Food Is Medicine: How Your Diet Can PREVENT Disease

it's my mission to show how much more consensus there is than controversy more vegetables more Whole Foods less added sugar and less refined grain those are four of the biggest problems with the U.S diet if you put all those together they are all well aligned with a plant-based diet episode is brought to you by timeline nutrition which is this new skin health line of products check it out and get 10 off your first order it is a pleasure and an honor to meet you and to have you here I mean you are one of the world's Premier leading nutrition scientists focused on studying what to consume and what to avoid for Optimal Health there's so much nutrition science out there uh and many of these studies trickle down or find their way into mainstream media and click bait titles and reductionist sort of briefs on what these studies said or perhaps didn't say that creates a lot of confusion in the public hence the nutrition Wars on social media Etc but you know why do we find ourselves in that situation and and you know what are you doing in terms of the studies that you're creating to try to rectify that perception yeah I think you've captured it really well and it's it's my after being in this field for 30 years it's my mission to show how much more consensus there is than controversy uh and and the deal there is as you said you could find a study that has almost any position you want out of the context of all the literature that there is so especially I'm sure the world of social media has really exacerbated all this what what gets the click bait going here it's everything you knew for 50 years is wrong right the contrarian point of view that's what you want to click on or Jelly Beans really are good for you or ice cream which is preposterous which actually was an Atlantic headline just in the last month oh yeah yeah I remember that yeah that just came out I mean that who wants to click on something that says you should eat more vegetables really oh my God I better click oh wait I've heard that 50 times and I don't really like vegetables or something along those lines so that the challenge is when you do food food is is a pain in the butt to study it's really complicated it's cultural there's all kinds of preferences involved and pill studies are easier so supplement studies are like medical design studies there's a placebo and an active what's the placebo to food there isn't one right and so for me that the challenge is how generalizable can you make this that it's real food and how rigorous can you make it that it's science because a lot of stuff in nutrition is matching let's make sure everything is matched well if everything is matched then it's not food anymore so it's sort of this balance of generalizability and rigor that floats my boat so yeah I've been approaching it uh in my studies trying to make it practical involve other disciplines that's been really fun for me too so I have a PhD in nutrition science but there's really a lot of Economics psychology here taste pleasure joy and when you put them all together to be perfectly honest Michael pollen really nailed it eat food not too much mostly plants right and he gets away with so much I'm so jealous like he writes that book and it's very engaging and I really do think he nailed it but he did come up with indefensive food after that which is 27 chapters or so of here's what I really meant and as he gets into it and he starts picking apart what's food what's mostly what's not too much that all requires some definition and then people get embroiled in controversy again when it it doesn't need to be so I which I shouldn't even have a job really I should be out of a job if people would just eat food right I wouldn't have but it is complicated and people are messy so that's the problem right even in the most well-designed trial um and you can come up with you know you can run a trial and control it to the best of your you know ability Etc uh and come up with some pretty Ironclad results as a result of that and yet because you can't create the perfect scenario you're always open to criticism for people who refuse to believe that this is the case right because people are involved because there are always going to be variables outside of your control or whatever um you know kind of definitions you apply to your study about term or you know portion size or whatever somebody will say well you didn't do this or you should have done it this way and if you had it would have been different hence we can't read anything reasonable into this yeah and so my Approach and all my so I design a study and I write it up and I don't do any animal model studies but mechanistic people do and they control everything and they can chop a head off and grind up a spleen or a liver and look at some very mechanistic things which that's not what I do but I sometimes cite that and you've got observational epidemiology where you're tracking people for 40 years and the knee-jerk reaction is Association not causation and my immediate reaction is oh my God that is so cool they know who ended up in the hospital with cancer or heart disease I never had that option in my job I wouldn't get promoted if I said cool I've started this study and in 30 years I'll report can I just keep my job for 30 years until they're done so I do little studies of risk factors so I recruit live human beings feed them real food and try to lower their cholesterol blood pressure weight or something cool and new like trimethylamine oxide and then I say okay I change the risk factor that should lead to preventing a disease but I honestly don't know because something else might have happened in the meantime and as you were just saying oh what if I double the dose what if it was in half what if it was that instead of something else so as soon as I report one of my randomized controlled trials which is sort of the gold standard of nutrition research instant feedback is yeah but what if you change that one parameter and I say crap you're right that that's totally plausible but I didn't do that study I did the one I did in it the randomized controlled trials are very narrow questions as opposed to is meat bad for me is soy good for me yeah those are unanswerable questions they have to be much more specific yeah in order to answer that how are you defining good or bad right and what factors or things are you looking at to make that determination and one of the things that you've done kind of as an innovator is go beyond the conventional approaches when it comes to weight loss and you know sort of disease disease prevention to look at things like um metabolic health and tmao as you said inflammatory markers uh that we're now learning are perhaps more informative in terms of telling us what's going on in our bodies and how we're responding to the foods that we're eating yep and it's exciting and and fun to explore these new areas and let's just start with inflammatory markers for one so if you put together all the traditional risk factors that you go to see when you get your doc looking at you your lipid profile your glucose your blood pressure your weight you put all that into a mathematical model and they say yeah this explains like 50 percent of heart disease or diabetes or cancer and 50 is unexplained what could it be ah immune function inflammation insulin resistance in in my scientific World those are all really hot topics right now the microbiome what's happening in your microbiome ah maybe that's the other 50 percent this is super exciting let's engage in this none of those have progressed to the point where they're easy clinical measures have you been to your doctor and gotten your immune function number your inflammatory status your microbiome your microbiome number no because there's a thousand species of microbes and in my world of inflammation here's here's my quick story on this I was very excited to get into this and I had a colleague in this area and we've got three different grants from the NIH and we focused on mcp1 intracellular soluble adhesion molecule one tnf alpha something else so these are the four if you look at these four inflammatory markers nobody agrees on all of them but at least every reviewer will like one of these and I said four it seems like a lot so we had these measured and then I went for another study and said this is we have a cool new deal for you you can get 50 of them for a hundred bucks and I said wow 50. then so we have a new platform called o link you can get 90 for the same amount as you were getting 50. said I I think that sounds good and they said actually we have nine different platforms that have 90 markers so you could get this many and I said I don't think I want nine platforms with 90 markers I want a number I want an inflammation number and the field isn't there yet so we all kind of agree this chronically elevated inflammation that's not rheumatoid arthritis not a very acute condition uh where you're being treated but just chronically moderately elevated that's probably is underlying a lot of diet related chronic disease we can't help you clinically we don't have a number and and it makes it really hard for me to do a study on that topic and be very precise this dose this duration this outcome at the end it is just too complicated and the science is only now emerging in that field and like so many of the the you know things that you're looking at um the complexity extends so much further beyond what the general public is aware hence I know you're working on a book and you were telling me last night that your operating title that was rejected by the publisher is it depends right like it's not a satisfying phrase like it but it does depend there are so many things uh upon which these outcomes Depend and it just is impossible to you know refine that down to a paragraph or a sentence that's going to be uh you know an operative directive for the average person to just say just tell me what to eat just do I do what do I do come on you know it depends but that's the truth and that's science and it and I think if you if you narrow that down to a couple of things like what was the food what was the comparator what did they eat it with who was the person I think as a community the the folks interested in nutrition reading this could be more effectively critical if they just got a couple of those basics down so one of my experiences back in my PhD in the early 90s was two articles that came out in in just one year and one said oat bran is great for you and the other one said oat bran doesn't work and it looked like those are Polar Opposites all he had to do was look very closely and see the one where it worked was older men with high cholesterol the oat bran lowered their cholesterol the other one was college students with normal cholesterol and it didn't go lower than normal it was already normal the headline made it seem like they were opposite and really it would have been easy to say if you don't have elevated cholesterol then this oat bran probably isn't going to lower it below normal but if you do have elevated cholesterol and you want to avoid a drug you might want to try this oat bran that's all you'd have to say or you could make it controversial the nutrition scientists never agree right I feel like I mean I'm all for free speech but I feel like there needs to be some kind of counsel for the responsibility of of uh medical and nutritional uh journalism in this regard because you know those those are simple titles to articles and who knows what those articles actually said in whatever uh Publications they were in but they have such a huge impact on the average person who doesn't have who's never going to go to PubMed and may not even read that entire magazine article or newspaper article yeah and there are a couple Publications out there that are Center for Science and public interest puts out a health action newsletter the Berkeley Wellness letter is really good your podcast is really good Simon Hills podcast is really good it's sort of like there was a new study and in the context of the rest it made a little difference but there was a huge context that it goes in and so it doesn't overturn everything we knew for the last 50 years right it adds another dimension to this and that's interesting and usually it doesn't overturn what you knew yesterday right which is like again that goes to the that that thing inside of us that wants that hot take that contrarian yeah you know reductionist perspective and it's disappointing when it doesn't pan out that way but you know the truth hopefully you know surfaces to the top over time um and on that topic let's let's talk about a few of your you know better known studies um I think the study that you're probably initially became very well known for was this A to Z study where you paired a variety of I guess they're called fad diets are they fat you know fat whatever protocols at the time so this was like 2007 2000 in 2007. yeah so walk me through um how you came up with this idea and how you designed this study and and what you discovered yeah it was pretty fun so and actually this goes way back before then I applied originally to the USDA for some funding and this is sort of just in the early 2000s when Atkins uh had been revived the Atkins book came out in the seven 1970s and was dismissed and all of a sudden it was revived and there was a huge amount of interest in it and the Zone was coming out then and your swimmer actually did you know Barry Sears well I have a story about that actually so I I graduated Stanford in 89. um and the coach skip Kenny was well known for getting really excited about one thing or another from time to time and he would find these people and bring them in and have that person talk to us whether it was a mindset coach or some new idea that he thought would be helpful and I remember a couple years after I graduated I came back for an alumni weekend it must have been 91 92 or something like that and I was at a tailgate party before the football game with a bunch of the swimmers the younger guys and they're like man skip brought this guy very very Sears in to talk to us because skip was all about the Zone diet the coach and he was he was trying to get the whole team on board and he had I think he hired Barry Sears who like worked with the team to try to get these guys on the program and and I think in retrospect if memory serves me later on Barry Sears sort of publicly took credit for some some of the successes of these athletes at the Olympics but I will tell you as somebody who knows these athletes personally and talk to them about this they were like yeah he came in he wanted us to do this 30 40 whatever it was yeah like we didn't no way they're burning like you know they're they're so hungry they're eating so many calories none of them actually did it so Barry Sears may have claimed that he got everybody on board with this diet but they weren't actually practicing it in real life and so they were kind of you know dismissive of him irregardless of whether his ideas were correct or good or or what have you and I think that speaks to a larger issue that you come across which is the real world you know adherence versus like oh we designed this study and these people did this well did they really and what did they do afterwards and you know what's actually real here yeah so it's a great story for that but I will add one comment as I remember at that time said Stanford swimmers are winning all kinds of metal since they went on this diet and somebody said what happened didn't they win all kinds of medals before the diet too yes yeah so like did that trajectory change uh no so again context but for for my interest was there were these New York Times best-selling books and uh here's a little inside baseball is if you follow nutrition there's something called the acceptable macronutrient distribution range it's a marble mouthful of amdr and the Atkins diet is outside of that and the ornish diet is outside of that and the Zone diet is barely in it and so this is like wait there's a whole bunch of popular diets out there outside the acceptable macronutrient distribution range what do we think of these they're New York Times bestsellers and so my idea was yeah why don't we do this and it was kind of interesting some of the pushback I got from reviewers so it's like this is a popular diet I mean why would you study that if it is a fad diet it'll be out of fashion by the time you have your results so there's no reason to study a fad diet it's like no no some of these books have been around for a really long time somebody should study the books say okay so are you going to match the protein and you're going to match this and you know as part of our scientific rigor there's there's things to match and not and my idea was they're selling the books Let's just have them read the book let's see what happens