In this episode, I sit down with Dr. Daniel J.R.J. Kresser, a cardiologist, author, podcaster, and health coach, to discuss plant-based medicine, veganism, and chronic illness in general. We talk about his journey to becoming a vegan, how he got started, and what he's learned along the way. I hope you enjoy this episode as much as we enjoyed recording it. If you like what you hear, please HIT SUBSCRIBE and leave us a rating and review on Apple Podcasts! You can also join our FB group, and join the conversation by using the hashtag on the Apple App Store or Google Play, and tag me in the comments! if you have a question or would like to suggest a topic for next week's episode, please get in touch! Timestamps: 5:00 - What is a healthy vegan diet? 8:30 - What are the benefits of a plant based diet? 9:20 - Why is it better than a traditional diet? 14:00- What is the difference between a vegan diet and a macrobiotic diet? 16:30- What does it take to be a vegan? 17:00 - How to be vegan? 18:15 - What's the best way to eat plant based? 19:40 - How do I know if I should be vegan or not vegan? 22:40- What are my goals for my life? 27: Should I be a vegetarian or a vegetarian? 29:35 - What kind of diet? 31:00 + 32: What are you going to eat? 35:00+ - What do I need to eat meat? 36:30 + 39:00 What is veganism? 40:00 Can I eat meat or fish? 41:00 Is it better? 45:00 How can I eat fish? 47:00 Do I know what I ve been vegan? 44:00 Why do I ve veg? 45:10 - What can I veg like that? 46:30 47:50 - What s veganism be a healthy diet? 51:00 | What do you veg enough? 56:00 My thoughts on veganism have been a good idea? ? 55:30 | How do you know I vegans need to be vegetarian or vegetarian? , 47:40 | Can I be vegan enough?
00:00:22.000I feel like the head broccoli in the United States today.
00:00:25.000But 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.
00:00:36.000Very hard to be vegan in Dallas, but I did it in the 80s because I've been doing this.
00:00:44.000Age 18. And then Kansas City, Missouri, another tough town to eat plants in only, the steakhouse, KC Masterpiece, did training in stenting.
00:00:52.000I was blasting open heart attacks from 1990 on.
00:00:56.000Came back to Michigan, very active cath lab heart attack.
00:01:06.000Three 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.
00:01:17.000And along the way with my wife and son, we now own three plant-based restaurants, two in Detroit, one in Austin, Texas.
00:02:02.000I 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.
00:02:17.000And I came to this from my own experience with chronic illness.
00:02:22.000As 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,
00:02:46.000you 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.
00:03:00.000And you, at one point in time, were vegan?
00:03:04.000I was apprenticing with a macrobiotic chef.
00:03:09.000What's the difference between a macrobiotic vegan for folks and a regular vegan?
00:03:13.000Macrobiotic is a particular philosophy.
00:03:16.000It's a particular approach that came from Japan.
00:03:21.000It'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.
00:03:32.000So 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.
00:03:46.000And before that, I had been a vegetarian for quite a while as well.
00:03:50.000When I was traveling around the world and got sick, actually, I was a vegetarian at that point too.
00:03:55.000And you discovered through your own personal...
00:04:01.000And 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.
00:04:15.000Yeah, for me personally, vegetarian diet and particularly vegan diet was a disaster.
00:04:24.000I don't put a lot of stock into a single person's experience one way or the other.
00:04:28.000But 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.
00:04:38.000And 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.
00:04:49.000I 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.
00:05:02.000We share a lot in common as human beings, but we have a lot of important differences, too.
00:05:06.000And from the beginning, I've always argued that there's no one-size-fits-all approach when it comes to diet.
00:05:12.000But I think there are some common themes, and I'm sure we'll get to those later.
00:05:18.000It's really important to discuss that people really do have different requirements.
00:05:23.000Yeah, 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.
00:05:28.000I mean, one, if we ate together, it would probably be 90% the same.
00:05:33.000Really respectful of what we call functional medicine, root cause medicine.
00:05:36.000I don't write scripts without thinking about the patient.
00:05:38.000He certainly doesn't do that without thinking about the entire patient.
00:05:41.000It's pretty unusual, and we're going to represent a very small section.
00:05:44.000I honor what he's doing with his new book, Unconventional Medicine and the rest.
00:05:48.000You 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.
00:06:16.000Let 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.
00:06:23.000The biggest problem with nutritional research, epidemiology, It starts with the assumption that there is one diet for everybody.
00:06:48.000There's a guy in Australia, a professor, who calls this approach nutritionism.
00:06:56.000This 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.
00:07:14.000So 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.
00:07:26.000And then another diet, they're getting 50% of fat from avocados and olive oil and even, you know, eggs and animal foods.
00:07:34.000Those are two totally different diets.
00:07:37.000And yet in the scientific literature, those are equated as the same because all they're looking at is the calories from fat.
00:07:43.000They're not considering the quality of the diet.
00:07:46.000And I'll just add in, and again, we go anywhere with this conversation, but a lot of the problem has been imprecision of language.
00:07:52.000So even the word low-carb diet, I eat a low-carb diet if we talk low-refined carbs.
00:08:54.000A lot of scientists, I'll give a shout out to Los Angeles, brightest nutrition mind, somebody that I know Chris honors too, Walter Longo.
00:09:01.000No label, not vegan, not paleo, not nothing.
00:09:04.000He's at USC, been honored by the Royal Academy of Swedish Medicine, which is a Nobel Prize committee and this and that.
00:09:11.000He says, you know, you do basic science, and then you do an epidemiology study to test the hypothesis.
00:09:16.000You 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?
00:09:26.000Do you mind explaining epidemiology studies to people?
00:09:29.000So 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.
00:09:48.000Sometimes it's a crappy old database, sometimes Harvard has these gigantic ongoing databases.
00:09:54.000Loma Linda, an hour from here, has a gigantic database, and there's others, an EPIC study, this PURE study I mentioned.
00:09:59.000You 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.
00:10:09.000Do we have the data to ask the question, does protein correlate with survival, protein correlate with early death, animal protein, plant protein?
00:10:17.000These studies have been coming out a lot lately, and they let you parse it out.
00:10:32.000Nowadays, 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.
00:11:38.000So that little four-pod pedestal to sit on, basic epidemiology, randomized studies, and centenarian studies, allows you to make reasonable conclusions.
00:11:52.000I think there's huge problems with epidemiology.
00:11:54.000So, 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.
00:12:07.000So, 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.
00:12:18.000And 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.
00:12:26.000Okay, and then we try to, you know, correlate that with their amount of saturated fat intake.
00:12:31.000Now, 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.
00:12:44.000There'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.
00:12:50.000But I'll just give you three of the, I think, the worst problems with nutritional epidemiology.
00:13:30.000Back 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.
00:13:45.000If 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.
00:13:56.000If 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.
00:14:06.000And yet our entire foundation of nutritional epidemiology is based on that.
00:14:12.000Basically people reporting on what they ate at some time in the past.
00:14:18.000You know, how much of a problem is this?
00:14:20.000There'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.
00:14:42.000So, the average person in those studies reported a calorie intake that would not support an elderly, bedridden, frail woman.
00:15:35.000The second problem is the healthy user bias, which I know we talked about before.
00:15:39.000But 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.
00:15:53.000So let's say you do a study of people who eat more red meat.
00:15:58.000Well, red meat has been perceived as unhealthy for a long time.
00:16:01.000And so what we know is that in those observational studies, the people who eat more red meat are also smoking more.
00:16:15.000So how do you know that it's the red meat that's causing the problem and not those other things?
00:16:20.000You don't, because they cannot control for all those potential confounding factors.
00:16:24.000The 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.
00:16:37.000So 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.
00:16:50.000So 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.
00:17:09.000And the studies that have shown that eating aflatoxin, which is a mycotoxin-increased liver cancer risk, that's 600% increase.
00:17:19.000Okay, the IARC, the WHO report that suggested that processed red meat was a carcinogen, that was 18% increase.
00:17:29.000Most 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.
00:17:42.000So 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.
00:17:51.000And this is over people that are also consuming sugar.
00:17:55.000So 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.
00:18:11.000So, 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,
00:18:27.000we wouldn't even accept a paper for publication if it didn't have at least a 200% increase.
00:18:33.000Especially if it was a new association or the biological mechanism wasn't known.
00:18:38.000And here we are today saying that, you know, this increased that by 7% or by 10%.
00:18:45.000And 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.
00:19:01.000Is 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.
00:19:15.000And 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.
00:19:26.000Which any epidemiologist would tell you that that's a faux pas.
00:20:55.000But it is, you know, a reliable long-term peer review.
00:20:58.000This stuff's published in the finest of journals, and it at least lets you ask questions.
00:21:02.000I 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?
00:21:52.000It's like you say, people love to see this stuff.
00:21:54.000So 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.
00:22:23.000The 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.
00:22:30.000It's going to be true of the paleo group.
00:23:05.000To stop you for a second, meat eaters do get lumped in with the paleo group.
00:23:10.000They consider paleo group part of the meat eater group.
00:23:13.000Like 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.
00:23:22.000They're not referring to paleo dieters.
00:23:24.000People that are eating avocado and grass-fed beef.
