Food Is Medicine: How Doctors Can Prescribe Food For Chronic Disease - Transcript

Introduction: Coming up on this episode of The Doctor's Farmacy.

Mark Walker: There's millions of people that qualify for these benefits nationwide right now, but almost nobody knows about it. I honestly have not talked to a doctor to date that is aware that they can actually prescribe meals.

Dr. Mark Hyman: Welcome to The Doctor's Farmacy. I'm Dr. Mark Hyman. That's farmacy with an f where we have a place for conversations that matter. And if you've heard the term food is medicine, you're not sure what it means or why it's important, or how it actually is the solution to our healthcare crisis and our obesity crisis, our chronic disease crisis, pretty much our economic crisis, I think you're going to like this podcast, because we're going to talk about the nitty-gritty of what is food-as-medicine, how do we actually prescribe food as physicians into the healthcare system, and what will that mean for the health of our nation and even the economics of our healthcare crisis, which is now insane? I mean, we're now at $4.3 trillion a year in healthcare expenditures in our nation. In 2000, it was $1.4 trillion, and it's expected to be over $7 trillion by the end of this decade.

So today we have with us Mark Walker, who's the Chairman and CEO of Performance Kitchen, which is a leading food-as-medicine company that's revolutionizing US healthcare systems. It specializes in use of medically-tailored meals, and we're going to explain what that is, to treat chronic disease. Mark is one of the leading experts in the country on the new industry of food-as-medicine, which is the application of healthy food paid for by the US healthcare system. Imagine that. Having your food instead of drugs paid for. Mark is a CPA and founder of Dugout Ventures, and athlete-based investment group with Hall of Fame baseball players like David Ortiz, Nolan Ryan, and Barry Larkin. So welcome, Mark.

Mark Walker: Thanks, Mark. Good to be here.

Dr. Mark Hyman: Great to be with you. So just full disclosure everybody, I'm a massive believer in food-as-medicine. I have been involved in this space a long time. I'm an advocate for it with my Food Fix campaign, working on medically-tailored meals, bills in the Senate and Congress, and I'm also an investor in Performance Kitchen, because I believe that we need to create models where we can actually prescribe food, not just, "Oh, we're going to eat healthy food," but literally prescribe food as medicine, which requires us to have different medicines for different problems. What I'm going to prescribe for somebody who's obese is different than I'm going to prescribe for an athlete or different from what I would prescribe to someone who's got an autoimmune disease or digestive disorders, and it's literally as granular as dose and milligram and drug in pharmacology. So we really need to understand a way for us to commercialize that and get meals made that can be delivered to people to treat chronic illnesses in a targeted way that gets results.
It's really not just about the general idea of eating healthy. And I always say if you have a headache, a milligram of aspirin doesn't do much. Say, "Oh, well, you eat better, and we'll see if it cures your diabetes." Well, that doesn't really work. What is the diet to cure diabetes? So I want to get into this with Mark and share, but I just want to be in full disclosure that I'm an investor in Performance Kitchen, because I think we need more companies like this doing this type of work and pioneering this in ways that are really tough and that require rolling up your sleeves and getting in the trenches and doing the hard work. And Mark has really been doing that.

So Mark, would you start out by telling us what is the big picture state of our current state of our food and healthcare system, and what are the opportunities and the challenges that we're facing around solving for our poor healthcare outcomes?

Mark Walker: Yeah, so first of all, thanks for having me here. As you already mentioned, we spent $4.3 trillion a year on healthcare in this country. It really is an astronomical number. Just to put it into perspective, that's higher than the GDP of Canada and Italy combined. It's a big number. It's 20% of our GDP, and our GDP outstretches everybody else's. But it's hard to even conceptualize what that means.
So what's crazy about our system is that I wouldn't even call it a healthcare system, because it's really not. It's a sick care system. Now, look, before we start throwing shade at people, it's an unbelievable sick care system. We're exceptional at treating the result of the underlying problem. We are. I mean, good examples of this, I just talked to a buddy of mine the other day, and he goes, "I was just talking to my dad. He's got a pacemaker in his heart." Let's just stop for a second and realize how fantastic that is that we can actually put a pacemaker in our body. My father had open heart surgery, and unfortunately, I'm not a physician, so I can't stomach seeing that, but I heard about it, and it's one of the most, I'm sure you've seen it, Mark, it's one of the most amazing things.

Dr. Mark Hyman: No, it's impressive. Yeah, I mean, I had atrial fibrillation, and I had two five-hour surgeries where they put giant catheters up my groin, mapped out my heart with various electrodes, and I mean, did this incredible surgery that cured me, and now I'm riding my bike 25 miles a day up in the mountains of Greece and mountain biking and having a great time. So yes, it's really important that we don't minimize the benefits of our sick care system, but it is not a healthcare system.

Mark Walker: That's exactly right. It's not, and just to put it into perspective, of that $4.3, and you probably know this better, I think it's 95% that's spent on sick care. Once there's a problem that occurs, we're exceptional at doing our best to fix the problem. It's just the problem is we get to that point where we're spending $4.3 trillion a year. And honestly, this is what drove, I'm not a physician, I'm not a healthcare guy, what drove me into the space was that graph, and we can put it for your audience in the show notes, but it's an unbelievable curve. The graph looks like this. We went from 5% of GDP in 1960 to 20% today. It's an unsustainable trend, and to your point, it's only going up. So it really is a massive issue in the industry, which most people are just not aware of.

