The Joe Rogan Experience - Joe Rogan Experience #1175 - Chris Kresser & Dr. Joel Kahn

00:00:02.000 Five, four, three, two, one.

00:00:07.000 Gentlemen, thank you very much for being here.

00:00:09.000 Really appreciate it.

00:00:10.000 Dr. Kahn, before we get started, why don't you just tell everybody what your background is.

00:00:16.000 You will be representing the vegan portion of this discussion.

00:00:20.000 Tell people about yourself a little bit.

00:00:22.000 Thank you.

00:00:22.000 I feel like the head broccoli in the United States today.

00:00:25.000 But I am from Motown, Motor City, badass, born and raised, University of Michigan School of Medicine, summa cum laude, internal medicine training, cardiology training in Dallas, Texas.

00:00:36.000 Very hard to be vegan in Dallas, but I did it in the 80s because I've been doing this.

00:00:40.000 42-year vegan.

00:00:41.000 42 years.

00:00:42.000 42-year vegan, thank you.

00:00:43.000 That's impressive.

00:00:44.000 Age 18. And then Kansas City, Missouri, another tough town to eat plants in only, the steakhouse, KC Masterpiece, did training in stenting.

00:00:52.000 I was blasting open heart attacks from 1990 on.

00:00:56.000 Came back to Michigan, very active cath lab heart attack. 0.95

00:01:00.000 You're dead, I bring you back.

00:01:02.000 Practice 24 hours a day with great partners. 0.97

00:01:04.000 And about...

00:01:06.000 Three to four years ago, I used all these decades of plant-based medicine I've been basically bringing my family up with and teaching patients, but opened a completely preventive cardiology practice.

00:01:17.000 And along the way with my wife and son, we now own three plant-based restaurants, two in Detroit, one in Austin, Texas.

00:01:23.000 Write books, do TV, write blogs.

00:01:26.000 Teach, teach, teach.

00:01:27.000 Not going to stop them 150. Because there's a lot of erectile dysfunction to stamp out.

00:01:31.000 That's my passion.

00:01:33.000 That?

00:01:33.000 Oh, my God.

00:01:34.000 What else?

00:01:35.000 What better purpose in life?

00:01:38.000 Well, we can get to that later.

00:01:40.000 Heart disease is somewhere in that mix, too.

00:01:43.000 Okay, and if people want to read more about you, website is?

00:01:48.000 Yeah, d-r-j-o-e-l-k-a-h-n, drjoelkahn.com.

00:01:53.000 And you've written a ton of books, right?

00:01:55.000 Five books, a bunch of medical papers, and a whole lot of blogs.

00:01:58.000 Awesome.

00:01:59.000 And Chris?

00:02:00.000 Yeah, Chris Kresser.

00:02:02.000 I did my undergrad at UC Berkeley and then got a Master's of Science and co-director of the California Center for Functional Medicine, which is a functional medicine clinic here in California, up in Berkeley.

00:02:17.000 And I came to this from my own experience with chronic illness.

00:02:22.000 As you know, Joe got really sick back in my early 20s when I was traveling around the world and, you know, conventional medicine didn't have much to offer for me and so that led me on a path of trying to figure out the best approach from a diet and behavior and lifestyle perspective to heal From my own chronic illness and then that evolved into me starting to write,

00:02:46.000 you know, I started a blog and a website and then wrote a couple of books and now have an organization that trains practitioners in functional medicine and also trains health coaches.

00:03:00.000 And you, at one point in time, were vegan?

00:03:02.000 I was a macrobiotic vegan.

00:03:04.000 I was apprenticing with a macrobiotic chef.

00:03:09.000 What's the difference between a macrobiotic vegan for folks and a regular vegan?

00:03:13.000 Macrobiotic is a particular philosophy.

00:03:16.000 It's a particular approach that came from Japan.

00:03:21.000 It's vegan, but it's heavily influenced by Japanese tradition and cuisine, and it has some kind of different beliefs than a typical vegan approach.

00:03:32.000 So when I was originally studying Chinese medicine, I was working and apprenticing with a macrobiotic vegan chef, and we were going around cooking for people who were really ill, often people with cancer who were following a macrobiotic diet.

00:03:46.000 And before that, I had been a vegetarian for quite a while as well.

00:03:50.000 When I was traveling around the world and got sick, actually, I was a vegetarian at that point too.

00:03:55.000 And you discovered through your own personal...

00:03:58.000 What are you doing over there, buddy?

00:04:01.000 And you discovered over there through your own personal practice that your body worked better and your illnesses went away when you changed your diet away from macrobiotic.

00:04:15.000 Yeah, for me personally, vegetarian diet and particularly vegan diet was a disaster.

00:04:22.000 But I'm just one person.

00:04:24.000 I don't put a lot of stock into a single person's experience one way or the other.

00:04:28.000 But certainly that did lead me down the path of questioning some of my earlier beliefs that I had about vegetarianism and veganism, and it led me to make some different choices.

00:04:38.000 And that is important to discuss here, that everybody's body really is different, and different people's bodies and lifestyles, they're going to have different requirements.

00:04:49.000 Absolutely.

00:04:49.000 I mean, I would say, just to start off this whole discussion, if we're trying to answer the question, what's the optimal diet for everyone, I think that's a terrible question, and it's an unanswerable question.

00:05:02.000 We share a lot in common as human beings, but we have a lot of important differences, too.

00:05:06.000 And from the beginning, I've always argued that there's no one-size-fits-all approach when it comes to diet.

00:05:12.000 But I think there are some common themes, and I'm sure we'll get to those later.

00:05:17.000 I think that's really important, right?

00:05:18.000 It's really important to discuss that people really do have different requirements.

00:05:23.000 Yeah, and I mean, we'll get in the mud a little bit as we need to, but we also, Chris and I, share a lot in common.

00:05:28.000 I mean, one, if we ate together, it would probably be 90% the same.

00:05:33.000 Really respectful of what we call functional medicine, root cause medicine.

00:05:36.000 I don't write scripts without thinking about the patient.

00:05:38.000 He certainly doesn't do that without thinking about the entire patient.

00:05:41.000 It's pretty unusual, and we're going to represent a very small section.

00:05:44.000 I honor what he's doing with his new book, Unconventional Medicine and the rest.

00:05:48.000 You know, that is what is happening throughout medicine, and it's necessary because we're just running out of dollars in health when we're just pushing pills and not even asking a person what they eat, how they sleep, you know.

00:06:00.000 The whole thing.

00:06:01.000 We're real people.

00:06:02.000 Yeah, we know that.

00:06:03.000 We all agree on this.

00:06:04.000 But it's still rare, Joe.

00:06:06.000 I mean, this is a pretty rare segment.

00:06:09.000 I don't know that 2% of the people in America will have a patient leave the office and actually ask what they ate today.

00:06:15.000 It's true.

00:06:16.000 It doesn't happen.

00:06:16.000 Let me say one more thing about this, though, because I think you hit on a really important point, and I'm glad you did it right off the bat.

00:06:23.000 The biggest problem with nutritional research, epidemiology, It starts with the assumption that there is one diet for everybody.

00:06:32.000 That's something that's rarely discussed.

00:06:34.000 It's this idea that should everyone be on a low-carb diet?

00:06:39.000 Should everyone be on a high-carb, low-fat diet?

00:06:44.000 Should everyone do this?

00:06:45.000 Should everyone do that?

00:06:48.000 There's a guy in Australia, a professor, who calls this approach nutritionism.

00:06:56.000 This idea that we can reduce foods down into these individual components, just like macronutrients, you know, protein, fat, carbohydrates, and we can figure out what works best for everyone just by looking at these isolated components without considering the whole context of the diet.

00:07:14.000 So I think, you know, Joel would agree that if you talk about a diet that's 50% calories and fat, And one diet is they're getting all of those fat calories from pizza and chips and candy bars and things like that.

00:07:26.000 And then another diet, they're getting 50% of fat from avocados and olive oil and even, you know, eggs and animal foods.

00:07:34.000 Those are two totally different diets.

00:07:37.000 And yet in the scientific literature, those are equated as the same because all they're looking at is the calories from fat.

00:07:43.000 They're not considering the quality of the diet.

00:07:46.000 And I'll just add in, and again, we go anywhere with this conversation, but a lot of the problem has been imprecision of language.

00:07:52.000 So even the word low-carb diet, I eat a low-carb diet if we talk low-refined carbs.

00:07:56.000 I don't eat white flour.

00:07:57.000 I don't eat sugar.

00:07:58.000 I'm very careful about all those components.

00:08:00.000 I eat a very high, complex carbohydrate diet.

00:08:05.000 Vegetables.

00:08:06.000 A giant study that's been released last year, the Pure study, talks about carbs in the diet.

00:08:11.000 They didn't differentiate, complex, and refined.

00:08:13.000 Very hard to know what to do with data that doesn't spread that apart in your own life.

00:08:17.000 I mean, low-fat, high-fat.

00:08:19.000 I mean, we need to talk about, is it soybean oil that's, you know, processed and rancid?

00:08:24.000 Or are we talking about avocados and, you know, healthy whole foods?

00:08:28.000 So the precision of language Even protein.

00:08:31.000 Protein, the big divide, is animal versus plants.

00:08:33.000 Anytime that word comes up, we need to differentiate.

00:08:37.000 Be precise, and then we'll help more people if we're precise.

00:08:40.000 Yeah, and if you can, just to illuminate this for people, what is the problem with epidemiology studies?

00:08:46.000 Oh boy.

00:08:47.000 You know, I'll go there real quick.

00:08:49.000 I mean, I don't think there's a problem, but they're a part of the solution.

00:08:53.000 They're not the whole solution.

00:08:54.000 A lot of scientists, I'll give a shout out to Los Angeles, brightest nutrition mind, somebody that I know Chris honors too, Walter Longo.

00:09:01.000 No label, not vegan, not paleo, not nothing.

00:09:04.000 He's at USC, been honored by the Royal Academy of Swedish Medicine, which is a Nobel Prize committee and this and that.

00:09:11.000 He says, you know, you do basic science, and then you do an epidemiology study to test the hypothesis.

00:09:16.000 You see something in a petri dish, you see something in a mouse, you see something in a cell, you ask the question, is animal protein pro-longevity, pro-early aging?

00:09:26.000 Do you mind explaining epidemiology studies to people?

00:09:29.000 So you would take that concept, I'll just remember that, that you look at an amino acid found in animal protein, throw out methionine and leucine, and a petri dish looks like it might cause accelerated aging in a single cell.

00:09:41.000 That's biochemistry. 0.97

00:09:42.000 That is something you honor, but it's a long jump from there to a human.

00:09:46.000 Then you look at a database.

00:09:48.000 Sometimes it's a crappy old database, sometimes Harvard has these gigantic ongoing databases.

00:09:54.000 Loma Linda, an hour from here, has a gigantic database, and there's others, an EPIC study, this PURE study I mentioned.

00:09:59.000 You can test a hypothesis of what happens if our data may be crappy, but it's still data, and it allows you to go further with 100,000 people, 50,000 people, 500,000 people.

00:10:09.000 Do we have the data to ask the question, does protein correlate with survival, protein correlate with early death, animal protein, plant protein?

00:10:17.000 These studies have been coming out a lot lately, and they let you parse it out.

00:10:21.000 It's what Chris talks about.

00:10:23.000 Do you know everything about the person in the database?

00:10:26.000 Do you know smoke or do you know diabetes?

00:10:27.000 Do they go to the gym?

00:10:28.000 Do they lift weights?

00:10:29.000 Do they smoke dope?

00:10:29.000 Do they smoke crack?

00:10:30.000 You don't know everything.

00:10:32.000 Nowadays, most of these things are going to ask are your blood pressure, cholesterol, all the basics to try and take those factors away and isolate.

00:10:40.000 That's the question you're asking.

00:10:41.000 It will be imperfect.

00:10:42.000 And then you go to the best study, but it won't happen often, the randomized clinical trial.

00:10:47.000 I mean, there's never been a randomized clinical trial of smoking, because that'd be unethical.

00:10:50.000 You're never going to do it.

00:10:51.000 It was epidemiology that proved an association strong enough to recommend to the public, don't smoke.

00:10:58.000 There'll never be a randomized trial.

00:11:00.000 And not everything, parachutes don't need a randomized trial.

00:11:04.000 You know, taking folic acid in a pregnant woman to not have spino bifida doesn't need a randomized trial.

00:11:10.000 I mean, there's some things that are so pressing, the public health can't allow that.

00:11:14.000 And there's even more than that.

00:11:16.000 The last little section is, you can study old people.

00:11:19.000 Chris enjoys studying ancient societies.

00:11:22.000 I enjoy studying the elderly in current, you know, modern environment, which is called the blue zones, and there's others.

00:11:29.000 What do old people do, the old healthy people, what we would like to be?

00:11:32.000 Would you like to be 90 and have your brains and have your joints and everything working?

00:11:36.000 Well, we have that database.

00:11:38.000 So that little four-pod pedestal to sit on, basic epidemiology, randomized studies, and centenarian studies, allows you to make reasonable conclusions.

00:11:48.000 You know, we'll be wrong sometimes.

00:11:50.000 We're not going to be very wrong.

00:11:51.000 Chris?

00:11:52.000 I think there's huge problems with epidemiology.

00:11:54.000 So, epidemiology, observational studies, are studies that look at a certain group of people and then try to draw inferences from their behavior about associations with disease.

00:12:07.000 So, let's say we take a group and we look and see, you know, how much saturated fat are they eating and we separate them into, you know, low consumption, medium consumption, high consumption.

00:12:18.000 And in a prospective study where we're watching them over time, we might then look 20 years later and see how many people had heart attacks and died.

00:12:26.000 Okay, and then we try to, you know, correlate that with their amount of saturated fat intake.

00:12:31.000 Now, I actually just published two articles with Going in detail on the problems with observational nutritional research, and you can find them at Kresser.co slash Rogan.

00:12:44.000 There's a whole bunch of information that we're going to be talking about today there, so people can go and get the details themselves.

00:12:50.000 But I'll just give you three of the, I think, the worst problems with nutritional epidemiology.

00:12:55.000 The first is data collection.

00:12:57.000 So there's a saying in science, which is that data are only as good as the tool used to collect them.

00:13:05.000 And in nutritional observational studies, the tool used to collect data is a questionnaire.

00:13:12.000 Okay?

00:13:13.000 And so that relies completely on memory.

00:13:17.000 And we know that memory is not a precise, accurate, or literal representation of events.

00:13:22.000 It's more like a highly edited anecdote of what happened in the past.

00:13:26.000 It's a little bit like the Kavanaugh thing going on, right?

00:13:29.000 Yeah.

00:13:30.000 Back in the 13th century, you had Francis Bacon who said, for something to be scientific, it has to be independently observable, measurable, and falsifiable, and then accurate and valid.

00:13:43.000 And so let's use an analogy.

00:13:45.000 If you're sitting there eating an apple, and I'm watching you do that, I can observe that you're eating the apple, I can measure how much of the apple you eat, and I can confirm or refute that you're eating the apple.

00:13:56.000 If you tell me that you were eating an apple 15 years ago or 10 years ago, I obviously can't observe that, I obviously can't measure it, and I obviously can't confirm or refute it.

00:14:06.000 And yet our entire foundation of nutritional epidemiology is based on that.

00:14:12.000 Basically people reporting on what they ate at some time in the past.

00:14:18.000 You know, how much of a problem is this?

00:14:20.000 There's a guy named Edward Archer who's done some really interesting studies, and he looked at the NHANES data, the nurses' health data, which is one of the longest-running nutrition studies, 39 years, and he found that the self-reported calorie intake in those studies was either physiologically implausible or incompatible with life.

00:14:42.000 So, the average person in those studies reported a calorie intake that would not support an elderly, bedridden, frail woman. 0.69

00:14:53.000 So it's just inaccurate.

00:14:55.000 It's completely inaccurate.

00:14:56.000 And the people who are most likely to underreport are people who are overweight and obese.

00:15:02.000 So if calories are that much underreported, all nutrition comes through calories.

00:15:08.000 Everything we get, fat, protein, carbohydrates, micronutrients, they all come through calories.

00:15:12.000 So if calories are that underreported, that completely invalidates the data set.

00:15:18.000 So this is an obesity study.

00:15:19.000 So they're underreported because of shame?

00:15:21.000 It's not an obesity study.

00:15:22.000 It's just Americans are overweight and obese. 0.89

00:15:26.000 The majority of Americans are overweight and obese.

00:15:28.000 So in any data set of Americans, you're going to have the majority of them overweight or obese.

00:15:32.000 So that's the first problem.

00:15:35.000 The second problem is the healthy user bias, which I know we talked about before.

00:15:39.000 But it's basically the idea that because when someone engages in a behavior that's perceived as unhealthy, They are more likely to engage in other behaviors that are perceived as unhealthy and vice versa.

00:15:53.000 So let's say you do a study of people who eat more red meat.

00:15:58.000 Well, red meat has been perceived as unhealthy for a long time.

00:16:01.000 And so what we know is that in those observational studies, the people who eat more red meat are also smoking more.

00:16:07.000 They have higher body mass index.

00:16:09.000 They're eating fewer fruits and vegetables.

00:16:11.000 They have a lower level of education.

00:16:13.000 They're less physically active.

00:16:15.000 So how do you know that it's the red meat that's causing the problem and not those other things? 0.92

00:16:20.000 You don't, because they cannot control for all those potential confounding factors.

00:16:24.000 The third problem with observational research, and maybe the biggest, is that the relative risks in nutrition are so low that they're indistinguishable from chance.

00:16:37.000 So in fields outside of nutrition and epidemiology, Nobody would consider a relative risk, an increase in risk less than 100%, a doubling, to be really worth paying attention to.

00:16:50.000 So to put this in perspective, the observational studies that Joel was referring to that confirm that cigarette smoking led to lung cancer, That showed between a 1,000 and 3,000% increase in lung cancer in smokers.

00:17:09.000 And the studies that have shown that eating aflatoxin, which is a mycotoxin-increased liver cancer risk, that's 600% increase.

00:17:19.000 Okay, the IARC, the WHO report that suggested that processed red meat was a carcinogen, that was 18% increase.

00:17:29.000 Most epidemiologists you talk to will say that is so low that it's really indistinguishable from chance, especially given the healthy user bias and the problems with the data collection that I mentioned before.

00:17:42.000 So the studies that are cited, so when people are talking about red meat causes cancer, they're literally talking about something that showed an 18% increase.

00:17:51.000 Yeah.

00:17:51.000 And this is over people that are also consuming sugar.

00:17:55.000 So that translates into four and a half, there were four and a half cases of cancer out of 100 in people with no lowest intake of processed meat, and that went up to 5.3 cases out of 100 in people with the highest intake of processed meat.

00:18:11.000 So, you know, there are quotes, like, if you look even 20 years ago, like, there's an article in Science, the journal Science, and Marcia Angel, who was the former editor of New England Journal of Medicine, was quoted as saying,

00:18:27.000 we wouldn't even accept a paper for publication if it didn't have at least a 200% increase.

00:18:33.000 Especially if it was a new association or the biological mechanism wasn't known.

00:18:38.000 And here we are today saying that, you know, this increased that by 7% or by 10%.

00:18:45.000 And when you consider that the data is usually questionnaires of what people ate, and all of these confounding factors like exercise and fruit and vegetable consumption and things like that are not accounted for, then we're really just playing games with numbers.

00:19:01.000 Is part of the problem as well that there's this clickbait culture now in terms of journalism where they just want to publish something that says, a study shows, you know, 18% of people eat red, may get cancer.

00:19:14.000 That's a huge problem.

00:19:15.000 And there is a study that was done that showed that 43% of findings came from observational studies were portrayed in the media as being causal.

00:19:26.000 Which any epidemiologist would tell you that that's a faux pas.

00:19:31.000 You can't do that.

00:19:32.000 But nobody is going to click on a headline that says, you know, small association between these two variables seen.

00:19:41.000 We don't know what it means, but please read the story.

00:19:44.000 It's really interesting.

00:19:46.000 Let me just grab a couple.

00:19:47.000 And again, a lot of respect and agreement, but...

00:19:49.000 If we throw epidemiology away, we throw away about 80% of nutrition knowledge, because that is the most common kind of study.

00:19:56.000 And that still leaves us with basic science, which is rocking.

00:20:00.000 It leaves us with randomized clinical trials, which are very hard in nutrition, and they're very expensive, and there's less than we need.

00:20:06.000 And it finally leaves us with studying old, healthy people, centenarian studies.

00:20:11.000 We'll just go to Loma Linda.

00:20:12.000 Ten times more people in Loma Linda are over 100 than there are in Los Angeles.

00:20:16.000 Ten times more.

00:20:16.000 Really?

00:20:16.000 That's by definition, yeah.

00:20:17.000 It's called the Blue Zone, and we'll talk about Blue Zone.

00:20:20.000 Well, it was discovered in the 1950s.

00:20:22.000 If you lived in Loma Linda, you were living 12— Where is Loma Linda? 0.96

00:20:25.000 Loma Linda is an hour east of here.

00:20:26.000 What's going on over there?

00:20:28.000 Well, it's the center of the Seventh-day Adventist Church, which teaches people, eat your veggies, don't drink, don't smoke, and exercise.

00:20:34.000 It's an amazing lifestyle-oriented aspect of the Christian Church.

00:20:38.000 And they, in 1958, got huge funding from the government to explore why the heck are they living 12 years, 8 years, 10 years longer.

00:20:44.000 And they've parsed that out in probably 1,000 publications.

00:20:48.000 It's not a randomized study.

00:20:50.000 It wasn't L.A. versus Loma Linda.

00:20:52.000 We'll feed you different diets.

00:20:53.000 It won't ever happen.

00:20:55.000 But it is, you know, a reliable long-term peer review.

00:20:58.000 This stuff's published in the finest of journals, and it at least lets you ask questions.

00:21:02.000 I mean, why is there a 104-year-old cardiac surgeon, Elliot Warsham, walking around doing his gardening, and he just finished operating on heart patients?

00:21:10.000 I mean, it's insane.

00:21:11.000 That's 104?

00:21:11.000 104, Elliot Warsham.

00:21:13.000 Love you, buddy.

00:21:14.000 But let me go back for a minute.

00:21:15.000 If we throw epidemiology out, we are left with basic biochemistry.

00:21:20.000 I'm not suggesting that, by the way.

00:21:20.000 No, I know, I know, I know.

00:21:21.000 But so food, this is all technical stuff, but you've got a sophisticated audience.

00:21:26.000 Food frequency questionnaires, what Chris said, is the source of a lot of these epidemiology studies.

00:21:31.000 You fill out a four-page, a 40-page in Loma Linda, it's a 58-page survey.

00:21:36.000 But you do it once.

00:21:38.000 That's called the PURE study.

00:21:39.000 The headlines, you've seen them.

00:21:41.000 Cheese, eggs, meat are good for your heart.

00:21:43.000 It's been in the news the last two weeks.

00:21:44.000 That comes from a giant international study.

00:21:46.000 They did one food frequency questionnaire at the beginning.

00:21:49.000 Twelve years later, they're reporting the data.

00:21:51.000 It's all clickbait headlines.

00:21:52.000 It's like you say, people love to see this stuff.

00:21:54.000 So if we throw out some studies, we have to throw out the largest nutritional study that's been reported and the most recent one that's getting all the headlines.

00:22:02.000 It's got to be played fair.

00:22:03.000 Now, you go to Loma Linda, it's every four years they're asking.

00:22:06.000 You go to Harvard School of Public Health, every four years.

00:22:08.000 They update the data.

00:22:09.000 So if you change your diet, that's the weakness.

00:22:11.000 You fill out the survey and then you get healthy or you get sick and you make changes and then they're counting if you're dead or alive.

00:22:17.000 Well, it might be what you did year six, not what you filled out year one.

00:22:20.000 So there are...

00:22:21.000 There are better and worse forms.

00:22:23.000 The second I'd say, healthy user bias is the idea that people pick a certain diet and might have other lifestyles that might be as or more important.

00:22:30.000 It's going to be true of the paleo group.

00:22:32.000 I mean, these guys are...

00:22:34.000 Look at Chris.

00:22:35.000 He looks wonderful.

00:22:35.000 He's healthy.

00:22:36.000 He's thin.

00:22:36.000 He's not the obese American, the 75% that are overweight and obese.

00:22:40.000 I mean, that's true in the plant community to some extent.

00:22:43.000 We have chubby vegans.

00:22:44.000 Oh, my God.

00:22:45.000 But there's no observational studies with significant numbers of paleo dieters.

00:22:49.000 Well, I know.

00:22:49.000 I know that.

00:22:50.000 So the health user bias is not an issue for paleo people.

00:22:53.000 But if you don't have data, it doesn't mean...

00:22:55.000 I mean, you don't have data because it's a new movement that hasn't had the data.

00:22:58.000 But it's not to cast stones that plant-based eaters go to the gym more. 0.84

00:23:02.000 It's probably true.

00:23:03.000 We don't know.

00:23:04.000 And that's the third thing.

00:23:05.000 To stop you for a second, meat eaters do get lumped in with the paleo group.

00:23:10.000 They consider paleo group part of the meat eater group.

00:23:13.000 Like when people talk about these epidemiologists, Epidemiology studies where they show that people that consume red meat are more likely to get sick or more likely to get cancer.

00:23:22.000 They're not referring to paleo dieters.

00:23:24.000 People that are eating avocado and grass-fed beef.

00:23:27.000 Most of the paleo movement is the last dozen, 15 years.

00:23:31.000 We can talk about that.

00:23:31.000 1985, 2002. Lauren Cordain published his book in 2002. The book didn't sell.

00:23:36.000 It republished in 2010. It took off.

00:23:38.000 This is a relatively new movement.

00:23:40.000 So if you filled out the study in Loma Linda in 1958...

00:23:44.000 You don't have to worry.

00:23:44.000 There weren't too many people following a classic paleo diet.

00:23:47.000 This is also true at Harvard.

00:23:49.000 The last is just the relative risk.

00:23:52.000 That's what we call it.

00:23:52.000 These are pure statistics.

00:23:53.000 I'm a heart doc, not a statistician.

00:23:55.000 But there are some exceptions.

00:23:57.000 I mean, anybody, and I'll just say, I've got a red button on my website that says Rogan References, because I thought it would be good to have people, a place to go, just like Chris mentioned.

00:24:05.000 And I'm not massaging the data.

00:24:07.000 It's scientific peer-reviewed data.

00:24:09.000 There was a study October 2016, October 1, 2016, SONG is from Harvard.

00:24:15.000 6,000 people, observational data, animal protein, plant protein.

00:24:19.000 Actually, let me go to 2014, Morgan Levine.

00:24:21.000 This is an amazing Harvard researcher, beautiful woman, Morgan Levine.

00:24:25.000 She looked at 6,000 people prospectively.

00:24:27.000 Observation, fill out all these data.

00:24:29.000 If you were an animal protein eater, that's called meat, you had a 3-400% increase in cancer risk.

00:24:37.000 3-400%, that's 3-4 times, isn't 1.1, 1.08, 18%.

00:24:41.000 The data's there.

00:24:42.000 This is peer-reviewed data.

00:24:43.000 If you ate plant-based proteins, the risk of cancer goes down.

00:24:47.000 This is in the highest level.

00:24:49.000 Pause for a second.

00:24:50.000 Let's pause on that.

00:24:51.000 I just want to say there are nutritional data that have powerful risks.

00:24:55.000 Okay, but this is an example.

00:24:55.000 But this is also an epidemiology study?

00:24:58.000 That's where 80...

00:24:59.000 You know, nobody's going to do a randomized study of 6,000 people.

00:25:02.000 You eat beans and you eat beans.

00:25:04.000 Listen, I think I have a good example that can clear some of this up.

00:25:08.000 So, you mentioned the Loma Linda and the Seventh-day Adventist studies.

00:25:13.000 So, first of all...

00:25:17.000 Let me just make a comment about observational nutritional research.

00:25:20.000 There are good observational studies and there are bad ones.

00:25:23.000 You can design an observational study in a way that controls for some of these potentially confounding factors like the healthy user bias, etc.

00:25:32.000 But this is a story that will, I think, clear some of this up.

00:25:35.000 So there are about eight studies, major studies, that have compared lifespan in vegetarians and vegans and omnivores.

00:25:43.000 So the earlier studies, there are three studies that were Seventh-day Adventist studies.

00:25:48.000 So they were done in the Seventh-day Adventist community, which Joel mentioned is a religious group that has, as part of its credo, a healthy lifestyle, diet and lifestyle ideology.

00:26:00.000 Yeah, about 20 million.

00:26:02.000 Let's not talk over each other.

00:26:03.000 Let's just make sure we give each other a chance to breathe.

00:26:06.000 Vegetarian diet, but also live healthy, eat fruits and vegetables, don't smoke, don't drink excessively, etc.

00:26:15.000 So a health-conscious group of people.

00:26:18.000 And the Seventh-day Adventist study in the Netherlands compared them with the general population, which is just garbage because of the healthy user bias.

00:26:28.000 So we can just cross that one off the list.

00:26:31.000 The two Seventh-day Adventist studies that were done in Loma Linda in the US, they did a better job because they compared people who do eat meat amongst the Seventh-day Adventist population with people who don't.

00:26:42.000 And there was a slight advantage in lifespan in the vegetarians versus the meat-eaters.

00:26:48.000 But one of those studies didn't control for smoking and body mass index, so that data is highly suspect.

00:26:55.000 And the other study did, and there was a slight advantage.

00:26:58.000 Since then, there have been four studies that I think did a much better job.

00:27:03.000 So this is kind of an interesting design.

00:27:05.000 So they said, let's try to find a group of more health-conscious omnivores to compare these vegetarians against. 1.00

00:27:10.000 So the first one was called the Health Food Shopper Study.

00:27:13.000 So they looked at people who shop at health food stores when the idea is people who shop at health food stores are going to be generally more health conscious.

00:27:21.000 By health food store, you mean like a Whole Foods or Air One?

00:27:23.000 I mean, there was no Whole Foods at this point, but that was the idea, right?

00:27:27.000 And so that study found that both groups, vegetarians and omnivores who shop at health food stores, had a hugely reduced risk of death compared to the general population, but there was no difference between vegetarians and omnivores.

00:27:40.000 Second study, Oxford Vegetarian Study in the UK, they recruited people by, first they recruited vegetarians, and then they asked the vegetarians to ask their friends who also ate meat.

00:27:52.000 So the idea was that people that the vegetarians were hanging out with might be more health conscious than the general population.

00:27:58.000 Same result.

00:28:00.000 Big difference in lifespan between those two groups and the general population, but no difference between vegetarians and omnivores.

00:28:07.000 Epic Oxford cohort, same thing, same way of recruiting people, same result.

00:28:12.000 Big difference between the two groups and the omnivores, but no difference between vegetarians and omnivores.

00:28:18.000 And then the Heidelberg study was in Germany, and similar way, I think they recruited people who read vegetarian magazines.

00:28:27.000 And then they asked them to bring their friends or family members who ate meat.

00:28:30.000 Big difference in lifespan between the two groups and general population.

00:28:34.000 No difference between vegetarians and omnivores.

00:28:37.000 And then you had the 45 and up study that was recently done in Australia.

00:28:41.000 This was a little different because they didn't set out to find, you know, more health conscious people.

00:28:46.000 Instead, they looked at 250,000 people, big sample size, and they did a much better job of controlling for all of the various factors that might affect You know, the results.

00:28:57.000 So exercise, physical activity, fruit and vegetable consumption, cigarette smoking, alcohol, education level, because we know that has a big impact on lifespan.

