Meet the Solutionists, with Mark Scott

Why’s it so hard to be healthy? Why does everyone recommend a Mediterranean diet? Is diet or exercise more important? Is intermittent fasting actually useful? 

When the entire world’s collective knowledge is at your fingertips, why’s it still so difficult to answer the kinds of questions we’ve been asking for millennia? Nutrition and longevity expert Luigi Fontana says it’s because nutrition isn’t as simple as we’d like to think. 

Food is complex; it’s deeply tied to our emotions, our health and our sense of culture and community. How you eat is also influenced by a wider food system, one that profits most from the kinds of ultra-processed food Luigi recommends minimising. 

So, what should you eat? 

Luigi shares the results of his groundbreaking experiment, in which he’s investigating what a more proactive and holistic healthcare system could look like. He teaches you the core principles he teaches the subjects of that experiment, and introduces you to Marzio Lanzini, the Charles Perkins Centre’s chef-in-residence. 

If you want to dive deeper into Luigi and Marzio’s work, visit the CPC RPA Health for Life Program’s website. And if you want to make Marzio’s lentil Bolognese, you can find a video walkthrough here.

Mark Scott  00:01

This podcast is recorded at the University of Sydney's Camperdown campus on the land of the Gadigal people of the Eora nation. They've been discovering and sharing knowledge here for 10s of 1000s of years. I pay my respects to Elders past and present, and extend that respect to all Aboriginal and Torres Strait Islander people.

Marzio Lanzini  00:27

So welcome to my kitchen. It's something between a commercial and a home kitchen. So we have a cooking area, and here a long stainless steel bench where I do most of my prep work. I do like to keep it very minimalistic, so that there is a lot of bench space to work on. My name is Marzio Lanzini, I'm a chef, and I work at the Charles Perkins Centre in Sydney Uni. My job is to try and get some of the nutrition science involved in the project of Health for Life into manageable and practical nuggets in the form of workshops and videos, blogs for users to be able to then put into their life and change the way they eat. My background has been mostly in fine dining. I started my culinary journey quite early in my parents restaurant, and then got inspired to cook into higher caliber kitchens around Europe and eventually in Sydney. It is quite strange to be a chef inside the University, especially a building like the Charles Perkins Centre that is dedicated purely to science and medicine. At the beginning, I was a fish out of water, but I think with enough content now going out, it's becoming a bit more familiar and part of the family, so to speak. Today I want to share a dish that is not only nutritious, but familiar to most people, and also still very delicious, despite taking out some of the core ingredients of this dish. It's a lentil bolognese. The reason I use lentils is because they are high in vegetable protein. A lot of Italians will raise their nose at lentil bolognese served with wholemeal pasta. But I think their opinion changes when they taste it.

Mark Scott  02:31

What does a regular day look like for Australian adults? You might wake up just in time to get ready for work. If you have breakfast at all, it might come out of a cardboard box. You're probably chugging caffeine instead of water, which continues for your long work day spend in a polluted city center. If you've got time, you might swing by the gym on the way home, and then it's a few glasses of wine after some takeaway food and then off to bed. Fundamentally, this isn't working. Most people over the age of 65 have at least two chronic health conditions, which are probably avoidable. And some believe if we don't get these conditions under control, healthcare will be so expensive that by 2050 countries won't be able to fund anything but healthcare. So what do we do? Enter Luigi Fontana, who wants to redesign the way we live. Luigi is a Professor of Medicine and Nutrition at the University of Sydney. Now, Luigi, you wanted Australia's approach to healthcare to change quite dramatically, and you've run a trial to see what it might look like. Tell us about the Osana experiment.

Luigi Fontana  03:41

So the Osana experiments is composed of three big elements. One is a preventative medical approach, using basically lifestyle medicine, together with health assessment, chronic disease planning, and then patient activation is very important to activate the patients you know, to take care and control of their health and data science with the gamification to make the process more fun.

Mark Scott  04:12

So to keep the patient engaged in the process of preventatively looking after their health, learning, yes, so what do we need something like the Osana experiment? What are we trying to replace or update?

Luigi Fontana  04:23

Because typically, you go to the to see your doctor when you are sick, when you already have a disease, instead of we think you know you should go to your doctor 10, 15, years before you develop a disease. And it's very easy at that point, you know, to bring back the values to the normals, and therefore stop the accumulation of metabolic molecular damage that is leading to multiple chronic diseases.