Dr. Mark Hyman: Absolutely, and I think we are really facing a crisis point where we have to do something different. And I think it's exciting to me, because I used to say food is medicine, and I would get laughed at at medical conferences and by my colleagues, and they're like, "Yeah, yeah." And when you have a real problem, you need real medicine.

Mark Walker: That's right.

Dr. Mark Hyman: And my argument is that food is real medicine, and that it actually is more effective most of the time for chronic disease than pharmacology. And you can do things with it you can't do with drugs. For example, I can't reverse type two diabetes with medication. There's just no way to do it. I can manage it, I can control your blood sugar, but I'm piling all kinds of pills and injections, but I can cure your diabetes, type two diabetes with food and lifestyle. So it's far more powerful. Autoimmune disease is the same thing. A lot of diseases are managed, but food actually has a powerful ability to transform things when you know how to use it properly. And it's not just how much calories you're eating or are they eating more fruits and vegetables or levels of carbs or fat or protein. It's really much more nuanced than that.

We've really now reached a point where there's a food-as-medicine caucus in Congress. There's two food-as-medicine and medically-tailored meals bills in Congress. There's the Rockefeller Foundation spending $250 million to fund research on food-as-medicine. There's universities popping up all over the place to deal with this. Tufts University has just stood up an institute for food-as=medicine. So this is actually really coming along very fast compared to how it's been for the last 25 years that I've been doing this, and we've both been advocating for this for a long time. Can you give us an idea of how this concept of food-as-medicine could work in our healthcare system and what are medically-tailored meals exactly, because I don't think people know necessarily what that is?

Mark Walker: No. So to address the how does it work issue, so the first issue that we have to deal with is that $4.3 trillion industry. Just realize that there are players within that industry right now that don't have an enormous incentive to change. But it's a challenge, because if you look at the numbers on inflation, areas of inflation in the country, hospital costs are the number one area of inflation over the past 20 years. So there's an incentive for people to just keep the same system afloat, and there's a lot of experts out there that feel like the existing healthcare system just cannot handle it. It's going to collapse under the weight of the cost, and there are states dealing with this right now. And so that's the biggest issue is that the existing system isn't incentivized enough to change itself.
Now that being the case, that doesn't mean it's not ripe for disruption. What's happening right now is a lot of articles about retail actually getting into healthcare. And it's an interesting conversation, because as we get further and further down the road of social determinants of health, and I don't know if your audience is familiar with that concept or not, but social determinants is the concept that 80% of our healthcare has nothing to do with the healthcare system. It has to do with daily living activities, like transportation and housing and food. And the challenge is all of these issues the existing healthcare system doesn't handle. But it's interesting when you start looking at the retail space, when you've got groceries or Amazon or CVS where people are walking into these retail locations once or twice a week, and these groups, massive retail organizations, are now diving into healthcare. And it's really interesting to look at the broader macro aspect of that, of what's actually happening.

And we just announced our partnership with Kroger. This is where it gets really interesting because Amazon, CVS, Walmart are all getting into the space, but they're getting into it by buying existing companies that are healthcare providers and trying to deploy that throughout the existing system. Kroger's doing something a little bit different. They're using food as the largest grocer, traditional grocer in the nation as a replacement or an enhancement of existing healthcare. Now that's a really interesting move, but it's not coming from the existing system, it's coming from outside of it.
So as far as ... Well, let me stop real quick, because I meant to do this at the beginning, but I haven't. And you said you were laughed at at conferences in the past 25 years. I've got to personally thank you, because where I sit today is largely because of you.

Dr. Mark Hyman: Well, I don't know about that.

Mark Walker: And I know you to be humble about it and whatever else. And I know personally that's the case, and here's the reason why is when I got into this space five years ago, as I told you, I was just looking at the math. I'm like, "Hold on. Time out. This is unsustainable. This is going to bankrupt our country." And then I dove in and started looking at it, and where I got was I started looking at crazy people like you. I was one of those doctors saying ...

Dr. Mark Hyman: Thank you. I take that as a compliment.

Mark Walker: No, and seriously, I read every book and I'm like, "Hold on. Maybe he's not crazy. Maybe he actually knows something that everybody doesn't." And now that I've dove in the past five years, I'm absolutely convinced of it. And it's not just you, but I honestly don't think we or hundreds if not thousands of others would be here without your advocacy over the past 25 years. So thank you for doing that.

Dr. Mark Hyman: Thank you.

Mark Walker: Honestly, on top of that, I'm now in your boat where I see everything as clear as day, but I'm having to preach and tell people, and they're not believers, and it's just a weird, and I can't imagine spending 25 years in that space. Like you said, I've got the momentum of Congress and companies now saying, "What is food-as-medicine? What is this concept?" So the momentum is absolutely there.
You asked another question of what is food-as-medicine? It's an actually interesting term, and you've developed it as a healthy food concept where it can actually be applied as medicine. We actually extend that one step further and say it's not only that, but it's actually somebody else paying for it. And that, we think, is a crucial, crucial component of the overall equation. And one of the reasons why is, as you know, eating healthy is not easy, and it's not cheap.
And so what we started looking at is who are the beneficiaries of this? Well, obviously the individual themselves is a beneficiary, but the second-highest beneficiary is the payer, the insurance company, because if they can reduce your overall cost of care, they make a killing, especially with the numbers that we see in the data, which is for every dollar you put into healthy food, it saves about $3 in healthcare costs. So it really is a home run for the payers that get behind it. So that's why, that's a-

Dr. Mark Hyman: I mean, that's a 300% return on investment. That is pretty damn good.

