Chris Kresser & Dr. Joel Kahn

00:02five four three two one gentlemen thank you very much for being here really appreciate it dr. Conn before we get started why don't you tell everybody what your background is you will be representing the vegan portion of this discussion tell people about yourself a little bit thank you I feel like the head broccoli in the United States today but I am from Motown Motor City badass born raised University of Michigan School Medicine summa laude internal medicine training cardiology training in Dallas Texas very hard to be vegan in Dallas but I did it in the 80s because I've been doing this 42 year vegan 42 division thank you that's impressive age 18 and then Kansas City Missouri another tough town to eat plants and only the steakhouse Casey recipes did training and stenting I was blasting open heart attacks from 1990 on came back to Michigan very active cath

00:58lab heart attack you're dead I bring you back practice 24 hours a day with great partners and about three to four years ago I used all these decades of plant-based medicine I've been basically bringing my family up with and teaching patients but it opened a completely preventive cardiology practice and along the way with my wife and son we now own three plant-based restaurants two in Detroit one in Austin Texas write books do TV write blogs teach teach teach and that can stop the 150 because there's a lot of erectile dysfunction to stamp out that's my passion that oh my god what else what better purpose in life well heart disease is somewhere in that mates do okay and if people want to read more about you website is yeah drj OE l ka h and dr. joel kind and you've written a ton of books right now bunch of medical papers a whole lot of blogs awesome and Chris yeah Chris presser I

02:02did my undergrad at UC Berkeley and then got a Masters of Science and co-director of the California Center for functional medicine which is a functional medicine in clinic and in here in California up in Berkeley and I came to this from my own experience with chronic illness I as as you know Joe got really sick back in my early 20s when I was travelling around the world and you know conventional medicine didn't have much to offer for me and so that led me on a path of trying to figure out the best approach from a diet and behavior and lifestyle perspective to heal from my own chronic illness and then that evolved into me starting to write you know it started a blog and a website and then wrote a couple of books and now have an organization that trains practitioners and functional medicine and also trains health coaches and you at one point in time were vegan I was a

03:03macrobiotic vegan it was apprentice' the macrobiotic chef so what's the difference sheet of macrobiotic vegan for folks and a regular vegan macrobiotic is a particular philosophy it's a particular approach that came from Japan and it's vegan but it's it's you know it's heavily influenced by Japanese tradition and cuisine and it has some kind of different beliefs than a typical vegan approach so I was when I was originally studying Chinese medicine I was working and apprentices with macrobiotic vegan chef and we were going around cooking for people who were really ill often people with cancer who were following a macrobiotic diet and before that I had been a vegetarian for quite a while as well what when I was traveling around the world and got sick actually I was I was a vegetarian at that point - and you discovered through your own personal what you doing over

03:59there buddy and you discovered over there through your own personal practice that you your body worked better and your illnesses went away when you change your diet away from macrobiotic yeah for me personally vegetarian diet and particularly vegan diet was a disaster but I'm just one person I don't put a lot of stock into you know a syncretic perience one way or the other but certainly that did lead me down the path of questioning some of my earlier beliefs that I had about vegetarianism and veganism and it led me to make some different choices and that is important to discuss here that everybody's body really is different and different people's bodies and lifestyles they're gonna have different requirements absolutely I mean I I would say just to start off this whole discussion if we're trying to answer the question what's the optimal diet for everyone I think that's

04:58a terrible question yeah and it's an unanswerable question we share a lot in common as human beings but we have a lot of important differences too and from the beginning I've always argued that there's no one-size-fits-all approach when it comes to diet but I think there are some common themes and we can I'm sure we'll get to those later yeah I think that's really important right it's really important to discuss that people really do have different requirements yeah and I mean we'll get in the mud a little bit as we need to but we also Chris and I share a lot in common I mean one if we ate together it would probably 90% the same we both are really respectful what we call functional medicine root cause medicine I don't write scripts without thinking about the patient he certainly doesn't do that without thinking about the entire patient it's pretty unusual

05:42and we're gonna represent a very small section I I honor what he's doing with his new book on conventional medicine the rest you know that is what is happening throughout medicine and it's necessary because it's just we're just run out of dollars in health when we're just pushing pills and not even asking a person what they eat how they sleep you know the whole thing you know we're real it's still rare Joe I mean this is they have you know this is pretty rare segment I don't know that 2% of the people in America will have a patient leave the office and actually ask what they ate today you know yeah I mean sure doesn't happen let me say one more thing about this so cuz I think you hit on a really important point and I'm glad you did it right off the bat the biggest problem with nutritional research epidemiology is that it starts with the assumption that there is one diet for everybody

06:31that's that's something that's rarely discussed but it's it's this idea that you know should everyone be on a low-carb diet should ever beyond a high-carb you know low-fat or low-fat diet you know should everyone do this should everyone do that and the whole you know there's a guy in Australia a professor who calls calls this approach nutritionism this idea that we can reduce foods down into these individual components just like macronutrients you know protein fat carbohydrates and we can figure out what works best for everyone just by looking at these isolated components without considering the whole context of the diet so I think you know Joel would agree that if you talk about a diet that's 50% calories in fat and one diet is they're getting all of those fat calories from pizza and chips and candy bars and things like that and then another diet they're getting 50% of fat

07:29from avocados and olive oil and even you know eggs and animal foods those are two totally different diets and yet in the scientific literature those are equated as the same because they're all they're looking at is the calories from fat they're not considering the quality of the diet and others that in and again we've going anywhere with this conversation but a lot of the problem has been imprecision of language so even the words low carb diet I had a low carb diet if we talk low refined carbs I don't eat white flour I don't eat sugar I'm very careful about all those components I eat a very high complex carbohydrate diet so well vegetables a giant study that's been released this years of pure study talks about carbs and the diet they didn't differentiate complex and refined very hard to know what to do with data that doesn't spread that apart and in your own life I mean

08:17low fat high fat I mean we need to talk about is it soybean oil that's you know processed and rancid are we talking about avocados and you know healthy Whole Foods so the precision of language even protein protein the big divide is animal vs. plants anytime that word comes up we need to differentiate what you know be precise and then will help more people for precise yeah and if you can't just to illuminate this for people what is the problem with epidemiology studies you know I'll go there real quick I mean I don't think there's a problem but there are part of the solution there the whole solution a lot of scientists I'll give a shout out to Los Angeles brightest nutrition mind somebody that I know Chris honors to Valter Longo no label not vegan that Palin not nothing he's a USC been honored by the Royal Academy of Swedish medicine which is a Nobel Prize Committee in this that he

09:11says you know you do basic science and then you do an epidemiology study to test the hypothesis you've sees something in the petri dish you see something in a mouse you see something in a cell you ask the question is animal protein Pro longevity Pro early aging Jesus my explaining epidemiologist usher people so you would take that concept of this wrong with that that you know you you look at an amino acid found in animal protein throw it out methane and leucine in a petri dish looks like it might cause accelerated aging in a single cell that's biochemistry that is something you honor but it's a long jump from there to human then you look at a database sometimes it's a crappy old database sometimes it's Harvard has these gigantic ongoing database Loma Linda an hour from here has a gigantic database and there's others an epic study this pure study mentioned you can

10:00test the hypothesis of what happens if our data may be crappy but it's still data and it allows you to go further with a hundred thousand people 50 thousand people five hundred thousand people can we have the data ask the question does protein correlate with survival protein correlate with early death animal protein plant protein these studies have been coming out a lot lately and they let you parse it out now it's what you know Chris talks about do you know everything about the person in the database do you know smoke or do you know diabetes do they go to the gym to lift weights they smoke dope do they smoke crack you know you don't know everything nowadays most of these things are gonna ask are your blood pressure cholesterol all the basics to try and take those factors away and isolate the question you're asking it will be imperfect and then you go to the best

10:43study but it won't it won't happen often the randomized clinical trial I mean there's never been a randomized clinical trial smoking because there be unethical you're never gonna do it it was epidemiology that proved an association strong enough to recommend to the public don't smoke they'll never be a randomized trial and not everything parachutes don't need a randomized trial you know you know taking folic acid a pregnant woman did not have spina bifida doesn't need a randomized trial I mean there's some things are so pressing the public health can't allow that and there's even more than that the last little section is you can study old people Chris enjoys studying ancient societies I enjoy studying the elderly in current you know modern environment which is called the Blue Zones and there's others but you know what old people do the old healthy people what we

11:32would like to be would you like to be 90 and have your brains and have your joints and everything working well we have that database so that that little four pod pedestal to sit on basic epidemiology randomized studies and centenarians studies allows you to make reasonable conclusions you know will be wrong sometimes we're not gonna be very long Chris I think there's huge problems with epidemiology so observe epidemiology observational studies are studies that look at a certain group of people and then try to draw inferences from their behavior about associations with disease so let's say we we take a group and we look and see you know how much saturated fat are they eating and we separate them into you know low consumption medium consumption high consumption and in a prospective study where we're watching them over time we might then look 20 years later and see

12:23how many people had heart attacks and died okay and then we try to you know correlate that with their amount of saturated fat intake now I actually just published two articles with going in detail on the problems with observational nutritional research and you can find them at crecer dot CEO slash rogen there's a whole bunch of information that we're going to be talking about today there so people can go and get the details themselves but I'll just give you three of the I think the moat the worst problems with nutritional epidemiology the first is data collection so there's a saying in science which is that data are only as good as the tool used to collect them all right and in nutritional observational studies the tool used to collect data is a questionnaire okay and so that relies completely on memory and we know that memory is not a precise accurate or

13:20representation of events it's more like a highly edited anecdote of what happened in the past and a little bit like the Kavanagh thing going on right back in that back in the 13th century he had Francis Bacon who said for something to be scientific it has to be independently observable measurable and falsifiable and then accurate and valid valid and so let's use an analogy if you're sitting there eating an apple and I'm watching you do that I can observe that you're eating the Apple I can measure how much of the Apple you eat and I can confirm or refute that you're eating the Apple if you tell me that you were eating an apple 15 years ago or 10 years ago I obviously can't observe that I obviously can't measure it and I obviously can't confirm or refute it and yet our entire foundation of a nutritional epidemiology is based on that basically people reporting on what

14:15they ate at some time in the past so you know how much of a problem is this there's a guy named Edward Archer who's done some really interesting studies and he looked at the N Haines data the nurses health data which is one of the longest-running nutrition studies 39 years and he found that the the self-reported calorie intake in those studies was either physiologically implausible or incompatible with life so the average person in those studies reported a calorie intake that would not support an elderly bedridden frail woman so they just is just inaccurate it's completely inaccurate and the people who are most likely to underreport are people who are overweight and obese so if you if calories are that much underreported all nutrition comes through calories everything we get fat protein carbohydrates micronutrients they all come through calories so if calories are that underreported that

