I’m sure we’re not at the end line.


Dr.  Wendy Slusser  29:37

Michael Beck, do you have any?


Michael Beck  29:39

Yeah, I mean, Michael described it well. You know, we still have a fair number of challenges ahead of us. And, you know, I’m confident we’ll get through it, but I also recognize the fact that, you know, the entire organization is tired. And so you say, “what do you look forward to the most?” was actually the end of the pandemic, and I think everybody is still looking forward to that. And I’m hopeful that it’ll come sooner than later, and we can focus. You know, so much of the energy that’s put into responding to and preparing for the different phases of the pandemic is taking away so many resources from the focus of the campus and the other important issues that the campus is facing and needs to prepare for, for the future, to ensure that we continue to be the number one public university in the country. And so I look forward to the opportunity for us to be able to dedicate more time to those other issues. And as Professor Meranze articulated, I think we have learned that, as an organization, we have more in common than we have differences between the faculty and the administration and the students. And so I think we have really great opportunities to solve some very difficult challenges that are not unique to UCLA – they’re societal challenges, in particular. And I look forward to when we can really put the energy behind being able to help resolve those and build our campus community in a very thoughtful way.


Dr.  Wendy Slusser  31:18

That’s a hopeful ending to a vision, which I agree with. I can see us heading in that direction, and I think that we have some building blocks from this experience, as well as our overall culture, which is one to strive and thrive and dedicate to knowledge building and learning and working hard and contributing to our world, right, to be a better world. So I’m thinking I’d like to end this with a thought: what keeps you both up at night?


Michael Beck  31:50

I mean, certainly, what’s keeping me up is: what’s next, and what are we forgetting? There’s so much to do, throughout this entire process, that there’s always the fear that somehow we’re missing something – and we’re going to miss and make something worse because we forgot to do something, or prepare something, or something won’t be ready when we need it to be. And that’s just a continual challenge because there’s no instruction book for this pandemic, even though we have a pandemic emergency plan, and we pulled that out and looked at it. It’s very different to have a plan on paper and actually prolonged, you know, year and a half – will probably be two years by the time this is really behind us – and those are very different than a tabletop exercise that takes a half a day. So those are the things that keep me up and really just constantly worrying about the safety of our community.


Dr.  Wendy Slusser  32:51

Is there anything that you think of that’s good, that you can take with you, that we’ve learned so far?


Michael Beck  32:57

I think there’s a lot that we’ve learned and a lot of really positives. And like I said, I mean, there’s really been some amazing employees, some faculties, staff, and even students who have really risen to the occasion and been heroic behind the scenes where the campus community will never know, right? But they have really enabled us to move forward and undertake the right efforts on the campus and bring people together and avoid having a stumble. And that’s, you know, that’s just been remarkable. And you mentioned earlier, the reality that there might be some changes in the way in which we work and be able to create an environment for a new set of employees and reducing the amount of time people commute for some of our workforce. And even that’ll help reduce the commute for some of our workforce that has to come to campus. So I think there’s still some really wonderful things that come out of this. I’d still like to hear what keeps Michael up at night.


Dr.  Wendy Slusser  34:02

So that’s – we’ll end there, then. Michael, Dr. Michael Meranze, what keeps you up at night, and what good can we take from this?


Dr. Michael Meranze  34:09

Well, I think, you know, what keeps me up at night – besides my dog – is, as Michael says, I mean, we’re mostly out of this, but we’re not completely out of it. And we’ve already asked a tremendous amount from everybody in the campus community. And so, we now are asking people to return and to figure out how to re-engage with the campus, at a point when the overall public health situation is fluid. So I think that there continues to be a good deal of uncertainty, and I worry about the demands that will be placed on students, faculty, and staff as they return, having had an exhausting, extraordinarily bizarre year, and to a situation where people are going to have to, in certain ways, relearn what at residential experience is like. And I just agree with Michael that there’s still a lot of challenges, and it’s hard to know for sure everything that you need to be prepared for. I think that we’ve learned a lot through the pandemic. It’s highlighted both strengths and weaknesses, both at UCLA and certainly highlighted many weaknesses in society at large; and I think that those are the things that we should take with us moving forward to try to fit.


Dr.  Wendy Slusser  35:32

Well, on my part, I’m so grateful that, Dr. Meranze and Vice Chancellor Beck, you were leading us in this charge. And having you thinking through things, some of which we don’t even know what to expect in the future, but knowing that you’re thinking about it constantly – not that it’s a great thing, you need to also unplug yourselves – makes me really proud to be working at UCLA, to have two people like you, collectively, leading us through this really challenging time. So, thank you both so much for your time. I know it’s valuable.


Michael Beck  36:05

One thing, very quickly, because we sort of didn’t get into it – and Wendy that’s part of the organization that you’re part of, which is UCLA Health – and what an amazing and remarkable job that they did – you and your colleague did – during this period and continue to do. And when we talk about the campus, we can’t forget about the role that, particularly, the clinical operations have provided during this period. And it has been amazing to watch them continue in the eye of the storm for such a prolonged period of time. And I’m just immensely proud of that group and just grateful that they’re here. And I know that the campus – the health and safety of our campus community is better because of you and all your colleagues that have been focusing on the health of our community, in that way. So I do think it was important to sort of make that particular shoutout. So, thank you.


Dr.  Wendy Slusser  37:02

Thank you for making that point. And when you were talking about the connectivity of our whole campus, I was in my head thinking exactly that – how much we are working together – the health system and the campus community. So, thanks for bringing that up. Well, thank you both and really appreciate it, and I hope you get a little bit of rest and relaxation, if there is such a thing this summer. Thank you, again, for joining us. For more information about today’s episode, visit our website at healthy.ucla.edu/livewellpodcasts. Today’s podcast was brought to you by the Semel Healthy Campus Initiative Center at UCLA. To stay up to date with our episodes, subscribe to UCLA LiveWell on Apple podcasts, Spotify, or wherever you listen to podcasts. Leave us a rating to tell us how we’re doing, and if you think you know the perfect person for us to interview next, please tweet your idea to us @HealthyUCLA. Have a wonderful rest of your day, and we hope you join us for our next episode as we explore new perspectives on health and well-being.

Episode 27: Part 2: Feeding our Planet Sustainably and Equitably


Dr.  Wendy Slusser  00:03

What is the food print? And how does our diet impact our planet? In this second part of a two-part episode, UCLA Public Health doctoral student Hannah Malan shares her current research involving sustainable diets and Impossible meat. Keep listening to learn about how we can feed our planet sustainably and equitably. And how UCLA students reacted to Impossible meat. And what does nudge theory have to do with it? Okay, so explain to me and the audience, your project, your PhD.


Dr. Hannah Malan  00:41

Sure. Okay, this is fun. So I guess I’ll go back a little bit and talk first about how I was even exposed to the topic I’m working on, which is thinking about our food print. So in 2016, for Food Day, when I was working with Semel Healthy Campus Initiative, again, this is you know, working, collaborating with folks who are already doing things and expanding that work. But Professor Amy Rowat, who co-leads the Eat Well pod and Professor Jenny Jay, were talking about this idea of a food print. And when I say that I’m referring to the carbon footprint of food, that’s how we’re using the term. And so the carbon footprint of food includes everything in the life cycle of producing that food. So this includes the growing, harvesting, processing, and distributing of food all around the world. And so each step involves using resources and emitting greenhouse gases. So the carbon footprint of food. People often think of transportation and packaging as a big part of it but a large share actually comes in changes in land use. So cutting down natural ecosystems, forests, which are natural carbon sinks, and replacing that with often livestock, which are producing large amounts of greenhouse gases. So cows, I think many of us know now, produce methane, mostly through their burps.


Dr.  Wendy Slusser  00:48

And people think it’s the other end, right?


Dr. Hannah Malan  02:12

That, too, is part of it. Yeah, but…


Dr.  Wendy Slusser  02:15

The burps are more.


Dr. Hannah Malan  02:16

The burps are more. So the growing of the livestock, too, when they’re alive. But animal foods in general tend to have higher carbon footprints than plant-based foods, not just because of the emissions they produce by burping or other things, but also when you think about the feed efficiency conversion. So if you grow food and eat it directly, it’s a lot less resource intensive than growing food to feed animals. So that step in the process right there, compounds the environmental effects. The evidence demonstrates very clearly that plant-based foods have a much lower carbon footprint than animal based foods.


Dr.  Wendy Slusser  02:56

Yeah, I mean, I was reminiscing with you earlier, about 12 bushels of grain is equivalent to one pound of red meat.


Dr. Hannah Malan  03:04



Dr.  Wendy Slusser  03:04

I’m sure that equates, I learned that in college 40 years ago.


Dr. Hannah Malan  03:08

Right, and the data just keep getting more accurate and better. So if we think about moving a little bit down the food chain, a serving of beef has about five times the carbon footprint as the serving of chicken. But a serving of beef has 34 times the carbon footprint as a serving of beans or lentils.


Dr.  Wendy Slusser  03:27

Geez, that’s incredible.


Dr. Hannah Malan  03:29

Yeah, it really makes you think.


Dr.  Wendy Slusser  03:30

And also we know distribution is an issue, but just in terms of the impact on, the stress to the planet.


Dr. Hannah Malan  03:38

To the planet. Yeah, I mean, for me, learning about lifecycle analyses of food, and really quantifying environmental impacts this way has actually been really eye opening and empowering because it really reveals that you don’t have to participate in this elite food economy to make a difference. You don’t have to be shopping at Whole Foods and buying specialty green juices and you know, all organic and pasture-raised and all of that to make an impact. The data really demonstrate that the ingredients you choose matter more than the production techniques. So there are many other reasons to buy organic, buy local, to support your local economy and farmers, and support a food system or practices that you support. But if you think about it on the large scale and you really choose to shop and eat by the numbers, ingredients are the most important things you can do.


Dr.  Wendy Slusser  04:38

You mean by ingredients, meaning choosing the red meat versus the chicken or the beans.


Dr. Hannah Malan  04:44

Exactly, so whether you’re eating at McDonald’s on campus or preparing your food at home, choosing a lower impact option like a fish fillet or a chicken over a beef, choosing to do a bean burrito with veggies rather than a beef burrito. That makes a huge impact and a greater impact than choosing organic or something like that. So a planetary health diet is quite accessible in that way.


Dr.  Wendy Slusser  05:14

As a communicator, you know, educated by that wonderful institution, UC Santa Barbara, and your research in the focus groups of people wanting to see infographics, you developed something, right, that could help tell people this.


Dr. Hannah Malan  05:31

So another part of the qualitative research, an outcome of that was understanding how students learn. And we know at a place like UC Santa Barbara, too, but UCLA students have amazing access to academic courses. But two things that really emerged for me regarding food literacy were this experiential learning in the dining halls. So the food environment as a learning tool, and also using visuals, infographics, and really comparative information to help students understand the relative impacts of what they’re doing. So what we’re doing in my PhD work is informed by science that helps us understand how to capture people’s attention, how to translate information in a way that is intuitive and makes sense to people. So sort of two fields of research that I’ve been drawing upon are social marketing and nudge theory. So social marketing is really this theory of traditional marketing, but marketing socially beneficial behaviors and products, but connecting behaviors with desirable outcomes or things that people want. So if you think about Coca-Cola, they’re selling the idea of happiness or engagement. They’re not selling the idea of a product, maybe sometimes they are, but it’s more than that. So this exchange theory, which is often how we explain what’s happening, is we’re aligning a product or a behavior with an outcome that people want. So for my dissertation work, rather than discussing health or some other outcome like that, we’re really aligning the behavior change with fighting climate change. So we know that something that’s important to students, and this is important, I think, for public health practitioners to keep in mind is that not everybody makes decisions based on health. And I think when you work in public health for a while, you kind of forget that it’s not people’s priority. And so this culture of health becomes especially important, but also aligning healthy behaviors with outcomes that are aspirational, and are attractive to people. So for students, climate change is an issue that’s top of mind. It’s very timely, it’s important, feels good to participate in, not the changing of the climate but the mitigation of climate change. So we identified that as something to align our campaign with. At the same time using the principles, as I mentioned, from nudge theory, which is all about structuring choices in a way that makes the healthy choice the easy choice, or facilitates a socially desirable outcome. So this can be making a menu item stand out more on a menu, or using intuitive stoplight colors to help people understand the relative impacts of things rather than giving numbers. So we wouldn’t put calories on a menu because, and the evidence supports this too, people don’t really have a good sense of what that means. People aren’t paying attention to that type of thing. Only the nutrition elite, so folks who are highly educated and concerned about their weight, are likely to interpret those in a productive way. So it’s really thinking about how do we communicate ideas in a way that can capture people’s attention that can not require or put too much burden on them to process the message. So again, it’s making the healthy choice the easy choice. We’re exposed to so many messages and so much information. So thinking about how to present options or information in ways that that resonate, or that stick with people beyond that moment.