Mark Walker: And what's even more about that, we're not talking about $5, we're talking about $4.3 trillion, that 90% of which, we're talking about trillions. I mean, it really is an unbelievable concept when you start thinking about it. So you, as a medical side, you know all the clinical side of it. I look at it from a math standpoint. I'm like, "Hold on. Time out."

Dr. Mark Hyman: Yeah. You're a CPA. You get the numbers.

Mark Walker: The numbers, and I'm like, "If this guy's even half right, this is one of the biggest industries we've ever seen." It's just math. And not only that, you get the bug of helping people along the way. Right?

Dr. Mark Hyman: It's so true. And so tell us, when people say medically-tailored meals, what do they mean? I mean, there's now two bills in Senate and Congress that are trying to advocate for medically-tailored meals and do research on it, to create a pilot to establish its efficacy. What are medically-tailored meals?

Mark Walker: So just the shortest definition I can give of medically-tailored meal is it is a meal pre-cooked, pre-prepared, designed by registered dieticians, doctors, physicians that have the clinical aspects that are necessary. And in our case, actually from a culinary standpoint, created by professional chefs, because again, we'll get into this in a minute, but the meals don't work if people don't voluntarily take them. And so that's really what it is. And we actually have some expertise as my investment group Dugout Ventures.
As you said at the beginning, I'm partnered with Hall of Fame professional athletes, and if you can imagine medically-tailored meals this way is throughout their career, the vast majority of them have professional chefs and doctors and physicians surrounding them on how to have peak athletic performance. They oftentimes prepare their meals for them. That's all a medically-tailored meal is. The difference is those chefs costs thousands and thousands of dollars, now hundreds of thousands, right? The goal of medically-tailored meals is actually deploy this in a system that's economically feasible that we can get it to people that need it most at their house. And I mean, you're a physician, you've done this for years, with your experience, what would you say out of a hundred people, you could actually cure a hundred of them by feeding them anything you wanted?

Dr. Mark Hyman: I mean, cure is a big statement, but I think we definitely can improve health for a hundred percent, and we could cure a lot of things depending on what the root cause is. So diabetes is close to a hundred percent, getting them to normal A1Cs. People who have severe obesity, I've reversed that so many times I can't even count. Autoimmune diseases, digestive disorders, migraines, skin disorders, mood disorders. I mean, it's pretty impressive.

Mark Walker: So it's remarkable. I mean, what I heard you say is that of a hundred diabetic, cure is probably not the right word. Let's call it reverse it, normalize their A1C. It really is remarkable, because what we just discovered in this thought exercise, if you have carte blanche authority over their diet, you can cure diabetes. It really is a remarkable statement, because what that tells us in this ...
Now, here's the problem with the thought exercise is you can't do that. You may be able to do it with a hundred, but you can't do it with 135 million that are diabetics or pre-diabetics today. And so now it becomes a bigger problem of, "Okay, we've got a drug, food, that's almost a hundred percent efficacy as far as improving the quality of their health outcomes." And here's the important part, with almost no side effects. So now you have a hundred percent efficacy drug with no side effects, but that also shows you the problem with this industry is you can't do that.
People have to voluntarily take this drug two, three times a day every day for 90 days. And that's where the industry really comes in is how do you voluntarily get somebody to take this medicine, which is a drug, on a voluntarily basis, because we've already discovered the efficacy of the drug works almost every time. So it really shows you the problem of the industry of ... I mean, just think about any other pharmaceutical that has that track record. None of them, right?
You know what's funny about this concept is that obviously, we all know the concept of food, but I'm not a doctor, so I didn't know what medicine actually was. So I actually went to the dictionary and looked it up, and it's actually fascinating when you look it up. It's a substance used to treat disease. Just think about that. That's the technical definition of medicine, a substance used ...
So the better question is when did we start defining medicine as what comes in a pill bottle or in a syringe, right? I mean, for thousands of years, food was the medicine, and now it's an awkward thing for us to think about that, "Why are you calling food medicine? It's not medicine, it's food." "Well, hold on. It's a substance used to treat disease." So it really is a fascinating space when you think about it that we can ... I've heard payers, I mean insurance companies, chief health officers, tell me this exact statement. "I believe we can cure diabetes by feeding people." So the momentum is out there, it's just a matter of how do we solve the business problem? And that's really where the issue comes in. How do we solve that?

Dr. Mark Hyman: Well, I want to get into that, because I think it is an interesting issue. How do we sort of break the log jam? There's not a lack of data. Harvard published a whole series of papers that were a review of all the data on showing food-as-medicine's benefits and its economic impact, it's health impact. There's lots of data looking at this. I mean, one of the pilot studies that was done by Geisinger, which I always quote, which is so compelling, which is they took food insecure diabetics, who were very poorly controlled. They gave them basically a year's worth of meals, basically two meals a day for them and their families. I think the price was like, I don't know, 65 cents a meal. I don't know how they did that exactly, but it was healthy food. They gave them coaching support and education.
And basically what they found was in a year, with the most poorly controlled food insecure diabetics, in a year, they found a reduction in adverse healthcare outcomes by 40%, meaning hospitalizations, heart attacks, deaths and strokes. They found a dramatic reduction in A1C at a magnitude bigger than any current medicine on the market. And more importantly, three, they found an 80% reduction in healthcare costs. So the average costs went from $240,000 to $190, sorry, to $48,000, which is $192,000 of savings per patient in a year. That is a dramatic savings.
I mean, you think about the fact that right now one in three Medicare dollars is for type two diabetes, you're talking about literally of the trillion-dollar budget, 300 billion, you're seeing 80% reduction of that, you're talking about over $200+ billion dollars in savings just from this one condition alone. So I think when I hear this and I see this sort of disconnect between where we are from payers and healthcare insurers, from Medicare and Medicaid to where we have to be, it's a big gap. So can you kind of talk about a roadmap for how we get people across the finish line, how we can actually start to leverage these incredible results and the science of the data to actually make this stuff a reality for people?
Because I think many people don't know how to cook, they don't know how to shop, and it's not just giving them meals. It's like you say, you can give a man a fish and you can eat for a day. You can teach a man a fish, and you can eat for a lifetime. So it's part of it's like giving them a fish right now so they're not starving and fix the problems, but then educating them actually on how to implement this on their own after.