15:15completely invalidates the data set this is an obesity study so they're underreported because if she's not an obesity study it's just every Americans are overweight and obese the majority of Americans are overweight and obese so in any data set of Americans you're going to have the majority of them overweight or over B's so or obese so that's the first problem the second problem is a healthy user bias which I know we talked about before but it's basically the idea that because you know when someone engages in an unhealthy and a behavior that's perceived as unhealthy they are more likely to engage in other behaviors that are perceived as unhealthy and vice-versa so let's say you do a study of people who ate eat more red meat well red meat has been perceived as unhealthy for a long time and so what we know is that in those observational studies the people

16:04who eat more red meat are also smoking more they have higher body mass index they're eating less fewer fruits and vegetables they have a lower level of education they're less physically active so how do you know that it's the red meat that's causing the problem and not those other things you don't because they cannot control for all of those potential confounding factors the third problem with observational research and maybe the biggest is that the the relative risks in nutrition are so low that they're indistinguishable from chance so in fields outside of nutrition and epidemiology nobody would consider a relative risk an increase in risk less than a hundred percent a doubling to be really worth paying attention to so to put this in perspective the observational studies that Joel was referring to that confirm that is that cigarette smoking led to lung cancer

17:00that children between a 1,000 and 3,000 percent increase in lung cancer in smokers okay and the studies that have shown that eating aflatoxin which is a mycotoxin increased liver cancer risk that's 600 percent increase okay the aya the IAR see the w-h-o report that suggested that process red meat was a carcinogen that was 18% increase most epidemiologists you talked to will say that is so low that it's really in the student indistinguishable from chance especially given the healthy user bias and the problems with the data collection that I mentioned before so the studies that are cited so when people are talking about red meat causes cancer they're literally talking about something that showed an 18% increase yeah and this is over people that are also spending sugar so what that translates into four and a half there were four and a half cases of cancer out of a hundred

18:00and people with no lowest intake of processed meat and that went up to 5.3 cases out of a hundred in people with the highest intake of processed meat so you know there are quotes like if you if you look even 20 years ago like there's an article in science the journal Science and Marsha Angelle who was the former editor of New England Journal of Medicine was quoted as saying we wouldn't even accept a paper for publication if it didn't have at least a 200% increase especially if it was a new Association or the biological mechanism wasn't known and here we are today saying that you know this increased that by 7% or by 10% and when you consider that the data is usually questionnaires of what people ate and all of these confounding factors like exercise and and fruit and vegetable consumption and things like that are not accounted for then we're really just playing games

19:00with numbers it's part of the problem as well that there's this clickbait culture now in terms of journalism where they just want to publish something that says a study shows you know 18 percent of people eat red meat get cancer that's a huge problem and there is a study that was done that showed that 43 percent of findings came from observational studies were portrayed in the media as being causal which which any epidemiologist would tell you that that's a faux pas you can't do that but nobody is gonna click on a headline that says you know small association between these two variables seen we don't know what it means but please read it this story it's really interesting let me just grab a couple and again a lot of respect and agreement but if we throw a bit DME ology away we throw away about 80% of nutrition knowledge because that is the most common kind of study and that still

19:57leaves us with basic science which is rockin it leaves us with randomized clinical trials which are very hard in nutrition and they're very expensive and there's less than we need and it finally leaves us with the studying old healthy people centenarian studies but this go to loma linda ten times more people in loma linda are over a hundred than there are in los angeles ten times more that's by definition it's called the blue zone and well it was discovered in the 1950s if you lived in loma linda you were living 12 Loma Linda there's an hour east of here what's going on well there's a center of the seventh-day Adventist Church which teaches people eat your veggies don't drink don't smoke and exercise so it's an amazing lifestyle oriented aspect of the Christian Church and they in 1958 got huge funding from the government to explore why the heck are they live in twelve years eight

20:43years ten years longer and they parsed that out in probably a thousand publications they're you know it's not a randomized study you know it wasn't la versus Loma Linda will feed you different diets and fought won't ever happen but it is you know a reliable long-term peer review this does published and not the finest of journals and it at least lets you ask questions I mean why is there a hundred and four-year-old cardiac surgeon Elliott Worsham walking around doing his gardening and he just finished operating on a heart patients I mean it's insane for 104 le Awards Jim love your buddy so let me go back from him if we throw epidemiology out we are left with basic boxing I know I know I know but so food this is all technical stuff and but you've got a sophisticated audience food frequency questionnaire is what that chris said is the source of a lot of

21:29these epidemiology studies you fill out a four page of forty page at in Loma Linda it's a 58 page survey but you do it once that's called the pure study the headlines you've seen them cheese eggs meat are good for your heart it's been the news the last two weeks that comes from a giant international study they did one food frequency questionnaire at the beginning twelve years later they're reporting the data it's all clickbait headlines it's like you say people love this stuff so if we throw out some studies we have to throw out the largest nutritional study that's been reported and the most recent one that's getting all the headlines it's got to be played fair now you go to Loma Linda it's every four years they're asking you go to Harvard School Pub house every four they update the data so if you change your diet that's the weakness you fill out the survey and then you get healthy or

22:14get sick and you make changes and then they're counting if you're dead or live well it might be what you did you're six not what you filled out your one so there there are better and worse forms the second I'd say healthy user biases the idea that people pick a certain diet might have other lifestyles it might be as are more important it's going to be true with a paleo group I mean these guys are a look at Chris he looks wonderful he's healthy he's thin he's not the obese American the 75% that are overweight and obese I mean that's true in the plant community to some extent we have chubby vegans oh my god there's no observational studies with significant numbers of Paleo diet errs - I know I know the user bias is not an issue but if you don't have data doesn't mean it mean you don't add a because it's a new movement that hasn't had the data but it's not the cast stones that

23:00plant-based eaters go to the gym more it's probably true we don't know but and that's the third thing to stop you for a second yeah meat eaters do get lumped in with the paleo group they consider paleo group a part of the meat-eater group like when people talk about these epidemiology studies where they show that people that it's ensue red means it's more likely to get sick more cancer eating avocado and grass-fed mean most of the paleo movement is the last dozen 15 years you know we top of that in 1985 2002 Loren Cordain published his book in 2002 the book didn't sell republished 2010 it took off this is a relatively new movement so if you filled out the study in Loma Linda in 1958 you don't have to worry there weren't too many people following a classic Paleo diet that's also true at Harvard these dishes the last is just the relative risk that's what we call these are pure

23:53statistics I'm a heart doc not a statistician but there are some exceptions I mean anybody and others say I've got a red button on my website that says rogen references because I thought it would be good to have people a place to go just like Chris mentioned and I'm not massaging the data it's scientific peer-reviewed data there was a study October 2016 October 1 2016 songs from Harvard 6,000 people observational data animal protein plant protein actually let me go to 2014 Morgan Levine this is an amazing Harvard researcher beautiful woman Morgan Levine she looked at 6,000 people prospectively servation fill out all these data if you were an animal protein eater that's called meat you had a three to four hundred percent increase in cancer risk three to four hundred percent that's three to four times isn't 1.1 1.0 eight eighteen percent the data is there

24:42this is peer-reviewed data if you ate plant-based proteins risk of cancer goes down this is in the highest I just want to say there are nutritional data that are powerful but this is annex but this is also an epidemiology study that's where eighteen you know nobody's gonna do a randomized study of 6,000 people you eat beans and you eat listen I think I have a good example that can clear some of this up so you mentioned the Loma Linda and the seventh-day Adventist studies so first of all the let me just make a comment about observational nutritional research it can there are good observational studies and they're bad ones you can design an observational study in a way that controls for some of these potentially confounding factors like the healthy user bias etc so but this is a story that well I think clear some of this up so there are about eight studies major studies of compared

25:39lifespan in vegetarians and vegans and omnivores so the the earlier studies there three studies that were seventh-day adventists studies so they were done in the seventh-day Adventist community which Joel mentioned is a religious group that has as part of its credo you know a healthy lifestyle diet and lifestyle about twenty twenty million people it's night which others just maybe you know vegetarian diet but also you know live healthy fruits and vegetables don't smoke don't drink excessively etc so you know a health conscious group of people and the that's the the first one at the seventh-day adventists study in the Netherlands compared them with the general population which is just garbage because of the healthy user bias so we can just cross that one off the list the two seventh-day Adventist studies that were done in Loma Linda in the US they did a

26:35better job because they compared people who do eat meat amongst the seventh-day Adventist population with people who don't and there was a slight advantage in lifespan and in the vegetarians versus the meat-eaters but one of those studies didn't control for smoking and body mass index so that data is highly suspect and the other study did and there was a slight advantage since then there have been four studies that I think did a much better job so this is kind of an interesting design so they said let's try to find a group of more health-conscious omnivores to compare these vegetarians against so they the first one was called the health food shopper study so they looked at people who shop at health food stores when the idea is people who shop at health food stores are going to be generally more health-conscious and they find health food store you mean like a

27:22Whole Foods or there's no Whole Foods at this point but doctor that was the idea all right and so that study found that both groups vegetarians and omnivores who shop at health food source had a hugely reduced risk of death compared to the general population but there was no difference between vegetarians and omnivores second study Oxford vegetarian study in the UK they recruited people by first they recruited vegetarians and then they asked the vegetarians to ask their friends who also ate meat so that the idea was the people that the vegetarians were hanging out with might be more health-conscious than the general population same result big difference in the life span between those two groups in the general population but no difference between vegetarians and omnivores epic Oxford cohort same thing same way of recruiting people same result big difference between the two groups in the

28:15omnivores but no difference between vegetarians and omnivores and then the heidelburgh study was in the in Germany and exactly a similar way that I think they recruited people who read vegetarian magazines and then they asked them to bring their friends or family members who ate meat big difference in lifespan between the two groups and general population no difference between vegetarians and omnivores and then you had the 45 and up study that was recently done in Australia this was a little different because they didn't set out to find you know more health-conscious people instead they looked at 250,000 people big sample size and they did a much better job of controlling for all of the various factors that might affect you know the results so exercise physical activity fruit and vegetable consumption cigarette smoking alcohol education level because we know that has a big

29:05impact on lifespan and they found that there was no difference in life span between omnivores and vegetarians in that study as well then there have been two meta analyses of all of the studies that have looked at this both meta analyses found no difference between vegetarians and omnivores in in total in lifespan so I think this is a really good example of what we're talking about here that's all observational data so we're not throwing it out or saying we should throw it out but all of those studies did a better job at dealing with the potential pitfalls of observational studies and when they did that they found no difference so and I want to point out that it those ways of picking more health-conscious omnivores were there they still weren't comparing like someone on a paleo type of diet with a vegetarian they were just guessing that someone who shopped at a health food