Dr.  Wendy Slusser  09:16

And then also on our campus, we don’t want to put calories up because we don’t want to, you know, focus on weight or stigma.


Dr. Hannah Malan  09:23

Right, absolutely. Yeah, I think that’s a big one and something I feel strongly about in my work too, is that it’s not about weight. It’s not about appearance, it’s about eating in a way that fuels your body for health and well-being in the long term, and eating in a way that supports the planet, that is enjoyable for you, that makes you feel good about what you’re doing, that you can optimize your life as a student, all of those things.


Dr.  Wendy Slusser  09:51

You have a great logo, what’s the logo that you used for your promotion?


Dr. Hannah Malan  09:54

So our slogan is “swap the meat, save the planet.” Yeah. So we’re really focusing on on the positive outcomes of behavior and not taking any options away. The project with Dining that I’m studying for my dissertation is introducing the new Impossible plant-based meat at one of their most popular to-go restaurants on the Hill. So the location was chosen based on its popularity with students. Students love this location and the quantity of meat that they sell. So they serve high amount of red meat, large quantities, I mean UCLA Dining does 6 million meals a year, and so this restaurant alone is doing hundreds of thousands of covers a year. And meat was the majority of entrees they were selling, with beef making up about 30% of the items, so it was a huge target and a really ambitious project to try to see what could we introduce to move the needle, as they like to say. So I think many folks have heard about Impossible meat but it’s a plant-based meat alternative. It’s scientifically engineered to taste like meat, to mimic the texture and some of those sensory qualities that people love about meat, the way it cooks and sizzles, it has heme iron in it which is intended to give it that meaty flavor, and it’s intended to be satisfying like meat. So in many ways to give people the experience of eating meat that we’ve come to know and love in American culture, so really a product that can help this shift towards lower meat diets. So in addition to introducing this product, we ran the social marketing campaign which was all framed around climate change, the “swap the meat, save the planet,” and some of these educational materials that are informed by the nudge techniques I mentioned, so providing students with intuitive stoplight-colored graphs that show the relative impacts of foods using icons.


Dr.  Wendy Slusser  12:05

On health, or I mean rather, on planet health.


Dr. Hannah Malan  12:08

On carbon footprint, yeah. So everything was about climate change and the carbon footprint of different foods.


Dr.  Wendy Slusser  12:15

And so tell us what you’re finding.


Dr. Hannah Malan  12:17

Sure, so this has been such an exciting project because it’s such a new area of research. And we keep hearing that these products are so popular and people love them and I really commend Impossible for their mission and to introduce a product that can compete with beef but the results are a little bit more nuanced than that. So the most surprising result that we saw was while animal based protein consumption did decrease, we also saw that Impossible cannibalized some of the other vegetarian options. So this is great for a company like Impossible, but we need to look a little bit more closely what that means for nutrition and health, and what that means for overall reductions in animal-based protein and carbon footprint. So unfortunately what it’s looking like at this point, just looking at comparisons from this fall to last fall, so this fall when we introduced the product compared to last fall, we saw that beef consumption only decreased about 2%. So it’s a small percentage but on scale it amounts to a large number of portions of beef so I’ll be crunching those numbers to calculate the carbon footprint savings. What surprised me and I think surprised the dining directors was that we saw more of a decrease in the medium-impact category foods, so poultry and cheese and pork, rather than in the highest-impact category which was beef. So while we did see increases overall in low carbon footprint items, which included Impossible, we didn’t see beef decrease as much as I had hoped. And then again, these shifts from folks who are choosing other vegetarian options to choosing Impossible, to me that’s an unintended consequence and something that we need to look at more closely and discuss.


Dr.  Wendy Slusser  14:17

And see whether was that consistent or was it just one time. Did the vegetarians continue to go back to Impossible, or were they just trying it because it’s a novelty?


Dr. Hannah Malan  14:26

Well, this is looking at data from the entire quarter. And this is looking at proportions of meals sold over the entire quarter so I was anticipating that, that maybe in the first few weeks we saw a lot of students come over and try it and then it dropped off. But it looked like Impossible actually continued to gain popularity throughout the quarter, so part of what I’m thinking is that students who maybe weren’t eating at this restaurant before started coming there because we saw an increase in covers as well.


Dr.  Wendy Slusser  15:02

Oh, you did.


Dr. Hannah Malan  15:02

So we have to look more closely at all the dynamics because there are more students living on the Hill this year than there were last year. And this is also a challenge of doing food environment research, is you have to think, did the clientele change? Or did the people who were eating here change their behavior? And that’s a really challenging question to understand. Because if we’re just having people come eat this food, who would have been eating vegetarian elsewhere, we’re not really having the intended impact. So folks who were eating beef are still eating beef, but other new people are coming to eat Impossible. We’re not really meeting the mission. But as I said, we did see decreases overall in animal-based protein, so about a 7% drop in animal-based protein sales, which at scale is huge.  That is huge.  That’s huge, yeah.


Dr.  Wendy Slusser  15:55

And what you’ve taught me about vegetarianism is that the cheese is a big impact on the environment.


Dr. Hannah Malan  16:02

Yeah, sorry to be a Debbie Downer on this one to all the cheese lovers out here, including myself, but it’s one of the shocking things to see is, yeah, so cheese has a higher carbon footprint than chicken. But that’s looking at it by weight. So you wouldn’t usually eat a 4-ounce serving of cheese. We found that actually, on the Hill, quite a few items do, like quesadillas, personal pizzas. So those very cheesy items can have up to 4 ounces of cheese. But again, and I think this is important for us to think about in general and I really want to emphasize this message, is that eating a planetary health diet doesn’t mean you have to become vegan. It doesn’t mean that you have to cut out all the food you love. And I think this moderation is important and conscious awareness is important. And just simply by reducing the frequency and the quantity of high-impact foods really makes a difference and the data support that that’s a viable strategy for staying within our planetary boundaries as well.


Dr.  Wendy Slusser  17:11

Yeah, I mean, I heard like if we all kicked out one serving a week, in the United States, of high-impact foods, which means red meat, like hamburgers and lamb, right? Just once a week, if you ate one less serving a week, we would meet the Paris agreement by 30%?


Dr. Hannah Malan  17:32

Yeah, we would get 30% of the way there. So just reducing one serving a week, that’s awesome.


Dr.  Wendy Slusser  17:39

And the average consumption in the United States currently is six times a week. That’s what I’ve heard.


Dr. Hannah Malan  17:45

Yeah, yeah. So it’s about 2.7 ounces a day, which is a little less than a serving. So that makes sense. Yeah, and just when we’re talking about reducing, I think it’s important to remember when you’re creating your meal that most Americans are eating far more protein than we need to be eating. So when you’re creating a meal, of course, you want to get enough protein to meet your needs and to help you feel full. But that doesn’t need to be your main goal every time you’re creating a plate. Most foods have protein in them. So even a bowl of oatmeal is going to give you protein. And throughout the day, if you’re eating a lunch of vegetables and grains, that’s going to be satisfying to tie you over.


Dr.  Wendy Slusser  18:29

So what I’m hearing you say, Hannah, is that we can reassure people that generally in the United States, our protein intake is actually well over the recommended daily recommendation. And that by having a planetary health diet, which would include no more than one serving, 4-ounces of a red meat, bovine meat, which is a cow meat or lamb meat, that you could spread over the week if you want, but no more than that a week. And then having protein in your diet every day is recommended. But it can come from plant-based proteins, like lentils, black beans, and that other animal-based proteins don’t have to be eaten every day to get your recommended daily amount of protein.


Dr. Hannah Malan  19:20

Right. And if you think about it on a population level, I mean, there are entire cultures of vegetarian eaters who consume no animal meat. And if we look at dietary patterns and health outcomes over time, vegetarians tend to do better than folks who eat a more Western diet. And pescatarian diet tends to be the most helpful for long-term health outcomes. Which is eating fish and plants. So small amounts of meat, in general we can say, and this is on a population level, it’s not to give individual advice about what to eat, but especially among Americans, we are eating too much protein. And so reducing protein overall, and eating more fresh fruits and vegetables and whole grains is a great way to improve your health and make a positive impact on the planet. I feel really, really optimistic for my generation. I mean, I think there’s so much more that we could be doing right now on a policy level. We have so many policy tools in our toolkit to be changing the incentives and the political will just doesn’t seem to be there. But I think it will be. I think our generation is really waking up to these issues. And that’s why I think communication is an important part of it at this point. Where we are in this transition is changing the culture around eating meat, and a university is a great place to start. So I feel really proud of UCLA for being at the forefront of that and for our Dining folks to be interested, as I said, in not only trying this but learning what happens when we do it too, being open and transparent with their data and sharing that with others. So I think this is how we all move forward, is trying new things, seeing what works. As I mentioned, I think Silicon Valley is amazing at coming up with quick solutions and being innovative and creating technologies that solve problems, but we do have to be honest about unintended consequences. And, you know, my dad used a phrase recently that really resonated with me, which is regretable substitution. And I’ve been thinking about that a lot with plant-based meat. And, you know, we don’t want to be creating new problems while we’re solving others.


Dr.  Wendy Slusser  21:43

Right. I mean, there’s that real challenge that you discovered as you were doing your plan with the Impossible Burger’s health versus planet health, individual health versus planet.


Dr. Hannah Malan  21:57

Absolutely. So Impossible meat is an ultra-processed product. It’s high in sodium and saturated fat. It has heme iron, which has some questionable linkage to colon cancer, and which regular meat has as well. So yeah, it’s possible that heme iron is one of the mechanisms by which red meat is detrimental to health. So there are still many questions about why red meat is associated with increased risk of diabetes and heart disease, and colon cancer, as I mentioned. We know over long-term studies that we see those patterns. But yeah, with Impossible meat, it’s hard to know right now. Like when my friends ask me, well, is eating Impossible meat better than eating red meat? And I say for your health, we don’t know. For the planet, absolutely. And so it’s been really valuable for me to work with the dietician on campus as we’re rolling all of this out, and to also be transparent about that as well. So all the nutrition facts for UCLA’s recipes are available online for students to see. This product is not being promoted as a healthy option. And we still have more questions than answers about the health implications of eating products like this. So, one of my hopes is that this research encourages others to do more studies, controlled feeding studies, or more long-term studies about the implications of eating processed meat alternatives.


Dr.  Wendy Slusser  23:34

Yeah. And one of the things that struck me when you described your study, that you said also is in the literature about how health messaging actually makes people find food not as tasty?