Mark Walker: Well, so what you just brought up is actually one of our core philosophies. So medically-tailored meals are unbelievably effective, but one of the reasons they are effective is because they don't have to educate as a prerequisite to getting healthy, and that's a crucial, crucial component of this. However, back to the teach a man-to-fish concept, I'm a big believer that medically-tailored meals should be a short-term intervention. They should not be a lifelong benefit for the exact reason that you described is that they're unbelievably effective over a short period of time. But when you start becoming reliant on them, it's a different equation. So I think there is an educational component that's necessary as part of it. So in Club Hyman, you don't actually have to educate everybody. If you just feed them for 90 days, they will get better, but they're walking out of there without any education whatsoever on how to replicate that process. They're going home.
Now, one benefit that they get when they're walking out is now you've given them an unbelievable gift, and here's the gift that we as a company feel like we have the ability to give for the payer benefits is you've given them a gift of what it feels like to be healthy, and that's a crucial, crucial part of behavioral change. And here's the reason why is because now you've given them their why. What does feeling healthy mean for you?
I mean, in my personal situation, when I started eating healthy, I still remember I was probably two or three weeks in, I was eating PK meals on a regular basis and went outside, and this is all anecdotal for each of us, but my boys were two and five at the time, and they're bouncing off the walls always, all over the place, and I just felt like playing with them. I felt like bouncing off the walls with them. And again, for everybody that's different, your why is different, but I still remember that, this was four years ago, I still remember it to this day of that's the why that it gave me.
So back to the roadmaps, what I would tell you is here's the big disconnect in the industry, what I hear from almost everybody, "We're believers, Mark. We're believers, we're believers. However, I need your help making the business case for it."

Dr. Mark Hyman: It's so ridiculous that we can spend, let's say, $113 on the war in Ukraine or $8 trillion on COVID relief and not take a million dollars or two or 10 or 50 or 500 to study the biggest threat to humanity right now, which is foodborne illness, meaning not salmonella, but processed food and junk food that's making us sick and accounting for 85 or more percent of our healthcare costs and killing more people than anything else in history, every year.

Mark Walker: And I think that's how you may move the business case forward is you obviously have a significant understanding of the underlying issues and you are willing to make the financial commitment. What we have to figure out is how to bring these people closer to the understanding of how effective this is going to be. And again, one of the challenges we have is there's no formal definition of food-as-medicine. There's three primary areas of food-as-medicine, which is services, groceries, and medically-tailored meals, and there's 700 different dosage questions within each of them.
I mean, there was a recent study that came out that said grocery programs can be effective. We can break even on grocery programs over a long period of time, but if you dive into the details, it was an average $32 a month benefit. Just to back up a little bit, we average about $300 to $400 a month in spending. That's about 10% of your budget spent on groceries, healthy groceries. I personally don't have a whole lot of confidence that that level of commitment into groceries is going to be all that effective. The other issue we have is how many medically-tailored meals work? Some people are saying a meal a day for five days, and we'll give you the benefit over three weeks. Well, I don't have a whole lot of confidence that's going to work. We have other payers-

Dr. Mark Hyman: Well, I'm going to give you five milligrams of aspirin for your headache every other week and see if that works.

Mark Walker: Well, and here's the biggest issue with that is the headline that come out-

Dr. Mark Hyman: I'm going to give you a statin, but you only get to take statin once a week, or you only get to take one milligram of statin instead of 80 and see how that goes for your cholesterol. I mean, the whole thing is absurd, right?

Mark Walker: Well, and that's a perfect example, because what happens after that study that's done on aspirin is a headline comes out that says aspirin doesn't work to cure headaches. And you're like, "Hold, slow down. Hold on." Let's look at the dosage. They gave them five milligrams. Of course it's not going to work. And so that's happening a lot in the space is that people have budgets, they want to tiptoe into the space and say, "Okay, I want to see if food-as-medicine works." We have RFPs right now that are saying this. "I want to prepare a meal a day. I want to pay for a meal a day for four weeks." And I'm like, "Guys, I don't have a whole lot of confidence that supplementing their existing diet is going to work." Our philosophy is you got to replace their existing diet, because if you don't do that, then they still are eating a large portion of their diet in crap.
So there's a lot of business issues with it, business questions that people have. I've largely seen that most people are believers on the clinical side. They just don't know what a proper deployment of the benefit is, right? And there's a lot of service companies that have a vested interest, there's a lot of produce companies that have a vested interest, and obviously there's medically-tailored meals companies. So from a dosage, just a short little description of the three different categories, the challenge in the services side is it's largely educational. You're trying to coach somebody, teach somebody into better health. And behavioral change is hard. By the way, I quote you all the time on this and say, "Look, we're talking about food. Mark Hyman talks about this study." I'm going to ask you about it today, because it's the sugar study. I'm like, "He quotes a study that says that you can get rats off of cocaine by feeding them sugar." Right?