29:56store was at least a little more conscious about health than the general population so quickly quick quick quick locally I just want to go back for a minute to meat and cancer World Health Organization is not a vegan group it's not a nothing group you know it's a fairly well respected international organization that puts out health claims so although I absolutely Kris had the data right 18% increase in cancer risk with processed red meat I want to make that clear I hope you don't eat too many hotdogs salami Bologna pepperoni that's the yeah well it may be more than nature's but it's always it's the salt that's a preservatives it's junky pieces of the animal that they're putting into a hot dog that was a group that's an 18% increase you can go four and a half percent to five and a half percent that's still fifty to sixty thousand people a year they get colon cancer if

30:42that data's right they wouldn't get colon cancer if they just would stop eating hot dogs at a minimum and I know Chris will agree frigging hospitals are serving hot dogs and the data is out there that it promotes cancer to people getting chemotherapy with the IV pole it's insanity so 50,000 people avoid colorectal cancer with small differences that the World Health Organization suggests it was 800 papers in 22 world experts there's no perfect study but when they announced that October 25th 2000 fifteen the world was shocked you just said that process Ramiz his cancer they didn't say related they were strong enough data said cause they've been beat up they published more data they have them back down I just wanna put that out the healthy user bias will exist in the pelo community when the studies done because they in May look at pale effects there it's everything and I honor that I

31:27mean we should promote healthy lifestyle foods only one part of this I mean we will all at this table live longer than the average American we're not smoking two-pack-a-day we don't have thirty eight inch waist lines the whole deal we're doing the whole thing hopefully you guys are enjoying a little Cabernet now and then or that's always on the list just don't overdo it but the healthy user bias that particular that health food study paper with nineteen ninety six is very old paper in the paper in the limitations they beat themselves up we were missing this or that anybody just read the paper it's not that it doesn't bring up an interesting point but to say that we again throw away all these papers cuz they are biased lastly and I'm done multivariate analysis Chris was just talking about better studies that factor all this stuff let's not bore your audience with statistics statistics but

32:12there's certainly the ability now to say does animal protein associate with an increased risk of cancer and put in smoking and weight and diabetes and blood pressure and vegetable intake and alcohol intake and family history and then you just isolate the one thing reserve Roybal czar their downsides of course but all modern epidemiology does multivariate analysis to try and isolate it you know you can cast stones everywhere but you know there are the World Health Organization I mean there's 21 organizations say limit your saturated fat in your diet and none and that our international societies say increase it so you put nutrition science needs incorporate as much as you can with as much reliability and at the end of the day you can see we'll still have questions say don't eat much cholesterol now they don't they used to say limit your total fat and now they don't it's

33:02wrong because they've gone out the guideline eat as little cholesterol is not a nutrient of concern because they couldn't identify the exact milligram to recommend used to be 300 the science doesn't support its limiting dietary cholesterol anymore let me go back and to the limit cholesterol they say limit class melt as little as possible what's this Z they who is there USD at USD USDA the guidelines come out every five years and they are used for school menus and Hospital menus it was a big buzz in 2016 ones announced they no longer giving a so many milligrams of cholesterol they never exceed they said we can take the number USDA behind the curve influential total mortality is the most important endpoint we should be talking about here that means deaths from any cause okay so if because that's what we care about most right if I die of you know if I if

34:02an intervention reduces the risk of a heart attack that increases the risk of cancer I'm not happy with that right okay in fact I'd rather go out have a heart attack it might one-shot so you need to consider total mortality and if something you know if meat increases the risk of cancer and cancer mortality then why aren't we seeing that in the studies that compared lifespan with vegetarians and omnivores we have as I said we have five studies that did a better job of controlling for that healthy user bias and there was no difference in any of those studies there's not a single study that should that that compared you relatively equivalent groups of people that shows that vegetarians or vegans have a lifespan advantage period there is not and so if you know red meat isn't if we're saying red meat processed meat increases the risk of cancer by 18 percent maybe maybe not but that's not

34:55showing up any of the total the total mortality data the second thing and this is a really good example what we talked about the very beginning of the show context is everything quality is more important than quantity so let's talk let's think about processed meat so there's several proposed mechanisms for how processed meat causes cancer one is that it increases and nitroso compounds or NoCs which damage damaged the gut lining another is that they when you cook meat at high temperatures it forms heterocyclic amines or hcas which damage the gut another is that the heme iron content in meat causes oxidative stress and increases the risk of cancer that way and then there's TMAO and neu5gc but let me just give you a few examples of why context is important so there's evidence that chlorophyll rich green vegetables prevent myoglobin from being turned into

35:50n nitro so compound so if you're eating processed meat but you're also eating kale and broccoli then it's not going to have the same effect on the body as if you're just eating a hotdog cruciferous vegetables and spices and marinades have been shown to reduce the formation of heterocyclic amines or HTA's so same thing if you're you know if you're marinating meat or if you're eating broccoli and cruciferous vegetables with meat it's not going to have the same impact there are several studies have shown that eating fruits and vegetables attenuates the oxidative capacity of heme iron and even reduces the absorption of heme iron in the gut and you know dietary antioxidants have been shown to reduce the risk of gastric cancer so heme iron intake really you can think of it as a proxy for a crappy diet in these observational studies there's a quote from a study that did

36:42find a relationship with heme iron and cardiovascular disease and they but the study the study author himself said with respect to heme iron intake we found a significant association only in the studies that were based on American cohorts they didn't find an association in the Netherlands Canada France Italy Japan and Sweden which suggests that it's because of the standard crappy American diet you know most people who are eating processed meat in in the US are eating it in the form of hotdogs and all kinds of other and health food and it's another example of healthy user bites I'm not saying I'm open to the possibility that too much processed meat can be problematic but you have to consider the context it's not gonna have the same effect if someone's eating a ton of fruits and vegetables versus the someone who's on a standard American diet and we have no studies that

37:35separate that out okay I think we have a gong moment because I'm I really want your listeners to come away with a few tips from Chris and I that make a difference cuz I know your listeners aren't gonna stop eating meat at the end of the show they might just said meat with vegetables is safer than meat without vegetables meat with chlorophyll is safer than meat without I can give you a cardiac study said agree I type leech not G process me well it's all meat I teach me yeah if you ain't the same no listen we agree here I want people to hear this but doing when you grill how many people in the audience grill barbecue everybody if you grill meat another chemical group that's formed or called advanced glycation end-products AG es that go along with the list but if you grill meat that's marinated and this is the tip in dark beer this is science randomized science

38:21you put a piece of beef in dark beer and you're grill it you don't create as many of these toxic chemicals as a dried piece of beef so let's say that's like right now everybody listening next time you eat meat get a salad next time e meat order broccoli next time you bacon get a get a you know sliced tomatoes you will actually improve your health there's this classic and now I'm shift into cardiology that they took healthy volunteers and they took them down the hospital cafeteria and they fed them a hospital burger and they were measuring on their arm how their arteries function cardiology topic artery function goes down in three hours we need a hospital burger it X like you just had a toxin in your body you did they took the same group a week later they had to meet the same burger with a big salad they didn't see that finding I mean I want this to

39:04be an important point you know everybody should be jamming fruits and vegetables they're at least vegetables with some fruits you can go low glycemic berries I'm fine with papayas cantaloupe and apples but you know op your veggies listeners and you'll counteract lot of the crap that's out there in the world that is important message I don't disagree with that no you know you wouldn't you have to we glossed over this very quickly in the beginning of this but there was a dispute about cholesterol and a dispute about saturated fat you know serious you were saying that saturated fat that there's recommendations to reduce saturated fat there's and reduce cholesterol so let me get a real quick overview and I'm gonna talk fast so just talk normal it was a penny time it was felt so until the 40s it was not commenting of a heart attack heart attacks were described in 1916 not

39:53to say they didn't happen but the first medical article that used word myocardial infarction 1916 1940 there were not many heart attacks seen in a modern American city after World War two we our economy went up in the city a minute Minneapolis executives started suffering heart attacks it was also Franklin Delano Roosevelt died of high blood pressure a few years later Eisenhower had a massive heart attack that's when our government National Institutes of Health started funneling major money into studies like the Framingham study or from Newton Framingham the city outside of Boston and they basically invaded this town in 1958 today so we're spending money we're gonna figure this crap out the idea had come up heart disease wasn't just aging heart disease could be explained by what's called risk factors smoking might not you can smoke and live 100 but it's

40:40going to increase your risk and then they got into blood pressure and cholesterol and family history they identified what we call risk factors so until that point diet was not considered a factor in the development the number one killer men and women I want to point out and Chris puts this on his website I do too during this interview every 39 seconds an American dies of heart disease every 39 second most frequent cause of death so there will be about 200 people perhaps that will die during this podcast the number one killer and 80% of it's preventable chris is going to prevent some I'm gonna prevent some because the biggest enemy out there smoking and crap diet calorie rich and processed foods crap sad diet standard American diet it became apparent in the early 1950s diet might play a role in a notorious scientist and many others his name dr. Ansell Keyes PhD PhD at two of

41:31them suggested dietary fat might be a factor it was a hypothesis it's his early stage epidemiology doesn't prove anything he went out and did Studies other people went out and did Studies and the idea transitioned actually he was criticized for saying dietary fat that is the the conversation transition there's some good fats like omega-3 fatty acids are essential you have to have them and then maybe polyunsaturated fats from plants are more helpful but the focus went on saturated fat in food which is bacon chicken red meat pizza those are the highest sources and subsequently enough data accumulated that guideline started to suggest we've got this huge problem with heart disease we should limit saturated fat in the it was never limit all fat and 35% of calories that's not in anybody's word a low-fat diet and that has now promulgated in 21 international

42:25statements there is no opposite whether it's a World Health Organization American Heart Association American College of Cardiology whether it's Institute of Institute of Medicine says eat as little saturated fat as possible they couldn't be more clear and these are highbrow these are not associated with vegan movements or paleo movements or whatever these are medical authorities if there was half-and-half you'd say controversy 21 and 21 say the same thing they might pick a different cutoff point but we will enhance the health and cut down the number one killer whether it's in Asia whether of whether in Australia whether it's in the United States there's unanimity why did they come to the basic science because there is basic science and let me tell you it when you eat foods rich in saturated fat which is called meat cheese eggs and such receptors on your liver for cholesterol i've got

43:13cholesterol in my blood I'd like to get some of it out into the liver to be metabolized I need a receptor you eat saturated fats receptors go down cholesterol has no place to go cholesterol stays in the blood bumps into your artery wall I'm putting a stent in the artery that's the basic biochemistry then they had epidemiology studies flawed perfect it doesn't matter there was a man well Chris Chris thank you very much then they did control trials three everybody just go read Clark 1997 395 it's called metabolic studies change the diet see what happens you add saturated fat cholesterol skyrockets on average not in a single person if I gave you a steak Chris's taking me a steak our cholesterol would rise differently it would rise it would rise differently it's our microbiome it's our genetics it would rise so if that's a problem in the studies when your average everything together so they