Dr. Hannah Malan  23:50

Yeah, so this is a really interesting field of research. Folks at Stanford and involved in the Menus of Change research group have have done quite a bit of work on this and I’m doing another experiment right now that’s finding similar results. But the way we describe food influences how people perceive it, how they anticipate their enjoyment of the food, whether they choose it, and how much they enjoy it. So it’s important and it’s looking like introducing the word “healthy” into the equation may reduce people’s enjoyment of the food and make them less likely to choose it. So health can have a negative connotation even though most people will tell you, eating healthy is important to me, I’m trying to eat healthfully. There are so many different priorities and values or so many different goals, I guess, we’re managing when we make a food choice, right? Especially for students. Is this gonna fill me up? Is going to get me through the next six hours of my day, or maybe the rest of the day if I can’t afford to eat another meal? Is this is going to be tasty? Is this going to nourish me and make me, you know, do well in class? Is this going to be something that is going to make me feel good? So we’re all doing, you know, every time we make food decisions, even though it’s a habitual behavior that we do multiple times a day, we’re managing these various goals. So health is one part of it, but can easily be trumped by other goals. We tend to prioritize short-term goals over long-term goals, right? So, often people will think of health as a sort of delayed goal or long-term goal, especially for young people. So emphasizing things like feeling good, or having a positive impact on something like the environment, which is quantifiable or immediate. Those things can be more impactful. So, yeah, I guess a message about messaging would be, don’t emphasize the healthiness of the food, emphasize other attractive attributes, which can include things like environmental benefit, which what I have seen does not detract from people’s enjoyment of food, and may actually bolster it.


Dr.  Wendy Slusser  26:10

It was really interesting, because what you’re describing, the word health in general is so interpreted by the individual. And I’m thinking, you know, our transportation director, as you know, Rene Fortier has used what she refers to as the health message, but it’s not really the health message. She refers to the fact that she was able to reduce single-occupancy car driving to the campus, commuting, significantly by sending out the message that you’ll lose 10 pounds in a year if you switch to active transport. Now, she didn’t say you’d be healthier, she said you’d lose. There was like a direct impact, sort of similar to what you’re describing about the planet health. So you’re driving people to health, like being more alert, but you’re not saying you’re healthier, but you’re going to be more alert, which is healthier. Yeah. That’s the outcome of good health.


Dr. Hannah Malan  27:05

Right, absolutely. I think short-term benefits are really important to communicate. Aspirational desires are important to communicate. Quantifiable outcomes, like you mentioned, with the 10 pounds, or an environmental impact is quantifiable. So we’re able to show the reduction in carbon footprint in that swap, right, a reduced relative risk of X percent over 20 years, you know, of heart disease is really hard to communicate to someone.


Dr.  Wendy Slusser  27:36

So abstract. Yeah.


Dr. Hannah Malan  27:36

So I think as communicators, we need to keep these things in mind and keep learning from the marketers who have been really good at selling stuff for a long time.


Dr.  Wendy Slusser  27:47

That’s for sure. Well that’s what you’ve done. You’re merging public health with one of your advisors from the Anderson School of Business here at UCLA. So you’re combining the two sciences, really.


Dr. Hannah Malan  28:00

Right. And I love working with her, because we think about food in such a different way, we think about human behavior in such a different way. And I think she’s a good reality check for me, too, when I’m imagining that everyone’s going through their day, you know, making food decisions a certain way. So again, that’s a good example of food being this topic that is so interdisciplinary and brings people together.


Dr.  Wendy Slusser  28:26

So you know, you started out this conversation describing how you really were raised defining your success by helping others. And so far already with your research with the focus groups you have by identifying a priority of our student body here at UCLA. And now we have a teaching kitchen. And that should make you feel good. It makes me feel good knowing that that happened. And I’m thinking that some of the pearls of of what an individual can do to help planet health and at the same time, your own personal health, were some of the following that I picked up from you, was 1) you don’t have to completely go vegetarian or vegan, you can just minimize your bovine meat-eating which would be red meat and lamb, I guess.


Dr. Hannah Malan  29:18

Yeah, ruminant meat. So, beef and lamb. And not only reducing that but really making an effort to replace that with nutritious whole foods. So plant-based proteins are a great way to do that, so lentils or black beans. Get creative with beans is an awesome way to do it. I mean, even doing a peanut butter and jelly sandwich is a really inexpensive and great way to eat a low carbon footprint meal. Rice and beans with guacamole, getting creative with veggie tacos and beans or lentils.


Dr.  Wendy Slusser  29:53

And your goal will be one a week of the red meat, if that.


Dr. Hannah Malan  30:00

If you can get to one serving a week of red meat, you are golden.


Dr.  Wendy Slusser  30:04

That will help all of us.


Dr. Hannah Malan  30:05

That will help all of us. And really, you’ll participate in this transition, which is not just changing your own behavior. But we have to remember that in capitalism, when you buy something, you’re voting. So you’re voting with your fork, you’re signaling to food companies what you want. And that’s really, really powerful. You need to vote on Election Day, always. But you have a lot of power as a consumer. And I hope that’s something that students realize, that Dining responds to what they want and what they’re choosing. And this will continue throughout your life as a consumer.


Dr.  Wendy Slusser  30:41

That’s very good advice for everyone. And one other piece, which you mentioned, the Menus for Change Research Collaborative that looked into, for instance, a burger being mixed with mushrooms. So perhaps even for those that really want to have two meals a week have some sort of burger-tasting meal, could just mix half their portion of burger one day with some mushroom and the other…?


Dr. Hannah Malan  31:09

I love this. You can, seriously, there are so many ways to do this. When I say eat it once a week, this is your 4-ounce portion that you get. So split that over four days and have a small amount mixed into a stir fry or, you know, blend the meat with something else. Yeah, find at UCLA, you can get the blended burger, which is beef blended with vegetables, to reduce the portion size. So we when we talk about how much you’re eating, it’s not only frequency, but it’s portion size. So, yeah, I think that’s another great way to think about it, is cutting your portion and having it twice a week instead of once.


Dr.  Wendy Slusser  31:50

Right. And that’s sort of the flip.


Dr. Hannah Malan  31:53

That’s the protein flip. Yeah, use meat as a condiment and a flavoring agent.


Dr.  Wendy Slusser  31:58

And we’re talking red meat, right? So people can still have their chicken and others. So practically speaking, 4 ounces of red meat a week is really what your aspirational goal should be if you want to really make a difference on Planet Earth and also for your own personal health.


Dr. Hannah Malan  32:19



Dr.  Wendy Slusser  32:20

So, thank you so much. Is there anything else you’d like to add before we wrap this up?


Dr. Hannah Malan  32:26

No, I think just a thank you to you, Wendy, for being one of those mentors for me who made it possible to be here and for so many students you do that for, so.


Dr.  Wendy Slusser  32:40

Well, having having students like you as part of the family is really, you know, speaking of defining your success by helping others, that’s, like, a really great way to live and I’m really glad that to see you move forward and I can’t wait to see what you do next. You’ve forever happily surprised me.


Dr. Hannah Malan  33:03

Thank you.


Dr.  Wendy Slusser  33:03

Thanks so much.  Thank you for tuning into UCLA Live Well. For more information about today’s episode and the resources mentioned, visit our website at healthy.ucla.edu/livewellpodcast. Today’s podcast was brought to you by the Semel Healthy Campus Initiative Center at UCLA. To stay up to date with our episodes, subscribe to UCLA Live Well on Apple Podcasts, Spotify, or wherever you listen to podcasts. Get to know us a little better and follow us @healthyucla. If you think you know the perfect person for us to interview next, tweet your idea to us, please. Have a wonderful rest of your day and we hope you join us for our next episode as we explore new perspectives on health and well-being.

Episode 26: Part 1: Feeding our Planet Sustainably and Equitably



Dr.  Wendy Slusser  00:04

Today, I chat with UCLA Public Health doctoral student Hannah Malan about how she has applied her background in communication research and food security to a social cause that she is passionate about: feeding our planet sustainably and equitably. Please join me in the first of a two-part episode. In this part, I chat with Hannah about her journey to UCLA and research on the challenges our UCLA students face with food insecurity. So Hannah, this is such a pleasure having you here. Thank you for making time in your day on your visit down here from San Francisco to talk with us. I know this is your home away from home now, versus San Francisco was that way before. So I’d like to know what brought you here in the first place, to Los Angeles and to study at UCLA. Like what drove you here, what were some of the surprises that you found when you got to Los Angeles and then to UCLA?


Dr. Hannah Malan  01:11

Sure, I mean, I think like many people, it’s a million different turns, and opportunities, and connections, and false starts, and then new directions. I went to UC Santa Barbara, I did my degree in communication studies with a minor in professional writing, which left the job opportunities after school quite broad but also pretty vague. I didn’t know quite where I fit and what I wanted to do, so I just took a temp job at an advertising agency type of thing in San Diego and that’s where I learned to write a compelling headline and clear website copy. I was a junior writer there for a while and then came to Los Angeles when my boyfriend, now-husband, started pursuing graduate school in biostatistics. And at that time I was like okay how can I start working on things I care about? How can I use my skills to do something and work in a field that I felt like was meaningful and could start a more of a career trajectory for me? I’ve always been interested in sustainability and healthy communities, environmental issues that overlap and intersect with human health, which to me are most environmental issues, if not every environmental issue.


Dr.  Wendy Slusser  02:29

You were kind of early – you were ahead of the game in a lot of ways.


Dr. Hannah Malan  02:33

Yeah, well I don’t know. I mean I also grew up in a home where my dad is in environmental policy and my mom is a preschool teacher, so they’ve always been such amazing examples of defining your success by serving others and, you know, making progress towards a world you want to live in, however that looks. So whether it’s being kind to people in your life or, you know, working on broader scale change. So I think for me I’ve always been driven to a career like that. I think that’s actually quite common in my generation, is finding purpose and mission driven work, so I really though didn’t know what public health was before I came here. And my husband sent me a press release about a new global media center they were opening at the Fielding School. That sort of piqued my interest and I learned more about public health. At that time I was working at Global Green, an environmental organization, doing social media work, but I was exposed to the sorts of climate change resiliency programs they were working on. They were working on food hubs and I think at that point, food stood out to me as this real connector, so it brought together people from public health from sustainability from, you know, people who are working on the ground and also broader policy issues and figuring out incentives to promote local food and healthy food, so yeah. I think at that point I was like, okay public health seems like it’s the people-focused part of environmental sustainability or of health. So that made more sense to me than going into something like environmental health because I knew I wanted the focus of my work to be on people. That’s a great way to define the role of public health in a world of sustainability, yes. So and then what, so then you just applied and then…? So then I applied, yeah I came to campus and visited. I didn’t get into UCLA for undergrad so i was like, alright this is my chance. And I thought, yeah let’s give it a try. You know a master’s degree is only two years so it seems like a relatively accessible thing to do. And UCSB has a quite a an academic approach to communication studies so I was familiar with that social science part of research and learning. So it was quite a natural fit for me in public health, which tends to take a social science approach to health issues. So I felt comfortable in that way. You know, I had taken some statistics and that type of stuff, but I guess I was just surprised by how much I didn’t know. And I keep being surprised by that. I mean, I think it’s –


Dr.  Wendy Slusser  05:25

When you started at the school?


Dr. Hannah Malan  05:26

When I started at the school, yeah. And I keep feeling that way of, you know, the more I learn, the more I feel. And I think that’s why I wanted to get a PhD is, you know, as soon as you scratch the surface of something, you realize all the complexities underneath.


Dr.  Wendy Slusser  05:42

Let’s unpack what attracted you to public health and its relationship to food in the environment.


Dr. Hannah Malan  05:49

Okay, sure.


Dr.  Wendy Slusser  05:49

And I think that that’s a really important subject, because as we learn more and more how food impacts our climate health, and it could be both positive or negative. So with your interest in food and the environment, when you first got to the School of Public Health, what did you think you could solve? Or what was your inspiration that drove you to thinking that this might be the way you can make a difference, which is what drives you?


Dr. Hannah Malan  06:23

I think it’s never one thing. And I still don’t feel sure about what I’m doing is the right approach. I think, as I said, often when we learn things that it brings up more questions. But I think food to me really emerged as something that touches so many parts of our life. The production of food, the distribution of food, the selling of food, not only in markets, and grocery stores, but food as art in restaurants and experience and bringing people together, cooking at home, you know, culture and all of that history and beauty that comes into experiencing and enjoying a meal with someone.


Dr.  Wendy Slusser  07:07

That’s food literacy, really.


