Joan Grinzi, rn, served on the Price-Pottenger Nutrition Foundation (PPNF) board of directors for over 18 years, and she was selected to become executive director in 2005. She became a registered nurse in 1974 and has received training and experience in other alternative medicine modalities, but her passion has always been in nutrition, believing that properly nourishing the body is the key to enhancing the body-mind-spirit connection.
David Getoff, ccn, is vice president of PPNF and is an elected member of both the American College of Nutrition and the International College of Integrative Medicine and has a private practice in El Cajon, California. He has presented at numerous scientific medical, nutritional, dental, and organic agriculture conferences in the United States.
Integrative Medicine: A Clinician’s Journal (IMCJ): What is the Price-Pottenger Nutrition Foundation, or PPNF, and what is the foundation’s mission?
Ms Grinzi: We are a 62-year-old nonprofit education foundation, founded originally to store and disseminate the work of Dr Weston A. Price, dds, and Dr Francis M. Pottenger Jr, md. Along the way, we also were given the research archives of most of the great nutrition pioneers. So we have housed and disseminated the information since 1952. We encourage people to obtain optimal health based on ancestral wisdom, but we also add modern day application of this wisdom.
We recently tweaked both our mission and vision and I just love it. The vision of PPNF is: “A world where optimal nutrition is the standard, the environment fosters the health of all living things, and people are thriving.” Our mission is “To teach the public and professionals about foods, lifestyle habits, healing modalities, and environmental practices that can help people attain vibrant health.” PPNF is committed to being a leading resource for the work of Price and Pottenger and others who have discovered the underlying causes of disease and degeneration and how to prevent or reverse these conditions.
Mr Getoff: As far as goals, one would be that we will become one of the go-to places, so that if somebody is doing an article that has to do with food or nutrition or organics or sustainable agriculture—that without even thinking—PPNF will be on the short list of people we have to contact to get their opinions.
Ms Grinzi: Nobody else has the archives and there is so much misinformation out there. We are an incredible resource for people.
IMCJ: Briefly describe the work of Dr Price and Dr Pottenger and what their major contributions to the field were.
Ms Grinzi: Dr Price was a dentist back in the 1930s. He observed degenerative disease was on the rise in America. So, at his own expense over a 10-year period, he traveled around the world to visit 14 countries, venturing deep into the bush to find what health looked like. In America at the time, they were looking at what disease looked like and how to turn it around. Price said, “Wait a minute. Let’s go look at health and see why people are healthy”—which is why he went. In each country it would take them 3, 4, or 5 days to get deep enough into the bush to find tribes eating the foods of their ancestors. He found that they were all very happy, had no depression, were healthy from head to toe, had wide dental arches and plenty of room for their wisdom teeth—God, Mother Nature, whatever you believe, made no mistakes. They did not know what a toothbrush or floss was and they had no cavities. Did I add that there was no social misbehavior either, like we have, rampant in society today?
They all ate different food, but the common denominator was that they all had some form of quality animal protein and animal fat, but the animals ate what they were supposed to eat, not what man thinks that they should eat today. As soon as sugar, white flour, and overcooked, overprocessed food got traded into these tribes, he was able to document the turning point of the decline of health of all mankind. And, of course, the first place it showed up was in the mouth and he was a dentist.
When I say quality animal protein and animal fat, it was different for each culture. Some had the blood from an animal, some had insects. Of course, we are not telling people we have all got to be eating insects, but it was part of the research. Those along the waters had fish and there were those inland that had 2- and 4-legged animals, the cow and chicken. Some drank raw milk—not everybody had raw milk in their diet—it was all very, very different. What we say is, if you can do this today, people need to go back to what their healthy ancestors ate and those are foods that would be right for them.
Dr Pottenger did 10 years of research during this same period in the 1930s. The 2 men did not know each other at the time, but they did meet later on, before they died. Dr Pottenger stumbled upon his theory accidentally, doing a 10-year study with cats. He started with 900 cats. Half of them were on overcooked, overprocessed food, and the other half were on raw food. The raw food cats were very happy, very healthy. They had wide dental arches—we have their skulls in the office today—and huge litters of kittens—10 and 12 kittens at a time—and they were very docile.