Dr. Mark Hyman: They'll tend to go for the sugar over the cocaine. If they're already hooked up to a cocaine IV and they can hit it and give them as much cocaine as they want, they'll always change over and get the sugar. And even when they put them in electric shock cages, they'll shock them until they're basically dead, and they'll keep eating the sugar, which is basically, when you think about it, what happens to people, they now go from a normal 150 pounds to 400 pounds overnight. It's like this slow thing. Even while their health is degrading, they can't stop.

Mark Walker: Well, and that really is the issue is that we're trying to educate them into better health, and the challenge is that's just not how people change behavior. People change behavior by having experience with the why, of why do they need to change their health. And so groceries go a little bit further. Now, assuming we have Club Hyman and people come in and you say, "Okay, here's $30 of groceries a week, I mean a month. Good luck." No cook, no chef, no anything. I don't know what the results are going to be, right? I mean, now we are trying to create apothecaries out of people where they have to construct their own drug. And obviously, the reason medically-tailored meals are so effective is that they take all of that guesswork out of it. Now, as I've already described, I'm a big believer of feeding them for 60 to 90 days, but then educating through the process so they can replicate that after, and then introducing produce prescription programs, RD services, everything else along the way.
So really, it's a dosage question, and this is why I think the advocates of the industry have such an enormous responsibility to make sure the data we're putting out is right. Right? It's because everybody's looking at this. As you've already mentioned, Congress is sitting back like this, going, "Let's see if this works." But if somebody comes out with a five milligram aspirin study and then Congress is looking at it and says, "Well, food-as-medicine doesn't work." We've got to be very conscious of the types of programs that we put out there and make sure that we have a large probability that they're going to be effective if we do.

Dr. Mark Hyman: Yeah, exactly. So true. I'm interested to hear what's happening in this space, because it's not just the government acting on this. There are private payers that are now moving in this space. There's California, which is funding medically-tailored meals. Massachusetts has programs for this. It's actually starting to happen. And can you talk about what's actually happening now, what the positive signs are, and what the pitfalls are? Because like I said, if we don't do it right, if we don't actually ...
It's like when the patient comes in, and they're overweight, and the doctor goes, "We'll just eat better and exercise more, eat less, exercise more." And they come back a month later, "Oh, it didn't work, doctor." First, they didn't tell them what to do or how to do it. And second, I'm like, "Okay, then you can take Ozempic." Or when you look at the guidelines for heart disease, diabetes, high blood pressure from professional societies like the American Heart Association, American Diabetes Association, they're always saying the first line of treatment is lifestyle.
But then the doctors say, "Okay," maybe they'll give lip service. They'll come back, it doesn't work. Then they basically say, "Okay, we'll take the drug." So we're in a situation where we have to be able to understand how to prescribe these things and make them work. So can you talk about where we're at in the healthcare space, how this is starting to unfold, and where some of the obstacles are, the challenges are?

Mark Walker: Well, and so you've said a key term, let's prescribe. I've talked to a lot of physicians on this. We have a lot surrounding the company. I've heard their stories, and it's really fascinating to hear the story of physicians that believe in the concept of food-as-medicine, whether it's functional medicine, lifestyle medicine, integrative, whatever it is. It seems like it's the same journey. I don't know what the number is, but 98% of healthcare professionals got in this space because they want to help people. They're not saying, "I'm about to make a killing," right? They're not finance people. They want to help people.
But what they do is they get in, and they realize they're putting band-aids on everything, especially the people that I just described that realize there's a cure that's outside of it. But now they have an impossible question. They say, "Okay, there's a cure, or there's something I can do to help. I can't get paid for it, I can't prescribe it. I have to take out of my own time to help my patient, despite the fact that there are no tools in place to be able to do it."
So this is why we think payers are such a crucial, crucial part of this equation. Payers are the ones that, they're really the gatekeepers of the system. They're the ones that decide what's a paid benefit and what's not. So I'm a firm believer. Look, we've talked about this numerous times, but there's not a ton of education in healthcare, but there doesn't really need to be. There's not a doctor on the planet that doesn't recognize that eating better is better for you. They just don't have any tools.

Dr. Mark Hyman: Well, that's changing actually. Yeah, that's changing, actually. The American College of Graduate Medical Education, which is responsible for all residency fellowship programs, has finally said, "Hey, we need to mandate nutrition education in graduate medical education." And the certification group for undergraduate medical education is also looking towards that. So I think we're going to end up there pretty soon. It's been a big problem, because doctors knew nothing about nutrition, they don't know how powerful it can be. And they go, "Well, I've never seen nutrition work to solve my patient's problem, so it's not really that good of a medicine, so let's not focus on that. Let's focus on real drugs." But they haven't actually learned how to use food as a drug.