44:01had that and then finally finally they looked at populations that live over a hundred these are called the pillars of longevity they don't eat foods rich in saturated fat they have a little they don't a lot need a lot of olive oil in Italy in Greece they eat almost no dietary fat in Okinawa Japan and they live they have the greatest longevity in the world in 1970 they eat almost no dietary fat about 6-7 percent okay no it's actually that is the basis for a major push to say cut back on animal products because that's largely with the exception of coconut and palm your we're saturated fact comes from so that too to negate that is to throw out every major health agency in the world and I don't believe Chris crecer can do that no disrespect I don't think Chris can throw out a hundred years of cluster over okay let's back up a little bit here yeah so first of all every food that we consume

44:55has all of the fats in it polyunsaturated mono unsaturated and saturated fat and in fact two tablespoons of olive oil has more saturated fat than a 7 ounce pork chop that's a little-known fact the oily fish mackerel you know which all of these health agencies that Joel is talking about advises us to eat has twice the total fat and one and a half times the saturated fat that were of the meat that we're told to avoid does it make sense that nature you know would include that you can eat you know mackerel and the polyunsaturated fats in it are good for you but the saturated fat in it is bad for you that's kind of nonsensical but you know let's talk a little bit more about the research so there never really was good evidence to suggest that dietary cholesterol and saturated fat are connected to heart disease and Zoey harcum who's has a PhD in nutritional

45:51researcher she wrote her thesis her PhD thesis on the evidence back in the 70s that led to the restrictions on saturated fat and cholesterol and then she also reviewed the evidence your yeah all the way up into 2016 and and if I have the this information on my website if you go crecer CEO slash rogen you can find it and what you'll find is there never was in really good evidence to support the limitations on died on saturated fat and cholesterol and people have started to look at this more recently and for example you have a meta-analysis of observational studies including about 350,000 participants recently that found no really a ship between saturated fat intake and cardiovascular disease you have an exhaustive review of studies something like 25 randomized controlled trials gold standard of clinical evidence and almost 40 observational studies involving 650,000 participants and I'll

46:58read you a quote from the conclusion current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of saturated fatty acids now look one of my favorite quotes is the the philosopher Anatole France even if 50 million people say a foolish thing it's still a foolish thing and the other thing to consider is that the history of science is really the history of most scientists being wrong about most things most of the time and you know sign in science we have to continually challenge our hypotheses and try to falsify them and that's how the scientific process moves forward and that's why in 2010 the US federal government removed restrictions on total fat whereas before there was a restriction on total fat because they they acknowledge that the research was showing that not all fat is

47:51the same and that you know we don't need to be restricting fat from avocados and things like that and in 2015 they removed the restriction on dietary cholesterol now they did that fairly quietly because how do you think it looks when people have been told to you know limit their fat and limit their cholesterol and then the the federal agency goes back on that that recommendation after so many years of telling people to do that people lose faith in the agencies that are that are issuing these guidelines you know and don't take it for me you know I'm I'm not expecting anyone to believe me and that's why I put all of the studies and the research supporting this at crecer co / Rogan but how about Johnny Unitas who's one of the most renowned epidemiologists in the world he's a professor of medicine at Stanford and he has wrote some written some scathing critiques of nutritional research

48:45recently that had been published in JAMA and British Medical Journal so here's a quote from one of them some nutrition scientists and much of the public and consider epidemiological associations and nutritional factors to represent causal effects that can inform public health policy and guidelines however the emerging picture of nutritional epidemiology is difficult to reconcile with good scientific principles the field needs radical reform and he goes on to point out that meta analyses of observational studies have found that almost all foods are associated with the higher risk of death if you crunch the data in certain ways so it's not enough to say that that you know government's are recommending this or that we have to look at the science and what the science is saying and as I said too recent meta analyses covering over a million people are not showing a

49:35relationship between saturated fat and heart disease and they're not showing any benefit from replacing saturated fat with polyunsaturated fats so these organizations Joel that you were describing why do you think that they recommend based on what Chris has just said why do you think that they recommend reducing your saturated fat reducing your cholesterol okay and thank you and you know the importance here which we are you know technical in the weeds but I want to bring it back this discussion is do you have a stroke heart attack erectile dysfunction lose a leg or do you not because at least one factor in development of these horrible medical problems that are 80% preventable at least one of it is your nutrition and the content nutrition I mean there's no doubt it's a single most important factor it's never been the only fact okay but what organizations

50:21are saying this okay he's saying studies don't support that well I disagree that the science and I want to be very specific let's talk about cholesterol let's talk about saturated fat so stay with saturate fat because there is differences there there okay both you know contents of food fatty contents of food but they're chemically different and the volume weight is very very different cholesterol only comes from animals saturated fat is in animals and plants depending on the food source so when this rise in heart attacks developed research began 1948 1950 1958 there were observations made that carefully done dietary logs suggested these were hypotheses there might be a connection between what you eat in heart attacks and then it's centered on you know is it foods high in protein foods high in sugar foods high in fatty sources ultimately they got sophisticated food tallien plant fat

51:14sources foods high in animal fat sources so by the late 1950s there was a very strong consensus already that foods high in animal products with saturated fat they go together we're talking meat egg and cheese maybe a roll why let me give you a great example in 1959 you grew up in Japan you have a cholesterol of 120 you almost never see a heart attack you move to Hawaii because there's migration your cholesterol rises to 180 welcome to America your heart attack risk triples you move to this great city Los Angeles this was published in 1959 your cholesterol is now 210 you have 10 times the heart attack risk that you had when you lived in Japan genetics don't change that quick this is within one generation they're called Nisei people that leave Japan to move to California the Nisei and there's the Nisei han study that tracked these people now is that the air

52:03is it that they adopted other bad habits sure it could be but within a very short time that 10 times the risk of heart attack so public research and dollars this stuff is correlated with animal fats and proteins and why isn't it correlated with sugar and refined carbohydrates so carefully done studies say and I think we all agree more so now because we're overweight and now we're more insulin resistant and added sugars in the diet are more important in 2018 than they were when the country was thin in 1960 they weren't good then they aren't good now but when you parse it out multivariate analysis there's a stronger relationship between the number one food and studies like this is usually butter more than red meat it's actually butter that's just at our value it's called statistic I don't want to go so deep into statistics it is somewhere there is sugar I'll give you a classic

52:51study if you could hold sugar the same an increased dietary saturated fat heart disease Rockets if you could hold saturated fat the same increased sugar in these manipulations coronary heart disease doesn't increase let's point something out I've been inside the hearts 15,000 times I've never scooped sugar out of a blocked artery i scoop cholesterol out of blocked arteries 20% of every blockage in a heart is cholesterol it's a fact that was discovered in 1910 it's never varied then we fed animal let's pause for a sec yeah Chris you have something to say about that yeah so that doesn't mean that the cholesterol is there because people were eating it Joel you know that it could be though that let me let's say let's look at the what the research says again here so they've done controlled feeding studies where they've fed people two to four eggs a day and those show that in 75% of

53:37cases has zero impact on blood cholesterol levels for the other 25% of people they're termed hyper responders and in that group dietary cholesterol or does modestly increase LDL cholesterol but also increases HDL cholesterol and it does not increase the risk of heart disease this is why the the guidelines were changed on dietary cholesterol as there is no evidence that the consuming dietary cholesterol increases the risk of blood cholesterol most people and even when it does there's no evidence that it increases the risk of the heart attack which is again why the Dietary Guidelines change for saturated fat again most of the studies that showed harm were short-term studies these longer-term studies have shown that on average each inge saturated fat does not increase saturated fat levels in the blood and of all of the long-term studies that looked at this only one

54:32showed any association between saturated fat intake and cholesterol levels in the blood then we have a meta analyses lots of meta analyses actually but one of the best-known meta analyses was of 17 randomized controlled trials of low carb diets that were high in saturated fats in published in the journal Obesity reviews and they found that low-carb diets neither increase nor decrease to LDL cholesterol but what they did find was that low-carb diets were associated with decrease in body weight improvements in several cardiovascular risks risk factors including triglycerides fasting glucose blood pressure body mass index abdominal circumference plasma insulin c-reactive protein as well as an increase in HDL cholesterol now there have now been ten meta analyses of randomized controlled trials looking at low carb diets for weight loss all ten showed that the low-carb diet either outperform

55:32in most cases or was was on this at the same level as low-fat diets there have been several meta analyses now you can see them all at Kresser dot CEO slash Rogan that have looked at low-carb diets for diabetes and even cardiovascular risk markers and all of these meta analyses have found that low-carb diets are superior for glycemic control for reducing insulin for reducing triglycerides and have beneficial effects across the board without increasing cardiovascular risk markers so we're now we're talking about randomized controlled trials which is the best form of evidence that we have and we're not seeing any harm from Inked you know increased consumption of saturated fat so it was the problem that you're citing epidemiology studies from the 1940s in the 1950s we need to to prefer randomized controlled trials over that kind of evidence for sure why do

56:28you continue to go back to these studies from the 1940s and 1950s well they're just the beginning the weather the beginning but Chris just like took 14 topics and put them into one for meta-analysis Terez controls the low-carb low-fat I mean they're all different topics and I don't know how you put that all together it you need clarity and laser focus so we were talking saturated fat I mean so hypothesis is generated saturated fat in the diet butter eggs and cheese may be bad for heart disease something killing Americans left to right in 1949 to 50 let's go into countries with widely different diets let's see what they're eating let's actually take their friggin diet back to Minneapolis let's analyze it so it's not guessing not food frequency questionnaire we're taking their meals back the United States analyzed them but boom there's a relationship between dietary saturated

57:13fat and your risk 50 year follow-up there's no short term follow-up the study I'm referring to as 50-year fell 1958 to now and that strongly suggested the dietary saturated fat in heart disease that does it that's not what's called the ultimate randomized clinical study but it's one high quality second study done in China at the same time with you know years of follow-up so these are right up to date there's publications right now from studies starting at then but the publications are now but then you get the best kind of study okay I'm still in saturated fat I'm not talk any other topic you put people in a metabolic ward at the National Institute of Health 395 of these studies published in 1979 you change their diet this is the ultimate careful experiment it might be for four weeks or six weeks you up there saturated fat their cholesterol Rises sure as can be we're all different

58:03the change in cholesterol is consistent you're going to go up 20% 20% 20% we start at different points you have to track the change in cholesterol Chris referred to gee can I go off on a tangent it's really interesting this will fascinate your listeners but it's right on the topic 2008 this is published data I don't on this 2008 Mexico City the national the International Dairy Council meet and they published their notes which is why we notice and they said we are losing the battle people are eating less dairy around the world and we are losing sales what we can do is influence researchers influence ekam editions in space each other well it's every every Dairy Council in the world just happens to meet in Mexico City that year then they go meet in Portugal then they go meet in New York whatever 2008 we're going to put dollars into changing research and