00:23:27.000Most of the paleo movement is the last dozen, 15 years.
00:23:57.000I 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.
00:25:17.000Let me just make a comment about observational nutritional research.
00:25:20.000There are good observational studies and there are bad ones.
00:25:23.000You can design an observational study in a way that controls for some of these potentially confounding factors like the healthy user bias, etc.
00:25:32.000But this is a story that will, I think, clear some of this up.
00:25:35.000So there are about eight studies, major studies, that have compared lifespan in vegetarians and vegans and omnivores.
00:25:43.000So the earlier studies, there are three studies that were Seventh-day Adventist studies.
00:25:48.000So 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.
00:26:03.000Let's just make sure we give each other a chance to breathe.
00:26:06.000Vegetarian diet, but also live healthy, eat fruits and vegetables, don't smoke, don't drink excessively, etc.
00:26:15.000So a health-conscious group of people.
00:26:18.000And the Seventh-day Adventist study in the Netherlands compared them with the general population, which is just garbage because of the healthy user bias.
00:26:28.000So we can just cross that one off the list.
00:26:31.000The 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.
00:26:42.000And there was a slight advantage in lifespan in the vegetarians versus the meat-eaters.
00:26:48.000But one of those studies didn't control for smoking and body mass index, so that data is highly suspect.
00:26:55.000And the other study did, and there was a slight advantage.
00:26:58.000Since then, there have been four studies that I think did a much better job.
00:27:03.000So this is kind of an interesting design.
00:27:05.000So they said, let's try to find a group of more health-conscious omnivores to compare these vegetarians against.
00:27:10.000So the first one was called the Health Food Shopper Study.
00:27:13.000So 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.
00:27:21.000By health food store, you mean like a Whole Foods or Air One?
00:27:23.000I mean, there was no Whole Foods at this point, but that was the idea, right?
00:27:27.000And 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.
00:27:40.000Second 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.
00:27:52.000So the idea was that people that the vegetarians were hanging out with might be more health conscious than the general population.
00:28:00.000Big difference in lifespan between those two groups and the general population, but no difference between vegetarians and omnivores.
00:28:07.000Epic Oxford cohort, same thing, same way of recruiting people, same result.
00:28:12.000Big difference between the two groups and the omnivores, but no difference between vegetarians and omnivores.
00:28:18.000And then the Heidelberg study was in Germany, and similar way, I think they recruited people who read vegetarian magazines.
00:28:27.000And then they asked them to bring their friends or family members who ate meat.
00:28:30.000Big difference in lifespan between the two groups and general population.
00:28:34.000No difference between vegetarians and omnivores.
00:28:37.000And then you had the 45 and up study that was recently done in Australia.
00:28:41.000This was a little different because they didn't set out to find, you know, more health conscious people.
00:28:46.000Instead, 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.
00:28:57.000So exercise, physical activity, fruit and vegetable consumption, cigarette smoking, alcohol, education level, because we know that has a big impact on lifespan.
00:29:07.000And they found that there was no difference in lifespan between omnivores and vegetarians.
00:29:30.000So we're not throwing it out or saying we should throw it out.
00:29:32.000But all of those studies did a better job at dealing with the potential pitfalls of observational studies.
00:29:39.000And when they did that, they found no difference.
00:29:43.000And 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.
00:30:39.000That's still 50,000 to 60,000 people a year that get colon cancer if that data's right.
00:30:43.000They wouldn't get colon cancer if they just would stop eating hot dogs.
00:30:46.000At 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.
00:32:28.000But all modern epidemiology does multivariate analysis to try and isolate it.
00:32:33.000You know, you can cast stones everywhere, but...
00:32:35.000You 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.
00:32:45.000So 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.
00:32:55.000The U.S. used to say, don't eat much cholesterol, and now they don't.
00:33:00.000They used to say, limit your total fat, and now they don't.
00:33:49.000Total mortality is the most important endpoint we should be talking about here.
00:33:53.000That means deaths from any cause, right?
00:33:55.000Because that's what we care about most, right?
00:34:01.000If an intervention reduces the risk of a heart attack but increases the risk of cancer, I'm not happy with that.
00:34:08.000In fact, I'd rather go out and have a heart attack in my sleep.
00:34:13.000So you need to consider total mortality.
00:34:16.000And 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?
00:34:26.000We 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.
00:34:35.000There's not a single study that compared relatively equivalent groups of people that shows that vegetarians or vegans have a lifespan advantage, period.
00:34:45.000And 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.
00:34:58.000The second thing, and this is a really good example of what we talked about at the very beginning of the show, context is everything.
00:35:05.000Quality is more important than quantity.
00:35:09.000So there's several proposed mechanisms for how processed meat One is that it increases N-nitroso compounds, or NOCs, which damage the gut lining.
00:35:19.000Another is that when you cook meat at high temperatures, it forms heterocyclic amines, or HCAs, which damage the gut.
00:35:27.000Another is that the heme iron content in meat causes oxidative stress and increases the risk of cancer that way.
00:35:36.000And then there's TMAO and NU5GC. But let me just give you a few examples of why context is important.
00:35:43.000So there's evidence that chlorophyll-rich green vegetables prevent myoglobin from being turned into N-nitroso compounds.
00:35:51.000So 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.
00:36:02.000Cruciferous vegetables and spices and marinades have been shown to reduce the formation of heterocyclic amines or HCAs.
00:36:10.000If 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.
00:36:17.000There 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.
00:36:26.000And, you know, dietary antioxidants have been shown to reduce the risk of gastric cancer.
00:36:34.000Heme iron intake, really, you can think of it as a proxy for a crappy diet in these observational studies.
00:36:40.000There's a quote from a study that did find a relationship with heme iron and cardiovascular disease.
00:36:49.000But 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.
00:36:59.000They 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.
00:37:08.000Most 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.
00:37:17.000And it's another example of healthy user diet.
00:37:26.000It'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.
00:37:33.000And we have no studies that separate that out.
00:38:37.000You will actually improve your health.
00:38:39.000There'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.
00:39:47.000So until the 40s, it was not common to have a heart attack.
00:39:51.000Heart 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.
00:40:03.000After World War II, our economy went up.
00:40:05.000In the city of Minneapolis, Executive started suffering heart attacks.
00:40:10.000It was also Franklin Delano Roosevelt died of high blood pressure.
00:40:13.000A few years later, Eisenhower had a massive heart attack.
00:40:15.000That's when our government, National Institutes of Health, started funneling major money into studies like the Framingham study.
00:40:23.000Framingham's a city outside of Boston, and they basically invaded this town in 1958 to today.
00:40:28.000So we're spending money, we're going to figure this crap out.
00:40:31.000The idea had come up, heart disease wasn't just aging.
00:40:34.000Heart disease could be explained by what's called risk factors.
00:40:37.000Smoking might not, you can smoke and live to 100, but it's going to increase your risk.
00:40:41.000And then they got into blood pressure and cholesterol and family history.
00:40:45.000They identified what we call risk factors.
00:40:48.000So until that point, diet was not considered a factor in the development of the number one killer, men and women.
00:40:53.000I 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.
00:41:01.000Every 39 seconds, the most frequent cause of death.
00:41:04.000So there will be about 200 people, perhaps, that will die during this podcast of the number one killer.
00:41:54.000And then maybe polyunsaturated fats from plants are more helpful.
00:41:58.000But the focus went on saturated fat in food, which is basically chicken, red meat, Pizza, those are the highest sources.
00:42:06.000And 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.
00:42:14.000It was never limit all fat, 35% of calories.
00:42:17.000That's not, in anybody's word, a low-fat diet.
00:42:21.000And that has now promulgated in 21 international statements.
00:42:27.000Whether 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.
00:42:48.000They 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.
00:42:59.000Okay, but why did they come to the conclusion of saturated fat?
00:43:01.000Well, basic science, because there is basic science.
00:43:04.000And 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.
00:43:49.000If I gave you a steak, Chris a steak, and me a steak, our cholesterol would rise differently.
00:43:53.000It would rise, it would rise differently.
00:43:54.000It's our microbiome, it's our genetics, it would rise.
00:43:58.000That's a problem in the studies when you average everything together.
00:44:01.000So they had that, and then finally, finally, they looked at populations that live over 100. These are called the pillars of longevity.
00:44:07.000They don't eat foods rich in saturated fat.
00:44:10.000They have a little, they don't have a lot.
00:44:11.000They eat a lot of olive oil in Italy and Greece.
00:44:13.000They 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%.
00:44:26.000Actually, 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.
00:44:39.000To negate that is to throw out every major health agency in the world.
00:44:44.000I don't believe Chris Kresser can do that.
00:44:46.000No disrespect, I don't think Chris can throw out a hundred years of cholesterol research.
00:44:50.000Okay, let's back up a little bit here.
00:44:52.000Yeah, so first of all, every food that we consume has all of the fats in it.
00:44:58.000Polyunsaturated, monounsaturated, and saturated fat.
00:45:01.000And in fact, two tablespoons of olive oil has more saturated fat than a seven ounce pork chop.
00:45:09.000The 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.
00:45:22.000Does 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?
00:45:34.000But You know, let's talk a little bit more about the research.