The cats eating overcooked, overprocessed food, by the third generation—the females, 100 percent of them—were infertile. And they were using the male stud cats from the raw foods group. Infertility is rampant in society today. You see infertility clinics cropping up on every street corner. Dr Pottenger also found the same degenerative diseases that Price found in the tribes that were eating cooked food and sugar and white flour. There was also aggressive behavior among the male cats in this group, so we say that we have got third-generation Pottenger cats walking around today in the way of the aggressive behavior, the infertility, and the degenerative disease that is rampant in society today.
Because of the very important work of Dr Pottenger and how we felt that it dovetailed with the work of Dr Price, the name of the foundation was changed to PPNF from the Weston A. Price Memorial Foundation in 1965.
IMCJ: How was PPNF originally founded and how it has progressed through the years?
Ms Grinzi: We were given all the research of Dr Price and that included over 20 000 photos that he took during that 10-year period. Then we added the work of Pottenger, because it was so important. The work of other great nutrition pioneers followed, including Royal Lee, dds; Melvin Page, dds; Emanuel Cheraskin, md, dmd; Henry G. Bieler, md; William A. Albrecht, ms, phd; and others who are all listed on our Web site at http://www.ppnf.org. We continue to disseminate their work, including publishing Nutrition and Physical Degeneration, by Weston A. Price, dds, Pottenger’s Cats, by Francis M. Pottenger, Jr, md, and Root Canal Cover-Up, by George E. Meinig, dds.
“If it is true with human beings as it is with cats, that nutritionally caused degeneration is passed down to our children, a sobering challenge stands before us.” Francis M. Pottenger, Jr, md
All the research of the 17 great nutrition pioneers, including Dr Price and Dr Pottenger, is being digitized, thanks to the support of our members and donors. Just recently, we uploaded them online and all this research is available to our members. We have 11 of the 17 done, and we are working on the other 6 right now.
One of the first projects we did in 2005 when I became the executive director is digitizing the 20 000 photos of Dr Price. We cleaned them up and they are now off site protected in a vault in case there would ever be a fire at the foundation. We began the process of going through the 20 000 photos. As you can imagine, it is a huge task, but we hope to complete it in the next couple of years. We estimate out of the 20 000 photos, there are probably 5000 excellent photos that the world has never seen. Because he took a lot of duplicate pictures, we estimate there are about 5000 gems in there. Eventually, we want to make them available in thumbnails on the Web site so that people can see what we have. They are copyrighted material, but people can request permission to use them for educational purposes only. We want the world to know what we have.
IMCJ: Ms. Grinzi, How did you become associated with PPNF?
Ms Grinzi: I found out about Price-Pottenger in 1986 and volunteered for 18 years on the board of directors because I just fell in love with the organization. In 2005, I gave up my job in nursing to become their executive director and it is just a labor of love. PPNF is a wonderful organization and we are doing a lot of good work.
IMCJ: Mr Getoff, what led to your association with the Foundation?
Mr Getoff: I would like to go back in time before 1979 to when I lived in New York. I knew of PPNF and I believe that I was even a member for a while, you know, as you get memberships and they lapse. It is very easy for me to remember the age of the association because we were both born in 1952, so we are both going to be 62 in 2014. I never forget those numbers. The current association began when our long-time executive director before Joan took over, who was Marion Patricia Connolly—we all just called her Pat. She took a class I had developed called “Attaining Optimal Health in the 20th Century.”
One day when I was teaching—at that point I was teaching it in the main auditorium at Grossmont Hospital—this older woman comes up to me, introduced herself, and said, “Hi, my name is Pat Connolly. I am the executive director of the Price-Pottenger Nutrition Foundation. Have you ever heard of it?” I said, “Yes, absolutely, I have heard of it. I think I used to be a member a long time ago.” She said, “Well, you are teaching our principles. This is terrific and I just wanted to thank you. I have not ever been in a class where I can agree with what is being taught all the time.”
And then the next semester, she was back. She took it a second time and this time she came up to me at some point and she asked, “Would you be willing to come and be on our board, just on our advisory board, so if we have some questions, you would be one of the people we might come to and say, ‘hey, can you help us with this?’” And I said, “Yeah, I guess so, sure, fine.” And then later toward the end of the class, she said, “Actually, would you come to a couple of our board meetings and maybe even be on the board?” I said, “I do not have any time for that. When is it?” She said it was on Mondays. “Oh, my day off,” I said. “Yeah, I will come to a couple of board meetings.”
