What are Common Nutrition Myths? Unraveling Truths with Dr. Matthew Nagra | The Proof Podcast EP#268

a high quality diet so this was a diet that's more rich in fruits vegetables whole grains and fish was one of the main protein sources they were looking at or low quality and those eating or eating a hundred grams of unprocessed red meat per day was associated with a 93 higher risk of ischemic heart disease amongst those with the highest diet quality yeah it was basically double almost double the risk intro lactone so this is a breakdown product of lignans which are found in flax seeds being one of the the major sources of that the reason it's such a good marker is that we don't make it the only reason it's in your body is because you ate it or you consumed something was broken down into it there was a 30 percent lower risk of all-cause mortality and a 45 lower risk of cardiovascular mortality when comparing high levels to low levels that's crazy and and again the only reason that's there is because you ate these Foods welcome back to another episode of the proof I'm Simon Hill your show host and today's guest is Dr Matthew nagra if you're a regular listener you'll be well aware of Dr nagara he's been on the show a handful of times now bringing Clarity to topics such as plant protein and soy Foods Dr nagara is a naturopathic doctor devoted to helping people better understand what Healthy nutrition looks like both on social media and in his clinic in Vancouver Canada our plants trying to kill us is Dr nagara biased is there a single optimal diet does eating fat make you fat do phytates Rob our bodies of minerals should we all avoid gluten is a low-fat plant-based diet the best way to do a plant-based diet we discuss all of this and plenty more before we get into the episode a quick reminder to please subscribe on YouTube Apple Spotify or whatever platform you're tuning in from your support is greatly appreciated and enormously important to this show Finding its way into the ears of more people and now my conversation with Dr Matthew Niagara how was the workout at Gold's this morning it was good it was good it's cool I've wanted to go there for ages is that the first time first time well yesterday was the first time today was bigger than you thought yeah there's I heard that that whole front open area is brand new or something so that's definitely added but I'd really only seen videos of that back blue wall you know that that famous one from the game changers and all that we've got a photo there yeah for the memory bank uh we're going to get into some cool stuff and you've been on the show two or three times five times I think five times uh so you know most people know who you are and there was phenomenal feedback from from those episodes people were really really appreciative of everything that you came on and shared and all the the great work that you do on social media clearing up uh a lot of confusion well that's the goal yeah uh busting a lot of myths and I'm actually interested though before we get into some of these different topics I get asked a lot on emails and DMS from people who are kind of aspiring to to get to a position like you are where you're helping patients but you're also online communicating science and looking through a very evidence-based lens what can you can you share I guess with regards to your journey and and sort of the events that have unfolded that have led you to that position that you're in now um yeah I think it really started with my personal health journey and when I was you know 14 I was um you know struggling with asthma I was overweight um you know actually one point I had a really serious asthma attack had to be put on oxygen and I was kept in the office for for I think over an hour hour and a half something like that and um it was once I started to shift my nutrition that you know I started losing weight I started breathing easier whether that was connected or not I mean maybe there's a little bit of debate around that but um that's what led me to wanting to dive further into nutrition and then within a year my dad had a you know cardiovascular issue and and um you know a minor if you can call it heart attack and he also in the Years following was really confused about nutrition and and what to do and and he started working with someone who really dove into that topic and helped him change a lot of it I think I helped a lot too on the way as I started to learn more and since he's turned that around he's you know improved all his biomarkers he feels better than ever the anxiety he had around his health is largely dissipated and so as I went through school I had the goal of wanting to help others kind of do the same thing and and improve their health um and now fast forward you know seven eight nine years and we're in a place where it's not just the people one-on-one that you're helping it it's all of these messages that you get that I get the comments you know from people confused online about this stuff and I find that if we're able to disseminate this information to them maybe we're able to to help you know a large number of individuals maybe not again that one-on-one context but at least help he's through some of the misinformation and provide some clarity for them so that's really the goal is just to help with that sort of confusion that I once had and my dad one Tab and he studied neutropathy yes yeah and I actually in undergrad prior I got a Bachelor's in microbiology where I also studied some nutrition okay what's the difference between neutropathy and or naturopathic medicine and so sort of allopathic I guess maybe conventional yes in medicine it's often described as what would the main differences be between those um I I think that does depend a little bit on where you are so uh depending on you know Province to Province state to state there are different sort of regulations in North America anyway the education is largely the same and you know the first couple years probably mimic a lot of what you would learn in in commercial medicine I actually had some people I went to school with who were medical doctors and then went that route and they did say there was a lot of similarity in the basic Sciences you know the chemistry biochemistry biology Etc where there are some differences is we do learn about pharmaceutical therapy I do prescribe I know that's a common misconception that we're like anti-medicine or something that's not the case um perhaps not as in-depth as they do we can't prescribe everything that they do we also don't have as much training in emergency medicine yes we can do things like CPR and whatnot if if needed but certainly don't work in an ER um but where other differences come in is we do have a lot more of a focus on nutrition we learn some other modalities like physical therapies actually so I do work with people injuries and I know you have a physiotherapy background as well um and then even some you know nutraceutical supplementation herbal supplements and whatnot as well I'm not super convinced on a lot of the evidence around that stuff personally but uh um but I think there's actually a lot more similarities uh than most people realize at least from the accredited schools um where there are of course some differences in the the mentality around it and what sort of treatments we we learn more about we're going to go through a bunch of different claims um and maybe I'll do this in a sort of true or false way and we can step through them and you can help us unpack them but before we kind of get to those at a high level why do you think there is so much confusion why do you think that the the average person would or do you think the average person would find it difficult to determine what a healthy diet is um I think especially with social media the access to information is is so you know broad at this point everybody has access and you know anybody can be an expert and we have podcasts with you know Millions upon millions of followers who are you know listening to a lot of the information being put out there and I think it's just that you have people with certain beliefs whether that's because they adopted a certain dietary pattern and improved their health in some way or at least subjectively like in the short term improve their health in some way and they they then believe that's the answer and I can you know I can understand that to a degree I feel like I had that early on as well um of course now I'd say I'm much more objective in the way I evaluate research but it's certainly it's compelling when you make a change and you feel so much better um and then you hear from others that they've experienced the same thing and you want to believe that that this is the way you know so to speak um I I think that's really it you have individuals like that with large platforms you know preaching their stories they're great storytellers a lot of them thank you and then others who maybe have had a similar experience or tried something that they recommend felt better they'll of course Believe it or or you know then the next day that you're conflicting information and they're confused again but I think that's sort of where it comes from we can get a bit lost in our n equals one anecdote yeah and and forget that that's uncontrolled and not necessarily the same result well two things one is we might be attributing our result to the wrong thing yeah and secondly the result that we got from whatever we did may not be something that's replicated for everyone else exactly yeah and that's what the research is for have you heard of Dunning Kruger effect yeah yeah just kind of the oh people tend to over um what's the word or they think they know more than they do and um particularly at the beginning when you've learned something so there's a very steep uh uh learning curve at the beginning of delving into a new topic and in that early phase you can sort of become overconfident yes that's the word I was looking for and so your your confidence actually never returns to that level even as you study for years and years and decades um you know often the people that are dedicated and continue studying start to realize how much they don't know and then humility sort of comes in and even though they're actually gaining more knowledge over the years their level of confidence and how they talk about that topic doesn't get back to that very initial mountain of confidence that that read that they wrote yeah you get like I mean I get these comments I know you do too where people say this is wrong or this is that or um you know they're very direct and and very confident in their their claim but then you hear an expert I'm talking about you had Mark Messina on the other day or at least I listened to it the other day and he's talking about like you know this may be something or we don't quite know at this level of exposure what the result is or you know it's that more cautious sort of language that I don't think we see when you're first learning about the topic and you've become you know overconfident in your position you mentioned beliefs and one of the the true or false statements that I have for you is Dr Matthew Niagara Niagara is a biased vegan and you also mentioned before being objective so true or false is Dr Matthew Negra a biased vegan I would say yes I have a bias because I am vegan you know I would prefer that we didn't use animals for you know the purposes that we do but does that mean that that affects my objectivity when it comes to talking about the literature I don't think so I can look you straight in the face and say that fish is a health food the low-fat Dairy can certainly be a part a regular part of a healthy diet that small amounts of red meat aren't going to hurt you but when it comes to the environment or ethics I think that is problematic and I can be honest about that too but where I really think it's it's sort of ironic is I tend to see more bias in people who claim to not have a bias I've seen that a lot of there's a lot of people online who kind of hide behind this you know I'm not biased because I'm an omnivore I eat meat I eat plants I don't you know I'm not in the keto camp or carnivore camp but not in the vegan Camp um and uh you know to claim that you don't have a bias I mean I don't think anybody is totally free of bias I think everybody has a bias we all eat we all have to eat we all enjoy certain things you're sitting there I'm not affected by any sort of bias you're probably very much affected exactly exactly and you know I would just have to ask this individual do you or what's your favorite food you know I can just ask something Broad and they might say oh a nice rib eye or something well do you so you enjoy eating meat or perhaps it's it's on the plant-based side so you enjoy eating that the fact that you get enjoyment out of that means that there's probably some level of bias there and to claim others are biased but not recognize your own bias actually has a term it's called highest blind spot and that's something that comes out a lot I get called biased all the time by people who claim to be free of bias and and I think that is is just really shining through in those cases um but uh I think you have to recognize your bias first before you can even you know set it aside and address it right so I go ahead yeah I try to go that extra mile of like am I looking at this through a biased lens or not you know how can I be objective about this whereas if you don't even realize you have a bias how do you do that right we're much ideally we're much better off if objectivity is the goal we're much better off if our biases are operating within the window of awareness not outside of exactly um and you'd be familiar with Melanie Joy's yeah work on looking at you know often you hear veganism it's an ideology and it's almost said as if it's the only food ideology yeah right but her work sort of puts forward the fact that actually the dominant food ideology is called carnism and one of the sort of interesting I guess uh facts about that idea ideology is that it is mostly Invincible because it is the dominant ideology so it's not really questioning if you follow that ideology because it's not challenging or questioning something because it's accepted as the norm most people are not aware that it even exists yeah that I would 100 agree Okay so you're saying that you do have a bias but when you review the evidence you're aware of that so talk us through your process so when you when you go and look at nutrition evidence what are you doing to keep that bias in check so I I try to review any piece of literature whether it is something you know based on the title or abstract appears to be Pro my position or or anti my position I try to just review it all the same you know I'll I'll go through the method section say okay how did they conduct this study what are you know potential concerns how did they track food you know intake for example did they do it sequentially you know every like the nurse's health study and health professionals