Dr. Hannah Malan  07:08

And that’s food literacy. But then yeah, as you mentioned, there’s also this part of food that has some really, there’s like a darker side, right. And I think that is interesting and compelling. And while food can bring such joy and so many benefits to our lives, it can also increase our risk of disease, and damage our planet, and be stressful for students, and other people who are struggling to afford nutritious, balanced meals. So I see food as a topic that is essential to health and environmental sustainability. And I think we can think big and tackle both of those issues at the same time.


Dr.  Wendy Slusser  07:49

So Hannah, when I first met you, you were pitched by another student saying how fantastic you are, and what a great writer, and also how you were so interested in environmental issues as well as food. And so you started working for the Semel Healthy Campus Initiative and helped us with our progress report. But what emerged during that time of you helping us with the work was how much you were able to digest and synthesize the information, and the work that we did, and apply it. You had a real researchers mind, in my opinion, and I observed. And so as you entered your second year, and you were going to do a master’s in science, you drove yourself towards another student. And you both created a really super interesting research project that was applied and important for our campus because we had discovered that there was food insecurity on our campus, prior to the UC-wide survey. And I’d love to hear more about what food security is for students on campus. What does that mean? And then what made you decide to dive deeper? And what were some of the things that surprised you, what you found?


Dr. Hannah Malan  09:03

Sure. So this is one of the awesome things about working for Semel HCI, is they’re always quick to respond to the needs of campus and aware of what’s happening on campus and able to mobilize students and faculty to work on those issues. And I think coming from, sort of, this big picture public health, environmental approach to food security, I had always thought about it more in terms of how the UN defines food security, which is really thinking about all people, at all times, having access to sufficient safe and nutritious food. You know, that’s acceptable to them that can help them live a healthy and active life. And so in that way, when we think about food security issues like climate change, and other environmental sustainability issues like water, land use. Those things become crucially important as we’re trying to feed this global population that’s expected to reach 10 billion by 2050. But then on a smaller scale, when you when you delve into, really again, the human side of it and the human experience. The USDA has a more specific and two-level definition of food security, which includes both low food security, which is really reduced diet quality, and preference, desirability of the food you’re eating, as well as very low food security, which is what we typically call hunger. So reduce food intake because you don’t have the resources to afford enough food. And so in that context, that’s how we were thinking about food security and how it’s been measured in the United States and among students here on campus. So, yeah, my understanding is that, you know, we had known that students were skipping meals, and it was common for students to replace complete meals with things like ramen or other inexpensive food options. But this whole issue of why, how, to what extent, students were experiencing food insecurity, how they cope with it, their perceived solutions, and the role of the university – that was still unknown to some extent. There was a survey that came out of UC students that found 40% of UCLA students in particular were food insecure, with about 24% of them in this low food security category, and 16% in very low food security. You know, there are a lot of questions to be asked still. And at the same time, the Global Food Initiative from the Office of the President was interested in this topic of food literacy, which has many different definitions, but in general, refers to the collective knowledge, skills and behaviors required for healthy eating. So sounds quite like primal and animalistic, but really, how do we feed ourselves? Right? In this food environment you’re in, how do you make sure that you are getting enough healthy food to support your life? And that means different things to different people in different contexts. So what does food literacy look like for a college student? And how does that interact or intersect with food security? My colleague, Tyler Watson, was also a graduate student at the time in Semel HCI. Wendy, were really the mastermind bringing us together to work on these two topics. And so we were able to do a series of focus groups. So small group discussions, we did 11 with different subpopulations of students on campus, about eight students in each group. And so by subpopulations, I mean, graduate students, undergraduate students living off campus, undergraduate students living on the Hill, students, we identified who were currently using food resources, which I can talk a little bit more about later, but things like the Food Closet. And so we really talked to students about their experiences, how they get food, what they think causes food insecurity, how students are coping. Again, what they see the role of the university is, and we heard pretty overwhelmingly that, and this was not a surprise, because it had been reported in other literature. But the cost of attendance was overwhelming for students. So that was a big part of the cause of food insecurity is students just feeling like they couldn’t make ends meet. And by cost of attendance, I mean, not just tuition, but also the cost of living in these really high rent areas. Anyone who lives in LA, or San Francisco, knows that it’s a struggle to afford the rent. So it’s that, you know, you can’t afford the rent you live farther from campus. So the transportation costs and time.


Dr.  Wendy Slusser  13:58

Right because actually the numbers are even higher than what you would expect for students who might be receiving the free or reduced school lunch during the K-12. period, like there seems to be more food insecurity.


Dr. Hannah Malan  14:11

So that’s a really important point. And something that I found surprising in the in the research that came out of the Global Food Initiative Survey, which was 56 or 57% of students who reported experiencing food security in college were new to food insecurity. Which suggests it’s not an issue of, as you mentioned, it’s different than what they experienced as a child. So there’s something about the college context that is particularly challenging. Economics is part of it. And another part we heard from students was that they’re fending for themselves for the first time and this is where food literacy comes in. So, you know, we think about different types of solutions and upstream approaches to addressing these issues. Economics is absolutely one of them, giving students more money. I think it could solve a lot of problems. But there’s also this upstream solution of giving students opportunities to develop the skills, to not only cope with food insecurity, but actually prevent food insecurity by utilizing the resources they currently have and finding additional resources. So food literacy can mean making the most of your money, finding resources, like CalFresh, which is at a federal level is called the Supplemental Nutrition Assistance Program or SNAP, formerly called food stamps, but also cooking at home, preparing food, stretching your food dollars, and understanding that healthy eating doesn’t always have to be out of reach. And that was a common perception of students is that, to paraphrase a student’s quote, it’s, you know, there must be a way to eat healthy on a budget, I don’t know how. You know, or things like I can’t afford to eat right 100% of the time, or every day. So it’s this sense that eating healthy is aspirational, but it’s not something I can do as a student. And that to me was concerning, because I think this gets to the culture of health, this idea where students felt like struggling to feed themselves was a normal part of the student experience. And I strongly believe it shouldn’t be.


Dr.  Wendy Slusser  16:21



Dr. Hannah Malan  16:21

Especially at a university where we are educating and inspiring the next generation of leaders. I think a huge value and important part of Semel HCI is communicating to students that we do care about the whole student and the whole person. And I think we need more messages like that from every part of society, that you’re more than your job. You’re more than your degree or your grade.


Dr.  Wendy Slusser  16:47

Your productivity.


Dr. Hannah Malan  16:49

Yeah, I mean, as a graduate student, I felt that strongly. It’s being defined by your productivity.


Dr.  Wendy Slusser  16:55

Well, I think you’re talking about upstream solutions to food security or insecurity and one of the roles of university, of course, is education and capacity building. So food literacy really makes a lot of sense, from that point of view, too.


Dr. Hannah Malan  17:11

Absolutely. I mean, you know, some studies suggest that folks with higher food literacy and food skills have higher diet quality and are less likely to be food insecure. And if you think about it from a place like UCLA, we heard from students, too, that they wanted more support from the university to develop these skills to learn how to cook. You know, students discussed things like meal prepping, and, you know, shopping a few times a week to get fresh food, and find sales, and those types of things as strategies for not only improving their diet quality, but reducing stress around what to eat, and how to get food. At a place like UCLA, we can be doing more to help students develop those food literacy skills, which don’t just help them in college, but throughout their lives. Yeah, I mean, there’s been a general, what some scholars have called a culinary de-skilling. Which is, you know, our generation is much less likely to have the skills to prepare fresh food, and even grocery shop and those types of things. So college is really an appropriate time since the first time you’re living on your own, to be doing that. And when you’re in an educational setting, yeah, there’s no better time. I think another thing that was really important we heard from students is they felt like it was appropriate. They felt that it was appropriate for the university to be providing those types of resources and skills. And they trust the university. That’s a huge, huge part of it, too, we can talk more about this later but I think many of us feel confused in this information environment that we live in. But students really discussed trusting information from the university and wanted more support from the university.


Dr.  Wendy Slusser  19:04

So I think, you know, your focus groups really uncovered some rich information that a survey can’t. A survey can, you know, get numbers and get a cross-sectional kind of view of a population. With the focus group, you really found some areas that we could actually change or improve on. And I really have to say that yours and Tyler Watson’s results, inspired and have really helped us create a teaching kitchen on campus, which was not here before for students. And since that has happened, I’ve talked to professional students, medical students, nursing students, who didn’t know how to even crack an egg. So we’re confronting, you know, we’re confronted with this group of students, not all of them of course, that really could use these rudimentary skills, these life skills. And it’s not just helping them while they’re at college but for life. And so how do you feel about the fact that some of your research is actually already impacting practice?


Dr. Hannah Malan  20:18

That’s awesome. That’s really exciting. And that’s my favorite part of research, turning research into action. And that’s why I have loved working with Semel HCI. And I think really what led me to continue and do a PhD is feeling like, okay, research matters.


Dr.  Wendy Slusser  20:40

How do you think you were able to translate your research so quickly, because I think that that’s something that would be a great piece, or pearl, that you could share with other early researchers, you know, emerging students and PhD candidates?


Dr. Hannah Malan  20:57

I think this is advice that you gave me, Wendy, and I’ll just pass it along. But it’s really about, and I think it’s applicable for not just research or careers but so many things, is building on strengths, and also acknowledging and building on what’s already happening. So I think, rather than always trying to go at things alone, it’s really important to understand what’s already being done, to align yourself with, and build upon existing efforts, too. You know, if folks are working on things, and you have a different approach, to communicate that to them rather than going off on your own. And I think that sort of collaboration and acknowledgement of what’s happening and trying to identify how you can best contribute is a great way to go about doing research. I think something that I’m continuing to learn is thinking about, what are we trying to learn? Like, what is the most important thing that we’re trying to learn from this research? And knowing that from the start, before just doing something for the sake of doing it? So how will we use this information and sort of working backwards from there, developing your research questions based on, I mean, it sounds like a no brainer. But sometimes I think in the research process, you can get distracted from the real world, but really thinking about how would this be applied? And how can we best structure our questions and our research to support the practical nature of things that are happening on the ground?


Dr.  Wendy Slusser  22:37

With that observation actually, it’s interesting, because you started naturally, in a sense a community-based participatory research project. And that has now evolved into a more structured, community-based participatory research project for your PhD thesis. So explain to the audience what does that mean, community-based participatory research project? Because I think what you’ve just described is what a lot of people do naturally, not a lot, but a fair number where they will look at the strengths and they’ll work with the community and research something that is mutually agreed upon. Which you did with those series of focus groups. And then you did it in a more decisive way for your thesis?


Dr. Hannah Malan  23:24

Sure. So community-based participatory research refers to research that is community-driven, and collaborative, rather than just community-placed. So often in public health, we’re working on settings-based approaches to public health. So working in an institution like a school or a university, working in a community, in a hospital, rather than with a person one-on-one. So that’s a settings-based or a community approach. But community-based participatory research is a little bit different, because rather than the researcher going in, collecting the data, and deciding what’s done, you really involve the community members from the beginning. Their shared decision making and ownership over what’s done, how the data are collected, what is done with the data, what questions we want to ask, what problems we want to solve, what strengths are already exists that we want to build upon. And I really think that’s the best approach for creating solutions that are acceptable to people, that address community-defined needs, rather than the researcher saying this is what needs to be done. They’re more sustainable in the sense of long-lasting, more scalable because the lessons learned from those types of projects can be applied elsewhere. And it’s more of a recipe I guess, than a strict set of rules. I never follow recipes exactly. But, you know, you have to adapt them. You have to adapt them to your kitchen. What supplies you have and preferences and all of that. So yeah, I mean, I think it’s been a wonderful experience. And I think another important part of it is that the researchers have a lot to learn from the communities they’re working with. So, you know, the folks in dining that I’m working with now have 30-plus years experience working in restaurants, and, you know, decades of experience doing nutrition education and sustainability operations. And so we’re all learning from each other and really trying to bring together our different skill sets to elevate each other’s work and to create solutions that in the end, you know, I love Pete Angelis, who’s the head of Housing & Hospitality. He’s always just interested in trying and learning. And I see research is such an important part in helping us understand what works, potential unintended consequences of doing things. And I think that openness to learning and trying is something that the private sector has done really well. If you think about Silicon Valley and their openness to trying and failing and learning. I think we could all learn a lot from that in terms of how researchers can support communities who, you know, want to go through iterations and learning about creating solutions.