58:53influencing people doesn't mean it's all bad they published those notes that our global initiative for the next year they looked for sympathetic researchers that would change public opinion that was right before the milk moustache campaign they find a guy I actually respect now but I'm gonna beat him up a little dr. Ronald Kraus MD in Berkeley California right by him runs it a lipid Center he's had beef funding for 10 years he's had dairy funding all of a sudden he's speaking to dairy industries all over in 2010 two years later he publishes we call it a meta-analysis that's not new research that's statistical playing with previous studies that can be fair can be unfair whatever whatever it is their conclusion is they could not find and verify that saturated found the diet butter eggs and cheese raises the risk of heart disease they never said eat butter eggs and cheese they just

59:42couldn't verify it what's amazing it's an American Journal of Clinical Nutrition that same journal is a is a editorial that destroys the study this is 15 reasons this is horrible epidemiology like guy named Jeremiah Stanley I've never seen a medical journal destroy a piece that they accepted for publication okay so everything's like stirred up and 2014 a guy named Chowdhury publishes a similar analysis that is the reason that Time magazine put on the cover butter is back because it was not new research so it's a meta-analysis it's all following this Mexico City effort to fund very positive publications a study so bad that both the Journal required them to adjust and republish the data cuz of mistakes the Harvard School of Public Health said take this thing away statistically this is nonsense since those two times and that's just the bottom line we have had

60:36confusion in the public we've got experts like Chris experts like me experts like dr. Mark Hyman experts like dr. Walter will it not or not there is a quote from the tobacco industry that our product is confusion they didn't care about you know winning the battle when the public's confused are just going to keep on doing habits they have and that is I got to stop because now we're in the weeds with conspiracy theories just when the pendulum of 1950 1960 1997 395 the best done studies in the world say you eat more saturated fat your cholesterol goes up more saturated fat Cornette heart disease goes up it was crystal clear and the guidelines set it the guidelines still say it the guidelines still say limits at using like the same science from the 1950s in the 1940s today if it's in retrospect valid let's point out one bit yeah absolutely do you think it is absolutely

61:35we're going back to observational studies done 5060 years ago that suffer from all the problems that I mentioned to begin with and several more that we didn't have time to go into we have randomized controlled trials now and you know observational studies were never meant to prove a hypothesis they're meant to generate a hypothesis and it's true that in some cases it's not possible to do a randomized control trial like with cigarette smoking you'd have to you know does have the trial lasts for so long and you'd have to isolate people and award so they weren't exposed to air pollution and other factors that can affect the result you can't do that but in that case the risk was a thousand at 3000 percent higher so there are criteria called the Bradford Hill criteria which you can use and apply to observational studies to assess the chance that there's a causal

62:24relationship and in the case of smoking which actually was when the Bradford Bradford Hill criteria were created that really that meets many of those criteria in the case of nutrition research very seldom do they meet more than a couple of the Bradford Hill criteria now observational research in order to be valuable needs to be confirmed you know it the results need to be replicated in a randomized controlled trial that's how science is supposed to work but there was one analysis that found that zero of 52 claims that were made in observational nutrition studies were replicated when they were tested later and in fact five were replicated in the opposite direction in other words they when they did an experiment they found the opposite result to what the observational studies suggested so good examples of this our observational studies originally suggested that beta

63:16carotene an antioxidant that people with the highest intake of beta carotene had something like a 30% reduce risk of death which is not really plausible anyways but then when they started doing trials where they were giving people beta-carotene supplements not only did it not improve their lifespan they got more cancer it increased the risk of cancer so this is why it's so important not to rely just on observational data and to do these experiments now going back to saturated fat as I said we've got a 2013 meta-analysis of 20 randomized controlled trials that found that low carb high protein diets led to greater improvements in glycemic control compared to low-fat American Heart Association American diabetic Association diets we've got a 2014 meta-analysis of 10 randomized controlled trials that showed that low-carb diets are more effective than high carb diets for patients with type 2

64:08diabetes and we've got another meta-analysis of 25 randomized controlled trials just published in 2018 that found the same thing so you know science marches on we we learn more we change and now we've got randomized controlled trials that are replacing some of the observational evidence from the 50s and 60s and 70s which but which by the way in dr. Hawkins paper you see that that evidence was never strong to begin with and this is what we should be looking at so why are you consistently bringing up these studies well fifties because Chris is mixing everything up he's talking low-carb data let's talk low-carb diet that's keto diets low carb I know I know you you consistently bring up these studies from the 1950s the 1900 fat okay 1956 was initiation 1997 Clark 395 randomized clinical trials what Chris looking for in metabolic Ward say you jack up the saturated fat your diet you

65:07jack up your cholesterol we can talk about cholesterol in a minute but cholesterol matters elderly plus what matters is that's the across a 395 randomized clinical trial of metabolic wards day I could show you here it's right here I give it a 95 he we say if I'm viewed 395 randomized controlled trials in a meta-analysis in metabolic Ward the tightest dietary exchange studies the best it is but I don't understand the 395 that's how many were there energy five people now 395 individual studies that played with fat on a diet and looked at markers of cardiovascular risk occurs 395 words that were randomized controlled trials in metabolic words yeah they're gonna be short turn that's true you got to read the literature it's there it's all I've read the literature well you missed that one that's a pretty boy you know okay let's go back but hold on a second this

66:04is a dispute here right so what is your it's no big deal good Chris what is your issue this I'm not aware of 395 randomized controlled trials that have been done in a metabolic word on this question so I'd love to learn more about that if that's true Clark but so I mean I'm not stuck in the 1950s but you know if you don't you would agree right that science has moved far past that and our understanding of nutrition and our understanding of the the mechanisms of the effect of the food and the body all that has changed radically our we have not changed has changed but that's someone asked has our understanding of the science change I actually think I well actually I would say that the observations made in the fifties and sixties have held up which is why 21 international societies they say you what the oceans have held up that low saturated fat in the diet

67:00chicken eggs cheese beef is related to raising your cholesterol as related to your increased risk of heart attack strokes 1950s epidemiology studies initial initial then we got randomized clinical trials we called metabolic Ward studies and such the first the first in the in the armor was a 2010 it gave you the background to it the cirrie Torino study the Chowdhury study but they have been resolved we've decided to throw out 50 years aside I just mentioned several other meta analyses of I know probably 50 randomized controlled trials collectively and these are modern studies so Joel what is the difference like what why why do you think that these old studies are applicable and why are you dismissing this new evidence okay so I just just so Chris and I can resolve this issue British Medical Journal 1997 dietary lipids and blood cholesterol 395 individual dietary

67:59experience put together in a meta-analysis it's a classic study that people know they actually estimated if we could lower the saturated fat content of the British population by 60% we would save X number of days in what year 1997 yeah 1987 so to answer your question why do I think old studies are relevant you have to keep probing and questioning and probing and questioning but until this date every major Medical Society not one if there was one you'd question a 21 international sizes say you will further the populous health if you lower saturated fat in the diet and we can't pinpoint the amount of cholesterol you should lower which is only from animal sources but you should lower it to as low as possible according to USDA but again these are epidemiology studies well they're this is randomized data it's it's randomized data based on and the guidelines have changed as we said in 2010

68:53new evidence there's a new evidence is the new science like whatever they've studied today right like what wouldn't they have better methods of detection yeah more more understanding more data to go from wouldn't you agree that we should look at new studies well we should let me tell you so what is so let's say so wait let me tell you one I published a study in 2012 this woman quoted 100,000 times from a major medical journal it uses something called Mendelian randomization we don't need to do randomized clinical trials all the time there are these gigantic databases now about genetic abnormalities and certain other parameters so there is a database with 300,000 people we know what's called their snips you've probably heard of snips you know Chris's biology and genes aren't the same as mine and there's variability if you're born with one of nine snips that keeps

69:42your cholesterol low your entire life this is a genetic gift to you the observation in this major study quoted all over the world the first authors Brian Ference but I'm their number five LDL randomization is new data that it is an advantage to your survival and advantage your risk of heart attack stroke to have a low LDL your whole life new data is it consistent with sixty years of science but boom it sure was we actually have learned stuff that has changed our mind when you do that same cutting-edge science on HDL the happy one the high one you cannot show the same Association anymore we're totally confused by the HDL particle LDL is the focus of atherosclerosis low LDL and I'll just finish dr. Loren Cordain I'd love to talk about the history of the Paleo moment dr. Loren Cordain who had the first popular book a PhD in Colorado has written an article in 2004 it says

70:34the ideal LDL cholesterol is 50 to 70 well man he should be a cardiologist because I'm gonna hug him for that because he thought that saturated fat raises your blood cholesterol increase your risk of heart attack and stroke this is the founding decision of the pillars this 2004 in a big it's not Medical Journal this is peer-reviewed it was an editorial but his peer review of 50 to 70 LDL I'm really cool there with Loren Cordain and 50 to 70 but our understand of nutrition is advanced pretty radically since 2000 yeah and I'm not here to represent paleo I mean I have never been a ideological about paleo even might if you read my first book it's like I'm recommending dairy products and I don't want to get lost in this because yeah put pause for a second so what is your response though to all these studies that he was reciting you you're citing these old studies that

71:26seem to contradict what he's saying but these new studies that he's showing and you could we can go over them again but you didn't address you know I think you did well he didn't I'm saying them by name what why are the results so different in the new studies well people better at statistics in me would say manipulation of what's called meta-analysis these aren't new studies I mean these are old studies lumped together with different analyses that led to a conclusion that was these are these are randomized controlled trials long-term that's 20 years 30 years 40 years there's no such show of course they're not doing 20 or 30 or 40 year randomized controlled trial we have 50 we have 50 year data additional study of 50 years difference again we've read your outline there's a big different epigenetic studies and randomized trials randomized controlled trials are not

72:28short term many of them are go up to two years in length if we're gonna see changes and lipids we're gonna see them within a few weeks and certainly within a few months so if we're not seeing them in a few hunts we're not going to see them later and you know the if you look at dr. R combs paper sheet reviews all the the meta analyses and looking at saturated fat and the connection with heart disease there are 39 meta analyses of RC T's or prospective cohort studies that looked at saturated fat in health outcomes 35 of 39 did not show significant correlations between saturated fat and any outcome okay 35 of 39 of the four that did one was more related to trans fats saturated fats one showed a benefit of replacing saturated fat with polyunsaturated fat but it excluded two studies that would have totally changed the result and as I mentioned there's the meta-analysis of 25 RCTs and 40