Mark Scott  04:46

So this is really preemptive medicine intervention, getting ahead of it and on the specifics of the metabolic diseases that you, in a sense, could anticipate and intervene to stop. What were you seeing there, as far as improvements were concerned?

Luigi Fontana  05:02

There were improvement in all the cardiometabolic risk factor, cholesterol, blood pressure, glucose and many others because typically we think that cancer, dementia, cardiovascular disease, liver disease, kidney disease, they are separate disease, and they are if you wait them to fully develop. But you know, what we found in the biology of aging field that you know I help funding, is that many of these common chronic disease, they share a common metabolic substrate, and so if you work well in advance, you are preventing all of them together. So breast cancer, colon cancer, diabetic nephropathy, vascular dementia, fatty liver disease, stroke, coronary heart disease, they are the same disease in some way.

Mark Scott  05:53

So how many patients have been involved in this so far? Luigi: It was 6000 patients. Mark: And what have you seen?

Luigi Fontana  05:59

So the striking effect was a 51% reduction in hospitalisation. 51% reduction in hospitalisation is huge. So basically, it's in this it was a saving of $9 million per year, if you save it up at the national level, we are talking about 30 billion saved per year.

Mark Scott  06:28

So it saves money, but it sounds like it would cost quite a bit up front. How much does it cost per patient to be involved with this?

Luigi Fontana  06:35

You're right. The cost, basically, it was much higher than, you know, the usual fee for service primary care that is, on average, is $500 per person. Sort of, with this model, it was $2,000 per person. But because, on average, basically, if you get admitted to the hospital in Australia, is around $6,000 then you see that, you know, you're going to have a huge savings.

Mark Scott  07:01

The savings then then come to bear. And what have health authorities said to you about the kind of outcomes that you've seen and published on the back of this?

Luigi Fontana  07:10

Everybody's excited, but it takes a lot of energy to change a system as you know, you know, something that is basically for decades, or more than decades has been the norm. I mean, ideally we should redo this experiment, because this was done in a high SES. Now I think it will be nice to repeat this one in a low SES and see the results, how much we can save. And you know, yes.

Mark Scott  07:39

Works for us all demographic backgrounds, particularly those demographics which have poor health outcomes to start with, right? In talking with you, I know you're very interested in food and in cooking, and that's part of the strategy here of this program, isn't it, training people how to eat in a way that's really beneficial to your health. What makes food so important in preemptively warding off bad health?

Luigi Fontana  08:12

Before I joined the University of Sydney, I worked for 18 years at Washington University in St Louis. That is one of the top medical school in US, and there I started basically calorie restriction with optimal nutrition is the most powerful intervention to delay aging. So in animal models, you can increase lifespan up to 50% it's like if a human being, instead of living 80 years, would live 130, 140 years in good health. So there is no doubt, you know, if you envision like a chess game, nutrition is the king and exercise is the queen.

Mark Scott  08:52

Now, remarkably, we've got a Chef in Residence at the Charles Perkins Centre. What does Chef Marcio work look like?

Luigi Fontana  09:01

Well, you know, we have this crazy idea that if you prescribe a diet to someone and you say, you know, you have to eat more vegetables and fish and legumes and whole grains, most people have a very loose idea of how to put together a healthy, tasty meal, because the idea, you know, eating healthy means eating, you know, boring food is not true, and Marcio is working with me to redesign some of these healthy cooking recipes, and we are going to schools because I'm convinced that one of the other key factors to make our healthcare system sustainable and our nation more healthy, basically, is also education. We should basically teach, starting from year one for the and even the University. I believe that every student, even if you are a law student or a business student, you should have a solid understanding of healthy nutrition, healthy exercise, stress reduction, good sleep, all these factors that are essential for every human being to stay healthy, to be more functional, more proficient, more creative.