00:45:38.000So, there never really was good evidence to suggest that dietary cholesterol and saturated fat are connected to heart disease.
00:45:48.000And 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.
00:46:04.000And then she also reviewed the evidence all the way up until 2016. And I have this information on my website.
00:46:14.000If you go Cressor.co slash Rogan, you can find it.
00:46:17.000And what you'll find is there never was really good evidence to support the limitations on saturated fat and cholesterol.
00:46:25.000And people have started to look at this more recently.
00:46:28.000And 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.
00:46:43.000You 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.
00:46:57.000And I'll read you a quote from the conclusion.
00:47:00.000Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of saturated fatty acids.
00:47:10.000Now look, one of my favorite quotes is the philosopher Anatoly France.
00:47:15.000Even if 50 million people say a foolish thing, it's still a foolish thing.
00:47:19.000And 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.
00:47:29.000And, 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.
00:47:38.000And 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.
00:47:58.000And then in 2015, they removed the restriction on dietary cholesterol.
00:48:02.000Now, they did that fairly quietly because how do you think it looks?
00:48:05.000When 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.
00:48:17.000People lose faith in the agencies that are issuing these guidelines.
00:48:23.000You 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.
00:48:33.000But how about John Ioannidis, who's one of the most renowned epidemiologists in the world?
00:48:38.000He'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.
00:48:50.000Some 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.
00:49:00.000However, the emerging picture of nutritional epidemiology is difficult to reconcile with good scientific principles.
00:49:11.000And 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.
00:49:21.000So it's not enough to say that governments are recommending this or that.
00:49:27.000We have to look at the science and what the science is saying.
00:49:30.000And 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.
00:49:44.000So 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?
00:49:57.000And, you know, the importance here, we are, you know, technical in the weeds, but I want to bring it back.
00:50:02.000This discussion is, do you have a stroke, heart attack, erectile dysfunction, lose a leg, or do you not?
00:50:07.000Because 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.
00:50:19.000Okay, but why do you think these organizations are saying this if he's saying that the studies don't support that?
00:50:25.000Well, I disagree that the science – and I want to be very specific.
00:50:29.000Let's talk about cholesterol and let's talk about saturated fat.
00:50:31.000So stay with saturated fat because there is differences there.
00:50:34.000They're both, you know, contents of food, fatty contents of food, but they're chemically different and the volume weight is very, very different.
00:50:42.000Cholesterol only comes from animals, saturated fat is in animals, and plants, depending on the food source.
00:50:47.000So when this rise in heart attacks developed, research began, 1948, 1950, 1958, there were observations made that carefully done dietary logs suggested.
00:51:01.000There 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.
00:51:10.000Ultimately, they got sophisticated foods high in plant fat sources, foods high in animal fat sources.
00:51:16.000So by the late 1950s, there was a very strong consensus already that foods high in animal products with saturated fat, they go together.
00:51:25.000We're talking meat, egg, and cheese may be a role.
00:52:07.000But within a very short time, they had 10 times the risk of heart attack.
00:52:10.000So public research in dollars, this stuff matters.
00:52:13.000Why is this correlated with animal fats and proteins?
00:52:16.000And why isn't it correlated with sugar and refined carbohydrates?
00:52:19.000So 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,
00:52:34.000they 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.
00:53:27.000Let's look at what the research says again here.
00:53:30.000So they've done controlled feeding studies where they fed people two to four eggs a day.
00:53:35.000And those show that in 75% of cases, that has zero impact on blood cholesterol levels.
00:53:40.000For the other 25% of people, they're termed hyper-responders.
00:53:44.000And 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.
00:53:54.000This is why the guidelines were changed on dietary cholesterol.
00:53:59.000There 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.
00:54:12.000For saturated fat, Again, most of the studies that showed harm were short-term studies.
00:54:18.000These longer-term studies have shown that on average, eating saturated fat does not increase the saturated fat levels in the blood.
00:54:26.000And 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.
00:54:38.000Then 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,
00:54:54.000and they found that low-carb diets neither increased nor decreased LDL cholesterol.
00:54:59.000But 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.
00:55:17.000Now, there have now been 10 meta-analyses of randomized controlled trials looking at low-carb diets for weight loss.
00:55:26.000All 10 showed that the low-carb diet either outperformed in most cases or was at the same level as low-fat diets.
00:55:37.000There have been several meta-analyses now.
00:55:39.000You can see them all at Kresser.co.rogan that have looked at low-carb diets for diabetes and even cardiovascular risk markers.
00:55:49.000And all of these meta-analyses have found that low-carb diets are superior for glycemic control, for reducing insulin, for reducing triglycerides.
00:55:57.000And have beneficial effects across the board without increasing cardiovascular risk markers.
00:56:03.000So 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.
00:56:14.000So is the problem that you're citing epidemiology studies from the 1940s and the 1950s?
00:56:20.000I would definitely, I think we need to prefer randomized controlled trials over that kind of evidence, for sure.
00:56:27.000Why do you continue to go back to these studies from the 1940s and 1950s?
00:57:21.000And 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.
00:57:31.000Second study done in China at the same time with years of follow-up.
00:58:24.0002008, 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.
00:58:32.000People are eating less dairy around the world, and we are losing sales.
00:58:36.000What we can do is influence researchers, influence academicians, influence speakers.
00:59:26.000That's statistical playing with Previous studies that can be fair, can be unfair, whatever.
00:59:31.000Whatever 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.
00:59:39.000They never said eat butter, eggs, and cheese.
00:59:43.000What's amazing, it's in the American Journal of Clinical Nutrition, that same journal It's an editorial that destroys the study.
00:59:50.000This is 15 reasons this is horrible epidemiology by a guy named Jeremiah Stamler.
00:59:55.000I've never seen a medical journal destroy a piece that they accepted for publication.
01:00:00.000Okay, so everything's like stirred up.
01:00:03.000And 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.
01:00:59.000But 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.
01:01:09.000You eat more saturated fat, coronary heart disease goes up.
01:01:12.000It was crystal clear and the guidelines said it.
01:01:35.000We'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.
01:01:45.000We have randomized controlled trials now.
01:01:48.000And, you know, observational studies were never...
01:01:53.000They're meant to generate a hypothesis.
01:01:55.000And it's true that in some cases it's not possible to do a randomized controlled trial like with cigarette smoking.
01:02:02.000You'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.
01:02:12.000But in that case, the risk was a thousand to three thousand percent higher.
01:02:16.000So 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.
01:02:25.000And in the case of smoking, which actually was when the Bradford Hill criteria were created, that meets many of those criteria.
01:02:34.000In the case of nutrition research, very seldom do they meet more than a couple of the Bradford Hill criteria.
01:02:42.000Observational research, in order to be valuable, needs to be confirmed.
01:02:45.000You know, the results need to be replicated in a randomized controlled trial.
01:02:49.000That's how science is supposed to work.
01:02:51.000But there was one analysis that found that zero of 52 claims that were made in observational nutrition studies were replicated.
01:03:02.000And in fact, five were replicated in the opposite direction.
01:03:05.000In other words, when they did an experiment, they found the opposite result to what the observational study suggested.
01:03:11.000So 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.
01:03:26.000But 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.
01:03:36.000So this is why it's so important not to rely just on observational data and to do these experiments.
01:03:41.000Now 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.
01:03:58.000We'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.
01:04:09.000And we've got another meta-analysis of 25 randomized controlled trials just published in 2018 that found the same thing.
01:04:19.000We 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.
01:04:35.000And this is what we should be looking at.
01:04:37.000So why are you consistently bringing up these studies from the 50s?
01:04:40.000Because Chris is mixing everything up.
01:06:21.000So, I mean, I'm not stuck in the 1950s, but, you know, if you don't...
01:06:25.000But 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.
01:06:43.000Has our understanding of food changed?
01:06:45.000Yes, the science has advanced pretty radically.
01:06:47.000Well, 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.
01:06:58.000That 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.
01:07:06.000Based on these 1950s epidemiology studies.
01:07:48.000So, 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.
01:08:02.000It's a classic study that people know.
01:08:04.000They 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.
01:08:12.0001997. To answer your question, why do I think old studies are relevant?
01:08:18.000You have to keep probing and questioning and probing and questioning.
01:08:22.000But until this date, every major medical society, not one, if there was one, you'd question it.
01:08:27.00021 international societies say you will further the populist health if you lower saturated fat in the diet.
01:08:34.000And 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?
01:08:47.000And 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,
01:09:03.000more understanding, more data to go from, wouldn't you agree that...
01:09:35.000You know, Chris's biology and genes aren't the same as mine, and there's variability.
01:09:39.000If you're born with one of nine SNPs that keeps your cholesterol low your entire life, this is a genetic gift to you.
01:09:47.000The 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.
01:09:56.000That 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.
01:10:06.000We actually have learned stuff that has changed our mind.
01:10:09.000When you do that same cutting-edge science on HDL, the happy one, the high one, You cannot show the same association anymore.
01:10:16.000We're totally confused by the HDL particle.
01:10:19.000LDL is the focus of atherosclerosis, low LDL. And I'll just finish.
01:10:24.000Dr. Lauren Cordain, I'd love to talk about the history of the paleo movement.