00:29:07.000 And they found that there was no difference in lifespan between omnivores and vegetarians.

00:29:12.000 In that study as well.

00:29:14.000 And then there have been two meta-analyses of all of the studies that have looked at this.

00:29:18.000 Both meta-analyses found no difference between vegetarians and omnivores in total in lifespan.

00:29:25.000 So I think this is a really good example of what we're talking about here.

00:29:28.000 That's all observational data.

00:29:30.000 So we're not throwing it out or saying we should throw it out.

00:29:32.000 But all of those studies did a better job at dealing with the potential pitfalls of observational studies.

00:29:39.000 And when they did that, they found no difference.

00:29:43.000 And I want to point out that those ways of picking more health-conscious omnivores, they still weren't comparing someone on a paleo type of diet with a vegetarian.

00:29:53.000 They were just...

00:29:54.000 Guessing that someone who shopped at a health food store was at least a little more conscious about health than the general population.

00:30:00.000 Can I quickly clean up?

00:30:02.000 I just want to go back for a minute to meat and cancer.

00:30:05.000 World Health Organization is not a vegan group.

00:30:07.000 It's not a nothing group.

00:30:09.000 It's a fairly well-respected international organization that puts out health...

00:30:14.000 So although, I absolutely, Chris had the data, right?

00:30:17.000 18% increase in cancer risk with processed red meat.

00:30:20.000 I want to make that clear.

00:30:21.000 I hope you don't eat too many hot dogs, salami, bologna, pepperoni.

00:30:25.000 That's the...

00:30:26.000 Nitrates.

00:30:27.000 Well, it may be more than nitrates, but it's just the whole thing.

00:30:30.000 Anyway, it's the salt, it's the preservatives, it's junky pieces of the animal that they're putting into a hot dog.

00:30:35.000 That was a group.

00:30:36.000 That's an 18% increase.

00:30:37.000 You can go 4.5% to 5.5%.

00:30:39.000 That's still 50,000 to 60,000 people a year that get colon cancer if that data's right.

00:30:43.000 They wouldn't get colon cancer if they just would stop eating hot dogs.

00:30:46.000 At a minimum, and I know Chris will agree, Friggin' hospitals are serving hot dogs and the data is out there that it promotes cancer to people getting chemotherapy with the IV pole.

00:30:55.000 It's insanity.

00:30:56.000 So, 50,000 people avoid colorectal cancer with small differences that the World Health Organization suggests.

00:31:01.000 It was 800 papers and 22 world experts.

00:31:04.000 There's no perfect study.

00:31:06.000 But when they announced that, October 25, 2015, the world was shocked.

00:31:10.000 You just said that processed rib meat causes cancer.

00:31:13.000 They didn't say related.

00:31:14.000 They were strong enough data to say cause.

00:31:15.000 They've been beat up.

00:31:16.000 They published more data.

00:31:17.000 They haven't backed down.

00:31:18.000 I just want to put that out.

00:31:19.000 The healthy user bias will exist in the paleo community when the study's done.

00:31:23.000 Because they, I mean, look at paleo effects.

00:31:25.000 It's everything.

00:31:26.000 And I honor that.

00:31:27.000 I mean, we should promote healthy lifestyle.

00:31:29.000 Food's only one part of this.

00:31:30.000 I mean, We will all at this table live longer than the average American.

00:31:34.000 We're not smoking two-pack a day.

00:31:35.000 We don't have 38-inch waistlines.

00:31:37.000 The whole deal.

00:31:38.000 We're doing the whole thing.

00:31:39.000 Hopefully you guys are enjoying a little Cabernet now and then.

00:31:42.000 That's always on the list.

00:31:43.000 Just don't overdo it.

00:31:44.000 But the Healthy User Bias, that particular, that health food study paper, it was 1996. It's a pretty old paper.

00:31:50.000 In the...

00:31:51.000 Paper in the limitations.

00:31:52.000 They beat themselves up.

00:31:54.000 We were missing this or that.

00:31:55.000 Anybody just read the paper.

00:31:56.000 It's not that it doesn't bring up an interesting point, but to say that we, again, throw away all these papers because they are biased.

00:32:03.000 Lastly, and I'm done, multivariate analysis.

00:32:05.000 Chris was just talking about better studies that factor all this stuff.

00:32:09.000 Let's not bore your audience with statistics, statistics.

00:32:11.000 But there's certainly the ability now to say, does animal protein associate with an increased risk of cancer?

00:32:17.000 And put in smoking and weight and diabetes and blood pressure and vegetable intake and alcohol intake and family history.

00:32:23.000 And then you just isolate the one thing.

00:32:26.000 Is there foibles?

00:32:27.000 Are there downsides?

00:32:28.000 Of course.

00:32:28.000 But all modern epidemiology does multivariate analysis to try and isolate it.

00:32:33.000 You know, you can cast stones everywhere, but...

00:32:35.000 You know, there are, you know, the World Health Organization, I mean, there's 21 organizations say limit your saturated fat in your diet, and none that are in international societies say increase it.

00:32:45.000 So you put nutrition science needs to incorporate as much as you can with as much reliability, and at the end of the day, you can see we'll still have questions.

00:32:55.000 The U.S. used to say, don't eat much cholesterol, and now they don't.

00:33:00.000 They used to say, limit your total fat, and now they don't.

00:33:02.000 That's wrong.

00:33:02.000 Because they've gone out.

00:33:04.000 It's not wrong, actually.

00:33:05.000 Well, the USDA says in the guideline, eat as little cholesterol as possible.

00:33:08.000 It says cholesterol is not a nutrient of concern.

00:33:10.000 Because they couldn't identify the exact milligram to recommend.

00:33:13.000 It used to be 300. Because the science doesn't support limiting dietary cholesterol anymore.

00:33:19.000 Let me go back to the...

00:33:21.000 They say limit cholesterol.

00:33:23.000 They say limit cholesterol to as little as possible.

00:33:25.000 What's this they?

00:33:27.000 Who is they?

00:33:27.000 USDA. The guidelines come out every five years and they are used for school menus and hospital menus.

00:33:35.000 It was a big buzz in 2016 when it was announced.

00:33:38.000 They no longer were giving so many milligrams of cholesterol they never exceed.

00:33:42.000 They said we can't pick the number.

00:33:44.000 Isn't USDA behind the curve in terms of science?

00:33:47.000 They're influential.

00:33:49.000 Total mortality is the most important endpoint we should be talking about here.

00:33:53.000 That means deaths from any cause, right?

00:33:55.000 Because that's what we care about most, right?

00:34:01.000 If an intervention reduces the risk of a heart attack but increases the risk of cancer, I'm not happy with that.

00:34:08.000 In fact, I'd rather go out and have a heart attack in my sleep.

00:34:13.000 So you need to consider total mortality.

00:34:16.000 And if meat increases the risk of cancer and cancer mortality, then why aren't we seeing that in the studies that compared lifespan with vegetarians and omnivores?

00:34:26.000 We have, as I said, we have five studies that did a better job of controlling for that healthy user bias, and there was no difference in any of those studies.

00:34:35.000 There's not a single study that compared relatively equivalent groups of people that shows that vegetarians or vegans have a lifespan advantage, period.

00:34:44.000 There is not.

00:34:45.000 And so if we're saying processed meat increases the risk of cancer by 18%, Maybe, maybe not, but that's not showing up in any of the total mortality data.

00:34:58.000 The second thing, and this is a really good example of what we talked about at the very beginning of the show, context is everything.

00:35:05.000 Quality is more important than quantity.

00:35:07.000 So let's think about processed meat.

00:35:09.000 So there's several proposed mechanisms for how processed meat One is that it increases N-nitroso compounds, or NOCs, which damage the gut lining.

00:35:19.000 Another is that when you cook meat at high temperatures, it forms heterocyclic amines, or HCAs, which damage the gut.

00:35:27.000 Another is that the heme iron content in meat causes oxidative stress and increases the risk of cancer that way.

00:35:36.000 And then there's TMAO and NU5GC. But let me just give you a few examples of why context is important.

00:35:43.000 So there's evidence that chlorophyll-rich green vegetables prevent myoglobin from being turned into N-nitroso compounds.

00:35:51.000 So if you're eating processed meat, but you're also eating kale and broccoli, then it's not going to have the same effect on the body as if you're just eating a hot dog.

00:36:02.000 Cruciferous vegetables and spices and marinades have been shown to reduce the formation of heterocyclic amines or HCAs.

00:36:08.000 So, same thing.

00:36:10.000 If you're, you know, if you're marinating meat or if you're eating broccoli and cruciferous vegetables with meat, it's not going to have the same impact.

00:36:17.000 There are several studies that have shown that eating fruits and vegetables attenuates the oxidative capacity of heme iron and even reduces the absorption of heme iron in the gut.

00:36:26.000 And, you know, dietary antioxidants have been shown to reduce the risk of gastric cancer.

00:36:34.000 Heme iron intake, really, you can think of it as a proxy for a crappy diet in these observational studies.

00:36:40.000 There's a quote from a study that did find a relationship with heme iron and cardiovascular disease.

00:36:49.000 But the study author himself said, with respect to heme iron intake, we found a significant association only in the studies that were based on American cohorts.

00:36:59.000 They didn't find an association in the Netherlands, Canada, France, Italy, Japan, and Sweden, which suggests that it's because of the standard crappy American diet.

00:37:08.000 Most people who are eating processed meat in the U.S., Are eating it in the form of hot dogs and all kinds of other unhealthy food.

00:37:17.000 And it's another example of healthy user diet.

00:37:19.000 I'm not saying.

00:37:20.000 I'm open to the possibility that too much processed meat can be problematic.

00:37:24.000 But you have to consider the context.

00:37:26.000 It's not going to have the same effect if someone's eating a ton of fruits and vegetables versus someone who's on a standard American diet.

00:37:33.000 And we have no studies that separate that out.

00:37:36.000 Okay.

00:37:36.000 I think we have a gong moment, because I really want your listeners to come away with a few tips from Chris and I that make a difference.

00:37:42.000 Because I know your listeners aren't going to stop eating meat at the end of this show.

00:37:46.000 They might.

00:37:47.000 Chris just said...

00:37:49.000 Meat with vegetables is safer than meat without vegetables.

00:37:52.000 Meat with chlorophyll is safer than meat without.

00:37:55.000 I can give you cardiac studies that agree.

00:37:56.000 I teach...

00:37:57.000 He said processed meat.

00:37:58.000 Well, it's all meat.

00:37:59.000 I teach that if you...

00:38:00.000 Is it all meat?

00:38:01.000 Yeah.

00:38:01.000 Is it the same?

00:38:02.000 No, listen, we agree here.

00:38:03.000 I want people to hear this.

00:38:04.000 But do we?

00:38:05.000 When you grill, how many people in the audience grill barbecue?

00:38:08.000 Everybody.

00:38:09.000 If you grill meat, another chemical group that's formed are called advanced glycation end products, AGEs that go along with the list.

00:38:16.000 But if you grill meat that's marinated, and this is the tip in dark beer.

00:38:20.000 This is science.

00:38:21.000 Randomized science.

00:38:21.000 You put a piece of beef in dark beer and you grill it.

00:38:24.000 You don't create as many of these toxic chemicals as a dry piece of beef.

00:38:28.000 So let's, like, right now, everybody listening, next time you eat meat, get a salad.

00:38:32.000 Next time you eat meat, order broccoli.

00:38:34.000 Next time you have bacon.

00:38:35.000 Get a, you know, sliced tomatoes.

00:38:37.000 You will actually improve your health.

00:38:39.000 There's this classic, and now I'm shifting to cardiology, that they took healthy volunteers and they took them down to the hospital cafeteria and they fed them a hospital burger and they were measuring on their arm how their arteries function.

00:38:50.000 Cardiology topic.

00:38:51.000 Artery function goes down in three hours when you eat a hospital burger.

00:38:54.000 It acts like you just had a toxin in your body.

00:38:57.000 You did.

00:38:57.000 They took the same group a week later.

00:38:59.000 They had to meet the same burger with a big salad.

00:39:01.000 They didn't see that finding.

00:39:03.000 I mean, I want this to be an important point.

00:39:05.000 Everybody should be...

00:39:07.000 We're jamming fruits and vegetables, or at least vegetables with some fruits.

00:39:11.000 You can go low-glycemic berries.

00:39:13.000 I'm fine with papayas, cantaloupe, and apples.

00:39:15.000 But, you know, up your veggies, listeners, and you'll counteract a lot of the crap that's out there in the world.

00:39:21.000 It's an important message.

00:39:22.000 I don't disagree with that.

00:39:23.000 No, you know you wouldn't.

00:39:24.000 You have to.

00:39:25.000 We glossed over this very quickly in the beginning of this, but there was a dispute about cholesterol and a dispute about saturated fat.

00:39:31.000 Nah! 0.99

00:39:32.000 You serious?

00:39:33.000 You were saying that saturated fat, that there's recommendations to reduce saturated fat and reduce cholesterol.

00:39:40.000 So let me get a real quick overview, and I'm going to talk fast.

00:39:43.000 Just talk normal.

00:39:45.000 We've got plenty of time.

00:39:46.000 It was felt.

00:39:47.000 So until the 40s, it was not common to have a heart attack.

00:39:51.000 Heart attacks were described in 1916. Not to say they didn't happen, but the first medical article that used the word myocardial infarction, 1916. 1940, there were not many heart attacks seen in a modern American city.

00:40:03.000 After World War II, our economy went up.

00:40:05.000 In the city of Minneapolis, Executive started suffering heart attacks.

00:40:10.000 It was also Franklin Delano Roosevelt died of high blood pressure.

00:40:13.000 A few years later, Eisenhower had a massive heart attack.

00:40:15.000 That's when our government, National Institutes of Health, started funneling major money into studies like the Framingham study.

00:40:22.000 You're from Newton.

00:40:23.000 Framingham's a city outside of Boston, and they basically invaded this town in 1958 to today. 0.97

00:40:28.000 So we're spending money, we're going to figure this crap out. 0.87

00:40:31.000 The idea had come up, heart disease wasn't just aging. 0.93

00:40:34.000 Heart disease could be explained by what's called risk factors.

00:40:37.000 Smoking might not, you can smoke and live to 100, but it's going to increase your risk.

00:40:41.000 And then they got into blood pressure and cholesterol and family history.

00:40:45.000 They identified what we call risk factors.

00:40:48.000 So until that point, diet was not considered a factor in the development of the number one killer, men and women.

00:40:53.000 I want to point out, and Chris puts this on his website, I do too, during this interview, every 39 seconds an American dies of heart disease.

00:41:01.000 Every 39 seconds, the most frequent cause of death.

00:41:04.000 So there will be about 200 people, perhaps, that will die during this podcast of the number one killer.

00:41:09.000 And 80% of it's preventable.

00:41:11.000 Chris is going to prevent some.

00:41:12.000 I'm going to prevent some. 0.99

00:41:14.000 Because the biggest enemy out there is smoking and crap diet. 1.00

00:41:17.000 Calorie rich and processed foods, crap, sad diet, standard American diet. 0.99

00:41:21.000 It became apparent in the early 1950s diet might play a role. 0.86

00:41:25.000 And a notorious scientist and many others, his name, Dr. Ansel Keys, PhD, PhD, two of them, suggested dietary fat might be a factor.

00:41:34.000 It was a hypothesis.

00:41:36.000 It's this early stage epidemiology.

00:41:38.000 It doesn't prove anything.

00:41:39.000 He went out and did studies.

00:41:41.000 Other people went out and did studies.

00:41:42.000 And the idea transitioned.

00:41:44.000 Actually, he was criticized for saying dietary fat.

00:41:46.000 The conversation transitioned.

00:41:49.000 There's some good fats, like omega-3 fatty acids are essential.

00:41:53.000 You have to have them.

00:41:54.000 And then maybe polyunsaturated fats from plants are more helpful.

00:41:58.000 But the focus went on saturated fat in food, which is basically chicken, red meat, Pizza, those are the highest sources.

00:42:06.000 And subsequently enough data accumulated, that guideline started to suggest we've got this huge problem with heart disease, we should limit saturated fat in the diet.

00:42:14.000 It was never limit all fat, 35% of calories.

00:42:17.000 That's not, in anybody's word, a low-fat diet.

00:42:21.000 And that has now promulgated in 21 international statements.

00:42:26.000 There is no opposite.

00:42:27.000 Whether it's the World Health Organization, the American Heart Association, American College of Cardiology, whether it's the Institute of Medicine says eat as little saturated fat as possible.

00:42:37.000 They couldn't be more clear.

00:42:37.000 And these are highbrow.

00:42:38.000 These are not...

00:42:40.000 It's associated with vegan movements or paleo movements or whatever.

00:42:43.000 These are medical authorities.

00:42:44.000 If there was half and half, you'd say controversy.

00:42:47.000 21 to 21 say the same thing.

00:42:48.000 They might pick a different cutoff point, but we will enhance the health and cut down the number one killer, whether it's in Asia, whether it's Europe, whether it's Australia, whether it's in the United States.

00:42:57.000 There's unanimity.

00:42:59.000 Okay, but why did they come to the conclusion of saturated fat?

00:43:01.000 Well, basic science, because there is basic science.

00:43:04.000 And let me tell you, when you eat foods rich in saturated fat, which is called meat, cheese, eggs, and such, Receptors on your liver for cholesterol.

00:43:12.000 I've got cholesterol in my blood.

00:43:14.000 I'd like to get some of it out into the liver to be metabolized.

00:43:17.000 I need a receptor.

00:43:18.000 You eat saturated fats, receptors go down.

00:43:20.000 Cholesterol has no place to go.

00:43:22.000 Cholesterol stays in the blood, bumps into your artery while I'm putting a stent in your artery.

00:43:25.000 That's the basic biochemistry.

00:43:27.000 Then they had epidemiology studies, flawed, perfect.

00:43:30.000 It doesn't matter.

00:43:31.000 It does matter.

00:43:32.000 Whoa, whoa, whoa, Chris, Chris, thank you very much.

00:43:34.000 Then they did controlled trials.

00:43:37.000 Everybody just go read Clark 1997, 395, it's called Metabolic Studies.

00:43:43.000 Change the diet, see what happens.

00:43:45.000 You add saturated fat, cholesterol skyrockets.

00:43:47.000 On average, not in a single person.

00:43:49.000 If I gave you a steak, Chris a steak, and me a steak, our cholesterol would rise differently.

00:43:53.000 It would rise, it would rise differently.

00:43:54.000 It's our microbiome, it's our genetics, it would rise.

00:43:58.000 That's a problem in the studies when you average everything together.

00:44:01.000 So they had that, and then finally, finally, they looked at populations that live over 100. These are called the pillars of longevity.

00:44:07.000 They don't eat foods rich in saturated fat.

00:44:10.000 They have a little, they don't have a lot.

00:44:11.000 They eat a lot of olive oil in Italy and Greece.

00:44:13.000 They eat almost no dietary fat in Okinawa, Japan, and they have the greatest longevity in the world in 1970. They eat almost no dietary fat, about 6-7%.

00:44:22.000 Okay.

00:44:23.000 We're getting into the weeds here.

00:44:26.000 Actually, that is the basis for a major push to say, cut back on animal products, because that's largely with the exception of coconut and palm, where saturated fat comes from.

00:44:39.000 To negate that is to throw out every major health agency in the world.

00:44:44.000 I don't believe Chris Kresser can do that.

00:44:46.000 No disrespect, I don't think Chris can throw out a hundred years of cholesterol research.

00:44:50.000 Okay, let's back up a little bit here.

00:44:52.000 Yeah, so first of all, every food that we consume has all of the fats in it.

00:44:58.000 Polyunsaturated, monounsaturated, and saturated fat.

00:45:01.000 And in fact, two tablespoons of olive oil has more saturated fat than a seven ounce pork chop.

00:45:07.000 That's a little known fact.

00:45:09.000 The oily fish, mackerel, which all of these health agencies that Joel is talking about advises us to eat, has twice the total fat and one and a half times the saturated fat of the meat that we're told to avoid.

00:45:22.000 Does it make sense that nature would include that you could eat mackerel and the polyunsaturated fats in it are good for you, but the saturated fat in it is bad for you?

00:45:33.000 That's kind of nonsensical.

00:45:34.000 But You know, let's talk a little bit more about the research.

00:45:38.000 So, there never really was good evidence to suggest that dietary cholesterol and saturated fat are connected to heart disease.

00:45:48.000 And Zoe Harcombe, who has a PhD in nutritional researcher, she wrote her thesis, her PhD thesis, on the evidence back in the 70s that led to the restrictions on saturated fat and cholesterol.

00:46:04.000 And then she also reviewed the evidence all the way up until 2016. And I have this information on my website.

00:46:14.000 If you go Cressor.co slash Rogan, you can find it.

00:46:17.000 And what you'll find is there never was really good evidence to support the limitations on saturated fat and cholesterol.

00:46:25.000 And people have started to look at this more recently.

00:46:28.000 And for example, you have a meta-analysis of observational studies including about 350,000 participants recently that found no relationship between saturated fat intake and cardiovascular disease.

00:46:43.000 You have an exhaustive review of studies, something like 25 randomized controlled trials, gold standard of clinical evidence, and almost 40 observational studies involving 650,000 participants.

00:46:57.000 And I'll read you a quote from the conclusion.

00:47:00.000 Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of saturated fatty acids.

00:47:10.000 Now look, one of my favorite quotes is the philosopher Anatoly France.

00:47:15.000 Even if 50 million people say a foolish thing, it's still a foolish thing.

00:47:19.000 And the other thing to consider is that the history of science is really the history of most scientists being wrong about most things most of the time.

00:47:29.000 And, you know, in science we have to continually challenge our hypotheses and try to falsify them, and that's how the scientific process moves forward.

00:47:38.000 And that's why in 2010 the U.S. federal government removed restrictions on total fat, whereas before there was a restriction on total fat because They acknowledged that the research was showing that not all fat is the same and that we don't need to be restricting fat from avocados and things like that.

00:47:58.000 And then in 2015, they removed the restriction on dietary cholesterol.

00:48:02.000 Now, they did that fairly quietly because how do you think it looks?

00:48:05.000 When people have been told to, you know, limit their fat and limit their cholesterol, and then the federal agency goes back on that recommendation after so many years of telling people to do that.

00:48:17.000 People lose faith in the agencies that are issuing these guidelines.

00:48:21.000 And don't take it from me.

00:48:23.000 You know, I'm not expecting anyone to believe me, and that's why I put all of the studies and the research supporting this at Cressor.co slash Rogan.

00:48:33.000 But how about John Ioannidis, who's one of the most renowned epidemiologists in the world?

00:48:38.000 He's a professor of medicine at Stanford, and he has written some scathing critiques of nutritional research recently that have been published in JAMA and British Medical Journal.

00:48:48.000 So here's a quote from one of them.

00:48:50.000 Some nutrition scientists and much of the public often consider epidemiological associations of nutritional factors to represent causal effects that can inform public health policy and guidelines.

00:49:00.000 However, the emerging picture of nutritional epidemiology is difficult to reconcile with good scientific principles.

00:49:07.000 The field needs radical reform.

00:49:11.000 And he goes on to point out that meta-analyses of observational studies have found that almost all foods are associated with a higher risk of death if you crunch the data in certain ways.

00:49:21.000 So it's not enough to say that governments are recommending this or that.

00:49:27.000 We have to look at the science and what the science is saying.

00:49:30.000 And as I said, two recent meta-analyses covering over a million people Are not showing a relationship between saturated fat and heart disease and they're not showing any benefit from replacing saturated fat with polyunsaturated fats.

00:49:44.000 So these organizations, Joel, that you were describing, why do you think that they recommend, based on what Chris has just said, why do you think that they recommend reducing your saturated fat, reducing your cholesterol?

00:49:55.000 Okay.

00:49:56.000 And thank you.

00:49:57.000 And, you know, the importance here, we are, you know, technical in the weeds, but I want to bring it back.

00:50:02.000 This discussion is, do you have a stroke, heart attack, erectile dysfunction, lose a leg, or do you not?

00:50:07.000 Because at least one factor in development of these horrible medical problems that are 80% preventable, at least one of it is your nutrition and the content in your nutrition.

00:50:16.000 I mean, there's no doubt.

00:50:17.000 It's the single most important factor.

00:50:18.000 It's never been the only factor.

00:50:19.000 Okay, but why do you think these organizations are saying this if he's saying that the studies don't support that?

00:50:25.000 Well, I disagree that the science – and I want to be very specific.

00:50:29.000 Let's talk about cholesterol and let's talk about saturated fat.

00:50:31.000 So stay with saturated fat because there is differences there.

00:50:34.000 They're both, you know, contents of food, fatty contents of food, but they're chemically different and the volume weight is very, very different.

00:50:42.000 Cholesterol only comes from animals, saturated fat is in animals, and plants, depending on the food source.

00:50:47.000 So when this rise in heart attacks developed, research began, 1948, 1950, 1958, there were observations made that carefully done dietary logs suggested.

00:50:59.000 These were hypotheses.

00:51:01.000 There might be a connection between what you eat and heart attacks, and then it's centered on, you know, is it Foods high in protein, foods high in sugar, foods high in fatty sources.

00:51:10.000 Ultimately, they got sophisticated foods high in plant fat sources, foods high in animal fat sources.

00:51:16.000 So by the late 1950s, there was a very strong consensus already that foods high in animal products with saturated fat, they go together.

00:51:25.000 We're talking meat, egg, and cheese may be a role.

00:51:28.000 Let me give you a great example.

00:51:29.000 In 1959, you grew up in Japan.

00:51:31.000 You have a cholesterol of 120. You almost never see a heart attack.

00:51:35.000 You move to Hawaii because there's migration.

00:51:38.000 Your cholesterol rises to 180. Welcome to America.

00:51:41.000 Your heart attack risk triples.

00:51:43.000 You move to this great city, Los Angeles.

00:51:45.000 This was published in 1959. Your cholesterol is now 210. You have 10 times the heart attack risk that you had when you lived in Japan.

00:51:52.000 Genetics don't change that quick.

00:51:53.000 This is within one generation.

00:51:55.000 They're called Nisei. 1.00

00:51:56.000 People that leave Japan to move to California, the Nisei. 1.00

00:51:59.000 And there's the Nisei-Han study that tracked these people. 0.62

00:52:01.000 Now, is it the air?

00:52:03.000 Is it that they adopted other bad habits?

00:52:06.000 Sure, it could be.

00:52:07.000 But within a very short time, they had 10 times the risk of heart attack.

00:52:10.000 So public research in dollars, this stuff matters.

00:52:13.000 Why is this correlated with animal fats and proteins?

00:52:16.000 And why isn't it correlated with sugar and refined carbohydrates?

00:52:19.000 So carefully done, studies say, and I think we all agree, more so now because we're overweight and now we're more insulin resistant and added sugars in the diet are more important in 2018 than they were when the country was thin in 1960. They weren't good then,

00:52:34.000 they aren't good now, but when you parse it out, multivariate analysis, there's a stronger relationship between the number one food in studies like this is usually butter, more than red meat, it's actually butter.

00:52:45.000 That's just at our value.

00:52:46.000 It's called statistics.

00:52:47.000 I don't want to go so deep into statistics.

00:52:48.000 It is.

00:52:49.000 Somewhere there is sugar.

00:52:51.000 I'll give you a classic study.

00:52:52.000 If you could hold sugar the same and increase dietary saturated fat, heart disease rockets.

00:52:56.000 If you could hold saturated fat the same and increase sugar in these manipulations, coronary heart disease doesn't increase.

00:53:01.000 Let's point something out.

00:53:02.000 I've been inside of hearts 15,000 times.

00:53:04.000 I've never scooped sugar out of a blocked artery.

00:53:07.000 I scooped cholesterol out of blocked arteries.

00:53:09.000 20% of every blockage in a heart is cholesterol.

00:53:11.000 It's a fact that was discovered in 1910. It's never varied.

00:53:15.000 Then we fed animal...

00:53:18.000 Let's pause for a second.

00:53:19.000 Chris, you have something to say about that?

00:53:20.000 Yeah, so that doesn't mean that the cholesterol is there because people were eating it, Joel.

00:53:24.000 You know that.

00:53:25.000 It could be, though.

00:53:26.000 Hold on.

00:53:27.000 Let's look at what the research says again here.

00:53:30.000 So they've done controlled feeding studies where they fed people two to four eggs a day.

00:53:35.000 And those show that in 75% of cases, that has zero impact on blood cholesterol levels.

00:53:40.000 For the other 25% of people, they're termed hyper-responders.

00:53:44.000 And in that group, dietary cholesterol does modestly increase LDL cholesterol, but it also increases HDL cholesterol, and it does not increase the risk of heart disease.

00:53:54.000 This is why the guidelines were changed on dietary cholesterol.

00:53:59.000 There is no evidence that consuming dietary cholesterol increases the risk of blood cholesterol in most people, and even when it does, there's no evidence that it increases the risk of a heart attack, which is again why the dietary guidelines change.

00:54:12.000 For saturated fat, Again, most of the studies that showed harm were short-term studies.

00:54:18.000 These longer-term studies have shown that on average, eating saturated fat does not increase the saturated fat levels in the blood.

00:54:26.000 And of all of the long-term studies that looked at this, only one showed any association between saturated fat intake and cholesterol levels in the blood.

00:54:38.000 Then we have a meta-analysis, lots of meta-analyses actually, but one of the The best-known meta-analysis was of 17 randomized controlled trials of low-carb diets that were high in saturated fats and published in the journal Obesity Reviews,

00:54:54.000 and they found that low-carb diets neither increased nor decreased LDL cholesterol.

00:54:59.000 But what they did find was that low-carb diets were associated with decrease in body weight, improvements in several cardiovascular risk factors, including triglycerides, fasting glucose, blood pressure, body mass index, abdominal circumference, plasma insulin, C-reactive protein, as well as an increase in HDL cholesterol.

00:55:17.000 Now, there have now been 10 meta-analyses of randomized controlled trials looking at low-carb diets for weight loss.

00:55:26.000 All 10 showed that the low-carb diet either outperformed in most cases or was at the same level as low-fat diets.

00:55:37.000 There have been several meta-analyses now.

00:55:39.000 You can see them all at Kresser.co.rogan that have looked at low-carb diets for diabetes and even cardiovascular risk markers.

00:55:49.000 And all of these meta-analyses have found that low-carb diets are superior for glycemic control, for reducing insulin, for reducing triglycerides.

00:55:57.000 And have beneficial effects across the board without increasing cardiovascular risk markers.

00:56:03.000 So we're talking about randomized controlled trials, which is the best form of evidence that we have, and we're not seeing any harm from increased consumption of saturated fat.

00:56:14.000 So is the problem that you're citing epidemiology studies from the 1940s and the 1950s?

00:56:20.000 I would definitely, I think we need to prefer randomized controlled trials over that kind of evidence, for sure.

00:56:27.000 Why do you continue to go back to these studies from the 1940s and 1950s?

00:56:31.000 Well, they're just the beginning.

00:56:32.000 The beginning, but Chris just took 14 topics and put them into one, from meta-analysis to randomized controls to low-carb to low-fat.

00:56:40.000 I mean, they're all different topics, and I don't know how you put that all together.

00:56:44.000 You need clarity and laser focus.

00:56:46.000 So we were talking saturated fat.

00:56:48.000 I mean, so, hypothesis is generated.

00:56:51.000 Saturated fat in the diet, butter, eggs, and cheese may be bad for heart disease.

00:56:54.000 Something killing Americans left and right in the 1940s, 1950s.

00:56:57.000 Let's go into countries with wildly different diets.