follow up every four years so you don't just say yeah they use the food frequency yeah yeah frequency questionnaire this this study is garbage yeah exactly like look at how did they do it what um covariates like did they look at exercise smoking Etc um uh you know then what are the results is there anything that conflicts with our pre-existing knowledge on the topic if so why might that be try to figure it out I think that's another thing that gets thrown out there and maybe this is sort of a tangent but people will say well oh yeah there's conflicting information all over the place we have one study saying this another one saying that when in 99 of the cases you can explain it through you know the type of adjustments they made through the type of population you're looking at where they may be a sick population or healthy population how long the follow-up was what is the difference in meat intake for example if people will cite data out of like you know somewhere in Asia saying look high red meat consumption was not associated with cardiovascular disease well yeah they ate like a piece of meat every two weeks right so of course a high and low we're all very low exactly and so there's there's explanations for these things for these differences between the findings um that are pretty explainable there's explanations that are pretty explainable yeah if yeah you're trained and I think one of the problems with food is that because we all eat three four five times a day we feel like we're an expert yeah but I would say you know a lot of a lot of people that are putting out information about nutrition are not always equipped with those skills of going through the research at that level yeah I'd agree with that the other thing that is important you may have mentioned this is converging lines of evidence and the evidence hierarchy what is the strength of that data and are you seeing different types of study all pointing into the same direction yeah I agree that that's another thing especially with LDL cholesterol and I know apob as you discussed with Dr Day Spring being a better marker but a guy yeah yeah it was entertaining it was an entertaining listen um I loved the bit where he he started talking about going down into the uh into the intestine and interviewing cholesterol yeah and you can tell he's he's been at it for a while with the like how he's able to just pull stuff from from textbooks he'd written decades ago man this is classic yeah he's done a lot of stuff but but like just going back to what we were saying there is is that the converging lines of evidence we have animal models we have human data with you know randomized controlled trials using all sorts of different classes of medication and diet all showing that you reduce your risk of cardiovascular disease by lowering LDL and how much you lower out your LDL cholesterol determines how much you lower risk there's just no way that's due to other factors and even with that evidence I think we also have to accept that evidence will not be perfect exactly and a lot of this is looking at okay what's the alternative hypothesis and what's more likely based on the imperfect evidence that we have across different levels yeah I would agree with that okay speaking of alternate hypotheses true or false plants are trying to kill you I say false because if that's the case they're doing a pretty bad job did I do a good impersonation um I I'd say pretty good mind you I haven't listened to quite as much of the content as you have so maybe it's not burned into my memory as well but uh but yeah I mean obviously you're talking about uh Anthony Chaffee chap I think that's how you pronounce his name um and uh his view on you know polyphenols and phytochemicals uh trying to kill us and um you know a lot of that stems from this paper by Bruce Ames this was a paper from 1990 and you know in that paper they determined that about actually it's in the title of the paper 99.99 of the pesticides that we're exposed to these things that are meant to you know kill insects and pests aren't naturally found in the foods that we eat largely in plant foods and now his conclusion uh chaffee's conclusion from that is that well yeah these plants are trying to kill us because they're full of all these you know natural chemicals like the polyphenols and whatnot but there are you know several issues with that for starters in that paper they explicitly say that fruits and vegetables are healthy they say that they're consistently associated with great health outcomes and their ultimate conclusion in fact this is right in the abstract of that paper is that because most of our exposure to these potential pesticide-like compounds are naturally in foods that are actually healthy for us then the synthetic pesticides to make up this tiny fraction of what we're exposed to probably aren't a problem so it's actually arguing that these chemicals broadly are probably not an issue for us yet it gets spun into this this concern around those those chemicals that are naturally found being toxic or harming us and and there are so many issues with that sort of conclusion because that's largely based on like cell culture studies or rodent studies or um you know again looking at the impact on insects which is essentially what they're and also with the way the exposure on a milligrams yeah it's not something that humans would be exposed to through diet yeah exactly we would not be consuming anywhere near that amount and again the foods are Health promoting but what's really interesting is that polyphenol consumption whether it's from things like coffee tea fruits vegetables is very consistently associated with with great health outcomes lower risk of cardiovascular disease lower risk of total mortality this is what we need to look at the actual Health outcomes in humans and in fact there's some really really strong data on a particular metabolite of of a polyphenol called enterolactone so this is a breakdown product of lignans which are found in flax seeds being one of the the major sources of that and the reason it's such a good marker is that we don't make it the only reason it's in your body is because you ate it or you consume something was broken down into it and highest consumption in this meta-analysis of studies looking at levels found that there was a 30 percent lower risk of all cause mortality and a 45 lower risk of cardiovascular mortality When comparing high levels to low levels that's crazy and and again the only reason that's there is because you ate these foods not because you're genetically producing more or something because we don't produce it higher polyphenol intakes also been consistently associated with lower risk of Alzheimer's dementia as well yeah and there's some really cool studies on like Berry consumption what not improving you know some some markings of cognitive function even clinical trials yeah exactly not not necessarily as it relates to alzheimer's but even just acute yeah in the short term yeah I printed out that paper because I thought it would come up and just to to kind of emphasize what you said here's a direct quote from the Ames paper caution is necessary in interpreting the implications of the occurrence in the diet of natural pesticides that are rodent carcinogens it is not argued here that these dietary exposures are necessarily of much relevance to human cancer indeed a diet rich in fruit and vegetables is associated with lower cancer rates has that ever been quoted that was conveniently left out uh as was I will say and the reason I said plants are trying to cure you in that that kind of fashion I certainly wasn't mocking Anthony chafee that is a it's a video that's gone viral titled our plants are trying to kill you and it has I think 500 or 550 000 views by this stage and something else within that so Dr chafee cites the aims paper and leaves out that critical information that we just went over which is the dose how much are you exposed to through diet and also what the main takeaway from the paper was and he also cited the World Health organization's website where they talk about natural plant toxins and he used this as evidence to say see even the World Health Organization are aware of this but he left out again a very important paragraph from that page that he shared that says in a usual balanced diet the levels of natural toxins are well below the threshold for acute and chronic toxicity which I think is important yeah 100 I mean all of the fact that these points are being left out but he's aware of these papers is also like questionable as far as like you know is he just you know purposely leaving this stuff out or you know what's I don't know It's upsetting you know to to think about it that way yeah it seems like he's had an anecdotal experience and seen other anecdotal experiences maybe you can comment on this why someone who adopts a he he only eats meat and water but why someone who adopts a diet like that might experience some benefits to me it seems like he's trying to attribute that to the removal of of toxins but there could be many other raisins is is that something that you've thought about yeah um so he's like when you're removing basically everything you know from your diet except the the meat and certainly removing Ultra processed foods if you were having any it's kind of expected that if something was bothering you and you remove it you might feel better as far as your gut function maybe you had some like IBS like symptoms and you remove some some foods that you're having problems digesting that could be something um if you're eating a really heavily you know processed food it's possible that I mean the meat's gonna be a lot more nutritious than probably some of that stuff too maybe you were running into issues that way I don't know what his history was in particular but there are plausible explanations why someone might feel better in the short term at the same time that doesn't mean it's going to be great in the long term and I think that's where there's an issue I mean we can look at a lot of things smoking being one where people can actually feel better in the short term um you know it might calm their nerves it can help with weight loss it can do all of these things that that um you know in another context might be viewed as good but we know based on all the data epidemiological or observational data I should actually clarify that smoking you know leads to high risk of lung cancer total mortality cardiovascular disease Etc so I think we're focusing too much on these short-term changes which it's great that somebody has improved in that way but while forgetting about or trying to make excuses for why it won't be a problem in the long term right and and also overlooking that there are protocols that have been tested to help someone who perhaps does have food intolerances settled symptoms identity and then through a sort of reintroduction and challenging protocol established well which ones are maybe are causing some issues that they're intolerant to which ones are not and then reintroducing Foods they can tolerate to increase compounds like fiber that we know are associated with good long-term Health yeah yeah absolutely there's obviously like low FODMAP diet there's all sorts of other elimination diets that have been more well characterized and someone can work with a professional to walk them through that the other thing that I always think about with this this idea that plants are trying to kill us is that and and in that video Dr chafee goes on to sort of insinuate that he thinks the metabolic cardio metabolic conditions like type 2 diabetes and obesity Etc are being caused by these compounds in foods like broccoli and Brussels sprouts and he names those foods and others um going back to our alternative hypotheses I think there's much stronger hypothesis hypotheses to it that exists to explain why there are so many cardio metabolic conditions but just on his on the notion that you can blame these foods for type 2 diabetes and obesity it seems ludicrous given the actual average intake of these Foods across population is negligible yeah and when you think about especially naming some of those diseases like type 2 diabetes where it's like I mean in the U.S again I'm Canadian but I think in the US it's coming up to half of the population has diabetes or type 2 diabetes or pre-diabetes or something in that ballpark at this point are half of them overeating broccoli and Brussels sprouts and you know those types of foods I don't think so you know I think it's much more plausible that they're eating the McDonald's and the you know that sort of stuff this episode is proudly brought to you by inside tracker track your blood biomarkers understand your biological age and receive personalized lifestyle tips backed by evidence to optimize your health to get started with inside tracker today and get 20 off your first purchase head to insidetracker.com forward slash Simon that's insidetracker.com forward slash Simon for 20 off next true or false unprocessed red meats do not increase risk of cancer or cardiovascular disease that is old science I would say false based on the best available evidence now where that often stems from is there is this Canadian study the Alberta project or tomorrow Alberta project something along those lines where they looked at red meat intake and they separated processed and unprocessed red meat which is great I think most studies should do that and then they looked at what does you know a high versus low red meat intake do to cancer risk whether you're eating low moderate or high fruit and vegetable diet or intake and they found that in the higher red meat intake uh or in in those eating the most red meat while also eating the most fruits and vegetables there was not a statistically significant increase in risk of either all cancers combined or a combination of 15 specific cancers that they were looking at they weren't looking at individual cancers though and um since there wasn't a significant increase in Risk some people will claim that well there's no risk right there's just no risk to eating um unprocessed red meat in the context of a fruit and veg or fiber rich diet and there are like several layers of issues with that for one claiming that there's no risk isn't really accurate because all that means is that the result wasn't statistically significant one way or another right when we look when we get a result from a study let's say you know as I just cited um with the intro lactone you know 30 lower risk of all cause mortality that was sort of the average finding from that collection of studies in the meta-analysis but there's a range a confidence interval that's given so the True Value could be higher or lower there's a range there if that range covers no risk then we say it isn't statistically significant um and so just on a technical level saying there's no risk isn't quite accurate there could still be there could not be it just wasn't detected in that study um but some bigger issues are