01:10:27.000Dr. Lauren Cordain, who had the first popular book, a PhD in Colorado.
01:10:32.000Has 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.
01:10:51.000It was an editorial, but it's peer-reviewed.
01:10:53.00050 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?
01:11:04.000Yeah, and I'm not here to represent paleo.
01:11:06.000I mean, I have never been ideological about paleo.
01:11:12.000Even if you read my first book, it's like I'm recommending dairy products.
01:11:16.000But I don't want to get lost in this, because you pause for a second.
01:11:19.000So what is your response, though, to all these studies that he was citing?
01:12:26.000These randomized controlled trials are not short term.
01:12:29.000Many of them go up to two years in length.
01:12:32.000If we're going to see changes in lipids, we're going to see them within a few weeks and certainly within a few months.
01:12:38.000So if we're not seeing them in a few months, we're not going to see them later.
01:12:42.000And, 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.
01:12:53.000There are 39 meta-analyses of RCTs or prospective cohort studies that looked at saturated fat and health outcomes.
01:13:01.00035 of 39 did not show significant correlations between saturated fat and any outcome.
01:13:06.000Okay, 35 of 39. Of the four that did, one Well, it was more related to trans fats, not saturated fats.
01:13:14.000One showed a benefit of replacing saturated fat with polyunsaturated fat, but it excluded two studies that would have totally changed the result.
01:13:21.000And 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.
01:13:31.000And 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.
01:13:52.000No, Joel, I'm going to let you get to this in a second.
01:13:54.000Out 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.
01:14:08.000Now, 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?
01:14:28.000Yeah, that early studies showed some relationship, but they were short, very short term, between eating saturated fat and then cholesterol.
01:14:36.000The other problem is they were using cholesterol as a proxy marker.
01:14:40.000They weren't looking at, did people eat saturated fat and die more?
01:14:44.000They looked at, did saturated fat increase cholesterol?
01:14:48.000So when they did longer-term studies, there's no increase in cholesterol on average.
01:14:54.000That doesn't mean no one will experience an increase.
01:15:13.000Those 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.
01:15:28.000Important stuff, and a lot of stuff was said, and I doubt, unless you're really high-level, you understood.
01:15:34.000I just want to pick out one thing Chris said.
01:15:35.000Does 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.
01:15:49.000And we all love supplements around this table, but let's get out of that.
01:15:53.000Cochrane Database, every five years, comes out with a statement, does saturated fat relate to the risk of heart disease?
01:15:58.000In 2015, the most recent, Hooper, look up Hooper, look up Cochrane Database.
01:16:05.000No, 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.
01:16:27.000Your 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.
01:17:11.000The lower your LDL level beginning in life, the greater is your reduction in your risk of developing a heart attack and stroke.
01:17:17.000And I'll give you an interesting statistic.
01:17:19.000If 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%.
01:17:29.000If 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%.
01:17:38.000When 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.
01:17:45.000The 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.
01:17:51.000They've had 50, 60 years of deteriorating their arteries, and we help them.
01:17:55.000We can't help them like teaching children, eat fruits and vegetables and stay away from hot dogs.
01:18:25.000My 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.
01:18:33.000Besides that, there's allusions to significant randomized clinical trials and meta-analyses.
01:18:39.000We've got to keep the science clean as can be.
01:18:42.000The breakthrough has been the meta-analyses, Siri Torino, Chowdhury, 2010, 2014, D'Souza, 2015. They have severe flaws.
01:18:54.000There has not been a randomized clinical trial that really challenges the coronary heart disease risk of meaning and increased saturated fat.
01:19:13.000If 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.
01:19:22.000This is a total of 20 randomized controlled trials.
01:19:26.000And 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.
01:19:39.000Then we've got one from SnorGard, systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes.
01:19:50.000And 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.
01:20:03.000And then we have one from 2018. This is Sainsbury's.
01:20:08.000At all, and this is Effect of Dietary Carbohydrate Restriction on Glycemic Control in Adults with Diabetes.
01:20:14.000And 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.
01:20:25.000As part of an individualized management plan.
01:20:28.000So 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.
01:20:38.000There's actually an improvement in cardiovascular risk markers, and there's an improvement in diabetes markers like blood sugar, insulin, weight, visceral fat, etc.
01:20:49.000So, I mean, this is the gold standard of evidence that we have is randomized controlled trials and meta-analyses, of course, they do.
01:21:02.000That's true of any kind of scientific research.
01:21:03.000But 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.
01:21:15.000What 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.
01:21:28.000And these low-carb diets are high in saturated fat?
01:21:30.000They'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.
01:21:39.000Generally, people who are eating low-carb diets are eating a lot more saturated fat.
01:22:47.000They're usually correlated with better health.
01:22:49.000If 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.
01:23:00.000But 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.
01:23:37.000But I still need to bring you back to this.
01:23:40.000What 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.
01:23:50.000Sure, because the science says it does.
01:23:57.000I'm not just talking about biomarkers.
01:24:00.000Biomarkers 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.
01:24:08.000And 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.
01:24:22.000No 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.
01:24:42.000In other words, there's no meta-analysis of randomized controlled trials that shows that eating more saturated fat will increase your risk of death.
01:24:50.000And 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.
01:25:00.000But 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.
01:25:15.000And 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.
01:25:35.000So 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.
01:26:07.000There 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.
01:26:46.000I've got to go with the best science in the world because I deal with patients who have serious disease.
01:26:51.000I 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.
01:27:01.000Just up to date, Joel, I just mentioned several meta-analyses from 2018. This is not meta-analysis.
01:27:08.000This is randomized clinical studies, 59,000 participants.
01:27:15.000We have to look at the weight of evidence.
01:27:17.000There 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.
01:27:31.000Of course, we can go and find one study here, one study there that is different, has a different result.
01:27:40.000The scientific method is to look at the weight of the evidence and to continue to evaluate that over time as the evidence changes.
01:27:47.000And, you know, this is a great quote from John Ioannidis, the Stanford epidemiologist that I mentioned.
01:27:53.000That reminds us that we can't just rely on the past to inform the present.
01:28:00.000He said, claimed research findings may often be simply accurate measures of the prevailing bias.
01:28:07.000And 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.
01:28:18.000Then later, somebody We're good to go.
01:28:36.000And the whole thing is a house of cards.
01:28:38.000That's what most people don't realize.
01:29:02.000A scientific, peer-reviewed paper that quoted a reference, and everybody simply passively keeps re-quoting their reference that was wrong in the beginning.
01:29:10.000I can give you a real-life internet example, which goes to Gary Taubes, my new friend, but sometimes my adversary.
01:29:16.000But I can't give you a literature reference.
01:29:18.000It might be one, but these are very general statements.
01:29:30.000The 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.
01:29:44.000The saturated fat in your diet will lower the number of LDL receptors on your liver and your blood cholesterol goes up.
01:29:49.000That's backed by 395 metabolic ward studies, but that is biochemistry.
01:31:24.000There'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,
01:31:39.000quote, relatively healthy diet, like not junk, all the time increases your lifespan by 13 years.
01:31:47.000So 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.
01:31:57.000There'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.
01:32:05.000We use observational studies to come up with hypotheses, then we do randomized controlled trials to either confirm or refute those hypotheses.
01:32:14.000As 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.
01:32:27.000I 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,
01:32:47.000including 350,000 in one study and 650 in another, showing no relationship.
01:32:53.000So 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.
01:33:02.000If it did that, then we would see it in the observational studies and the randomized studies.
01:33:08.000Now specifically, Joel, what is your take on what he just said?
01:33:11.000Well, we just had another gong moment.
01:33:13.000So 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.
01:33:42.000You don't smoke, exercise 30 minutes a day, you eat better than average.
01:33:46.000That's very broad, but you eat better than average.
01:33:48.000You keep your waist under 25, BMI under 25, and you have a few alcoholic beverages a week.
01:33:55.000I want your listeners to write that down, because that is solid epidemiologic data that's very consistent across But that's my point.
01:34:08.000So you can't look at cultures that have a completely different lifestyle than the standard American lifestyle and draw any inferences about animal products.
01:34:17.000So 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.
01:34:29.000As I mentioned before, as part of their belief system, they don't smoke, they don't drink, they have a healthy lifestyle in general.
01:34:36.000What 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?
01:34:46.000Well, it turns out there is, the Mormons.
01:34:49.000And 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,
01:35:08.000that'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.
01:35:19.000They're not vegetarian like the Seventh-day Adventists.
01:35:22.000Your 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.
01:35:39.000Yeah, 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.
01:35:50.000And, 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.
01:36:04.000And again, I'm not saying we shouldn't use observational research.
01:36:08.000I'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.
01:36:20.000So, Joel, what is your opinion on what he's saying about saturated fat and cholesterol and mortality risk?
01:38:10.000And many of these studies that show you can reduce your risk of heart disease, stroke, and diabetes are talking about better quality of life.
01:38:17.000So when you put all that together, these centenarian studies that have low saturated fat diets are just one more piece.
01:38:24.000I just mentioned four incredibly solid pieces of evidence.
01:38:36.000In 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.
01:39:24.000But 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.
01:39:38.000Okay, but what's wrong with these studies that he's talking about?