00:57:00.000 Let's see what they're eating. 0.97

00:57:01.000 Let's actually take their friggin' diet back to Minneapolis. 0.98

00:57:04.000 Let's analyze it so it's not guessing. 0.97

00:57:05.000 Not food frequency questionnaires.

00:57:07.000 We're taking their meals back to the United States to analyze them.

00:57:10.000 Ba-boom! 1.00

00:57:11.000 There's a relationship between dietary saturated fat And your risk, 50-year follow-up.

00:57:16.000 There's no short-term follow-up.

00:57:17.000 The study I'm referring to has 50-year follow-up.

00:57:19.000 1958 to now.

00:57:21.000 And that strongly suggested that dietary saturated fat and heart disease, that's not what's called the ultimate randomized clinical study, but it's one high quality.

00:57:31.000 Second study done in China at the same time with years of follow-up.

00:57:35.000 So these are right up to date.

00:57:36.000 There's publications right now from studies starting at then, but the publications are now.

00:57:40.000 But then you get the best kind of study.

00:57:43.000 Okay, I'm still in saturated fat.

00:57:44.000 I'm not talking any other topic.

00:57:46.000 You put people in a metabolic ward at the National Institute of Health.

00:57:50.000 395 of these studies published in 1979. You change their diet.

00:57:54.000 This is the ultimate careful experiment.

00:57:57.000 It might be for four weeks or six weeks.

00:57:58.000 You up their saturated fat.

00:58:00.000 Their cholesterol rises as sure as can be.

00:58:02.000 We're all different.

00:58:03.000 The change in cholesterol is consistent.

00:58:05.000 You're going to go up 20%, 20%, 20%.

00:58:07.000 We start at different points.

00:58:08.000 You have to track the change in cholesterol.

00:58:11.000 Chris referred to...

00:58:13.000 Actually, can I go off on a tangent?

00:58:15.000 It's really interesting.

00:58:16.000 This will fascinate your listeners, but it's right on the topic.

00:58:20.000 2008, this is published data.

00:58:22.000 I don't bullshit on this.

00:58:24.000 2008, Mexico City, the International Dairy Council meet, and they published their notes, which is why we know this, and they said, we are losing the battle.

00:58:32.000 People are eating less dairy around the world, and we are losing sales.

00:58:36.000 What we can do is influence researchers, influence academicians, influence speakers.

00:58:39.000 This is in Mexico, though.

00:58:40.000 Well, every dairy council in the world just happens to meet in Mexico City that year.

00:58:46.000 Then they go meet in Portugal.

00:58:47.000 Then they go meet in New York.

00:58:48.000 Whatever.

00:58:49.000 2008. We're going to put dollars into changing research and influencing people.

00:58:54.000 Doesn't mean it's all bad.

00:58:55.000 They published those notes that are global initiative for the next year.

00:58:59.000 They looked for sympathetic researchers that would change Public opinion.

00:59:03.000 That was right before the Milk Mustache campaign.

00:59:06.000 They find a guy I actually respect now, but I'm going to beat him up a little.

00:59:09.000 Dr. Ronald Krause, MD, in Berkeley, California, right by him, runs a lipid center.

00:59:14.000 He's had beef funding for 10 years.

00:59:16.000 He's had dairy funding.

00:59:17.000 All of a sudden, he's speaking to dairy industries all over.

00:59:20.000 In 2010, two years later, he publishes, we call it a meta-analysis.

00:59:24.000 That's not new research.

00:59:26.000 That's statistical playing with Previous studies that can be fair, can be unfair, whatever.

00:59:31.000 Whatever it is, their conclusion is they could not find and verify that saturated fat in the diet, butter, eggs, and cheese raises the risk of heart disease.

00:59:39.000 They never said eat butter, eggs, and cheese.

00:59:41.000 They just couldn't verify it.

00:59:43.000 What's amazing, it's in the American Journal of Clinical Nutrition, that same journal It's an editorial that destroys the study.

00:59:50.000 This is 15 reasons this is horrible epidemiology by a guy named Jeremiah Stamler.

00:59:55.000 I've never seen a medical journal destroy a piece that they accepted for publication.

01:00:00.000 Okay, so everything's like stirred up.

01:00:03.000 And 2014, a guy named Chowdhury publishes a similar analysis that is the reason that Time magazine put on the cover, Butter is Back, because it was not new research.

01:00:13.000 It's a meta-analysis.

01:00:14.000 It's all following this Mexico City Effort to fund dairy positive publications.

01:00:22.000 A study so bad that both the journal required them to adjust and republish the data because of mistakes.

01:00:28.000 The Harvard School of Public Health said, take this thing away. 0.94

01:00:31.000 Statistically, this is nonsense.

01:00:33.000 Since those two times, and that's just the bottom line, we have had confusion in the public.

01:00:38.000 We've got experts like Chris, experts like me, experts like Dr. Mark Hyman, experts like Dr. Walter Willett, on and on.

01:00:45.000 There is a quote from the tobacco industry that our product is confusion.

01:00:48.000 They didn't care about, you know, winning the battle when the public's confused.

01:00:52.000 They're just going to keep on doing habits they have.

01:00:54.000 I've got to stop you, because now we're in the weeds with conspiracy theories.

01:00:57.000 I'd like to go back to saturated fat.

01:00:59.000 But that's when the pendulum of 1950, 1960, 1997, 395 of the best done studies in the world say, you eat more saturated fat, your cholesterol goes up.

01:01:09.000 You eat more saturated fat, coronary heart disease goes up.

01:01:12.000 It was crystal clear and the guidelines said it.

01:01:15.000 The guidelines still say it.

01:01:16.000 The guidelines still say limits.

01:01:18.000 Are you suggesting that the same science from the 1950s to the 1940s is applicable today?

01:01:24.000 If it's in retrospect, valid.

01:01:27.000 Let's point out one.

01:01:28.000 But is it?

01:01:29.000 Yeah, absolutely.

01:01:30.000 Do you think it is?

01:01:30.000 Absolutely.

01:01:32.000 Why do you think it's not?

01:01:33.000 Because we keep bringing this up.

01:01:35.000 We're going back to observational studies done 50, 60 years ago that suffer from all the problems that I mentioned to begin with and several more that we didn't have time to go into.

01:01:45.000 We have randomized controlled trials now.

01:01:48.000 And, you know, observational studies were never...

01:01:51.000 They're meant to prove a hypothesis.

01:01:53.000 They're meant to generate a hypothesis.

01:01:55.000 And it's true that in some cases it's not possible to do a randomized controlled trial like with cigarette smoking.

01:02:02.000 You'd have to, you know, have the trial last for so long and you'd have to isolate people in a ward so they weren't exposed to air pollution and other factors that can affect the result.

01:02:11.000 You can't do that.

01:02:12.000 But in that case, the risk was a thousand to three thousand percent higher.

01:02:16.000 So there are criteria called the Bradford Hill criteria, which you can use And apply to observational studies to assess the chance that there's a causal relationship.

01:02:25.000 And in the case of smoking, which actually was when the Bradford Hill criteria were created, that meets many of those criteria.

01:02:34.000 In the case of nutrition research, very seldom do they meet more than a couple of the Bradford Hill criteria.

01:02:42.000 Observational research, in order to be valuable, needs to be confirmed.

01:02:45.000 You know, the results need to be replicated in a randomized controlled trial.

01:02:49.000 That's how science is supposed to work.

01:02:51.000 But there was one analysis that found that zero of 52 claims that were made in observational nutrition studies were replicated.

01:03:00.000 When they were tested later.

01:03:02.000 And in fact, five were replicated in the opposite direction.

01:03:05.000 In other words, when they did an experiment, they found the opposite result to what the observational study suggested.

01:03:11.000 So good examples of this are observational studies originally suggested that beta-carotene An antioxidant that people with the highest intake of beta-carotene had something like a 30% reduced risk of death, which is not really plausible anyways.

01:03:26.000 But then when they started doing trials where they were giving people beta-carotene supplements, not only did it not improve their lifespan, they got more cancer.

01:03:34.000 It increased the risk of cancer.

01:03:36.000 So this is why it's so important not to rely just on observational data and to do these experiments.

01:03:41.000 Now going back to saturated fat, As I said, we've got a 2013 meta-analysis of 20 randomized controlled trials that found that low-carb, high-protein diets led to greater improvements in glycemic control compared to low-fat, American Heart Association, American Diabetic Association diets.

01:03:58.000 We've got a 2014 meta-analysis of 10 randomized controlled trials that showed that low-carb diets are more effective than high-carb diets for patients with type 2 diabetes.

01:04:09.000 And we've got another meta-analysis of 25 randomized controlled trials just published in 2018 that found the same thing.

01:04:17.000 So, you know, science marches on.

01:04:19.000 We learn more, we change, and now we've got randomized controlled trials that are replacing some of the observational evidence from the 50s and 60s and 70s, which, by the way, in Dr. Harcombe's paper, you'll see that that evidence was never strong to begin with.

01:04:35.000 And this is what we should be looking at.

01:04:37.000 So why are you consistently bringing up these studies from the 50s?

01:04:40.000 Because Chris is mixing everything up.

01:04:42.000 He's talking low-carb data.

01:04:44.000 Let's talk low-carb diet.

01:04:45.000 That's keto diet.

01:04:46.000 That's low-carb diet.

01:04:46.000 But before we go to that, you consistently bring up these studies from the 1950s and the 1960s.

01:04:53.000 Low-carb diets are high in saturated fat.

01:04:55.000 Okay.

01:04:55.000 But 1915, 1960s was the initiation.

01:04:59.000 1997, Clark, 395 randomized clinical trials.

01:05:02.000 What Chris is looking for.

01:05:03.000 In metabolic ward, say, you jack up the saturated fat in your diet, you jack up your cholesterol.

01:05:08.000 We can talk about cholesterol in a minute, but cholesterol matters all day long.

01:05:11.000 Can I just ask you a question?

01:05:13.000 Hold on.

01:05:13.000 Did you say 395 randomized controlled trials?

01:05:16.000 Clark, 1997. Clark, 1997. 395. I love that.

01:05:19.000 I'd love to see that reference.

01:05:20.000 Yeah, Metabolic Ward's Day.

01:05:21.000 I can show you here.

01:05:22.000 I mean, it's right here.

01:05:23.000 I'll give you the reference.

01:05:24.000 There's 395. Are you saying he reviewed 395 randomized controlled trials in a meta-analysis?

01:05:31.000 In Metabolic Ward, the tightest dietary exchange studies, the best science.

01:05:35.000 I understand what a Metabolic Ward is, but I don't understand the 395. That's how many were there.

01:05:41.000 395 people.

01:05:41.000 No, 395 individual studies that played with fat content in a diet and looked at markers of cardiovascular risk.

01:05:47.000 There's 395 metabolic ward studies that were randomized controlled trials.

01:05:54.000 In metabolic wards.

01:05:55.000 Yeah, they're going to be short-term.

01:05:56.000 That's true.

01:05:57.000 You've got to read the literature.

01:05:58.000 It's there.

01:05:59.000 It's there for you.

01:05:59.000 Oh, I've read the literature.

01:06:00.000 Well, you missed that one.

01:06:01.000 That's a pretty important one.

01:06:03.000 Okay, but let's go back.

01:06:04.000 But hold on a second.

01:06:04.000 This is a dispute here, right?

01:06:06.000 So what is your issue with this?

01:06:07.000 I mean, I'll just give you...

01:06:08.000 It's no big deal.

01:06:09.000 I'll give you a reference.

01:06:09.000 But Chris, what is your issue with this?

01:06:10.000 I'm not aware of 395 randomized controlled trials that have been done in a metabolic ward on this question.

01:06:17.000 So I'd love to learn more about that if that's true.

01:06:20.000 I'll give it to you in one second.

01:06:20.000 It's for Clark.

01:06:21.000 So, I mean, I'm not stuck in the 1950s, but, you know, if you don't...

01:06:25.000 But you would agree that science has moved far past that, and our understanding of nutrition and our understanding of the mechanisms of the effect of the food on the body, all that has changed radically.

01:06:38.000 We have not changed.

01:06:40.000 Our food source has changed.

01:06:41.000 But that's not what I asked you.

01:06:43.000 Has our understanding of food changed?

01:06:45.000 Yes, the science has advanced pretty radically.

01:06:47.000 Well, actually, I would say that the observations made in the 50s and 60s have held up, which is why 21 international societies still say you will lower your rate.

01:06:56.000 What observations have held up?

01:06:58.000 That low saturated fat in the diet, chicken, eggs, cheese, beef, is related to raising your cholesterol, is related to your increased risk of heart attack, stroke.

01:07:06.000 Based on these 1950s epidemiology studies.

01:07:09.000 Initial.

01:07:10.000 Initial.

01:07:10.000 Then we got randomized clinical trials.

01:07:12.000 Those are called metabolic ward studies and such.

01:07:15.000 The first...

01:07:16.000 The first chink in the armor was a 2010. I gave you the background to it. 1.00

01:07:22.000 The Ciri-Torino study, the Chaudhry study. 0.97

01:07:25.000 But they have been resolved.

01:07:26.000 We've decided to throw out 50 years of science.

01:07:28.000 I just mentioned several other meta-analyses of probably 50 randomized controlled trials collectively.

01:07:36.000 And these are modern studies.

01:07:38.000 So, Joel, what is the difference?

01:07:40.000 Like, why do you think that these old studies are applicable and why are you dismissing this new evidence?

01:07:47.000 Okay.

01:07:48.000 So, just so Chris and I can resolve this issue, British Medical Journal, 1997, Dietary Lipids and Blood Cholesterol, 395 Individual Dietary Experience Put together in a meta-analysis.

01:08:02.000 It's a classic study that people know.

01:08:04.000 They actually estimated if we could lower the saturated fat content of the British population by 60%, we would save X number of heart attacks every year.

01:08:11.000 This is in what year?

01:08:12.000 1997. To answer your question, why do I think old studies are relevant?

01:08:18.000 You have to keep probing and questioning and probing and questioning.

01:08:22.000 But until this date, every major medical society, not one, if there was one, you'd question it.

01:08:27.000 21 international societies say you will further the populist health if you lower saturated fat in the diet.

01:08:34.000 And we can't pinpoint the amount of cholesterol you should lower, which is only from animal sources, but you should lower it to as low as possible, according to the USDA. But again, these are epidemiology studies, correct?

01:08:45.000 It's randomized data.

01:08:45.000 It's randomized data based on...

01:08:47.000 And the guidelines have changed, as we said, in 2010. But wouldn't you agree that the new evidence, the new science, like whatever they've studied today, they have better methods of detection,

01:09:03.000 more understanding, more data to go from, wouldn't you agree that...

01:09:08.000 We should look at new studies?

01:09:10.000 Well, we should.

01:09:11.000 Let me tell you one.

01:09:12.000 So what did he just say?

01:09:13.000 So wait, let me tell you one.

01:09:14.000 I published a study in 2012 that's been quoted 100,000 times from a major medical journal.

01:09:19.000 It uses something called Mendelian randomization.

01:09:22.000 We don't need to do randomized clinical trials all the time.

01:09:25.000 There are these gigantic databases now about genetic abnormalities and certain other parameters.

01:09:30.000 So there is a database with 300,000 people.

01:09:32.000 We know what's called their SNPs.

01:09:34.000 You've probably heard of SNPs.

01:09:35.000 You know, Chris's biology and genes aren't the same as mine, and there's variability.

01:09:39.000 If you're born with one of nine SNPs that keeps your cholesterol low your entire life, this is a genetic gift to you.

01:09:47.000 The observation in this major study quarter all over the world, the first author is Brian Ferentz, but I'm their number five, LDL randomization, is new data.

01:09:56.000 That it is an advantage to your survival, an advantage to your risk of heart attack and stroke to have a low LDL your whole life.

01:10:01.000 New data.

01:10:02.000 Is it consistent with 60 years of science?

01:10:04.000 Ba-boom! 1.00

01:10:05.000 It sure was.

01:10:06.000 We actually have learned stuff that has changed our mind.

01:10:09.000 When you do that same cutting-edge science on HDL, the happy one, the high one, You cannot show the same association anymore.

01:10:16.000 We're totally confused by the HDL particle.

01:10:19.000 LDL is the focus of atherosclerosis, low LDL. And I'll just finish.

01:10:24.000 Dr. Lauren Cordain, I'd love to talk about the history of the paleo movement.

01:10:27.000 Dr. Lauren Cordain, who had the first popular book, a PhD in Colorado.

01:10:32.000 Has written an article in 2004. It says the ideal LDL cholesterol is 50 to 70. Well, man, he should be a cardiologist because I'm going to hug him for that because he thought that saturated fat raises your blood cholesterol, increases your risk of heart attack and stroke.

01:10:45.000 This is the founding father.

01:10:46.000 This is what year was this?

01:10:47.000 2004. It's in a medical journal.

01:10:49.000 I mean, this is peer-reviewed.

01:10:51.000 It was an editorial, but it's peer-reviewed.

01:10:53.000 50 to 70 LDL. I'm really cool there with Lauren Cordain and 50 to 70. But our understanding of nutrition has advanced pretty radically since 2004, would you agree?

01:11:04.000 Yeah, and I'm not here to represent paleo.

01:11:06.000 I mean, I have never been ideological about paleo.

01:11:12.000 Even if you read my first book, it's like I'm recommending dairy products.

01:11:16.000 But I don't want to get lost in this, because you pause for a second.

01:11:19.000 So what is your response, though, to all these studies that he was citing?

01:11:23.000 You're citing these old studies.

01:11:26.000 That seem to contradict what he's saying.

01:11:28.000 But these new studies that he's showing, and we can go over them again, but you didn't address why you did.

01:11:35.000 Well, he didn't say them by name.

01:11:36.000 I'm saying them by name.

01:11:38.000 The big one.

01:11:38.000 I'll tell you.

01:11:39.000 No, the big one.

01:11:41.000 Why are the results so different in the new studies?

01:11:45.000 Well...

01:11:46.000 People better at statistics than me would say manipulation of what's called meta-analysis.

01:11:50.000 These aren't new studies.

01:11:52.000 I mean, these are old studies lumped together with different analyses that led to a conclusion that was surprising.

01:11:57.000 Is that accurate?

01:11:58.000 These are randomized controlled trials.

01:12:00.000 Name one, name one, name one.

01:12:01.000 Okay, hold on.

01:12:02.000 Here we go.

01:12:03.000 That's long term.

01:12:03.000 That's 20 years, 30 years, 40 years.

01:12:06.000 There's no such beast.

01:12:06.000 Joel, of course they're not doing 20- or 30- or 40-year randomized controlled trials.

01:12:10.000 Well, we have 50-year data on seven countries.

01:12:14.000 You have an observational study of 50 years, and that suffers from all the same problems.

01:12:17.000 We agree that there's a big difference.

01:12:19.000 Again, we've already outlined there's a big difference between epidemiology studies and randomized trials.

01:12:25.000 Absolutely.

01:12:26.000 These randomized controlled trials are not short term.

01:12:29.000 Many of them go up to two years in length.

01:12:32.000 If we're going to see changes in lipids, we're going to see them within a few weeks and certainly within a few months.

01:12:38.000 So if we're not seeing them in a few months, we're not going to see them later.

01:12:42.000 And, you know, if you look at Dr. Harcombe's paper, she reviews all of the meta-analyses looking at saturated fat and the connection with heart disease.

01:12:53.000 There are 39 meta-analyses of RCTs or prospective cohort studies that looked at saturated fat and health outcomes.

01:13:01.000 35 of 39 did not show significant correlations between saturated fat and any outcome.

01:13:06.000 Okay, 35 of 39. Of the four that did, one Well, it was more related to trans fats, not saturated fats.

01:13:14.000 One showed a benefit of replacing saturated fat with polyunsaturated fat, but it excluded two studies that would have totally changed the result.

01:13:21.000 And as I mentioned, there's the meta-analysis of 25 RCTs and 40 observational studies that showed no benefit of replacing saturated fat with polyunsaturated fat.

01:13:31.000 And then the last two were Cochrane Reviews, and in those two, saturated fat and cardiovascular disease were correlated, but saturated fat was not correlated with total mortality, cardiovascular disease mortality, fatal heart attack, non-fatal heart attack, stroke, or death from heart disease or death from any diagnoses of diabetes.

01:13:52.000 No, Joel, I'm going to let you get to this in a second.

01:13:54.000 Out of those 39 trials, virtually none showed that eating saturated fat will increase your risk of heart disease, and none showed that it will increase your risk of death from any cause.

01:14:06.000 So that is pretty damning evidence.

01:14:08.000 Now, if I could summarize for you, or get you to summarize, your position is that his reciting of these older studies, that they are not relevant, that they are epidemiology studies, that they are not as rigorous, And that this new evidence is based on new understanding and new science and that he's ignoring this?

01:14:28.000 Yeah, that early studies showed some relationship, but they were short, very short term, between eating saturated fat and then cholesterol.

01:14:36.000 The other problem is they were using cholesterol as a proxy marker.

01:14:40.000 They weren't looking at, did people eat saturated fat and die more?

01:14:44.000 They looked at, did saturated fat increase cholesterol?

01:14:48.000 So when they did longer-term studies, there's no increase in cholesterol on average.

01:14:54.000 That doesn't mean no one will experience an increase.

01:14:56.000 That's not true.

01:14:57.000 Some people will.

01:14:58.000 But on average, there was no increase.

01:15:01.000 And then when they looked at...

01:15:02.000 They just took cholesterol out of the equation. 0.96

01:15:04.000 Let's just look at, is there an increase in heart attacks or death from eating saturated fat?

01:15:09.000 When they did that, there's no increase.

01:15:11.000 And these are...

01:15:13.000 Those are observational studies, and we have all these randomized controlled trials that are showing no increase in cholesterol, no increase in insulin levels, and actually a decrease in all of those markers.

01:15:28.000 Joel?

01:15:28.000 Important stuff, and a lot of stuff was said, and I doubt, unless you're really high-level, you understood.

01:15:34.000 I just want to pick out one thing Chris said.

01:15:35.000 Does anybody know what the Cochrane database, a word that flew out of his mouth, Cochrane, C-O-C-H-R-A-N-E, is a group of scientists that try and be very objective, very independent, don't have any emotional, any books, any supplements, any food, and nothing.

01:15:49.000 And we all love supplements around this table, but let's get out of that.

01:15:53.000 Cochrane Database, every five years, comes out with a statement, does saturated fat relate to the risk of heart disease?

01:15:58.000 In 2015, the most recent, Hooper, look up Hooper, look up Cochrane Database.

01:16:03.000 Yes, it does.

01:16:04.000 Chris said it, but he flew by it.

01:16:05.000 No, it wasn't powerful enough that your choice of butter, eggs, meat, and cheese necessarily predicted your total lifespan, but it absolutely predicted your risk of developing a heart attack and stroke according to this independent database.

01:16:18.000 How so?

01:16:19.000 That's 2015. Well, how does it do it?

01:16:22.000 Saturated fat in the diet lowers the LDL receptors in the liver.

01:16:25.000 Let's talk some real science.

01:16:27.000 Your liver, my liver, Chris's liver, when you don't have LDL receptors or less than you should on the surface of your liver cells, your LDL stays in your blood.

01:16:35.000 It gets into your arterial wall.

01:16:36.000 That's my field.

01:16:37.000 Don't jack with me on arterial walls. 1.00

01:16:39.000 It gets picked up by monocytes, macrophages become foamy cells, and you're fucking dead. 1.00

01:16:44.000 And that's how it starts. 0.99

01:16:45.000 When you eat saturated fat, there's a chain of events that biologists and chemists and scientists know.

01:16:50.000 There's no question.

01:16:52.000 1985 Nobel Prize in Medicine.

01:16:54.000 Okay, but let's not go to the 80s again.

01:16:56.000 You keep going to these old studies.

01:16:58.000 I just want you to refute what he's saying about these recent studies.

01:17:02.000 Okay, 2012, I published a study.

01:17:04.000 Which one of us is a scientist around the table?

01:17:06.000 I've got it open.

01:17:07.000 It's the Journal of American Chirology.

01:17:09.000 May I please read the conclusion?

01:17:11.000 The lower your LDL level beginning in life, the greater is your reduction in your risk of developing a heart attack and stroke.

01:17:17.000 And I'll give you an interesting statistic.

01:17:19.000 If you take Lipitor and you drop your LDL cholesterol 30%, you will typically drop your risk of a heart attack if you're in the coronary range by 30%.

01:17:29.000 If you drop your LDL by 30% because you're born with a genetic gift that it's just lower than the average American, you drop your risk of heart attack by 90%.

01:17:38.000 When you keep your cholesterol down your whole life, I'm talking your blood cholesterol level your whole life, you are golden in the heart attack and stroke risk.

01:17:45.000 The problem is we pick up people at age 50, 60 and we start jacking with their diet and jacking with their drugs and that's wonderful.

01:17:51.000 They've had 50, 60 years of deteriorating their arteries, and we help them.

01:17:55.000 We can't help them like teaching children, eat fruits and vegetables and stay away from hot dogs.

01:17:59.000 That's where we've got to go.

01:18:00.000 That's the second gong here.

01:18:02.000 Get kids healthy, because they've got their whole life.

01:18:04.000 Please, what is wrong with what he said?

01:18:08.000 Well, there's allusions to, so number one, two things wrong, and I'm really not trying to nitpick.

01:18:14.000 He doesn't like epidemiology, but he totally uses epidemiology to support his case.

01:18:18.000 You can't have it both ways.

01:18:19.000 I love basic biochemistry.

01:18:21.000 I love epidemiology.

01:18:22.000 I love randomized studies.

01:18:24.000 I love centenarian studies.

01:18:25.000 My foundation is broad, and it's what's called the scientific method that's used by scientists in Los Angeles, and that's who taught me it.

01:18:33.000 Besides that, there's allusions to significant randomized clinical trials and meta-analyses.

01:18:39.000 We've got to keep the science clean as can be.

01:18:42.000 The breakthrough has been the meta-analyses, Siri Torino, Chowdhury, 2010, 2014, D'Souza, 2015. They have severe flaws.

01:18:51.000 They're not new research.

01:18:52.000 They're rehashing old data.

01:18:54.000 There has not been a randomized clinical trial that really challenges the coronary heart disease risk of meaning and increased saturated fat.

01:19:01.000 I'll give you three right now.

01:19:03.000 How long are they?

01:19:04.000 Hold on.

01:19:04.000 There's American Journal of Clinical Nutrition, 2013, Ajala or Hala.

01:19:10.000 I'm not sure how to pronounce the name.

01:19:12.000 These are all on my website.

01:19:13.000 If you go to Cresser.co slash research, you can see them, or Cresser.co slash Rogan, and you scroll down to the saturated fat section, you can see them.

01:19:22.000 This is a total of 20 randomized controlled trials.

01:19:26.000 And the results, low-carb, low-GI, Mediterranean, and high-protein diets are effective in improving various markers of cardiovascular risk in people with diabetes and should be considered the overall strategy of diabetes management.

01:19:39.000 Then we've got one from SnorGard, systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes.

01:19:50.000 And this was a review of 10 RCTs and they found not only was the low-carb diet more effective for diabetes than the low-fat diet, the greater the carbohydrate restriction, the greater the effect.

01:20:03.000 And then we have one from 2018. This is Sainsbury's.

01:20:08.000 At all, and this is Effect of Dietary Carbohydrate Restriction on Glycemic Control in Adults with Diabetes.

01:20:14.000 And they found that the low carb, the conclusion this review suggests that low carb restricted or carbohydrate restricted diets could be offered to people living with diabetes.

01:20:25.000 As part of an individualized management plan.

01:20:28.000 So these are finding that these are, you know, reviews of several randomized controlled trials that are finding that there's no increase in cardiovascular risk markers.

01:20:38.000 There's actually an improvement in cardiovascular risk markers, and there's an improvement in diabetes markers like blood sugar, insulin, weight, visceral fat, etc.

01:20:49.000 So, I mean, this is the gold standard of evidence that we have is randomized controlled trials and meta-analyses, of course, they do.

01:20:58.000 There are problems.

01:20:59.000 They can be done poorly.

01:21:01.000 They can be done well.

01:21:02.000 That's true of any kind of scientific research.

01:21:03.000 But we can't throw out, really, the highest standard of evidence is meta-analysis of randomized controlled trials because you can just, anyone can pick one randomized controlled trial to support their view.

01:21:15.000 What a meta-analysis does is it looks at all of the evidence, and it looks at the quality of evidence, and then it comes up with a result from looking at all of these trials, and that's where science is today.

01:21:28.000 And these low-carb diets are high in saturated fat?

01:21:30.000 They're high in saturated fat, yeah, unless they're explicitly doing a trial where they're doing a low-carb diet that's higher in monounsaturated fat, but those are rare.

01:21:39.000 Generally, people who are eating low-carb diets are eating a lot more saturated fat.

01:21:43.000 Joel?

01:21:44.000 Just three quick bullet points.

01:21:45.000 Number one, it is low-carb literature.

01:21:46.000 We're talking saturated fat and coronary heart disease.

01:21:49.000 That's a mixture.

01:21:50.000 It's not the topic we're talking about.

01:21:51.000 Number two, these are- It's not the topic we're talking about?

01:21:53.000 Low-carb's a whole different nutritional topic.

01:21:56.000 But he's talking about high-saturated fat.

01:21:57.000 Well, that's that we haven't seen it.

01:22:00.000 That's just what he said.

01:22:01.000 Yeah, no, you can do low-carb and jack up protein, but most of the experts say don't do that.

01:22:05.000 That's called meat.

01:22:06.000 You can do low-carb and jack up fat.

01:22:08.000 That doesn't necessarily mean you're jacking up your saturated fat.

01:22:11.000 I do low-carb plant-based.

01:22:12.000 That's a whole different topic.

01:22:14.000 But it is not, number one, these are, okay, so one is low-carb.

01:22:17.000 It's not the main topic that's dominated cardiovascular research for 60 years, which is consistent to this day in every guideline.

01:22:24.000 Limit saturated fat so you don't die of a heart attack stroke.

01:22:27.000 Number two, these are words your listeners may not know.

01:22:30.000 These, he said, are biomarker studies.

01:22:33.000 I'm talking about dying of heart attacks, having heart attacks, having stroke.

01:22:36.000 I care if your blood sugar marker called hemoglobin A1C goes down.

01:22:40.000 I care if your LDL and your high sensitivity C-reactive protein goes down.

01:22:44.000 But that's not life and death.

01:22:46.000 Those are biomarkers.

01:22:47.000 They're usually correlated with better health.

01:22:49.000 If you're not tracking an artery, you're not in my scientific field, because I track arteries in clinic, we track arteries in our research studies, and I think that's the second thing I wanted to say.

01:23:00.000 But you know, I'm not here to actually negate the data that compared to the crappy, calorie-rich, and processed diet that most Americans are eating, what Chris is presenting as an alternative diet.

01:23:12.000 Won't improve numbers in the lab?

01:23:14.000 Absolutely.

01:23:14.000 It's a better choice.

01:23:15.000 I like your diet.

01:23:17.000 I do, Joe.

01:23:17.000 I like your diet, Chris.

01:23:19.000 Because I'm looking at people walking in Wendy's and Hardee's and McDonald's and hospital cafeterias and gas stations.

01:23:25.000 That's what we need to shut down and we'll make a main difference.

01:23:28.000 And all we're left with is Chris's diet, Joe's diet, and Joel's diet.

01:23:32.000 We're going to have an amazing country.

01:23:33.000 Then you can decide what you want.

01:23:35.000 Okay, I think we all agree with that.

01:23:37.000 But I still need to bring you back to this.