that well in those eating the most red meat when you compare them to those eating the least red meat we're talking about two two and a half servings or so a week you know and where we most consistently see an increase in risk of of certain cancers like colorectal cancer is around 100 to 150 grams per day right so a big big difference we're talking a serving plus per day not just two or three per week on that note this was looking at a combination of cancers it wasn't looking at the cancers that are most consistently associated with you know red meat consumption that would be like colorectal cancer being one of the primary ones so what if it's the case that red meat did increase colorectal cancer but then fruit and vegetables lowered risk of other cancers then your overall result is going to be null it's not going to appear like there's much risk there um and so there's yeah those issues and then at the same time it's only talking about cancer what about cardiovascular disease the number one killer or other issues why are we saying that there's no risk when it wasn't even looking at other health outcomes and when we look at research on that topic so there was one study I know we've discussed uh previously where they stratified diet into a high quality diet so this was a diet that's more rich in fruits vegetables whole grains and fish was one of the main protein sources they were looking at um and or low quality low diet quality and those eating or eating a hundred grams of unprocessed red meat per day was associated with a 93 higher risk of ischemic heart disease amongst those with the highest diet quality now again talking about the confidence intervals like 93 yeah it was basically double almost double the risk and but the confidence interval was quite wide meaning the true risk could be lower than that it could also be higher than that but the fact of the matter was there was a significant increase in Risk so why are we ignoring that because of this one study on this collection of cancers that suggested there wasn't a significant increase in Risk well because we like it may there you go I think the answer to that's right yeah I mean yeah but it's just like we have reason to believe and this data is consistent and even in the epidemiological or that again I got to start saying observational because for for those listening epidemiology can Encompass randomized controlled trials if they're looking at like disease outcomes and markers as well but when we look at the observational research on red meat consumption even on processed red meat consumption it adjusts for fruit and vegetable intake most of the time or Diet quality anyway and so those factors are largely being considered in most of the research that we have on the topic so that there is just a lot of issues and it just seems to me like that is largely bias playing into it what about the global burden of disease study Dr nagara have you seen that Oh you mean the burden of proof burden of proof yeah I was like Global burden I think says red meat's a problem yeah that's right it's not a burden of person yeah wrong burden I got there yeah but the you know the paper that came out maybe 12 months ago I think if someone was sitting here who was trying to argue their position of unprocessed red meat not being a problem they would challenge you with that state yeah so this was a large analysis they came out you said roughly a year ago it might even be a bit less than that but but somewhere in the last year and it was a meta-analysis and they were looking at a various outcomes so one of the health outcomes was colorectal cancer and they did find that 100 gram per day again that kind of threshold I was mentioning was associated with a higher risk of colorectal cancer uh statistically significant so we should I think be taking from that yeah there was still an increase in Risk in colorectal cancer but they did something really I think odd in their methodology how they came to their conclusions about what is considered a weak Association or no association or you know stronger Association is that again we have these confidence intervals this range of values they took essentially the bottom of that so so the result would have to be you know significant One Direction or another and then they took the very bottom lowest possible value almost not from the confidence can you explain to someone who's never heard of a confidence interval or an effect size what is this so so let's let's say we have a value we'll just go again I can't recall the exact numbers but I'm going to make them up for colorectal cancer let's say there was a 20 higher risk of colorectal cancer per 100 grams that you consume um now that will come with some sort of confidence interval this this range so let's say the confidence interval was anywhere from like the 10 Mark to 30 Mark just to make it easy so 20 is right in the middle that's what we're saying the value was that was found and that tells us that you know the true value is probably in that range it doesn't mean that it's 20 radon it could be less it could be more but if that is not Crossing that no effect line we can be confident that there is an effect that's essentially what it means I hope you think that's clear enough yeah okay um and so so what they did is they took the bottom of that range of the possible values and in the case of say colorectal cancer it was statistically significant so it was still suggesting an increase in Risk but they went further they then made these cutoffs these cutoff values if that number and again I'm making these up because I can't remember the exact numbers but let's say if that bottom number wasn't at least you know a 10 increase in Risk it's considered a weak Association you know it's probably not real essentially um if it was above you know 20 25 then it's considered a moderate Association if it was above like 50 think about that the bottom of that effect at least a 50 increase in Risk to to consider it a moderate effect again somewhere in that range then um then you know so for red meat and basically any health outcome they were ranked like weak essentially as far as associations and so they're written off as like no association well no that's like the lowest possible value suggesting a small increase in risk with the highest possible value increasing a much higher or suggesting a much higher increase in Risk um and the same thing applies to vegetables they did the burden of proof study for vegetables as well and almost every outcome was considered no or weak Association there was only one Association that was moderate and that was for type 2 diabetes so why not apply that same logic to vegetables um you know if you're supporting say the burden of proof finding and say well um yeah you know vegetables they might help with type 2 diabetes but they aren't going to help with anything else you know it doesn't make sense to take one but not the other right you'd have to hold both yeah views which maybe some people yeah I think there's some people listening to do but but yeah okay well someone's listening to this yeah thinking just tell me what the safe amount of unprocessed red meat is what what can I eat each day or on average over a week where you think it would be a safe level of consumption it's not increasing the risk of colorectal cancer cardiovascular disease I I think the safest level is probably well I mean zero can be one of those options but I think up to about two servings a week 200 grams or so servings per week per week yeah I and the reason is so there was analysis by zong this was looking at six prospective cohorts in the U.S excellent adjustment model great range of intake so low intake was quite low high intake was you know at least close to that 100 gram a day Mark and they found in the dose response analysis that two servings per week did lead to a small increase in risk of mortality so that's something to consider and then we have research on the Adventist cohort as well where they tend to have very low meat intake overall and they found that when you consider like low meat intake to you know say no meat intake There Was You Know roughly a I can't remember the exact number but a small increase in Risk again around the two servings a week Mark so that seems to be you know probably the cut off for what I would say is is you know totally safe but then the risk isn't going to be great a little bit above that either I think once you get into a serving per day is where you're most consistently seeing those Associates so 200 grams is that's one sort of Fairly large serving a week yeah or average serving yeah a week of a steak or something yeah um actually get pushed back on on you just mentioned the Adventist stuff yes yeah do you ever get pushed back on food frequency questionnaires are they reliable Matt isn't aren't they garbage so I do um we got I know we'll talk about it in a bit but in the debate with Tucker Goodrich that came up definitely um and I think there is kind of a misunderstanding of how they're conducted so prior to using them in this research they're validated so what you'll do is you'll take a smaller group of individuals you'll have them fill out the food frequency questionnaires and you'll actually track their intake with you know they could be weighted food records so they actually weigh their food out and and you have what they're eating at different points over an extended period of time and you might even check with them you know several months apart and you'll see does that fruit food frequency questionnaire the way that it's written does it actually end up tracking your overall food intake in the long term does it carlize yeah does it correlate well so they do that another way that they started to do it now um and I think this is newer but they'll look at blood levels of certain markers of intake and so you know blood levels of these different markers can correlate with intake so you can't lie about that right you you measure it um and uh and you can you know kind of see how well the the ffq correlates with that as well so these are validated instruments in most cases sometimes they use invalidated ones and that's why you look at the methods section to see if it's invalidated or not but um but if they're using a validated questionnaire like I wouldn't have too many qualms about it talk a good work good Rich good Rick uh one of the two or false talk a good rich won the seed oil debate see I think I'm I'm extra biased in this in this case but I don't think so I would say false can you tell people what this scene will debate uh was or is yeah those who maybe haven't seen it yeah so um just even backtracking to like what are seed oils for a second so kind of your classic vegetable oils the things like canola oil sunflower oil safflower soybean Etc corn oil which was a funny point that came up during the debate about corn oil but uh um yeah so so we had you know he's one of the people or faces behind this whole anti-seed oil movement um things that you know seed oils are the primary cause of most of our chronic diseases out there it thinks if you eliminate them you're pretty well safe at least as far as my understanding is of most of the the chronic diseases out there and I reached out to him on Twitter one day and just said hey you know I have some you know concerns with what you're saying you know would you be open to having a debate discussion about this and then it took a while to get rolling eventually we made it happen you hosted and it was like a four hour marathon and we had the bathroom breaks throughout like it was it was a long thing um but uh yeah I mean it really got into the weeds at some points um but I think I think it was clear and this sounded like the takeaway when you did a recap episode with Drew as well was that I did have answers to pretty much everything he threw at me and I had responses to it I knew his citations pretty well too and there were a lot of questions of mine that he was not able to answer that he tried to dance around and you know and some things even bit the bullet on like like he said that non-fatal heart attacks don't matter because seed oils in his own study show were shown to protect against heart disease events not necessarily cardiovascular mortality because you just need larger longer term studies to even detect that but because it was beneficial for heart attacks as a whole he said that non-fatal heart attacks don't matter which I think is absurd of a position um and uh just stuff like that there were just some some things I think he could have just said like oh you know maybe that is the case or or you know and we could have just left it there but instead went the extra mile and and I think that's when you see kind of who won the debate so to speak is when you have these you know very extreme positions being taken just to hold on to your you know View and to hopefully come out on top I guess remind us of the the bit on the corn oil that you just yeah so this was funny so there was one study I cited throughout because I think it's the best study we have on this topic in fact I would argue it's probably one of the best studies we have in nutrition this is so this is one of the things that taka found difficult to reconcile yeah yeah the LA Veterans Administration Hospital study so the double-blind randomized controlled trial people were were living um in an institution where they were randomized to one cafeteria or another in the one cafeteria they were having more of the saturated animal fats in the other cafeteria They removed the saturated fat I actually split them up and they they well they were randomized to different cafeterias yeah right yeah so so like you know that everything in that cafeteria is one type the other one is the other type but they don't know what they're getting and what they did in the seed oil one is they were moved the saturated fat from a lot of the foods so like they even had ice cream where they just like made it with like seed oils or they took sausages where they you know somehow extracted the saturated fat and fused it with seed oils so they're like going the extra mile and they did a small study prior to make sure that they tasted the same and people couldn't tell like it's just crazy the amount of work that went into it and um so at the end you know the the seed oil group ended up having better outcomes and he tried to criticize it but I already knew a lot of his criticisms to the study in advance because I knew he'd come across it and I had responses to every single one of his criticisms so at one point when he didn't have any more criticisms I just you know I listed the oils that they were using and one of the oil so it wasn't the only one but one of the three or four main oils they were using was corn oil and he said that corn oil isn't a seed oil which I mean technically it's a grain I guess but that is a seed like whatever we're getting technical there the makeup of corn oil as far as its fat content is you know identical or very similar to every other seed oil