and then there's another group saying okay now once they've read the book they'll have to follow exactly what the book said and said I don't think so I don't think a nutritionist comes with a book when you buy it at the bookstore they read it and then you have to see what they do so the fun of this study was it was designed very intentionally so that for the first eight weeks of the one year study a dietitian would come in and and I'm exaggerating but basically read the book out loud to you 1 8 of the book each time for eight weeks to make sure they had at least read it because what we did find here's a fun anecdote we put people on the Atkins diet again which was very popular at the time and some of them would show up to these classes and say half my office says they're on the Atkins diet but I have read it and they are not they say that they they obviously don't understand it I have read the book and these people say they're on and they got like one concept out of the book not having read it and they say they're on it so part of the rigor here was make sure they've read the book and then after eight weeks what we told him very intentionally was we're not going to help you anymore if you want moral support or social support we'll help you if you call us but if you have questions about adherence to the diet we're not going to help you you read it we're gonna see what happens and one of the funniest uh stories from this for me was I pretty sure it was an email from Barry Sears toward the end of this at the end of the study the Atkins group did a little better at six months from six months to 12 months the weight was coming on faster than the other group so I I suspect if we carried it out to two years they all would have been the same the actual finding of the study was the only two diets that were different from one another or Atkinson's own now this is a little bit of a head scratcher because by picking Atkins is the lowest carb zone is the second lowest carb learn which was sort of a health professional's approach and ornish which was the highest carb it was very intentionally a range of low fat to low carb extremes so low fat or low carb were different it should have been the two extremes that were different ornish and Atkins it wasn't the only two that were statistically different were Atkins and Zone those were the two low carb diets Zone lost the least and Atkins lost the most so it's not really an advertisement for low carb my personal opinion was the Zone instructions were really hard to follow and Atkins was quite easy don't eat carbs right so it's an adherence and kind of real world human problem not um not so much an issue it it was specifically and intentionally designed not to really pit these three different diets against each other but to see how actually people behave in the real world when they take in information how it works and so Barry's interpretation of this when they tried to follow Atkins and fell short they were pretty close to Zone so he said my diet wins and I said wait wait if you want to be on the Zone diet read the Atkins yes basically exactly and I have a flip side to that which is Dean ornish was quite upset said well I don't you know you didn't get them to follow my diet and I said Dean we bought them the book and we gave them a nutritionist and they read it if you looked so we did extensive dietary assessment on this at Baseline three months six months and 12. and if you looked at 12 months the ornish diet is 10 fat they were at 30 percent fat not ten if you were they claiming they were still on it well they were assigned to it I mean the way I wrote the paper up was they were assigned to this is and this is what they did and I sort of I have a chart of what the um Amer the guidelines of the American Heart Association and dietary guidelines for Americans are in shooting for ornish they fell into the dietary guidelines in shooting for Atkins they kind of fell into zone so it's almost like it was a Zone versus dietary guidelines study according to how they followed it but no they got assigned to these four different books and so as you started this conversation you said it's more about adherence and what real people can do they couldn't do the extreme diets they could not do ornish and they could not do Atkins and so that is how we wrote this study we assigned them to this we got them the book and they read it here's what happened they pretty much lost the same amount of weight at the end except for Atkins and Zone and our more stunning conclusion was it was like on average a couple pounds difference between them at the end but what's super cool is how variable they were within each group within each four of each of the four diet groups somebody lost 50 pounds and somebody gained 10 or 15 and those were not outliers everything in between so my Epiphany from this study was people getting the exact same advice can have wildly variable results ah that is humanly personally fascinating why are we so complicated but it was reading a book it seemed to me a very practical public health approach to this question of weight loss so extrapolating from that big picture humans are complicated there are all kinds of mechanisms at play that that must be accounting for this wide variety of results with weight gain and weight loss and and other sort of uh uh you know results that you were seeing and then also the very sticky problem of like how humans behave you know like just because you read a book or this says do this and it is sometimes I would imagine you see people who who say no I'm doing it exactly like they think they're doing it exactly right yes but in reality they're not and then other people who are like yeah I know I'm kind of veering off here and there but you know I'm trying to make it sustainable like I I guess what I'm getting at is different levels of self-awareness around adherence even within that population of people right yeah they do there are people who think they're doing it and you follow up with them and say this is one of the things we told you not to eat oh I didn't understand that I thought it was the other way but two of my favorite words in my field that you're kind of getting at is Effectiveness and efficacy and so in some of the studies that you do some of the some of the scientists will publish two things one is the intention to treat and one is per protocol is one of the ways to frame it an intention to treat is here's what everybody did what if you had somebody that you assigned to ornish and in the middle they hated it and they went Atkins and you know they did because you look at what they're eating you have to include them in the results and you have to keep them in the ornish group so that's intention to treat where there's a lot of there's a lot of variability because of that protocol is we only took the people who did it right and that's usually a much smaller subset of the population and it's a quite relevant question so if you followed it as designed this would have been the result so it's nice to know the efficacy results of if you did it this would happen and also see yeah but when you randomly assign people most people don't do it both of those our important perspective has to be infuriating for you I mean as as fascinating and as curious as that is it's got to be frustrating but it's less frustrating than doing a rat study keeping them in a cage feeding them exactly what you wanted and Reporting and flipping the news that this thing happened and seeing yeah but humans don't do that and so this isn't helping humans because we have to do this and understand someone got divorced someone got in a car accident someone lost their job life happened to them and this is what happens in Life or more realistically some of those very restrictive diets are good short term but personally I I really don't like the word diet in terms of I went on a diet that I'm going to go off as soon as I get what I need out of it diet should be a noun this is this is my diet I eat this way I'm going to eat this way for the rest of my life and so when you see these really restrictive diets they have short-term results but that's because the practicality you can do restrictive things for a few weeks or a month but you can't do them long term and when you go back to the old diet all the things that were plaguing you before come back and it's not effective right if you're a Gen X dude like me then skin care can feel a little indulgent but I actually wish that I didn't wait until my 50s to take care of my skin a little bit better because hey it's our largest organ it's essential to health and it's our first line of defense against environmental aggressors the fact is as we age our mitochondria generate less energy so anything that you can do to boost these little power plants is absolutely huge timelines worked it out in their nutrition 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did it yeah you see controversial yes maybe not maybe maybe not in 2023 okay but yeah I'm not sure I want to go there but yes that was a yeah an experiment gone awry but this idea of of trying to understand this uh unpredictable variability in weight loss and weight gain that came out of the say to Z uh study I gather that that must have been top of Mind in trying to uh design this diet fit study where you're going to look at some unique uh factors that maybe hadn't been looked at before at least with rigor in terms of nutrition and weight loss by pitting low-fat a low-fat diet against a low carb diet and looking not just at weight loss weight gain or some of the typical biomarkers but by honing in on insulin resistance and metabolic Health as well as genotype yeah so the fun at finishing that A to Z study again was seeing that variable response and thinking okay the cool question here is not which diet is better it's which diet is better for whom there must be some pre there aren't there predisposing factors so instead of telling the American public or the global Community here's the best diet what if there's a factor that predisposes you to doing better on one than that doesn't that make a lot of sense yeah we should go after some of those and so after we finished A to Z two things happened one is a group approached us and said can we look at your DNA and there was a signal in the DNA about a possible genetic predisposition it had to do with single nuclear polymorphisms nucleotide polymorphisms Snips and they had these two genotype patterns a low carb genotype pattern and a low-fat genotype pattern and retrospectively it looked like it would have worked in A to Z but that's more of a hypothesis generating approach by digging into old data and the more rigorous one would be okay now that we have these genotype patterns let's design a new trial and test it and the idea being that or the expectation perhaps being that somebody who has a certain um genotype for uh for doing well on a on a low carb diet is going to fare better versus the vice versa right and it should play out if we conduct this study and pretty easy if you just mismatch them so have some matched and some mismatched the other one that came out right about the time that we were finishing was a slew of relatively small short-term studies that focused on this insulin resistance idea and I found this super appealing or just intuitively appealing because I'm trying to look for what would be predisposing factors and people with insulin resistance have a hard time putting away carbs and so it doesn't really say it in the name but every low-fat diet is a high carb diet I don't know if you want to go here but protein across many many different diets barely budges it's almost always 20 sometimes the reviewers want to make sure I've matched for protein and maybe on another day we'll discuss I don't have to like protein always ends up about 20 of calories in a if you're just eating a variety of range of foods even if you manipulate low carb and low fat so it's all I wanted to do was do low carb or low fat and if you're low fat which carbs are you eating like you could be eating lentils and squash and whole grains or you could be drinking Coke and you could be having white flour tortillas and white flour bagels and donuts so we said all right let's do this thing let's only do low carb and low fat and let's do the genotype thing and the insulin resistance thing and so for insulin resistance uh it's actually a trigger trickier term than most people might imagine I bet a lot of your listeners have heard of insulin resistance it's not a dichotomous thing it's not like you are or you aren't there's a Continuum and there's multiple ways to measure it and some can be done with a fasting blood draw which is not as accurate as this thing called an oral glucose tolerance test you probably don't want to get too much into the weeds but on an empty stomach you have to drink 75 grams of glucose on an empty stomach glucose just flies into your bloodstream and you can monitor the insulin response to that and your pancreas freaks out thinking oh my God I have to put this glucose away here's how much insulin I'm going to spit out to get that put away in cells and if you're insulin resistance you see this huge Spike in insulin and you basically have to kind of cut people at the median there isn't a number that says your insulin resistance what you'll find is some people spit out a lot of insulin some people spit out very little and put it all away but you can Define it and so that's what we did the whole study was designed to say okay could genotype pattern or insulin resistance be part of the explanation for this huge variability in what we're seeing and one small feeding study did this with 20 people another did it with 24 people David Ludwig did it with 73 young adults those sort of three different studies that had approached this and all reported the same thing that if you can identify them ahead of time being insulin resistant then they do better on low carb because they have fewer carbs to put away now one of the things that's really a challenge here is defining low carbon low fat so one of the ways to do it is just say lower than yesterday right now so I've I've often asked students in my class okay what if I put index cards in front of each one of you and I ask you to Define low carb or low fat is it a gram amount is it a percent of calories would you all agree on the same thing so and this is true to my nature I hope this is part of what you were recognizing at the beginning of our talk I I knew not to give it a number I knew not to give it a gram amount or a percent and I did this thing that I maybe I got away with and I don't know if your listeners will appreciate this but this is compellingly what we called it the limbo titrate quality method which Probably sounds horrible and let me try to no it sounds super sexy okay explain here's how sexy it is we said okay we really want you to feel like you are in a weight loss diet study and you are expected to change your diet a lot so whatever carb or fat amount you're eating depending on which group you're assigned to you have to go to 20 grams of carb or 20 grams of fat most people eat 300 grams a day of carbs ish so 20 is enormous most people eat 100 grams of fat ish they had to go down to 20. but we said we we have some experience with these really restrictive diets and we know people can't stick with them so this is almost like we never confirmed or affirmed or anything that they got to 20 and we said you we won't be kicked out if you don't get there we just want to psychologically anchor you so that you know you're in a diet study and you're removing all the sources of fat and carb that you can out of your diet that's the limbo face we want to do that in eight weeks ish and some type aaa's got there in two weeks and at eight weeks some of the people weren't quite there so kind of all at their own speed we actually didn't even do any diet assessment at eight weeks the first diet assessment was at three months because we said once you got there as low as you can stay for a week or two if you can but if you don't think you could handle that socially culturally if you're hungry if you can't look Us in the eye and say yeah doc I could if this works I could do this for the rest of my life if you're not there yet add some back do this titrate thing so add a little fatter car back add a little more if you're still not there add a little more oh is the weight coming back on and you feel like that was fun losing weight you want to go back down again so you can titrate up or down but try to look Us in the eye and say I found this place and this is it man this is the lowest I could go and we kind of gave them all an out as they started the study we said you're going to have these classes with a bunch of other folks from your study and you're going to look across the table and somebody's going to say wow I'm nailing this I got this super