01:23:40.000 What he's talking about in terms of saturated fat and not being a risk and not increasing your cholesterol, you seem to disagree with that.

01:23:50.000 Sure, because the science says it does.

01:23:53.000 But he just cited a bunch of science.

01:23:55.000 The science does not say that it does.

01:23:56.000 Let me clarify something, too.

01:23:57.000 I'm not just talking about biomarkers.

01:24:00.000 Biomarkers are important, but I was the one who argued for looking at total mortality as the most important endpoint and mortality for many of these other diseases.

01:24:08.000 And the conclusion from Dr. Harcum's paper where she reviewed all of the evidence on saturated fat that I talked about before, I just mentioned 35 of 39 studies didn't show any relationship.

01:24:20.000 Here's the conclusion.

01:24:22.000 No meta-analysis of randomized controlled trials and or prospective cohort studies, those are observational studies, has found any significant difference for dietary fat interventions in all-cause mortality, that's deaths from any cause, Or deaths from heart disease or associated with dietary fat and heart disease mortality.

01:24:42.000 In other words, there's no meta-analysis of randomized controlled trials that shows that eating more saturated fat will increase your risk of death.

01:24:50.000 And your take on this is that this is the latest science and that what he's citing in terms of these studies from the 1950s and 1960s aren't really relevant.

01:24:58.000 Yes.

01:25:00.000 But even if we look at epidemiology, like I said earlier, there's a meta-analysis of studies including 350,000 participants that found no relationship between saturated fat intake and cardiovascular disease.

01:25:15.000 And then a more recent review that included both randomized controlled trials, 25 of them, and 40 observational studies with 650,000 participants that concluded Current evidence doesn't clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fat and low consumption of saturated fat.

01:25:35.000 So whether you look at the epidemiology or whether you look at the randomized controlled trials or the meta-analyses of randomized controlled trials, you end up in the same place.

01:25:44.000 Joel?

01:25:45.000 Most modern data.

01:25:47.000 We already talked this.

01:25:48.000 Everybody, please, Google Cochrane database saturated fat.

01:25:52.000 2015, Hooper is the author.

01:25:55.000 The introduction is, reducing saturated fat reduces serum cholesterol.

01:26:00.000 But we're not sure of the importance.

01:26:02.000 So we took 15 randomized studies with 59,000 participants.

01:26:06.000 The conclusion.

01:26:07.000 There is a potentially important reduction in heart disease risk by reducing saturated fat in your diet, 2015, which is why 21 international societies are solid, that we will help the public, we will help the listeners.

01:26:21.000 Have your piece of meat.

01:26:22.000 Make it four ounces, not 14 ounces.

01:26:24.000 Have your bacon.

01:26:25.000 Make it one strip, not four strips.

01:26:26.000 Have your cheese.

01:26:27.000 Just don't eat it every day and don't eat large amounts.

01:26:30.000 The amount of cheese in the United States has gone insane because the USDA funds cheese manufacturers.

01:26:35.000 Okay, so 2015, I can't get you a better one.

01:26:37.000 They'll update Cochrane database in 2020. It'll be the same.

01:26:41.000 What's your take on what he said, though?

01:26:43.000 I don't care honestly what he said.

01:26:46.000 I've got to go with the best science in the world because I deal with patients who have serious disease.

01:26:51.000 I can tell my patients the most up-to-date analysis of randomized clinical studies say saturated fat in your diet raises your cholesterol, lowering saturated fat like eating less animal products.

01:27:01.000 Just up to date, Joel, I just mentioned several meta-analyses from 2018. This is not meta-analysis.

01:27:08.000 This is randomized clinical studies, 59,000 participants.

01:27:11.000 No, they're reviewing studies.

01:27:15.000 We have to look at the weight of evidence.

01:27:17.000 There are lots of studies published all the time, and that's, again, why looking at meta-analyses of randomized controlled trials, looking at very large reviews of observational studies with over a million participants, And you end up in the same place.

01:27:31.000 Of course, we can go and find one study here, one study there that is different, has a different result.

01:27:38.000 But that's not the scientific method.

01:27:40.000 The scientific method is to look at the weight of the evidence and to continue to evaluate that over time as the evidence changes.

01:27:47.000 And, you know, this is a great quote from John Ioannidis, the Stanford epidemiologist that I mentioned.

01:27:53.000 That reminds us that we can't just rely on the past to inform the present.

01:28:00.000 He said, claimed research findings may often be simply accurate measures of the prevailing bias.

01:28:07.000 And what that means is that, let's say you have a paper that 30, 40, 50 years ago that says saturated fat increases the risk of cholesterol.

01:28:18.000 Then later, somebody We're good to go.

01:28:36.000 And the whole thing is a house of cards.

01:28:38.000 That's what most people don't realize.

01:28:40.000 That's bad science.

01:28:41.000 That is bad science.

01:28:43.000 This is good science.

01:28:44.000 That's bad science.

01:28:45.000 What is bad science?

01:28:46.000 Hold on a second.

01:28:47.000 You're saying these three...

01:28:48.000 You're saying what he's saying?

01:28:49.000 Because people are listening, not looking at your gestures.

01:28:52.000 Again, he's making comments that have no reference.

01:28:54.000 Certainly, if there's misquotes...

01:28:56.000 I just provided the references here and there on my website.

01:28:58.000 How does he have no references?

01:29:02.000 A scientific, peer-reviewed paper that quoted a reference, and everybody simply passively keeps re-quoting their reference that was wrong in the beginning.

01:29:10.000 I can give you a real-life internet example, which goes to Gary Taubes, my new friend, but sometimes my adversary.

01:29:16.000 But I can't give you a literature reference.

01:29:18.000 It might be one, but these are very general statements.

01:29:21.000 I think we should move on.

01:29:23.000 No, we definitely shouldn't, because we're not really clearing this up.

01:29:26.000 What is he saying that's wrong?

01:29:28.000 Okay.

01:29:30.000 The best scientific analysis of the global topic, the saturated fat rich containing foods which are animal sourced foods at high amount in your diet, increase the risk of dying a heart attack or stroke or having a heart attack or stroke, goes to the biochemistry.

01:29:44.000 The saturated fat in your diet will lower the number of LDL receptors on your liver and your blood cholesterol goes up.

01:29:49.000 That's backed by 395 metabolic ward studies, but that is biochemistry.

01:29:53.000 Then you get to epidemiology.

01:29:55.000 Countries that eat more saturated fat Finland.

01:29:58.000 Great story, and I gotta tell it.

01:30:00.000 1970, the highest heart attack rate in the world was Finland.

01:30:04.000 Guys were dying your age and my age at the highest rate.

01:30:06.000 The lowest heart attack rate in the Mediterranean was Crete.

01:30:09.000 40% of calories were from fat in Finland.

01:30:12.000 40% of calories were from fat in Crete.

01:30:14.000 You say, how can that happen?

01:30:15.000 Because I'm not an advocate for a low-fat diet, except for very selective clinical cases.

01:30:19.000 It was olive oil in Crete.

01:30:20.000 That's very low, not zero, low in saturated fat.

01:30:23.000 It was cheese, it was meat, it was beef, it was butter in Finland.

01:30:27.000 They instituted a national program to lower the content of saturated fat in the diet in Finland.

01:30:32.000 Five years later, a heart attack dropped 80%.

01:30:34.000 Okay, but do you understand that he's saying something totally different?

01:30:38.000 You're citing epidemiology studies about what people eat.

01:30:41.000 I started with biochemistry, then I went to epidemiology.

01:30:43.000 I want to know what's wrong with what he said.

01:30:45.000 Because he's not being broad with the science.

01:30:47.000 He's getting mired in the woods.

01:30:49.000 I'm telling you, the broadest view from 50,000 feet up, biochemistry supports it, epidemiology supports it, 395 metabolic ward studies, my randomized Mendelian randomization study.

01:31:01.000 What's wrong with Wade's head, though?

01:31:01.000 Because he's not looking at the entirety of the data.

01:31:03.000 And I'm telling you the entire data.

01:31:05.000 Then you go to Loma Linda, Okinawa, you go to Icarus, you go to Costa Rica, and you go to Sardinia.

01:31:11.000 If you live to 100 and you're still operating on somebody's heart, is your diet likely high in animal saturated fat or not?

01:31:17.000 The answer is it isn't.

01:31:18.000 It's as low as 3% of the diet in Okinawa.

01:31:22.000 That's healthy user bias.

01:31:24.000 There's a great new study recently that came out that showed that just following the top five health behaviors, which are basic, so we're talking about not smoking, not drinking, maintaining a healthy body weight, getting some physical activity, and eating a,

01:31:39.000 quote, relatively healthy diet, like not junk, all the time increases your lifespan by 13 years.

01:31:47.000 So you can't look at these populations and make inferences about animal products being the driving factor one way or the other because there's just too many other factors.

01:31:57.000 There's no way to control for all of those factors in a study, and that's why we have to come back to The scientific method.

01:32:05.000 We use observational studies to come up with hypotheses, then we do randomized controlled trials to either confirm or refute those hypotheses.

01:32:14.000 As I said before, in many cases, what is apparent in observational studies or what seems apparent It's not later confirmed in randomized controlled trials, and that's where we're at now with saturated fat and dietary cholesterol.

01:32:27.000 I just mentioned three very large meta-analyses of randomized controlled trials that failed to confirm any association of saturated fat and heart disease, or saturated fat and increase in these And I mentioned two reviews of very large observational data,

01:32:47.000 including 350,000 in one study and 650 in another, showing no relationship.

01:32:53.000 So the mechanistic arguments about liver, you know, like saturated fat does this or that, that's not convincing if it's not showing up in the data.

01:33:02.000 If it did that, then we would see it in the observational studies and the randomized studies.

01:33:08.000 Now specifically, Joel, what is your take on what he just said?

01:33:11.000 Well, we just had another gong moment.

01:33:13.000 So Chris just quoted, and it's actually a little bit comical, a Harvard School public health study on how do you live 14 years longer.

01:33:21.000 It's epidemiology, but he's using it.

01:33:23.000 The senior author is Dr. Walter Willett, a guy he calls a vegan pro advocate who's not at all vegan.

01:33:29.000 He's written a book about the Mediterranean diet with all kinds of animal recipes in it, which is Fine with me.

01:33:34.000 He's a brilliant, brilliant senior Harvard researcher, but he's using data that he says is weak and such.

01:33:39.000 Yet, the teaching point is there.

01:33:41.000 How do you live 14 years longer?

01:33:42.000 You don't smoke, exercise 30 minutes a day, you eat better than average.

01:33:46.000 That's very broad, but you eat better than average.

01:33:48.000 You keep your waist under 25, BMI under 25, and you have a few alcoholic beverages a week.

01:33:55.000 I want your listeners to write that down, because that is solid epidemiologic data that's very consistent across But that's my point.

01:34:08.000 So you can't look at cultures that have a completely different lifestyle than the standard American lifestyle and draw any inferences about animal products.

01:34:17.000 So a really good example of this is, you know, the Seventh-day Adventists, the claim is that it's the vegetarian diet that makes them live longer than the general population.

01:34:29.000 As I mentioned before, as part of their belief system, they don't smoke, they don't drink, they have a healthy lifestyle in general.

01:34:36.000 What if there was another population that also had those kind of belief systems about not smoking, not drinking, and healthy lifestyle, but they also ate meat?

01:34:46.000 Well, it turns out there is, the Mormons.

01:34:49.000 And there have been three studies on Mormons, and each of the Mormon, the studies that have been done on Mormons found that their mortality, I'll give you the exact numbers here in just a second, For whatever reason,

01:35:08.000 that's not coming up here, but their risk of death compared to the general population was something like 50% lower than the general population on average.

01:35:18.000 And yet they're eating animal foods.

01:35:19.000 They're not vegetarian like the Seventh-day Adventists.

01:35:22.000 Your point of bringing that epidemiology study in the first place, bringing up healthy lifestyle, increasing your lifespan by 14 years, is to show that any positive move is going to show, whether it's just exercise and not eating sugar or whatever, is going to show an increase in your lifespan.

01:35:39.000 Yeah, and just to show how hard it is to isolate single variables and the influence of those single variables in an observational study on those effects.

01:35:50.000 And, you know, this is something that John Ioannidis has said over and over again, is that it's almost impossible, if not impossible, to disentangle The influences of all of these single variables in observational research.

01:36:04.000 And again, I'm not saying we shouldn't use observational research.

01:36:08.000 I'm saying we should be circumspect about how we use it and we should be aware of the limitations and the flaws and keep those in mind when we're designing observational studies and when we're interpreting their results.

01:36:20.000 So, Joel, what is your opinion on what he's saying about saturated fat and cholesterol and mortality risk?

01:36:27.000 Okay.

01:36:27.000 Well, I think I've said it, but I'll repeat it.

01:36:30.000 I just want to point out we just shared another common moment.

01:36:33.000 We're both lifestyle medicine doctors, of which nutrition is just one part.

01:36:37.000 We just went through a list of lifestyle factors.

01:36:39.000 We now add sleep.

01:36:40.000 We add social support.

01:36:42.000 We add stress management skills.

01:36:43.000 It's not all smoking, diet, exercise, and the size of your body.

01:36:47.000 We are aligned, and we will go at patients side by side and do a lot of exactly the same thing.

01:36:54.000 In fact, I think the only thing there's squabble about in lifestyle medicine is optimal nutrition to prevent chronic disease.

01:37:01.000 And there's probably more than one path, but God knows the plant-based medicine group has a tremendous body of science.

01:37:07.000 I'll conclude one more time, and I don't know how many times I can say it.

01:37:10.000 The highest level of science is to integrate all that's available.

01:37:14.000 Biochemistry's on the side.

01:37:15.000 Saturated fat raises your risk of coronary heart disease.

01:37:18.000 It doesn't mean...

01:37:19.000 Nobody eats a no-saturated fat diet, but you can lower it.

01:37:22.000 Observational studies were there...

01:37:24.000 Epidemiology studies were to test that hypothesis.

01:37:27.000 They confirmed Finland and Crete.

01:37:29.000 I've talked about it.

01:37:29.000 I won't go there again.

01:37:31.000 Randomized clinical trials have confirmed it.

01:37:33.000 Hooper, Cochrane database, 2015. My study, 2012, widely cited worldwide, has confirmed it.

01:37:40.000 Get your LDL cholesterol down, genetically or by diet, as long as you can, as early as you can.

01:37:45.000 And finally, the last is, what do old healthy people do?

01:37:47.000 Actually, Chris, I just think there's a good concept to let your listeners know.

01:37:52.000 Yeah.

01:38:08.000 And I foley up your hoo-hoo. 1.00

01:38:10.000 And many of these studies that show you can reduce your risk of heart disease, stroke, and diabetes are talking about better quality of life.

01:38:17.000 So when you put all that together, these centenarian studies that have low saturated fat diets are just one more piece.

01:38:24.000 I just mentioned four incredibly solid pieces of evidence.

01:38:27.000 Not one.

01:38:27.000 It's four.

01:38:28.000 It's all that's out there.

01:38:29.000 It's what Nobel Prize winners use when they describe the cholesterol hypothesis.

01:38:33.000 Is this correct?

01:38:34.000 Well, he may not know it.

01:38:36.000 In this city of Los Angeles, our shared friend, Dr. Walter Longo, often considered, and you should have him on the show, perhaps the world's leading expert in nutrition, longevity, and such, will say you incorporate all the bases for nutritional evaluation.

01:38:50.000 You keep it big picture.

01:38:52.000 He calls it pixel mentality.

01:38:54.000 You don't get hung up on one study.

01:38:55.000 You get the whole picture.

01:38:57.000 Biochemistry, epidemiology, randomized clinical trials, finally centenarian studies.

01:39:02.000 I think it's very consistent.

01:39:03.000 You will enhance your health by lowering animal-based products.

01:39:06.000 Now, we can argue, is that 70%, 80%, 90% plant-based?

01:39:11.000 Lauren Cordain and the founder of the Paleo Movement, Boyd Eaton, we were talking about 70% plants on your plate.

01:39:18.000 I love that.

01:39:19.000 You know, I'm not telling people, quit eating meat today or you'll die.

01:39:22.000 I'm not a reactionary.

01:39:24.000 But to say that plant-based medicine doesn't have a strong basis, that I can't reverse plaque with just plant-based medicine, we haven't even talked about the ability to do that, but is absolute heresy because it, in fact, is one of the most powerful pieces of nutrition we have.

01:39:38.000 Okay, but what's wrong with these studies that he's talking about?

01:39:41.000 They're pixel mentalities.

01:39:43.000 I don't know how observational data of over a million people and three different meta-analyses of 20 to 25 randomized controlled trials each is pixel mentality.

01:39:57.000 This is the gold standard for assessing a question like this in medicine.

01:40:02.000 It's not mechanistic data or mechanistic arguments don't make Are not persuasive if they don't translate into real outcomes that you can measure in randomized controlled trials or observational studies.

01:40:13.000 I'm trying to boil this down.

01:40:15.000 So what is your take on that?

01:40:16.000 Without any references to the past and people who lived in Mongolia that lived longer?

01:40:21.000 These are the three disruptive randomized trials from 2010 on that question the relationship between diet.

01:40:26.000 No, those are different trials.

01:40:28.000 Joel, these are three different trials.

01:40:30.000 I'm not referring to Cross's research or Chowdhury's.

01:40:34.000 You need to throw them out there and let us know the reference.

01:40:37.000 I did, before.

01:40:38.000 You want me to do it again?

01:40:39.000 No, because we'll get mired.

01:40:42.000 What is wrong with what he's saying?

01:40:44.000 Look, I'm obviously the non-expert here, and I'm baffled.

01:40:48.000 So I'm trying to boil this down with as little rhetoric as possible.

01:40:52.000 Okay.

01:40:52.000 It takes...

01:40:54.000 A heretical conspiracy attitude to say everybody's got it wrong for 60 years.

01:41:01.000 21 international societies have it wrong.

01:41:02.000 They could, but it's a controversy theory to say that, that Hooper-Cochran database 2015, they've got it wrong, that metabolic ward studies got it wrong.

01:41:13.000 This is one or two or three pieces of data, and they're observational.

01:41:18.000 You don't throw out the baby with the bandwagon.

01:41:21.000 These are randomized controlled trials.

01:41:22.000 Why are you saying they're observational if they're not?

01:41:25.000 What meta-analysis by nature is implying, it's not a new study.

01:41:29.000 It's taking previous studies and doing.

01:41:31.000 So let me give you one quick example.

01:41:33.000 In the Chowdhury meta-analysis, created, butter is back on the cover of Time Magazine, created a whole fervor out there that we can go back to eating all these great foods that Atkins wants us to eat.

01:41:44.000 They correlated your blood cholesterol with your risk of having heart disease.

01:41:48.000 They couldn't confirm it.

01:41:49.000 Well, they allowed people in that meta-analysis that were on Lipitor.

01:41:53.000 Well, of course, you're on a medicine, lowers your cholesterol.

01:41:56.000 They didn't exclude those people.

01:41:57.000 That has been resoundingly criticized as, yes, it looks good.

01:42:01.000 It's in a journal.

01:42:01.000 It's a meta-analysis.

01:42:03.000 That is fraudulent or at least relatively inappropriate statistics.

01:42:07.000 It's so technical.

01:42:09.000 It's beyond, I think, the importance of this discussion.

01:42:13.000 I just say, 50,000 feet elevation view of the best nutrition is, again, four pillars that I keep talking about indicate you'd be very wise to limit the amount of saturated fat, and that's endorsed by every major medical society in the world.

01:42:28.000 It's not controversial.

01:42:30.000 It's not controversial.

01:42:31.000 I don't think it's conspiracy.

01:42:33.000 I think it's just a natural progression of science.

01:42:35.000 We used to think the world was flat.

01:42:37.000 We used to think ulcers were caused by stress.

01:42:40.000 There are a lot of things that have changed over time as the evidence evolves and as we become more educated and aware.

01:42:51.000 So why are you implying that it's some sort of a belief in a conspiracy?

01:42:56.000 Chris is suggesting we got it wrong, which means the American Heart, the American Cause, the World Health, the Institute of Medicine, the European Society of Atherosclerosis, the Australian Society of Health, all these people that tell you 10% or less saturated fat, some say as little as you could possibly get in your diet,

01:43:13.000 have got it wrong.

01:43:14.000 And that suggests there's been a total misrepresentation of all the science.

01:43:18.000 Can I pause to you for a second there?

01:43:19.000 What are their recommendations based on?

01:43:22.000 Is it based on old science?

01:43:24.000 How long have they been saying this, and what is it based on, and have they adjusted to this new science that he's discussing?

01:43:31.000 They republish, republish, republish.

01:43:33.000 So the USDA republishes every five years.

01:43:36.000 2016, not long ago?

01:43:37.000 Every five years.

01:43:38.000 2016 was the last USDA publication.

01:43:41.000 They'll do it again in 2020. But doesn't this science change pretty rapidly?

01:43:44.000 Not that fast.

01:43:45.000 Not that fast.

01:43:46.000 There's nothing new since 2016 that rocks the idea that 21 international societies got it wrong.

01:43:52.000 There's nothing.

01:43:53.000 There isn't.

01:43:54.000 The 2015 report did not use...

01:43:58.000 The USDA set up the Nutrition Evidence Library to help conduct systemic reviews to answer some of these questions.

01:44:07.000 And in the 2015 report...

01:44:09.000 The committee stated that it didn't use that database for 70% of the topics, and a lot of the guidelines hadn't used any newer science since 2010. And there had been large reviews,

01:44:26.000 as I just mentioned, these three reviews that I mentioned.

01:44:29.000 One was in 2013, one was in 2017, and one was in 2018. These are the reviews of the randomized controlled trials that didn't show increase in cardiovascular risk markers from saturated fat consumption.

01:44:45.000 And then we had those reviews of observational studies of 300,000 and 650,000 people I think the same thing will happen with saturated fat.

01:44:54.000 As I said, in 2010, they changed their recommendations on total fat.

01:44:58.000 They used to limit total fat, and then they changed those in 2010. 2015, they changed their recommendation on dietary cholesterol.

01:45:06.000 And I think probably the next time, you know, maybe it's the next time or maybe it's the time after that, you'll see a change in the saturated fat guidelines.

01:45:14.000 And it's not a big conspiracy.

01:45:15.000 I'm not saying, you know...

01:45:17.000 It's not a conspiracy, it's the advancement of science.

01:45:19.000 It's just the advancement of science, yeah.

01:45:20.000 So your take is that these organizations are behind the curve?

01:45:23.000 Yes, and if we want to talk about conflicts of interest, there are huge conflicts of interest in these organizations.

01:45:29.000 Something like 40% of the funding of the...

01:45:32.000 Well, I don't want to get this number wrong, but the American Heart Association, American Diabetic Association, a lot of these organizations have funding from big food.

01:45:42.000 You know, Coca-Cola...

01:45:44.000 You talk to a nutritionist who goes to these conferences and there's like Nestle bars and Coca-Cola at the nutrition conferences.

01:45:52.000 That's hilarious.

01:45:53.000 Yeah, it's hilarious, isn't it?

01:45:54.000 It's terrible.

01:45:54.000 It's horrible.

01:45:56.000 It's actually funny and sad at the same time.

01:45:58.000 And so I'm not saying there's a big conspiracy, but I am saying there's a problem.

01:46:03.000 In terms of scientific integrity when you have these organizations that are tasked with creating the guidelines that have these financial conflicts of interest.

01:46:11.000 That's not really how it should be.

01:46:13.000 But I don't even want to go too far down that road because we don't need to go there in order to show what the science is showing in peer-reviewed journals.

01:46:23.000 So, Joel, what is wrong with what he just said?

01:46:28.000 Well, I'll say this.

01:46:29.000 Until 2020 USDA guidelines come in, I actually think he's factually wrong because the USDA guidelines say keep the percentage of calories and saturated fat to 35% or less.

01:46:41.000 I could be wrong on that.

01:46:42.000 I'm not an encyclopedia.

01:46:43.000 I know they say— Oh, I agree with that.

01:46:46.000 Right.

01:46:47.000 Well, you said they eliminated it.

01:46:48.000 I said they changed their limitation on total fat in 2010. And I'm speculating that they will eventually change their guidelines on saturated fat because the science has evolved.

01:47:00.000 And I will buy you guys an all-paid trip to Bali if you see in the 2020 guidelines that saturated fat is still not to be limited to avoid cardiovascular disease.

01:47:08.000 We're wasting our time with that, right?

01:47:08.000 So what's wrong with what he said?

01:47:11.000 I don't know.

01:47:12.000 Well, I agree.

01:47:14.000 There are conflicts of funding, but they're not unique to any particular sector.

01:47:19.000 We just had one of the most famous food psychologists in Connecticut, Brian Wansick, who was a hero of mine, said, eat on small plates because when you eat on small plates, you're mindful and you don't get obese.

01:47:28.000 Had to have six papers retracted and had to resign.

01:47:31.000 It's pervasive.

01:47:32.000 It's a problem.

01:47:33.000 Doesn't mean there's not a majority of good scientists.

01:47:35.000 And I think most of the people we've been talking about are largely good scientists, that their reputation hasn't been tainted.

01:47:41.000 I don't want to get too mired in this, but if you look at the egg industry, prior to 1990, about 30% of egg studies on nutrition were funded by the Egg Board since 1990. It's 92%.

01:47:53.000 It's a conflict.

01:47:54.000 Who's got the money to study nutrition?

01:47:56.000 It's not the broccoli.

01:47:57.000 I've got to stop you because we're getting in the weeds again.

01:47:59.000 What is wrong with what he said?

01:48:03.000 Well, he's predicting that there'll be a change in the recommendation.

01:48:06.000 Forget about that.

01:48:07.000 What about what he said about saturated fat?

01:48:09.000 I think there's no substantial new data on saturated fat since 2015 Hooper and 2016 USDA that changes anybody to question that they should not recognize and follow the leadership of 21 international societies that are out there to try and improve the public health.

01:48:24.000 Okay, let me stop you there.

01:48:25.000 Because those 21 international societies and all these different organizations, they rely on current science to make the recommendations, correct?

01:48:32.000 Sure.

01:48:32.000 And are they often behind the curve?

01:48:35.000 I don't believe so.

01:48:36.000 The USDA goes through this whole process.

01:48:37.000 Now, they haven't published anything new since 2016. It's an expensive process.

01:48:42.000 But they did change, like he said, their total fat requirements.

01:48:45.000 They did change what they believe to be healthy and not healthy.

01:48:50.000 You said they changed it in 2010, correct?

01:48:53.000 They changed the limitation on total fat in 2010, and then they changed the limitation on dietary cholesterol in 2015. So they admit that the science has advanced and changed their perceptions of what is and is not healthy.

01:49:05.000 So what's wrong with what he's saying about saturated fat?

01:49:10.000 They didn't change saturated fat, so if we stick just on topic...

01:49:13.000 But not them.

01:49:14.000 They rely on the current science.

01:49:17.000 Right.

01:49:18.000 So he's saying that the current science is showing that there is no negative consequence of saturated fat.

01:49:22.000 That's BS. That's BS! So what is wrong with these studies that he's citing?

01:49:29.000 I don't know.

01:49:30.000 I have not read every article in the world, nor has Chris.

01:49:33.000 I don't know specifically.

01:49:35.000 There are three famous studies that I've read, Siri Torino, Chowdhury, and D'Souza.

01:49:40.000 Those have been dissected.

01:49:41.000 So you believe those, but you don't believe the ones that he's citing?

01:49:45.000 Well, I don't know.

01:49:46.000 Actually, he would probably cite those to support his case, but they've been so resoundingly criticized.

01:49:51.000 And they created fervor.

01:49:53.000 Have they been resoundingly criticized?

01:49:57.000 I'm aware that there has been criticism, but you could say the same thing about the vegetarian lifespan studies, the IARC report on processed meat.

01:50:07.000 Right, but have they been scientific?

01:50:09.000 Yeah.

01:50:31.000 I just want to say the USDA in 2015 said total fat intake should be 20 to 35 percent of all your calories.

01:50:37.000 They didn't eliminate anything in 2010. That's 2015. I think that's a factual error, Chris.

01:50:43.000 They clearly changed the cholesterol recommendation to say as little as possible.

01:50:46.000 They just didn't put a number on it.

01:50:47.000 We all know that.

01:50:48.000 My cardiology group went bananas and got them to add that sentence as keep cholesterol as low as possible.

01:50:54.000 Chris?

01:50:54.000 It says cholesterol is no longer a nutrient of concern.

01:50:58.000 But you were talking that they removed the total fat intake.

01:51:00.000 That's actually inaccurate.

01:51:01.000 It's right here.

01:51:02.000 I mean, I haven't got the guideline open.

01:51:04.000 You know, it is.

01:51:05.000 I mean, we're allowed to make mistakes.

01:51:07.000 We're trying to incorporate the whole world literature and we're just two guys.

01:51:10.000 Is that a mistake, Chris?

01:51:11.000 It's right here.

01:51:12.000 I mean...

01:51:13.000 It's a mistake.

01:51:15.000 So what was his mistake?

01:51:17.000 What did he say that was wrong?

01:51:18.000 He said that in 2010, the USDA guidelines, which are supposed to be followed by schools and colleges and the rest, removed a total fat percentage recommendation.

01:51:25.000 It remains at 20 to 35 percent.

01:51:28.000 That's fairly modest fat intake.

01:51:30.000 I have to look at the specific language to see.

01:51:33.000 My recollection is that in the same way that there's some contradiction with the cholesterol, there's a sentence that says cholesterol is no longer a nutrient of concern.

01:51:46.000 And then Joel mentioned that he and his cardiologist friends got them to add something back.

01:51:51.000 That was, you know, kind of seemed to step back from that.

01:51:55.000 And I think the same thing happened with TotalFat.

01:51:58.000 I don't know and I can't, I don't have it to look at right now.

01:52:02.000 Can we find it?

01:52:03.000 So because it seems like a pretty major point of dispute.

01:52:06.000 And Joel says it's a mistake.

01:52:08.000 It is and it isn't because still the question at hand is what do the meta-analyses of randomized controlled trials and what do the reviews large I'm still waiting to hear About a study that shows that eating more saturated,

01:52:38.000 a convincing review of meta-analysis of randomized controlled trials or even large observational data that lasted for more than a short period of time that shows that eating saturated fat And I'm not even talking about in the context of a healthy diet,

01:52:55.000 which is a whole other discussion, but just in any diet increases the risk of heart disease.

01:53:01.000 Okay, but can I stop you, please?

01:53:02.000 Because we were discussing this on the assumption that the USDA had changed the requirements for fat.

01:53:09.000 Joel's saying that's a mistake.

01:53:10.000 I really think we should clarify that.

01:53:12.000 We should find out if he's right.

01:53:13.000 You can go choosemyplate.gov.

01:53:15.000 It's right here, 2015-2020.

01:53:18.000 Questions about the USDA? It said healthy diets can include up to 35% of calories from fat.

01:53:23.000 They put a clear-cut limit on it.

01:53:24.000 It's right here.

01:53:25.000 I'm reading it.

01:53:26.000 I'm not making it up.

01:53:27.000 It's USDA. It's a government.

01:53:29.000 So what was it that you remembered from 2010, and did you remember it erroneously?

01:53:36.000 Let's see here. 0.90

01:53:39.000 This is so fucking complicated. 0.97

01:53:41.000 It's so bad. 0.99

01:53:42.000 Yeah, eat your vegetables.

01:53:44.000 Everything else follows.

01:53:46.000 Have some fun.

01:53:47.000 Love your fellow man.

01:53:53.000 I have an anecdote.

01:53:54.000 This came from a paper.