73:25observational studies that showed no benefit of replacing saturated fat with polyunsaturated fat and then the last two were Cochrane reviews and in those two saturated fat and cardiovascular disease were correlated but saturated fat was not correlated with total mortality cardiovascular disease mortality fatal heart attack non-fatal heart attack stroke or heart death from heart disease or death from any diagnosis of diabetes had you know you've out of the 39 trials virtually none showed that eating saturated fat will increase your risk of heart disease and none showed that it will increase your risk of death from any cause so that is pretty damning evidence now if I could summarize for you or get you to summarize your position is that his reciting of these older studies that they're not relevant that they are epidemiology study the there they are not as as rigorous and that this new

74:24evidence is based on a new understanding and new science and that he's ignoring this yeah that early studies showed some relationship but they were short very short term between eating saturated fat and then and then cholesterol the other problem is they were using cholesterol as a proxy marker they weren't looking at did people eat saturated fat and die more they looked at did saturated fat increased cholesterol so when they when they did longer term studies there's no increase in cholesterol on average that doesn't mean no one will experience an increase that's not true some people will but on average there was no increase in and then when they looked at they just took cholesterol out of the equation let's just look at is there an increase in heart attacks or death from eating saturated fat when they did that there's no increase in and these are that those are observational studies and

75:15we have all these randomized controlled trials that are showing no no increase in cholesterol no increase in insulin levels and actually a decrease in all of those markers Joe important stuff and a lot of stuff was said and I doubt unless you're really high level you understood I just want to pick out one thing Chris said does anybody know what the Cochrane Database of where the flow is month Cochrane CEO CHR any is a group of scientists that try and be very objective very independent don't have any emotional any books any supplements any food and nothing and we all love supplements around this table but let's get out of that Cochrane Database every five years comes out with a statement the saturated fat relate to the risk of heart disease in 2015 the most recent Hooper look up Hooper look up Cochrane Database yes it does Chris said it but he flew by it

76:05no it wasn't powerful enough that your choice of butter eggs meat and cheese necessarily predicted your total lifespan but it absolutely predicted your risk of developing a heart attack and stroke according to this indepence Davis that's that's 2015 well how does it do it saturated fat in the diet lowers the LDL receptors in the liver let's talk some real science your liver my liver Chris's liver when you don't have LDL receptors or less than you should on the surface of your liver cells your LDL stays in your blood it gets into your arterial wall that's my field don't Jack with me on arterial walls it gets pick it up by monocytes become macrophages become foamy cells and you dead and that's how it starts when you eat saturated fat there's a chain of events that biologists and chemists and scientists know there's no question 1985 Nobel Prize in medicine nobody would let's not

76:55go to the 80s again I just want you to refute studies okay 2012 I published a study okay which one of us is a scientist around the table I've got it open it's a journal American cardiology may I please read the conclusion the lower your LDL level beginning in life the greater is a reduction in your risk developing a heart attack and stroke and I'll give you an interesting statistic if you take lipitor and you drop your LDL cholesterol 30% you will typically drop your risk of a heart attack if you're in the coronary range by 30% if you drop your LDL by 30% because you're born with a genetic gift that it's just lower than the average American you drop your risk of heart attack by 90% when you keep your cholesterol down your whole life I'm talking your blood cholesterol level your whole life you are golden and the heart attack and stroke risk the problem was they do we pick up people at

77:47age 50 60 and we start jacking with their diet and jacket with their drugs and that's wonderful they've had 50 60 years of deteriorating their arteries and we help them we can't help them like teaching children eat fruits and vegetables and stay away from hot dogs that's where we got to go that's the second Gong care get kids healthy okay because I guess the whole life please what is wrong with what he said well there's there's allusions to rant what's the number one two things wrong and I you know I'm really not trying to nitpick he doesn't like epidemiology but he totally uses epidemiology to support his case you can't have it both ways I love basic biochemistry I love epidemiology I love randomized studies I love centenarian studies my foundation is broad and it's what's called the scientific method that's used by scientists in Los Angeles and that's who

78:30taught me at number two besides that there's there's allusions to significant randomized clinical trials in meta-analysis we got to keep the science clean as can be a the breakthrough has been the meta-analyses Siri Torino Chowdhury 2010-2014 de Souza thousand fifteen they have severe flaws they're not new research they're rehashing old data there has not been a randomized clinical trial that really challenges the coronary heart disease risk of meaning an increased saturated fat American Journal of Clinical Nutrition 2013 Jolla or holla I'm not sure how to pronounce the name these are all on my website if you go to crecer CEO / research you can see them or crecer CEO slash Rogan and you scroll down to the saturated fat section you can see them this is a total of 20 randomized controlled trials and the results low carb low GI Mediterranean and high-protein diets are effective in

79:32improving various markers of cardiovascular risk in people with diabetes it should be considered the overall strategy of diabetes management then we've got one from snore guard systematic review and meta-analysis of dietary carbohydrate restriction and patients with type 2 diabetes and this was a review 10 RCTs and they found not only was a low-carb diet more effective for diabetes than the low-fat diet the greater the carbohydrate restriction the greater the effect and then we have one from 2018 this is Sainsbury at all and this is effective dietary carbohydrate restriction on glycemic control and adults with diabetes and they found that the low-carb the conclusion this review suggests that low-carb restricted our carbohydrate strict diets could be offered to people living with diabetes as part of an individualized management plan so these are finding that these

80:29these are you know reviews of several randomized controlled trials that are finding that there's no increase in cardiovascular risk markers there's actually an improvement in cardiovascular risk markers and there's an improvement in diabetes markers like blood sugar insulin weight visceral fat etc so I mean this is the the the the gold standard of evidence that we have is randomized controlled trials and meta-analysis of course they do there there are problems they can be done poorly they can be done well that's true of any kind of scientific research but we can't throw out really the highest standard of evidence is a meta-analysis of randomized controlled trials because you can just anyone can pick one randomized controlled trial to support their view that what a meta-analysis does is it looks at all of the evidence and it looks at the quality of evidence

81:21and then it comes up with a result from looking at all these trials and that's that's where science is today and these low-carb diets are high in saturated fat they're high in saturated fat yeah unless they're explicitly doing a trial where they're doing a low-carb diet that's that's higher and monounsaturated fat but those are rare generally people who are eating low carb diets are eating a lot more saturated fat Joel just three quick bullet points number one it is low carb literature we're talking saturated fat and coronary disease that's a mixture it's not the topic we're talking about number two these are bile at the top that we're talking about not low carbs a whole different nutritional that's that we haven't seen it that's not what he said yeah no you can do low carb and jack-up protein but most of the experts say don't do that that's called me

82:06you can do low-carbon jack-up fat that doesn't necessarily mean you're jacking up your saturated fat I do low-carb plant-based that's a whole different topic but it is not the number one these are it's one it's low carb it's not the main topic that's dominated cardiovascular research for sixty years which is consistent to this day and every guideline limit saturated fats you don't die of a heart attack stroke number two I just these are words your listeners may not know these he said are biomarker studies I'm talking about dying of heart attacks having heart attacks having stroke I care if your blood sugar marker called hemoglobin a1c goes down I care if your LDL and your high sensitivity c-reactive protein goes down but that's not life and death those are biomarkers so you usually correlate it with better health if you're not tracking an artery you're not

82:51in my scientific field because I track arteries in clinic we track arteries in our research studies I think that's the second thing I wanted to say but you know I'm not here to actually negate the data that compared to the crappy calorie rich and processed diet that most Americans are eating what Chris is presenting as alternative diet won't improve numbers in the lab absolutely it's a better choice I like your diet I do Joe I like your diet Chris because I'm looking at people walking in Wendy's and Hardee's and McDonald's and hospital cafeterias and gas stations that's what we need to shut down and we'll make a main difference and all we're left with is Chris's diet Joe's diet and Joel's diet we're gonna have an amazing country then you can decide what you want okay we know I think we all agree with that but I still need to bring you back to this what he's talking about

83:41in terms of saturated fat and not being a risk and not increasing your cholesterol you seem to disagree with that sure because the science says it does I mean he just let me clarify something too I wasn't I'm not just talking about biomarkers biomarkers are important but I was the one who argued for looking at total mortality is the most important endpoint and mortality from any of these other diseases and the conclusion from dr. Harkins paper where she reviewed all of the evidence on saturated fat that I talked about before I just mentioned 35 of 39 studies didn't show any really chip here's a conclusion no meta-analysis of randomized controlled trials and or prospective cohort studies those are observational studies has found any significant difference for dietary fat interventions and all cause mortality that's deaths from any cause or deaths from heart disease or

84:38associated with dietary fat and heart disease mortality in other words there's no meta-analysis of randomized controlled trials that shows that eating more saturated fat will will increase your risk of death and your take on this is that this is the latest science and that what he's citing in terms of these studies from the 1950s and 1960s aren't really relevant yes and that but even if we look it up a dimmi ology like I said earlier that there are there's a meta-analysis of studies including 350,000 participants that found no relationship between saturated fat intake and cardiovascular disease and then a more recent review that included both randomized controlled trials 25 of them and 40 observational studies with 650,000 participants that that concluded current evidence doesn't clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fat

85:33and low consumption of toll of saturated fats so whether you look at the epidemiology or whether you look at the randomized controlled trials or the meta analyses of randomized controlled trials you end up in the same place joël most modern data we already talked this everybody please google Cochrane Database saturated fat 2015 Hooper is the author he the introduction is reducing saturated fat reduces serum cholesterol but we're not sure of the importance so we took 15 randomized studies with 59 thousand participants the conclusion there is a potentially important reduction in heart disease risk by reducing saturated fat in your diet 2015 which is why 21 international societies are solid that we will help the public we will help the listeners have your piece of meat make it four ounces not 14 ounces have your bacon make it one strip not four strips have

86:27your cheese just don't eat it every day and don't eat large amounts the amount of cheese the United States has gone insane because the USDA cheese manufacturers okay so 2015 I can't get you a better one they'll they'll update Cochrane Database in 2020 it'll be the same what's your takeaway he said though so here's Johnny I don't care honestly what he said I've got to go with the best science in the world because I deal with patients who have serious disease I can tell my patients the most up to date analysis of randomized clinical studies say saturated fat in your diet raises your cholesterol lowering saturated fat like eating less animal products not the most up-to-date 2015 mentioned to several meta analyses from 2008 this is randomized clinical studies 59 thousand participants out there reviewing studies it's not a met that's yeah and that's we have to look at the

87:16weight of evidence there are lots of studies published all the time and that's again why looking at meta analyses of randomized controlled trials looking at very large reviews of observational studies with over a million participants and you end up in the same place of course we can go and find one study here one study there that that is different has a different result but that's not the scientific method the scientific method is to look at the weight of the evidence and to continue to evaluate that over time as the evidence changes and you know this is a great quote from John Ian Ennis the Stanford epidemiologists that I mentioned that that that reminds us that we can't just rely on the past to inform the present he said claimed research findings may often be simply accurate measures of the prevailing bias and that what that means is that let's say you