low and I feel great and you're gonna You're Gonna Save that oh man I'm struggling and I'm not as low as you part of this study was because of the genotype thing and the insulin resistance we're actually betting that some of you can't go as low as the others that's part of the study so don't feel bad don't feel like you're psychologically not prepared for this think that you're metabolically or genotypically predisposed that's part of the study be okay with yourself and just help us test this so they all had an out they were just supposed to go as low as they could titrate up and the quality part was really important to me and I think is an important part of the conclusion so he said and you can't do this with low-fat brownies or low carb chocolate chip cookies you you have to go to buy food you should go to the market farmer's market and Shop you should try to have a salad every day both groups low carbon low fat should have a salad every day one of the common themes was please get rid of as much added sugar as you can please get rid of all the white flour that you can the refined grain and after that eat a quality low fat and a quality low carb and they did so if you track this out and you read our paper you'll see all the diet stuff that they and there were ranges some people were more successful than others but they really ate a pretty good quality low-fat and low carb diet and at the end drum roll after a year Not only was there no difference between low carb and low fat which there wasn't on average they both lost 11 to 12 pounds at the end of a year but the genotype pattern and the insulin resistance thing both failed to be an effect modifier or to predict as a predictor any right of the variability which stood in contrast to these short-term studies where they fed them food and they did it with 20 people or 70 people and so writing up the discussion we have to say you know our results differ from those others why would I actually totally expected this to work I actually was a little skeptical of the genotype thing I totally expected the insulin resistance thing to work and I looked at it again and again and again and it didn't work I thought you know maybe that's because this low-fat group that they were worried about that had high carbs for people who are insulin resistant they got rid of their added sugars and they're refined grains and so maybe those people who in other maybe that's what they were eating on some of these other studies and that was part of the reason for the effect they saw that we didn't see that was our explanation of why don't these two nutrition studies agree well because not all low carb and low-fat studies are the same you can set up a study maybe subconsciously maybe consciously to make a kick-ass diet a and a crappy diet B if you're a diet a proponent sure that happens all the time kick ass B crappy diet a if you're a diet B proponent our incentive here was ah God if everybody loses 100 pounds we're going to be famous so let's make both diets the best we can in fact the health Educators that we're teaching these Health classes had to teach both low-fat and low carb throughout the whole study so that even if you know one of the health Educators was more inspiring or motivating in another both groups were getting that same person yeah I get it in other words what you're saying is if you go in with a bias or you're trying to establish that your Camp is better than the other and you're pitting two dietary protocols against each other the one that you're in favor of you will Design to be very clean in Whole Food and kind of the best version of what that has to offer whereas the competitor will be the low-grade version that you know is not going to do well because it's it's an uncharitable interpretation of that right but I guess what I so it's again like wow we didn't figure out what we thought we were going to figure out and where does that leave us and what do we make of this and what can we extrapolate from this and what can we not like I think about um I would imagine that maybe a Critic would say uh well you hear this all the time like well your low fat wasn't low fat enough like if it was it was if it was really low fat you would have gotten the result that I know that you would have gotten and conversely you know your your low carb that wasn't low carb like look at what they were eating that's not I when I say low carb I mean this that's not what you did and then um sort of an ancillary uh critique could possibly be well how many genotypes did you test for right yeah three like how many are there like you just picked the wrong ones yeah you pick the right ones you would have seen what you were expecting to see there is another genotype paper that's coming out soon so I know there will be a delay from the time we have this conversation to when it comes out but there'll be another genotype paper that shows genotype didn't work but again there's probably a million different genotype options here to pick from and so you pick the one that makes the most sense another one again this is a Time issue I just got an email this morning from a postdoctoral research fellow who went back to our diet fit study and took the 10 percent of the people who were the lowest fat and the lowest carb got rid of the other 90 percent and pitted them head to head there's really no difference so here we are like I don't know 50 minutes into this conversation and you know I'm trying to sit in the chair of the listener thinking well all right so far what have I learned you've got what to do you've learned to eat a good quality diet so really what I'm after here in in doing my studies is to show that there it's not that there's disagreement here if you put this in context and said and see that we had a good quality low carb and a good quality low fat that's better than you're gonna you're gonna farewell yeah and that's already it goes also to this adherence and self-awareness issue which is if you I would imagine if you pulled you know 100 000 average people and ask them what they eat they would probably report that they're eating better than they actually are right and so we have these arguments around the margins around low carb low fat Etc uh when in reality the low-hanging fruit and the real issue that we should be looking at is you know what are the big areas on which there is just incredible consensus amongst the scientific community in terms of what we should be doing and and what we shouldn't be doing yeah and we just published a study on that from the American Heart Association if we can go there yeah yeah because it's sort of like start here and if you can do that then do this so I'll start describing what the the point of this scientific advisory was it came out in April of 2023 uh the American Heart Association has regularly for 50 years updated their dietary guidelines and the previous most recent update was 2006 and in 2021 they did it again didn't honestly change all that much but they refined a few things and they spent a ton of time in this paper looking all the literature that was available before 2006 and between 2006 and 2021 here's all the data we have on who has a heart attack myocardial infarction stroke any kind of cardiovascular disease here's 10 domains that cover a heart-healthy diet and those are sort of individual things about whole grains and veggies and beans and salt and saturated fat and they said here's the things to include or avoid and then the public said so does what does that mean should I be vegan or should I be Mediterranean or should I be paleo I said ah you know what we should do another paper on patterns so instead of individual components how many of these popular dietary patterns out there could be consistent with this set of domains in other words like the overlap in the Venn diagram between all of these different perspectives and so I want to focus on the overlap at first so that 10 patterns we picked were the dashed diet that's the dietary approaches to stop hypertension Mediterranean three types of vegetarians who had Pesca who had the ovo lacto vegetarian red vegan sort of a higher fat vegan we also had a really low-fat vegan diet we had a low carb a low fat a Paleo and a keto I hope that was 10 because we had 10 patterns and we tried to match them up to the 10 domains and we scored them from high to low and dash and Mediterranean got the best score and paleo and keto got the worst score as you were matching these domains and happy to go into some of those details if you want but one of my takeaways that I thought was great was across all 10. they all set more vegetables more Whole Foods less added sugar and less refined grain across all 10. now this could be a trivial response if those are things we already did those are four of the biggest problems with the U.S diet we don't eat many vegetables we eat a lot of ultra processed food we had a crap ton of added sugar and a crap ton of refined grain so for me this is a Kumbaya moment oh my God all the patterns agree on 50 percent of probably what plagues human health associated with diet why don't we all get together and work on that that's no fun ah yes it's not as the click bait doesn't work but we really oh agree on those and those are all big issues the one extra one I'd love to add in there is beans I actually think eating more beans is probably the biggest thing Americans could do to change their diet in a positive way and there's so many kinds of beans culturally appropriate lots of unapologetically delicious dishes with lentils and chickpeas and kidney beans and refried beans oh my God but you wouldn't get the Paleo and keto in there right because they're they're super low carb and beans are full of carbs so if you after the the four things I mentioned first that they all agree on the next ones I would add would be beans next yeah I mean I like that way of looking at it like this heat map sort of um perspective that allows you to transcend all the labels and the tribalism and all of that and really just focus on you know this is I think you've characterized this as being like 50 of the but it's it's kind of like 90 90 isn't it I mean it's really like if you do those four things and then maybe the fifth with the beans like you're on the five yard line pretty much right and in a nut so and another way to appreciate uh to yeah acknowledge that appreciate it is I do think there are Arguments for some of these low carb low-fat high protein individuals for whom and when at the margin yeah the margins you've got the foundation right so there'd be a lot less bickering if yeah I do all these things and huh and I actually prefer avocado to steel cut oats or something I I prefer this higher protein to this higher carb whatever yeah I think you could hedge your bets and at that point sort of biohack your own metabolism and come up with something that's a little better for you than the other thing but can you please fix the first 50 or 90 percent because we all agree on that and you're doing that wrong right so this first tier of the heat map less added sugar less refined grains way more starchy veg more Whole Foods less Ultra processed foods and then with the footnote around beans but then there's a tear just below this right okay we've done that now how do we get to the next level and flip that one little thing you said starchy veg so the one things they all agree on is non-starchy that's what I meant to say sorry about broccoli cauliflower leafy greens red bell peppers um but then then you get to the the avocado the avocados the nuts the seeds the olive oil fruits or we can eat fish or we can eat eggs like that kind of all falls into that next tier yeah we've got beans with leptins oh my God no no please just take one moment like let's go on a like put a pin in what we're talking about and just explain this lectin thing quickly yeah so well there's there's different things in plants there's fibrous things there you know fiber is great for the microbiome plants are toxic fiber binds some things and sucks it out of you in in your feces when it leaves but really the fiber was awesome for your microbiome and it came with lots of the plant foods that generated the fiber had lots of nutrients there's phytates there's oxalates there's there's lectins there's there's a couple things that are less than a hundred percent perfect but to avoid those would mean you'd be avoiding getting all the fabulous things that come with it and in my sort of you're talking about this this core that has a second ring and my second ring is beans oh my God reluctance fruits oh my God they have sugar nuts oh my God they have fat eggs oh my God they have cholesterol fish oh my God they have a face you know at that at that second level the lectins don't matter the sugar and fruits is fine it's in the food Matrix the nuts have unsaturated fat so that next tier of foods is pretty good um but it's at the margin after you deal that thing in the middle and let's assume we've now mastered this tier okay what comes next ah where are we gonna we're gonna go behind the Velvet Rope and yeah you know put the cherry on top of the sundae yeah so to be honest Americans eat too much wheat they eat too much grain they even eat too much whole grain bread so kind of cracks me up going from uh white flour to oh I used to buy Wonder Bread now I buy my local whole wheat bread or I buy my grocery store whole wheat bread well if you look some of the whole wheat grocery breads have 30 ingredients in them so we're like at this Ultra processed thing where there's dyes and additives and emulsifiers there's the whole wheat bread that has five ingredients that's all you need for bread right I think you need some flour and water and yeast and sugar and what's the last salt a little bit of sodium would make the bread I actually make a kick-ass wheat berry salad people say what what's a wheat berry and say that's the grain that you make the flour out of so instead of grinding it all to a powder and consuming it in bread you can soak it and add all the things that I add to my wheat berry salad which I'm happy to elaborate on if you ask me it but I'll start first with this fun thing about glycemic index so glycemic indexes how fast the glucose from the food you're eating ends up in your blood and a shocking thing for people who read into this and look it up is that white flower bread and whole wheat bread have the same glycemic index it's like wait very high high glycemic index is not good I I switched from white flour to whole wheat flour how why wasn't that better and the reason it wasn't better is because it was ground to a powder and most of the digestion was done so the time it takes you to eat it and absorb it is really small if you had used the whole grain which is the wheat berry it would have taken much longer for your enzymes to digest it and make the molecules small enough to absorb so the wheat berry salad glycemic index is quite low because it takes a long time so you're saying go to the next level of these concentric rings so grains so a funny thing that I learned from doing some studies related to protein and trying to figure out where our protein comes from is looking at the usda's fabulous website of all the food we produce and what we eat and under grains it's said okay grains include oats and barley and wheat and this other thing but because Americans uh 90 of the grains that eat are wheat we're simply using the value for wheat for this thing that we're analyzing and I stopped for a moment I said really has all these grains out there and 90 of what Americans eat is wheat and most of that is bread right pizza crust Donuts uh you know some kind of bread like things so at that next level I think it's grains so I've actually I hosted a debate one time between a Paleo person and a Mediterranean person in a middle of the road person and I tried to force them to say what do you agree on I know you guys disagree on some things what do you agree on and the first thing I got them all to agree on that people didn't expect was grains even like the vegan person said uh yeah if I was going to get rid of anything next it would be grains because so much of it is refined even even the whole grain bread so I'll pause for a minute there to see what you thought of that because if it was go ahead yeah no I mean I would say that yes of course if you're eating the whole grain and even better the sprouted version of the whole grain you're eating a very nutritious food uh it's difficult to find the whole grain and even more difficult to sprout it yourself or find it in sprouted form so even and because of the way packaging works very often we think we're eating whole grains when we're we're not as to your point right so this has led to you know a valid criticism of grains for their high glycemic uh you know impact and their the fact that they're sort of devoid of any nutritional value when they're in that