Mark Walker: Well, and so you're right. So there's no education, there's no higher education on doing it, but coupling that with no tools. They don't have the ability to prescribe it right now and have it paid for. And so because of that, it's just an impossible ask for doctors to actually, even the ones that are educated on it, they have to take time, take a cut in pay. And then I've had doctors tell me that, "Look, I've gotten reprimanded by my superiors for actively deploying this, because we can't get paid on it." So the key to the payers is that we are starting to give back the tools to healthcare professionals to be able to prescribe meals. So it's such a crucial part of the overall equation.
And by payers, just so your audience knows what we're talking about, we're talking about insurance companies, the people that have ultimate responsibility for the overall cost of care. The biggest payer is the federal government with Medicaid and Medicare. And then you've got commercial employers that are at-risk employers that are 60% of the country. So those are the two primary payers. Now, it gets into nuance Within each. Medicare is seniors. Within Medicare, you have what's called Medicare Advantage. Like you said, they've privatized Medicare to 50% of the members in the country. And there was an article that came out recently that said that Medicare Advantage has actually saved Medicare, because they're so efficient, so effective at producing these benefits.

Dr. Mark Hyman: So what Medicare Advantage is for people who don't know is essentially instead of Medicare paying directly to the providers or the healthcare systems when there's a bill from a Medicare patient, Medicare Advantage is like an HMO almost, where private insurers will take the risk from the government and then manage that risk by providing better programs. And now they have actually come to the conclusion that it's a good idea to offer food-as-medicine and medically-tailored meals, because they're going to save money, and they don't have to go through the complicated congressional budget office scoring where they kind of have these crazy rules that make everything that you want do for prevention or food as a huge cost instead of a huge savings.

Mark Walker: Well, here's why Medicare Advantage is such a crucial part of this is that, like we said, it's 50% of Medicare right now. They also get some flexibility on offering additional benefits on top of Medicare. And there's only a few of them. There's only about a dozen or so benefits that they can offer above the basic Medicare. Now, there's four of those, vision, hearing, dental, and fitness, that you're not a Medicare Advantage plan if you don't offer those. These are called supplemental benefits, but 98% of plans offer them. So the other reason for these supplemental benefits is they help differentiate one Medicare advantage provider over another.
So this is what's happening in the country right now is these Medicare Advantage private companies are saying, "Okay, we're going to introduce a meal benefit and see if it works for us," but there's not a lot of them that have done it. So the ones that have done it, we really need to support and say, "Look, we believe in this. We're going to give you our business, we're going to move to you." Because there are some big companies in the country right now, one of the ones we're working with right now, Wellcare Centene, Anthem, Amerigroup is doing it as well, but they offer three meals a day every day for 12 weeks. I mean, it's a very, very robust benefit. Anthem's is lower than that, but it's still two meals a day, every day for 12 weeks. So we need to be able to support these companies and make sure that we believe in this concept, especially the advocates of the industry.
And the other ones are watching this very, very closely. I've heard the other ones say publicly, "Look, we need more data before we're willing to write a million dollar check." And so they're kind of on the fence right now. But there are some that have introduced benefits and said, "We're going to introduce this, because we believe in it." So this is where we're at in the country right now, is that there are literally millions of people nationwide that qualify for a true chronic meal intervention. If you have diabetes, heart disease, some will even pay for pre-diabetes, that you call your customer service of your Medicare Advantage plan and say, "I'd like my meal benefit," and we will ship the meals to you.
I mean, it really is that easy, and it's really a remarkable position that the country is in right now. And again, I can't even imagine what that sounds like to you after 25 years of advocacy in this space. But literally, you as a physician, if your patient has the benefit, can say, "Prescribe Performance Kitchen Chronic Meal Program, done," and we ship the meals to the patient. I mean, it really is that easy.
And so part of this is just an education that these benefits are currently out there. And this is not just in Medicare Advantage. Medicaid has the same thing. The federal government also outsources the management of Medicaid to states. So states each manage their own Medicaid programs. As you mentioned, the State of California, it's one of the biggest, Massachusetts, New York, New Jersey. There's a lot of states that are now, the technical term is what's called an 1115 waiver where a state goes to the federal government and says, "We want to implement a food program," and the federal government says, "Sure. Here's the guidelines, blah, blah, blah." And so these are all coming.
And here's the third one is what I've already mentioned, the payer of commercial employers. So as I've discussed our partnership with Kroger, Kroger is the fifth, sixth-largest employer in the nation, and they're implementing an employee program to actually try to get their employees healthier. They have 500,000 employees currently. So this is moving across the board right now, and people are starting to get wind of the fact that, "Hold on." But where we're at, and just so you know, Mark, the vast majority of people are stepping their toe in the water saying, "Let's try a hundred people first and see if it works." Right? They're not willing to write the billion dollar check first. What they want to do is test it out and make sure this crazy Mark Hyman is right. And what we'll find out is, "Oh, I guess he was," and you're going to be like, after 25 years, you're going to say, "I told you guys so." Right?

Dr. Mark Hyman: I take the crazy as a compliment.

Mark Walker: It's 100% meant to be that. Because the reason I say it with such affection is that I feel it now, I feel the advocacy that you and others you have put in for decades. But I also feel the scorn of everybody else saying like, "Ah, that's not going to work. We need this drug." I mean, the Ozempic and Wacovia are perfect examples, right? So yeah, I mean, I couldn't say it with more respect and admiration of the challenges and the fight that you have put in over 25 years, but it is finally here. It really is an exciting time in the country where all three major payers are now implementing these benefits. But like I said, we got to make sure we do it right. We have to, because they're all paying attention. So it's an exciting space we're in right now.