Dr.  Wendy Slusser  26:24

Thank you for joining us today. And please tune in next week for the second part of this conversation. Hannah and I will dive into her current research on how to promote eating sustainably starting in our own backyard at UCLA. We hope you can join us next week.

Episode 19: Ensuring a Food Secure Future with Paula Daniels




Dr.  Wendy Slusser  00:03

When the COVID-19 pandemic broke out in the United States, the existing inequities and vulnerabilities of our food systems were starkly exposed. Join me as I chat with co-founder and chair of the Center for Good Food Purchasing, Paula Daniels, about how we can meet this moment to make transformative progress in our food systems. Paula, this is just such a pleasure to talk with you on our Live Well podcast. I’ve been waiting for the day to be able to interview you formally on this podcast.


Paula Daniels  00:37

The pleasure’s mine.


Dr.  Wendy Slusser  00:38

Oh, thanks. And we’re going to be talking about two very important reports that came out in the last month. One is the “Springboard for Equitable Recovery and Resilience in Communities across America” that you helped write. And then the Rockefeller Foundation report that you contributed to titled “Reset the Table: Meeting the Moment to Transform the U.S. Food System.” We’re going to talk about both of them, because it seems to me that in the area of food, and food security, and food systems, they have a lot of similar messaging, although the Rockefeller report, as we all know, is more focused on food. But I’d love to discuss with you, first of all, what was the impetus of both of these reports?


Paula Daniels  01:21

Yeah, well, both of the organizations that did these reports were very alarmed by what they were seeing happening in the food system, but you know, the long lines of people needing to get food. And then at the same time, you have that paradox this, you know, complete conflict and almost dissonance that you had a number of farmers that had food, but that weren’t able to get to the places of need. So it revealed a lot about the food system that a number of organizations were trying to draw some lessons from and to move forward and to think about how we can make changes so that this sort of thing doesn’t happen again. And for both, I mean, going through this effort, I think so many of us saw this, as well as all the other places that did news reporting. But the connecting-the-dots part that was very important through these processes of preparing the report for “Springboard” as well as Rockefeller was that these problems in the food system predated the COVID pandemic, and predated what was revealed. Because of the pandemic, the fissures in the food system, the fault lines became the earthquake that shook everything wide open, but these fault lines were already there. So many of the people who are working in the food system saw that this is what they had forewarned about the need to have a more resilient food system and the need to have more value-based relationships built into the food system. So these organizations embarked on an exploration of that. So the “Springboard” report which was done by the Well Being Trust, which is a mental health organization that’s affiliated with Providence Saint John’s, they combined with the CDC, the Center for Disease Control, and they did a paper on all the areas that have been impacted in this time. The economy, housing, governance, and food was one aspect of it, and which I did write that section. The Rockefeller Foundation had been making its entry into the United States. They’ve mostly been funding food issues on a global basis but started their U.S. initiative just last year. And so they had been examining how to engage with the U.S. food system, but also felt quite responsible once this crisis hit us and all these issues were revealed, to start trying to pull some initiatives and make some sense out of it. So for the Rockefeller Foundation, I helped facilitate two roundtables, they had quite a few roundtables. All told, they spoke with over 100 individuals from a select list representing every aspect of the food system, and in a diverse way as well, to get input. And that resulted in the paper called “Reset the Table,” which has a number of key recommendations.


Dr.  Wendy Slusser  03:56

So you talk about the food system and its fragility even before the pandemic. So in other words, they really weren’t prepared for this kind of a stress. That’s what you’re describing. So tell me, what makes you make that comment? What are you basing that on?


Paula Daniels  04:12

Well, the food system leading up to the pandemic was one that already was suffering from being fractured along these silos of production, distribution, and access. And there’s a lot of work that’s been happening in the last 10 or more years, some of which I’ve been a part of, to try to look at the food system in a more holistic way. It’s basically an economic system and has thrived in the last many decades based on economic incentives and disincentives that have been set into place by our federal government, largely to support lots of export and that’s the 20th century model. The Cold War imperative that came out of you know, post-World War 2 to compete with Russia and out-grain Russia, just you know, grow more grains, grow more of five key products in order to compete on the world stage. So that was how our system was built. But what that did was it left a lot of people out on the margin. It started shrinking out small business owners. So the consolidation into large companies, because of this competition, lends itself to kind of singular economic and linear approach to food system. Grow, distribute, eat. Grow, export, distribute, eat, it was just very linear. But what was lost in there was the aspect of health and also the aspect of supporting a smaller economy. And that’s been a problem for decades now. And that has been known for decades. And that’s why we formed the L.A. Food Policy Council in Los Angeles, this is trying to address those problems. Well, with the COVID system, just completely shaking up and disrupting and breaking the supply chain lines that moved on existing commercial relationships. That’s what broke, it revealed itself to be quite complex, but also quite fragile once it was shut down. So it’s like a spider web that you just break apart. And then the spider has to re-weave its connections. So the fact that there was a lack of connection, or a lack of a robust connection to the local food economy, to the communities that had need, is what was revealed. So a good example is with chicken, because we know that the chicken supply was disrupted because of a COVID outbreak in the meat processing plants. So that’s been on the march toward high consolidation since the beginning of the 20th century. And there are only now a few, there’s one main chicken supplier in the United States. It’s Tyson’s. There’s a handful of meat suppliers in the world. There’s six multinational companies that control all the meat supply, that means chicken and beef. So they have it consolidated into these very well-prescribed contractual relationships that are geared toward economics. But it’s not geared toward health. And it’s not geared toward serving certain communities. So all those relationships were disrupted, and the relationships where there was more of a direct connection to community are the ones that did thrive. So the farmer’s markets, the CSAs, meaning the direct sales where a farmer had a direct relationship with a restaurant or with a consumer already, those types of relationships went through the roof in terms of really supplying need. And they really showed how important it was to have a community relationship versus a purely commercial relationship, if that makes sense.


Dr.  Wendy Slusser  07:20

Yeah, it does. That last example makes a lot of sense. So let me understand the example about the chicken. So you’re saying because of the COVID outbreaks in the chicken centralized growing or processing site, that is what disrupted the distribution to the communities around the country.


Paula Daniels  07:40

Well, so because chicken is consolidated into the hands of six multinational companies, they’ve started consolidating to create economies of scale into a few processing plants. So for economies of scale, the more efficiencies you have in the system, the better, that’s what they always work towards. So efficiency means high production, it means less people, if they can manage it, like less labor to pay, like highly automating things so it’s cheap, and they can get as much profit as possible, right? That’s the business imperative. So meat processing has been consolidated into 15 meat processing plants, and there were very few that were local. So when there was a COVID outbreak in the meatpacking plants and they had to shut it down, that disrupted the meat supply chain, which is why they then went to the federal government and asked for an emergency declaration that this needed to keep working. But that’s to keep that existing model going. If you had local meat processing, some of the more local producers, so maybe some of the free-range chicken producer, some of the heritage poultry producers, some of the grass-fed-and-finished beef producers, might have had somewhere to send their meats for processing and that could have still supplied the local communities. In fact, there are places where there are local abbatoirs, like places that do process their own meat, and that send it to local communities. So those are the relationships that are more robust if they’re already geared towards supporting local economies and supporting local communities. That’s what we found was still working well.


Dr.  Wendy Slusser  09:05

What you’re describing is a situation where some of the solutions you have been thinking about for probably decades. And now during this time of stress, and there’s an opportunity to make a change and transform us to a more sustainable food system. And I know, in the “Springboard” paper you wrote, you detail how we should transform the U.S. food system. And I know there are three areas that you specifically focused on. One is what you’re just describing now, which is the coordinating for regional change, such as food hubs. And so I’d love to hear from you. What does that mean, you’ve described farmer’s markets and CSAs, which I think a lot of people are familiar with, but I don’t think a lot of people might understand what that means: food hub.


Paula Daniels  09:48

Yeah. So food hubs are an essential part of a local food system. And it’s something that many have been working toward for the last, I would say, 10 to 15 years or so. And food hub can sound, like, vaguely meaning it’s anywhere where you go to get food that’s been collected. So in some ways, some would think of a farmer’s market as a food hub because food’s been aggregated there from smaller farmers. But the way we’re thinking of it, the way it was recommended in these reports, is it’s a business that is intentionally mission-driven to support the regional food economy and to support community health. So it’s intentionally designed to support smaller farmers in the surrounding region, and also to provide healthy food to communities. So typically, the food hub that I’m thinking of and that we recommend here is not a for-profit enterprise. It could be, but part of what I’ve seen in some studies of food hubs, and then some of the information I’ve gathered from firsthand interviews, is that a for-profit enterprise starts needing to continue to make money and sometimes the mission of the enterprise drifts. So they start needing to make value-added foods, they start not being able to give as much time to the small farmer to help them with their food safety needs, whatever it is. So typically, a really successful food hub is either a nonprofit or some other form of business, so that they can devote themselves to the mission. And there’s a very well-known one that started in Pennsylvania called The Common Market. So it’s a nonprofit, and it provides support to the small local farmers in the region, particularly farmers of color. And they provide technical assistance, and they provide marketing assistance, they act as intermediaries for the farmers. And for smaller farmers, it’s a struggle to compete in that larger marketplace. So The Common Market, this food hub, would provide that cushion for them and just be able to aggregate whatever they’re selling, versus having the smaller farmer have to figure out their sales chain, other than through the direct sales of a farmer’s market or a restaurant. But to get to more volume, so you can get to more success, you need to sell to larger institutions. And the food hub can be that intermediary, because large institutions have very efficient ordering processes. So sometimes that doesn’t match with how the farmers growing, or what their capacity is in terms of fitting into that high-volume setting. So the food hub would be that very important intermediary, mission-driven. And the food hub will also make sure that the produce goes to certain communities, so school districts, but also communities of need, they often will work with food banks. So when COVID hit, the food hub Common Market in New York already had a number of relationships with the small farmers and relationships with the school districts and relationships with the food bank. So there wasn’t any disruption, they went directly from serving a certain stream and operating a certain way to, okay, now I know where the need is, and they could move everything to the need. Whereas the very large distributors didn’t have those relationships already. And you can’t make those relationships overnight. And you can’t make them in the middle of an emergency. So those relationship-driven and values-driven nonprofits are the ones that did really well, as well as the others that were more local. So there’s a number of food hubs from around the country that I think we’re hearing some similar success stories from.


Dr.  Wendy Slusser  12:55

It sounds like a really promising proposals. So how do these food hubs that are not-for-profit, how do they sustain themselves?


Paula Daniels  13:02

Yeah, really good question. So right now, a number of them are philanthropically funded. That’s not often a good long-term solution, because philanthropy has funding cycles. So a number of them do also have earned income. So The Common Market is a combination of philanthropic funding as well as earned income. But I believe, and this is one of the recommendations in the “Springboard” report, that this is a place for government support. So we recognized during the COVID crisis, that food is an essential good, and that food workers are essential workers. I mean, it was declared as such, because they’re allowed to continue working, but if we take that idea to a philosophical point, if you’re an essential worker, you’re providing a public service. This is a public good, there should be public investment in this. So it seems like a really good opportunity for local and state government, and particularly local government, to invest in food hubs to create economic development, funding streams and direct their economic development funding towards support of food hubs, so that that can be a more long-term solution and could maintain its viability with some public funding that’s durable. There could also be public finance arrangements. We pass a lot of bonds for water protection for parks and open space for transportation. Can you imagine if we were to pass some sort of a bond that would allow us to support food system infrastructure, so we could have a more robust local and regional food system and create a lot of jobs out of that. We know for a fact that there’s jobs in the food system. So if we were to make sure that they were supporting a more regionally resilient food system, and we could keep those jobs here, instead of some export line somewhere else, we’d really benefit the local food economy.