and um what's really ironic about that is that two of the three studies that he cited in that he said were the best studies on the topic of seed oils where the Minnesota coronary experiment where they used a corn oil margarine and um The Rose corn oil study literally in the title of the paper and so I didn't catch him on it in that moment I wish I did but it was it was just so out of left field this whole corn oil thing that I didn't even think of that and put two and two together but he's contradicting himself if that's the case that that corn oil isn't relevant to the discussion then two of his favorite studies are out the window yeah it's a it's a logical inconsistency yeah exactly so what's the takeaway Point here for someone again they're going to the grocery store and thinking about what they're going to cook their vegetables in or add to their recipe are they choosing corn oil safflower oil canola oil olive oil avocado oil Macadamia Oil how does someone navigate that so I I would say you can't really go wrong with any of the ones that you mentioned I would say the one at least for blood lipids like LDL cholesterol canola oil is probably the best it's also the highest in the mega three of the ones that you listed there so that has a pretty bad wrap though yeah I think I think a lot of people here canola and assume inflammatory obesogenic increased risk of cardiovascular disease yeah that's the challenge is it has it has this bad rap even though the health outcome data is completely on the other side and in fact there's not a single study that's ever shown that it increases inflammation not one in fact that goes for all seed oils from what I've seen I think many people form that view or convinced of that after hearing about how it's made yeah I I agree and it's the whole like processing nature industrial nature of it I guess I mean but that goes for so many foods that we eat that goes for olive oil as well you know in a lot of cases and what I would say though is if someone is truly confused if they're not convinced by what I'm saying here go for olive oil you can't go wrong with that and that's something that actually Tucker and I agreed on was that olive oil is a good option so if you want some level of agreement there and that's this is a good a good thing for us to underline there were some agreements I think that both parties would agree that consuming Ultra processed highly palatable foods that contain seed oils it's probably not a great idea um you two May differ in why those foods are deleterious for health he might isolate and take look out of all of those ingredients in that food Matrix the artificial ingredients the additives the the other fats the refined sugars all of these things the the fact that there's no fiber he might still say it's the seed oils yeah whereas you would and I'm sort of speaking for you but I imagine you would say it's a combination of many factors yeah and more than anything you nailed it with the hyper palatability I think that's the number one factor which can be contributed to by the high fat content and the sodium content and all that stuff as well but that's a little bit different to adding some canola oil to your cooking on your vegetables or some olive oil on a salad yeah that's not at all comparable okay it's like actually an analogy I often use it's like saying that water is deleterious to health because it's the main ingredient in Coca-Cola right it's the package it's not it's not the water that's doing it true or false because a vegan diet requires vitamin B12 supplementation or the inclusion of vitamin B12 containing fortified Foods it's not natural and therefore it cannot be a healthy diet I'd say true it's not natural I'd say false to that means that it can't be a healthy diet um just because something's natural doesn't mean it's healthy just because something's unnatural doesn't mean it's it's harmful um we can look at I mean we've talked a bit about red meat I know there's debate around that but that being one of the food that's like natural but in you know with a certain level of exposure can be deleterious to help um for you know processed foods we'll get into plant milks in a bit I'm sure tofu we've already talked about we did two full episodes on soy and and that's very health promoting food um and so this this like kind of naturalistic fallacy um I I think it drives a lot of people's at least in the wellness space their kind of decisions around foods and and health but but really at the end of the day it comes down to the the health outcome data like what does the research actually say about the impact of this on our health and in that case I mean there are a lot of of unnatural things that you know could be quite healthy for us you want to take that route then you kind of need to accept that you'll end up back living in a cave and maybe the life expectancy is only 30 years yeah exactly and and like I mean I know the question was specific to vegan diets too like vegans consistently do better than meat eaters and and most of the the research out there whether it's the advantage studies the Epic studies or whatever there might be certain outcomes where the vegans do do worse and we can dive into some of those if you want but like but generally speaking when it comes to cardiovascular disease mortality Etc they tend to do better it's also not just vegans taking supplements because there are nutrient deficiencies that omnivores can bid increased risk of developing as well there's they tend to be different nutrients yeah um so that's worth I guess pointing out yeah there was a great review from I think it was in 2021 a systematic review of these studies published between 2000 and 2020 and it was looking at nutrient intake or status of basically anything on a vegan vegetarian or omnivorous diet and they had a fantastic chart in there where it highlighted nutrients that are at risk of inadequacy on a vegan diet and then nutrients that are favorably high things like fiber and magnesium yeah folate and then you look at the same chart for the omnivores in that in that paper and it's just kind of the opposite it's like so there are some nutrients the vegans are doing awesome with but the meat eaters might need to worry about a little bit Yeah like magnesium and then and then there were some that there was overlap all dietary groups were um you know had concerning uh intakes or levels of vitamin D same with iodine and you know a few other nutrients as well so on the on the vegan side of that just to kind of refresh everyone's memories I know this is right in your wheelhouse someone sits down with you they're newly adopting a plant-based diet let's say it's plants exclusive in this scenario what are the of core nutrients of focus that you're bringing their attention to that they would either need to supplement or pay particular attention to certain food groups yeah so um B12 is an obvious one I think that goes I think everyone's hopefully everyone's aware of that are you on the sciatica bellamon yeah I tend to favor cyano for a couple reasons for one it's just cheaper and more widely available it seems you pick it up at like any pharmacy um and then it's more shelf stable which is nice um and it's just the one that's been more well researched at this point I don't think there's a problem with doing methyl or adenosil or whatever I think they'll work as well but I just tend to favor say I know because of yeast and you can always test your levels as well and make sure that whatever you're taking is keeping you in the sort of normal or optimal part of the reference range yeah yeah exactly and then um because especially me being in Vancouver and we don't get a ton of sunshine year round maybe a few months or the summer vitamin D is one that I tend to emphasize you know whether supplementing or fortify Foods I'd say most my patients end up supplementing with that and then or testing perhaps if they're relying on fortified Foods we can always test that too and then calcium is one that I think is only a concern if you're avoiding like fortified milks and whatnot so I try to promote the consumption of four to five milks a cup or two per day that just helps add a bit of an insurance policy um you know if you're getting say 300 milligrams per cup even a single cup adds quite a dent to your overall intake um but if they're not consuming four or five melts if they don't like plant milks and if there aren't other fortified Foods available then maybe considering a supplement for that um what do you think the typical vegan would consume on a daily basis if they weren't supplementing with calcium well they weren't getting a calcium fortified plant milk are we talking like five six seven hundred milligrams I I think so if you look at like some of the research on the Epic Oxford cohort for example and these would be people who probably weren't eating much in the way of fortified Foods they're on average getting I think it's around 550 or so milligrams and I think that's reasonable I think that's reasonable to get out of foods like tofu that isn't calcium set we can't get that in Vancouver I don't know if you're able to in Australia but I know over in the UK it's more of a thing but um so you can get a fair amount from tofu some from other legumes almonds almond butters uh broccoli certain greens um but it's just nowhere near that huge dose so you're trying to get people up more towards 1000 milligrams at least 700. well I know that's the the recommendation in the UK I tend to favor a thousand because let's have a safety net um but I would say like bare minimum you want to get at least that 700. okay so calcium vitamin D B12 iodine you mentioned before yeah iodine so if they're using an iodized salt um then they could be covered if they're having about half a teaspoon or so per day that again it depends on their intakes I'll like go into detail on like how much are you using regularly in that um otherwise a supplement could be a reasonable option or for people with high blood pressure provided they don't have kidney disease or other contraindications you can actually use potassium based um salt Alternatives so it's a potassium chloride instead of a sodium chloride which can be better for your blood pressure as well and you can get iodized versions of that do you find when you're working with people who are new to this this can all sound a little bit overwhelming it I think it can the way we're kind of talking about it here but one thing that I will often kind of offer to them is like look we can do this multivitamin that just covers it all and and then you don't have to worry about it and I think that's so easy so that's another option if you have a multi that covers the things like b12d iodine and so on um if there's you know concerns around zinc or selenium potentially depending on their diet and what they're eating you can just get that in one one pill per day and that makes it so easy so and there's another problem with I mean I think there might be this idea out there I know there is that consuming these synthetic supplements can't be good there are some people who come with concerns but I ask them what their concerns are and and I'm fortunate that I have a lot of time to spend with my patients especially on a first visit um we can spend you know up to an hour and and you know I'll just go through what are your concerns and we'll go through them one by one and usually by the end of that sort of educational period they're on board it's just again it's so easy to do it's not worth the risks of falling short especially on something like B12 and so usually they get on board and the same thing goes for medications I mean I get people coming in who don't want to take statins but they're ldls through the roof or something and we'll have this sort of you know one-on-one like we'll spend half an hour on just the topic of like what are your concerns about statins and and we'll you know come to a conclusion we're able to to you know let's start with a low dose and and see how you tolerate it and then we can you know consider upping the dose if we need to from there and and so um I think it's all just education but unfortunately what as we talked about earlier when you're online you're getting all sorts of conflicting information all over the place or if you're going to to your doctor in most cases you don't have the time there's a lot of fear-mongering yeah because that that creates high up and clicks and um what's lost in all of that is that person on the end who just ends up totally confused and maybe makes a decision about their health that is not the best yeah um even folic acid comes to mind there what's your view we mentioned folate um there's certainly a camp out there that are convinced that folic acid is increasing rates of cancer yeah I honestly I don't even know where that comes from uh I haven't like seen good data suggesting it's it's you know causing cancer or anything like that um and it is actually really important for like pregnancy outcomes so if you're you know female of uh menstruating age and you're planning to become pregnant at some point then that's definitely something to be you know taking and considering um and you know folate like you can get full eight supplements as well and then they may do the same thing but um but most of the research we have is on folic acid so I just wouldn't mess around right folate's one of those nutrients we mentioned if you're eating a vegan diet and it's full of Whole Foods you're getting quite a lot yeah yeah yeah like that's one of the things that like in most of the studies comparing again like meat eaters to vegans the the vegans tend to have double the intake at least like it tends to be really really high you mentioned plant milks before yeah this is not a plant milk yeah which one have you tried some I have not have a have a safe have a set and this is not a sponsored post yeah you have a sip and then I'll tell you what what it is it's interesting sorry mate that's the uh the first cow's milk that you've had in a while yeah no well it's technically technically not cow's milk it's a dairy protein yeah um no that that was like it had the it's been 14 years since I've had dairy milk so maybe I'm I'm misremembering but it does have that sort of texture or mouth feel it's no longer vegan yeah yeah right I'm not not vegan anymore but it has that sort of mouth feel that I kind of I mean it says animal free right on it I think I'm good but um but uh it has that mouth feel that I kind of remember daily um it's interesting right so for anyone who's listening on the audio uh Dr Niagara just tried bought is a board cow broadcast so this is this is not a sponsored post by the way uh although it did get sent to me uh not for this purpose but um this is a new way of producing dairy milk through Precision fermentation I've had an episode on it previously but in in short you can use microbes to microbes produce proteins and providing whatever instructions they have will dictate the proteins that they produce and