Dr. Mark Hyman: Yeah, it's pretty remarkable. And I think the thing that I'm seeing that's really exciting is, for example, the American Heart Association and Kroger partnering, for example, which is the sixth or fifth-largest employer in the country with over half-a-million employees, they're actually working together to sort of advance food-as-medicine. I'm working with the Rockefeller Foundation to help them design their protocol for how do we design a food-as-medicine intervention, because like I said, if you give one milligram aspirin, it doesn't work. You have to know what to do for each patient, and it's customized. So can you talk about how Performance Kitchen is actually interfacing in this space, what they're trying to advocate for, how they're pushing this forward?

Mark Walker: So we, as we've already discussed, we're a medically-tailored meal company, but we also offer benefits for produce prescriptions, RD services, all the other services combined. We partner with everybody in the space that's doing it currently. Our formal position is that, and I've talked to our entire staff and every partner that we have about this, is our number one goal is to advocate for the industry, because we truly believe it's such a massive space. There's no one company that can handle it all. It's too big. And so we collectively, as the industry, need to come together and make sure we advocate for this, but also be responsible. There's a lot of programs out there that when I hear about them, I'm like, "I don't know where you got that from, but I don't read that anywhere in the data. I don't think that's going to work." But it will have the same headline as us, Food-As-Medicine Program Tried, Failed.
Okay, well, back to your point. It may have been a five milligram aspirin program. So we are primarily in the medically-tailored meal space, but we're also a massive, massive advocate for the industry. So part of the issue of the industry right now is what I've already described is there's millions of people that qualify for these benefits nationwide right now, but almost nobody knows about it. I mean, I honestly have not talked to a doctor to date that is aware that they can actually prescribe meals. I mean, it really is crazy. So part of our objective here is just an awareness campaign that these benefits exist. Now, they're not everybody. It's primarily people with chronic disease and Medicare and Medicaid, commercial is coming.

Dr. Mark Hyman: Which is 6 out of 10 Americans.

Mark Walker: No, that's right. I mean, it's a ton of people.

Dr. Mark Hyman: And if you count overweight as a chronic disease, it's 75% of Americans. And if you count those who are metabolically unhealthy, it's 93% of Americans.

Mark Walker: And that's really where the key is is some of the payers that, when I say payers, the private payers, will introduce a benefit and say, "We're only going to pay for two meals a day for 10 days and only for diabetics," which okay, but I don't have a whole lot of confidence that's going to work. Other payers say, "We're going to give you a 30-day benefit, but it's only for ESRD." Okay. And then you have others who say-

Dr. Mark Hyman: That's a kidney disease, that's end stage renal disease for people who don't know what that is.

Mark Walker: The other is we have some payers that say, you know what? If you have any chronic disease, any of the 20+ chronic diseases that CMS authorized, we'll pay for a food benefit for 12 weeks. So it's kind of the wild, wild west right now on what benefits are being approved, what's being offered and what's not. So our primary goal is to just make people aware that these benefits exist. We've actually created a tool internally, we call it a benefit locator tool, but you can actually go in and enter your zip code and find long-term medically-tailored meal benefits in your area that exist today. Literally, if you are on a plan today, really, if you're a customer of ours, we'll submit your request on your behalf to your insurance company. If you're not, we're still a big advocate. We're going to tell you where to contact, show you where to go, get your benefits, because once again, we believe that just promoting the industry, we all have an enormous responsibility to promote the industry at this point, but it really is exciting.
Now, we are at the nascent baby stages of it, and this is the bad news. You've been advocating for this for 25 years. I truly feel like we are now starting. Now is when all of the data is going to be coming out, and we're going to have to collectively make sure it's the right data. And to your point, as a physician, what do you prescribe to a 7.5 diabetic? What do you prescribe to a 9.3 diabetic? There's a lot of nuance to this space. What about a heart disease patient? What about a heart disease patient that's also a diabetic? You can imagine there's a whole lot of nuance, but just the fact that payers have introduced the benefit and said, "Okay, we agree. We've read Hyman's books. It's going to work. We'll pay for it." It really is a remarkable state of the system right now of where we're at. So it really is exciting, and we just want everybody to be aware that these exist today.

Dr. Mark Hyman: Yeah, no, it's so great. And I think that there's you and there's other companies working on this, and I think it's really about getting the right treatment for patients. I think maybe you can share a little bit about your wake-up call when you went from being a pre-diabetic to a diabetic, to then back again to being a non-diabetic, and how this is really not just a business for you. This is actually a life mission.