Marzio Lanzini  10:23

So I'm going to pull together all the ingredients, we have some vegetable stocks, some lentils, red split lentils, which I soaked last night, some chopped crushed tomatoes, chopped onion, walnuts, miso paste, tomato paste, olive oil, carrots and celery. The ‘aha’ moment for me in in this journey to more nutrition and healthier cooking has probably been this bolognese, simply for the fact that I do come from a family with generational pride in cooking bolognese and being able to do one that still passed the mama test was a big ‘aha’ moment for me. I used a couple of smart tricks to get around the lack of texture from meat and the lack of moreish umami mouth filler and flavor that comes from mince meat, such as some crushed walnuts for texture and the so called secret ingredient, which is miso paste. So it allows you to add salt to the dish, but at the same time, it comes with a lot of umami and some nutrition as well. The problem with the way we eat today is the ultra processed food is very high even in young children, from packaged breads and, you know, yogurts and all these premade items, other than being very harmful to the environment, for the packaging and all that. The aim for these companies is obviously to make them as cheap as they can, as flavorful as they can. And nutrition doesn't really come in, other than it being a marketing stand and a way to get you to buy to make you think it's healthy. The processing levels of food have definitely changed the way we eat. Convenience is the dangling carrot, and time restraint is what kind of closes the loop. I think, that with a little bit extra knowledge on how to cook these ingredients in a timely fashion and organise a week, and also knowing that at the end of that there is a tasty meal and not something that you kind of don't really want to come home to, makes it realistic to eat healthy and still cook with real produce. It's just that we have kind of forgotten and moved away from it so much that it seems like such an uphill struggle to get back to it, but in small steps, I think, especially starting with the younger generation and in schools, I think we can get there.

Mark Scott  12:51

Part of what I would suspect is that, you know, people are just wanting to be able to make food quickly and convenient. I mean, fast food is enormous now, but take away food or prepackaged food and the like. To what extent are you concerned that convenience is standing in the way of health?

Luigi Fontana  13:08

Ah, yeah, we know that, you know, ultra processed food is a major problem. In there are studies in US where 60% of daily calories of children is from ultra processed food. So believe it or not, in Australia right now, these are data from the government. 25% of children between two and 17 years of age are overweight or obese. 54% of men and women age 24 to 35 they are overweight or obese. Can you guess you know men aged 45 to 54 in Australia, how many they are overweight or obese? Try.

Mark Scott  13:50

I would hate to think, tell me.

Luigi Fontana  13:52

82.9%. 83% of men aged 45 to 54, according to governmental data, they are overweight or obese.

Mark Scott  14:02

But that would be the highest figure ever in recorded history, wouldn't it? Luigi: t's getting worse. Mark: Luigi: Yeah, it's getting worse. Mark: So why is it getting worse?

Luigi Fontana  14:12

Because of this ultra processed food, very low consumption of vegetables. You know, when I was in US, there was this, you know, that for people, vegetable was ketchup and potatoes, okay, and no beans, no whole grains, a lot of refined processed grains, lots of animal products, alcohol, high calorie in alcohol, No exercise, very little exercise, all these factors together, basically are promoting these, I will say, pandemic of overweight or obesity and unfortunately, centrally located fat, the fat around your stomach, basically your abdomen, that is producing all these hormones that are causing insulin resistance, hyperinsulinemia, inflammation, and these factors are the main factors that are driving aging.

Mark Scott  15:09

One of the strategies you recommend for better health is to consume a predominantly plant based Mediterranean like diet. Tell us about the origin story who discovered that the Mediterranean diet is King.

Luigi Fontana  15:22

Ancel Keys, basically, was the first scientist who went to south Italy, and he found that, basically, after World War second, cardiovascular disease was non existent. Nobody was dying of heart attack. And he was surprised, impossible. In US, where I'm coming from, you know, people, they are dying like flies of heart attacks and in south Italy, there were no heart attacks. And then he started to study the Mediterranean diet and the cholesterol, blood pressure and other factors that was responsible for these preventative and now we have many, many randomised clinical trial confirming that, yes, a Mediterranean like because, you know, Okinawans and other in China, in other region of the world, you can have the same ingredients with different taste, different type of varieties. It's promoting health.

Mark Scott  16:20

And it's almost like there'll be a version of that diet that works for you but has the same medical benefits. But when you grew up in Italy, was this the diet that you grew up eating?

Luigi Fontana  16:29

Yes, yes, exactly. And by the way, my father is from north Italy, so he has a typical North European diet. In fact, you know, in the family of my father, there is a lot of heart attacks, a lot of problems, stroke, because being from north Italy, meat, butter, milk, pork was very heavy instead of my mom is from south Italy, from Calabria, and there food was lots of different type of vegetables, whole grains, beans, fish, no refined processed food. And there is a huge difference in health.