So I came to a couple of board meetings and they wanted me to continue on with them, and so I kept on going. I cannot even remember how many years ago it was that they wanted to elect me vice president. At first I said no. They said, “You have already given us information and answered questions for us and been helpful and we want you to continue to do that, but we want to give you a title because you deserve it for the amount of help you are giving us.” I said okay.
So, I teach my classes and refer people to join the Foundation. When we attend conferences, I represent PPNF in exhibit halls simply to let more people know that we exist. Sometimes I will lecture at scientific conferences and, of course, that gets even more people to PPNF. So, I love it. I love helping them. I love promoting them. It’s a perfect marriage because they are promoting what I am trying to teach people to do in my office anyway.
IMCJ: Why is the work of the Foundation, in preserving and professing the work of Price and Pottenger, so important?
Ms Grinzi: You cannot redo the Price research today. Those tribes do not exist. That is one of the most important reasons. As far as the Pottenger cat study goes, it could be redone if you can battle against the animal activists. We would love to see that redone, wouldn’t we, David?
Mr Getoff: Yes, but it would be massively expensive. In the case of Price, it could not be redone because there are not enough tribes that modern culture has not touched. I was just reading a book on the Amazon—it is the one by Mark J. Plotkin, Shaman’s Apprentice, and just in the amount of time that he had been going back to these tribes of the Amazon, conditions had changed, and the book was written about 10 years ago. When he originally went in, everybody was in loin cloths. Nobody had anything except their traditional and minimal clothing, if there was any, that they made for themselves from animals. Everything that was eaten was local and they were getting it from the environment.
And just a few years after that, when he went back to do follow-ups, people were wearing jeans. They were wearing sweatshirts with English names that they had no idea what they meant—all sorts of different things. They had rifles and lighters and radios and hoped that anybody visiting them would bring them some more batteries. This was 10 years ago. To be able to find over a dozen different tribal populations around the world in which there is no encroachment by industrialization or humanity—to see what they were eating that was keeping them the way they are—you cannot do it anymore. So, it is very important to keep this research alive.
Ms Grinzi: One of Dr Price’s greatest disappointments—and this shows what an expert researcher he was—was that he found no healthy vegetarian society.
Mr Getoff: When he went out to do this, one of the things he expected to see was healthy vegetarian societies. The best researchers do not care what they find; they report on it. These days, a lot of people do research in which they direct the process to make happen what they wanted to happen. Good researchers are going to report on their results, whatever they are, even if it shows an opposite result. Dr Price was a good researcher. Even though he was pretty much convinced that the healthiest people were going to be the strictest vegetarians, he found out he was wrong and, of course, reported on it anyway.
IMCJ: So if strict vegetarian diets are not the healthiest, then why have diets such as the one described by Dean Ornish, md, been found to offer such significant benefits?
Mr Getoff: The main point is that in vegetarian diets, first of all, the term vegetarian does not tell you anything about what the person is eating. It only tells you what they are not eating, and people do not understand that. That vegetarian simply means you are not eating whatever food that particular vegetarianism avoids—whether it is total vegetarian—which is vegan—whether it is lacto, lacto-ovo, etc. The things that people see as health improvements in those research studies examining vegetarian diets are predominantly derived from the addition of a larger amount of nonstarchy vegetables than the person would otherwise have been eating.
Even though they are not required, if we consume good quality, nonstarchy vegetables, there are a lot of nutrients in the different colored vegetables. I will certainly give them that and I am not against their use.
A second reason is that automatically all of the luncheon meat, ham, bologna, salami, and a number of other really horribly made, toxic foods—because of all of the preservatives and the garbage that is in them—have been eliminated. The problem in vegetarianism is they have also eliminated the good animal-based foods. What nobody is really doing, because the politics and money are not promoting that level of science, is tracking groups on vegetarian diets through several generations. This is always a problem, because multigenerational research is the only thing that shows you long-term effects very accurately.
Imagine that somebody ran a study for 5 years, which is not long enough but it will show something, where a group of people only ate grass-fed meat and eggs from pastured chickens and organic produce that is picked ripe and consumed within 36 hours of when it was picked, not warehoused in a store. And another group was asked to eat a vegetarian diet with no other guidance. I want to look at that comparison because I am convinced that there is not going to be any comparison. It will be like, “There must be something wrong with this experiment. It cannot be that the people eating all this beef and all these eggs and all this milk are healthy in every parameter we are looking at.”