refined form so there's this vilification of grains that makes it very difficult to have the conversation around the appropriateness or the nutritional value of the whole grain such that if you raise that to the Paleo Community or whatever other you know kind of dietary tribe they will bristle at the idea that you that there is a place for incorporating healthy whole grains into your daily routine and they could find data they could pull up a study that said look what happens to the people who eat grains and what we really need is the study that said okay they had steel cut oats for breakfast and they had a barley soup and they had Christopher's Kick-Ass wheat berry salad for dinner what happened to them that we don't have that study the grains are wheat and it's mostly refined and I I can see why there's some adverse studies when we sure overdo that and then kind of Beyond these generalizations that's when we get into uh the charting of of undocumented terrain with respect to personalizing your nutrition right which is some of the kind of emergent work that you're doing um which I think is really interesting and well hopefully in time account for some of these findings that you've discovered in your studies where different people are having you know different you know responses to these dietary protocols in a way that you know to date you've been struggling to account for yep and we could do some microbiome stuff if you want or we could wait till later I want to wait till later for that because there are a couple other things I want to I want to get into I mean there's so many studies I don't know that we can go through all of them I mean you did this keto Med trial in in 2022. you know I guess in in in a nutshell like without going through the whole the whole rigmarole of this like it was kind of the same right like okay like if you're doing this right we're getting good results for both of these communities what do we make of that what are we supposed to do with that information quality of food maybe is of more Paramount importance than how this macro nutrient breakdown is is being kind of applied to these two groups I mean in the wake of that like again it goes to generalizations and perhaps this personalized nutrition kind of piece yeah and keto Med we're really hanging on everything we talked about so far so I'm very frustrated with keto this idea that no beans no fruits no grains that's just contrary to every Public Health diet recommendation across a planet no refined grain no added sugars that's also consistent with Keto and all the rest so we set up these two diets to be compared to one another where both groups ate as many vegetables as they could and absence of added sugar and refined grain so those are matched this is sort of this this the fun for me in designing a study is what do you match and what don't you match to make it realistic so those were matched but opposites on grains beans and fruits so Mediterranean yes encouraging all those keto no don't have any of those and my hypothesis was if you get rid of the dam added sugar and refined grain that is 90 of the battle and that's pretty much what happened in the study and so without going into all the details if you if you could follow those first three pieces of the advice yes vegetables no added sugar or fine grain yes your glycosylated hemo would would improve your blood sugar would be down um you'd be monitoring that so on on this study LDL cholesterol went up on keto and down in Mediterranean triglycerides actually got better on keto they got better on Mediterranean but keto was even more better why would you get rid of beans and Grains and fruits if if you could include them and that's that's what I was having like that's that's too restrictive why would you need to go to that level if you took care of 90 of the problem first you could still enjoy those interesting I think on a psychological level for some people it's if you if regardless of the how restrictive the protocol is there's something easy or comforting about the fact that you can just say these are off the table and you can eat these things and so it makes that decision tree a little bit simpler and even if it's challenging from a sustainability point of view there's something about the Simplicity of it that makes adherence perhaps easier or a little bit better have you found that yeah and again that's as you started out our conversation yeah this adherence to whatever the guideline is for a study is a huge component of this I don't really want to go into into intermittent fasting but I will bring it up just for the moment because I don't like intermittent fasting there's no attention to the quality of the diet it's just a time thing but I understand why Americans like it let's see should I eat now let me look at my watch no should I eat now let me look at my watch yes ah thank God that is so clear yeah it's it's really I agree that it's clear but I know some people who eat a pretty crappy diet intermittently fasting in that long term that isn't going to do it eat crappy food in a narrow window you're still going to have to eat good food it's not enough so as somebody who's incredibly steeped in nutrition science who intimately knows the details the benefits the pros the cons of every single you know kind of protocol out there popular protocol keto low carb low fat vegan you know Etc you have been personally like eating a plant-based diet for a very long time since 83. so knowing what you know and seeing that people can do well on a Mediterranean diet Etc like why have you decided to eat this way like there is an argument to be said for like this is the guy who spends who's devoted his entire life to looking at all this stuff here's what he's learned but like let's just eat what he like why don't we just let's just do what he does yeah so walk me through why you're plant-based or you know how that fits into you as a human but also as a scientist yeah it really all started out with a girl I got dumped by 1983. from Marina Del Rey in your neighborhood here okay yeah are you having a moment being back here yeah I drove past the area where I was on the beach where I got dumped it's on the way 40 years ago yeah so that was kind of funny so I I Did It for the Girl and then I was like ah wow this is personally aligned with my values more actually had never been hunting I actually hated fishing I thought that's pretty funny that I could be eating all this food and have it be inconsistent with my personal values I'm liking this oh I'm liking the people that I'm eating this is fun I'm a pretty active person I play multiple Sports and I would never want my sports performance to be impaired by this or my physical activity level I I've never really been overweight I certainly want to maintain a healthy weight be active be sharp yeah it's supported that over the years so 83 on I went vegetarian and then I teach a class at Stanford called food and society and I've now been teaching it for 15 years and this is a pediatrician named Tom Robinson and I who got into this years ago and there's a background story that I'll spare you it's actually all done to collect data from Stanford students it was going to be a one-year thing and we decided for fun it would be a food related course but we would never talk about health we had a handshake and said okay in this class we're it's going to be called food and Society and we're going to deal with animal rights and Welfare environment and climate change human labor abuses and slaughterhouses and fast food restaurants but let's not talk any metabolism or any health and it was career changing for me to hear the students be very engaged in social justice issues and they most of them reported changing their diet in class and we actually published a paper on this but let's let's put the paper aside one of the books we read was Jonathan saffron force uh eating animals animals yeah I went vegan it's like oh yeah I've been having Dairy all this time oh yeah all the the male cows go to Veal Slaughter and all the cows making milk go in this Factory process and it sounds pretty horrible why am I supporting that since I'm not supporting other things so I can't remember exactly what I don't know it's 10 or 15 years ago but when vegan and I would say my personal philosophy is you don't need to be vegan I actually would I prefer the term Whole Food plant-based but part of the reason I keep doing it is I kind of feel a personal responsibility like hey I'm 64 and I'm I'm pretty active shouldn't I stay this way just so I can hopefully I'll be 75 and then 85 and 95 and say you could do this kind of like the game changers documentary I don't think that documentary was saying you have to do this to be a good athlete I hope to take your message was you could you could do this in your athletic performance would not suffer so I've done it uh and this is actually what my book is getting at so this book that's coming out that won't be called it depends each chapter in the book says here's the metabolism that's going on and here's the reasons it might be good or bad for you if you want to ask an answerable question about whether to avoid it or eat it but I know for a lot of people part of that answer to choose it or avoid it is ethical or is environmental or is human labor Associated so what if what if you actually don't believe in the metabolism or think the metabolism is important for you but the ethics are or the environment is or the human labor is and if if you put all those together they are all well aligned with a plant-based diet if you add those three other factors and I not only is it well aligned but I think for a lot of people aligning with your personal values is more of a motivator to be able to sustain it then knowing the metabolism and the enzyme and the organ that it goes to and you know it's the kind of thing where you see this food in front of you and you just say okay if it's a metabolic thing I know I'm going to die someday I know I shouldn't have that but today I will and tomorrow I won't but if you look at it and you say oh it's not just me I that choice is having a bigger impact okay I guess I'm not going to eat it I'm gonna go with a whole food plant-based diet and in that regard for the people who are headed toward vegan but stop short and they have eggs once in a while and they have some fish once in a while and I can't point to a health benefit that is for 100 vegan versus 95. I don't think anybody's ever done that study yeah but in other words what you're saying is not only is it doable and healthy to eat this way it's sustained you for a very long time you're thriving and vital you know at your age and have every expectation of being able to continue to do the active things that you love doing you're not sacrificing anything by living this way and you're able to sustain maintain um this way of life because it's tied to a bigger why yeah not just about like what I want and my blood markers or whatever my doctor told me but you know there's a there's an ethical you know responsibility or or or not obligation but you know just that that that deeper sense of like can I be a little bit of a better person or is there a better choice that I could make right here that has a consequence that's beyond my selfish you know uh uh taste buds in this moment yeah and that Jonathan saffron Boar's book was so uh inspirational for me there is one lying almost exactly what you said and I won't be able to quote it but two friends go to a store and they both want to order a hamburger and one has it because they want to have the taste the other one says that I really would like the taste but it doesn't seem worth my preference for taste for all the consequences this this is going to happen and are used like uh self-experimenter where you're always testing your own blood and your markers and all that kind of stuff yeah because I get to just do that to other people yeah okay no yeah I get to look at my tmao and my LDL and my small dense ldls and my yeah all the other things it's all good I presume yeah I'm pretty good and I have a massive amount of heart disease in my family my dad died after 10 cardiovascular procedures wow my uncle died at 40 of a heart attack and so yeah I'm at risk of tons of things and I haven't had any cardiovascular procedures the 64 and I'm pretty active and so I I can't prove that it's my diet but I'd certainly rather take that chance and to your point earlier I'm not sacrificing anything I really enjoy the food that I eat if you look at Middle Eastern food Latin American African food I mean there's so many cultures Asian food so many cultures around the world that make fabulous tasting food my new friends are chefs I've sort of switched to hanging out trying to do studies with chefs because they make unapologetically delicious food and a lot of it is plant-based yeah I want to get to that but let me let's let's push that aside for a moment there is we were speaking a moment ago about revising dietary guidelines and how to think about um you know what's traditionally known as the food pyramid or the plate or what have you and I remember it wasn't that long ago there was there were some ripples around those guidelines being impacted by the environmental considerations of the food that we're eating and that caused quite a kerfuffle publicly people didn't like that yeah but you know to your point that you just made it seems like that should be a consideration like we all have a greater obligation to the whole yes Beyond ourselves and these decisions that we're making every single day do have a real world impact as much as we want to avoid really connecting with that um and I think that's something that you've clearly spent a lot of time thinking about I would suspect that you would be a in favor of those considerations being built into the recommendation structure I mean how do you feel about that I feel very strongly and I had the opportunity to pursue this and write a paper on it called sort of maximizing the optimal amount of protein that would be good for human health and the planet right yep and I got an environmental scientist to work with me and a food industry person to work with me so sort of a multi-disciplinary group looking at this and at the end of the day the conclusion was if you really understand the protein guidelines that are out there people need less than they think they're a little confused about how much they need and they think they need a lot and they need less I also underestimate how much they get because they get a lot more protein than I think they undervalue plant protein they think it's missing amino acids and it isn't they're all there there's a subtle issue about limiting amino acids but let's not go there for now it's not a big deal and it would be we modeled this how easy it would be to cut back 25 protein and still meet and exceed requirements what if you took 25 percent from animal and shifted it to plant you would be fine and here would be the impact on greenhouse gases and water and land use and other things like that you would make a huge difference with that 25 25 shift and that was just modeling it so you could go lower in protein and you could shift it all to plants and you'd have a bigger impact but yeah so I've been having fun writing that and it actually had to do with working with these chefs because they were thinking about this idea of a protein flip if you wanted me to go into that because it's a dietarily it's a pretty fun idea so a group called the menus of change that got started by Harvard and The Culinary Institute of America and the background story for this is pretty fun chefs were getting trained at The Culinary Institute of America going out and being in restaurants and the public just kept changing their mind gluten-free vegan paleo whatever the popular diet of the month was and the educational institution was feeling a little bad for the students they were promoting into the real world saying sorry but you're going to have to be reactive to however the public changes and said maybe not maybe we could get in front of this what if chefs we start defining what the right things to do are and we could serve our own menus and be more proactive than reactive let's let's get a scientific Advisory Board a business board and a chef board and let's put these concentric circles together and let's see some nutritional truths that will never change that make business sense that are culinarily delicious and so let's find this intersection of unapologetically delicious food that's good for humans and good for the planet and you can make money making it and selling it and so they came up with a 24 principles of the menus of change it's pretty easy fine and the CIA is awesome at making Graphics they have fabulous infographics so look for this iconic thing or there's Publications on their 24 principles of the menus of change but one of the