there are ways to get those microbes to produce the same proteins that are found in dairy products your favorite yogurt or cheese or milk and so there's been enormous innovation in this area over a long time and it dates back actually this is really interesting so most insulin today that someone who has diabetes is using is an insulin to protein or peptide protein that is produced through Precision fermentation and historically though do you know how they got it it was isolated from animals I think right I believe it was baby cows yeah yeah so they would have to slaughter baby cows to get the insulin and then of course they realized from an ethical one and a sustainable scalability point of view they needed to come up with another means and they worked out how to make insulin through Precision fermentation and then over the years it's a it's a um a technique that's been used to produce other types of protein that are found in cheese actually that people will have consumed before renin and now there's a bunch of companies that are using it already within market products to to offer I guess animal free versions of milk and yogurt and ice cream yeah and and this to note it's it's because it's just the protein that doesn't have any cholesterol it's actually very low in saturated fat I don't know what they use for the fat content but yeah what what would you say to someone who sort of pushes back and says is that healthy I mean I I would look for something like this we don't have long-term Health outcome data on proteins produced this way mind you we have a lot of research on these proteins and other contexts and I don't see a good reason to think that the protein itself would be detrimental in any way and in fact it could even be beneficial you know just by increasing protein intake the other thing I would look at is just the nutrient profile that's what we do have information for and I did look at the label earlier and it you know had like I said no cholesterol had it said zero gram saturated fat I think technically it's like less than 0.5 you know grams per serving or something like that the sodium wasn't very high it was like 140 milligrams like from a health standpoint I would I would consume that you know I don't see any issue with that I like soy milk better you know I would probably keep doing that but I wouldn't have any issue with drinking this saturated fat I've dedicated a bunch of episodes to this yeah Dr Jill Carvalho yeah and I did a deep dive on sort of whether or not saturated fat is harmful and all of the intricacies of the research things that you spoke about before like what is the uh what is the contrast when you're comparing high and low consumption and what is the replacement food and whatnot and we sort of walked people through all of that research to explain why the guidelines are what they are which recommends to limit saturated fat not that it's poisonous but the dose matters so how do you help someone navigate that if they say uh I understand I need to moderate saturated fat what does that mean and if I'm reading labels or thinking about my diet how do I ensure that my diet doesn't contain too much saturated fat yeah so if you're if you're going by guidelines which is typically to limit saturated fat to 10 grams of total or sorry 10 of total calories or less which translates to about 22 grams of saturated fat in a day then reading labels can be helpful and that you you just don't want to pass that on a given day so if you're looking at a label and it's got like two or three grams of saturated fat per serving that's not all that much that that's probably okay if you're having like seven servings then you can it can certainly get up there but but that I wouldn't worry too much about if it's you know seven grams per serving 10 grams per serving then maybe you're a little bit more concerned that that's going to add up you know a third or a half of my you know Target for the day or limit for the day um at the same time if you're somebody who's at risk or you have elevated apob then you might want to go even lower than that and generally speaking I would say the lower the better as long as you're having a you know well-balanced healthy nutritionally adequate diet now outside of food labels because not all foods have labels the foods that are typically going to be higher in saturated fat are like fattier cuts of meat so if you're doing like the extra extra lean meat it'll be lower in saturated fat doesn't mean it's risk-free for for other reasons but but generally the fattier cuts will be much higher butter is like very high coconut oil is very high some dairy products like the creams and full fat milk might be concerning cheese seems to be more middle of the road as far as its impact on lipids just the saturated fat there and then the one like true exception would be cocoa so the saturated fat and chocolate seems to have a neutral effect on blood lipids so to to bring all of that back basically reading labels generally you know a few grams or so per serving I think is reasonable um maybe up to five grams at most per serving is is probably a reasonable Target and then as far as Foods the fattier cuts of meat butter creams that sort of thing are are the things to generally limit right it's one of the advantages of either eating predominantly whole plant Foods or exclusively providing well that actually rules out coconut oil and palm oil yeah uh by by virtue of it being minimally or unprocessed Whole Foods but one of the advantages is you really don't have to count it just naturally occurs that that is a low saturated fat diet but then people are of course interested in all the the new meat alternative products that are coming out and some of those can be loaded with saturated fat where they use a lot of coconut oil palm oil um so that's something I think for people to keep an eye on and I think your rule of five grams of saturated fat or less is is a good one and keeping an eye on your APR b or LDL cholesterol levels and then you can ascertain is the current diet working for you or not or do you need to sort of titrate and change some of the foods yeah because there's genetic differences too like like my just personally my apob is very low I probably have a lot more yeah I know I'm lucky but but uh I mean it's diet plus probably some genetics right but um but I probably have a lot more leeway than someone else might or even you do right and so um so that's a good way to kind of figure out how much wiggle room do I have is by just testing right what else on a label if let's let's stick to uh these meat alternative products and then maybe we can talk about plant milks uh separately what else are you looking for to distinguish between a meat alternative that could be sort of less healthy versus one that is healthier so this is probably the hardest thing to find um in kind of an appropriate or healthier range on a in a plant-based meat but that's sodium you know if again we're going back to guidelines sodium intake is best limited to about 2300 milligrams and I think that's a fair Target especially when it comes to stroke risk if you are someone who's at risk who has high blood pressure then even lower um you know around 1500 milligrams and for reference the 2300 milligrams is about a teaspoon of salt um and so if you're looking at some of these plant-based meat Alternatives they'll have 600 milligrams of sodium in a burger I'll have two burgers you know like that's gonna add up really quick make some tasty yeah so but that's another thing it does make them tasty but but that can add up really quick um there are some Alternatives I've seen I can't recall specific brand names right now where it is more around the 200 250 milligram Mark and I think that's a much better option from a sodium standpoint especially for someone with high blood pressure um so that's another thing that I'm looking at is the sodium content if you look at saturated fat content five grams or less and then you look at sodium content was it 300 milligrams or less well I mean again these are Ballpark figures there's no hard line but those two things before even looking at anything else is knocking out it's a lot of narrowing the field yeah it is Big Time yeah it's really narrowing it um you're going to be stuck with like black bean burgers at that point probably in a lot of cases right one of the other things I'd like to see is some Fiber yeah yeah that's the I was gonna say that's probably the next thing I would look at is fiber and I don't know that I have a hard line for that either because it depends on if you're eating a ton of fiber rich foods in your diet you're getting like 40 50 grams of fiber I don't think you need to worry about it but if you are somebody like the average American perhaps who's getting very very little fiber you know every four five six grams matters um and in those cases yeah just looking for a higher fiber content maybe not the one or two grams but somewhere in the four or five grams might even make a difference yeah the context matters I know a lot of uh athletes who find it actually helpful to have some of the lower fiber main Alternatives because they're already getting so much fiber into their diet and they're trying to meet their very high caloric requirements yeah and I think the same thing goes for kids I think growing kids like that's another thing is their stomachs don't maybe stretch that much right and it's harder for them to get in the calories and so either having some of that stuff that is at least mildly processed or including things like oils and whatnot can help bump up the calorie density of it what about the idea that they're Ultra processed yeah um so like the thing about Foods being Ultra processed is so it's largely based on this Nova classification and so there's there's a zone or a class one two three four four is Alter processed and so if you're taking a food that is made primarily of food ingredients or has um has you know a certain number of additives to them they're going to be classified as Ultra processed now that might sound really bad just based on how I've described it but you think about fortified plant-based milks they fall in that category you can have a soil you you can make a homemade almond milk let's do that homemade almond milk and you can add something like you know calcium to it to fortify it yourself and all of a sudden it's Ultra processed think about that does that mean it's bad for you probably not we have food like tofu um yeah you do like a calcium satofu or something that's going to be considered Ultra processed so it's an imperfect system it's way too simplistic and there has been a lot of pushback on that classification lately because Ultra processed foods can vary a lot you you can't sit there and tell me a Twinkie is going to be the same as tofu right and and uh you know again specifically like a calcium set or like a smoked tofu or something which would be ultra processed so yeah I don't like the classification that much I think as a general rule limiting Ultra processed foods probably a good idea but there is Nuance there I love tofu but I do wish tofu tasted like Twinkies yeah I think a lot more people would eat it well we had tiramisu last night that was made with a tofu base it wasn't really yeah that was great that was incredible um shout out to uh Aisha yeah unbelievable cooking oh man I need that recipe Hospitality was incredible yeah and great conversation yeah she must you can I don't know if you want to show everyone a picture but that spread to she must have been cooking we'll put something up on the YouTube for sure um okay the other thing that often comes up here is a sort of side by side comparison or or maybe just a photo of the ultra processed food ingredient list and the idea that simply because the ingredient list is long that that food must be unhealthy yeah um have you seen that yeah oh you know what I'm talking about all the time yeah yeah all the time and and one of the the examples I always use for that is again the plant-based milks going back to that so if you were to take a uh soy milk for example um we'll say it's a fortified soy milk it'll have like you know the soybeans the water whatever those would be some of the first ingredients and then um and then there might be you know a couple of emulsifying agents you know some certain gums or whatnot and then it's just nutrients it's just like your your calcium your vitamin A all your B vitamins but they'll also use the scientific names for these things so it'll be like calcium carbonate they'll be like try uh try uh you know or try calcium phosphate so it sounds a little bit like something that you make in a chemistry level exactly you've got you've got uh cyanocobalamin you've got uh Cola calciferol you've got you know all these names they sound really complicated and yeah scientific those compounds are found in eggs exactly exactly these are just vitamins and minerals that they're adding they actually may make the food healthier you know and but because it it doubles the size of that list it makes it seem worse are you worried about are there any ingredients where you're like I really don't want to say that in the ingredient list whether it's uh refined sugars is a bunch of different names for what that could be uh you mentioned gums emulsifiers carrageenan often comes up is there anything that you would if a patient sort of sits down with you and says okay I understand the saturated fat and the the sodium and try and find something with fiber when I'm looking at the ingredient list is there anything that I really don't want to see there's one that I could that comes right to mind but you won't really find it anymore and that's partially hydrogenated oils so that would have been one just because of the trans fat content that I wouldn't want in there but otherwise it all comes down to the amount so you kind of have to like cross check the the ingredients list with the nutrition facts label because let's say sugar you mentioned if if they're adding that and then you look at the label and it's like two grams or something like who cares it's not really anything um but if it's if it's all of a sudden like 25 grams in a beverage that's a sugar sweetened beverage that's actually really not healthy to be having regularly but then I'd be more concerned but but that's not necessarily the I mean based on the ingredients list is based on on the kind of the amounts and everything the ingredient list could be a clue if the first ingredient which usually is the ingredient um of greatest concentration uh or input amount yeah it was like first or second ingredients high fructose corn syrup and then you look at the the nutrition facts it's like you know 25 30 40 grams maybe even of of sugar then yeah that's not great okay so is there a a number of a kind of threshold of added sugars that you'd like to see it below on a per served basis so it more for the most part um sugar seems to to impact us negatively based on the amount that it adds to our you know uh say