But, of course, it is—because it is grass-fed beef and it is grass-fed raw organic milk and everything was brought in fresh. And the eggs are from pastured chickens, not free-range chickens out there on dirt—pastured chickens that are getting worms and insects. People just do not understand the variables that are not being looked at.
IMCJ: Describe the basic tenets of diet professed by Dr Price and Dr Pottenger.
Ms Grinzi: You have heard of essential fatty acids and essential amino acids: fats and proteins. Have you ever heard of an essential carb? No, no, no. The only things essential for the human body are the fats and the animal protein; however, based on Dr Price’s research, there is no one food that is right for everybody. Some people need different amounts of animal protein or animal fat based on whether—especially if you look at the work of Nicholas Gonzalez, md—you are parasympathetic dominant or sympathetic dominant. So we do not say everybody needs to have the eggs every morning. If I do not have it, I do not feel good. I need it 3 times a day, but somebody else might need it 3 times a week. And then, which type of animal protein and animal fat is right for their body? What is the source? What did the animal eat? How was it treated? Was it pastured? Go back to what your healthy ancestors ate, if they were from the same nationality. That’s the food that would be best for you, if you can do that. We realize a lot of people cannot because their parents or grandparents married from different countries. However, the common denominator to the health of all the tribes worldwide was that they had some form of quality animal protein and animal fat from healthy animals in their diet. There are vegan clinics people go to for cleansing and detoxing. This can be a good thing, temporarily—you just cannot spend the rest of your life not having animal protein and animal fat.
Mr Getoff: Include any kind of animal protein. When I say animals, I also always mean fish, birds, etc. All living animal protein sources should be eating their natural, species-specific diet. Originally, animals of any kind, whether they were birds, fish, etc, were all presented by nature. They were all eating what they should be eating and so that is one of the tenets. It was not said that way, but that is what was happening and that is what we now know. It is very, very important that everything needs to be eating its species-specific diet. People should not second-guess nature by deciding what we should feed our ground-, our air-, or our water-based animals, rather than letting them consume their natural foods.
We should also use the original varieties, not these new hybridized varieties which have been bred, as with chickens for example, to have less red muscle meat, more white meat, and so they can no longer run or fly and some can barely stand up as overly fat adults. So another of the main tenets is that we want the foods that we are consuming to, in turn, have been consuming what they should be consuming and not have been hybridized for commercial reasons. This is something I stress in my class as one of the tenets of Price and Pottenger research—that you have to go one step further. You cannot just say, “I want to eat healthy foods and what are those foods?” You have to say, “I want to eat healthy foods and what are those foods, and I want the healthy foods I am eating to, in turn, have been eating what for them are healthy foods.”
Another tenet would be that foods should be consumed much closer to their time of harvest. Yes, there was some fermenting. Certain tribes did fermenting. Some tribes understood that you can dry things out—you can dry meats out so you can have them later. But in general, for the things that we all eat, that we consider the word fresh to be attached to, the word fresh currently has no legislation to define it.
Fresh means as close as possible to when it was plucked from the plant which produced it, which, of course, is not what we do. You go to the store and you see all the fresh produce. If it were required that there be little meters on these things where you could take a look at the meter and go, “This looks great. It is not getting rotten. It is not wilting. But according to this meter, it was picked 5 days ago” or “Wow, that was picked 3 weeks ago and it has been sitting in cold storage”—all of those things decrease nutrients, such as antioxidants, and probably do things that we have not even studied yet. So we want things consumed closer to their time of harvest—which, again, people did not say that—they just did it. It was part of the way they lived. And, of course, energy expenditure greatly alters the amount of starch-based foods that a population or individual can consume and remain healthy.
And so, when we consider people who are currently sitting in an office, as we all are right now—talking on the telephone, watching a movie, listening to an audio book, or working on a computer—and we compare that to somebody outside sweating in the sun or walking and dragging an animal back that they just killed or dashing at top possible speed to avoid becoming a meal—the food of some other animal—people did not exercise back then. They did not take time to think, “I am going to exercise.” They simply expended more energy every day—without it ever being referred to as exercise—than most people now ever do, with the exception of those who run out there and do exercise. That additional expenditure of energy allowed their bodies to use up a greater amount of starch and sugar-based foods without suffering the metabolic effects of those foods. As these turn into triglycerides and sugar, they greatly increase our risk of heart disease, cancer, diabetes, and cause most of our current obesity.