Dr.  Wendy Slusser  14:44

That’s a lot for me to think about. Because, you know, I remember trying to find, digging in to what resources are out there in terms of how people define food hubs, and like you said, it’s kind of a big umbrella for a lot of different structures like the farmer’s market versus this more Common Market model. Would you be able to direct the listener to a summary of these kinds of options? Or is it really something that is on your to-do list? You’re such a great writer.


Paula Daniels  15:14

Well, thank you. There was a really good report done by a USDA specialist. It’s about food hubs. And his name is James Barham. He did a study on food hubs and did quite a good analysis. And they came out around 2013, I would say.


Dr.  Wendy Slusser  15:31

Yeah, I remember reading that. That actually was the only paper that gave me any clarity, besides talking to you verbally. But I do think that there’s something to be said about the lessons learned that we’re coming out of with COVID in these kind of examples that you have just described in terms of The Common Market in New York. I feel that these kinds of models, would I think, inspire other municipalities, potentially, or local governments, just seeing how it works. So these are really important lessons that we’re all really trying to capture at this time. And I think these two papers that we’re discussing are the beginning, because it’s really sort of this first phase, like, hey, let’s not forget the lessons we’re learning, the hard lessons we’re learning, let’s, you know, be able to at least get something good coming from this real tragedy that we were confronted with today with the pandemic and continue to be. I think the food lines around the food banks and the students at UCLA have just exponentially gone up in terms of foods insecurity, as well, as we know, here in Los Angeles, all these families that have always been living sort of on the edge are now over the edge. So food hubs is one and I think this is interconnected with the next recommendation that you made in your paper for the “Springboard,” which was account for true food costs. What do you mean by that?


Paula Daniels  16:57

Yeah, this recommendation was in both papers, the Rockefeller Foundation as well, is true cost accounting in food. And it’s something to be taken into account by decision makers and buy businesses when they look at food. So what we know now is that our food is very cheap, we’re fortunate. It’s still hard for some folks to afford food, but by and large, when we look at it as a percentage of the average person’s budget, we’ve managed to keep food at affordable levels. But the reason it’s affordable is because some of the true costs are not embedded in the food product. And that’s because of government support in the production process and sometimes in other forms, like tax incentives, or other benefits. An example is if you were to look at the cost of, I’ll say, an organic strawberry, or the cost of a hamburger patty at McDonald’s. So a pound of ground beef, if it’s an industrially-produced beef, and it’s not grass-fed, is gonna be about the same as a pound of organic strawberries. Maybe organic strawberries might even be more. I know for sure, it’s the same as a cost of a pound of apples. So why is that? That you have this very large animal that takes up an awful lot of resources, that uses a lot of water, uses a lot of land in order to graze and then be maintained, and then its processing and transport emits an awful lot of greenhouse gas emissions. So why is it that it’s so cheap? It’s because all those consequences of producing the beef are either supported by subsidies, or they’re just not embedded in the cost of the food because of the economic efficiencies and the economies of scale.


Dr.  Wendy Slusser  18:29

Meaning the government. So people that are against government subsidies have to remember that their meat product is subsidized.


Paula Daniels  18:36

Highly subsidized. The water’s subsidized, there’s a lot of tax breaks that are given along the way, there’s a lot of different ways it’s subsidized. The growing of the corn and soy to feed the cows is highly subsidized. That’s where a lot of farm bill payments go. So those costs, those impacts, are called externalities. They’re external to the actual cost that you’re paying. But they’re not embedded in it so they’re not truly accounted for. Take that organic strawberry. It’s not subsidized, and you’re paying more for it, because it’s organic. So organic has a price premium. But what that means is that you’re also paying to not have the ground be polluted and to not have the farmworkers be exposed to one of the more toxic pesticides that strawberries are normally sprayed with, methyl bromide – very toxic. So it’s embedded in the cost of the strawberry when you pay that higher price premium, and it’s not pushed off on to the public. So the public, like the EPA, might have to clean up after some of the toxics that are emitted. That’s a public health consequence. If you’re paying for health care for somebody who’s been impacted by inhaling that methyl bromide, that’s an external cost that’s being borne by the public but not by you when you purchase the strawberry, so it’s embedded in it. Do you see what I mean?


Dr.  Wendy Slusser  19:47

Yeah, let me recap it, because really, in your paper, you do talk about true cost accounting, and I wanted to understand that in more detail. As I understand what you are describing is that there’s a lot of money costs in our food that the consumer doesn’t pay. Well, we end up paying for it indirectly, not directly, indirectly by our taxes that go to the farm bill that subsidize what appears to be many of the foods that you described early on would be part of the competitive commodities that we were focusing on post-World War 2, corn and soy and grain.


Paula Daniels  20:23

Yes, corn, wheat, rice, sugar, soy.


Dr.  Wendy Slusser  20:26

Much of that is exported. Is that correct?


Paula Daniels  20:29

Much of it is exported, yeah.


Dr.  Wendy Slusser  20:31

Okay. So that’s a cost that then goes through our taxes to support those foods that are then sold in the market externally. So we don’t even necessarily benefit from those foods that are subsidized that get exported, in a sense.


Paula Daniels  20:48

Not necessarily, yeah. And sugar is a really good example. So if you were to just take the cost of any sugary beverage, it’s not very expensive, let’s say it’s $1 for a can. But when you have lots of youth drinking lots of sodas every day and then experiencing obesity, as well as diabetes, then you have the public health costs of taking care of those children who had these cardiometabolic disorders. And that’s significant. And that public health costs of caring for the children or whoever else has those impacts is not borne by the cost of the product itself. So those are the negative externalities that we’re talking about, the negative impacts that aren’t in the cost of the food. So taking that into account, so that the idea of true cost accounting is to be aware of them, to assess them, and to make sure that we’re acknowledging that. So that if there’s a food product that has these negative externalities, and sugar is probably one of the best examples, that we’re aware of that. But also, as a decision maker, you can take that into account. A very, you know, blunt instrument for dealing with that is a tax. So when you’ve seen places where there’s been attacks on sugary beverages, and there was an attempt to do that in California in the city of Richmond, and in Mexico. They’ve done it in other places. That’s an attempt to cut level things out and to have the product then bear its true cost, it’s when you put a tax or a fee on it, that’s one way to do it. There’s other ways to do it. But that needs to be acknowledged, is what the impacts are of certain food products.


Dr.  Wendy Slusser  21:40

Well, in addition to the poor health outcomes of drinking sugar-sweetened beverages, which has been shown, two servings of sugar sweetened beverages increase your chances of getting diabetes by 26% and the billions of dollars, it costs in health care industry, or to us, ultimately, and the individual from all the lost work and pain and suffering that isn’t even accounted for. But we saw the cost to our environment. And experts call out that specific non-nutritive food as one of the methods to reduce the impact of our food system on the climate. So I think your point is really well taken in terms of we have to be looking at certain parts of our food system that not only are negative to the individual that we’ve seen with COVID. But overall in the future, I don’t think this is a sustainable step.


Paula Daniels  23:00

Yeah, that’s a really great example of, I mean, because we’re not going to be able to get this done without having corporate, you know, for-profit, nonprofit, university partnerships to solve these big challenges of our time.  Sorry, I just have one other quick example. So there’s a company, Danone, that’s based out of Europe, and they are beginning to do this. They’re beginning to be responsible about true cost accounting, and they are starting to add carbon into their financial balance sheets. They declared that as of last year, and they’re going to start doing it. So they’re being responsible corporate citizens, and and trying to implement true cost accounting in their financial frameworks, so a lot of ways to do it. And government, everybody.


Dr.  Wendy Slusser  23:40

And government. Exactly. And the third area that you cover is leveraging the power of public contracting. So explain to me what that means.


Paula Daniels  23:49

There’s an awful lot of money in food service that we learned about during COVID. We saw how much of a disruption rippled throughout the system. But the food service industry and institutional food is about 120 billion a year, it’s a lot of money. And of that, a large percentage of it is through public institutions. So school districts in particular are the largest food service provider in any given region, because they’re feeding tens of thousands, if not hundreds of thousands of students a day when they’re all in school and in the cafeteria. But we’ve also seen how important they are in terms of rising to meet the moment because they were quite heroic during the COVID crisis and regardless of the consequences to their budget, they just started feeding people. And it did cause a lot of them to lose an awful lot of money. LAUSD I think is in the hole for 30 million or something like that.


Dr.  Wendy Slusser  24:37

And they’re continuing to do that. No questions asked.


Paula Daniels  24:40

That’s right. Yeah, it’s quite heroic.


Dr.  Wendy Slusser  24:42

Largest food program in the country, L.A. Unified School District.


Paula Daniels  24:45

And New York is pretty big too. So New York and LAUSD are the top two so they have hundreds of millions of dollars that they spend so L.A. Unified School District was around $150 million, about 120 of that spent on food per year. So that’s a lot of money that can influence an economic system that we started talking about our food systems largely economic, in response to economic incentives and disincentives, primarily. So using those public purchasing dollars toward helping to build and create market demand, create market viability I should say, for regional food systems is really key. And that’s our theory of change. So we’ve been working with school districts and other municipal institutions to help direct their food purchasing dollars towards supporting local food economies and fair labor and community health. But the more institutions do that in any given region, the more likely you’ll really be able to build some robustness in those relationships that can be more resilient, more regionally resilient. So it can be a really key position, it’s a really key energetic lever toward developing a more regional food system because it creates the market demand for it. So if Mayor was to call for all large institutions serving over a certain threshold, let’s just say, I’m going to give an easy threshold, over 5 million of food purchasing in a year, to set aggregate targets to support the local food economy. Just think of how strong that would be in times of crisis. You’d already have those pipelines built, you’d already have those relationships in place for when there’s any sort of emergency such as in New York, there was Hurricane Sandy before there was COVID, where they had complete disruptions in service. And they’ve invested an awful lot into the local regional food economy there. So if we were to do that here in Los Angeles, if we were to do that in any region, to use aggregate purchasing targets, to say, we’re going to start creating this market relationship with our local food economy, and we’re also going to make sure we’re serving communities of need, and we’re also going to make sure everybody along that supply chain is well paid, then you start building that robust regional food economy. And it doesn’t have to replace the global system 100%. I don’t think that’s realistic, but if we were to get to a strong percent, like a 30% target, like we have with our renewable energy targets, then we’d start making a big difference in terms of supporting our original farming economy.


Dr.  Wendy Slusser  27:00

Okay so what you’re saying, actually, Paula, sounds like two important ingredients to this leveraging the power of public contracting. One is setting up what you’ve done. And I think you’ve been alluding to it, but we haven’t really specifically talked about it yet: your Center for Good Food Purchasing. And you’ve actually outlined what it would take to have something that you’re describing give people a roadmap to get to this kind of ultimate goal, which is really the best for everyone, right, this more regional kinds of food systems, at least some sort of hybrid of industrial and regional. Right now it’s just mostly all industrial. So we really need to have some sort of balance. But also setting goals. So maybe what would be great for us right now is hear a little bit about the history of your Center for Good Food Purchasing, where it started, and then some examples of how it’s really taken off in a significant way.