excessive calorie intake so um so that would come down to total calories are you eating calorie balance that's going to depend that's gonna vary so much person to person where I generally would be mindful especially if you're having it regularly is if you're having a beverage with like you know 20 plus grams of sugar in it because if you're having that kind of day in and out that's something that actually appears to increase risk of things like cardiovascular disease you know potentially diabetes and whatnot independent of body weight or at least some affects independent of body weight and so that that is one thing that I would be mindful of but I don't know that I can set like a hard number on it okay you already sort of gave us your views on the seed oils yeah but they of course show up on these labels yeah and they're the funny thing about that is yeah they'll often have like sunflower oil or something and then you you look at the ingredients list and it's like fat zero grams it doesn't even make sense and that's because it's a tiny drop basically it's just to help help with emulsification of the uh of the different ingredients in there so it's basically not even in there right okay and you mentioned you want to see two or three hundred milligrams of calcium ideally in the plant milk um and your preference is soy I like soy is that because of the protein content or um it's it's the protein just nutritional content overall um even like iron a little bit better than some of the other ones uh not that I'm personally concerned about that but uh just the protein content The Taste texture and I just like it more I know a lot of people prefer oat and that's fine uh but uh but I just like the soy true or false phytates and oxalates in foods like oats and dark leafy greens Rob your body of minerals um that's a false um do you know where I got that yeah um Rob your body that was from the same talk wasn't it no or was that from it's uh my friend Paul Saladin oh okay best buddy um so when you say they rob your body that that almost sounds like to people like it's removing it from your body stores of like like taking calcium out of your bones or something um and even if we grant for a second that they bind to minerals it's it's the minerals in the food that you're eating so it's not that it would Rob your body of them it's that if anything it might reduce the amount that you absorb to a degree now there are some other issues with that starting with let's start with phytates so the the main minerals that are often brought up with phytates are iron and zinc now in the short term if we were to look at like a single meal study and you take people who are having you know a high phytate food versus low phytate Foods same iron content you might see that the high phytate food leads to lower iron absorption but what they don't look at is long-term intake and there are at least two randomized controlled trials I'm aware of that looked at intake over eight or more weeks and when you randomize people to higher low phytate for that period of time there's no no significant differences in Iron status at the end of that period And so that tells us that the habitual intake regularly consuming these these Foods leads to to some sort of balance as far as absorption goes so if maybe in the beginning you don't absorb as much your body somehow modifies that and there's some speculation around the gut microbiome and how that might you know impact the interaction between phytates and minerals I don't know if it's entirely clear on what happens but the net result is that we see a similar level of iron absorption in the long run right and then with zinc we don't have as much research but there was one analysis of eight studies done on children in particular and they found that about a 500 milligram increase in phytate consumption which I think is about a cup of cooked brown rice so about like half a cup raw um uh I think it's roughly around that uh might have inhibited zinc absorption by like .04 milligrams a day like nothing and they ultimately conclude that there's just you know no major impact on um uh on uh absorption of zinc either but again we don't have as good data for zinc as we do for iron but but the point being that in the long run we don't see really a negative effect in fact if we look at urinary phytate levels in women and I think this was the nurse's health study we see higher phytate levels are associated with better bone mineral density you know so it's actually better outcomes there's speculative evidence if we were to look out you know animal models or cell culture studies that they might have anti-cancer or cardio protective decrease Advanced glycation and products exactly so the same types of speculations that a lot of these people in the carnivore Community can actually be used in favor of phytates versus against but but obviously they don't usually mention those that would make for some interesting content on social media yeah maybe I'll I'll uh think about it for future here um and then for the other side so for oxalates so it's well known that oxalates bind to calcium I think that's pretty well understood um and you know really the the solution there is just don't focus on oxalate-rich foods for your main calcium sources um and that would be things like spinach beets uh Swiss chard being some of the main ones and instead focus on other things like I mean we talk about four or five milks being a really awesome one even things like broccoli are pretty decent almonds almond butter yeah what are the what are the lower oxalate grains lower um so kale would be one that's low which is funny because I've seen people like Dave asprey call it a high Ox Lake I actually made a post about this it's in his uh book too I think saying that it's one of the main offenders as far as oxalates but Kale's actually very low in oxalates you can take almost any green other than the three I mentioned and they're pretty low in oxalates he has a kale Buster something yeah I know I know there's a kalebuster say no more you and you and Drew talked about that on your uh on your your um episode that was a funny one uh but then yeah like with oxalates it's really just just don't eat those those oxalate Rich greens as your main calcium Source it's okay to have them um just don't focus on them right okay so we can put that one to rest phytites and oxalates are not going to rob your body no I have minerals true or false and you've already alluded to this but I want you to answer it directly there is a single optimal diet um no I don't think so uh or if there is we haven't figured it out um what I would say is that there are characteristics of a healthy diet that can apply to multiple different healthy you know dietary patterns so um things like you know fruits I would say roughly two or more servings a day vegetables roughly three or more servings a day whole grains ideally three or more you know some might even argue five or more uh per day um legumes or this is kind of an either or because different populations will use different foods as their protein sources but either legumes or fish as some of your primary protein sources um and then nuts and seeds or Oils or and or Oils um as your polyunsaturated fat sources essential fats those are kind of the basis for what makes up a healthy diet and you can fill it in with other things but that applies to say the Mediterranean diet DASH diet portfolio um it couldn't be a vegan diet or like a Whole Foods plant-based sort of diet um depending on the iteration um it's not one you know diet so low saturated fat it features unsaturated fats it's high in fiber yeah low in Ultra processed foods exactly as the foundation and then you you can then you have wiggle room too that's the other thing you don't have to be like 100 you know um only healthy foods all the time like you can you can fill in gaps a little bit with other stuff you can enjoy yourself you know that's the other thing is is we don't have good reason to believe that that you know all of these these less healthy foods so to speak are going to be detrimental in any serving I wish we had another word phrase for Ultra processed foods because even in what I just said then contradicts the idea that there are some Ultra processed foods that you don't have to moderate that are actually healthy yeah and that it's it's such an umbrella term and as you said can be everything from uh what did you say Twinkie to a soy milk or something or tofu yeah um we need another word to distinguish between those yeah I don't know what it is I feel like it's too ingrained at this point it's it's just it's used all the time I think I think we need to get the Nova classification committee back get them back to the drawing board there yeah yeah hey friends are you ready to take your fermented food game and gut health to the next level look no further than my digital guide plant-based ferments inside you'll discover some of my favorite recipes including my soy labnay and homemade kombucha visit theproof.com forward slash ferments for more details that's theproof.com forward slash ferments okay that's enough from me let's get back to the episode true or false eating fat makes you fat it can if you eat it in excess calories but um I would say false as it was kind of stated there basically eating excess calories whether it's from carbs or from fat is what leads to Fat gain and both high fat and high carb diets can lead to weight loss if eaten in a calorie deficit and we've seen that in several studies now so um yeah I think that's really just a kind of quick answer to that one when you adopt a keto diet you burn more fat true but where is that fat coming from so so there's um this idea that when you're eating keto because you're in a fat burning state that you're burning your own fat but that just comes down to calories so if you're eating in a calorie deficit if you're eating less calories than you need whether it's on a ketogenic diet or otherwise you're gonna burn fat if you're eating let's say at a weight stable amount let's say you have 2 000 calories you're eating in a day in one case you're eating a ketogenic very high fat diet in the other case you're eating a low-fat high carb diet same amount of calories the keto diet will burn more fat because they're putting more fat in they're burning the fat or yeah they're just burning the fat that they're eating it's not necessarily burning the fat that they've stored whereas with the higher carb diet they're burning the carbs that they're eating not tapping into their fat or or carb stores that way either so I hope that's clear unless you have another way to rephrase that no I think that was great I think it confuses people yeah right the idea separating uh the fuel that you're using from the food you're eating versus body fat so fat in the diet yeah and what you'll be using to to generate energy versus body fat stores yeah they're two separate things okay a low-carb ketogenic diet is the best diet for treating type 2 diabetes um I would say false with like the exception that some people might do better on it so basically with type 2 diabetes the main factor is going to be um fat loss so the the main contributor to insulin resistance is going to be excess body fat accumulation especially liver fad and pancreas fat and um and so if you're able to lose fat whether it's on a ketogenic diet or again a higher carb diet you can help improve insulin sensitivity help prevent further damage to your pancreatic beta cells and hopefully improve your condition and in some cases even avoid things like medication down the road now if you're at a point and we talked about this a bit previously not not in this conversation but if you're in a case where the pancreas has been damaged and you're requiring insulin it might be the case that somebody on a ketogenic diet will just require less insulin perhaps maybe it's easier for them to to maintain a healthy blood sugar because they don't have to be as on top of it whereas somebody would say a similar level of pancreatic beta cell function um eating a higher carb diet needs to to you know modify their their insulin dosage depending on how much they eat um if they're both you know managing that and on top of it it doesn't matter but in the case where maybe one individual is more on top of it than the other that that person is not dosing appropriately or not monitoring as much maybe perhaps would do a bit better but but that's very speculative and very dependent on the specific case right yeah so personalization yeah and the management part being key in my conversation with uh Thomas delara we were talking about the fact that in some of Roy Taylor's research he was able to to notice that folks who had had type 2 diabetes for four years or less when they did the sort of very low calorie diet intervention that he provides which is like eight to twelve weeks of 800 calories like meal replacements just all the way through yeah and and the the rationale for that is to get a a huge calorie deficit and reduce the amount of visceral fat the hepatic fat pancreatic fat and in doing so you restore insulin sensitivity in the liver you restore beta cell function and um hopefully the the downstream effect of that is better blood glucose control but what he found was the sort of chance of someone going into remission was very much uh determined or could be predicted by how long they had type 2 diabetes for so if you had type 2 diabetes for a long long time 10 years or or more much fewer people would go into remission and the theory there is that the there is more uh beta cell sort of damage dysfunction that occurs over time Beyond repair and so I was thinking and and and Thomas kind of threw this out there that I can see the utility of a low-carb diet in the in the case of that person who just cannot restore beta cell function which means they can't get back to producing insulin um again in the context of they're having trouble with their management of of exogenous insulin because that's always an option yeah and actually something I would just add though if someone was going to go with that low carb approach I would really emphasize the importance of focusing on unsaturated fats over saturated fats as well because you don't want to sacrifice the you know the the heart health you know benefits of or some of the heart health benefits of managing your blood sugar by increasing your apob at the same time right yeah ideally you want to have both right and and even insulin sensitivity if you if you if you want to talk about that yeah there's plenty of data showing that when you swap saturated calories from saturated fat for an equal number of calories from unsaturated fats you increase insulin sensitivity yeah um and so it does it does seem like there's some resistance though from from many people in that Community to shift the type of fat in the diet from a sort of bias to towards saturated fats butter and fatty cuts of meat to unsaturated fats nuts seeds fatty fish Etc why why do you think that that