88:11know you have a paper that you know 30 40 50 years ago that says saturated fat increases the risk of cholesterol then later somebody makes that claim in a paper just like that initial sentence saturated fat raises cholesterol you see a little number there referencing that one paper then a couple years later somebody else makes that same claim they referenced the second paper which was referencing the first paper and on and on it goes and the whole thing is a house of cards that's what most people don't realize is that what that is bad science this is good cite that bad side what is you're saying that you're saying what he's saying is because we know this if you question again he's making comments that have no reference certainly if there's miss quad and the references can I give an example that's I have no references a scientific peer-reviewed paper that quoted a reference and

89:05everybody simply passively keeps recoating their reference it was wrong in the beginning I can give you a real-life Internet example which we goes to Gary Taubes my new friend but sometimes my adverse adversary but I can't give you a literature reference it might be one but these are very general statements I just want to I think we should move on but no I definitely shouldn't because we're not we've been really clearing this up what is he saying that's wrong okay the best scientific analysis of the global topic the saturated fat rich containing foods which are animal sourced foods at high amount in your diet increase your risk of dying a heart attack or stroke we're having our dinner stroke goes to the biochemistry that's a true fan your diet will lower the number of LDL receptors on your liver and your blood cholesterol goes up that's backed by 395 metabolic Ward

89:51studies but that is biochemistry then you get to epidemiology countries that eat more saturated fat Finland great story and I got to tell it 1970 the highest heart attack rate in the world was Finland guys were dying your age in my age at the highest rate the lowest heart attack rate in the Mediterranean was Crete 40% of calories were fat in Finland 40% of calories were from fat and Crete how can that happen cuz I'm not an advocate for a low-fat diet except for very selected clinical cases it was olive oil and Crete that's very low not zero low in saturated fat it was cheese it was meat it was beef it was butter in Finland they instituted a national program to lower the content of saturated fat in the dine in Finland five years later heart attack dropped 80% okay but do you understand that he's he's saying something totally different you're you're citing epidemiologist

90:41chemistry then I went to epidemiology what's wrong with what he said because he's not being broad with the science he's getting he's getting mired in the woods I'm telling you the broadest view from 50,000 feet up biochemistry supports it epidemiology supports it 395 metabolic Ward studies my randomized mendelian ran because he's not looking at the entirety of the data and I'm telling you the entire data then you go to Loma Linda Okinawa you go to e gross you go to Costa Rica and you go to Sardinia if you live to a hundred and you're still operating on somebody's heart is your diet likely high in animals to etre fat or not the answer is it isn't it's as low as 3% of the diet in Okinawa couldn't it possibly be other faculty user bias there's a great news recently that came out that showed that just following the top 5 health behaviors which are basic so we're talking about

91:32not smoking not drinking maintaining a healthy body weight getting some physical activity and eating a quote health you know relatively healthy diet like not junk all the time increases your lifespan by 13 years and that's where you can boil it you can't look at these at these populations and make inferences about animal products being the driving factor one way or the other because there's just too many other factors there's no way to control for all of those factors in a study and that's why we have to come back to the scientific method we use observational studies to come up with hypotheses then we do randomized controlled trials to either confirm or refute those hypotheses as I said before in many cases what is apparent in observational studies or what seems apparent is not later confirmed in randomized controlled trials and that's where we're at now with saturated fat and dietary

92:26cholesterol I just mentioned three very large meta analyses of randomized controlled trials that failed to confirm any Association of saturated fat and heart disease and and saturated fat and increase in these risk markers and I mentioned two reviews of very large observational study data including 350,000 and in one study and 650 and another showing no relationship so the mechanistic arguments about liver you know the saturated fat does this or that that's not convincing if it's not showing up in in the data if it did that then we would see it in the observational studies and the randomized studies now specifically Joel now what is your take on what he just said well we just had another gong so Chris just quoted and it's actually a little bit comical a Harvard School of Public Health study on how do you live 14 years longer its epidemiology but he's using it till senior author is dr.

93:24Walter Willett a guy he calls a vegan Pro advocate who's not at all vegan he's were in the book about the Mediterranean diet with all kinds of animal recipes and it's fine with me he's a brilliant he's a brilliant brilliant senior Harvard researcher but she's using data that he says is weak and such yet the teaching point is there how do you live 14 years longer you don't smoke exercise 30 minutes a day he'd better than average that's very broad but you'd better than average you keep your waste under 25 BMI under 25 and you have a few alcoholic beverages a week I want your listeners to write that down because that is solid epidemiologic data that's very consistent across across the spectrum so let's all use something to teach your listeners but that's my point so you you can't look at cultures that have a completely different lifestyle than a standard American lifestyle and

94:15draw any inferences about animal products so a really good example of this is you know the Seventh day Adventists the the the claim is that it's the vegetarian diet that makes them live longer than the general population but they as I mentioned before as part of their belief system they don't smoke they don't drink they have a healthy lifestyle in general what if there was another population that also had those kind of belief systems about not smoking not drinking and healthy lifestyle but they also ate meat well it turns out there is the Mormons and there have been three studies on Mormons and each of the Mormon the studies that have been done on Mormons found that their mortality I'll give you the exact numbers here in just a second for whatever reason that's not coming up here but their risk of death compared to the general population was something like 50% lower than the general

95:16population on average and yet they're eating animal foods they're not vegetarian like the Seventh day Adventists so your point to bringing that epidemiology study in the first place bringing up healthy lifestyle increasing lifespan by 14 years is to show that any positive move is going to show whether it's just exercise and not eating sugar or whatever is going to show an increase in your lifespan just to show how hard it is to isolate single variables in the influence of those single variables in an observational study on on those effects and you know this is something that you noticed Johnny and it Isis said over and over again is it's it's almost impossible if not impossible to disentangle the influences of all of these single variables in observational research and again I'm not saying we shouldn't use observational research I'm saying we should be circumspect about

96:10how we use it we should be aware of the limitations and the flaws and keep those in mind when we're designing observational studies and when we're interpreting their results so Joe what is your opinion on what he's saying about saturated fat and cholesterol and mortality risk okay well I think I've said it but I'll repeat it I just want to point out we just shared another common moment we're both lifestyle medicine doctors of which nutrition is just one part right we just went through a list of lifestyle factors we now add sleep we had social support we had stress management skills it's not all smoking diet exercise and and the size your body but we are aligned and you know and we will go at patients side by side into a lot of the exactly the same thing in fact I think the only thing there's squabble about in lifestyle medicine is optimal nutrition to prevent

97:00chronic disease and there's probably more than one path but God knows the plant-based medicine group has a tremendous body of science I'll conclude one more time and I don't know how many times I can say it the highest level of science is integrate all that's available biochemistry is on the side saturated fat raises your risk of coronary heart disease it doesn't mean nobody eats a no saturated fat diet but you can lower it observational studies where there epidemiology studies were to test that hypothesis they confirm Finland and Crete I've talked about it won't go there again randomized clinical trials have confirmed it Hooper Cochrane Database 2015 my study 2012 widely cited worldwide has ferm did get your LDL cholesterol down genetically or by diet as long as you can as early as you can and finally in the last is what our old healthy people do actually Chris I just think there's a

97:49good concept to let your listeners know it isn't all about lifespan in fact lifespan the United States is dropping which is very scary for all the friggin money we spend on health there's something called healthspan which is to avoid chronic disease and die dancing or die swimming or die skydiving but don't die in a freaking hospital with a peg tube and a trach in it and a Foley up your hoo-hoo and many of these studies that show you can reduce your risk of heart disease stroke and diabetes are talking about better quality of life so when you put all that together these centenarians studies that have low saturated fat diets are just one more piece I just mentioned for incredibly solid piece of evidence not one it's four it's all vets out there it's what Nobel Prize winners use when they describe the cholesterol apophysis it's what is this correct heed may not

98:35know it in this city of Los Angeles our shared friend dr. Valter Longo often considered and you should have him on the show perhaps the world's leading expert Nutrition longevity and such will say you incorporate all the bases for nutritional evaluation you keep it big picture you don't that he calls it pixel mentality you don't get hung up on one study you get the whole picture biochemistry epidemiology randomized clinical trials finally centenarians studies I think it's very consistent you will enhance your health by lowering animal-based products now we can argue is that 70% 80% 90% plant-based Loren Cordain and the founder of the paleo movement Boyd Eaton we were talking about 70% plants on your plate I love that you know I'm not telling people quit eating meat today or your die I'm not a reactionary but it to say that plant-based medicine doesn't have a

99:26strong basis that I can't reverse plaque which is plant-based medicine we haven't even talked about the ability to do that but is is absolute heresy because it in fact is one of the most powerful pieces of nutrition we have yeah okay but what's wrong with these studies that he's talking about they're pixel mentalities picking one we don't know how observational data of over a million people and you know three different meta analyses of 22 twenty-five randomized controlled trials each is pixel mentality this is this gold standard for assessing a question like this in medicine it's not mechanistic data or mechanistic arguments don't make are not persuasive if they don't translate into real outcomes that you can measure in randomized controlled trials or observational studies like trying to boil this down so what is your take on that without any references of the past

100:18when people lived in mo Li that live longer these are the three disruptive randomized trials from 2010 on they questioned the relationship between their different trials Jo well then these are three different trials I'm not referring the crosses researcher or Choudhary's well you need to you need to throw them out there and let us know the reference I did before you want me to do it again no but because we'll get mired I mean what is wrong with what he's saying I'm just look it's obviously the non expert here and I'm baffled so I'm trying to boil this down with his little rhetoric as possible okay it takes a heretical conspiracy attitude to say everybody's got it wrong for 60 years 21 international societies have rung they could but it's a controversy ceará to say that that Hooper Cochrane Database 2015 they've got it wrong that metabolic Ward studies got it wrong this is one or

101:15two or three pieces of data and their observational you don't throw out the babies with the randomized controlled trials why are you saying they're observational if they're not what men analysis by nature is implying it's not a new study it's taking previous studies into it so let me give you a quick example in the Chowdhury meta-analysis created butter is back on the cover of Time magazine created a whole fervor out there that we can go back to eat and all these great foods that Atkins wants us to eat they correlated your blood cholesterol with your risk of having heart disease they couldn't confirm it well they allowed people in their meta-analysis they were on Lipitor well of course your honor medicine lowers your cholesterol they didn't exclude those people that has been rosanna criticized as yes it looks good it's in a journal it's a meta-analysis that is