01:39:43.000I 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.
01:39:57.000This is the gold standard for assessing a question like this in medicine.
01:40:02.000It'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.
01:40:54.000A heretical conspiracy attitude to say everybody's got it wrong for 60 years.
01:41:01.00021 international societies have it wrong.
01:41:02.000They 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.
01:41:13.000This is one or two or three pieces of data, and they're observational.
01:41:18.000You don't throw out the baby with the bandwagon.
01:41:21.000These are randomized controlled trials.
01:41:22.000Why are you saying they're observational if they're not?
01:41:25.000What meta-analysis by nature is implying, it's not a new study.
01:41:29.000It's taking previous studies and doing.
01:41:33.000In 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.
01:41:44.000They correlated your blood cholesterol with your risk of having heart disease.
01:42:09.000It's beyond, I think, the importance of this discussion.
01:42:13.000I 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.
01:42:37.000We used to think ulcers were caused by stress.
01:42:40.000There are a lot of things that have changed over time as the evidence evolves and as we become more educated and aware.
01:42:51.000So why are you implying that it's some sort of a belief in a conspiracy?
01:42:56.000Chris 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,
01:44:09.000The 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,
01:44:26.000as I just mentioned, these three reviews that I mentioned.
01:44:29.000One 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.
01:44:45.000And 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.
01:44:54.000As I said, in 2010, they changed their recommendations on total fat.
01:44:58.000They used to limit total fat, and then they changed those in 2010. 2015, they changed their recommendation on dietary cholesterol.
01:45:06.000And 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.
01:45:17.000It's not a conspiracy, it's the advancement of science.
01:45:19.000It's just the advancement of science, yeah.
01:45:20.000So your take is that these organizations are behind the curve?
01:45:23.000Yes, and if we want to talk about conflicts of interest, there are huge conflicts of interest in these organizations.
01:45:29.000Something like 40% of the funding of the...
01:45:32.000Well, 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.
01:45:56.000It's actually funny and sad at the same time.
01:45:58.000And so I'm not saying there's a big conspiracy, but I am saying there's a problem.
01:46:03.000In terms of scientific integrity when you have these organizations that are tasked with creating the guidelines that have these financial conflicts of interest.
01:46:13.000But 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.
01:46:23.000So, Joel, what is wrong with what he just said?
01:46:29.000Until 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.
01:46:48.000I 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.
01:47:00.000And 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.
01:47:08.000We're wasting our time with that, right?
01:47:14.000There are conflicts of funding, but they're not unique to any particular sector.
01:47:19.000We 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.
01:47:28.000Had to have six papers retracted and had to resign.
01:47:33.000Doesn't mean there's not a majority of good scientists.
01:47:35.000And I think most of the people we've been talking about are largely good scientists, that their reputation hasn't been tainted.
01:47:41.000I 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%.
01:48:07.000What about what he said about saturated fat?
01:48:09.000I 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.
01:48:25.000Because those 21 international societies and all these different organizations, they rely on current science to make the recommendations, correct?
01:48:36.000The USDA goes through this whole process.
01:48:37.000Now, they haven't published anything new since 2016. It's an expensive process.
01:48:42.000But they did change, like he said, their total fat requirements.
01:48:45.000They did change what they believe to be healthy and not healthy.
01:48:50.000You said they changed it in 2010, correct?
01:48:53.000They 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.
01:49:05.000So what's wrong with what he's saying about saturated fat?
01:49:10.000They didn't change saturated fat, so if we stick just on topic...
01:49:53.000Have they been resoundingly criticized?
01:49:57.000I'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.
01:51:18.000He 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.
01:51:30.000I have to look at the specific language to see.
01:51:33.000My 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.
01:51:46.000And then Joel mentioned that he and his cardiologist friends got them to add something back.
01:51:51.000That was, you know, kind of seemed to step back from that.
01:51:55.000And I think the same thing happened with TotalFat.
01:51:58.000I don't know and I can't, I don't have it to look at right now.
01:52:08.000It 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,
01:52:38.000a 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,
01:52:55.000which is a whole other discussion, but just in any diet increases the risk of heart disease.
01:54:50.000I think that is such a freaking beautiful concept, because we do need to leave here.
01:54:54.000As 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.
01:55:10.000You know, people eat your vegetables, people be really quality over quantity.
01:55:15.000And 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.
01:55:53.000Worldwide consensus by these groups that rely on current science that may or may not be behind the times.
01:55:58.000Yeah, 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?
01:56:06.000So these studies just tell us about averages.
01:56:09.000They tell us what happens on average when a group of people do something.
01:56:12.000They don't tell us actually what happens for person A, person B, person C, and that can be different.
01:56:19.000So 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.
01:56:45.000Let'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.
01:57:14.000But 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.
01:57:33.000Now 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...
01:57:46.000We've been so focused on these population-level recommendations and the idea that there's one diet that works for everyone.
01:57:53.000We don't have a lot of research that answers that question.
01:58:00.000One, did you find out if you made an error on this 2010 requirement from the USDA? So this came from a study that's...
01:58:10.000That 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.
01:58:19.000But 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.
01:58:50.000Even 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.
01:59:02.000So the sources of saturated fat in the American diet, 33% comes from pizza, desserts, candy, potato chips, pasta, tortillas, burritos, and tacos.
01:59:13.00024.5% is unaccounted for but most likely processed foods, according to the authors.
01:59:20.000And then 10% is, or almost 10%, sausages, hot dogs, bacon, ribs, and burgers.
01:59:28.000So the vast majority of saturated, oh, 13% is chicken and mixed chicken dishes.
01:59:47.000So 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,
02:00:03.000fruits and vegetables, nuts and seeds, some starchy plants like sweet potatoes and animal products, including saturated fat.
02:00:11.000We have no Research that suggests that saturated fat in that context is harmful.
02:00:17.000What is the mechanism that makes saturated fat more harmful when it's consumed with sugar?
02:00:22.000Well, 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
02:00:52.000from the effects of insulin essentially.
02:00:57.000Let 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.
02:01:15.000And then high carb diet, and I mean refined carbs here, not fruits and vegetables, can promote the synthesis of saturated fat in the liver.
02:01:24.000So it actually causes the liver to make more saturated fatty acids in the serum.
02:01:34.000This 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.
02:01:53.000You 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?
02:02:01.000Because again, I go back to biochemistry.
02:02:32.000Well, we know the biochemistry right here in Los Angeles, University of Southern California, Biogerontology Institute.
02:02:37.000You 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.
02:02:47.000So 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?
02:02:55.000I mean, my god, a hamburger and coke, you're activating everything we know about science that will make you age faster.
02:04:27.000But 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,
02:04:42.000plant protein beats the crap out of animal protein.
02:04:52.000Because 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.
02:05:01.000Selmatazin in 2014, Morgan Levine of Harvard.
02:05:24.000The 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.
02:05:38.000Their conclusion was that fresh red meat was 1.02.
02:05:47.000And 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.
02:05:58.000So again, you can talk about these proposed mechanisms all day long.
02:06:02.000But if it's not showing up in actual events that are meaningful to people, then you might be missing something.
02:06:09.000Maybe 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.
02:06:19.000And that's why we can't just focus on mechanistic studies.
02:06:22.000We have to look at actual endpoints that matter to people.
02:06:26.000I think death and cancer matter, Chris, and I know you know.
02:07:03.000You'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?
02:07:12.000I wouldn't want it based on a single study, but this is very consistent with the overall high level of mTOR, IGF-1, PKRs.
02:07:19.000I'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.
02:07:30.000So I would prefer to look at reviews that include lots of studies than just a single study that supports a particular viewpoint.
02:07:50.000These are real deaths, and these are real cancer cases.
02:07:52.000This is original science in one of the highest levels.
02:07:55.000But 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...
02:08:10.000Chris, 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.
02:08:19.000The available epidemiologic data are not sufficient to support an independent and unequivocal positive association between red meat intake and colorectal cancer.
02:08:30.0002015 meta-analysis did find a relationship with processed meat, but did not find a relationship with fresh red meat.
02:08:40.000There's also an issue of dose response.
02:08:43.000If red meat did cause cancer, then you'd expect to see a continuous increase in cancer rates as the intake of red meat increased.
02:08:51.000In many cases, you actually see the opposite.
02:08:54.000You can see a decrease in cancer rates in the people who ate the most red meat, which casts some doubt on that association.
02:09:01.000And again, we come back to the relative risks.
02:09:05.000Even with processed meat, it's only 18%.
02:09:10.000And you have to consider the healthy user bias that we talked about before.
02:09:13.000And with fresh red meat, it's either nothing, zero, or maybe like 2%.
02:09:18.000And that's just like, that level in observational research is not distinguishable from chance.
02:09:24.000You cannot draw any conclusions on that.
02:09:26.000And 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.
02:11:29.000But 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.
02:11:44.000And that's why you need to look at the real outcomes.
02:11:47.000There 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.
02:11:58.000And so total mortality is the most important endpoint.
02:12:02.000Deaths from all causes, but then also deaths from specific conditions are important too.
02:12:07.000And I would put that higher in the hierarchy of evidence than mechanisms.