01:53:56.000 It was talking about the shift in the guidelines, and I need to...

01:54:03.000 Why don't you tell us your anecdote, Joel, and we'll get into this.

01:54:09.000 I've got to tell you an anecdote, because I love Chris Kresser.

01:54:11.000 I want everybody to know that.

01:54:12.000 There's a very famous food doc in Santa Rosa named John McDougal.

01:54:16.000 He's been treating people with...

01:54:18.000 Crazy plant-based, high-complex carb diets.

01:54:21.000 He reverses diabetes, this and that.

01:54:23.000 His newsletter came out just as I'm pulling up here and bumped into Chris.

01:54:27.000 We actually walked in exactly the same time.

01:54:29.000 He quotes the New Testament, and I'm going to read this because as a Jewish boy, I just got to read it.

01:54:34.000 One man's faith allows him to eat everything.

01:54:37.000 There's some people around the table that would do that.

01:54:39.000 Another man's faith allows him to eat only vegetables.

01:54:42.000 The man who eats everything must not look down on him who eats only vegetables.

01:54:46.000 The man who does not eat everything must not condemn the man who does.

01:54:49.000 There should be peace.

01:54:50.000 I think that is such a freaking beautiful concept, because we do need to leave here. 0.94

01:54:54.000 As promoters of healthy lifestyles, whether we call it the Harvard School of Public Health, how to live 14 years longer, the Blue Zones, how to live like Loma Linda, whether you want to eat game that you hunt that is probably eight times less in saturated fat than what you're buying at the damn grocery store.

01:55:10.000 You know, people eat your vegetables, people be really quality over quantity.

01:55:15.000 And I'm going to tell you, at some point, let's talk about eating less and taking some breaks from eating so you can activate anti-aging pathways.

01:55:21.000 Because, you know, it isn't all food.

01:55:23.000 It's sometimes too much food is probably one of the biggest problems.

01:55:26.000 For sure.

01:55:27.000 We all agree about that.

01:55:28.000 I think the real question is, and for someone like me who really doesn't know, I'm baffled by this saturated fat dispute.

01:55:36.000 Because it seems to be, there's like, one of you has got to be wrong here.

01:55:41.000 The evidence has got to point one way or the other.

01:55:43.000 Chris is saying the evidence points to it being not an issue at all, and you're saying it points to being the major issue.

01:55:50.000 Worldwide.

01:55:51.000 Worldwide consensus in leading...

01:55:53.000 Worldwide consensus by these groups that rely on current science that may or may not be behind the times.

01:55:58.000 Yeah, and I want to step back and just clarify my position here because I'm not saying, you know, we started by saying there's no one-size-fits-all approach, right?

01:56:06.000 So these studies just tell us about averages.

01:56:09.000 They tell us what happens on average when a group of people do something.

01:56:12.000 They don't tell us actually what happens for person A, person B, person C, and that can be different.

01:56:19.000 So if you get, like, some people may experience a slight increase in I think the next generation of science is going to be more of an understanding of how various dietary components and various foods affect people on an individual level.

01:56:45.000 Let's say there's someone who's got genetic polymorphisms that mean that for that person, if they eat a diet that's very high in saturated fat, their LDL particle number, which is a risk factor for heart disease, is going to go up.

01:56:59.000 I've seen that in my clinic.

01:57:00.000 Absolutely.

01:57:01.000 I'm not saying that saturated fat will never increase cholesterol or LDL particle number in people.

01:57:08.000 That's just not true.

01:57:09.000 It will in some cases.

01:57:11.000 It will happen in some cases.

01:57:14.000 But I'm just I'm reporting on the science as in terms of the general question of is saturated fat going to increase the risk of heart disease and is it going to increase the risk of death on average according to the available research and the answer to that is no.

01:57:33.000 Now then the next question is like should you Joe eat a very a diet high in saturated fat or should I or should Jamie that's a different question and Unfortunately, science is not...

01:57:46.000 We've been so focused on these population-level recommendations and the idea that there's one diet that works for everyone.

01:57:53.000 We don't have a lot of research that answers that question.

01:57:56.000 That's a big gap in current science.

01:57:59.000 Okay, I have two questions.

01:58:00.000 One, did you find out if you made an error on this 2010 requirement from the USDA? So this came from a study that's...

01:58:10.000 That reference said, despite a lack of evidence supporting low-fat diets, only in 2010 did the Dietary Guidelines Committee stop recommending limits on total fat.

01:58:19.000 But I don't have the full guidelines in front of me, and I'm not sure what the language says, so I could have made an error.

01:58:27.000 It's possible.

01:58:28.000 So you made it based on that, what you just said?

01:58:32.000 In another study.

01:58:35.000 Now, in terms of saturated fat, isn't there an increased risk when you consume saturated fat with refined sugars?

01:58:43.000 There absolutely is.

01:58:45.000 This is another example of where context matters.

01:58:49.000 Well, let me just...

01:58:50.000 Even step back a second and say that the primary sources of saturated fat, and this is important to understand when you're looking at epidemiological data.

01:59:02.000 So the sources of saturated fat in the American diet, 33% comes from pizza, desserts, candy, potato chips, pasta, tortillas, burritos, and tacos.

01:59:13.000 24.5% is unaccounted for but most likely processed foods, according to the authors.

01:59:20.000 And then 10% is, or almost 10%, sausages, hot dogs, bacon, ribs, and burgers.

01:59:28.000 So the vast majority of saturated, oh, 13% is chicken and mixed chicken dishes.

01:59:34.000 Think KFC or chicken nuggets.

01:59:38.000 And eggs and mixed egg dishes.

01:59:40.000 So the vast majority of saturated fat that Americans are eating is coming from junk.

01:59:46.000 Right.

01:59:47.000 So even in an observational, even if we did see an increase in harm from saturated fat in observational studies, we still couldn't say that that would be true for someone who is eating what I would call like a Nutrivore diet, which is, you know, whole foods,

02:00:03.000 fruits and vegetables, nuts and seeds, some starchy plants like sweet potatoes and animal products, including saturated fat.

02:00:11.000 We have no Research that suggests that saturated fat in that context is harmful.

02:00:17.000 What is the mechanism that makes saturated fat more harmful when it's consumed with sugar?

02:00:22.000 Well, there's an interesting study that was done that showed that in the context of a ketogenic diet where there's no sugar, essentially, or very low amounts of sugar, that dietary saturated fat will actually decrease Blood levels of saturated fatty acids and that if you're eating refined carbohydrates then you see an increase in saturated fatty acids that comes

02:00:52.000 from the effects of insulin essentially.

02:00:57.000 Let me find you the specific So, if you're eating a high carbohydrate diet, it will increase insulin which inhibits the oxidation of saturated fat and so then when insulin levels are high, saturated fat tends to be stored rather than being burned as fuel.

02:01:15.000 And then high carb diet, and I mean refined carbs here, not fruits and vegetables, can promote the synthesis of saturated fat in the liver.

02:01:24.000 So it actually causes the liver to make more saturated fatty acids in the serum.

02:01:34.000 This showed that controlled feeding studies have shown that refined carbohydrates will actually increase levels of saturated fat in the blood, whereas eating saturated fat in the diet does not, if the diet is not high in those carbohydrates.

02:01:51.000 Joel, what's your take on that?

02:01:53.000 You know, the only key point I make to answer your question and follow up to Chris is why does high sugar diets combine with high saturated fat diets?

02:02:01.000 Because again, I go back to biochemistry.

02:02:03.000 This is serious science.

02:02:04.000 Where's saturated fat?

02:02:05.000 It's usually found in meat and other animal-based products.

02:02:09.000 It does exist in plants like some in avocado, some in olives and olive oil.

02:02:14.000 But anyways...

02:02:15.000 There's a pathway, getting science, but it's real stuff.

02:02:18.000 The amino acids found in red meat, combined with their saturated fat that's content, triggers a pathway that accelerates aging.

02:02:26.000 You don't want to age fast.

02:02:27.000 That's called the mTOR pathway, the IGF-1 pathway.

02:02:30.000 Then you eat a diet rich in sugar.

02:02:32.000 Well, we know the biochemistry right here in Los Angeles, University of Southern California, Biogerontology Institute.

02:02:37.000 You eat a lot of sugar, you activate another aging pathway called PK-RAS. And these two pathways, mTORIGF1 and PK-RAS, will make you an old man or an old woman quicker.

02:02:47.000 So when you're eating pastries, which is high saturated fat and high sugar, or you're eating meat with a coke, how common is that?

02:02:55.000 I mean, my god, a hamburger and coke, you're activating everything we know about science that will make you age faster. 0.96

02:03:01.000 That sucks. 0.84

02:03:02.000 So is that true that eating meat and the amino acids accelerate the aging process? 0.98

02:03:09.000 There's no studies that show that eating meat in the context of a healthy diet shortens your lifespan.

02:03:16.000 And so if that were true, then we would see that in the data.

02:03:21.000 But Joel, you're talking about an actual physical mechanism that accelerates the aging process.

02:03:26.000 Yeah, this is well known.

02:03:27.000 What is it called again?

02:03:28.000 Well, it's mTOR, IGF-1 is one pathway, and PK-RAS. The biochemistry, I mean, this is like high-level science.

02:03:36.000 I'm not stretching on the limb here.

02:03:38.000 But, you know, protein is really amino acids.

02:03:43.000 You know, I get this question.

02:03:44.000 You're a vegan.

02:03:44.000 Where do you get your protein?

02:03:45.000 My answer is, where do you get your amino acids?

02:03:47.000 Because my body breaks protein down into the building blocks, and then I build it back up to whatever the hell I need it for.

02:03:52.000 It's amino acids in meat.

02:03:54.000 There's amino acids in my edamame, wherever I want to get them.

02:03:58.000 The split of those 20 amino acids is different in meat than it is in edamame.

02:04:02.000 There's more methionine and more leucine.

02:04:04.000 Very technical stuff.

02:04:05.000 Leucine.

02:04:06.000 And there are some, you know, mixes of branched-chain amino acids of leucine.

02:04:09.000 I don't know what the hell that does your aging.

02:04:10.000 But we do know that meat rich in methionine will activate mTOR and IGF-1, and it is a very strong factor in aging.

02:04:19.000 You want a low methionine diet.

02:04:21.000 It's another reason plant-based seeders need to take B12 to keep their homocystine methionine down. 0.96

02:04:26.000 That's a separate topic.

02:04:27.000 But yes, the amino acid mix found in animal protein is different than the amino acid mix found in vegetable protein, which is why when Morgan Levine looks at the question, what's your survival, what's your cancer risk, what's your heart risk on animal protein and plant protein,

02:04:42.000 plant protein beats the crap out of animal protein.

02:04:45.000 This is high-level cell metabolism.

02:04:47.000 Try and publish a paper in Cell Metabolism. 0.93

02:04:50.000 The crap out of animal protein?

02:04:52.000 Because there's a 300 to 400% increase in cancer of those that diets concentrate on protein of animal source, and there's a 25% reduction in cardiovascular disease. 0.97

02:05:01.000 Selmatazin in 2014, Morgan Levine of Harvard.

02:05:05.000 Nobody's questioning her work.

02:05:06.000 October 1, 2016, SONG at Harvard.

02:05:09.000 Animal protein, plant protein lead to very different outcomes in large database observational studies at the highest level.

02:05:16.000 Because you can't take 6,000 people and randomize them in that way.

02:05:19.000 So if you're waiting for that to resolve the question, you know, good luck.

02:05:23.000 That's actually not the case.

02:05:24.000 The IARC panel that concluded that processed meat led to an 18% increase in cancer risk, which again is like indistinguishable from chance using that low of a relative risk.

02:05:38.000 Their conclusion was that fresh red meat was 1.02.

02:05:45.000 That's a 2% increase.

02:05:47.000 And many other studies have shown that unprocessed red meat is not associated with increase in cancer risk and is not associated with increase in heart disease risk.

02:05:58.000 So again, you can talk about these proposed mechanisms all day long.

02:06:02.000 But if it's not showing up in actual events that are meaningful to people, then you might be missing something.

02:06:09.000 Maybe red meat does act in a certain way that you might think would increase the risk of death, but maybe it does other things that reduce the risk of death.

02:06:19.000 And that's why we can't just focus on mechanistic studies.

02:06:22.000 We have to look at actual endpoints that matter to people.

02:06:26.000 I think death and cancer matter, Chris, and I know you know.

02:06:29.000 That's what I just said.

02:06:30.000 The studies don't show that fresh red meat increases the risk of death and cancer and heart disease.

02:06:38.000 And Joel, what was the number that you were saying, 300%?

02:06:41.000 It's right here.

02:06:41.000 Anybody look.

02:06:42.000 March 4th, 2014. Selma Tassel and Morgan Levine.

02:06:45.000 Right here.

02:06:46.000 Animal protein.

02:06:47.000 75% increase in death.

02:06:49.000 400% increase in cancer.

02:06:51.000 Over 18-year follow-up.

02:06:52.000 These findings were not found with plant-based protein.

02:06:56.000 So let's talk about reviews.

02:06:58.000 It's not reviews.

02:06:59.000 This is science.

02:07:00.000 This is science.

02:07:01.000 No, reviews are science, Joel.

02:07:03.000 You're saying that reviews of observational studies and reviews of meta-analyses are not science, and you would prefer to draw conclusions based on a single study?

02:07:12.000 No.

02:07:12.000 I wouldn't want it based on a single study, but this is very consistent with the overall high level of mTOR, IGF-1, PKRs.

02:07:19.000 I'm just referring to research that several large reviews that have not found a relationship between fresh red meat and cancer and fresh red meat and heart disease.

02:07:30.000 So I would prefer to look at reviews that include lots of studies than just a single study that supports a particular viewpoint.

02:07:39.000 Maybe.

02:07:40.000 Maybe?

02:07:41.000 Maybe.

02:07:41.000 Well, we need more than a maybe.

02:07:43.000 Well, okay.

02:07:44.000 300%.

02:07:45.000 What is that number based on?

02:07:47.000 It's human study.

02:07:49.000 These are real lives.

02:07:50.000 These are real deaths, and these are real cancer cases.

02:07:52.000 This is original science in one of the highest levels.

02:07:55.000 But is it epidemiology, where they don't take into account all the other risk factors, including the rest of their diet, smoking, sedentary lifestyle, obesity, all the various...

02:08:05.000 I'll answer it in a second.

02:08:06.000 I'll download the whole paper.

02:08:07.000 But you know, they do that.

02:08:08.000 They do multivariate analysis.

02:08:10.000 Chris, while he's downloading that, there's a 2011 meta-analysis of 34 prospective studies on red meat and colorectal cancer, which said that's 34 studies.

02:08:19.000 The available epidemiologic data are not sufficient to support an independent and unequivocal positive association between red meat intake and colorectal cancer.

02:08:30.000 2015 meta-analysis did find a relationship with processed meat, but did not find a relationship with fresh red meat.

02:08:40.000 There's also an issue of dose response.

02:08:43.000 If red meat did cause cancer, then you'd expect to see a continuous increase in cancer rates as the intake of red meat increased.

02:08:51.000 In many cases, you actually see the opposite.

02:08:54.000 You can see a decrease in cancer rates in the people who ate the most red meat, which casts some doubt on that association.

02:09:01.000 And again, we come back to the relative risks.

02:09:05.000 Even with processed meat, it's only 18%.

02:09:10.000 And you have to consider the healthy user bias that we talked about before.

02:09:13.000 And with fresh red meat, it's either nothing, zero, or maybe like 2%.

02:09:18.000 And that's just like, that level in observational research is not distinguishable from chance.

02:09:24.000 You cannot draw any conclusions on that.

02:09:26.000 And you cannot assume that someone who's eating a Nutrivore diet with fresh whole foods and is including some red meat in that diet is going to have the same response As someone who's eating pizza, candy, hot dogs, and all kinds of other junk food.

02:09:44.000 Common sense will tell you that.

02:09:46.000 Hence the problem with these kind of studies.

02:09:48.000 Exactly.

02:09:49.000 Joel?

02:09:50.000 Chris, you want a low IGF-1 or a high IGF-1?

02:09:54.000 You want a low IGF-1.

02:09:55.000 You know it.

02:09:55.000 Just say it.

02:09:56.000 I want to live a long, healthy life.

02:09:58.000 I don't want to be obsessing over individual markers.

02:10:03.000 I want to live a long, healthy life.

02:10:05.000 You like a lot of markers when it comes to low-carb studies.

02:10:08.000 You want a low IGF-1 for survival.

02:10:10.000 The science is strong.

02:10:10.000 This is LA science, so we're not making this stuff up.

02:10:13.000 Anyways, methionine and leucine and meat that raises IGF-1, and at least periodically take a break.

02:10:20.000 Raises insulin growth factor.

02:10:22.000 One, which will take your prostate and your breast tissue, makes it start growing at age 50. For males or for women? 0.96

02:10:29.000 For women.

02:10:29.000 Well, just because of the frequency of breast cancer in women.

02:10:31.000 It's women. 1.00

02:10:32.000 So, you know, there is a relationship between animal products and breast cancer.

02:10:36.000 There's an opposite relation.

02:10:37.000 These are relationships.

02:10:38.000 There is...

02:10:39.000 There is petri dish.

02:10:41.000 Let me just say, go back to biochemistry.

02:10:42.000 You take breast cancer cells in a petri dish, you put plant proteins, they stop growing.

02:10:46.000 You put animal proteins, they start growing.

02:10:47.000 That's pretty good science.

02:10:49.000 Now, you say that's a petri dish.

02:10:51.000 They happen to be human breast cancer cells, but until you do a randomized controlled study of animal versus vegetable, it won't be done.

02:10:58.000 Should a breast cancer patient eat more broccoli? 1.00

02:11:01.000 Yeah, let's dong the bell there again for sure, and I can tell you how to cook the broccoli so they get the best benefit.

02:11:09.000 You were going to respond to that?

02:11:12.000 Yeah.

02:11:12.000 I come back to important endpoints.

02:11:15.000 Total mortality or deaths from any causes and diseases.

02:11:19.000 I'm not persuaded by mechanisms unless they're tied to real outcomes that we care about.

02:11:27.000 I think mechanisms are interesting.

02:11:29.000 But as I said, you have to be aware that if foods have multiple effects, they might have one impact that you might think would lead to harm, but then they could have several other impacts that would be beneficial.

02:11:44.000 And that's why you need to look at the real outcomes.

02:11:47.000 There have been so many examples in the past of ideas where the mechanism that was originally proposed for the harm doesn't turn out to be what we thought it was.

02:11:58.000 And so total mortality is the most important endpoint.

02:12:02.000 Deaths from all causes, but then also deaths from specific conditions are important too.

02:12:07.000 And I would put that higher in the hierarchy of evidence than mechanisms.

02:12:12.000 Absolutely.

02:12:13.000 Joel?

02:12:14.000 I don't know how you abandon the unbelievable dedication and explosion of scientists around the country and around the world to, you know, come up with mechanisms of disease, because we're on the verge of this unbelievable breakthrough to change your genetics and alter your mechanism.

02:12:27.000 If you don't understand them, you can't do it.

02:12:29.000 I think Chris has it backwards.

02:12:30.000 More commonly, basic science drives questioning a human population, an epidemiologic study, and then maybe a randomized clinical trial.

02:12:37.000 That's a usual progression.

02:12:40.000 For example, we have not even talked cholesterol.

02:12:43.000 This literally has been all saturated fat.

02:12:46.000 1975, my mentors in Dallas, Texas, but this is relevant in 2018. Brown and Goldstein, in basic science, identify your liver cell has a receptor called the LDL receptor.

02:12:57.000 Nobody knew it.

02:12:57.000 It completely controls the metabolism of cholesterol in the body.

02:13:01.000 They then find that there's a disease where you don't have that receptor and your cholesterol is 1,000 and you die before you're 15. And I took care of those children in Dallas, Texas in 1986, 1989. From that came the development of a drug called Mevacor and Lipitor and Lovastatin and all the rest.

02:13:15.000 And we were able to test in humans.

02:13:18.000 Does that basic science make a difference?

02:13:21.000 Kaboom! 0.99

02:13:21.000 The 4S study says you live longer if you have heart disease and you take a statin. 0.99

02:13:25.000 Yeah, there's side effects.

02:13:26.000 Yeah, there's this and that.

02:13:27.000 Go down to the bottom line.

02:13:29.000 You want your LDL cholesterol, like Lauren Cordain, the founder of the Modern Paleo Movement said, 50 to 70, and it's all consistent across epidemiology, basic biochemistry, randomized clinical studies, and what's the average LDL cholesterol in a hunter-gatherer, in Okinawa,

02:13:45.000 in Loma Linda?

02:13:46.000 LDLs are 70 or 80. In fact, humans are the only free living animal on the planet with an LDL cholesterol over 80 because we eat and we gorge and we have jacked up saturated fat that drives our cholesterol.

02:13:58.000 We're the only animal on the planet and we're suffering terribly from it.

02:14:01.000 Okay, let me pause you there.

02:14:02.000 Does saturated fat raise your cholesterol?

02:14:04.000 That's the whole point.

02:14:05.000 We need to keep coming back to dietary cholesterol and dietary saturated fat.

02:14:11.000 The evidence is showing that, on average, they do not raise cholesterol in the blood.

02:14:15.000 And even when they do, that doesn't translate into an increased risk of heart disease.

02:14:21.000 That's what the data show.

02:14:22.000 I mean, I don't know what more I can say about that. 0.99

02:14:25.000 I call bullshit on that. 0.84

02:14:28.000 It's called the Hegestedt equation and the Keyes equation. 0.95

02:14:30.000 I shared the data on controlled feeding.

02:14:33.000 You mentioned metabolic word studies as a high standard of evidence.

02:14:37.000 Controlled egg feeding studies where 75% of people experience no change in their blood cholesterol from eating two to four eggs a day.

02:14:45.000 I don't know how more clear it can be than not.

02:14:48.000 Eggs is an isolated topic because that's a cholesterol topic.

02:14:50.000 We have not talked cholesterol.

02:14:52.000 We've been talking saturated fat.

02:14:53.000 But we're talking about cholesterol right now.

02:14:55.000 Okay, well, but you just asked saturated fat and I'm trying to be very specific.

02:14:59.000 No, no, no, I said cholesterol.

02:15:00.000 Well, does saturated fat raise blood cholesterol?

02:15:03.000 To deny that is whack.

02:15:06.000 And I'm sorry, that's called the Hegested equation.

02:15:09.000 Google it.

02:15:09.000 Look it up on Wikipedia.

02:15:11.000 It's called the Keyes equation.

02:15:13.000 So you're saying consumption of saturated fat raises cholesterol in the blood?

02:15:19.000 It's what you're saying.

02:15:21.000 But he's saying, Chris is saying that it doesn't.

02:15:24.000 No, I'd say it does sometimes for some people, but on average, the studies are saying that it doesn't have a significant effect.

02:15:30.000 On average.

02:15:31.000 Disagree.

02:15:31.000 So meaning if you get a large enough group of people, you'll have some aberrations, and some people will find a significant rising of their cholesterol.

02:15:40.000 Yeah, and again, more importantly, the presumption here is that serum cholesterol, we care about it because it will increase your risk of a heart attack.

02:15:50.000 As I said before, large studies that have forgotten about cholesterol just analyzed the relationship between saturated fat intake and heart attacks.

02:16:01.000 Which is what everyone cares about, right?

02:16:02.000 If they're thinking about cholesterol, the middle is a mediator in that situation.

02:16:08.000 So they remove that and they just say, does eating saturated fat increase your risk of heart disease?

02:16:14.000 And that large review of 350,000 participants did not show a relationship on average.

02:16:19.000 So is the concept that cholesterol is just one factor and that perhaps we've isolated it as more significant than it really is?

02:16:27.000 In our typical reductionist paradigm, absolutely.

02:16:30.000 There are many factors that contribute to heart disease and that's one of them.

02:16:34.000 And so that's why, again, it's important to look at the studies that directly examine the relationship between saturated fat intake and heart disease rather than Doing this dance where we go, does it increase cholesterol and then assuming that high cholesterol will lead to heart attack?

02:16:51.000 Joel, I'm sure you can understand why this is so confusing for me.

02:16:54.000 I actually feel really badly for your viewers and listeners.

02:16:58.000 No, no, no.

02:16:58.000 They're going to be able to go over this with a fine tube.

02:17:00.000 This is so important.

02:17:01.000 I thank you both for doing this because this is the kind of conversation that you just don't get to have.

02:17:06.000 We get two experts with opposing views and You have a decent conversation where you go over all the actual details of it, and you get to see how each one of you thinks about these things and how you've drawn these conclusions.

02:17:19.000 I agree with that, actually.

02:17:21.000 I think it's great and all, but, you know, we've had a couple moments of clarity and advice, and I just want people to have as many as possible because, you know, it does matter.

02:17:31.000 A friend of mine says heart disease is not theoretical.

02:17:33.000 I mean, we've had many 39-second deaths while we've been doing this.

02:17:36.000 So just to respond, I mean, Does saturated fat-rich diets raise cholesterol?

02:17:42.000 Absolutely.

02:17:42.000 It's such a tight relationship.

02:17:44.000 There's a line with a correlation that's just straight up.

02:17:47.000 Can I pause you for a second?

02:17:48.000 What is wrong with these studies that he's showing that show that it doesn't in most people?

02:17:55.000 I believe, and again, there are studies that are being referenced, but we're not looking at it, and that's a limitation.

02:18:00.000 We can live with that.

02:18:01.000 Since 2010, the question has come up, does an increased saturated fat cause coronary heart disease?

02:18:07.000 And that has been questioned in some studies.

02:18:09.000 The idea that it doesn't raise blood cholesterol is...

02:18:13.000 It's the reason all the guidelines up through 2015, 2016 still say limit saturated fat because that science hasn't changed.

02:18:21.000 There's such a tight correlation.

02:18:23.000 The line is straight up.

02:18:24.000 Percentage of dietary fats, percentage of dietary saturated fat, blood cholesterol, blood cholesterol.

02:18:29.000 The challenge is...

02:18:31.000 How much yours is going to raise and how much mine is going to raise is going to depend on your genetics and your microbiome and where you're starting.

02:18:37.000 If I ate a steak, my cholesterol goes up.

02:18:39.000 If I ate an egg, this has been shown because I don't eat any dietary cholesterol as a plant eater, my cholesterol skyrockets.

02:18:45.000 You become habituated eating two, three eggs a day and the curve Flattens out.

02:18:50.000 After two, three eggs a day, which is 400-500 milligrams of cholesterol a day, it's like if you smoke 20 cigarettes and you go to 24, it's going to be pretty hard to show much of a difference.

02:18:59.000 Two, three eggs a day for a chronic eater is tough to challenge.

02:19:02.000 So your body just creates a tolerance for it?

02:19:05.000 Is that right?

02:19:05.000 Well, there's a level of absorption that starts to level off.

02:19:09.000 But an interesting statistic, a toothpick is 100 milligrams.

02:19:13.000 Most of us eat 300 to 400 milligrams of cholesterol a day, three to four toothpicks.

02:19:17.000 We're talking fat.

02:19:19.000 We're talking 150 grams.

02:19:21.000 So that's why the saturated fat, it's like overwhelmingly more of a topic.

02:19:29.000 I just come back to the studies.

02:19:33.000 Two to four eggs a day, controlled metabolic ward feeding studies, do not have any impact on blood cholesterol in 75% of people.

02:19:42.000 That's about as conclusive as the evidence can get.

02:19:44.000 Quote, reference, reference, reference.

02:19:47.000 Okay, I'll give one to you.

02:19:49.000 You gotta give it.

02:19:50.000 I always have it.

02:19:51.000 And they're always there at Kresser.co slash Rogan.

02:19:54.000 Yeah, I know.

02:19:55.000 And here it is.

02:20:01.000 If you Google Cressor saturated fat, that's the first article that comes up.

02:20:08.000 So this is Dius from 2009, Dietary Cholesterol and Coronary Artery Disease, a Systemic Review.

02:20:18.000 I'll just show you.

02:20:20.000 I know your viewers.

02:20:20.000 Maybe your viewers can see it.

02:20:22.000 I don't know.

02:20:22.000 That's called...

02:20:24.000 Saturated fat in the diet, that's called changing your LDL. That's called the line going up like a straight rocket.

02:20:30.000 Why don't you tell me where someone can see this and we'll have Jamie pull it up on the big screen.

02:20:35.000 Anybody that Googles, it's called Hegsted equation.

02:20:38.000 H-E-G-S-T-E-D. Okay, Hegstead, he's from the late 1970s.

02:20:44.000 This was a 1993 reference.

02:20:46.000 I know, but the Hegstead equation comes from Hegstead, who was one of the doctors who was involved with the McGovern Report in 1977, which was the original report that led to the limitation on dietary cholesterol and saturated fat.

02:21:00.000 So I think that's a little bit outdated, perhaps.

02:21:05.000 If humans have changed.

02:21:06.000 Like I said...

02:21:09.000 But what's wrong with the studies?

02:21:10.000 Like what Joel just said, though, if humans have changed.

02:21:14.000 As I said, one study doesn't, you know, the exception doesn't make the rule.

02:21:18.000 We have a meta-analysis of observational studies.

02:21:23.000 Including 350,000 participants that found no relationship between saturated fat intake and cardiovascular disease.

02:21:30.000 The review of 25 RCTs and 40 observational studies, 650,000 people that concluded that replacing saturated fat with polyunsaturated fat doesn't lower the risk of cardiovascular disease.

02:21:42.000 We have to look at the weight of the evidence.

02:21:45.000 We can't just choose one study or a mechanistic argument to support our view.

02:21:49.000 So it's your take that this study is flawed and outdated?

02:21:52.000 That's not a study.

02:21:54.000 That's an equation that was meant to represent the relationship between saturated fat intake and...

02:22:04.000 Blood cholesterol that was created by a doctor in the late 70s that was originally involved in this diet hypothesis in the McGovern report, which led to the restrictions on cholesterol and saturated fat in the first place.

02:22:18.000 So yes, I am saying that we should be looking at more recent evidence, large reviews of observational studies, and then meta-analyses of randomized controlled trials.

02:22:27.000 That's a much more persuasive source of evidence for me.

02:22:32.000 Joel?

02:22:33.000 It was based on metabolic or carefully done studies at Harvard.

02:22:37.000 The equation derived from human data where you put people in, change their diet.

02:22:42.000 Dietary change studies drives up LDL cholesterol.

02:22:45.000 You just plot it out.

02:22:46.000 The plot's very clear.

02:22:47.000 It's changing cholesterol to dietary saturated fat.

02:22:50.000 It's well accepted in the medical community and it's incorporated in the guidelines.

02:22:54.000 It'll never change.

02:22:55.000 Human physiology is not going to change.

02:22:57.000 LDL receptors don't change.

02:22:58.000 It all goes back to basic biochemistry.

02:23:01.000 When we understand it, we can manipulate it to better health.

02:23:04.000 We can do it through pharmacology.

02:23:05.000 We can do it through diet.

02:23:06.000 We'll be doing it through gene therapy, stem cell therapy.

02:23:09.000 But if we don't understand the biochemistry, we're cutting out a pillar we have to have for better health.

02:23:15.000 Chris?

02:23:16.000 I don't know how many more times.

02:23:18.000 I mean, I feel like I'm just saying the same thing over and over again.

02:23:21.000 We have to look at the research, the weight of the evidence.

02:23:24.000 We have to look at randomized controlled trials that actually look at what happens when people consume saturated fat and dietary cholesterol.

02:23:32.000 These studies that he's citing, this graph does not.

02:23:36.000 Mechanistic arguments are not persuasive if it's not happening in real people.