Paula Daniels  27:54

Sure, yeah. So the Center for Good Food Purchasing is an outgrowth of the Los Angeles Food Policy Council. We founded the L.A. Food Policy Council, oh, the work started back in 2009 with that idea of wanting to celebrate then the 30th anniversary of farmer’s markets by building on the idea. So farmers markets, when they were started in 1989, were intended to provide economic support to small struggling farmers, and then also to get food to low-income communities that didn’t have access to it because there weren’t enough supermarkets because of redlining. There wasn’t enough healthy food in their neighborhoods, just junk food in their neighborhoods. So it was intended to solve that problem. So taking the nub of that idea, the central philosophy of that idea, and saying, how do we then make that be bigger than an occasional Saturday market? How do you make that be a larger idea and have it really start making transformative shifts in this disaggregated system? So we founded the L.A. Food Policy Council and developed a food policy framework having Los Angeles be a leader in that region, which we saw is the 250 mile radius around L.A. So taking into account the 10 county farming regions around L.A. And among the key goals was to develop a procurement policy for large institutions so that we could support the direction of food service providers to buy food that would support the local food economy, as well as support fair labor and community health and environment, for sure. So the Good Food Purchasing Program does have those five values, and it has a rating program for large institutions. It works something like LEED certification works for buildings. In other words, we have the five very clear categories: local economies, environmental sustainability, fair labor, animal welfare, and nutrition. And it’s metric based. So when an institution enrolls in the program, they agree that their purchasing will be directed and rated on how well they’re doing in the five categories. So we get their purchasing information and analyze it. And because we give the direction and give a pathway for the institutions to know how to do it, it does make a difference right away. It might be something they’ve been trying to figure out, how to be environmentally sustainable, but they wanted to support local economies, perhaps, but hadn’t come up with a plan, etc. So we have the plan that we can give them and that they can follow. An example was L.A. Unified School District. So when L.A. Unified School District enrolled in our program, they had been thinking a lot about nutrition and making nutritional improvements. But I think you were part of a program, Wendy, they put salad bars in schools that was tremendously successful. So they’d been thinking about that for a while, but hadn’t focused as much on some of the other aspects. So once they enrolled in our program, they went from less than 10% local sourcing of produce, on average, to then an average of 60% local sourcing of produce. And that directed $12 million into the local food economy just in the first year, and it created 150 new jobs in food processing. So that is one example. Then their vendor, the person who was supplying them with the produce was also inspired by the program to start sourcing local and sustainable wheat for the bread products. And then that also had the ripple effect of then LAUSD looking at its meat contracts. So then they put a requirement that all poultry would have to be raised without the routine use of antibiotics. So those sorts of changes started happening. And LAUSD is now directing even more money into the local food economy, which is sustaining more jobs. So then we expanded after that, it got some national attention. So now we’re the Center for Good Food Purchasing. And we’re now in 20 cities around the country and 53 institutions. So we’re also in New York, and Chicago, and Boston, and DC public schools, and San Francisco, Oakland, Fresno, a lot of different places, and all these places, in aggregate, are making these shifts in the food system. So it’s not actually surprising, then, that we’re learning that the school systems have been a huge safety net, not just during pre-COVID but during COVID. In a way, you’ve actually enhanced that because of the nature of your local system that you’ve helped develop through Good Food Purchasing. That’d be an interesting look at, I mean, looking at the ones that you had the schools committed to your Good Food Purchasing to see how they played out compared to others. Well, yeah, I think that they deserve the credit on their own for being pillars of the community and for being very responsible and very interested in serving the public that they do serve. So they’re all very committed public servants and really want to do a good job by their community, which is why they were interested in our program to begin with.


Dr.  Wendy Slusser  32:23

Yeah, I totally agree. There’s no question. You know, there’s no i in team. So that, you know, I know, the Urban School Food Alliance, you were actively working with them, too, around this commitment to no antibiotics in poultry. And tell me has that impacted the industry itself? Based on that purchasing signal from the school districts in terms of more poultry being offered up with no antibiotic? Have you been able to determine that or…?


Paula Daniels  32:52

I think that a number of the large poultry producers are reformulating their product lines, for sure. And they are moving more toward trying to figure out how to develop poultry products that are raised without the routine use of antibiotics. So the school districts are a big market, and it can have quite a difference.


Dr.  Wendy Slusser  33:09

So in other words, just that one lever of that one purchaser or group of purchasers can really make a difference.


Paula Daniels  33:16

They definitely can.


Dr.  Wendy Slusser  33:17

How do you see the Center for Good Food Purchasing fitting into these recommendations in these two different documents we’re talking about?


Paula Daniels  33:25

Well, we’re happy to support all of the recommendations in the documents, and we definitely do have a path toward helping municipal and other institutions direct their purchasing. So if there’s an opportunity for folks to participate in our program, and use that to help set their aggregate purchasing targets, that would be terrific. Doesn’t have to be ours, they can move forward in any way that makes a difference. But we’re happy to offer what we have.


Dr.  Wendy Slusser  33:50

Well, to wrap up, what good do you think will come out of this pandemic? Or what do you want to see come out of it?


Paula Daniels  33:56

Well, I think it’s high time that every level of government understood and invested in the value of having a robust regional food system. And that means really not just talking about local, but putting some backing into that. So providing whatever economic development support they were able to provide to creating more of a renewable energy portfolio, taking that same level of effort and putting it into a local regional food system. I think it’s high time. And you can see that need arising in a number of places around the country. But for too long, we have depended on our federal government to be able to fund these strategies. I think it’s in the hands of local government to take it from here.


Dr.  Wendy Slusser  34:38

And so what would be the path that you would like to see happen to make that a reality?


Paula Daniels  34:43

I think there’s a suite of initiatives that any local government could embrace. So one would be to set aggregate purchasing targets in their region. And the other would be to, and I know how difficult it is when you’ve got a crumbling budget and you have to lay off government workers and put them on furlough and programs are being diminished. So I don’t say this lightly, but developing a regional food system can create jobs. And it can create local jobs. And it can create jobs that are long-term and actually quite satisfying for the workers. And that can be a good source of income and well-paid. So it’s an investment in the future of the region, if you can provide that economic development support, once you set the aggregate purchasing targets, to then back that up with all the capital infrastructure and the soft infrastructure. So the local processing, the local distribution, the relationship infrastructure, the technology infrastructure, all of that to make that local food system work well, and then to invest in the health of the communities at the same time. So that means having the capital infrastructure, the hard infrastructure of those access points, if it’s small markets, or however else, you’re going to be able to access it, and then invest in the people that make all these things happen.


Dr.  Wendy Slusser  35:56

That sounds like a win-win-win for everybody, locally, or even regionally, or nationally. To end, then, I guess, what keeps you up at night, Paula?


Paula Daniels  36:06

Oh, gosh, Wendy. I mean, we’re seeing all the behaviors of the past of our society coming to bear in a way that’s quite powerful and cataclysmic. So we’re seeing the consequences of climate change right now, in the heat, and the fires that are burning outside our doors in California. We’re seeing it throughout the world, we’re seeing the consequences of a 100-year pandemic, a lot of which has to do with how we manage our agricultural production and animal production. We’re seeing the consequences of a lack of investment in our healthcare systems. We’re seeing the consequences of our participation in democracy coming to bear. So there’s just so much here right now that I think we’re at a moment where we need to really show what we believe in and what we value. If we were to learn anything from this, it’s that we need to rethink our relationships to each other and to the world. And I think we’ve fallen into the trap of thinking that we could automate so much of all of that, and that we could attenuate it through commercial transactions or other transactions. But we need to rethink our relationships to each other and the world in this sense. We’ve not been in partnership with the world for a long time. But ages ago, we understood that we were but a part of the earth. And the Earth wasn’t separate from us and wasn’t a resource to merrily exploit. And I think what we’re seeing now, in this time, is that the Earth is pushing back and telling us you haven’t been a good partner. You’re not paying attention. We need to change how this works. So we need to rethink all those relationships and to work in all of our relationships with much greater respect.


Dr.  Wendy Slusser  37:48

I couldn’t say it any better. That’s so right. Mother Nature is raising her hand and telling us to slow down, put pause on our lives, and think about where we’re heading. Well, that’s a great way to end this conversation because clearly, your work, your commitment to creating a fair, equitable world through food is huge. I know you have other commitments as well. I think food is a great unifier. And also, it’s a necessity of life. It’s directly related to health and well-being in so many different facets. So thank you for all you do, Paula, every day, you think about it. You live and breathe it, you enjoy food. And I think you really are a great leader and I can’t wait to see some of this work continue to transpire and augment and multiply in our country and around the world as well.


Paula Daniels  38:47

Thank you so much, Wendy, and I can say it right back at you, all the change that you’re making.


Dr.  Wendy Slusser  38:56

Thank you for tuning into UCLA Live Well. For more information about today’s episode and the resources mentioned visit our website at healthy.ucla.edu/livewellpodcast. Today’s podcast was brought to you by the Semel Healthy Campus Initiative Center at UCLA. To stay up to date with our episodes, subscribe to UCLA Live Well on Apple Podcasts, Spotify, or wherever you listen to podcasts. Get to know us a little better and follow us @healthyucla. If you think you know the perfect person for us to interview next, tweet your idea to us, please. Have a wonderful rest of your day and we hope you join us for our next episode as we explore new perspectives on health and well-being.

Episode 10: Older Adults and Well-being with Ayesha Dixon


Dr.  Wendy Slusser  00:03

This current moment of social distancing is particularly hard on populations most vulnerable to isolation and loneliness, like older adults, people with disabilities, and those with mobility issues. Social isolation among older adults is a serious public health concern that we are even more worried about during this pandemic. Today, I will be chatting with Ayesha Dixon, the director of UCLA’s Emeriti/Retirees Relations Center, about the effects of COVID-19 on the lives of seniors, and what we can all do to help reduce this isolation and loneliness.  What a pleasure to be able to talk to you today about a really important subject that surrounds COVID-19, which is the subject of our population who is over 60 or 65, who are really a group a population that we’re trying to protect in this period of hunkering down at home. And I’d love to hear from you, first of all, how you started in this field in the first place, what got you to think about studying it as a map for a Master’s program and make it a career for yourself.


Ayesha Dixon  01:18

Yeah, absolutely. This career kind of just came out of the interest that I had in college. I have always done some sort of volunteer work, and working with special populations. I considered a degree in urban planning and noticed a lot of the issues surrounding urban planning were also involving seniors and access to resources. So I focused my attention on services that would benefit older populations. who are either rural, low-income, even tribal groups who don’t have access to as many resources as someone in a younger generation. Technology evolves so fast, and I found it important to try to keep up with keeping seniors engaged. And it just kind of snowballed. I started out as a program assistant, just creating PowerPoints for an organization in D.C. And it just grew. A lot of the new grants that were being given out were for technology and telehealth, and it really just exploded into a whole new field that I didn’t even know gerontology existed. But it definitely spurred my interest and to relocating to California and getting the Master’s in gerontology.


Dr.  Wendy Slusser  02:36

So when I first met you when you arrived at UCLA, I didn’t even know there was such a thing as a Master’s in gerontology. And I remember you telling me that your class, your cohort, was a class of about 50. And now how many are there in that particular Master’s program?


Ayesha Dixon  02:52

There’s almost about 200 or so in the gerontology program at USC. It’s definitely as baby boomers are getting older and a lot of folks are in this sandwich generation of taking care of children and older adults. It’s grown enormously as far as the field and the interest that people are having into the older population. And it’s interesting, because I remember in the Obama administration, he had moved his mother-in-law into the White House. And people were all kind of up in arms as, oh, he’s caring for, you know, his mother-in-law and a lot of the new policies and administration things that he did were about older adults and Medicaid and Medicare services.


Dr.  Wendy Slusser  03:35

I love that his mother-in-law lived with them. It just was really close to my own experience with my own family. Tell me, what do you study in gerontology?


Ayesha Dixon  03:45

So in gerontology you’re focusing on the non-medical aspects of aging. So whereas geriatrics is the medical components of physically, biologically how people age, gerontology is the psychosocial aspects of well-being and inclusivity and reframing what people think about aging and making it more age-positive, where we’re thinking about things about longevity, people living longer, healthier ways to get older and incorporating a lot more mindfulness and understanding how people adapt emotionally and socially with getting older. A lot of people do become isolated when they’re older, a lot of their friends, perhaps, pass away and they become really, really sheltered and they’re trying to figure out how their life plays a role post-retirement and it’s a big challenge for a lot of seniors to retire, especially if they’ve been in a field where they helped grow the field, or they’re a part of research projects, or they’re really tied to their community. And it’s a definitely a different mental adjustment to just make that work-life transition to your new phase of life. People have different phases of life where they have children, they get married, maybe they move, and retirement is the next biggest life change. And people still struggle with having to stay busy and having to now fill their time with non-work-related activities. It’s a really big adjustment for a lot of people.