02:12:14.000I 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.
02:12:27.000If you don't understand them, you can't do it.
02:12:40.000For example, we have not even talked cholesterol.
02:12:43.000This literally has been all saturated fat.
02:12:46.0001975, 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.
02:12:57.000It completely controls the metabolism of cholesterol in the body.
02:13:01.000They 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.
02:13:29.000You 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,
02:13:46.000LDLs 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.
02:13:58.000We're the only animal on the planet and we're suffering terribly from it.
02:15:31.000So 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.
02:15:40.000Yeah, 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.
02:15:50.000As I said before, large studies that have forgotten about cholesterol just analyzed the relationship between saturated fat intake and heart attacks.
02:16:01.000Which is what everyone cares about, right?
02:16:02.000If they're thinking about cholesterol, the middle is a mediator in that situation.
02:16:08.000So they remove that and they just say, does eating saturated fat increase your risk of heart disease?
02:16:14.000And that large review of 350,000 participants did not show a relationship on average.
02:16:19.000So is the concept that cholesterol is just one factor and that perhaps we've isolated it as more significant than it really is?
02:16:30.000There are many factors that contribute to heart disease and that's one of them.
02:16:34.000And 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?
02:16:51.000Joel, I'm sure you can understand why this is so confusing for me.
02:16:54.000I actually feel really badly for your viewers and listeners.
02:17:01.000I thank you both for doing this because this is the kind of conversation that you just don't get to have.
02:17:06.000We 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.
02:17:21.000I 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.
02:17:31.000A friend of mine says heart disease is not theoretical.
02:17:33.000I mean, we've had many 39-second deaths while we've been doing this.
02:17:36.000So just to respond, I mean, Does saturated fat-rich diets raise cholesterol?
02:18:31.000How 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.
02:18:37.000If I ate a steak, my cholesterol goes up.
02:18:39.000If I ate an egg, this has been shown because I don't eat any dietary cholesterol as a plant eater, my cholesterol skyrockets.
02:18:45.000You become habituated eating two, three eggs a day and the curve Flattens out.
02:18:50.000After 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.
02:18:59.000Two, three eggs a day for a chronic eater is tough to challenge.
02:19:02.000So your body just creates a tolerance for it?
02:20:46.000I 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.
02:21:00.000So I think that's a little bit outdated, perhaps.
02:21:10.000Like what Joel just said, though, if humans have changed.
02:21:14.000As I said, one study doesn't, you know, the exception doesn't make the rule.
02:21:18.000We have a meta-analysis of observational studies.
02:21:23.000Including 350,000 participants that found no relationship between saturated fat intake and cardiovascular disease.
02:21:30.000The 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.
02:21:42.000We have to look at the weight of the evidence.
02:21:45.000We can't just choose one study or a mechanistic argument to support our view.
02:21:49.000So it's your take that this study is flawed and outdated?
02:21:54.000That's an equation that was meant to represent the relationship between saturated fat intake and...
02:22:04.000Blood 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.
02:22:18.000So 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.
02:22:27.000That's a much more persuasive source of evidence for me.
02:23:18.000I mean, I feel like I'm just saying the same thing over and over again.
02:23:21.000We have to look at the research, the weight of the evidence.
02:23:24.000We have to look at randomized controlled trials that actually look at what happens when people consume saturated fat and dietary cholesterol.
02:23:32.000These studies that he's citing, this graph does not.
02:23:36.000Mechanistic arguments are not persuasive if it's not happening in real people.
02:23:40.000You're measuring in a randomized controlled trial, you're measuring what happens when people eat saturated fat and cholesterol.
02:23:48.000And then you do a meta-analysis of these controlled trials and you're finding what I just said.
02:23:58.000The Royal Academy of Science in Sweden gave the Nobel Prize in Medicine for what we're talking about, and nobody's changed that.
02:24:08.000I 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,
02:24:27.000Well, how are these studies made and what's wrong with them then?
02:24:34.000Nothing's changed about understanding the biochemistry of our lipid metabolism in cells.
02:24:39.000Of course, there's always advancements, but the LDL receptor has led to the statin field, a new class of drugs called PCSK9 inhibitors.
02:24:47.000It'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.
02:24:56.000Right, but what is wrong with these studies?
02:24:58.000These 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?
02:25:05.000I would urge everybody to take the broad, high-level view of science and not pixels.
02:25:17.000There is no new data that you live to 100 by adding saturated fat to your diet.
02:25:22.000Yeah, but we're not talking about that.
02:25:24.000We're talking about the actual physical results on human bodies when you consume saturated fat, what he's just describing.
02:25:30.000I 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.
02:25:46.000We 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.
02:25:59.000And we have many RCTs of low-carb diets and even ketogenic diets that are not showing significant impacts.
02:26:09.000Joel, is it possible that this is correct?
02:26:11.000Here's a 2018 review of all the previous science on dietary cholesterol and eggs.
02:26:19.000And the conclusion says, overall recent intervention studies with eggs, recent.
02:26:26.000Demonstrate 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.
02:26:40.000And he talks about here in the conclusion that eggs shift LDL particles to the less detrimental large buoyant LDL, which is less atherogenic.
02:26:51.000He 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.
02:28:01.000Until 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.
02:28:17.000Now 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.
02:29:09.000Nobody 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.
02:30:12.000New 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.
02:30:24.000Actually, Joel, what in the diet increases TMAO orders of magnitude more than red meat?
02:30:29.000Fish, 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?
02:30:38.000Can we use epidemiology studies, or I thought they were off the table.
02:30:41.000As I said before, we can use epidemiology when we use it wisely.
02:30:51.000We've been talking about large reviews of epidemiology that suggest that saturated fat and cholesterol don't increase the risk of heart disease.
02:31:00.000So if you could answer the question, I'd appreciate it.
02:31:26.000If you look at the data, there are a few things that are associated with a greater decrease in cardiovascular disease risk than fish consumption.
02:32:31.000And that's so cod and halibut are increasing TMAO, as I said, orders of magnitude more than beef or eggs.
02:32:38.000You can't even see eggs and beef there.
02:32:41.000And 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.
02:33:46.000If 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.
02:34:01.000Whereas if you take someone who's got a healthy microbiome because they're eating...
02:34:05.000You know, lots of plant foods that support healthy gut, then you may not see the same association.
02:34:10.000And 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.
02:34:27.000So consumption of fish has been universally shown to decrease heart disease.
02:34:33.000The mechanism is interesting, but overall it may be very complicated with many factors and we might not know all of them.
02:34:41.000Yeah, 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.
02:35:43.000Why are we instantly giving the ball to pharmaceuticals?
02:35:48.000You asked the question, is there any new human physiology that's relevant?
02:35:52.000We 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.
02:36:01.000Right, but we're talking about what he just showed in the graph.
02:36:04.000You dismissed the graph, then he gave you a study for the graph, and you just sort of glossed over it.
02:36:23.000And 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.
02:36:32.000So a bunch of layers there real quick.
02:36:34.000Everybody who studies TMAO knows that the microbiome is a critical component.
02:36:50.000Because my microbiome is different than yours.
02:36:52.000Feed an omnivore a steak, they make TMAO within 12 hours.
02:36:55.000An omnivore eating a standard American diet.
02:36:58.000Sure, but nonetheless, it pointed to the fact that it was the microbiome.
02:37:02.000You 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.
02:37:16.000Is fish always healthy in a world of DDT, PCB, mercury?
02:37:20.000I 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.
02:37:29.000That's another subject, because you were talking about...
02:37:30.000No, you want to look at old data on fish, and now I'm bringing up 2018 clinical experience.
02:37:36.000No, no, no, that's not what he's doing.
02:37:37.000We're not bringing up old data on fish.
02:37:38.000Well, I was being beat up for old data...
02:37:41.000And I'm bringing relevant clinical material in 2018. You were talking about the absolute mechanism that's caused by the consumption of meat.
02:37:49.000He brought up fish consumption, which vastly elevates this, and yet fish consumption is not correlated with heart disease.
02:37:58.000In fact, it's correlated with people having healthier hearts.
02:38:02.000So 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.
02:38:10.000That's not what it says, because the fish consumption vastly elevates what you were saying was a significant issue.
02:38:17.000He'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.
02:38:32.000Yeah, I would say that's true, and I would say it's another proxy marker for a crappy diet.
02:38:38.000What 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.
02:38:50.000So you brought up this TMAO, and he's basically just squashed that argument.
02:38:54.000Yeah, but I think he's scientifically wrong because, again, the wealth of the body...
02:38:58.000About TMAO? About TMAO. But what about the fish?
02:39:07.000The 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.
02:39:25.000That process is correlated with increased activity of LDL within your cell wall.
02:39:41.000What hasn't been studied is if fish flesh already has preformed TMAO. We don't know if it activates LDL activation.
02:39:49.000We 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.
02:39:58.000They'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.
02:40:07.000Okay, well now we're talking about a totally different thing.
02:40:11.000If 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.
02:40:21.000Well, I think that's reductionist, because what does fish have?
02:40:25.000But isn't it reductionist to bring up TMAO in the first place?
02:40:28.000Because you brought it up as a significant factor.