02:23:40.000 You're measuring in a randomized controlled trial, you're measuring what happens when people eat saturated fat and cholesterol.

02:23:48.000 And then you do a meta-analysis of these controlled trials and you're finding what I just said.

02:23:52.000 That's way more persuasive to me.

02:23:55.000 What is your take on that, Joel?

02:23:58.000 The Royal Academy of Science in Sweden gave the Nobel Prize in Medicine for what we're talking about, and nobody's changed that.

02:24:08.000 I totally disagree with Chris that human physiology didn't change from 1985 Nobel Prize to 2018, that the relationship between eating saturated fat, lowering your LDL receptor, raising your blood LDL, developing atheroma, I go in at 3 in the morning and bust open your plaque so you live,

02:24:25.000 has not changed.

02:24:27.000 Well, how are these studies made and what's wrong with them then?

02:24:34.000 Nothing's changed about understanding the biochemistry of our lipid metabolism in cells.

02:24:39.000 Of course, there's always advancements, but the LDL receptor has led to the statin field, a new class of drugs called PCSK9 inhibitors.

02:24:47.000 It's all because of the biochemistry that people are living longer, living better, their plaques are being reduced through lifestyle medicine, but thank God we also have pharmacology that's advancing.

02:24:56.000 Right, but what is wrong with these studies?

02:24:58.000 These studies that are showing these results that he's describing, that you're disputing, what is wrong with these studies and what is wrong with the results?

02:25:05.000 I would urge everybody to take the broad, high-level view of science and not pixels.

02:25:11.000 What's the basic biochemistry?

02:25:12.000 I know we're circling around.

02:25:13.000 What's the epidemiology?

02:25:14.000 What's the clinical randomized trials?

02:25:16.000 And what's the centenarian studies?

02:25:17.000 There is no new data that you live to 100 by adding saturated fat to your diet.

02:25:22.000 Yeah, but we're not talking about that.

02:25:24.000 We're talking about the actual physical results on human bodies when you consume saturated fat, what he's just describing.

02:25:30.000 I mean, it would take a new metabolic ward study that negated the Keyes equation, the Hegstead equation, that there's a linear relationship, 395 metabolic studies.

02:25:40.000 It doesn't exist.

02:25:41.000 What are you saying to that, Chris?

02:25:42.000 A metabolic ward study that says eating saturated fat.

02:25:44.000 It would not take that, Joel.

02:25:46.000 We have randomized controlled trials, which is a very high standard of evidence, and observational data, large amounts of observational data that have been reviewed That answer this question.

02:25:59.000 And we have many RCTs of low-carb diets and even ketogenic diets that are not showing significant impacts.

02:26:09.000 Joel, is it possible that this is correct?

02:26:11.000 Here's a 2018 review of all the previous science on dietary cholesterol and eggs.

02:26:19.000 And the conclusion says, overall recent intervention studies with eggs, recent.

02:26:26.000 Demonstrate that the additional dietary cholesterol does not negatively affect serum lipids and in some cases appears to improve lipoprotein particle profiles like have a beneficial effect and HDL functionality, which is the so-called good cholesterol.

02:26:40.000 And he talks about here in the conclusion that eggs shift LDL particles to the less detrimental large buoyant LDL, which is less atherogenic.

02:26:51.000 He says eggs also typically increase HDL. He says that eggs probably have other beneficial impacts in terms of their phospholipid contacts and that there's no relationship between the consumption of eggs and heart disease.

02:27:08.000 So this is a 2018 review.

02:27:11.000 It's by Christopher Blesso.

02:27:13.000 Dietary cholesterol, serum lipids, and heart disease.

02:27:15.000 Are eggs working for and against you?

02:27:17.000 Published in Nutrients.

02:27:18.000 Joel, is it possible that that's correct and that there's just some misunderstanding about the previous data?

02:27:24.000 It's a different topic.

02:27:26.000 It's eggs.

02:27:27.000 It's cholesterol.

02:27:28.000 We were talking saturated fat.

02:27:29.000 Does it raise your cholesterol?

02:27:30.000 So they're different topics.

02:27:31.000 And then we've introduced a very hot topic about LDL particle size, which we should break down and talk about.

02:27:36.000 So I'm not sure quite how to respond because we got off track by shifting to consistently low carb and eggs and other things.

02:27:43.000 Actually, we were talking about cholesterol.

02:27:45.000 Well, we're talking about desaturated fat, raised blood cholesterol.

02:27:49.000 So I stand by the fact human physiology will not change.

02:27:53.000 We have receptors.

02:27:54.000 But doesn't our understanding of human physiology advance?

02:27:59.000 Well, I'll give you an example.

02:28:01.000 Until 20 years ago, nobody ever heard a word PCSK9. God or somebody gave us a protein in our blood, PCSK9, that goes to your liver, sits in a receptor, causes the LDL receptor to go internal, and your friggin' blood cholesterol goes up.

02:28:17.000 Now there's a class of drugs that's an antibody to PCSK9, lowers your cholesterol dramatically, and we're finding it reduces plaque and lowers your risk of heart attack.

02:28:25.000 Sure, new science, amazing.

02:28:27.000 Totally consistent with what Brown and Goldstein showed that led to statins.

02:28:31.000 Now we have a new treatment.

02:28:33.000 That's a wonderful thing.

02:28:34.000 It didn't rock the boat.

02:28:35.000 We still don't know to this day why we have that protein in our blood.

02:28:40.000 And if you're lucky enough to be born with a low level of PCSK9, your cholesterol is lower, you have less disease, you live longer.

02:28:47.000 That was part of the data I published in 2012 with Brian Ferentz.

02:28:50.000 At Wayne State University.

02:28:52.000 So yes, we've learned more about human physiology, totally consistent, didn't disrupt anything, and led to better treatments.

02:28:58.000 That's great.

02:28:59.000 Has human physiology been challenged?

02:29:02.000 I'll give you another.

02:29:03.000 We've learned, and Chris mentioned this, so I think it's fair to go there.

02:29:06.000 It's like a corps de la.

02:29:07.000 He opened it up.

02:29:08.000 I'm cross-examining.

02:29:09.000 Nobody in the world ever heard the word of four letters, TMAO, 2011. Cardiologists sitting at the Cleveland Clinic said, there's got to be more in the blood that hurts arteries.

02:29:19.000 Let's go find them.

02:29:20.000 They found this chemical.

02:29:21.000 They learned how to measure it.

02:29:23.000 They patented how to measure it, TMAO. They took 4,000 people on the cath lab table.

02:29:27.000 They said, I wonder if the level of TMAO in the blood correlates with how clogged up your arteries are.

02:29:31.000 But doom!

02:29:32.000 It worked perfect.

02:29:33.000 Then they figured out, if you eat red meat that has rich in L-carnitine, amino acid.

02:29:38.000 You eat eggs that's rich in choline and a nutrient, I think amino acid.

02:29:42.000 I'm blanking for a minute.

02:29:43.000 Those directly led your liver to create TMAO. They took studies where they reduced carnitine, reduced choline in the diet, TMAO goes down.

02:29:51.000 What does TMAO do?

02:29:52.000 It stuns your HDL so it doesn't reverse cholesterol transport.

02:29:55.000 It causes LDL to enter the cell wall and create foam cells, macrophages, plaque, And you get a heart attack.

02:30:00.000 It actually screws up your kidney and causes it to be fibrose.

02:30:03.000 If you have heart failure, diabetes, or heart disease, or hypertension, your TMAO is up.

02:30:07.000 I've actually drawn more TMAO levels than I think any physician in the United States.

02:30:11.000 This is my baby.

02:30:12.000 New human physiology that has not led us to back off the idea that limiting the Animal product consumption, in this case specifically, egg yolk and red meat, may have benefit to your health.

02:30:23.000 We just learned a new pathway.

02:30:24.000 Actually, Joel, what in the diet increases TMAO orders of magnitude more than red meat?

02:30:29.000 Fish, because fish has it right in their fish flesh, along with that mercury in their PCBs and their DDT. What is the association of seafood intake with heart disease and mortality?

02:30:38.000 Can we use epidemiology studies, or I thought they were off the table.

02:30:41.000 As I said before, we can use epidemiology when we use it wisely.

02:30:45.000 Oh, that's so selective, Chris.

02:30:47.000 Use it or don't use it.

02:30:48.000 I always use epidemiology, 100% of the time.

02:30:50.000 What do you mean, Joel?

02:30:51.000 We've been talking about large reviews of epidemiology that suggest that saturated fat and cholesterol don't increase the risk of heart disease.

02:31:00.000 So if you could answer the question, I'd appreciate it.

02:31:03.000 Quality over quantity.

02:31:07.000 What would most doctors and researchers say about fish consumption and cardiovascular disease and mortality?

02:31:14.000 Well, since it has saturated fat, most high-level 2018 advisors are two meals a week of fish.

02:31:21.000 Balancing out with 19 meals a week of plant-based is the USDA guidelines.

02:31:25.000 I'll answer the question.

02:31:26.000 If you look at the data, there are a few things that are associated with a greater decrease in cardiovascular disease risk than fish consumption.

02:31:36.000 Fruits and vegetables.

02:31:38.000 TMAO is, if you look at a graph, and you can, if you Google, let's see, maybe, Jamie, you can pull this up.

02:31:47.000 Cressor TMAO. And you click on that first link, red meat and TMAO. And you scroll down, and there's a picture.

02:31:59.000 Oh, cool, Jamie.

02:32:01.000 Where you been?

02:32:03.000 There's a picture.

02:32:04.000 Scroll down.

02:32:07.000 There you go.

02:32:08.000 So that picture shows the increase in TMAO from eggs, beef, cheese, milk, clams, and then look at cod and halibut.

02:32:17.000 Wow.

02:32:18.000 Let me just see the reference.

02:32:19.000 What's a reference there, buddy?

02:32:20.000 Egg and beef.

02:32:21.000 The reference is in the article, Joel, as always.

02:32:23.000 Hang on.

02:32:23.000 Let's see it.

02:32:23.000 I would see it.

02:32:24.000 You can see it.

02:32:26.000 It can't be Chris Masterjohn referenced.

02:32:28.000 That's not fair.

02:32:29.000 It's not Chris Masterjohn.

02:32:31.000 And that's so cod and halibut are increasing TMAO, as I said, orders of magnitude more than beef or eggs.

02:32:38.000 You can't even see eggs and beef there.

02:32:41.000 And the data show that fish consumption, I think almost every public health authority would agree with this, is reducing the risk of heart disease and mortality.

02:32:51.000 So, TMAO is another mechanism.

02:32:53.000 It's another interesting mechanism, but it's not fully understood.

02:32:59.000 And again, we have to look at the data on red meat consumption and heart disease and mortality to really figure this out.

02:33:09.000 It's a speculative mechanism.

02:33:11.000 I don't disagree that it's important to look at mechanisms, but you can't draw conclusions based on them.

02:33:18.000 And this single fact about TMAO Just kind of blows the thing apart.

02:33:23.000 The other thing about TMAO to know is that certain types of gut bacteria metabolize choline and carnitine into TMAO, whereas others don't.

02:33:34.000 And so a lot of scientists have speculated that High TMAO levels are essentially a result of a disrupted gut microbiome.

02:33:43.000 And that makes sense.

02:33:46.000 If you have 60% of the calories that Americans are consuming are from ultra-processed food, and we know that that totally screws up the gut microbiome, then if you get a person eating a standard American diet, then their TMAO levels may go up with red meat.

02:34:01.000 Whereas if you take someone who's got a healthy microbiome because they're eating...

02:34:05.000 You know, lots of plant foods that support healthy gut, then you may not see the same association.

02:34:10.000 And part of what supports that is there's studies showing that Rifaximin, which is an antibiotic that treats bacterial overgrowth in the small intestine, reduces serum TMAO levels, which suggests that it's mediated by the gut microbiome.

02:34:27.000 So consumption of fish has been universally shown to decrease heart disease.

02:34:33.000 The mechanism is interesting, but overall it may be very complicated with many factors and we might not know all of them.

02:34:41.000 Yeah, and then that's what takes us back to let's look at the data on whether red meat increases the risk of death or heart disease.

02:34:50.000 Joel?

02:34:52.000 Chris's reference was giving credit to another blogger's article.

02:34:56.000 That's not science.

02:34:57.000 You'd have to go to the blogger's article and look at it.

02:34:59.000 It was number 16. Joel, there's...

02:35:01.000 I know, but we have to find the article.

02:35:03.000 It's okay.

02:35:03.000 It's sloppy referencing.

02:35:06.000 Hold on.

02:35:07.000 Let him explain what the reference is because you challenged it.

02:35:09.000 It said there that that graph came from...

02:35:11.000 Let him explain it.

02:35:12.000 Number 15 is the reference.

02:35:14.000 Dietary precursors of trimethylamine in MANA pilot study.

02:35:18.000 Okay.

02:35:18.000 TMAO is...

02:35:18.000 Okay, so it's not a blog.

02:35:20.000 It's actually a study.

02:35:21.000 Okay.

02:35:21.000 TMAO is a hot topic right now that is largely being researched in terms of egg yolk and meat consumption.

02:35:27.000 It doesn't really matter.

02:35:28.000 It's not preliminary science.

02:35:30.000 It does matter.

02:35:30.000 No, no.

02:35:31.000 It's not preliminary science.

02:35:31.000 They're coming up with pharmacologic agents right now to block it, and we'll see a new class of drugs.

02:35:36.000 Wait a minute, but is that what's significant, or is it more important to concentrate on gut biome and healthy diet?

02:35:42.000 No.

02:35:43.000 Why are we instantly giving the ball to pharmaceuticals?

02:35:48.000 You asked the question, is there any new human physiology that's relevant?

02:35:52.000 We started with PCSK9. I'm introducing TMAO as new human physiology that's relevant that could lead to improvements in clinical outcomes as suggested by obstinators.

02:36:01.000 Right, but we're talking about what he just showed in the graph.

02:36:04.000 You dismissed the graph, then he gave you a study for the graph, and you just sort of glossed over it.

02:36:08.000 Right.

02:36:09.000 I'm the one that contributed.

02:36:11.000 Fish is a flesh source of TMAO. We can talk about whether fish in 2018 is uniformly a healthy food product.

02:36:19.000 But that's not what he's saying.

02:36:20.000 And he's also talking about gut biome and gut bacteria.

02:36:23.000 Right.

02:36:23.000 And the consumption of red meat being significantly less than the consumption of fish, which is universally said to be a good thing for your heart.

02:36:32.000 So a bunch of layers there real quick.

02:36:34.000 Everybody who studies TMAO knows that the microbiome is a critical component.

02:36:39.000 Two people can eat a steak.

02:36:40.000 It's a classic study.

02:36:41.000 Cleveland Clinic study.

02:36:42.000 Feed a vegan a steak.

02:36:44.000 This is a classic Cleveland Clinic research study in the New England Journal of Medicine.

02:36:48.000 I don't make TMAO. Why?

02:36:50.000 Because my microbiome is different than yours.

02:36:52.000 Feed an omnivore a steak, they make TMAO within 12 hours.

02:36:55.000 An omnivore eating a standard American diet.

02:36:58.000 Sure, but nonetheless, it pointed to the fact that it was the microbiome.

02:37:02.000 You give a mouse meat and give it an antibiotic that wipes out a microbiome, it won't make TMAO. The microbiome dependency of TMAO is well-known science.

02:37:11.000 So that is not...

02:37:14.000 Denigrate the topic.

02:37:15.000 I mean, it's a side topic.

02:37:16.000 Is fish always healthy in a world of DDT, PCB, mercury?

02:37:20.000 I don't know about Chris's practice, but every patient I see gets blood mercury levels, and those that eat routinely heavy are very often very high.

02:37:28.000 Okay, but that's another subject.

02:37:29.000 That's another subject, because you were talking about...

02:37:30.000 No, you want to look at old data on fish, and now I'm bringing up 2018 clinical experience.

02:37:36.000 No, no, no, that's not what he's doing.

02:37:37.000 We're not bringing up old data on fish.

02:37:38.000 Well, I was being beat up for old data...

02:37:41.000 And I'm bringing relevant clinical material in 2018. You were talking about the absolute mechanism that's caused by the consumption of meat.

02:37:49.000 He brought up fish consumption, which vastly elevates this, and yet fish consumption is not correlated with heart disease.

02:37:58.000 In fact, it's correlated with people having healthier hearts.

02:38:02.000 So if you're suggesting to me as the recommendation today in this discussion, eat fish but limit egg yolk and meat, I'd agree with that.

02:38:10.000 That's not what it says, because the fish consumption vastly elevates what you were saying was a significant issue.

02:38:17.000 He's saying it's not a significant issue, that it's a mechanism, and it's an interesting mechanism, but it's part of a much larger and probably very poorly understood situation.

02:38:28.000 I don't think that's completely true.

02:38:30.000 Is that true?

02:38:32.000 Yeah, I would say that's true, and I would say it's another proxy marker for a crappy diet.

02:38:38.000 What we know is that eating red meat in the context of a standard American diet may slightly raise your TMAO, but not nearly as much as eating fish will.

02:38:50.000 So you brought up this TMAO, and he's basically just squashed that argument.

02:38:54.000 Yeah, but I think he's scientifically wrong because, again, the wealth of the body...

02:38:58.000 About TMAO? About TMAO. But what about the fish?

02:39:04.000 Because a few specific fish...

02:39:06.000 Number one...

02:39:07.000 The way that egg yolk and red meat, Cleveland Clinic, New England Journal of Medicine is, is it's a step of ingesting the precursor, going through your microbiome, going through an enzyme called lyase in your small intestine, going to your liver as TMA and going to metabolize the TMAO. That process is correlated with atherosclerosis.

02:39:25.000 That process is correlated with increased activity of LDL within your cell wall.

02:39:29.000 Correlated by epithelium.

02:39:30.000 No, no, no.

02:39:31.000 Biochemistry.

02:39:32.000 Biochemistry.

02:39:32.000 We know how it works in the petri dish.

02:39:34.000 That was the brilliance of this rapid development from 2011 to 2013 to now.

02:39:39.000 So it's specifically meat and eggs.

02:39:41.000 What hasn't been studied is if fish flesh already has preformed TMAO. We don't know if it activates LDL activation.

02:39:49.000 We don't know if it stuns HDL. Nobody's looked at the correlation of fish-flesh preformed TMAO and a 4,000 patient study in the cath lab table.

02:39:58.000 We don't know.

02:39:58.000 They're wonderful questions to ask, but until they're done, there is reason to be concerned that there's a new pathway that might be involved in atherosclerosis.

02:40:07.000 Okay, well now we're talking about a totally different thing.

02:40:09.000 Yeah, exactly.

02:40:11.000 If consuming food that raises your TMAO increased the risk of heart disease, then you'd see people who are eating the most fish having the most heart attacks, and that's the opposite of what you see.

02:40:21.000 Well, I think that's reductionist, because what does fish have?

02:40:25.000 But isn't it reductionist to bring up TMAO in the first place?

02:40:28.000 Because you brought it up as a significant factor.

02:40:29.000 No, even more reductionist than what I just said, because I zoomed out a little bit to look at the actual relationship with mortality.

02:40:35.000 Well, that was a blood level.

02:40:37.000 That's not atherosclerosis.

02:40:38.000 That's not outcome.

02:40:39.000 That's not kidney function.

02:40:40.000 That's not stroke risk and heart risk, which have been studied.

02:40:42.000 But you're talking about TMAO. I am talking about TMAO. That's what that graph showed was TMAO. So back it up.

02:40:49.000 You eat red meat, you make TMAO if your microbiome is of a certain constitution.

02:40:53.000 You eat egg yolk, you make TMAO if that's a certain constitution.

02:40:56.000 Is it good to have high levels of TMAO in the blood, whether they're from fish, egg yolk, or red meat?

02:41:01.000 The science suggests it's not good.

02:41:02.000 What can you do to lower your TMAO? Let me pause you.

02:41:05.000 Let me pause you.

02:41:06.000 How does a science suggest it's no good if there's large levels of TMAO that come from fish, and when you eat that fish, it's directly correlated with less heart disease?

02:41:15.000 It would take an evaluation, what's the calorie content in the United States that's from cod, halibut, red meat, and egg yolk.

02:41:22.000 I would think...

02:41:23.000 The calorie content of egg yolk and red meat is higher than cotton halibut.

02:41:27.000 I don't have that data, and that's a global perspective.

02:41:29.000 But if you are up to date on the science and say, I'd like to lead a low TMAO life, which, again, I'm going to say with all boldness, I've drawn more blood levels on than anybody in the United States.

02:41:38.000 I believe, according to the Cleveland Heart Labs, you will want to do all steps to lower it.

02:41:43.000 And maybe you want to leave fish in, because the complementary benefit that fish has shown may be from omega-3.

02:41:49.000 This is purely speculative, though, right?

02:41:50.000 We don't understand.

02:41:51.000 But you were talking about TMAO. TMAO as a mechanism.

02:41:54.000 Right.

02:41:55.000 It's purely speculative to say that the TMAO from fish is healthy, but the TMAO from beef and eggs is not.

02:42:01.000 No, I don't think it's speculative.

02:42:03.000 I don't think we know the answer, because it's seven-year-old science.

02:42:05.000 But you're stating it, though.

02:42:07.000 No, I'm not stating it.

02:42:07.000 But you're stating that TMAO is a massive concern.

02:42:11.000 That is scientifically true.

02:42:12.000 But how is it scientifically true if there's so much TMAO in fish and there's no concern?

02:42:17.000 There's two species of fish that have the highest levels.

02:42:20.000 You saw the other levels.

02:42:21.000 What are the other ones?

02:42:22.000 Fish in general is higher in TMAO. Those are very popular fish.

02:42:25.000 This isn't rare fish.

02:42:27.000 It's cod.

02:42:28.000 We're not talking about higher.

02:42:29.000 We're talking about like beef and eggs barely even register on that graph.

02:42:33.000 Sensationally higher.

02:42:34.000 Orders of magnitude higher.

02:42:35.000 Like what percentage?

02:42:37.000 It looked like 10, 20 times.

02:42:38.000 It was higher.

02:42:39.000 Yeah, probably 20-fold higher.

02:42:41.000 20-fold.

02:42:42.000 20 times higher.

02:42:43.000 I might have even mentioned that in my original article.

02:42:47.000 Joel, the problem is you brought up TMAO in the first place, like it was this magic bullet.

02:42:52.000 Well, but let me just tell you, okay, let's everybody look at Molecular Nutrition Food Research 2016. Does fish protein, when it elevates TMAO, accelerate atherosclerosis?

02:43:04.000 According to a research study, when fish raise TMAO, they accelerate atherosclerosis.

02:43:09.000 Anybody can check the reference.

02:43:11.000 Lead author, I cannot say the name, Yazdikashki.

02:43:14.000 How is this conclusion reached?

02:43:17.000 A petri dish data is a petri dish.

02:43:20.000 I'm looking for a minute.

02:43:21.000 It's basic biochemistry.

02:43:22.000 What happens to atherosclerosis in arteries when you feed?

02:43:26.000 This is mouse data.

02:43:27.000 That's how you generate hypotheses.

02:43:30.000 Well, it hasn't been done in humans yet.

02:43:32.000 But why are you bringing it up as pure fact, then?

02:43:35.000 Well, the assumption is that fish is a superfood.

02:43:37.000 I've already knocked it down for several reasons.

02:43:39.000 One, the fish intake is associated with increased risk of diabetes.

02:43:43.000 I'm sorry, that's epidemiology.

02:43:44.000 Wait a minute, fish is associated with increased risk of diabetes?

02:43:48.000 Risk of diabetes, yes.

02:43:49.000 And this is also epidemiology studies?

02:43:52.000 So the question is, is there a randomized study?

02:43:55.000 Basic biochemistry, you'd understand it from the saturated fat content of fish.

02:44:00.000 It would be largely epidemiologic studies.

02:44:02.000 But when you're saying epidemiology studies, you're asking people, what do you eat on a regular basis?

02:44:08.000 And they say fish and french fries and hot dogs.

02:44:12.000 You say, oh, the fish is associated with an increase.

02:44:17.000 But it's connected to all these other things, and it's not isolated.

02:44:22.000 It's connected to other things, but it's not isolated.

02:44:24.000 Well, you try and isolate out things by multivariate analysis.

02:44:27.000 I mean, it's not one study, it's many studies.

02:44:29.000 Right, but diabetes in fish?

02:44:31.000 Really?

02:44:32.000 Yeah.

02:44:32.000 Is that real?

02:44:33.000 It's real.

02:44:33.000 It's in the science.

02:44:34.000 There was one review that said that.

02:44:37.000 But why is there a review?

02:44:38.000 Because there's many papers.

02:44:40.000 Here's a 2012 review that does not find any association between fish consumption and diabetes.

02:44:52.000 Follow-up, published in the American Diabetes Association Diabetes Care Journal.

02:44:58.000 So, yeah, I don't think, you know, it's hard, I think, to make a claim that fish consumption is harmful for health, given the enormous weight of evidence.

02:45:10.000 And yes, there are concerns now about toxins, and it might change over time.

02:45:14.000 And there are also concerns Issues with overfishing and all of that.

02:45:17.000 Different story.

02:45:36.000 Well, maybe. 0.99

02:45:37.000 I mean, I'm just, I'm not making this shit up. 0.93

02:45:38.000 Journal American College of Nutrition, intake of fish was correlated positively with the increased risk of diabetes. 0.97

02:45:44.000 I mean, the science is out there.

02:45:45.000 Is it crystal clear?

02:45:46.000 Is it as well-defined as the Hegg-Astead equation?

02:45:49.000 Dietary saturated fat, change in cholesterol?

02:45:51.000 No.

02:45:51.000 Is it an association that could be of concern?

02:45:54.000 And basic biochemistry said?

02:45:56.000 Fish have saturated fat.

02:45:57.000 That could possibly cause something called lapotoxicity.

02:46:00.000 Fish have animal protein.

02:46:01.000 We already talked about where animal protein is very different than plant protein.

02:46:04.000 The concept is plausible.

02:46:06.000 Sure, is it resolved?

02:46:07.000 It's not resolved.

02:46:08.000 Is fish a better choice than eating fried chicken or a piece of Philly hoagie steak?

02:46:14.000 Absolutely, it's a better choice.

02:46:15.000 Jamie just pulled something up here.

02:46:17.000 It says, the findings do not support a beneficial effect of total fish, type of fish, or EPA and DHA intake on the risk of type 2 diabetes.

02:46:27.000 Alternatively, other dietary components such as selenium and unmeasured contaminants present in fish might explain our results.

02:46:37.000 Jamie, dude, read the sentence.

02:46:38.000 Total fish intake was associated positively with the risk of type 2 diabetes.

02:46:42.000 That says there's epidemiology that should be further studied, but maybe somebody wants to cut back their fish.

02:46:50.000 But we're looking at a single study here.

02:46:53.000 I agree.

02:46:54.000 We need to look at the weight of evidence.

02:46:55.000 Jamie, you're bad, man.

02:46:57.000 Weight of evidence.

02:46:57.000 But wait a minute.

02:46:58.000 It says findings do not support a beneficial effect of total fish, type of fish, or EPA, DPA on the intake, on the risk of type 2 diabetes.

02:47:10.000 Even lean fish was associated with developing type 2 diabetes.

02:47:15.000 Fatty fish was not, because you probably want that omega-3.

02:47:19.000 But, you know, I'm not telling anybody it's a resolved issue.

02:47:22.000 But you were saying TMAO from animal protein is what causes this problem.

02:47:28.000 It's actually more specific.

02:47:29.000 It's choline and carnitine.

02:47:31.000 Egg yolk, it's not really animal protein.

02:47:33.000 But you said TMAO. Yeah, TMAO. TMAO is...

02:47:39.000 What's in meat that's not good for you?

02:47:42.000 Although, if you're hungry on an island and you're dying, eat meat.

02:47:45.000 We all recognize it.

02:47:46.000 But if you're looking for optimal health, you should be concerned about the saturated fat content.

02:47:50.000 You should be concerned that animal protein accelerates aging through mTOR and IGF-1.

02:47:56.000 Has it been proven that animal protein accelerates aging?

02:47:59.000 Well, if he says no, we should just stop because that's...

02:48:02.000 Well, because it's world-class science.

02:48:05.000 I mean...

02:48:06.000 Just because you say it doesn't...

02:48:08.000 It's true.

02:48:08.000 We need to go over this.

02:48:09.000 I am open to the possibility that high intakes of methionine, which is one of the amino acids in animal protein, In the absence of sufficient intakes of glycine, which is another amino acid that's in animal proteins, and then intake of nutrients like B12 and B6 and B9,

02:48:30.000 which is folate, some of the animal studies suggest that that has an effect on longevity.

02:48:37.000 But this is why I've always been an advocate of eating nose to tail, so not just eating lean meats that are very high in methionine, Making sure you're getting enough of the glycine-rich foods, the bone broth, etc.

02:48:48.000 And then you're also eating plenty of, you know, a mixed diet that contains B12 and folate and B6 and the other nutrients that balance out the effects of excess methionine.

02:48:59.000 As well as fiber for a healthy gut bio.

02:49:01.000 Absolutely.

02:49:02.000 And when you pulled up that conclusion, Jamie?

02:49:04.000 No fiber in meat.

02:49:05.000 No fiber in meat.

02:49:06.000 Yeah, well, you eat other things with it.

02:49:08.000 I've never argued for an all meat.

02:49:10.000 I've never argued for an all meat.

02:49:11.000 Except Sean Baker.

02:49:13.000 Well, there's a whole other ball of wax with that whole carnivore diet.

02:49:18.000 Conclusions.

02:49:19.000 An accumulated evidence generated from this meta-analysis does not support the overall inverse association of fish or fish oil intake with incidence of diabetes.

02:49:30.000 So that's saying that increased fish intake doesn't lower the risk of diabetes.

02:49:36.000 It's not saying that it increases the risk.

02:49:39.000 So it says there's no relationship there that they can analyze.

02:49:43.000 So no one's saying that it causes diabetes.

02:49:47.000 So where does it say that it causes diabetes and what is this study?

02:49:53.000 Nobody said it causes it.

02:49:54.000 This is classic association because you don't know if it's the protein, the fat, the mercury, the PCBs, the DDT, or the other factors in your diet.

02:50:03.000 Yeah, they're eating fish and chips watching TV. Absolutely.

02:50:06.000 Right.

02:50:06.000 This is clearly not to the level of saying processed red meat cause cancer.

02:50:11.000 This is saying fish consumption in some studies is associated with type 2 diabetes.

02:50:15.000 But these are heavily flawed studies.

02:50:17.000 Would you agree?

02:50:18.000 I wouldn't throw them all under the bus.

02:50:20.000 You know, that's how science works.

02:50:22.000 I mean, it slowly plods forward.

02:50:24.000 Chris is smiling.

02:50:25.000 Yeah, I mean, we were starting, Joel brought up TMAO, and that's how we got onto fish and diabetes.

02:50:34.000 I think there is no strong evidence that eating fish causes diabetes.

02:50:39.000 There's a lot of evidence that suggests that eating seafood reduces significantly the incidence of cardiovascular disease.

02:50:47.000 And again, if TMAO were a problem, then eating a lot of fish should not have that impact.

02:50:53.000 And you believe that this is probably, well I shouldn't say you believe, do you believe this is from essential fatty acids that are found in fish, particularly fatty fish?

02:51:01.000 Yeah, I think that's plausible, given what we know about EPA and DHA, which are the long-chain essential fatty acids and their benefits.

02:51:10.000 Fish is also a great source of selenium, as that one study said.