bias exists I mean I think part of it is preference I think it's it's a lot easier to do a low carb diet in that way than it is to do one that's rich in unsaturated fats um but but you know otherwise I I think it might be if you're doing keto I think it's hard to do that on a say a plant-based diet well I'm talking about a sort of Mediterranean diet with olive oil and fatty fish and nuts and seeds and avocado that's a good point with fish and stuff too it would be a lot easier than like a strictly plant-based approach and it would certainly be more comparable to what people are currently doing is just be replacing the things like the butter and the meat with more of the fish and the olive oil and whatnot so so yeah I can see that I don't want to just pick on one diet here so let's Let's uh switch sides here okay perfect uh true or false a low-fat vegan diet is the optimal way to do a plant-based diet um I would generally say false I think some people might do better that way they might prefer it um maybe to have an easier time with it or just feel better that's fine but generally speaking I don't see any reason to consider that optimal or to do that over a more say moderate fat approach where you're having more nut seeds and oils at the same time I think for growing children who I've mentioned where just calorie density could be an issue and it's harder for them to get enough calories having more of those oils and higher fat foods can be really beneficial I think for athletes I know myself like if I was doing super flow and I'm not even a huge guy but if I was doing you know super low fat I feel like I'd be eating like crazy um whereas having some more of those fats in there makes it a lot easier as far as the volume of food you have to eat as well and I've heard similar from other other athletes so so yeah I would say um I would say I wouldn't call it optimal necessarily but I think some people might do better that way just out of preference so let me push back for a moment yeah I'm going to take the position of someone who would argue for a low-fat vegan diet it's not my position okay um but I'm going to argue their position for a moment isn't there data to suggest that fat damages endothelial function and that the best diet for cardiovascular health which is the leading cause of death so we should take it seriously the best diet is a low fat diet that promotes endothelial Health not dysfunction and has been shown in clinical trials to reverse cardiovascular disease okay so there's a lot to unpack there so we'll take a one at a time as far as the oil and endothelial function so where that largely stems from is there was one trial where they took participants they measured flow mediated dilation and how they did that was they essentially put on like a blood pressure cuff pumped it up held it there I think for like five minutes or so and then they released it and saw how well the arteries dilated now the participants were first given oil and it was something like a quarter cup or so of oil and I believe it was with bread so it wasn't even just oil Alone um so this was a lot of oil with some some carbohydrates as well and they measured then the ability of the arteries to dilate you know immediately and shortly thereafter after the meal and it you know there was some impairment relative to to not having had that meal and from that the conclusion is then while it's you know crippling the arteries is the word that's often used it's not able to open up and allow blood flow and there are a couple kind of problems with that for one um oh and it was olive oil I'll mention but for one they were like that postprandial post-meal State um having any sort of endothelial function in that state has never actually been shown to translate to higher risk of cardiovascular disease that's just pure speculation at this point that that would lead to a higher risk of having a cardiac event second when we look at the impact of say olive oil consumption on fasting level or fasting ability of the arteries to dilate so flow mediated dilation in the morning it actually improves function so an argument argument can be made for olive oil actually improving artery function in the case that's actually been shown to protect against cardiovascular disease which is those kind of Baseline fasting levels what do you think is that the polyphenols I think it could be I think that makes sense and I also wonder if replacement matters a bit mind you in that study they did do a a subgroup analysis based on what was being replaced and it seemed to be pretty consistent regardless of replacement um it was even similar to omega-3 fats which is really interesting which I thought might even be preferable so it could be polyphenols it could be a few things if you take the acute so if you take the acute uh endothelial cell function following olive oil and then you apply a large dose with bread right and so you could you could you could come to the same conclusions if you were assessing how exercise also affects anything I was just gonna yeah make that comparison because exercise can trigger inflammation post meal or post-workout as well and it can last that way for even two days depending on the intensity so that really illustrates if you look at something in isolation yeah so we could theoretically we could be very reductionist Zoom right in on exercise I could get you to go and run measure inflammation or endothelial cell function show increase in inflammation reduction and flow mediated dilation and without knowing any other information I could on paper say exercise is going to be bad for cardiovascular health yeah I've made that comparison on my Instagram as well a few times just because I think it really illustrates the point because I don't think there's any debate around the benefits of exercise at this point so um so yeah it is very reductionist okay and what about the claims of reversing cardiovascular disease yeah so those stem from a couple um a couple places so there's the lifestyle heart trial so this was the randomized trial by Dr Dean ornish um it's been I think three decades since SAS has been been around 1990 yeah yeah so it's been about that um and um so what they did was they took it it was 28 participants with coronary artery disease so you uh they had angiograms showing um coronary artery disease and they then randomized them to an intervention or a control group so in the intervention group they were put on a low-fat vegetarian diet now the vegans always like this as a vegan diet it wasn't they were allowed to have egg whites and they were allowed to have some low-fat Dairy so it was not strictly vegan they were also having a B12 supplement they were walking primarily for exercise um they were attending support groups and then smoking cessation was a part of the protocol as well but only one participant actually smoked that Baseline so I don't think smoking had a huge Effect one way or another then the control group underwent standard care now they measured um uh they essentially measured the amount of plaque in the arteries at the beginning and then after the trial and they noted some regression now the issue with that is that the type of measurement they used was not gold standard and for that measurement there's a certain threshold value of difference you need to see right so and you need to see at least a certain amount of a of a you know decrease in plaque size so to speak in order to say that there was some reversal and it didn't meet that threshold when you say it's not gold standard just to be clear it's not gold standard today or at the time it wasn't gold standard so definitely not today now this is a little outside my wheelhouse but I believe some of these limitations were at least known then whether or not there were better methods I'm not sure but but some of the limitations were noted at that time so so it could go either way I won't say with super you know a lot of confidence um either way on that but uh but basically uh it didn't meet that threshold for for regression um and so it could just be due to margin of error and measurement another thing that's noted is actually the reference artery so you have the plaque you know the the or sorry the artery and you have plaque blocking a part of it um and you're kind of looking at how much of the space the plaque is blocking and what they noted was there was actually a wider space so it could be the case the artery actually dilated and the plaque stayed the same like that's another way to potentially look at it there are a lot of potential variables there so it wasn't oh sorry I knocked Mike um so it wasn't just biceps yeah this morning has you pumped up and we're hitting microphones yeah hopefully that wasn't too loud um but uh but yeah so so it wasn't a vegan diet even though it's often cited in favor of a vegan diet uh it wasn't just diet it was a multi-factorial intervention the um it didn't meet the you know threshold that it needed to meet to claim that there was you know reversal um and uh and you know we now have have you know better ways to measure these things and actually more recently the chordio prev trial which compared a Mediterranean diet higher in fat versus a low fat diet again not a strictly low-fat vegan diet but but a low-fat and pretty healthy diet based on on you know what they were eating um and that found that there was actually some regression in the uh in the um Mediterranean diet group that was higher in fat so so unsaturated fats yeah unsaturated fat in particular and so that is is you know another reason to to push back on the claim that it's like the only diet that's shown shown this artifact and they had significantly less events as well in Claudio Pro yeah and I think that's the big takeaway from from The ornish Trial as well is that at the five-year follow-up the control group had like two and a half times the events yeah so that's this is a very important yeah because uh some of them might think you're sort of trashing on that study you're more talking about the interpretation yeah of that so so by definition and by by the study design we cannot determine the independent effects of of diet in that study period because there was uh was it exercise yeah there was a little bit of smoking cessation yeah um support groups so there's a bunch of different things within the intervention that could be affecting the outcomes so that's the first I think that you're I'm just kind of feeding back to you what you said but it's the first thing that stops you saying a vegan diet reversed it and then the second is the Imaging but what you're saying is it probably doesn't matter too much who cares yeah because that intervention did lead to a reduction a significant reduction in cardiovascular events exactly and that's what I care about I don't care if you know one marker improves if you or improves or even gets worse if you end up having a lower risk of disease like that's what I I care about is do you have a lower risk of having a heart attack and or a stroke or whatever it may be and if that's the case then great that's what we're looking for what about the did Dr esselstyn study that often gets cited as well so that was a case series um and they had 198 I believe participants um and this was over time um who had previously had you know heart disease and he enrolled them in their program went on a strictly low-fat plant-based this one I believe was strictly plant-based some of the participants I I can't recall the exact proportions were on a cholesterol lowering medication as well so they weren't just doing the diet that's something that often gets left out and they were followed for a period of up to a few years I I can't recall the exact follow-up time but basically they found that they had a much lower the people who stuck with the program long term had a much lower risk of having a cardiovascular event than those who fell off the program now there are multiple variables there because well for one this wasn't a randomized controlled trial to begin with they were all enrolled and they were comparing people who stuck with it versus people who didn't stick with it now people who didn't stick with it probably aren't as healthy and other factors as well maybe they aren't exercising is not as much and doing other things as well um and uh and but at the end of the day yeah they saw a much lower risk and that's great it's it's some evidence it's not the highest quality evidence we have better evidence out there but what often gets cited is there's one angiogram one image of an artery of a before and after and you see that you know apparently the artery just opened up right that the plaque kind of melted away so to speak um and if that is the case I mean I know I've heard of other cases from from cardiologists where this this sort of thing does happen on occasion and they don't know exactly why um but the other thing is even if you were to take that image from a slightly different angle it can appear as though it's a completely new artery right so it could just depend on the Imaging because these are done you know a year plus apart um so so that's a possibility and at the end of the day it was one individual out of the 198 that this image is from um so I I wouldn't put a lot of stock in that either but again at the end of the day we know by even better data than that that it lowers your risk of having a heart attack so it doesn't matter we don't need to sell it on this you know image um that that they had in there we can just sell it on the fact that consistently we see that people eating plant-based diets whether strictly plant-based or mostly plant-based have a lower risk of cardiovascular disease and that's what we should care about and what would you say to someone who's interested in prevention so primary prevention versus secondary prevention so a number of these trials like the the dean Awana Schwann the cordioprev and Leon are all secondary prevention so they're looking at how does a diet dietary intervention affect cardiovascular disease in the context of someone having the existing cardiovascular disease whereas the the other and I think you've made it clear there what the evidence sort of shows yeah the other question is what about preventing the disease from occurring in the first place is it the exact same sort of principles the same principles apply um for the for the most part and we have some evidence um as far as observational research we have quite a bit as far as randomized trials like long-term randomized trials we don't have a ton we have things like the pretty Med study that found a Mediterranean diet whether it's rich in nuts or olive oil could lower risk of cardiovascular events um by quite a bit as well but yeah generally speaking we see that each of these individual components of a healthy diet that I talked about seemed to lower risk even in primary prevention and overall dietary patterns Mediterranean diet scores healthy plant-based diet index scores which is basically scoring your diet according to how many