02:40:29.000No, even more reductionist than what I just said, because I zoomed out a little bit to look at the actual relationship with mortality.
02:41:06.000How 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?
02:41:15.000It would take an evaluation, what's the calorie content in the United States that's from cod, halibut, red meat, and egg yolk.
02:41:23.000The calorie content of egg yolk and red meat is higher than cotton halibut.
02:41:27.000I don't have that data, and that's a global perspective.
02:41:29.000But 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.
02:41:38.000I believe, according to the Cleveland Heart Labs, you will want to do all steps to lower it.
02:41:43.000And maybe you want to leave fish in, because the complementary benefit that fish has shown may be from omega-3.
02:41:49.000This is purely speculative, though, right?
02:42:43.000I might have even mentioned that in my original article.
02:42:47.000Joel, the problem is you brought up TMAO in the first place, like it was this magic bullet.
02:42:52.000Well, 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?
02:43:04.000According to a research study, when fish raise TMAO, they accelerate atherosclerosis.
02:44:40.000Here's a 2012 review that does not find any association between fish consumption and diabetes.
02:44:52.000Follow-up, published in the American Diabetes Association Diabetes Care Journal.
02:44:58.000So, 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.
02:45:10.000And yes, there are concerns now about toxins, and it might change over time.
02:45:14.000And there are also concerns Issues with overfishing and all of that.
02:46:17.000It 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.
02:46:27.000Alternatively, other dietary components such as selenium and unmeasured contaminants present in fish might explain our results.
02:46:58.000It 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.
02:47:10.000Even lean fish was associated with developing type 2 diabetes.
02:47:15.000Fatty fish was not, because you probably want that omega-3.
02:47:19.000But, you know, I'm not telling anybody it's a resolved issue.
02:47:22.000But you were saying TMAO from animal protein is what causes this problem.
02:48:09.000I 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,
02:48:30.000which is folate, some of the animal studies suggest that that has an effect on longevity.
02:48:37.000But 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.
02:48:48.000And 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.
02:48:59.000As well as fiber for a healthy gut bio.
02:49:19.000An accumulated evidence generated from this meta-analysis does not support the overall inverse association of fish or fish oil intake with incidence of diabetes.
02:49:30.000So that's saying that increased fish intake doesn't lower the risk of diabetes.
02:49:36.000It's not saying that it increases the risk.
02:49:39.000So it says there's no relationship there that they can analyze.
02:49:43.000So no one's saying that it causes diabetes.
02:49:47.000So where does it say that it causes diabetes and what is this study?
02:49:54.000This 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.
02:50:03.000Yeah, they're eating fish and chips watching TV. Absolutely.
02:50:25.000Yeah, I mean, we were starting, Joel brought up TMAO, and that's how we got onto fish and diabetes.
02:50:34.000I think there is no strong evidence that eating fish causes diabetes.
02:50:39.000There's a lot of evidence that suggests that eating seafood reduces significantly the incidence of cardiovascular disease.
02:50:47.000And again, if TMAO were a problem, then eating a lot of fish should not have that impact.
02:50:53.000And 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?
02:51:01.000Yeah, I think that's plausible, given what we know about EPA and DHA, which are the long-chain essential fatty acids and their benefits.
02:51:10.000Fish is also a great source of selenium, as that one study said.
02:51:15.00016 of the 25 top sources of selenium come from ocean fish.
02:51:19.000Fish is a great source of bioavailable protein.
02:51:23.000There are lots of reasons why fish consumption could be beneficial.
02:51:27.000So, 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.
02:51:48.000Yeah, 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.
02:52:26.000And 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.
02:52:38.000And TMAO, I think, is a great example of that.
02:52:41.000Is it fair to say that we really just are looking at a puzzle and we don't have all the pieces?
02:53:25.000Because we have enough to make recommendations to the public.
02:53:28.000And the True Health Initiative has crystallized that.
02:53:31.000Okay, but that's not what we were discussing right there about recommendations to the public.
02:53:34.000We 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.
02:53:43.000It's an endless flow of new knowledge.
02:55:23.000So that was interesting, and some are now developing anaphylaxis, carrying EpiPens, because they have a meat allergy.
02:55:29.000That isn't 2.4%, it's 24% have the antibody.
02:55:32.000But 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.
02:56:46.000Do 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?
02:56:59.000I doubt, you know, the basic biochemistry of meat and the carbohydrates in meat have changed.
02:57:04.000Has the lone star tick become more frequent?
02:57:36.000There's a great study done, one of my favorites, that was purposely done to illustrate the danger of assuming that correlation equals causation.
02:57:44.000It was a study done of the most common diagnoses for hospitalization in Canada, 10.6 million people.
02:57:52.000And they found that 24 diagnoses were significantly associated with the participants astrological signs.
02:57:59.000So 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.
02:58:18.000The proposed increase in risk for processed meat and cancer is 18%.
02:58:23.000So these risks are at processed meat, at that same level.
02:58:30.000So Sagittarian has a higher risk of being, if we believe, In this correlation data, you know, you can't assume correlations or causation.
02:58:39.000I 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...
02:59:00.000There 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.
02:59:16.000So 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...
03:00:26.000There'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.
03:00:36.000There 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.
03:01:50.000You've got to talk to a patient Monday morning.
03:01:53.000I don't want to get mired in confusion.
03:01:55.000I'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.
03:02:04.000Are we going to evolve that to something more brilliant?
03:02:09.000Five days a month, or don't eat 12 hours a day.
03:02:12.000We might be able to refine it with some of the new science on using fasting intelligently, but that's pretty strong.
03:02:18.000When 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.
03:02:32.000That, I can tell my patient on Monday, is something they can actually activate.
03:02:36.000And 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.
03:02:47.000But for now, these are critically simple lessons.
03:02:50.000I'd actually agree with that, including the part about plants.
03:02:53.000I mean, my recommendation is your plate should be, you know, two-thirds or three-quarters plants and then animal products, animal foods.
03:03:12.000Animal 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.
03:03:27.000You know, that's my argument, is that on that plate, for most people, they're going to benefit from having some animal foods.
03:03:36.000You 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.
03:03:45.000But, 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.
03:04:17.000Animal protein is more nutrient dense in essential nutrients.
03:04:25.000Making it clear that I support eating both plants and animal foods.
03:04:30.000So 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.
03:04:49.000Whereas plant foods tend to be higher in carotenoids, polyphenols, flavonoids, diallosulfides, which are in cruciferous vegetables, and fiber.
03:05:02.000And 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.
03:05:13.000And what would be negative about removing the animal products from that one quarter of your plate?
03:05:21.000What could you not fill in with plant protein?
03:05:25.000Because clearly some people get by with just plant protein.
03:05:44.000But yeah, in non-animal foods, I guess you could say.
03:05:48.000But it's not just a question of what's theoretically possible.
03:05:53.000It's a question of looking at the studies that show us what are the average, you know...
03:05:59.000How common are nutrient deficiencies on omnivorous versus vegetarian and vegan diets?
03:06:05.000And 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%,
03:06:26.000Of depletion, which is the first stage.
03:06:28.000There's four stages of B12 deficiency, and that's the first stage.
03:06:32.000And 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.
03:06:48.000And when you use those newer markers, you see those broad, very big differences in deficiency rates.
03:06:56.000And furthermore, there was a study done in vegans and vegetarians in the Netherlands that were at a summer camp.
03:07:03.000So these were people who were educated vegetarians and vegans.
03:07:07.000And 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.
03:07:21.000And 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.
03:07:32.000And you really need 250 micrograms to get your levels up.
03:07:36.000And if you're deficient, you need 200 times more than the RDA, 500 micrograms.
03:07:42.000And all the studies are there on my site.
03:07:45.000It is a problem that B12 is non-existent in plant-based foods or that it's not as bioavailable?
03:08:16.000Well, that doesn't necessarily make the difference.
03:08:19.000It's are they taking enough to meet their needs.
03:08:22.000So 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?
03:08:29.000Bacteria make B12. So if cows are eating dirty ground, they get bacteria.
03:08:35.000Plants, if you don't wash, will give you B12, but it's the bacteria hanging on the carrot.
03:08:39.000And we make B12, too, but it's in the colon, and we can't absorb it in the small intestine.
03:08:46.000But 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.
03:08:52.000Serum B12 only goes out of range in the final stages of B12 deficiency, and by then it can be too late.
03:08:59.000Some of the effects of B12 deficiency are irreversible.
03:09:03.000So 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.
03:09:13.000So, 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.
03:09:21.000Well, number one, it's responsible for a healthcare practitioner to advise somebody eating plant-based to take...
03:09:31.000There are people that do it because it's fortified in many foods and nori if you eat sushi and nutritional yeast.
03:09:38.000I 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.
03:10:25.000But if you're saying you don't recommend it?
03:10:27.000I don't recommend it, but they should get blood work.
03:10:29.000Know 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.
03:10:39.000I don't take pills and look at my blood work.
03:11:44.000It's algae for DHA. It's synthesized for B12. And vitamin D3 is synthesized, too.
03:11:50.000It used to be made from sheep's secretion called lanlin, but it's synthesized now.
03:11:55.000But 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.
03:12:09.000And 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.
03:12:18.000There's issues with supplementation sometimes.