Dr.  Wendy Slusser  05:19

What I find interesting based on what you’re describing, too, is that, you know, I know there’s this longitudinal study going on right now with the aging population in the United States with a cross sectional group of people. And Dr. McClintock published a study that was in the Proceedings of the National Academy of Sciences talking about what were the biggest predictors of well-being or death in the next five years in this population. And what you studied really are what are the biggest predictors, almost, irregardless of the medical diagnoses that they have. The poor mental health, poor sensory function, and poor social engagement were the among the biggest predictors of poor health or death in the next five years. And the greatest predictor of well-being and being alive in the next five years is mobility. And those have nothing to do with the medical system, per se. They do in the sense that physicians need to be and other health care providers need to be cognizant of these as being so impactful. But your specialty seems to be the one that’s so important in this stage.


Ayesha Dixon  06:23

Absolutely. It’s a real vulnerable population. Especially as you age, the loss of independence is terrifying for a lot of people, and also the mobility issues. And when they had to go get their driver’s license renewed, the fear of having to take a driver’s test, so the fear of not remembering something. And for a lot of seniors, if they lose their driver’s license, that’s a huge decline for them, because they feel like now they have no way to get around and no way to see those friends and families. And there really needs to be a stronger connection between the coordinated services of our healthcare system that deals with seniors who may be, you know, check their eyes, check their ears, check their blood pressure, and those community-based resources that deal with the more social well-being and the emotional needs of an older population. It’s even those with disabilities, not just older adults, but those who have other disabilities.


Dr.  Wendy Slusser  07:17

So, you know, with your expertise, and the COVID-19 pandemic that we’re confronted with today, with the understanding that we are sheltering-in-place really to protect vulnerable populations, like the the older population, and with the understanding, though, that these populations, then are therefore more isolated. I mean, it’s a real kind of rub between two issues: isolation to be safe from the pandemic, but then there’s isolation that can cause more distress among this population, which is already vulnerable and that’s in and of itself.


Ayesha Dixon  07:56

Yeah, I think no one knew that this unintended consequence of social distancing would really impact seniors the way it has. I think a lot of healthcare providers are getting more into telehealth and kind of helping people understand what that means, and how to engage our seniors with telehealth medicine, and to put interventions in place to make those of doctor’s appointments happen. The key here is awareness and communication. While online technology is wonderful, it’s great, there needs to be supportive service networks that can help reach those seniors who maybe have not the best literacy and digital resources, are not able to access internet. I seen a lot of commercials of different mobile companies promoting free internet, and they’re giving out discounts for internet providers so that people can access internet. Because if people can’t access a social network or access the internet, then they’re going to be really isolated. But we are trying to promote that social distancing does not mean isolation. We’re trying to find creative resources to keep seniors vibrant, engaged, and just provide that companionship and emotional support for those who are in isolation. So this could be, you know, encouraging younger relatives to call, versus try to FaceTime. If they don’t know how, in other ways to sort of combat this social isolation and do that, you know, peer-to-peer community building, get in touch with your neighbor, trying to find ways to re-engage this population that didn’t have these resources years ago.


Dr.  Wendy Slusser  09:41

So what would be your recommendation, for instance, the group that you’re responsible for in your role at UCLA, the retirees? How would you reach out to people maybe that you didn’t even know before this pandemic?


Ayesha Dixon  09:56

So a few things we’ve done. We’ve completely redone our website to have “Connecting During COVID.” It’s a list of different resources to help people find early opening grocery hours, to find meal delivery programs, to figure out how to work Zoom. We created a whole Zoom tutorial so people could access it. And then a simple thing we did was we created this program called TeleBruin, which is exactly what it sounds like. It’s a phone pilot initiative we started to connect retirees to other retirees by just giving a simple phone call. So everyone got paired up, and John might call Mary, and then Mary will call Sue. And it’s just, you know, completely, a friendly, hey, how are you, tell me about your time at UCLA. And it’s just a way for people to connect over the phone, which for a lot of times our population, they’re more comfortable making a phone call than maybe younger generations with text. So having a phone call of just checking in is definitely a way to kind of help the mental health and the the emotional need that people can reestablish connections that maybe they didn’t have before.


Dr.  Wendy Slusser  11:08

So that sounds like some thing that people could replicate in other organizations and other universities. That’s a really simple, low-tech, low-cost kind of way to connect to people and really addresses unintended consequences, where, as you say, social distancing doesn’t mean social isolation. Also, your website that you just mentioned, is that accessible to other people outside of UCLA that they could go on and find out about the Zoom things like that?


Ayesha Dixon  11:34

Absolutely. Our website is public, it’s errc.ucla.edu. It does have a lot of content pertaining to just UCLA retirees, but this “Connecting During COVID” can be utilized by anyone. A lot of it’s hyper focused on L.A. and Southern California and the resources from Ventura County down to Orange County. But a lot of the things are universal. What this means for the state of California, for our UC retirees who are concerned about their pension, a lot of things are definitely focused for a lot of other retirees. And we designed it based on those elders who maybe their only way of contact was going to a daycare center in the afternoon, or community center. And a lot of retirees, you know, their only engagement was a faith-based worship center. And now that all of those are closed, how can they still connect to what they’ve always loved, and some may not have these robust family networks or friends, and they feel the most isolated. So we were really trying to find digital resources, whether it’s music performance, or your local Meals-on-Wheels that’s delivering, just to kind of have it all in one place. Because there’s a lot of information coming out daily, and we were trying to just be concise and have it all in one location.


Dr.  Wendy Slusser  13:01

That’s terrific. I really am grateful for you for doing that. I’m going to make sure that everyone knows about that in my network. Having thought a lot about some of the suggestions that you just made and others have in terms of trying to keep connections not just for people in the older population but in general, many of these sort of standout for all of us. I was thinking, using the observation of my 91-year-old father. When my mom passed away in November, we noticed that he was mostly sad and missed her lot at mealtime. And mealtime, of course, we know is a very important time for all age groups to sit around and talk. And so I was thinking that could be also a suggestion even if you’re not on Zoom. If you just are on the phone, if you’re using mealtime to talk to your loved one at mealtime might really enhance somebody’s well-being and then they can go on their merry way in between mealtimes. The other thing was music. You know, we have a podcast about music and how it really enhances your well-being through the limbic system. And I know the research that Oliver Sacks and others have done around music in the neurological system and how it promotes healing, it’s considered to be very soothing and actually promotes improved neurological function with people with Parkinson’s and Alzheimer’s and so forth. But also, playing music that you are familiar with, like that you grew up with, also enhances the well-being of older folks. So what other things would you give like those sort of tips that you would give people to help their family members or themselves?


Ayesha Dixon  14:40

So I think, thinking of where we are in the middle of COVID-19, and I heard it mentioned on TV, that this is not only an economic recession, it could also be a social recession. A lot of people are dealing with not having the connections that they used to have and you know, the collapse in social contact is going to be ongoing for a few years. People may not ever feel comfortable getting in large groups again. So we’re really trying to support new and existing channels of that peer-to-peer community-building by thinking of music, thinking of art, and even meditation. There’s so much stuff in the news every day, every hour. And we’ve been telling folks, you know, if you must watch the news, maybe once in the morning or once in the afternoon, just to give yourself some relief from all the stress that’s going on in the world. And we’re promoting a lot of art that’s for stay-at-home, the different music that people can watch, L.A. opera and the Met, and just providing other opportunities so that they can live on a day-to-day basis with having art. Art and music are definitely two programs and resources that bring together a lot of people. Music is one thing that people can think of, and it just transports them to a moment in time from their childhood or their midlife, to a moment where they were happy, or a really good memory of a loved one and family member. So we’re doing a lot of encouraging of people to seek out different music venues, check out the online concerts, and to play music just so that you can have something that’s not the news because it can be very, very intense to watch it all day.


Dr.  Wendy Slusser  16:22

That is true. We give a lot of advice about the news diet. That’s important. You know, I think routines has been a really important theme throughout our podcast in terms of what people should be doing. And I was thinking about that routine that helps people cope and I was getting back to the family meals. I feel that, or mealtime in general, that there’s so many rituals and routines that you can keep that are associated with mealtime. And it’s almost like an opportunity to share from our older population to share the the traditions of their own rituals around food with others. So what would you leave our listeners with in terms of advice, or what you think the pearls of wisdom would be in your profession for the older population, and those people who are caring for the older population?


Ayesha Dixon  17:17

I think, you know, speaking in reality terms, the effects of loneliness can be overwhelming. The elderly are already dealing with a lot of other health factors and risk factors. So if the smallest communication can be a phone call, or teaching them FaceTime, or a text message, to just in the meantime, keeping them engaged and keeping that social interaction. The longer we have social distancing, the bigger impact isolation will be. It’ll be that much harder to reestablish those connections. So the connections are ongoing throughout this time, whether it’s once a week, twice a week. I’ve always had in my calendar, I always call my grandmother at three o’clock on Sundays, and now it’s becoming twice a week. But because we want to keep their physical environment safe and healthy, and offer those supportive services that can make sure we have this. I always call it an age-positive narrative so that way, we can focus on the positive parts of aging and longevity, and doing things that we can do now, and be able to have our retirees start exploring things they maybe never would have in the past. So it’s definitely a small step to address isolation. But it’s substantial to people who have never had an iPad before, or have never known what Facebook was, or Twitter, or Zoom. And these are the very small things that we could, you know, start. This might be a whole new, exciting venture for someone who’s never been on Facebook, and now they have time to learn the application. And it’ll definitely be able to help people to combat any sort of fear they have with social distancing, and not being able to see their friends and loved ones.


Dr.  Wendy Slusser  19:08

Ayesha, these wisdoms are really, really helpful. And we’re so lucky to have you at UCLA. It’s a work that you’ve been doing for years, but now it’s probably accelerated to a very high point. But thank heavens someone with your experience and and expertise is guiding our retirees and and others in our community. And so thank you for all you do.


Ayesha Dixon  19:35

Yeah, it’s been a great experience at UCLA and working with our retirees and seeing how this position has evolved and can evolve. We’re working with possibly getting a Twitter account so we can send out updates regularly. And if we get that set up, it’ll just be another channel where we can reach out to folks because now they’re going to be Twitter experts. I mean, we’re going to be learning everything in real time. So this position has always been working with seniors who are very heavily reliant on paper and telephone calls and faxes. And this is a new genre for them, having to email ,and send a text, or use Zoom. If I’d known years ago, Zoom is going to be what it is now, maybe we all should have bought stock in Zoom. So it’s definitely a new horizon. It’s very exciting to re engage with our seniors who, at UCLA, our senior population ranges from 55 to 103. So, we have a gamut of everyone who is on technology and their grandkids help put them on, to people who don’t even own a computer. So we’re trying to make sure we can reach out to people as much as we can during this really, really difficult, stressful, I keep hearing unprecedented a lot but which it is, it’s a very surreal time to live in 2020. Who would have thought this is where we will be in March and April?


Dr.  Wendy Slusser  21:07

Well, thank you so much, Ayesha, again, and look forward to working with you virtually and then in real life, I suppose.


Ayesha Dixon  21:18

Absolutely. Take care, you too.


Dr.  Wendy Slusser  21:22

Thank you for tuning in to Six Feet Apart, a special series of the Live Well Podcast. Today’s episode was brought to you by UCLA’s Semel Healthy Campus Initiative Center. To stay up to date with the rest of the episodes in this special series, and to get more information on maintaining your mental, social, and physical well-being during COVID-19, please visit our website at healthy.ucla.edu/livewellpodcasts. Thank you and stay remote.