But these active cultures were able to consume more than we do, so people will look at Dr Price’s research and say, “But look, this tribe ate this type of bread that they made themselves. This tribe ate these types of grains that they actually farmed.” Back in Dr Price’s time, they were doing some farming. It was not prehistoric. It was not paleo where everything was being supplied by nature; however, the amount of those starches that can be consumed when you have a higher energy expenditure is completely different. So now we have a population that is eating more starches than anybody has ever eaten in the past.
People are getting starch in their breads, getting starch in their pastas, getting starch in their pizzas, getting starch in their potatoes, and getting starch in their corn. Some are eating slightly better forms of starch, because they convert less quickly, such as beans other than soy. That is way more starch than their bodies can handle and not enough of the essential amino acids and fatty acids and not enough of the non-starch-based vegetables. As Joan said, if you go with the nutritional biochemistry, there are essential amino acids that your body cannot synthesize, so we know that there are parts of proteins that are required. That is why they get listed as essential. There are essential fatty acids. They only get listed as essential if they can be proven to be required for long-term health.
Vitamins are essential. Many minerals are essential, and some are not. You will not find an essential list of carbohydrates. They have never discovered an essential carbohydrate. So any time somebody says you have to have grains, you have to have fruit, you have to have fill-in-the-blank carbohydrate, they do not understand that carbohydrates are not required. The original Eskimos (before we began to call them Inuit) and the Masai in Africa had exceptional health consuming only animal based foods and zero plant foods which we lump together and call carbohydrates.
So to summarize, leave food in the form that nature created it; in most cases, eating a lot more of it rare and raw than we do today, eating it as close as possible to the point at which it was produced by the plant, and picking it ripe. You know, most peppers in the United States are consumed as green peppers. There are no ripe green peppers. Every single variety of pepper turns a color. Green is its unripe state no matter what kind of pepper it is. Everybody knows that lemons are yellow. Limes are also yellow—just let them get ripe. Traditional cultures knew that. They realized that something was better for them if it was ripe and, of course, they would not pick it and put it in their refrigerator—they did not have one.
IMCJ: From a physiological perspective, what are the benefits to traditional diets as advocated by Price and Pottenger?
Mr Getoff: Let’s start with the skeleton, which, of course, includes the skull and dental arches. Both in the cats that Pottenger studied and all the populations that Price was looking at, we have a skull, which on a good diet is supposed to be a certain approximate size for that particular individual and designed to be—we do not get into people’s belief systems, so whether it is Mother Nature, Father Time, God, whatever—able to house those things that are supposed to be there.
So let’s consider the number of teeth that are supposed to be in the mouth of either the cat or the human. Why would nature or God make a tooth and then not allow it to fit in the mouth because the dental arches are too small for it? Of course, that is not what happened. The answer is that there was plenty of room until we started eating wrong. When we started eating wrong, one of the things that happened is the skeleton was no longer formed the way it should be. The skull no longer grew as wide and deep as it was supposed to be to house all those teeth. When Dr Price was taking a look at all these various tribes, all their teeth were there. These tribes did not have dentists. And since there was plenty of room in the mouths of these people with traditional diets and now there is not plenty of room in the mouths of those eating Western diets, we know that these changes are all diet-related.
You can look at conditions, such as osteoporosis, which are rampant in North America these days and probably also in a lot of other countries. They were not rampant in these cultures. He didn’t find any of the conditions that we have now. They just were not there. And so that is really a major issue.
In addition to the effects that are physiological, you have the mental, emotional, and everything else you want to go into. But anytime the animal is eating species-specific, nutrient-dense, properly fresh foods—not what we call fresh, but truly fresh, meaning it is not old—the body develops correctly. Everything happens the way it is supposed to. If you break something, it heals rapidly and there is room for those appendages, such as our wisdom teeth, that there should be room for.
IMCJ: Ms Grinzi had mentioned Dr Price’s observation that the Swiss tribe he visited was able to avoid the tuberculosis epidemic that had washed across Europe. How does eating a traditional diet affect the body’s ability to fight infection?