interesting things after establishing this was you know what practical food choices could we suggest that hit multiple principles at once like what would be the biggest bang for our buck 24 sounds like a lot of principles do I do them one at a time So at their second annual meeting I remember them saying ah we have this idea called the protein flip it actually came from a previous request we had about the dessert flip and some folks had hired them and said we're getting a lot of flack for how many calories our desserts have in this age of obesity can you help us and they said yeah the dessert flip instead of cheesecake with a raspberry on top have a bowl of raspberries and a dollop of Cheesecake on top it'll be a flip reverse it I didn't take away your cheesecake I also have a smaller portion of it and most of it is fruit and I said kind of thinking a protein flip idea could work here so what if instead of meat being the center of the plate plants were the center of the plate but you didn't get rid of the meat it could be a side dish or a condiment or could be two ounces of fish or chicken on top but not 6 or 12 ounces in the middle and then they freaked out a little and they said oh but wait that protein thing oh my God the American public's gonna freak out they're gonna say where are they going to get their protein Christopher will you do uh at our meeting our second annual meeting can you do protein 101 I said yes I've been teaching this at Stanford for years I have like four hours of lecture materials how much time can I have I said eight minutes hahaha eight oh my God okay okay eight so I boiled it down to what I could and I finished and their mouths were wide open they said no I said no this is the real thing plants have protein they have enough they have all the amino acids they said next year you can have 20 minutes the year after that they gave me an hour the year after that a sports convention invited me to give a two-hour talk and so that paper that I was just describing about maximizing human health and planetary health grab probably 50 talks I've now given on protein I actually never did a controlled randomized trial on it I was actually just looking at metabolism and food and amino acids and starting to hang out with chefs and environmental scientists I'm sort of putting this all together much like the Lancet report did the eat Lancer report in 2019 and it it's all there it totally justifies this protein flip idea which can be unapologetically delicious but plant-based you could leave the meat off if you want to be all Whole Food plant-based or you could leave it on if that's an easier way for you to make this transition and it would make a huge impact for human health and the health of the planet yeah that's really beautifully articulated and and such a a worthy Mission you know but I think in thinking about protein as much as the tribalism lives and breathes around low carb low-fat keto Etc um there is a a really kind of emotional resonance or or persistence around this idea that somehow we're protein lacking and we should be eating more protein not less yeah plant protein is inferior uh yes plants have all the amino acids but something about bioavailable bioavailability blah blah blah it's just not quite as good and if you want to maintain your muscle mass particularly as we age and I'm getting up there as well uh you need to be increasing your protein intake so like walk me through I mean I don't have four hours but I have more than eight minutes to devote to getting some clarity on on this from your perspective yeah and actually there's a meta-analysis by uh Stu Phillips's group I'm blanking on the first author and they recently updated it and I and I don't have the updated paper sort of the conclusion of this meta-analysis looking at multiple studies about resistance training and either muscle mass or muscle strength was trying to show the optimal amount of protein that you need in it it was sort of getting at supplementation like when do you need to supplement and if you look at the conclusion of the paper it says you know once you get to 1.6 grams of protein per kilogram body weight after that it you don't really need supplementation it doesn't really matter and so there's an important Point here is that the recommended daily allowance of protein is 0.8 grams per kilogram body weight so this 1.6 would be double the RDA but I want to walk it back a little before that even so when the nutrition Community came up with this the recommended daily allowance is a principle that holds for lots of different nutrients and what you do is you find sort of the normal distribution of nutrient need and everybody needs slightly different number just depending on how big or active they are whatever and in the protein in particular the average is called the estimated average requirement of protein and it's 0.66 grams per kilogram body weight lower a protein why then is the RDA 0.8 and the whole idea here is if the average requirement is 0.66 and everyone got average but upper half would be screwed they wouldn't be getting enough so in the field of nutrition for vitamins and minerals and protein the RDA is two standard deviations higher than the average requirement this is just a simple principle so think of this answer this question if everybody got exactly the RDA how many people would exceed their requirement and by definition in math that's 97.5 would exceed their requirement okay so 0.8 grams per kilogram per day is intended to exceed the requirement of the American population eating their diet if you look at n Haynes data that's the national health and nutrition examination survey it states that Americans 1.2 to 1.5 grams protein per kilogram body weight so if these muscle Builders are trying to gain weight and they need 1.6 grams per kilogram body weight that's kind of what the American public eats anyway already yeah but my point here is so let me add a Twist to this if you're trying to gain muscle if you're working out hard enough to gain muscle don't you have to eat more calories than the American public and as soon as you eat more calories you you surpassed yeah you're you're automatically no matter what increasing your protein over that and so the idea and Stu Phillips you know we had a conversation actually on Simon's uh podcast it was billed as a debate that it was going to be the gardener Phillips debate and they were going to go at it and he really doesn't like that 0.8 grams per kilogram by the way he thinks that's wrong and I if you wanted to get into that I could say I agree with some of his points of why it's wrong but I think it's kind of moot because when people eat protein they eat 20 of their calories from protein they eat 2 400 calories a day and they get 1.6 grams per kilogram anyway and one of his the point eight isn't even isn't even anything to discuss yes no one's eating that that little if you got that low that would be an issue but I actually have a textbook that I use uh one of the quotes from the textbook is uh assuming you're eating a reasonable variety of food in the diet if you had no beef no chicken no fish no egg no cheese it would be almost impossible not to get 0.8 grams per kilogram per day just if you were getting enough food so Stu Phillips conclusion is ninety percent of your your muscle strength building maintenance is the workout less than 10 percent is diet and so you don't need protein supplementation you don't even need that extra chicken breast if if you're eating enough food to support your workout you'll most likely get it I know this to be true for myself just based on personal experience when I was training my very hardest in my early and mid mid 40s putting in just you know I don't know 20 hours a week 25 hours a week at the peak and at that time seeing pretty rapid gains in in my fitness and my endurance and having no issues whatsoever building lean muscle mass and my protein intake which I was pretty closely monitoring just was not excessive at all yeah and it made me realize like there's so much misplaced emphasis or concern on this particular macronutrient and if you're just randomly grazing even predominantly on plant-based Foods Nature has it rigged that you're going to be taken care of had nature not had it rigged maybe we wouldn't have made it yeah like it's it's built in yes it's a it's a Fail-Safe sort of you know eat it and forget it sort of thing and yet this idea continues to really you know become an obsession for a lot of people and and there is a lot of discussion right now around what to do when we're aging so does that change as you get into your mid 60s like in you really have to worry about maintaining your muscle mass because that's such a primary factor in terms of longevity yeah and so that's not not an area of specialization for me and so I haven't done any studies in that area but you know when I talk to people about sarcopenia muscle loss issues like that yes protein in the diet is an issue but a bigger issue for sarcopenia is dentition loneliness depression being in a facility you know a retirement facility where the food doesn't taste it's just not eating enough food and so if you weren't eating enough food yes you should get a higher concentration of protein in the small amount of food that you're eating but if you were physically and mentally active and out there and working out you probably wouldn't need that much more protein it would it's some of these other related issues to muscle loss as you age having a more sedentary lifestyle it's much more complex than not getting enough protein I would be all in favor of saying yes and this isn't true so the US has not upgraded the RDA for older adults it's still 0.8 grams per kilogram people have said make it 1.0 grams per kilogram body weight I would be fine with that if if you did have access to a reasonable amount of variety in your diet you'd easily surpass that right interesting if you're not then you might not have access to that food there might be what if there's food insecurity nutrition and security issues going on what if you are lonely or depressed what if you don't like the food that they're serving in the retirement community what if you really are sedentary there are a lot of issues to address there interesting yeah I uh that makes a lot of sense um it's hard to talk about longevity in terms of specific variables like that because there are so many things that come into play and I think the community piece the connection piece the sense of purpose the ikigai and all of that probably is the most predominant like as you age losing that sense of connection and purpose in your life yeah leads to Rapid decline probably more so than your protein yeah yeah it's it's one of those things with people yeah I think the protein issue could be relevant at the margin there are a lot of other issues to address continuing this exploration of protein uh another thing that there's a lot of energy around right now is is um the health implications of of plant-based meat uh these these Burger analogs Etc um these processed versions of meat products that have found their way into mainstream culture all the way to the Fast Food Outlet such that now we are blessed with choice we don't have to get a cheeseburger we can get a beyond meat Burger we can get an impossible Burger but I think a lot of people are are wondering well okay it's not meat but it's processed there seems to be you know a fair amount of chemicals in these things or saturated fat like is this really better for me than the the regular burger is it worse are they the same this question occurred to you yes you said well let's look into this and figure it out so walk me through this swap meet trial that you did okay and first I hope everybody will appreciate the acronym swap meet means sub uh study with appetizing plant food a meat eating alternative trial oh I didn't even know that I just thought swap meet of course that's what you know it makes sense on its face we're pretty happy with our acronym so I hope you like that yeah that's very cheeky and uh what came to me was three full-page ads in the New York Times from uh meet supporting group saying oh my God don't eat these plant-based alternative Meats they're practically dog food they're all Ultra processed yes maybe they're better for the environment for these things that they're saving but they're going to be bad for your health because they have saturated fat from the coconut oil they have high sodium and they're also processed and Kevin Hall did a beautiful study on gaining weight with ultra processed food so you don't don't want to gain weight have high blood pressure have high LDL cholesterol don't eat them and I thought oh my god this is my superpower I know how to design studies looking at exactly those things me me call on me okay so um full acknowledgment here Beyond me paid for this study I am an industry shill for having taken the money well let's just let's would the NIH have given me money yeah I don't think so and it was a relevant question and so I I applied the most rigor I could but I just want to acknowledge that up front and let's ruminate in that subject just for a moment though because I think it's important um obviously when you see a study uh that was paid for by a lobbying group uh and the results of that study favor the lobbying group's political perspective you're going to question it right when the dairy when you see this study that says chocolate milk is the world's best you know recovery drink and you see that it was paid for by the dairy Lobby well I'm like all right well really is that what's going on here um likewise it's low hanging fruit criticism for you to say well beyond meat paid for this yeah we'll get into the results but the results were not unfavorable the beyond meat in this regard so uh you know uh duh right so the truth being that it is more complicated than that in terms of how these studies are structured and where the firewalls are placed and that applies to whether the dairy Lobby paid for our study or beyond meat paid for a study yeah so you should be skeptical but you shouldn't dismiss it so a lot of studies wouldn't get done if they didn't get paid for by the food industry so you should take the time to look at it and if you don't understand it ask somebody to explain the pros and cons of the study design and quite often the bias is blatant and in our study we took every opportunity possible to make this objective science and I stand by it to this day so put it aside for now and talk about the study yeah except to say also on top of that because I want to be I don't want to come off biased either like you know um I'm sure you would have preferred private funding or the NIH to have funded this yes and so that's a broader conversation around how the whole ecosystem of securing funding for these studies operates right like it's a it's hard to get money to do these things and they are expensive and on one level you got to take the money wherever you can get it try to protect the protocols as best as you can um but there's also I'm sure compromises that you had to make or have seen your colleagues make because is doing the study better uh than not doing it right because of yeah Source Etc like again you know it depends right like it depends applies to this it does well yeah I part of my I actually had a big tutorial before I released the study showing here's the things I did to protect the objectivity of the science so if you ever want to look for my tutorial on that which was part of it I will just say was Six industry-funded studies that I did that all failed they were all null findings I published all of them so that's just part of my defense I I did the science they didn't work I published the null findings did they did not want you to publish or just sometimes they say if it's negative you can't publish is that part of the no so Stanford won't let me take the money unless I get to publish whatever I find so some very strict guidelines that Stanford doesn't want their name brand sacrificed for this yeah no I have to get to publish and they can't have any say over it even if it's no right but all right go forward going forward so real fun in designing this study was what do we control for what do we let run wild um what do we provide what do we not provide what's the comparison group one of the first questions is what's the dose so if we want to do this what's the dose should we say uh Beyond Burger once a week that's not enough Beyond Burger every day uh I'm not even sure if that's enough all you get is beyond burger or red meat okay that nobody's gonna do that so this is supposed to be for eight weeks each so we can see cardio metabolic risk factors to change so here's one of these questions that you started in your original conversation we decided two servings a day of red meat or beyond me could some somebody could say what about three what