Mark Walker: My story started with a guy named Jim Abrams that was a top producer in Hollywood at the time. His son had epilepsy, just sudden deal, young son, just an excruciating story of a father where his son was having hundreds of seizures a day or dozens of seizures a day. And top producer in Hollywood, so he had every neurosci at his disposal, went to all of them and got to the point, expended all of his options, had brain surgery on his son, and nothing worked. And found out, back to the crazy people, found this crazy woman at Johns Hopkins University was doing this weird diet called the Keto Diet. And he said, "Ah, that's not going to work," but flew his son in. Within days, the seizures stopped, and I was like, "Whoa, whoa." This was really my coming out. It was like, "Hold on. Time out." Because as a father, I'm reliving this story.
I'm like, "Okay, it's got to be one of the most excruciating things in the world to see your son going through this every day." And so the joy, the hopelessness that you feel before, and then the joy you feel when he's better, it's got to be one of the most exhilarating things on the planet. However, within about five seconds, my joy would turn to just pure anger. "Are you kidding me? That this works, and I didn't know about it." I would just be irate at the system. And to his credit, he made a movie called First Do No Harm by Meryl Streep or with Meryl Streep, and it's about the keto diet. So that was the start of my kind of revelation of the space. And as I started diving in, I said, "You know what? I'm going to be a Guinea pig on this. I'm going to take my own medicine, take my own blood test." And that's what happened. I took a blood test, and lo and behold, I found that I was a pre-diabetic.
And it was such a crazy thing, because first of all, I didn't even know what it was at the time, and found out I was a pre-diabetic, read about it, and said, "Okay, well maybe 10, 20 years ago I'll deal with that, and whatever." Started going through the whole process of Performance Kitchen building. I hadn't actually done a program myself at the time. And then about six months later, I take another test, and I'm 6.8 A1C, and I was like ... Again, I didn't know what it was, but with your audience, I've got to convey what that feeling feels like when you get that diagnosis. It was a death sentence for me. I didn't know about all this at the time. I was just learning, but I knew the outcomes of diabetes, and it scared the piss out of me.
But then it became real to me. It became real. "Okay. I'm immediately going on a program." Again, this is the ignorance of me as a, and we'll have to talk about this later, but didn't go to a doctor. I just said, "Look, if I'm going to believe this stuff, I'm doing it." So I went in and started eating our meals, literally just took a test the other day, and I'm 5.6 again. And it really is a ... So I can tell you personally, it works. Now, mine worked out of ignorance, because I didn't go into the system and talk to a doctor. I just said, "If I'm going to do this, I'm going to do it," right?
But when you personalize this and realize that these are real problems that people are dealing with, and the fear and the hopelessness that you feel when you get a chronic diagnosis is just, and we want to be able to give people hope that there's actually something there that can actually help them, and maybe not reverse their disease, but absolutely manage it, And it doesn't have to be a death, and you don't have to eat cardboard for the rest of your life either.

Dr. Mark Hyman: No, it can be delicious. That's the whole point. It's got to be delicious, made from real ingredients, the right medicines in the food. You can't just have a bunch of processed foods that are not really doing the trick, so I think it's so important. And Mark, your work is really important. Performance Kitchen is doing a great job. I think people don't realize that they have ability to access medically-tailored meals now through their insurers or providers across many insurers. So I think Performance Kitchen offers a way for you to find out within your zip code who's actually doing this. So you can either switch insurers or activate your insurer to actually deliver the benefit, because a lot of times there's benefits in health insurance, and they don't want you to know, they don't promote it, they don't advertise it, because they see it as a cost, but it's actually out there. So how can people find out whether they can access medically-tailored meals now?

Mark Walker: Ours is a chronic meal program, which is 60 to 90 days of a long-term benefit to fight your chronic disease. And back to our Benefit Locator tool, you can go to our website,, we'll actually add an extension for /DrHyman in there, and you can actually look. I mean, it takes 30 seconds to go on there and look it up. So it really is an incredibly powerful tool. And look, luckily, a good portion of us are not going to qualify, because we don't have a chronic disease, but every single one of us knows somebody who does. And that's the key is my dad in particular wouldn't be able to walk through the 30-second process, because he's got a lot of issues later in his life. But just think about your loved ones. Go on here for them, see if there's a benefit in their area.
If there is, then you can decide what you want to do with it. You can switch payers, you can activate it, like Mark said, if you actually qualify for this benefit. But the vast majority of people just aren't aware. And where payers are right now is interesting, because they've introduced the benefits, so I do believe they're believers. But the real question is do you want a hundred percent of everybody? They're still kind of on the fence. The people that haven't introduced benefits are definitely on the fence.
So we need to not only support the insurance companies that have introduced benefits, because they really have come out early, but give them more business. Go to those people and say, "Look, we appreciate the fact that you're focusing on preventative health," and support them. So it really is an exciting time, and we, as consumers, can actually use our buying power with Medicare Advantage compliance specifically, but on the congressional side of the states, advocate for these programs, because they really are here.

Dr. Mark Hyman: That's so great, Mark. And I think also, the other angle is you can advocate for this with your members of Congress. Right now, there's a bill in the Senate that's been co-sponsored by Democrats and Republicans. It's a bipartisan issue. Sickness doesn't care what your ideological beliefs or political persuasions are. And this bill is being co-sponsored by both Democrats and Republicans, by Dr. Cassidy, who's a senator, who's a doctor as well, Corey Booker, Roger Marshall, also another doctor senator. So the two doctor senators get this, and then Debbie Stabenow and Cory Booker. And on the House side, there's another bill sponsored by Jim McGovern and co-sponsored by their Democrats and Republicans. I'd encourage you to call those members, call your congressmen and women and senators and ask them to support this because they listen. And if everybody who's listening to this podcast probably downloads over 300,000 times, make sure you do that. It makes a difference, and you can be part of the change.
So Mark, thank you so much for the work you're doing to get this out there, not just for your company, but for the field at large, and advocating so hard for this. And I'm going to keep working for this as well with the Food Fix campaign. I believe it's going to happen in the next years. I think we're seeing a real sea change in the region about how we need to deal with chronic disease using food-as-medicine. And thank you again for being on the podcast. If you love this podcast, please share it with your friends and family on social media. Maybe they should know about where they can go check the zip code of whether these services and benefits are provided by their health insurer. Leave a comment, how have you used food to heal your disease? We'd love to hear from you and subscribe wherever you get your podcasts. And of course, we'll see you next week on The Doctor's Pharmacy.

Mark Walker: Thanks, Mark.

Closing: Hi, everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit and search their Find A Practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.