Mark Scott  17:06

And when they married did your mother control the diet after that point? Luigi: Yes, yes. Mark: How important is food in a family? And a family, in a sense, prioritising food and eating well together, and as your mother taught you how to eat, your responsibility to generations ahead.

Luigi Fontana  17:28

It’s extremely important. You know, the social aspect of eating healthy food and cooking healthy food, learning how to cook healthy food, it's extremely important. It has also this sense of belonging, of family, of traditions, because at the end of the story, you know, we try to imitate what other people do. So if we really want to make a change in our society, that's why education and change in the primary health care model is extremely important, because then people, they tend to imitate. Think about smoking, you know, 50, 60 years ago, every single male was smoking. Nowadays, it's, I don't say it's completely eliminated, but you know, very few people that I know are smoking.

Mark Scott  18:14

It strikes me there's this gap between the world you articulate and the world that you actually experience, and what your research says is wise to the lived experience of so many of us in Australia with the high levels of obesity that we've already talked about. One way that people have attempted to lose weight is through intermittent fasting. That's been a phenomenon over the last decade, five/two, diet, time restricted diet, if we know we need to eat better and to lose weight, and that's a driver of our improved health. What's a wise approach? What's a good start? What should we be thinking about?

Luigi Fontana  18:51

First of all is exercise. Without exercise is impossible to sustain a healthy weight. And the reason why we published that is when you lose weight with diet, you lower the thyroid hormones, and you lower your rest metabolic rate, and you lose muscle mass. And then once you get tired, you get off the diet, you regain your body weight with interest, but you regain mostly fat, not the muscle.

Mark Scott  19:24

So let me see if I understand that, if you simply reduce your calories Luigi: With diet. Mark: With diet. Luigi: Any diet. Mark: You get tired, worn out, lose willpower, can't sustain the diet.

Luigi Fontana  19:38

You lower the rest of metabolic rate, because you lower the entire hormones, and therefore, basically, by lowering your metabolic rate, you are basically due to regain the weight. Instead of if you exercise, you keep your resting metabolic high, your schedule muscle is fit and you have more mitochondria that are these organelles that are burning calories, that are pumping.

Mark Scott  20:04

So it's not the exercise helping you lose more calories, but what the exercise does to your metabolic resting, right?

Luigi Fontana  20:11

Absolutely. We did a study where a lot of people, they think, you know, exercise can help you maintain your body weight, but cannot induce weight loss, or at least consider a weight loss. We did a study in US when I was in US and exercising one hour a day, six days a week, at 72% of your maximal heart rate resulted in a 8% weight loss in a year, but most importantly, a 40% reduction in abdominal fat,

Mark Scott  20:47

Incredible. What about intermittent fasting? Are you a supporter of that?

Luigi Fontana  20:51

Think about an orchestra. If I ask you. You know, I want to play Mahler Fifth Symphony, but I only want to use one instrument, no way. You need all the instruments in the right balance, each one playing their own parts, and the director then is putting them together to have this beautiful symphony. So if you want to lose weight, the five/two diet works, but I can just feed you with bread and water, and you're going to lose weight, but you're going to die of malnutrition in three, four years. So again, health and longevity, not weight loss. Health and longevity is a symphony, and there are different elements, components, ingredients, that each one of us, because each one of us is different, and therefore, you know, we have to design our best cocktail of interventions that is gonna help us to achieve these optimal health and longevity and wellbeing, because It's not only metabolic health, physical health, but emotional health and spiritual health are as important as basically your physical and metabolic health.

Marzio Lanzini  22:13

Okay, I'm gonna turn on my stove on medium. Start with the olive oil. Once it's nice and hot, we're going to add our onion, garlic, star anise, celery and carrot. We want to put the vegetables till they get a bit translucent, but we want to be careful not to burn the garlic. The reason we put star anise in this dish is because the flavor molecules that come from star anise react with Allium such as onion and garlic to create more meaty flavors. At this point, we can go in with our tomato and use a paste. When I cook this for a couple of minutes, being careful not to get anything stuck to the bottom of the pot, and then we're going to deglaze with the white wine. Smells beautiful. You do want to get as much of the white wine reduced, to get as much of the alcohol out, but it does do for a great scent in the kitchen. Developing the recipes with the nutritional concepts that that we have to uphold is a little challenging for a chef that comes from a commercial background. In commercial cookery, you're all about making it tasty, but here there are certain ingredients that you want to minimise and other ingredients you want to maximise. So what I try to do is obviously minimise any added sugar, minimise on animal proteins, and minimise on salt, which I have to say, salt is probably the hardest thing to minimise, especially for someone that likes salt, like myself, there's no way to get around it. You just have to adjust your palates to like things with less salt. But there are ingredients that you can use and be smart with, such as miso, fermented products, products that are naturally rich in umami, such as pecorino cheese, parmesan cheese, tomato that has been cooked for a long period of time, which develops umami in itself. This gives you the feeling of something that is moreish and almost salty without it actually being salty.