about one and a half yes we only did it with two so I can only answer this with two What proportion of your calories was that it was a quarter of their calories so three quarters of their calories they were getting themselves on their own and they were responsible for it and in the Run whatever they wanted whatever they wanted with the acceptance you said as part of this study we're not going to provide the rest of the food we will deliver the beyond meat or the red meat but the rest like if let's just take a burger for a simple example if you're we really want you to have the whole grain bun and the arugula lettuce and the farmer's market tomato on there with Organic ketchup if you do that for one phase it's a crossover everybody was doing both you have to do it for the other phase two if and we don't want this if you have a white bun and iceberg lettuce and high sugar ketchup or something on one phase you have to have it on the other face so that the other 75 percent is as close as possible between the two phases and the only thing different is this 25 of calories from two servings a day of beyond meat and it wasn't just Burgers so beyond meat makes crumbles and they had a chicken at that point and they had sausages and they had patties so we did that and think of this so who could we choose for the red meat should we get crappy red meat so that they have a better chance of winning no we went to a San Francisco company that sourced totally from organic regenerative farming all the right words so that it was high quality and very expensive red meat that we were delivering and in parallel we would deliver the same proportion of burgers versus ground beef versus chicken versus sausage that they want there's a little a little personalization there you got to choose whatever you wanted in the first phase and had to match that in the second phase and then we looked at all the nutrients so what do you get nutrient wise when you do this and it turned out yes beyond meat the coconut oil has saturated fat but it was less than the saturated fat in the red meat um yes the beyond meat has uh sodium added to it and ground beef has no sodium but you know what the participants salted their unsodium containing ground beef and the sodium levels were identical on the two phases interesting uh calorie wise they were totally matched on calories so very similar between the two fiber beyond meat was more fiber uh it was more of certain antioxidants and so we sort of have a whole higher in carb uh protein was the same actually protein was virtually identical because of the way they make their products so we we put these head-to-head in a in a nutrient context to show the relevant nutrients for LDL cholesterol and blood pressure and tmao trimethylamine oxide this thing that gets generated when you have red meat this emerging new risk factor Etc and at the end of the day and we can go back if you need uh in this crossover study with everybody doing both phases on the beyond meat there LDL went down their weight went down their tmao went down and their blood pressure stayed the same on both phases so if you go back to that New York Times front page article that said oh my God this is going to kill you because the LDL cholesterol goes up no it went down uh your weight is going to go up because of the Kevin Hall study nope actually went down a little not up your blood pressure is going to Skyrocket nope stayed the same it was the same amount of sodium and tmao is sort of emerging new thing it's not a typical clinical thing that went down to so nothing got better on red meat then beyond meat and beyond meat had three things that got better than red meat and as soon as I finished people said so this is what you want people to eat not lentils I said no that's not the question the question was instead of red meat I didn't say instead of lentils I've been trying to get people to eat lentils and chickpeas forever and a lot of people won't do it they're still eating their red meat but they might have Beyond or impossible rather than red meat what would happen that's the question right it was very limited to that one comparison yeah um a couple interesting thoughts on that um so just so we're clear each population did eight weeks of each right yeah so not each population the the adult population so 36 individuals right eight weeks of beyond meat and then organic beef and then another in the opposite orders okay okay so so but all of them did it meet first and then beyond meat or some of them did the other way around randomly assigned to order okay so half and half yeah and one interesting Insight was that people who did the pl correct me if I'm wrong people who did the plant-based uh eight weeks first um had uh didn't bump their tmao when they went to the meat as much yeah and this is this is kind of inside baseball but it's pretty fun for me so I'm happy to talk about it it's pretty fun okay quick one step back before I say that so you can do two kinds of studies in an intervention you can do parallel where everybody only does a or only does B or you can do crossover where everybody does both and people like the crossover because they want to compare for themselves how they did in both phases a problem comes up if whatever you did on the first phase influences the second phase hence washouts statistical prop but even with a washout so washouts are quite problematic because it's hard to decide should it be a day or a week or a month explain what that is for people that don't know what to wash out so the washout would be you finish part a and let's say there were changes it would be best if the changes went back to how they were in the beginning when they were randomized so you have to know how much time it would take for everybody to get back and you have them go back to their usual diet for as I said a day or a week or four weeks and our primary outcome in this study according to clinicaltrials.gov was this tmao trimethylamine oxide there aren't really any data on how long it would take to go if it changes how long it would take to go back and we chose not to do a washout my feeling is the phases were eight weeks long the main comparison is week eight versus week eight whatever kind of thing was going on would be washed out anyway by eight weeks and so I'm only going to compare the end we can go back to that if you want but this study had no washout you did one for eight weeks and you search the other one you've got an unexpected result which may have been due to the lack of washout which for me was pretty fun so let's start with the group that got animal first so when they got meat first their tmao went up now interestingly you couldn't be vegetarian to be in the study because we didn't think vegetarians be willing to eat red meat you had to be a meat eater if you were already a meat eater why did their tmao go up well looking back they were really eating one serving a day of red meat so when we moved them to two servings a day of red meat that was higher right tmao went up on average it didn't actually go up in everybody but it went up enough to be statistically significant and that when they switched to the plant-based meat within two weeks it dropped and it stayed down for the next six in that group so I have a beautiful graphic of showing that and it's very clean and then switch to the group that got plant meat first so these were meat eaters their tmao level wasn't very high to begin with it went down a bit certainly didn't go up and after eight weeks they switched to meat and we expected the tmao to shoot up and it didn't it didn't really go up at all so partly this is not what we expected and super fun to think about geekily from science it's like crap there was a carryover effect something that happened in phase one for plant first didn't jive with what happened and the ones who got animal first oh my God now there's sort of a problem for me collapsing the two orders and treating them like they are identical it was actually still statistically significant even when you match them and it didn't happen in one order the overall was still statistically significant but what I thought was really fun was going to the literature saying oh my God how did this happen and what looks like it was the explanation we actually have some stool samples being analyzed right now to see if this is it is on the plant-based diet they changed their microbiome and generating tmao relies on a conversion of these two molecules and meet carnitine and choline in the gut from the microbiome and so if eight weeks of being vegan modified their internal milia their microbiome so they no longer were supporting the microbes that converted to tml meant they were kind of protected in the second phase so as much as it was annoying for me to explain in the study what went on it was also kind of this personalized nutrition cool thing like oh my God they did this thing first and they didn't have the same response as the other folks this is another hint that the microbiome is important right first this this uh very interesting Alliance that you now have with the sonnenbergs yes we I used to call myself a feeder and a bleeder because of all my studies with cholesterol and tmao and Insulin glucose and now I'm a feeder and bleeder and pooper yeah it's all it's all about the poop now right I get poop from everyone which I initially assumed okay this is so icky no one will do this everyone is willing to give their Putin like I never get through discussing the whole study and then mention the poop and they say oh you had me until now but if you want poop I'm out it doesn't happen people are fascinated to learn about their microbiome and they're willing to do it and I have all the in the freezer to prove it it is it is amazing how much poop we have in the freezer people want to know it's a really fun topic and it's so emergent you know it's exciting because it's new and technology has you know sort of progressed to the point where you're able to extract information that wouldn't have been possible not that long ago which makes it like this new frontier and Stanford's working on the smart toilet so it'll collect it oh wow um you know indirectly after you use the toilet there's like a butt imprint so it knows who sat on the toilet or there's a finger imprint on the thing with the Privacy landscape of like now even my toilet has to know what's happening all the time yeah it's I'm imagining uh the powers that be over at Zoe thinking we could we could we could come up with some use cases for the personalized toilet yeah capturing these samples and doing what we do with them it is a really fun New Field wow um just to kind of put a put a button on the whole um swap meet thing I'm interested in the follow-up study that you did where you basically took this and applied it to athletes with a with a tweak um not Stanford versus the athletes but like really active athletic students at Stanford sort of in maybe in some part in response to game changers like how does this swap meet thing work for people who are concerned about you know how fast they can run or how much they can lift right Jim I mean again given this is a protein issue and so many athletes are obsessed with how much protein they get I most of my Studies have been in older adults with cardio metabolic risk factors and they involve blood and poop but a pretty simple thing is strength and performance so I had a master's student who really liked this first idea and she was a runner and she said you know what ideas can you come up with for an honors thesis for me I said God I've been really wanting to work with athletes especially now that I've got into protein and all this bias that you need protein what if we replicated swap meet among athletes and added that arm that people complained to me about added the vegan arm and so now we'll have omnivore versus vegan and vegan plus two servings of plant meat a day and you got you nailed this right so actually this is during the pandemic it had been designed to be done in dining halls with undergrads but they were all gone and the dining Halls were closed she still needed a an honors thesis and so we advertised among grad students who interestingly stayed on campus to do their research they didn't have to go to so many classes so they were allowed to stay and we advertise for only recreational lifters and Runners because so we didn't want a training effect we didn't want while you're on this diet we have to figure out what the training effect is being on we want you to be running at your best right now lifting at your best right now and if you switched your diet would that improve your import performance or impair your performance or or nothing and our hypothesis was nothing it wouldn't change it why not I know the answer to this but why not just go to The Varsity athletes go to the pool go to the track go to the basketball the coaches won't let me touch their teams uh and interestingly I've been approached once in a while by a coach says oh here we have a nutrition Professor on campus so what do you think about this I said well the literature's limited but this uh but if on off season I could mess with your players nope thank you anyway goodbye like and I kind of get it they paid all this I know they put a lot of effort into their varsity teams yeah but in their off season okay never mind that that has never gone very far but you know having having closed that door I actually think that in terms of generalizability I like this recreational athlete thing how many folks are out there that they care about their performance because they've been running for or Lifting for their personal health for years and they intend to keep doing it for years and they might have considered changing their diet but thinking well I don't want performance to suffer I'm not competing I'm not going in some event but I I still like how fast I run and how much I lift yeah it's much more relatable and applicable yeah I mean we can look at the Olympic Athlete but the reality is most people like to your point is this going to make me weaker am I going to be slower and more sluggish if I eat this way am I somehow impairing my physical capabilities by not eating this and eating this instead yeah and so there are some limitations of the study because it was only 22 people it was only four weeks it was a crossover again so everybody did all three phases which really makes recruitment easier because they were curious that you could tell the people who signed up were like I've thought about this before but I I never was really a reason and a structure yeah if there's a study and I'm not only going to learn what happens to me but happens to others like me who are trying this I would be interested in this and and the bottom line is the running and the strength training did not change among the three four week arms over time and it was really irrespective of group these three groups basically result on parity and very importantly vegans got less protein plant protein was in the Beyond Burger or the plant-based Meats were in the middle and omnivores had the highest protein the envoirs had the lowest carb and the lowest fiber the plant-based meat in the middle and the vegans had the highest fiber and the highest carbs and you can see similar things for saturated fat and cholesterol I mean if if this wasn't a match like I'm not matching protein and cholesterol unsaturated fat if I'm just having the meat plant-based versus omnivore and plus plant-based meat Alternatives everything went in the direction that you would think many of the nutrients were different and what the I think the Aubry Roberts did very nicely in this was look at some of the sports guidelines out there showing that even with fewer carbs the weight weight lifters were getting enough carbs and even with less protein the vegans were getting enough protein and this idea that you have to maximize these things is is a little unnecessary if you're eating a healthy mixed diet you're getting enough carbs and enough protein interesting and we should point out that that study was not funded by beyond meat yeah actually that was almost a nothing so we just Aubry did all the work on this and because um the outcomes were a composite score of a lap pull down a bench press and a leg press that doesn't cost anything and the perform the runner's performance was a 12 minute timed run that doesn't cost anything so Aubry did all the work uh and I'm happy to say that we had 24 grad students sign up and 22 did everything which is pretty good from a dropout rate yeah it's a Stanford student they're good students they know how to like follow directions yeah they were really fun to work with and they were really interesting to talk with about these results and yeah it was a blast working with them the study that I think a lot of people would like to see performed is the plant-based versus carnivore so walk me through