healthy plants you eat and then you get kind of negative points for animal foods and the less healthy plant Foods those with the highest scores versus the lowest have a much lower risk of cardiovascular disease in the first place and this is consistent you know amongst all the different dietary patterns of almost all the major cohorts that we have this data on I think it it's another scenario where it's it's it seems like it's difficult for some people to accept that there might be a few different ways of going about this right yeah it could be what if if you were adopting a low-fat vegan diet and and they're probably people listening to this that have had great results doing that what would you want to draw their attention to where are the potential blind spots of a low-fat vegan diet things that they could keep an eye on to optimize within that variation that they choose yeah I think there's a couple things so at least in the trials that have been done like Dr Neil Bernard's trials um with diabetes I think protein intake tends to be sub-optimal tends to be quite low so one thing I would emphasize are things like legumes tofu uh hopefully not so fast so low fat that you're avoiding tofu as well but uh but legumes tofu even considering a protein powder to help you you know up the the protein intake what do you think about the idea of someone gets older and let's say they have lower appetite and they're following a plant-based diet slowly adjusting some of their calories so they're getting a little bit less calories from say whole grains and starches and more calories from the legume Food Group I think that's fine I I think I mean as long as you're eating a nutritionally adequate diet as long as you're still consuming some you know a couple servings of those Foods um I don't think you need to like maximize intake of them I think it is probably more important to resistance train um to eat those legumes for their nutrient density and protein because it is your main protein Source in that sort of a diet um and and I I think that can be totally suitable I don't see any reason why it wouldn't be why the concern with low protein from a health point of view what are you concerned by what do you what do you think increasing protein will help protect someone against so you know one of the issues with aging is that we just absorb less protein to begin with um so we have we have issues absorbing as much which is why some experts will recommend higher protein intake as we age and then for you know helping prevent things like sarcopenia along with resistance training that is the takeaways that resistance training is number one protein second to that so resistance training helping maintain bone mineral density particularly in that at-risk population especially post-menopausal women that that's one of the areas where we've seen the biggest effects um that would be the reason is just to help maintain Mobility quality of life you know A reduced risk of Frailty and then we also have a meta-analysis from a couple years ago looking at it was like 31 cohorts over 700 000 participants or something well it might have been even more um looking at protein intake and mortality and the highest protein intake and specifically highest plant protein intake was associated with a lower risk of mortality relative to lower intakes and so I think we have a good reason to emphasize protein intake especially in those people who are at risk of consuming too little which would be those eating a like low-fat plant-based diet the resistance training Pace I find very interesting I think we've spoken about this before but there does seem to be at the moment a a real and I appreciate the importance of protein I think it's important but there seems to be this kind of obsession with protein particularly animal protein and a common theme or rhetoric that I see currently is around Falls and Falls being you know I think there have been claims people saying it's the number one cause of death people age 65 and over yeah so so if we're doing true or false I'll say false and that's because where that comes from is um at least where we've traced it back to is um so according to the CDC CDC or World Health Organization yeah that was a CDC data we were talking about um so according to the CDC the well number one cause of death was cardiovascular disease the um then unintentional injuries made up 2.7 percent of the total risk of death or causes of death uh in that age group now of those unintentional deaths Falls was number one so it's not that falls were the number one cause of death period it was that of that 2.7 percent of the death it was the number one cause and so it gets um which is super important to understand yeah because as you said 25 of deaths were cardiovascular disease yeah well that was heart attack when you add in stroke type 2 diabetes Alzheimer's and cancer it's over 50 yeah um but this becomes important when you're thinking about your food selection because if you're making the claim that falls are the number one cause of death of people aged over 65 and then you're assuming that the primary reason people are having Falls and breaking bones is because of a lack of protein well that could be argued yeah on its own because there are a number of contributors right yeah medications like all sorts of yeah um what someone could be making a decision to include say more animal Foods in their diet to negate the effect of Falls while at the same time worsening their cardio metabolic health risk which is what they're most likely going to die of yeah I know that's the that's the big problem and uh and it's always yeah it's always specific to like promoting the animal protein as well you know it's always like you need the animal protein to prevent your risk of Falls and and yeah how much protein is optimal and what's up sub-optimal um so I would say a good Target and I'm open to this shifting a little bit depending on on evidence if if better evidence comes out but I tend to focus on about 1.2 grams of protein per kilogram of body weight I think especially in that older age group that's a really good Target and I think it's also great to start building those habits earlier on and to aim for that sort of Target while again you know resistance training or doing some sort of physical activity is going to be great to do on top of that sub-optimal certainly below the RDA I think you're you're definitely too low which is 0.8 grams per kilogram but I would say you know anywhere below that that 1.2 could potentially be sub-optimal relatives at 1.2 plus and then any benefits you're going to get from 1.2 to 1.6 grams per kilogram or you're primarily going to be among strength athletes and aren't massive there's something there and that can add up over you know your training for 10 15 years that adds up but it's not like going to be Earth shattering for the average person what's that meta-analysis we'll put it on the screen yeah and it makes it really clear that when it comes to strength like the greatest stimulus but you can eat as much protein as you want but if the resistance training is not there you're not getting much increase in strength yeah and so that was on for the figures if you have it on the screen here on the right side was uh for protein without resistance training and it's like this tiny bump in in um it was like lean math right just tiny tiny bump in in that uh whereas on the left side where you have it with resistance training you see that it's like way up here where where just resistance training alone was great and then as you go from the low protein to high protein you'll see further you know improve yeah and and the other very notable observation which comes back so you you're talking about 1.2 grams per kilogram when you look in the context of people doing resistance training so by far resistance training clearly is is the most important stimulus here and then what's interesting is if you compare 1.2 grams per kilo to say 1.6 and there's a lot of argument over these numbers online that's really just like squeezing the last bit of water out of the towel right the the the the the sort of greatest magnitude of effect comes from adding resistance training yeah 100 I don't think there's any debate around that true or false most people should avoid gluten gluten is inflammatory and it causes leaky gut otherwise known as intestinal permeability um so I say false um now there is about a percent of the population it'll vary a little bit depending on the population but we'll say roughly a percent of the population who has celiac disease which is an autoimmune condition that can be dangerous can even be life-threatening if you're consuming gluten so in those cases if you're having gut issues one of the first things you'll often be tested for on your blood test is a marker called TTG trans or tissue transglutaminase which is testing for one of the antibodies that's present in Celiac disease so um so you test for that rule it in or rule it out to figure that out and and if it isn't Celiac then then that's probably not a problem now there's also another um we'll say roughly six percent of the population there are different estimates I'll give you the link to this particular paper that cites about six percent of the population who have non-celiac gluten sensitivity so it's not that celiac disease it's not life-threatening but this can lead to you know gut symptoms and things like that that just aren't comfortable um and in that group of individuals as well yeah avoiding gluten might be beneficial but then for the you know over 90 of the population who don't have either of those issues there's just no good reason to avoid gluten and in fact gluten-free diets have been associated with a high risk of type 2 diabetes uh in the uh I think that was the nurse's health and health professionals follow-up studies uh as well so um and that's probably because when you're eating gluten-free you tend to eat more of the refined less of the whole grain carbohydrates because a lot of the gluten-free products are made from the the refined grains as well and whole grains can be protective we can't talk about gluten without talking about lichens can we uh lectin certainly gets a lot of air time since plant Paradox I think yeah plant Paradox certainly um was a it was a New York time best-selling book I think it's become a household name and one of this I guess the thesis of the book is that lectins are causing leaky gut again and as a consequence leads to inflammation and all of these different inflammatory related conditions so true or false lectins cause leaky gut false I don't even know where that claim can come from I've never actually heard that specific claim it's usually about lectins poisoning us or being toxic um but yeah the the one thing about lectins though to understand is that selectins are most concentrated in you know certain plant foods like legumes in particular and and especially the lectins that could potentially be toxic are concentrated in certain legumes like kidney beans the thing is when we cook them you destroy the lectins to the point that they're not even detectable and it doesn't take a lot of cooking either and so if you're cooking legumes to the point that they're actually edible so they're soft like you're going to eat them then the lectins are destroyed anyway and if you're buying canned they're already cooked so it's already taken care of so really it's just an issue of improperly prepared legumes and there are some cases of raw kidney bean poisoning where they're undercooked or raw there was one analysis from the UK over 13 years there were 50 reported suspected not even confirmed cases of lectin poisoning and one argument I've heard recently that I thought was just awesome so I want to bring it up is that this is an issue of improperly prepared food legumes and it's often coming from more of the animal-based diet crowd well what's the risk of improperly prepared meat right if we look at the UK again in 2014 there was an analysis that found in a single year poultry alone was responsible for 250 000 cases of foodborne illnesses and a thousand hospitalizations if we look at U.S data salmonella from poultry alone so forget about other foodborne illnesses but just salmonella is responsible for almost 100 deaths per year why not point in that direction if you're going to talk about this you know a specific case of not preparing your food properly um whereas like in reality legume consumption if you look at um you know any of the recent there's a couple meta-analyzes that have come out in the last couple years one looking at cardiovascular disease and one looking at total mortality and both found the higher legume consumption is associated with a lower risk so do people need to use a pressure cooker or are they canned beans okay canned is okay can gets gets rid of the lectins anyway it's already it's already been cooked it's already been taken care of you don't have to worry about even boiling you don't have to worry about it if you're boiling to the point that they're soft again you squish it with a fork you know that's the point where you're going to be eating it the lectins won't be there anymore well it's a pretty easy test yeah think about the texture yeah I think you'd know if you were having a an uncooked I know I don't think it'd be very pleasant no don't try that all right Dr Negra this has been uh excellent thank you again for sitting down with me I know that the audience is very appreciative of your time and everything that you're doing you haven't finished your milk so I will finish it you will finish it I'll make you finish yeah and uh yeah thanks for doing this and hopefully we can do it again sometime soon continue the conversation yeah thanks for having me on it's good to finally connect in person after like two years of talking almost every day thousands more than a thousand how many messages do you think I don't know it's going on 30 a day probably yeah and it's WhatsApp it's Twitter it's Instagram it's too hard to keep up yeah thanks dude there you have it friends I hope you enjoyed this episode if you did and want to stay up to date with future episodes be sure to hit that subscribe button on YouTube and follow on Apple or Spotify finally thank you for showing up and the effort that you're making to take control of your health I look forward to hanging out with you again in the next episode

Channel: The Proof with Simon Hill

Views: 43,852

Keywords: simon hill, science, nutrition, evidence, facts, plant based, healthy living, wellness, podcast, conversation, the proof, the proof podcast, plant proof, health, fitness, dr matthew nagra, vegan diet, vegan nutrition, plant based diet, plants are trying to kill you, nutrition research, whole food nutrition, Tucker Goodrich, is seed oil bad, Precision fermentation, plant based milk, saturated fat, heart disease, low fat high carb diet, keto diet, fiber rich diet, gluten free diet

Id: jU80CY75l9Y

Length: 118min 58sec (7138 seconds)

Published: Mon Jul 03 2023