Mark Scott  24:41

Luigi, you're an eminent researcher in this field. You're a well known global speaker on these events. You're a published author. But one of the things in this era is that everybody has an opinion, and so if I go on YouTube or Tiktok, there are all the influences with all the advice. Are you worried that whilst people are more and more desperate for knowledge around these areas, that quality knowledge is harder to find amidst all the noise.

Luigi Fontana  25:09

Absolutely, there is a lot of noise on socials, and it's dangerous, because most people are ignorant on even understanding what are the results of a epidemiological study versus a randomised clinical trial. Preclinical study in yeast, worms, rodents versus a trial in humans. Is this study powered enough or not? People don't understand so they just read the title, or maybe the results, the findings, and then you they conclude that you know something is doing. But they don’t have, they don't have the understanding. They are not able to read a scientific paper. They are not able to understand, you know, their study with 20 people is not powered to give you a solid answer to your question, and so that's why you know what we are doing here at the University of Sydney is extremely important, because not only we are trying to help both students and patients to understand how they can use this beautiful instrument that is a healthy diet, healthy cooking, exercise, how you use your mind, you know, to promote your health, but also the instruments to read data, so that when someone on socials tells you that you know this diet saved my life, the question is, tell me, where are the data?

Mark Scott  26:37

Luigi, there's an old line ‘Physician, heal thyself,’ I can just tell you, You are the embodiment of all that you you speak, and I know in the previous conversations that I've had with you around the University, this is a real passion for you, and you really feel like you have these tools, this evidence in your hands that could make a transforming difference to so many people, if they can learn what the research has taught you.

Luigi Fontana  27:00

Absolutely, and it is also going to make a major change in the sustainability of our nation, because otherwise we're not going to have enough financial resources to provide a high quality care for everybody.

Marzio Lanzini  27:19

At this point, it's already starting to look quite delicious, but most of the wine has evaporated. We're going to go in with the rest of the ingredients being the lentils, the walnuts, the thyme, balsamic vinegar, chopped tomatoes and vegetable stock. From here, we just let it simmer for about 30 to 40 minutes until it's ready to go. This is now thickened up nicely. Let's have a taste. Delicious, I don't even need to add any salt. All we need to do now is toss it through some pasta, and we have a delicious meal.

Mark Scott  28:10

I'm Mark Scott, Vice Chancellor of the University of Sydney, and that's Marzio Lanzini, Chef in Residence at the Charles Perkins Centre. And I've been talking to nutrition and longevity expert, Professor Luigi Fontana, and you can head to the show notes if you want to see any of Chef Marcio healthy recipes and learn more of the programs available at the Charles Perkins Centre. If you enjoyed this episode of The Solutionists, make sure you stroll back in your feed, because we've got plenty of episodes for you to listen to right now, and if you want to hear about the solutions to everything from heat stress to eating disorders, follow The Solutionists in your podcast app right now. The Solutionists is a podcast from the University of Sydney produced by Deadset Studios. This episode was recorded at the Faculty of Arts and Social Sciences media room, and our thanks to the technical staff here.

The Solutionists is podcast from the University of Sydney, produced by Deadset Studios. Keep up to date with The Solutionists by following @sydney_uni on Twitter, Facebook, and Instagram. 

This episode was produced by Liam Riordan with sound design by Jeremy Wilmot and field sound recording by Max Petrovic. Executive producer is Madeleine Hawcroft. Executive editors are Kellie Riordan, Jen Peterson-Ward, and Mark Scott. Strategist is Ann Chesterman. Thanks to the technical staff at the Faculty of Arts and Social Sciences Media Room. 

This podcast was recorded on the land of the Gadigal people of the Eora nation. For thousands of years, across innumerable generations, knowledge has been taught, shared and exchanged here. We pay respect to Elders past and present and extend that respect to all Aboriginal and Torres Strait Islander people.