02:51:15.000 16 of the 25 top sources of selenium come from ocean fish.

02:51:19.000 Fish is a great source of bioavailable protein.

02:51:23.000 There are lots of reasons why fish consumption could be beneficial.

02:51:27.000 So, in your opinion, this sort of highlights that there's a lot of complex different moving parts that we don't totally understand and that this is why you don't want to rely completely on just the mechanisms and these things that are occurring in petri dishes or mice studies or things along those lines.

02:51:48.000 Yeah, so going back to the Bradford Hill criteria that I mentioned before, which are ways of kind of determining whether associations that show up in observational studies might be causal.

02:52:02.000 One of the criteria is a mechanism.

02:52:05.000 Is there a plausible mechanism that could explain the relationship between this variable and that variable?

02:52:10.000 But there are other criteria.

02:52:12.000 Strength, consistency, specificity, temporality, biological gradient, like a dose response, coherence, experiment, analogy.

02:52:21.000 So yes, mechanisms are great.

02:52:23.000 It's important to study them.

02:52:25.000 I'm all for that.

02:52:26.000 And we absolutely need to correlate them with real outcomes and real human beings to see Both in observational studies that are well-designed and in randomized controlled trials to see if it makes sense.

02:52:38.000 And TMAO, I think, is a great example of that.

02:52:41.000 Is it fair to say that we really just are looking at a puzzle and we don't have all the pieces?

02:52:46.000 Absolutely.

02:52:47.000 You can say that in many cases and in this case for sure.

02:52:52.000 Yeah, I disagree.

02:52:53.000 There's a tremendous group, and you can pull this up if you want, Jamie, called True Health Initiative.

02:52:58.000 It's more than 400, I'd call, world experts on nutrition.

02:53:02.000 Very divergent food philosophies.

02:53:05.000 Paleo, Mediterranean, plant-based.

02:53:07.000 Specifically, what are you disagreeing with?

02:53:08.000 Well, so that there's no consensus to advise the public on a healthy diet for humans.

02:53:15.000 I disagree that we don't know enough.

02:53:16.000 That's not what we said.

02:53:17.000 What we said was that it's a complex puzzle and we don't have all the pieces.

02:53:22.000 Well, I agree with that, but we have enough to make recommendations.

02:53:24.000 Then why are you disagreeing?

02:53:25.000 Because we have enough to make recommendations to the public.

02:53:28.000 And the True Health Initiative has crystallized that.

02:53:31.000 Okay, but that's not what we were discussing right there about recommendations to the public.

02:53:34.000 We were talking about mechanisms and whether or not it's understood, all the different moving pieces in terms of how your body absorbs nutrients in food.

02:53:43.000 It's an endless flow of new knowledge.

02:53:46.000 Right.

02:53:46.000 That's what I said, but why did you disagree with that?

02:53:49.000 I didn't disagree with it.

02:53:50.000 That's exactly what you disagreed with.

02:53:51.000 You said I disagree when he said that that's an accurate assessment, that we don't have all the pieces to the puzzle.

02:53:57.000 We definitely don't have all the pieces.

02:53:58.000 We have enough to make recommendations.

02:54:00.000 And then we'll reevaluate knowledge.

02:54:02.000 You want another new meat problem?

02:54:03.000 It's coolest, latest science.

02:54:05.000 Sure.

02:54:05.000 Okay.

02:54:06.000 Jamie, will you go to, please, meat allergy on Google, University of Virginia atherosclerosis.

02:54:13.000 Meat allergy.

02:54:14.000 Meat allergy.

02:54:14.000 You wait this, baby.

02:54:15.000 Is this like the Lone Star Tick?

02:54:18.000 Oh, you got it, baby.

02:54:19.000 You are so good, Joe.

02:54:20.000 Alpha-galactose.

02:54:20.000 Oh, my, Joe, I am so overwhelmed by your science, and I mean that sincerely.

02:54:24.000 You see the one that says NIH? It's a number two hit on Google?

02:54:29.000 Sure.

02:54:29.000 But this is something that's caused by an adverse reaction to a tick.

02:54:34.000 So you've got a listener here who's in Virginia, maybe.

02:54:38.000 You see the second one?

02:54:39.000 How is this relevant to the question of whether the average person should eat meat, though? 1.00

02:54:46.000 If you get bit by this tick, you're fucked. 0.99

02:54:47.000 No, but this started with... 1.00

02:54:49.000 Here, go ahead.

02:54:50.000 So this is...

02:54:51.000 I don't know.

02:54:52.000 I go to the second one.

02:54:53.000 I'll have the picture.

02:54:54.000 Just real quick.

02:54:55.000 You live in Virginia.

02:54:57.000 You end up on a...

02:54:59.000 Right.

02:54:59.000 You end up on my cath lab table because you're in the emergency room for whatever reason.

02:55:05.000 I draw a blood sample on you.

02:55:08.000 24% of those people have an antibody to alpha-gal, which is a carbohydrate found in meat.

02:55:15.000 And that shocks people.

02:55:17.000 There are carbohydrates in meat.

02:55:18.000 And only red meat specifically.

02:55:19.000 And only red meat specifically.

02:55:21.000 24% of Virginians show the antibody.

02:55:23.000 So that was interesting, and some are now developing anaphylaxis, carrying EpiPens, because they have a meat allergy.

02:55:29.000 That isn't 2.4%, it's 24% have the antibody.

02:55:32.000 But what was discovered at the University of Virginia is if you then look at their heart arteries by ultrasound, the more plaque they have, the higher is their titer of the antibody.

02:55:40.000 Brand new science.

02:55:42.000 It's an association.

02:55:43.000 Nobody knows.

02:55:44.000 There is, of course, the possibility of inflammation from immune activation.

02:55:48.000 That's wild data.

02:55:49.000 Now, I don't wish that on people.

02:55:51.000 I wish we live in a world where people didn't have nut allergies, didn't have lactose intolerance, and didn't have meat allergies.

02:55:56.000 But the reality is there may be a pathway, previously unknown, that is hot.

02:56:02.000 And this all goes back to your question.

02:56:04.000 Is there any new physiology about this whole topic?

02:56:06.000 Okay, but can I stop you right there?

02:56:07.000 This is a pathogen-activated...

02:56:10.000 And it's pretty severe.

02:56:12.000 People don't walk around with this without knowing that they have it.

02:56:14.000 They have severe allergic reactions.

02:56:16.000 It's basically like Lyme disease.

02:56:18.000 I mean, it's a horrible tick-borne disease.

02:56:21.000 Anaphylactic.

02:56:22.000 We're not talking about a mild GI discomfort.

02:56:25.000 I don't think this is a mechanism that has existed for a long time that could explain anything about red meat.

02:56:31.000 This is something that's only been discovered over the last couple of decades.

02:56:34.000 Yeah, of those 24% that have the antibody, very few had the full clinical syndrome, but it's still correlated with heart disease.

02:56:40.000 The point is, keep an open mind, I don't see the data accumulating that means getting healthier.

02:56:45.000 Can I stop you right there?

02:56:45.000 Can I ask you this?

02:56:46.000 Do you think that it's because they have a mild case of this tick-borne disease, or this tick-borne disease is, like, because it is fairly recent, In terms of our discovery of it, is it advancing and evolving and getting more potent?

02:56:59.000 I doubt, you know, the basic biochemistry of meat and the carbohydrates in meat have changed.

02:57:04.000 Has the lone star tick become more frequent?

02:57:09.000 Has it become more potent?

02:57:12.000 Absolutely.

02:57:13.000 Is there a cross-reaction between glyphosate and being bit by a tick and our intestinal permeability?

02:57:18.000 There's all kinds of crazy ideas that Which is Monsanto's round-off.

02:57:24.000 We hate it.

02:57:25.000 We hate it.

02:57:25.000 That's right.

02:57:26.000 It's Bayer.

02:57:27.000 It's Bayer now.

02:57:28.000 It's all Bayer.

02:57:29.000 Correlation is not causation.

02:57:31.000 I know you agree with this, Joel.

02:57:33.000 We have to keep that in mind.

02:57:36.000 There's a great study done, one of my favorites, that was purposely done to illustrate the danger of assuming that correlation equals causation.

02:57:44.000 It was a study done of the most common diagnoses for hospitalization in Canada, 10.6 million people.

02:57:52.000 And they found that 24 diagnoses were significantly associated with the participants astrological signs.

02:57:59.000 So people who were born under the sign of Leo had a 15% higher risk of being hospitalized for gastrointestinal hemorrhage and Sagittarians had a 38% higher risk of being hospitalized for an arm fracture.

02:58:15.000 Now remember What?

02:58:18.000 The proposed increase in risk for processed meat and cancer is 18%.

02:58:23.000 So these risks are at processed meat, at that same level.

02:58:30.000 So Sagittarian has a higher risk of being, if we believe, In this correlation data, you know, you can't assume correlations or causation.

02:58:39.000 I mean, that's basic, and it doesn't, again, you can use Bradford Hill and other things to strengthen the association, but you need to test it with an experiment or...

02:58:49.000 The association needs to be strong.

02:58:51.000 It needs to be over 100% at least to really rise out of the noise and say, okay, we're really seeing a signal.

02:58:59.000 Let me give you another example.

02:59:00.000 There was a recent study just published that showed that pregnant women with the highest maternal consumption of gluten had a two-fold risk of type 1 diabetes in their offspring.

02:59:13.000 In their children.

02:59:13.000 That was a double.

02:59:15.000 That was over 100%.

02:59:16.000 So that is actually worth paying attention to because that's such a large increase in risk that it doesn't confirm it by any stretch, but it does mean...

02:59:27.000 It's a red flag.

02:59:27.000 Yeah, maybe we should look into this further.

02:59:29.000 If that was a 5% increase risk, I mean, you might as well say that Sagittarians have a higher risk of arm fracture. 0.68

02:59:37.000 Is it fair to say that when we're doing all these nutritional studies that you're looking at a poverty of data?

02:59:43.000 Yeah.

02:59:45.000 John Ioannidis had a quote.

02:59:48.000 Let's see if I can quickly find it.

02:59:52.000 Because we're comparing all these different studies and obviously Joel thinks one thing, you think another thing.

02:59:59.000 So here's the Ioannidis quote.

03:00:01.000 Moreover, given the complicated associations of eating behaviors and patterns Oops, lost my place.

03:00:13.000 So he's saying...

03:00:25.000 You know, layperson translation.

03:00:26.000 There's so many factors that affect our health, from our sleep to our physical activity to whether we smoke, whether we drink, our social relationships.

03:00:36.000 There was a study that I think I talked about on one of my previous appearances that shows that not having enough good relationships will increase your risk of death more than smoking 15 cigarettes a day.

03:00:49.000 No studies are controlling for that.

03:00:51.000 Right.

03:00:51.000 Gut microbiome we now know is really important for our overall health.

03:00:56.000 Are any studies actually controlling for the state of people's gut microbiome?

03:01:01.000 Absolutely not, which is a problem with the TMAO research.

03:01:04.000 So again, it doesn't mean that observational studies are not useful.

03:01:09.000 It means we have to take them with a huge grain of salt.

03:01:12.000 And the fewer things that are actually controlled for, the bigger the grain of salt will be.

03:01:18.000 Joel?

03:01:19.000 I kind of hear a sense that it's so overwhelming and there's so many spots in the data that we're unable to advise the public again.

03:01:28.000 I don't agree with that.

03:01:29.000 I think we have more than enough data.

03:01:31.000 You can go to Michael Pollan, eat food, not too much, mostly plants.

03:01:35.000 Everybody loves it because it's consistent with the overwhelming 50,000 level look.

03:01:39.000 You can go to True Health Initiative that says...

03:01:41.000 50,000 level look?

03:01:42.000 Yeah, you know, the whole level of biology, basic science, centenarian...

03:01:48.000 Randomized clinical trials, epidemiology.

03:01:50.000 You've got to talk to a patient Monday morning.

03:01:53.000 I don't want to get mired in confusion.

03:01:55.000 I'm going to tell that patient, eat real food, don't eat too much, and eat mostly plants, because that is a synthesis of 50 years of nutritional research.

03:02:04.000 Are we going to evolve that to something more brilliant?

03:02:07.000 You might add now, fast food.

03:02:09.000 Five days a month, or don't eat 12 hours a day.

03:02:12.000 We might be able to refine it with some of the new science on using fasting intelligently, but that's pretty strong.

03:02:18.000 When I go to True Health Initiative and say, it's all confusing, but 400 scientific international experts say, Locally sourced, close to the ground, plant predominant with water, 400 scientists say that's pretty reasonable.

03:02:32.000 That, I can tell my patient on Monday, is something they can actually activate.

03:02:36.000 And we'll figure out TMAO with a blocker, with fish, or with eggs, or with choline, or whether this tick allergy ends up spreading into Michigan or California, and there's a way to deal with it.

03:02:47.000 But for now, these are critically simple lessons.

03:02:50.000 I'd actually agree with that, including the part about plants.

03:02:53.000 I mean, my recommendation is your plate should be, you know, two-thirds or three-quarters plants and then animal products, animal foods.

03:03:03.000 So the question here is not that.

03:03:06.000 Should we eat, you know, a healthy whole foods diet?

03:03:08.000 We both agree on that 100%.

03:03:10.000 The question is whether...

03:03:12.000 Animal foods should be a part of the diet based on their nutrient density, which unfortunately we haven't had a chance to get into yet, and their bioavailability, and the fact that humans and our hominid ancestors have been consuming them for over two and a half million years.

03:03:27.000 You know, that's my argument, is that on that plate, for most people, they're going to benefit from having some animal foods.

03:03:35.000 How much?

03:03:36.000 You know, what proportions of carbohydrate, fat, Protein and all that, that depends on the person and you're going to see big differences actually from person to person.

03:03:45.000 But, you know, I think today has made it clear there's no convincing data that shows that completely removing animal products from that plate is going to lead to a longer lifespan Or significant reductions in disease.

03:04:03.000 Let me put it this way.

03:04:04.000 What is the benefit of putting that one quarter of your plate, putting animal protein?

03:04:11.000 What is the nutrient density of it that makes it?

03:04:15.000 There are lots of benefits.

03:04:17.000 Animal protein is more nutrient dense in essential nutrients.

03:04:25.000 Making it clear that I support eating both plants and animal foods.

03:04:30.000 So animal foods are higher in B12, bioavailable zinc, iron, calcium, choline, taurine, creatine, and not just higher in terms of the actual amounts, but higher in the amount that you absorb.

03:04:47.000 And that's a very key point.

03:04:49.000 Whereas plant foods tend to be higher in carotenoids, polyphenols, flavonoids, diallosulfides, which are in cruciferous vegetables, and fiber.

03:05:00.000 And those are important as well.

03:05:02.000 And so to get the best of, you know, the widest spectrum of nutrient density, we want to eat the animals for those nutrients, animal foods, and then the plant foods for those other nutrients.

03:05:13.000 And what would be negative about removing the animal products from that one quarter of your plate?

03:05:21.000 What could you not fill in with plant protein?

03:05:25.000 Because clearly some people get by with just plant protein.

03:05:29.000 B12 is the biggest issue for sure.

03:05:32.000 It's not really found in plant foods except for some exotic species of wild mushrooms and nori.

03:05:40.000 And mushrooms aren't really plants.

03:05:43.000 Right.

03:05:44.000 But yeah, in non-animal foods, I guess you could say.

03:05:48.000 But it's not just a question of what's theoretically possible.

03:05:53.000 It's a question of looking at the studies that show us what are the average, you know...

03:05:59.000 How common are nutrient deficiencies on omnivorous versus vegetarian and vegan diets?

03:06:05.000 And if you go to Kresser.co slash Rogan, there's a whole section on that that links to a very in-depth article that shows that, for example, vegetarians and vegans, the average omnivore The rate of B12 depletion is 11%, and then for vegetarians it's 77%,

03:06:22.000 and for vegans it's 92%.

03:06:24.000 92%?

03:06:26.000 Of depletion, which is the first stage.

03:06:28.000 There's four stages of B12 deficiency, and that's the first stage.

03:06:32.000 And the earlier studies that showed less of a difference used only serum B12 as a marker, but it turns out that serum B12 is not a very accurate marker of B12 deficiency, and we need to be using more accurate markers like holotranscobalamin, Methylmalonic acid and homocysteine.

03:06:48.000 And when you use those newer markers, you see those broad, very big differences in deficiency rates.

03:06:56.000 And furthermore, there was a study done in vegans and vegetarians in the Netherlands that were at a summer camp.

03:07:03.000 So these were people who were educated vegetarians and vegans.

03:07:06.000 They were really into it.

03:07:07.000 And the average serum B12 level for them, even what was below 200, which is in a deficiency state, And even the people who were supplementing had significant levels of B12 deficiency.

03:07:21.000 And that's probably because studies have shown that the amount that you need to supplement with is about 100 times higher than the RDA. So the RDA is 2.5 micrograms.

03:07:32.000 And you really need 250 micrograms to get your levels up.

03:07:36.000 And if you're deficient, you need 200 times more than the RDA, 500 micrograms.

03:07:42.000 And all the studies are there on my site.

03:07:45.000 It is a problem that B12 is non-existent in plant-based foods or that it's not as bioavailable?

03:07:50.000 It doesn't exist.

03:07:52.000 The true cobalamin absorbable B12 doesn't exist in plant foods.

03:07:57.000 You can get other cobalamides, other forms in plant, even algae.

03:08:04.000 Even algae.

03:08:05.000 Most vegans who are educated about this know this and they take a B12 supplement.

03:08:11.000 But the B12 supplement is probably based on what?

03:08:14.000 Like what's it coming from?

03:08:16.000 Well, that doesn't necessarily make the difference.

03:08:19.000 It's are they taking enough to meet their needs.

03:08:22.000 So I hope that anyone who is listening to this makes sure that they're getting enough B12. Right, but what is it coming from if it's not coming from plants?

03:08:29.000 Bacteria make B12. So if cows are eating dirty ground, they get bacteria.

03:08:34.000 Cows store it in their stomach.

03:08:35.000 Plants, if you don't wash, will give you B12, but it's the bacteria hanging on the carrot.

03:08:39.000 And we make B12, too, but it's in the colon, and we can't absorb it in the small intestine.

03:08:46.000 But yeah, just making sure that if someone is following this diet, they're getting enough B12 and that they're using the right markers to assess their status.

03:08:52.000 Serum B12 only goes out of range in the final stages of B12 deficiency, and by then it can be too late.

03:08:59.000 Some of the effects of B12 deficiency are irreversible.

03:09:03.000 So it's a pretty serious thing, and it's a really important thing for any vegetarian or vegan to be aware of, given those big differences in depletion between the populations.

03:09:13.000 So, Joel, if you've been a vegan since you've been 18, obviously you must have been on top of all the supplementation and making sure that you get your right nutrients.

03:09:21.000 Well, number one, it's responsible for a healthcare practitioner to advise somebody eating plant-based to take...

03:09:29.000 Vitamin B12, absolutely.

03:09:31.000 There are people that do it because it's fortified in many foods and nori if you eat sushi and nutritional yeast.

03:09:38.000 I don't advise my patients to rely on food because there's a neurologic and hematologic potential for trouble if you don't B12. It actually takes years to deplete your B12. It's an interesting statistic.

03:09:49.000 I want to come back to humans.

03:09:50.000 90% of all B12 right now is being given to feedlot cows because they don't eat dirt anymore.

03:09:55.000 They're inside a building that has no dirt.

03:09:57.000 They don't get B12, but the public wants B12 rich meat, so they give B12 to cows to make B12. They're little vegans, these cows.

03:10:05.000 They don't have a source anymore.

03:10:07.000 No animal makes B12. You're only talking about factory farming.

03:10:09.000 Factory farming.

03:10:10.000 If you're out there eating dirt in the field, you're going to have a cow rich B12. Can I stop you right here? 1.00

03:10:15.000 When you say that...

03:10:17.000 Is it impossible to live a healthy, plant-based lifestyle without supplementation?

03:10:24.000 No, many, many people do.

03:10:25.000 But if you're saying you don't recommend it?

03:10:27.000 I don't recommend it, but they should get blood work.

03:10:29.000 Know your vitamin D, know your omega-3, and know your B12. I'm all for optimal health, and I'm practicing high-level medicine, but I have friends that adamantly show me their blood work.

03:10:39.000 I don't take pills and look at my blood work.

03:10:41.000 I mean, they may sneak by.

03:10:42.000 It's not my medical recommendation.

03:10:44.000 The official recommendation is everybody over each 50 in the United States take B12 for brain and mental health, whatever your diet.

03:10:52.000 And that's a wise advice, whether you take a multivitamin every couple of days like Dr. Longo recommends.

03:10:58.000 This is a real problem.

03:11:01.000 Nobody's denying it.

03:11:02.000 Chris has laid it out well.

03:11:03.000 It's such a simple solution.

03:11:05.000 I'm going to demonstrate my B12. And what's the source of your B12? It's synthesized methylcobalamin.

03:11:11.000 I just got 1,000 micrograms of vitamin B12 with 400 milligrams of DHA with 2,000 international units of vitamin D3. And that's all vegan?

03:11:22.000 I just did that once a day and I'm done, you know?

03:11:24.000 And it's all vegan and has nothing to do with living organisms?

03:11:27.000 Yeah, it's made...

03:11:27.000 How's it synthesized?

03:11:29.000 B12 is synthesized in labs.

03:11:32.000 Methylcobalamine, some people believe, is the preferred choice, which I think Chris would agree with.

03:11:37.000 So contrary to popular belief, it can be gotten by completely humane and ethical ways if you're a vegan.

03:11:43.000 Oh, it's algae.

03:11:44.000 It's algae for DHA. It's synthesized for B12. And vitamin D3 is synthesized, too.

03:11:50.000 It used to be made from sheep's secretion called lanlin, but it's synthesized now.

03:11:55.000 But it does beg the question of whether we should be following a diet that can't meet our essential nutrient needs and that leads to deficiencies of many other nutrients much more commonly than an omnivorous diet.

03:12:09.000 And my position has always been we should get as many nutrients as food as we can because that's the way that humans are adapted to getting nutrients.

03:12:18.000 There's issues with supplementation sometimes.

03:12:23.000 Getting too much of a nutrient can be a problem in several cases.

03:12:27.000 That's not the case in B12, which is great because it means people could take really high doses and it won't be a problem.

03:12:33.000 But as I mentioned, a lot of vegetarians and vegans who are supplementing are still at risk and still deficient because serum B12 is the main marker that is used in this country.

03:12:44.000 And not even most physicians don't test for serum B12. I know this.

03:12:48.000 You probably know this, Joel, from people come in.

03:12:50.000 They've never had a B12 test.

03:12:51.000 But then when they do get the serum B12 test, it's going to miss a large percentage of people who are already in stage 2 and 3 deficiency.

03:12:57.000 I do methylmalonic acid.

03:13:02.000 And homocysteine are much more important markers.

03:13:05.000 I agree.

03:13:06.000 If you look at average homocysteine levels in vegans and vegetarians, they're significantly higher than in omnivores because of this issue, because of the high prevalence of B12 deficiency.

03:13:19.000 And what's ironic about that is a lot of people turn to a plant-based I don't even want to say plant-based, because I would consider NutraVore or Paleo diet to be plant-based too, but teams do a no-animal product diet to improve their cardiovascular health, and yet you're seeing much higher rates of homocysteine,

03:13:37.000 like the average in vegans, is 16, which is a rate that's clearly associated with increased risk of not only cardiovascular disease, but also dementia and Alzheimer's.

03:13:46.000 Chris, I couldn't agree more. 0.87

03:13:47.000 I've written many articles, don't be a dumb vegan, and I don't mean to offend, but we are prone, and there's no bullshit here, this is too important for people. 0.98

03:13:56.000 We are prone to have a few holes in the wall that an intelligent person knows how to plug. 0.98

03:14:02.000 It's vitamin D, it's DHA, it's B12, you might go on to say iodine, taurine, vanadium, chromium.

03:14:10.000 I just got those.

03:14:11.000 That's what I do every other day.

03:14:12.000 I'm totally complete.

03:14:14.000 My patients are totally complete.

03:14:15.000 The industry has provided solutions to a relatively simple problem.

03:14:19.000 Let me ask you a question.

03:14:23.000 Is it fair to say that you believe that what the vegan diet is, it's like you can essentially hack your way to a better, healthier life by just adding a few things like B12, a few other nutrients, That you're not going to get from the diet,

03:14:39.000 but with those together, you feel like you're far healthier.

03:14:43.000 Well, because what I didn't get, I substituted.

03:14:45.000 But what I don't want, I'm not taking in, which is animal saturated fat, animal protein.

03:14:50.000 I'm not taking in tea.

03:14:50.000 So that's the main disagreement here.

03:14:52.000 Between the two of you, is whether or not saturated fat is...

03:14:56.000 Chris and I would both agree, as educators, all the public, and specifically plant eaters, should be aware of nutritional deficiencies.

03:15:03.000 A two-year paleo follow-up study said that people were deficient in iodine on the paleo diet.

03:15:08.000 But vegans have much higher...

03:15:09.000 Yeah, they do.

03:15:11.000 But, you know, it's common in America.

03:15:13.000 These have much higher rates of iodine deficiency than paleo people?

03:15:15.000 Unless you eat some nori, some kelp, unless you use iodized salt.

03:15:19.000 So it's a poor argument, though, that the paleo diet is the issue.

03:15:24.000 No, it's actually not.

03:15:24.000 It just seems like a lot of people have an iodine deficiency.

03:15:27.000 Paleo diet goes back 10 to 12 years in the literature.

03:15:30.000 2009 is about the first good paleo science that showed up.

03:15:32.000 And I honor the paleo diet.

03:15:34.000 There is good reason to consider it as a food option.

03:15:36.000 The U.S. News& World Report does not agree with that.

03:15:39.000 But what are they basing it on?

03:15:42.000 They're not scientists.

03:15:43.000 Well, they're panelist scientists.

03:15:45.000 They're panelist scientists.

03:15:45.000 They rate it the lowest.

03:15:48.000 The bigger question is just what's going to happen for the average person who's following these diets?

03:15:54.000 And I agree 100% with Joel that we have to educate people on whatever diet they're on.

03:16:00.000 I've said this to people.

03:16:01.000 That's why I'm not...

03:16:02.000 I've never advocated strict paleo.

03:16:05.000 I mean, I think that can work for some people, but I've never been ideological about that because I actually think that Full-fat fermented dairy is really beneficial when it's well-tolerated, and one of the reasons for it is iodine.

03:16:18.000 Dairy is actually one of the best sources of iodine in the diet, and it's not because the dairy products contain iodine, but they're stored in tanks.

03:16:26.000 Iodophore is the cleanser that's used for the tanks, which is basically just pure iodine.

03:16:31.000 That's interesting.

03:16:32.000 How bizarre.

03:16:34.000 That sounds gross.

03:16:35.000 It's not.

03:16:36.000 You know the iodine you use to clean?

03:16:39.000 It's a natural nutrient.

03:16:41.000 Where do you get it from food, though, outside of that?

03:16:44.000 So the three top sources of iodine would be, well, iodized salt is the main one.

03:16:49.000 That's why it was added to salt in the first place.

03:16:51.000 But a lot of people on a healthy diet remove iodized salt in favor of sea salt, which I think is a good choice overall.

03:16:57.000 But one of the downsides of that is that they're no longer consuming the main source of iodine.

03:17:02.000 Then dairy products, and then sea vegetables, as Joel mentioned, like kelp and hijiki and arame and nori, not as much, which is the only sea vegetable that most Americans consume in the form of sushi, right?

03:17:15.000 So if you take someone on a vegan diet or a paleo diet, for that matter, and they remove dairy, iodized salt, and they're not eating sea vegetables, then yes, that is a risk for iodine deficiency.

03:17:26.000 I have written about that.

03:17:28.000 But let's look at things like calcium.

03:17:30.000 Let's look at iron.

03:17:31.000 Let's look at zinc.

03:17:32.000 Let's look at choline.

03:17:33.000 Let's look at taurine.

03:17:34.000 Let's look at creatine.

03:17:35.000 Let's look at retinol, which is preformed vitamin A. Let's look at EPA and DHA. All of these are shown to be lower in vegetarians and vegans than they are in omnivores.

03:17:46.000 And it just, yes, you can supplement, but it just, you know...

03:17:50.000 Do the supplements have the same effect?

03:17:52.000 Like, look at calcium.

03:17:53.000 Dietary calcium has inversely related to heart disease and kidney stones, meaning the more dietary calcium you eat, the lower risk of those conditions.

03:18:03.000 But when you look at studies on calcium supplements, the opposite is true.

03:18:08.000 Calcium supplements are associated with an increase in heart disease and an increase in kidney stones.

03:18:15.000 Associated by epidemiology studies?

03:18:17.000 Yes.

03:18:19.000 But the theory is that with supplemental calcium, it's not the same as dietary calcium.

03:18:25.000 You get a large bolus of calcium that goes into your blood all at once, and then it can get into the soft tissues, which can make them stiffer, which as Joel will tell you is not good for your heart health.

03:18:38.000 And so my point is that supplements don't always affect the body in the same way.

03:18:42.000 That's why I just think it's better to get nutrients from food if you can, because that's the way we've been getting them for millions of years, you know?

03:18:49.000 Let's talk about something I think you guys can both agree on, because I am baffled by this carnivore diet.

03:18:56.000 Yes.

03:18:57.000 I'm baffled.

03:18:58.000 I'm baffled by how many people are clinging to it as a panacea.

03:19:03.000 I'm baffled by whether or not it's a physiological effect or whether there's a placebo effect going on.

03:19:11.000 I have a theory.

03:19:11.000 Please.

03:19:12.000 So, my theory is that it mimics some of the benefits of fasting.

03:19:18.000 But it allows people to persist for longer because it's providing some nutrition.

03:19:23.000 If you look in the scientific literature, fasting is like the cure-all for everything.

03:19:28.000 I agree with you.

03:19:29.000 You can look at any condition and fasting is the cure.

03:19:32.000 We're talking water fasting so you can do it for two, three, four weeks.

03:19:35.000 The problem is try that for a year.

03:19:38.000 That will be the cure for life in that case.

03:19:41.000 The longest example is a year of water fasting.

03:19:45.000 That's that guy that lost 300 plus pounds.

03:19:47.000 He was extremely obese.

03:19:49.000 He was living off of his fat stores.

03:19:53.000 The fascinating thing about that was that his skin shrank too.

03:19:56.000 Which doesn't usually happen with weight loss.

03:19:59.000 So this is just a theory.

03:20:01.000 I have nothing to, you know, I don't have any evidence.

03:20:03.000 But meat is absorbed very high up in the digestive tract.

03:20:07.000 And so when you only eat meat, it's a low residue diet.

03:20:11.000 And there's nothing left over to irritate or inflame the gut.

03:20:15.000 My theory is a lot of people who are benefiting from this have a really disrupted gut microbiome.

03:20:20.000 Alessio Fasano has argued that leaky gut is kind of a precondition for autoimmunity.

03:20:25.000 And the carnivore diet is essentially like a gut rest or a fast.

03:20:30.000 And so I don't, you know, doubt that people are benefiting from it.

03:20:34.000 The question is, what is the long-term implication?

03:20:37.000 Well, there is no, I mean, there's a few people that have been doing it.

03:20:41.000 There's some anecdotal evidence that have been doing it for a few decades.

03:20:43.000 Well, you know, it's pretty cool.

03:20:44.000 I'm actually going on my homeboy Sean Baker's podcast in a few weeks.

03:20:48.000 You guys are homeboys?

03:20:50.000 Sean and I started as enemies.