03:12:23.000Getting too much of a nutrient can be a problem in several cases.
03:12:27.000That'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.
03:12:33.000But 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.
03:12:44.000And not even most physicians don't test for serum B12. I know this.
03:12:48.000You probably know this, Joel, from people come in.
03:13:06.000If 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.
03:13:19.000And 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,
03:13:37.000like 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.
03:13:47.000I'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.
03:13:56.000We are prone to have a few holes in the wall that an intelligent person knows how to plug.
03:14:02.000It's vitamin D, it's DHA, it's B12, you might go on to say iodine, taurine, vanadium, chromium.
03:14:23.000Is 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,
03:14:39.000but with those together, you feel like you're far healthier.
03:14:43.000Well, because what I didn't get, I substituted.
03:14:45.000But what I don't want, I'm not taking in, which is animal saturated fat, animal protein.
03:16:05.000I 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.
03:16:18.000Dairy 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.
03:16:26.000Iodophore is the cleanser that's used for the tanks, which is basically just pure iodine.
03:16:41.000Where do you get it from food, though, outside of that?
03:16:44.000So the three top sources of iodine would be, well, iodized salt is the main one.
03:16:49.000That's why it was added to salt in the first place.
03:16:51.000But a lot of people on a healthy diet remove iodized salt in favor of sea salt, which I think is a good choice overall.
03:16:57.000But one of the downsides of that is that they're no longer consuming the main source of iodine.
03:17:02.000Then 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?
03:17:15.000So 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.
03:17:35.000Let'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.
03:17:46.000And it just, yes, you can supplement, but it just, you know...
03:17:50.000Do the supplements have the same effect?
03:17:53.000Dietary calcium has inversely related to heart disease and kidney stones, meaning the more dietary calcium you eat, the lower risk of those conditions.
03:18:03.000But when you look at studies on calcium supplements, the opposite is true.
03:18:08.000Calcium supplements are associated with an increase in heart disease and an increase in kidney stones.
03:18:19.000But the theory is that with supplemental calcium, it's not the same as dietary calcium.
03:18:25.000You 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.
03:18:38.000And so my point is that supplements don't always affect the body in the same way.
03:18:42.000That'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?
03:18:49.000Let's talk about something I think you guys can both agree on, because I am baffled by this carnivore diet.
03:21:07.000But 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.
03:21:19.000I don't want the guy to drop dead, but, you know, it's way preliminary for the bandwagon that's growing.
03:21:24.000The 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.
03:21:31.000Could that have significantly decreased his testosterone?
03:21:34.000He said he repeated it a few times and it stayed low, but if your serum total...
03:22:00.000So 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.
03:22:15.000You love vitamin C. I love vitamin C. I love it from foods.
03:22:21.000Vitamin C is, Linus Pauling, there's so many benefits to the body.
03:22:26.000Where 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.
03:22:39.000The 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.
03:22:49.000There's some sort of, there's an adverse effect.
03:22:53.000Well, if you take 1,000 milligrams of vitamin C, you'll absorb a lot of it.
03:22:58.000If you take 10,000 milligrams, by percentage, you won't absorb as much, but you'll still get more than 1,000 milligrams.
03:23:04.000But 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.
03:23:36.000I 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?
03:23:52.000Well, I've gone to dinner with Jordan Peterson.
03:23:54.000He's eaten his big giant steaks and he looks great.
03:23:57.000He's lighter than he's been since he was 25 years old.
03:24:14.000He's contributing amazing things to the world.
03:24:16.000But 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.
03:25:18.000I 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.
03:25:27.000If you're only eating lean meat, I think, yeah, I would be very concerned about that.
03:25:56.000But 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.
03:26:12.000She He has some sort of an allergic reaction.
03:26:14.000You, I think you both think that that could be because of a fucked up gut.
03:27:22.000And 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.
03:27:35.000And we know with 100% certainty that this is safe for the long term.
03:27:39.000Those are two very different questions.
03:27:42.000And again, I'm totally empathetic to that.
03:27:45.000And I would probably do the same thing.
03:27:47.000Especially a person like yourself that has gone through this process of being extremely unhealthy.
03:27:51.000And I might even say, hey, maybe I'll die five years later.
03:27:56.000But I'll enjoy those years of my life.
03:27:59.000I won't be in pain and discomfort the entire time.
03:28:11.000So maybe even though the all-meat diet might have some downsides, it actually might be reducing inflammation and therefore that will cancel out.
03:29:02.000Yeah, well, that is what happens in a high meat diet.
03:29:05.000But is it 100% with every single person?
03:29:08.000When you chew it well and drink water, does it always get stuck?
03:29:11.000It'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.
03:29:19.000I 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,
03:29:35.000and we have people like Justin Sonnenberg at Stanford who's done a lot of good work here.
03:29:55.000They have a very high meat diet, but still.
03:29:58.000The Warriors consumed milk and meat and blood at certain times of year.
03:30:04.000And other times of year, they did eat more plants.
03:30:09.000Even 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.
03:30:22.000And then during the summer, when they were able to collect berries and things like that, they would definitely do that.
03:30:29.000So every culture that we know of that's been studied ate some combination of animal and plant foods.
03:30:35.000You know, what ratio, what amount, you know, that varies from place to place depending on where they are.
03:30:41.000But that's what the anthropological data show.
03:30:45.000There's actually, you know, when you talk about this, two super, super cool pieces of data.
03:30:50.000There'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.
03:31:04.000And they measured every single thing they could measure in the microbiome and their stool.
03:31:44.000I'm just pointing out just the remarkable resiliency, and that's part of the issue.
03:31:48.000You 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.
03:31:55.000We're talking about from procreation to death for optimal health, longevity, health span.
03:32:01.000There'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.
03:32:10.000We'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.
03:32:20.000Isn't that done through a ketogenic diet as well?
03:33:41.000For me, Nutrivor is a more inclusive term that just means what I said.
03:33:48.000Some 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.
03:34:02.000Isn'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?
03:34:11.000There's been recent data that suggests that grain consumption and legume consumption went back further than it was originally thought it was.
03:34:23.000Prominent parts of the diet or fallback foods is another question.
03:34:59.000You go back to Los Angeles, California in 1948. Dr. Lester Morrison, internist.
03:35:04.000Real 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.
03:35:14.000He said, I wonder what happens with my heart patients in Los Angeles.
03:35:18.000There 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.
03:35:26.000Eight years later, 50% on the high plant, low fat diet were alive, 0% on the standard Los Angeles diet.
03:35:33.000And then a series of people said, let's start doing that more routinely.
03:35:36.000Ultimately, 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,
03:36:41.000So 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.
03:36:53.000It's like, wow, number one in the world.
03:36:56.000I agree with that statement, but we don't have research.
03:37:01.000It's not like studies have been done taking people from Standard American to NutriVore or Paleo, and we haven't seen benefits.
03:37:08.000We have RCTs that have shown significant benefits in cardiovascular markers, in NutriVore diets, and Paleo and low-carb, for that matter, and ketogenic.
03:37:36.000How 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.
03:38:02.000So 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.
03:38:37.000Junk food vegetarian or junk food vegan diet.
03:38:40.000So 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.
03:38:53.000Yeah, and one of the ways to answer this is to look at nutrient density.
03:39:43.000If 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.
03:39:52.000That's not really a controversial statement.
03:39:55.000Fatty 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.
03:40:14.000And, you know, grains and legumes don't even really make the, you know, they're nowhere close in terms of nutrient density.
03:40:22.000I 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.
03:40:38.000Assuming 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.
03:40:49.000And, 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.
03:41:01.000And 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.
03:41:07.000But if they do, they're probably going to have good health.
03:41:09.000There's a concept called the spectrum.
03:41:11.000Dr. 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.
03:41:54.000We'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.
03:42:01.000Again, I'm not ideological about this at all.
03:42:05.000So 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,
03:42:21.000you 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.
03:42:37.000So this is what I said before, like the spectrum is large.
03:42:41.000Some 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.
03:42:57.000And 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.
03:44:02.000Just stop beating on us because we're doing pretty well.
03:44:06.000But 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.
03:44:15.000They just cut out all the land animals.
03:44:32.000Sean 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.
03:44:54.000You know, a great, great tight end and such.
03:44:56.000I 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.
03:45:04.000I mean, insane level of athletic fitness.
03:45:27.000But I think one thing that we came to a really solid conclusion on is that standard American diet sucks.
03:45:34.000And 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.
03:45:46.000The dispute is whether or not the nutrient-dense organ meats, shellfish, meat, fish, That these things, eggs, that these would benefit you significantly.
03:46:08.000I mean, we may have this dispute about saturated fat and cholesterol, and it's not unimportant, but he's a prime practitioner.
03:46:14.000He's treating people at the right level.
03:46:16.000I believe I'm doing that in Detroit and the people that come to see me.
03:46:19.000You 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.
03:46:24.000Well, you both handled yourself admirably.
03:46:26.000I mean, this is a very emotional, tightly contested sort of a dispute, and I thank you both very much for being here.
03:46:34.000Well, thanks for the opportunity, Joe.
03:46:35.000I mean, to have the chance to do this for, what, almost four hours now?