where your head is at with this and why or why not that would be a good idea and how it could even conceivably be structured yeah so uh on paper that sounds fascinated there's actually quite a few fascinating things in nutrition it could be done and you can start you could start looking at mechanisms you could start looking at observational epidemiology who is a vegan who is a carnivore at the end of the day we've had a bunch of examples in nutrition beta carotene being one vitamin E being another one outside of nutrition hormone replacement therapy being another where all the mechanisms and the observational data pointed One Direction so clearly that it seemed almost unethical to do a randomized control trial but if you really want to know cause and effect you have to do that at the end in other words saying everything that you know about nutrition over the many decades that you've been looking at this you can't in good conscience uh Corral a population of people and compel them to eat only meat for however long yeah yeah if you took all the existing data you couldn't definitively say this is this you'd want the randomized control trial but uh what most if I want your listeners to feel my pain so for whatever question you ask I have to recruit them I have to say I have funding I'm going to run a study you have to do this or that and my students will often say yeah I'll sign up for that I said do you realize what the comparison Group is because like if it's a coffee study you have to agree to drink coffee for the next 10 years or not you have to be fine with avoiding all coffee or never giving up coffee if it's an alcohol study you do have to agree to drink all the time or never drink but let's go to omnivore versus let's go for carnivore versus vegan who would be willing for some duration of time longer than a day longer than a week longer than a month to be meaningful this would have to be quite a while let's say at least six months or a year sure I'd be happy either way I'd be happy going vegan or have been going carnivore uh you can't you can't possibly talk me into trying to recruit for that stuff I is there any any wisdom though in in doing it for 30 days or 60 days like do you think you could extrapolate enough actionable helpful information from a shorter truncated period of time you could but then you'd have to say we need a follow-up to study to see if they can sustain these and that the thing for me is having done the A to Z study which was Atkins versus ornish which are both quite extreme for 12 months even at three months which is of all the time points we had three months was the peak of enthusiasm for them they weren't doing Atkins and ornish at three months at six they were doing it last at 12 many who had gone astray and so if you're gonna say yeah I'm going to do a one month study and I'm gonna see what happens to these cardio metabolic risk factors or weight or other things in a short amount of time I mean Kevin Hawk could do this did this he did well not carnivore but he did a keto versus very low fat vegan and showed fascinating changes in two weeks on both groups in terms of energy intake in terms of body composition but you you really need more people than the number he gets to do in his studies and you need longer amounts of time you could you could do it you could report on it and I would be super skeptical will that metabolic change continue and could they continue the diet and if they can't what how much help yeah is this study providing yeah yeah yeah what is your perspective on that diet and some of the um information that's being spread around the internet regarding LDL regarding cholesterol regarding the importance or lack thereof of fiber in the diet like there's there's a lot of people who are experimenting with this diet many of which are are claiming it to be transformational in terms of how they feel their weight their energy levels Etc I'm sure you've you know seen this and have spent some time thinking about this yeah and I think there's there is a subset of people that have done this long term this is also a subset of vegans who have done this long term I I have a hard time getting people to stay vegan uh in some of our in the general population but I know there's people who've done it for a long long time for the carnivores um yeah it's it's so restrictive I would want to see it for longer shorter term as a nutrition scientist you can't get all the nutrients how to meet you can't and fiber all of us think fiber is is one of the nutrients of note that people aren't getting enough of already and this is clearly far less there's no fiber in meat I don't know I guess you could take fiber supplements but that would be I'm not ready for fiber supplements yet there are so many nutrients that you need to get from a varied diet a varied diet that we all evolved on forever had all the food that was available she actually I remember a nice YouTube video of there isn't a paleo diet there's probably eight paleo diets depending on what part of the world you evolved in and it was whatever was fresh and seasonal because there wasn't a food industry around but to focus on one food group alone yeah I just after all my years of training I there's no way I could support that it doesn't have all the nutrients what do you say to the person who says all this stuff about elevated LDL is misunderstood if you're on the carnivore diet and you're experiencing that you have nothing to worry about yeah so I come from the Stanford prevention Research Center which is a division of the Department of Medicine and my division Chief is a cardiologist and he sees these people in his Cardiology clinic and it it worries him and he's concerned um yeah yes people yes I know my LDL is Sky High and it's no problem because I read this here and he says Nope that is wrong I really need to put you on a Statin I'd really rather have you change your diet oh but the small dense LDL versus the large puffy the whole particle size I actually my first major paper was on LDL particle size so I've actually known about this since 1996. one of my studies that had to do with a Stanford group I was working with helped to establish small dense LDL as an independent risk factor for cardiovascular disease and there is something there but it's one of these at the margin things yeah yeah the particle size matters but a sky-high LDL it isn't diminished by the fact that maybe they're larger and fluffier particles so one of the things that people in clinical world are moving towards is an apob count is the number of particles out there and April when April B goes up it's probably more powerful than LDL cholesterol the number of particles you have and on a carnivore diet or a ketogenic diet it's up with that saturated fat it's up and clinically from everything I know it's not good for you you can't dismiss this with particle size apob being the new kind of more accurate more definitive way to assess your cardiovascular disease risk and so it's because so LDL stands for low density lipoprotein cholesterol this is a goofy story if you'll allow me 30 seconds if you go back 60 years instead of a centrifuge somebody used an ultra centrifuge and spun it like 24 000 revolutions per second per minute for 24 hours in a blood sample and it would really make particles in the blood sample separate and that's why it's called low density lipoprotein high density life of protein cholesterol there's a very low density there's an intermediate density after this Ultra centrifugation it's split based on Dent who cares what the hell the density is oh it was just a very practical thing and then what they found was oh these these are all related to this family of things called lipoproteins which carry fat but on their outside surface there are little balls that go through your blood that have cholesterol and protein and phospholipids on the outside of the particle and some of the proteins one is called apolipoprotein B there's actually a b48 and a B100 and there's an apoe and there's an apoc but let's not go there the APO B tends to be a really good reflection of the actual number of the particles that are these lipoproteins circulating in the blood and so rather than worry about how fluffy or puffy or small or dense they are one is just LDL happens to basically just have this APO B100 so why don't we just look at the APO right and it's like a proxy for this is probably better than LDL cholesterol itself is the number of and so when people say oh statistically I have the LDL cholesterol the HDL cholesterol I have the triglyceride and I have the apob and the apoc and the apoe huh APO B looks like a better mathematical predictor of who gets heart disease and who doesn't even better than LDL cholesterol so it's sort of come down to if if you have that assay and it's not a standard clinical measure that might even be better and so on a carnivore diet the APO B is way up the LDL is up clinicians I feel like are only at the beginning of actually even advising this test so if people are listening and they're concerned about their cardiac health I would suggest that you specifically ask yeah for that marker when you do your next blood test and I'd specifically ask for insulin so here's another twist along those same lines so in the community of metabolism yes we know that blood sugar is a really important marker but people who are pre-diabetic tend to be insulin resistant which could mean that your glucose levels are actually still being maintained at a non-diabetic level at the expense of very high insulin insulin is not a standard clinical measure and it's amazing how much we all understand that an insulin Spike is really important if you got to blood pressure or blood glucose or LDL HDL cholesterol there are National standardization programs so if you had your blood measured at any Clinic you'd be reasonably comfortable knowing that they're probably very replicable across Labs not for insulin so we've never had an insulin standardization program so it's not a standard clinical measure so if they're going to ask about their apob ask about your insulin too because there actually is some movement afoot to make insulin a standard clinical that's interesting yeah I hadn't even thought about that as somebody who's played around with cgms and the like you're thinking about your your blood glucose level but that's only relevant in proportion to how much insulin you're putting out and it's if you are putting out too much insulin and your curve looks healthy you're not really seeing the whole picture potentially in one of the studies we did we had 60 people in a pilot project and they had to be non-diabetic so their glucose had to be under control and we did this that oral glucose tolerance test we get the 75 grams of glucose and you measure blood at 0 30 minutes 60 and 120 and I plotted all the insulin curves and for the best person versus the worst person the worst person had 40 times the insulin production of the first one they were both non-diabetic wow so that for that person who had 40 times as much probably got diabetes within the next year but but that person had even if that person had a CGM wouldn't know it would it would look fine maybe not fine but it wouldn't look like ah I'm not too much out of range yeah I'm not out of range for sure I'm okay but it was at the expense of there pancreas was cranking out insulin keep it there and there's some point when you exhaust the pancreas's ability right right wow you could know that ahead of time if insulin was a standard clinical measure yeah and it's not ask your doctor that too why is there no standardization of that don't know you have to ask the endocrinological society and I do think there's a movement afoot to make it a standardized measure it's easy for me to get as a research method but here's a fun thing so when I in all our studies we hand our results back and insulin is one of the ones we have to say this is not a standard clinical measure you can bring this to your doctor if you want we can't tell you anything about it because we don't have a standardized cutoff for a high or low you were higher or lower than the rest of the people in the study but this is for research purposes only in the lab that does this for us won't give it to us unless we put that disclaimer on the report that we are not clinicians this is not a this is a research value this is not a clinical value interesting wow after all these years I'm actually kind of stunned that that hasn't happened yet huh is that like a like a cover your ass litigation thing for the yeah for well I don't know about the left I think yeah because that we don't have this it's just they've been doing it for 20 years with me and they'd keep right but since they've been doing it for 20 years hasn't somebody stepped up and said why don't we just we have a lipid National standardization program we have a glucose National standardization but why don't we have and you know what you have to do for this is every year your lab gets an anonymous blood sample or two or ten and you have to analyze it and report back and it has to be in the range that got done in a standardized lab and if it's outside they have you check your equipment maybe your reagents are out of date or something but there's some monitoring of how comparable they are to the rest of the country yeah yeah why don't you just do that with insulin how hard could that be it's not an expensive assay it's a radio immunoassay I mean I feel like that should get dealt with immediately given the incredible rise in pre-diabetes insulin resistance type 2 like this the curve on that is insane this is something that's impacting so many people and is going to continue to only accelerate and this is an important um thing to have wrapped around you know your heads and where everybody is with it and that's easier than a microbiome standardization or an inflammatory standardization oh my God if we're not have insulin how the hell are we going to get the inflammatory number or the microbiome number can we at least have insulin right before I let you go I do want to spend a few minutes on this idea of stealth nutrition which is this really cool thing that you've you've pioneered that I think is interesting in the context of what we were speaking about earlier like what are the most important things to look at you know we can have fun on the margin cases over here but when we look at the big issues that we can all agree upon in terms of what we should eat and should should be avoiding stealth nutrition kind of plays into that same philosophy in terms of what are we really doing here in terms of moving the Needle And getting people to eat better and where should we be focusing our time in our energy yeah and this all came about because of this class that I was teaching where we agreed never to talk about health only to talk about animal rights and Welfare environmental concerns and human labor issues and it was career changing for me to see how engaged the Stanford students were in those issues saying hey I they'd come early to class they'd be talking about they'd stay after class he'd be saying I sent this book to my parents I'm trying to get my brother to change my roommate doesn't want to talk to me anymore because every time I come back from this class I'm talking about this thing and they're annoyed that I'm so obsessed with this thing it's like that never happened when I talked about how cool cholesterol metabolism is this is really fascinating and a clarification I want to point out is stealth nutrition is not about being deceitful I think for a lot of people who first hear this term for me they say oh it's cauliflower rice it's not real rice and you fake them out by like sticking block broccoli into this thing but didn't tell them no it's not deceit at all the stealth part is just hey I'd like to talk about metabolism and health oh you're not interested okay animal rights and Welfare oh don't you pet your dog and don't you love cows and pigs and yeah I'm still not getting a reaction the environment how about land use water use Greenhouse oh I'm seeing you perk up okay so I had this other tool in my tool test so you're interested in the environment can I tell you from a protein perspective the impact of animal Foods versus plant foods and now I've got you engaged and if it wasn't that maybe it was human labor issues and slaughterhouses where the immigrants are poorly treated and that those are the only ones working in the slaughterhouse and terrible other people won't volunteer for that and it's very abusive system and we should slow down the speed of the slaughterhouse and we should take better care of the work for some people that gets their attention so what I learned in this class was of all the one hour lectures I can get give on insulin or antioxidants or microbiome or whatever if it doesn't change or die if I had these other things in my tool