03:20:51.000 We love each other.

03:20:52.000 Sean, I love you, brother.

03:20:53.000 We're going to have an honest discussion as much as you can to say, why is Michaela Peterson feeling good?

03:21:00.000 And you've got to love that and honor that.

03:21:01.000 If she had done water fasting, transitioning to an ultra-clean diet, would she have done as well?

03:21:06.000 Who knows?

03:21:07.000 But to look at Sean Baker's labs and say, pre-diabetic, low testosterone, high BUN, I'm concerned, although he just published his coronary calcium scan of zero, and I honor that.

03:21:18.000 He's got little kids.

03:21:19.000 I don't want the guy to drop dead, but, you know, it's way preliminary for the bandwagon that's growing.

03:21:24.000 The problem with the testosterone thing, though, is he said that he had been deadlifting the day before, and the day before he took his test.

03:21:31.000 Could that have significantly decreased his testosterone?

03:21:34.000 He said he repeated it a few times and it stayed low, but if your serum total...

03:21:38.000 It raised quite a bit.

03:21:39.000 It could have.

03:21:40.000 I think it raised by 100%.

03:21:41.000 No, it was like 237. I can't memorize his labs.

03:21:45.000 It's low, though.

03:21:46.000 There's plenty of data.

03:21:47.000 If your serum total testosterone is less than 250, it's an adverse mortality predictor.

03:21:51.000 And, you know, he wants to be alive.

03:21:53.000 He doesn't need to do it.

03:21:54.000 Michaela Peterson and Jordan might need to do it until they find a better path.

03:21:58.000 Mm-hmm.

03:21:58.000 Sean's, you know, adopted it.

03:22:00.000 So there's, you know, the biggest puzzle is, quickly, quickly, one of the things that plant-based eaters and people that fill three quarters of their plate with fruit and vegetables get way more than everybody else is lots of vitamin C. And vitamin C builds healthy walls and builds healthy immune systems.

03:22:15.000 You love vitamin C. I love vitamin C. I love it from foods.

03:22:18.000 I don't mind it as a supplement.

03:22:19.000 I don't mind it intravenous.

03:22:21.000 Vitamin C is, Linus Pauling, there's so many benefits to the body.

03:22:26.000 Where are these people when every chart says that meat has no vitamin C? Are they eating raw meat, which might have vitamin C? Are they eating organ meat, which might have some vitamin C? Let me stop you there, because I'll tell you what the explanation's been to me.

03:22:39.000 The explanation to me has been that there is a decrease in absorption of vitamin C when you're consuming vitamin C with all these other things, cruciferous vegetables, carbohydrates, all these different things.

03:22:49.000 There's some sort of, there's an adverse effect.

03:22:52.000 Is that a fact?

03:22:53.000 Well, if you take 1,000 milligrams of vitamin C, you'll absorb a lot of it.

03:22:58.000 If you take 10,000 milligrams, by percentage, you won't absorb as much, but you'll still get more than 1,000 milligrams.

03:23:04.000 But there's also this theory that since they're eating basically a no-added glucose diet, that there's some kind of competition in us between glucose and C. So even if they get a touch of C, they're absorbing it hyper-efficiently.

03:23:17.000 Nobody knows.

03:23:18.000 They haven't developed scurvy.

03:23:19.000 And then they're getting their glucose from glucogenesis.

03:23:23.000 Internally, right, because they're adding, you know, surely it's a low-carb diet, no doubt about it.

03:23:26.000 It's a zero-carb diet.

03:23:27.000 A little alpha-gal in there, maybe.

03:23:29.000 That's about the only curve.

03:23:30.000 I think, I mean, the point is we just don't know.

03:23:33.000 We don't know.

03:23:34.000 It seems so risky.

03:23:36.000 I mean, as a practitioner myself and as someone who's dealt with chronic illness who wasn't able to find help anywhere else, I mean, I do not begrudge people for Sticking with something that when they've tried everything and nothing has worked and they do this and they feel good, I mean, who can blame them?

03:23:52.000 Well, I've gone to dinner with Jordan Peterson.

03:23:54.000 He's eaten his big giant steaks and he looks great.

03:23:57.000 He's lighter than he's been since he was 25 years old.

03:24:00.000 That's true.

03:24:00.000 And I'm 100% empathetic with that because I've been through something like that myself.

03:24:05.000 But to then take that and say that we're certain that it's safe is a big leap.

03:24:10.000 And the other thing is, you know, my field, atherosclerosis, takes years to develop.

03:24:13.000 And I wish him well.

03:24:14.000 He's contributing amazing things to the world.

03:24:16.000 But unless he's tracking carotid and coronary and doing it year after year after year, you know, it's an experiment you might not want to run.

03:24:23.000 But Sean did run those tests.

03:24:27.000 Some nutrient deficiencies also take many years to develop.

03:24:30.000 So that's another thing to consider.

03:24:32.000 Now, there's another guy that I follow online.

03:24:34.000 I'm sorry, I forget the gentleman's name, but he advocates organ meat.

03:24:37.000 And he's saying that organ meat, if you're just eating steak, that you've got an issue.

03:24:41.000 But if you take into account liver and heart, kidneys, that you're going to get all these essential nutrients from that.

03:24:48.000 You're still not getting vitamin C that I'm aware of in any significant amount.

03:24:52.000 You're not getting carotenoids and flavonoids and polyphenols.

03:24:55.000 So how are these people not getting scurvy?

03:24:57.000 We don't know.

03:24:58.000 We don't know.

03:25:00.000 We don't know is a good summation of is it possible that there's some mechanism that's going on?

03:25:06.000 I mean, Sean posted a picture.

03:25:08.000 He was eating steak and cheese.

03:25:09.000 So it's apparently not an all-meat diet.

03:25:11.000 And I'm not slamming him.

03:25:12.000 I really wish him well and he can do what he wants.

03:25:15.000 I don't know.

03:25:15.000 He's a very nice guy.

03:25:18.000 I agree that the nose to tail is important though because the organ meats and then like the fattier cuts of meat have glycine and other nutrients that are really important.

03:25:27.000 If you're only eating lean meat, I think, yeah, I would be very concerned about that.

03:25:32.000 Children do not try this at home.

03:25:34.000 Someone tried to get me.

03:25:35.000 They were saying, you should try a carnivore diet for 90 days.

03:25:38.000 And I said, well, the real problem with that would be I eat game.

03:25:42.000 And that's extremely low fat.

03:25:44.000 Very lean, yeah.

03:25:44.000 It's not smart.

03:25:45.000 And I like vegetables.

03:25:47.000 I like vegetables.

03:25:48.000 I like to eat them.

03:25:49.000 I eat vegetables with essentially every single meal.

03:25:52.000 Yeah, that's very smart.

03:25:53.000 As I told you, it's an antidote, if nothing else.

03:25:55.000 I mean, it's awesome.

03:25:56.000 But I do think that it's entirely possible that maybe it's people that have this disrupted gut microbiome, but that some people might be alert, like one of the things that Michaela Peterson brought up when she was on the podcast, that it might very well be that she's allergic to almost everything.

03:26:12.000 She He has some sort of an allergic reaction. 0.98

03:26:14.000 You, I think you both think that that could be because of a fucked up gut. 1.00

03:26:18.000 No doubt. 1.00

03:26:19.000 Absolutely.

03:26:20.000 She just hasn't had it evaluated.

03:26:21.000 She started to laugh when I talked to my naturopath.

03:26:24.000 That's what she should have kept on doing and gotten her gut analyzed and gotten her gut healed. 0.99

03:26:28.000 I mean, maybe that would have helped her.

03:26:30.000 The problem with those naturopaths, it's like good psychics.

03:26:34.000 Try to find one.

03:26:37.000 Look, not all problems are solvable.

03:26:40.000 That's a really hard thing to accept.

03:26:44.000 But let's say you get in a car accident and your spine is crushed.

03:26:49.000 Short of a miracle, that person is not going to fully regain 100% of their musculoskeletal capabilities.

03:26:59.000 But we don't have that same understanding with other conditions, health conditions.

03:27:04.000 Let's say I go to Indonesia and I get 10 parasites and then I have to take tons of antibiotics to deal with that.

03:27:15.000 Is my gut ever going to return to 100% of the function that it had before that, even with all the right things?

03:27:22.000 Maybe not.

03:27:22.000 And so I'm not saying that people should give up hope, but I'm saying that We have to separate between this is helping me and it's making me feel great and nothing else worked.

03:27:35.000 And we know with 100% certainty that this is safe for the long term.

03:27:39.000 Those are two very different questions.

03:27:42.000 And again, I'm totally empathetic to that.

03:27:45.000 And I would probably do the same thing.

03:27:47.000 Especially a person like yourself that has gone through this process of being extremely unhealthy.

03:27:51.000 And I might even say, hey, maybe I'll die five years later.

03:27:56.000 But I'll enjoy those years of my life.

03:27:59.000 I won't be in pain and discomfort the entire time.

03:28:02.000 Then sign me up.

03:28:02.000 Or I might say to myself, well, wait, it can't be that good for me to be inflamed all the time.

03:28:08.000 And that can't be good for me.

03:28:11.000 So maybe even though the all-meat diet might have some downsides, it actually might be reducing inflammation and therefore that will cancel out.

03:28:19.000 We just don't know.

03:28:20.000 What about an all-meat diet?

03:28:21.000 The thing that gets me is there's no vitamin supplementation.

03:28:24.000 I'm like, what about an all-meat diet with a good supplementation of multivitamins?

03:28:28.000 Pretty smart idea.

03:28:29.000 What about fiber?

03:28:30.000 Where's omega-3 coming from?

03:28:32.000 Is fiber essential?

03:28:33.000 Well, it's being questioned.

03:28:35.000 I mean, is it as central to health in the medical literature?

03:28:40.000 Dr. Dennis Burkett from England went to Africa, described fiber, described it, reduced all kinds of chronic diseases.

03:28:47.000 He wrote a book called The Fiber Man and all.

03:28:49.000 It's being questioned now.

03:28:50.000 It's so entrenched.

03:28:52.000 Have we got it all wrong?

03:28:53.000 And only plants have fiber.

03:28:55.000 It's a good question.

03:28:56.000 Where are they getting their fiber? 0.54

03:28:57.000 Their meat is sticking in their colon.

03:28:59.000 It's called putrefaction for days and days.

03:29:01.000 Is it?

03:29:02.000 Yeah, well, that is what happens in a high meat diet.

03:29:05.000 But is it 100% with every single person?

03:29:08.000 When you chew it well and drink water, does it always get stuck?

03:29:11.000 It's generally thought that it's fiber that is the process of moving abdominal contents, whether you eat an all-plant diet or a mixed diet.

03:29:19.000 I think there's definitely controversy about fiber, but I think the weight of the evidence still does suggest that fermentable carbohydrates, fiber, essentially, are beneficial because they're very important for the microbiome,

03:29:35.000 and we have people like Justin Sonnenberg at Stanford who's done a lot of good work here.

03:29:40.000 Do we know with 100% certainty?

03:29:42.000 No.

03:29:42.000 But we also know that virtually every human population that's ever been studied had significant amounts of fiber in their diet.

03:29:50.000 Except the Maasai, right?

03:29:53.000 No, they did.

03:29:55.000 They have a very high meat diet, but still.

03:29:58.000 The Warriors consumed milk and meat and blood at certain times of year.

03:30:04.000 And other times of year, they did eat more plants.

03:30:09.000 Even the Inuit, the traditional Inuit, they had during certain times of year, like the winter when the ground was covered with snow, they had a very low intake of plant foods, but they would still trade for them.

03:30:22.000 And then during the summer, when they were able to collect berries and things like that, they would definitely do that.

03:30:29.000 So every culture that we know of that's been studied ate some combination of animal and plant foods.

03:30:35.000 You know, what ratio, what amount, you know, that varies from place to place depending on where they are.

03:30:41.000 But that's what the anthropological data show.

03:30:45.000 There's actually, you know, when you talk about this, two super, super cool pieces of data.

03:30:50.000 I'll go quick.

03:30:50.000 There's a professor at the University of Pittsburgh, Stephen O'Keefe, who took 20 African-Americans in Pittsburgh eating an inner-city, not-healthy diet, and 20 rural Africans in South Africa eating from the bush and largely plants, and they switched them for 20 days.

03:31:04.000 And they measured every single thing they could measure in the microbiome and their stool.

03:31:07.000 I think we're good to go.

03:31:25.000 The rural Africans suffered American illness in terms of what you can measure within two weeks. 0.98

03:31:29.000 Now there's data I just learned yesterday in Los Angeles that our microbiome changes in five days.

03:31:34.000 You go to a low-sugar, low-protein plant diet.

03:31:37.000 This is University of Southern California.

03:31:39.000 I can tell you in five days, Michaela Peterson's microbiome would change. 0.52

03:31:42.000 Would she feel better?

03:31:43.000 I don't know.

03:31:44.000 I'm just pointing out just the remarkable resiliency, and that's part of the issue.

03:31:48.000 You can feed a human a whole lot of diets and make it through procreation, which is our main purpose of evolutionary biology to be here.

03:31:55.000 We're talking about from procreation to death for optimal health, longevity, health span.

03:32:01.000 There's more than one path, but let's not beat on our plant-based people out there because we've shown you can reverse atherosclerosis.

03:32:10.000 We've shown you can reverse prostate cancer, University of California, UCSF. And we've shown you can lengthen your telomeres, which may have implications for longevity.

03:32:20.000 Isn't that done through a ketogenic diet as well?

03:32:23.000 Doesn't that lengthen your telomeres?

03:32:25.000 I don't think that's been published.

03:32:27.000 It would be an interesting project.

03:32:29.000 You know, it takes about three to six months, so you'd have to...

03:32:31.000 No, it's not been looked at.

03:32:33.000 I thought there has been established.

03:32:35.000 We could say the same thing about a diet that is rich in, you know...

03:32:41.000 Vegetables and fruits and animal foods.

03:32:44.000 You can't reverse heart disease with what you just said.

03:32:48.000 Don't touch that.

03:32:49.000 You cannot reverse atherosclerosis with animal products.

03:32:51.000 It's never been studied.

03:32:53.000 So then how can you say you cannot do it?

03:32:57.000 What would you tell a patient with the 99% blockages that come to me?

03:33:00.000 Go eat meat?

03:33:01.000 That would be unethical in my life.

03:33:02.000 I would say, do we have studies that show that switching from a standard American diet to a Nutrivore diet...

03:33:10.000 This is a new word, Nutrivore.

03:33:14.000 You coined this?

03:33:15.000 Sarah Ballantyne.

03:33:16.000 Okay, and the idea is just plant-based with meat?

03:33:21.000 Yeah.

03:33:22.000 Yeah.

03:33:22.000 Yeah, it's a whole foods diet with fruits, vegetables, nuts and seeds, some starchy plants and animal foods.

03:33:30.000 Why don't you call that paleo?

03:33:31.000 Why don't you call that paleo?

03:33:33.000 Well, the problem with paleo is paleolithic people didn't really eat like that.

03:33:36.000 They ate a lot of grains.

03:33:37.000 Well, I don't think that's true, Joe.

03:33:39.000 What do they eat?

03:33:41.000 For me, Nutrivor is a more inclusive term that just means what I said.

03:33:48.000 Some Nutrivor might include some dairy products, they might include some grains or legumes, but they're eating whole, real foods and they're including animal foods there, to distinguish that from vegan or vegetarian.

03:34:02.000 Isn't the criticism of the Paleolithic diet or calling it the Paleolithic diet that people in the Paleolithic era actually did experience at least some form of agriculture?

03:34:11.000 There's been recent data that suggests that grain consumption and legume consumption went back further than it was originally thought it was.

03:34:23.000 Prominent parts of the diet or fallback foods is another question.

03:34:27.000 And does that even matter?

03:34:29.000 I mean, this is why I've argued that the evolutionary perspective is important.

03:34:34.000 It's just a way of generating hypotheses, kind of like observational research.

03:34:40.000 You can't look at what our ancestors ate and say, therefore, that's what we should eat.

03:34:45.000 You can look at it and say, oh, that's interesting.

03:34:47.000 Let's test this out.

03:34:48.000 Joel, how does it reverse heart disease?

03:34:50.000 Okay.

03:34:51.000 Ketogenic diet and telomeres.

03:34:52.000 There's no science studies out there just to follow up.

03:34:54.000 Okay.

03:34:54.000 I didn't know.

03:34:57.000 How does it reverse heart disease?

03:34:59.000 You go back to Los Angeles, California in 1948. Dr. Lester Morrison, internist.

03:35:04.000 Real answer, saw that in the country of Norway in World War II, where they dropped their animal food consumption because of the Nazis, heart disease slowed for those two, three years.

03:35:14.000 He said, I wonder what happens with my heart patients in Los Angeles.

03:35:17.000 He had a hundred of them.

03:35:18.000 There was no treatment in 1948. He put half of them on a low animal diet with very high plants, let half of them eat like Los Angeles people. 0.98

03:35:26.000 Eight years later, 50% on the high plant, low fat diet were alive, 0% on the standard Los Angeles diet.

03:35:33.000 And then a series of people said, let's start doing that more routinely.

03:35:36.000 Ultimately, there were randomized clinical studies using cath lab techniques Using ultrasound techniques, using PET scanning, this shows, it actually causes small decreases in the amount of plaque in your heart arteries, which results in tripling of blood flow because it's fluid physiology that is 4R squared,

03:35:53.000 so small decreases in plaque.

03:35:56.000 Nobody ever thought you could decrease plaque with Diet and lifestyle, but you can.

03:35:59.000 It causes a big increase in flow.

03:36:00.000 So within three, four weeks, chest pain goes away.

03:36:03.000 Within three, four months, stress tests get better.

03:36:05.000 And as you keep going, a number of hospitalizations, procedures go down dramatically.

03:36:10.000 To the point, initially small studies got big enough.

03:36:13.000 In 2010, Medicare said, we'll pay for patients to learn how to do this reversal lifestyle.

03:36:19.000 They don't pay for Mediterranean diet.

03:36:20.000 They don't pay for DASH diet.

03:36:22.000 They don't pay for paleo, keto, neutrophores.

03:36:24.000 They pay for plant-based diets for advanced heart patients.

03:36:26.000 That's only because these concepts of Nutrivore and Paleo have not been around for very long.

03:36:31.000 Do the study!

03:36:33.000 Do the study!

03:36:34.000 Okay.

03:36:35.000 I don't have the millions of dollars to do the study.

03:36:38.000 But don't suggest you can do it.

03:36:40.000 Be rigorous.

03:36:41.000 So all that you have said, which I agree with, is that a vegan or plant-based kind of diet compared to a standard American diet will reverse markers of atherosclerosis.

03:36:53.000 It's like, wow, number one in the world.

03:36:56.000 I agree with that statement, but we don't have research.

03:37:01.000 It's not like studies have been done taking people from Standard American to NutriVore or Paleo, and we haven't seen benefits.

03:37:08.000 We have RCTs that have shown significant benefits in cardiovascular markers, in NutriVore diets, and Paleo and low-carb, for that matter, and ketogenic.

03:37:19.000 I agree with you.

03:37:20.000 Your assertion is that the real issue is the standard American diet is killing people.

03:37:23.000 Oh, yes.

03:37:25.000 And lack of evidence is not evidence against.

03:37:31.000 How long have these concepts been around?

03:37:35.000 Nutravore, paleo.

03:37:36.000 How many studies have been done comparing, for example, it would be great if we had a study where you had standard American diet and then you had two different groups.

03:37:45.000 You had We don't have that study.

03:37:53.000 So we can't say that eating a diet that's rich in whole foods but contains some animal foods isn't going to reverse atherosclerosis.

03:38:01.000 We can't say that.

03:38:02.000 So I think one thing that we can absolutely agree on is that the standard American diet sucks, and that a vegan diet is superior to the standard American diet.

03:38:11.000 Amen, brother.

03:38:12.000 These two things are agreed, right?

03:38:14.000 If the vegan is supplementing wisely.

03:38:17.000 Supplementing wisely.

03:38:17.000 I just tell you, and this is very subtle, but vegan diet says what you can't do.

03:38:21.000 You can't eat dairy, you can't eat eggs, you can't eat fish, you can't eat meat.

03:38:24.000 Whole food, plant-based is really the proper medical term.

03:38:27.000 What do you eat?

03:38:28.000 Eat whole food.

03:38:28.000 Right, that's what John Joseph talks about, too.

03:38:30.000 He calls it plant-based, whole food, plant-based, because you don't want to be just eating pasta all day.

03:38:36.000 Oh, absolutely not.

03:38:37.000 Junk food vegetarian or junk food vegan diet.

03:38:40.000 So the dispute is whether or not animal protein and organ meats will advance your health, and that it's a superior diet when you add that one quarter of your plate.

03:38:53.000 Yeah, and one of the ways to answer this is to look at nutrient density.

03:38:56.000 So I have this study on my website.

03:38:59.000 It's mailot, I think. 0.94

03:39:00.000 Mailot, my French is terrible.

03:39:02.000 M-A-I-L-L-O-T. And it's cressor.co slash rogan.

03:39:11.000 And he looked at nutrient density of foods and he categorized them based on nutrient density.

03:39:16.000 And he was only looking at essential nutrients, so all the vitamins and minerals that we absolutely need for health.

03:39:22.000 He wasn't looking at polyphenols and flavonoids and things like that, which are beneficial, but we don't absolutely need.

03:39:28.000 So the number one food in terms of nutrient density, do you want to guess?

03:39:34.000 What?

03:39:34.000 Meat.

03:39:35.000 Organ meats.

03:39:36.000 Organ meats.

03:39:36.000 Score of 754. Next highest, shellfish, 643. And I've often said this to my patients.

03:39:43.000 Where's kale?

03:39:43.000 If you could be a vegetarian and only eat organ meats and shellfish, you'd be doing really well because of just how nutrient-dense they are.

03:39:52.000 That's not really a controversial statement.

03:39:54.000 Let me continue here.

03:39:55.000 Fatty fish, 622. Lean fish is 375. And then vegetables are 352. So, you know, vegetables are on there, but organ meat, shellfish, fatty fish, lean fish are all higher than vegetables.

03:40:14.000 And, you know, grains and legumes don't even really make the, you know, they're nowhere close in terms of nutrient density.

03:40:22.000 I think we can all agree that when someone goes from the standard American diet to the vegan diet, there's a real reason why they're experiencing significant health benefits, particularly if they supplement.

03:40:38.000 Assuming they're eating a whole foods vegan diet, not just subsisting on baguettes and vegan cookies and stuff like that, which unfortunately people do, just like people eat the standard American diet.

03:40:49.000 And, you know, for that matter, just like people who go paleo and are eating like paleo donuts and paleo whatever, you know, like you can do it on any dietary approach.

03:41:00.000 Whole foods.

03:41:01.000 And what I was going to say, you know, I never have proposed, except for one small subset, that everybody needs to eat a completely plant-based diet.

03:41:07.000 But if they do, they're probably going to have good health.

03:41:09.000 There's a concept called the spectrum.

03:41:11.000 Dr. Dean Ornish, some people beat up on, but he's done all these studies on reversal of atherosclerosis, and he's celebrating around the world, has a book called The Spectrum.

03:41:18.000 Go as far towards it as you can.

03:41:20.000 I'll love you wherever you're at.

03:41:21.000 You choose.

03:41:22.000 We're not judging you.

03:41:23.000 And that's, I think, the message for your listeners.

03:41:25.000 I mean, when you're eating vegetables or fruit, or maybe it's just vegetables every meal, that's the example people need to hear.

03:41:32.000 And they don't need to abandon everything else.

03:41:33.000 Just don't do it with a donut.

03:41:35.000 Don't do it with a bagel.

03:41:36.000 Don't do it with these calorie-empty foods.

03:41:37.000 And also time-restricted eating.

03:41:39.000 I think we all agree on that.

03:41:40.000 It's awesome.

03:41:40.000 12 hours, 14 hours a day.

03:41:42.000 I'm a big fan of four or five days a month lowering calories with low protein, low sugar.

03:41:48.000 Now the science is coming out unbelievable.

03:41:49.000 It's right here from Los Angeles.

03:41:52.000 I want to say this.

03:41:54.000 We're talking about helping people and I was a vegan at one point and a vegetarian and I have friends that are vegans and vegetarians.

03:42:01.000 Again, I'm not ideological about this at all.

03:42:05.000 So I want to say to someone who is a vegetarian or vegan and just to show how nutrient dense organ meats and shellfish are, If you wanted to be a vegan, but you're not, you know, ideologically opposed to eating some small amount of animal product or animal food,

03:42:21.000 you could eat one clam, one oyster, and four grams, which is a tiny amount of liver, a day, and you would completely meet your needs for B12, zinc, Copper, choline, and many other nutrients with no other consumption of animal foods beyond that.

03:42:37.000 So this is what I said before, like the spectrum is large.

03:42:41.000 Some people might consume a higher percentage of animal foods, some people could consume just that much, and they would still improve their health and well-being by doing that from then eating a strictly plant diet.

03:42:57.000 And one thing that I do have to tell you, Joel, unfortunately, is that you keep saying that Nick and Nate Diaz are vegan, and they're not.

03:43:04.000 I know.

03:43:04.000 They've fallen back.

03:43:05.000 I don't keep saying it, but they've fallen back.

03:43:07.000 Well, you brought it up a bunch of times.

03:43:09.000 Well, he was when he won the fight he was.

03:43:11.000 I don't think he was.

03:43:12.000 He was eating fish.

03:43:13.000 He was eating fish and eggs.

03:43:15.000 It's cool.

03:43:15.000 I worry about his TMO level, but it's cool.

03:43:17.000 No, I'm serious.

03:43:18.000 But you know, the explosion, the Tennessee Titans and Kyrie Irving and Serena Williams, I mean...

03:43:23.000 Serena Williams is a vegan as well?

03:43:24.000 Yeah, she reversed an autoimmune disease called Sjogren's.

03:43:27.000 Yeah, so is it necessary to be plant-based, to be a world-class athlete?

03:43:32.000 Obviously not.

03:43:33.000 Is it compatible to be a...

03:43:34.000 Do you know who Patrick Bubamian is?

03:43:36.000 He holds a world record for powerlifting.

03:43:38.000 He's been plant-based his whole life.

03:43:40.000 Big, stocky.

03:43:41.000 Look at the guy up.

03:43:42.000 Patrick, P-A-T-R-I-K. I mean, he's this big, stocky German, but he lifts 1,200 pounds and he has the world record. 1.00

03:43:48.000 He hasn't eaten a piece of meat.

03:43:50.000 Nick Delgado.

03:43:54.000 Point is, it's an option to be a super athlete without animal products.

03:43:57.000 We're seeing it more and more.

03:43:59.000 Recovery, rich role on your...

03:44:00.000 But, you know, it happens.

03:44:02.000 Just stop beating on us because we're doing pretty well. 0.96

03:44:06.000 But yeah, if Diaz has gone back to eating fish and vegetables, it's a whole lot better than the crap American diet that a lot of athletes see. 0.90

03:44:15.000 They just cut out all the land animals. 0.75

03:44:17.000 Yeah.

03:44:18.000 You initially start doing it to make weight.

03:44:21.000 Okay.

03:44:22.000 I got it.

03:44:23.000 Got it, got it.

03:44:24.000 A lot of people are talking about quicker recovery.

03:44:27.000 Alex Caceres, he's a world-class fighter.

03:44:30.000 He's completely vegan.

03:44:32.000 Sean O'Malley was for a while, but he found himself to have much more energy when he started eating meat, but he might have been doing it wrong or not.

03:44:41.000 Microbiome and supplementation, yeah.

03:44:44.000 Believe it.

03:44:44.000 You know, but it's really cool.

03:44:45.000 I forget his name right now.

03:44:46.000 The chef that cooks for 15 Tennessee Titans. 0.99

03:44:49.000 And, you know, they're just kicking ass. 0.98

03:44:50.000 And Griff Whalen used to be with the Miami Dolphins. 0.98

03:44:53.000 I forget where he is now.

03:44:53.000 Oakland Raiders.

03:44:54.000 You know, a great, great tight end and such.

03:44:56.000 I mean, it's possible that we can say Scott Jurek set the world record for the Appalachian Trail faster than any other person eating beans.

03:45:04.000 I mean, insane level of athletic fitness.

03:45:07.000 The Appalachian Trail?

03:45:08.000 Yeah, it's like 2,400 miles, fastest human to ever accomplish it on beans.

03:45:13.000 I mean, pretty cool.

03:45:15.000 I mean, this was such an amazing thing to watch a documentary.

03:45:19.000 Should we wrap this up?

03:45:21.000 Yeah, I think so.

03:45:21.000 I think we obviously, we've left a lot on the table.

03:45:25.000 There's still a lot that's disputed. 0.98

03:45:27.000 But I think one thing that we came to a really solid conclusion on is that standard American diet sucks.

03:45:34.000 And any deviation from it that's a whole food-based diet, especially with proper nutrients that are supplemented, if you're vegan or what have you, is going to be better than standard American diet.

03:45:46.000 The dispute is whether or not the nutrient-dense organ meats, shellfish, meat, fish, That these things, eggs, that these would benefit you significantly.

03:45:57.000 And I think that's...

03:45:59.000 Hallelujah!

03:46:00.000 We got through it very peacefully.

03:46:02.000 Just eat real food.

03:46:03.000 Just eat real food.

03:46:04.000 I actually refer people in San Francisco to Chris.

03:46:07.000 I honor what he's doing.

03:46:08.000 I mean, we may have this dispute about saturated fat and cholesterol, and it's not unimportant, but he's a prime practitioner.

03:46:14.000 He's treating people at the right level.

03:46:16.000 I believe I'm doing that in Detroit and the people that come to see me.

03:46:19.000 You know, we're the solution, we're not the problem despite the differences, and you're a good man to bring us on and, you know, point all that out.

03:46:24.000 Well, you both handled yourself admirably.

03:46:26.000 I mean, this is a very emotional, tightly contested sort of a dispute, and I thank you both very much for being here.

03:46:34.000 Well, thanks for the opportunity, Joe.

03:46:35.000 I mean, to have the chance to do this for, what, almost four hours now?

03:46:41.000 That's amazing.

03:46:41.000 And it serves people because on most TV segments, it's like five minutes, and you just get the headlines, and there's no depth.

03:46:48.000 Or you get these clickbait articles, and it's confusing.

03:46:51.000 So thanks for giving us the chance to really dive deeply on it.

03:46:54.000 And anybody that wants more, download Chris's references.

03:46:57.000 Go to my website, the Rogan References.

03:46:59.000 You know, read more.

03:47:00.000 Study this.

03:47:01.000 Educate yourself.

03:47:02.000 One more time...

03:47:03.000 Yeah, drjoelkahn.com.

03:47:05.000 Big red button, Rogan references.

03:47:07.000 You can keep yourself busy.

03:47:08.000 And your Twitter, which is on my page, but we could anyway.

03:47:11.000 At drjkahn, drjkahn.

03:47:14.000 And Chris?

03:47:16.000 ChrisKresser.com slash Rogan for all the resources here.

03:47:20.000 K-R-E-S-S-E-R. K-R-E-S-S-E-R slash Rogan.

03:47:24.000 And then Chris Kresser, Twitter.

03:47:26.000 All right.

03:47:26.000 Beautiful.

03:47:27.000 Thank you, guys.

03:47:27.000 Thank you.

03:47:28.000 It was really a lot of fun.

03:47:29.000 Thank you.

The Joe Rogan Experience - September 27, 2018

Joe Rogan Experience #1175 - Chris Kresser & Dr. Joel Kahn

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