Mr Getoff: We are learning more about the immune system all the time. But the number and activity of your natural killer cells and ability to mobilize and do what they are supposed to do are all dependent on the body being healthy. And the body being healthy comes back to food, again. So those people who eat well always have a better operating immune system. We have a time of year called winter, which is often referred to as “cold and flu season.” There are 2 groups out there saying, “No, that is not really what is going on.” The Vitamin D Research Council says that it is just because everybody is afraid of the sun. Instead of getting plenty of sun and being careful not to get burned, they are putting on SPF 2000 and staying away from the sun. Every population used to be out in the sun all the time and had adequate vitamin D, and if you had adequate vitamin D, your immune system worked better.
Then there was another nutritional professional and I loved what she always used to say—usually in front of a room full of medical doctors. She would say, “We don’t have a cold and flu season. We have an eat crap season. It begins with Halloween, continues into Thanksgiving, and then it goes into the other holidays through Christmas and New Year’s Day.” She said, “More starches and sugars are consumed in a period of months than any other such period of months in the year.” Since we know that it does not take very much sugar in the blood, above the level where it should be—whether it’s been from consuming sugar or from consuming a starch or alcohol—to depress immune function for 4, 5, or 6 hours, then, of course, your immune system is depressed all the time.
Whereas, if we go back in time, they were not eating all that processed food. They were not having potatoes all day. They were not eating breads all day, although some of them did eat some bread. They did not have the amount of starch, and that which they consumed was equated well enough with their energy expenditure to be used up. And so they did not have this massive increase and up/down blood sugar dysregulation that destroys immune function—or at least makes it way below what it should be.
Ms Grinzi: Plus, it was heirloom seed ground fresh and fermented before it was baked.
Mr Getoff: Yes, and any fruits that they did eat were picked ripe during the 6, 8, 10, and 12 weeks that they were available before they were not seen it again until the next year when they popped out on the plants again. Any vegetables they consumed were picked ripe when they had the largest amounts of all their nutrients, instead of sitting in a store where you get what looks like it is fresh but might have been picked 2 months ago. And, of course, they never ate the same fruits and vegetables year-round because they did not have any refrigeration.
IMCJ: There are a number of different ways PPNF works to inform and educate professionals in employing the nutritional concepts of Price and Pottenger. Could you discuss some of these resources that are available to professionals to use?
Mr Getoff: One is my class, which is now available online for people to access around the world. In many fields there is a gigantic difference between what the professional would want and what the lay public would want. In the field of nutrition, because the professionals in almost all cases have been taught nothing—or in the majority of cases what they have been taught is all wrong—educating the public and educating the professional is very often nearly identical.
I get medical doctors, acupuncturists, and surgeons, and during the class they will say, “You are exploding everything that I’ve been taught. But this is terrific, because when I go to look up the things that you talk about, there really is research backing up what you’re saying. And there really is not proper research backing up what we have been taught.”
The next resource is our library that people can arrange to fly in and use if they are doing research. But we also have a bookstore. Our bookstore is made up of books that are all reviewed by one of our board members. If it is a book that we love, it simply gets brought in. We write a review on it or at least a blurb on the Web site and we start carrying it. If it is a book that is good, but for some unknown reason the author happens to support one idea that we are massively against, then we will carry the book and put an errata in it with a disclaimer that says that the information is very good and very important, but we completely disagree with that one idea. Everything else in the book, we approve of. Therefore, you can walk into our catalog of available books blindfolded and know that you are getting information that PPNF is behind.
Ms Grinzi: All of our members also have access to our journal archives. We have been publishing journals since 1969 and all of the articles, a tremendous resource of information, recipes, and book reviews are in there. We encourage professionals to have their patients join Price-Pottenger because that’s information they can trust. Doctors do not have time to teach their patients about all this, so just send them to a reliable source, www.PPNF.org. Professionals get double the journals. Instead of sending them 1 quarterly, we send them 2—1 for their own personal collection and 1 to share with patients.
Ms Grinzi: We hope through the research of Price and Pottenger and the other pioneers that people are able to understand the cause of disease and degeneration and through teaching people how to apply that ancestral wisdom—that they will be able to prevent or reverse disease.
Mr Getoff: We want people to have a better feel for how much control they have—that they do not realize they have—on their future health.