chest and I brought them in if they choose to follow animal rights and Welfare or climate change or human labor abuses they would be eating the way I wanted them to the first time it's sort of they are discovering the what's animating a person and using that enthusiasm as a trojan horse to bring in this stuff about nutrition and it's aligned it's actually surprisingly what when when you see what they're doing after they hear about these issues they're eating more plant Foods they're eating less fast food they're eating less meat they're cooking more on their own they're going to the farmers market they're eating fresh food they're eating less Ultra processed food it's just getting at them another way and just finding what what are their hot buttons to motivate them to make a change and sustain it uh and the last one there is deliciousness where we're sort of working with chefs now we're doing this protein flip getting to eat more plants and say you um unapologetically delicious is a very important term to me because it reminds me I don't know how much it resonates with everybody else but it came from Greg Drescher at The Culinary Institute of America and as soon as he said I thought you're right I have been apologizing I know how metabolism works and I've been saying I know you want to have the steak or the cookie I have some cardboard for you cardboard is going to lower your cholesterol and my face scrunches up and I say I'm sorry that you're giving up on taste to have cardboard and Greg Drescher looked at me and said why are you apologizing why don't you say that this is kick-ass global fusion of flavors this plant-based mouth-watering relentlessly delicious dish that we have created by putting Moroccan spices on this Heritage Grain topped in seared vegetables or this so that you're salivating listening to and you're not apologizing anymore you're saying this is the Taste is amazing so we've been leading with taste which is not that hard to do working with chefs and having Health in the environment in the back pocket and a couple of other issues and so I I think of it as stealth nutrition not deceit just recognizing how many values a person brings to the table when they're thinking do I choose a or b I think of it as seamless nutrition okay you know taking like removing that negative kind of connotation all together the seamlessness part being the connection between the animating Force within an individual and the better food choice but also deploying those chefs in the right way to move the most number of people in other words by employing them at institutions that are serving lots of people three times a day because for many people students and in our Workforce that's where they're getting their food yeah and if you can elevate the quality of food that's being offered at those institutions you're making a much much bigger Dent than trying to convince people one-on-one or you know that they should it's like it's that blue Zone's idea of you have to make the healthier choice that the one that's within Arm's Reach and the more convenient choice if you can go Step Beyond that we actually have to grow and raise different food to be able to do that if institutions start ordering that food a farmer would be inclined to change you really want me to change my crop I need to make a living I'm not sure if there would be a demand oh my God the universities are asking for this the work sites are asking for this the the institutional food settings are asking for this change I can see the demand I'm going to change what I'm growing and respond that way and the more that's available in the chef's offer to the students in the worksite folks and they respond positively the more they'll order it again right but you're making it sound a lot easier than I'm sure that it is when you start talking about school lunch and you know hospital food service I mean there's massive corporations bureaucracies lobbying efforts like this is a you know there's a lot of people who've tried to solve this problem and have walked away you know sort of but well beaten here so there's a second class I teach now called healthy and sustainable Food Systems and in that class I bring in a speaker from a hospital from a University from Google for a work site from a food bank from a K-12 School food service director and when the students sign up for the class they think this is all theoretical and the people I bring in have made those changes in their orders and the students are blown away like this isn't theoretical you actually you changed what you order you did that you don't offer that anymore you focus on that you emphasize why did you do that and it's working so I would say there is movement in that direction in institutional food which is why I want everybody to hug a chef because part of this is bringing the chefs in as partners in this movement because taste is so important here and taking advantage of their skill set to help move this forward they've been fabulous partners for me they're my most intriguing new partners in research is bringing in a chef yeah that's cool and I know you've done a bunch of stuff with Google yeah not regard too super fun interesting Yeah final thing uh and I I asked this question frequently with with people of your credentials and caliber which is if you woke up tomorrow morning in a parallel universe and found yourself to be the Surgeon General of the United States what is first order of business like how are you tackling the problems that we Face from a nutrition perspective and and what are the changes regulatory policy wise legislative just or otherwise that you would be interested in pushing forward yep look everything we've talked about today but a focus on beans beans are so undervalued and underappreciated so thinking about all the things that we talk about and eating better one of the things that often gets left out is people with food insecurity or nutrition insecurity like who has the resources for this food how can it be culturally appropriate there are so many kinds of beans we got lentils we got dolls pulses uh chickpeas hummus think of how many amazing bean-based dishes there are and how inexpensive dried beans are and all you got to do is soak them overnight or even canned beans are pretty expensive super nutritious high fiber the highest of any kind of plant food of protein so if you are trying to displace some of those animal-based Foods beans are the obvious answer and it is embarrassing how few beans Americans eat compared to the rest of the world and the other food groups so if I were to do anything I do want to focus on what we said in the beginning more vegetables more Whole Foods less added sugar lesser fine grains but almost separate than that beans there's a woman in Liz Carlisle who wrote Amazing book called The lentil underground and it is a really fun thing about Trader Joe's partnering with the lentil farmers and finding a way to package lentils that was sort of just consumer friendly and it elevated lentil farmers at least for a while I don't know where it is today and it was one of these structural issues of oh wow lentils actually cook more quickly than the other beans they're quite versatile so I mean among the bean family lentils would be a great example but what could oh how easy is it to make hummus at home I my kid I had some raw veggies at the table and my kids said I would eat these if there was any hummus but there isn't and I got up from the dinner table and I got my food processor out I had hummus on the table in three minutes I chucked in garbanzo is an olive oil and you know some tahini that I had there and some lemon and some what is it uh super fast I just blended it up and kid ate the vegetables with the hummus and it was super delicious so yeah if I was Czar for the day you'd be the bean guy you're the bean Surgeon General I think I would be the bean Surgeon General because it's so versatile and everything we talked about the the lentil thing with Trader Joe's is that part of like because they offer they're the only place I've been where you can buy cooked lentils in like a shrink wrapped thing they're already cooked yeah and I buy those all the time because they make for a great snack you just crack them open into a bowl and put some whatever hot sauce on it or just eat them the way that they are right and it's super cheap and right Trader Joe's has done a marvelous job of making things convenient and relatively inexpensive so that model if we could build on that model of making some very simple Foods more accessible um yeah and even sort of like chopping and freezing the veggies so a bunch of people think oh frozen vegetables I want fresh frozen veggies are pretty good if you imagine all the miles the fresh stuff had to travel and how to lock in the nutrients right yes there was versus no I froze it on site it's more shelf stable now although you do have to have refrigeration yeah I would I would try to take advantage of some things like that that everyone could enjoy and you'd done sort of partial prep so because people also fear inconvenience in the U.S and so it needs to be low cost tasty and convenient and I think there's a lot of room for movement there um so you get this book that you're working on it's coming out when sometime next year sometime next year yeah yeah and beyond that what are you working on right now or what's got you excited what is the study that you want to be performing or that you want to see put into action yeah so if it's okay the two that are most exciting right now is one with pregnant women and the microbiome so we're getting for second and third trimester moms are getting randomly assigned to have more fiber or more fermented food or both or neither so there's four arms 130 pregnant women and we monitor their microbiome during pregnancy and then we wait for the birth and one month in we measure the kid's microbiome and that's our main outcome but we continue to follow the kid for years after that we're trying to learn how the mom could optimize for maternal microbiome in a way that she passes it off to her kit so what is the lasting effect of that over time in the child and well how does how persistent so we've got these dietary changes but we're also facing gestational diabetes C-section versus vaginal birth breastfeeding versus not what foods they wean their kids on so we're trying to sort of open the door on this transmission of optimizing maternal microbiome that gets to the kid because what we find is whatever you got from your mom a lot of that sticks with you right forever so that one's pretty fun we're uh is that with the sonnenbergs yeah so we've got 120 women now we just need 10 more women we already have 70 babies born so that one's super fun the other more interesting one is one along the lines of one of the last things about food security so in the fall of 2022 the White House had a conference first one of this magnitude in 56 years on Hunger nutrition and health and in that American Heart Association and the Rockefeller Institute pledged 250 million dollars to address food as medicine or food as medicine depending on which way you want to call it the idea being ensures pay a lot of money for covering drugs would it be worthwhile for insurers to cover meals and there's act so food working has met they're they're covering meals like they would cover a drug for somebody with diabetes or heart disease or cancer or something so there are a bunch of small short-term studies out there that aren't very appropriate for proving this concept would work so American Heart and Rockefeller say okay how about 250 million dollars over years let's design this thing let's take people with food insecurity who classify as having food insecurity and have these conditions and see if we can do there's a couple things you can do what's called medically tailored meals or medically tailored groceries or produce prescriptions there's a couple different ways you could do it how could we help these people eat a better diet and not go on drugs and prevent disease and could we get insurers to cover this isn't there a cost benefit to that so to me that is a long overdue issue that we could be helping with that would be a massive Watershed breakthrough yeah just to burst the seal on insurance coverage of food the broken healthcare system which is really not a Health Care System it's a sick care system it's only focused on people who are already sick you need to dial it back and prevent it and diet such a huge under appreciated underutilized factor for preventing disease I think that's a great place to stop it for today we didn't even get into uh much of the microbiome stuff in detail but that gives me an excuse to get you back here okay to talk about all the fascinating emergent work that's happening there as well as these advances in in the world of personalized nutrition I know you're on the scientific Advisory Board of Zoe yeah Zoe being the personalized nutrition company that was co-founded by Tim Spector founded who was recently a guest here and of course Dr Dr B will bolsowitz yeah been on the show a couple times so I think there's a lot of really interesting things that that company is doing and the caliber of of individuals who are involved with it I think is pretty interesting and compelling so I I look forward to learning more about what's coming out of that meeting of the minds and and all of this microbiome stuff as well yeah very excited and super happy that you're promoting this kind of thing because it the field is moving and I think you're really helping people stay on top of it yeah well thanks for coming and sharing today that was really eye-opening and and fantastic and uh it only scratches the surface so yes lots more to talk about uh so I appreciate you please keep doing all the work that you're doing if there's anything I can do to help you please reach out and in the meantime if people want to connect uh with you beyond this conversation where do you typically direct them you've got a Twitter and all that kind of stuff but is there somewhere I'll put links in the show notes to All the studies that we talked about Etc but um yep so we have a lot of our studies and a bunch of videos that you can get to uh so our website you can go to Just nutrition.stanford.edu it'll actually send you somewhere else but that's easier to remember nutrition.stanford.edu it's just past studies current studies we've held a whole series of food Summits on campus we have tons of videos about food Summits where we've brought people in from all seven schools in Stanford to give us their take on food and so you did this Camp do you are you still doing the camp so this is that 12th or 13th year of farm camp where I get Stanford undergrads to be counselors on an 11 acre organic farm on the grounds of a middle school in Sunnyvale California it had been a high school demographics changed and they went to a middle school where they didn't need the baseball football or soccer field they converted it into an 11 acre organic farm and we have a camp and the kids come and it's lunch time you say what should we have for lunch should we Slaughter some animals no there's no animals around let's pick veggies and then we say oh let's eat raw veggies no let's let's cook them we have stos and we have pots and pans and we hand kids knives and they say wow my mom and dad don't give me knives to cut things up with my mom and dad doesn't let me play with fire and they saute veggies and they pick fresh herbs and they it's a stealth nutrition way of just this the stuff part is just let's get them engaged in tending them harvesting them chopping them seasoning them and oh how about that they want to eat it after you did all that work you told me about a kid who was pre-med at Stanford who was on the track to becoming a plastic surgeon yep and he as a result of this experience course corrected was he a counselor or did he go to the other Summit he was a council counselor at the camp he came and uh he loved it so much he wasn't supposed to so I hope that person isn't listening but he would stay overnight and sleep on the farm he like changed his life and he became a farmer instead of a physician it's amazing and he's been going around the country working in different Farms was a wrestler wanted a BMW not anymore he plays guitar at the farm and and grows turned him into a hippie yep pretty fun awesome all right well thank you my friend come back again soon I appreciate you I'd love to thanks for having me that was really fun conversation peace what peace out

Channel: Rich Roll

Views: 53,481

Keywords: rich roll, rich roll podcast, self-improvement podcasts, education podcasts, health podcasts, wellness podcasts, fitness podcasts, spirituality podcasts, mindfulness podcasts, mindset podcast, vegan podcasts, plant-based nutrition

Id: Et4smdtKlGU

Length: 141min 58sec (8518 seconds)

Published: Mon Aug 14 2023