102:03fraudulent or at least relatively inappropriate statistics you know it's it's so technical it's beyond I think the importance of this discussion but I just say 50,000 feet elevation view of the best nutrition is again four pillars that I keep talking about indicate should be very wise to limit the amount of saturated fat and that's endorsed by every major Medical Society in the world it's not controversial this is I don't I don't think it's conspiracy I think it's just the natural progression of science why we usually think the world was flat ministers were caused by stress there are a lot of things that have changed over time as the evidence evolves and as we become more educated and aware of why you implying it's some sort of a belief in a conspiracy well Chris is suggesting we got it wrong which means the American Heart the American College the World Health Institute of Medicine the

103:03European Society atherosclerosis the Australian Society of Health all these bleep bull that tell you 10% or less saturated fat some say as little as you could possibly get your diet have got it wrong and that suggests there's been a total misrepresentation of all the science and I posit you for a second there what are their recommendations based on is it based on old science no I mean these are long have they been saying this and what is it based on and have they adjusted to this new science he's discussing they republish republished republished so the USDA republishes every 5 years 2016 not long ago 5 years 2016 was the last USDA publication there we'll do it again in 2020 but doesn't this science change pretty definitely not that fast not that fast there's nothing new since 2016 that rocks the idea that 21 international societies got it wrong there's nothing

103:52there isn't the 2015 report did not use that there was the USDA set up the nutrition evidence library to help conduct systemic reviews to answer some of these questions and in the 2015 report the committee stated that it didn't use that database for 70% of the topics and the the a lot of the guidelines hadn't used any newer science from - since 2010 and there had been large reviews as I just mentioned these these three reviews that I mentioned one was in 2013 one was in 2017 and one was in 2018 these are the reviews of the randomized controlled trials it didn't show increase in cardiovascular risk markers from saturated fat consumption and then we had those observation reviews of observational studies of 300,000 and 650,000 people I think the same thing will happen with saturated fat as I said in 2010 they changed their recommendations on total fat they used

104:58to limit total fat and then they changed those in 2010 2015 they changed their recommendation on dietary cholesterol and I think probably the next time you know maybe it's the next time or maybe it's the time after that you'll see a change in the saturated fat guidelines and it's not it's not a big conspiracy I'm not saying you know it's not a conspiracy science so your take is that these organizations are behind the curve yes and if we want to talk about conflicts of interest there are huge conflicts of interests in these organizations something like 40% of the funding of the why don't want to get this number wrong but a lot the American Heart Association American diabetic Association a lot of these organizations have funding from big food you know coca-cola you talked to a nutritionist who goes to these conferences and they you know there's like Nestle bars and

105:49coca-cola at the nutrition conferences hilarious yeah yeah I mean it's it's actually funny and sad at the same time and so I'm not saying there's a big conspiracy but I am saying there's a problem in terms of scientific integrity when you have these organizations that are tasked with creating the guidelines that have these financial conflicts of interests that's not really how it should be but I don't I don't even want to go too far down that road because we don't need to go there in order to show that the science is it what the shot what the science is showing in peer-reviewed journals so Joel what is wrong with what he just said well I'll say this until 2020 you the guidelines come in I actually think he's factually wrong cuz the USA guidelines say keep the percentage of calories from saturated fat to 35 percent or less I could be wrong and I'm not encyclopedia I know they say I agree

106:45well right well you said they change their total their limitation on total fat in 2010 and I'm speculating that but the schedule eventually changed their their guidelines on saturated fat because the science has evolved and I will buy you guys all paid trip to Bali if you see in the 2020 guidelines that saturated fat is still not to be limited to that right so what's wrong with what he said I don't know we just keep well it's about I agree there are conflicts of funding but they're not unique to any particular sector we just had one of the most famous food psychologists in Connecticut Brian once it was a hero of mine said eat on small plates because we do in small plates you're mindful and you don't get obese had to have six papers rejected and had to resign it's pervasive it's a problem doesn't mean there's not majority good scientists and I think most of the people we've been

107:37talking about are largely good scientists that the reputation hasn't been tainted I don't want to get get too mired in this but if you look at the egg industry prior to 1990 about 30% of egg studies and nutrition were funded by the egg board since 1990 it's 92 percent it's a conflict who's got the money to study nutrition it's not the broccoli girls stop you we can't get in the weeds again what is wrong with what he said well he's predicting that there'll be a change in the wreck there's no there's no substantial new data on saturated fat since 2015 Hooper in 2016 USDA that changes anybody to question that they should not recognize and follow the leadership 21 international societies that are out there to try and improve the promise copy there because those 21 international societies and all these different organizations they rely on current science to make the

108:31recommendations correct Kerr okay and are they often behind the curve I don't believe so the USDA goes through this whole presence now they haven't published anything new since 2016 it's an expensive process but they did change like he said their total fat requirement they did change what they believed to be healthy and not healthy oh well I said they changed in 2010 correct it changed the limitation on total fat in 2010 and then they changed the limitation on dietary cholesterol in 2005 a meant that the sciences advanced and changed their perceptions of what is in and is not healthy so what's wrong with what he's saying about saturated fat they didn't change saturated fat so if we stick damn there they okay they rely on the current science right so he's saying that the current science is showing that there is no negative consequence of saturated fat that's BS

109:23that's BS so what is wrong with these studies that he's citing well I don't know I have not read every article in the world nor has grist I don't know specifically there are three famous studies that I've read Siri Torino Chaudhary and D'Souza those have been dissected those are Venice leave those but you don't believe the ones he cited well I don't I don't know actually he would probably cite those to support his case but they've been so resoundingly criticized that and they created fervor and all I don't know the three sounding he said it criticized I'm aware that there has been criticism but you could say the same thing about the vegetarian lifespan studies the IAEA RC report scientifically debunked by any stretch of the imagination they are the papers stand the authors have defended against those criticisms and it's nothing like what Joel was just talking about with Brian Wansink

110:22who had to read you know all the papers were proven to be fraudulent and he had to retract them there's nothing like that that has happened with those papers and those were not the ones that I cited anyways I just want to say the USDA in 2015 said total fat intake should be 20 to 35% of all your calories they didn't eliminate anything in 2010 that's 2015 I think that's a factual error Chris they clearly change a cholesterol recommendation to say as little as possible they just didn't put a number on it we all know that my cardiology group went bananas and got them to add that sentence as keep cholesterol as low as possible Chris it says cholesterol is no longer a nutrient of concern but you were talking that the total fat intake that's actually inaccurate it's right here I mean I got the guide laying open you know it is I mean we're allowed to make mistakes

111:06we're trying to incorporate the whole world literature and we're just two guys is that a mistake Chris right here I mean it's a mistake so wouldn't know how did what it was his mistake what did he say that we said that in 2010 the USDA guidelines which are supposed to be followed by schools and colleges and the rest removed a total fat percentage recommendation it remains at 20 to 35% that's fairly modest fat intake I have to look at the specific language to see my recollection is that the in the same way that there's some contradiction with the cholesterol there's a sentence that says cholesterol is no longer a nutrient of concern and then Joel mentioned that he and his cardiologist friends got them to add something back that was you know kind of seemed to step back from that and I think this the same thing happened with total fat I don't know and I can't

112:00I don't have it to look at right now can we bet this is so because it seems like it's a major point of dispute and Joel says it isn't because the the still the question at hand is what do the meta analyses of randomized controlled trials and what do the reviews large reviews of observational studies including over a million participants suggests about the influence of saturated fat on important markers like heart disease and total mortality I'm still waiting to hear about a study that shows that eating more saturated convincing review of meta analyses meta-analysis of randomized control trials or even large observational data that lasted for more than a short period of time that shows that eating saturated fat and I'm not even talking about in the context of a healthy diet which is a whole other discussion but just in any diet increases the risk of heart disease can

113:01you let me can I stop you please because we were discussing this on the assumption the USDA had changed the requirements for fat Joel saying that's a mistake I really think we should clarify that we find out if he's running go choosemyplate.gov it's right here 2015 2020 questions about the use day guidelines that said healthy diets can include up to 35% of calories from fat they put a clear-cut limit on it it's right here I'm reading it I'm not making it up it's USDA it's a government so what was it that you remembered from 2010 and did you remember it erroneously let's see here is so bad yeah each vegetables everything else follows I have some fun love your fellow man tonight this came from a paper it was talking about the shift and the guidelines and I need to you know if why don't you tell the anecdote Joel and will first crasher I want everybody to

114:12know that there's a very famous food dock in Santa Rosa named John McDougall he's been treating people with crazy plant-based high complex carb diets he reversed his diabetes isn't that his newsletter came out just as I'm pulling up here and bumped into Chris we actually walked in exactly the same time he quotes the New Testament and I'm gonna read this cuz as a Jewish boy I just got to read it one man faith allows indeed everything there's some people around the table here they were doing it another man's faith allows them to eat only vegetables the man who eats everything must not look down on him who eats only vegetables the man who does not eat everything must not condemn the man who does there should be peace I think that is such a freaking beautiful concept because we do need to leave here as promoters of healthy lifestyles whether we call it the Harvard School of Public

114:58Health how to live 14 years longer the Blue Zones how to live like loma linda whether you want to eat game that you hunt that is probably eight times less in saturated fat than what you're buying at the damn grocery store you know people eat your vegetables people be really quality over quantity and i'm going to tell you at some point let's talk about eating less and taking some breaks from eating so you can activate anti-aging pathways but because you know it is an all food it's sometimes too much food probably one of the biggest prop for sure I'm sure that we all agree about that I think the real question is and for someone like me who really doesn't know yeah I am I'm baffled by the saturated fat dispute because it seems to be there's like one of you has got to be wrong here the evidence has got a point one way or the other Chris is saying the evidence points to be not an

115:46issue at all and you're saying your points to being wrong your issues worldwide consensus in one of these groups that rely on current science that may or may not be behind the times oh and yeah and I'm gonna step back and just clarify my position here because I'm not saying you know we started by saying there's no one-size-fits-all approach right so these studies just tell us about averages they tell us what happens on average when a group of people do something they don't tell us actually what happens for person a a person B person C and that can be different so if you get like some people may experience a slight increase in their cholesterol from eating saturated fats some people might actually experience a slight decrease and on a net basis that averages out right I think the next the next generation of science is going to be more of an understanding of how various dietary

116:41components and various foods affect people on an individual level because let's say there's someone who's got genetic polymorphisms that that mean that for that person if they eat a diet that's very high in saturated fat their LDL particle number which is a risk factor for heart disease is going to go up I've seen that in my clinic absolutely I'm not saying that saturated fat will never increase cholesterol or LDL particle number in people that's just not true it will happen it will happen in some cases but I'm just I'm reporting on the science as in terms of the general question of is saturated fat going to increase the risk of heart disease and is it going to increase the risk of death on average according to the available research and the answer to that is no now then the next question is like should you Joe eat vary a diet and saturated fat or should I or should

117:41I not sad if uhrin and unfortunately science is not we've been so focused on these population level recommendations and the idea that there's one diet that works for everyone and we don't have a lot of research that answers that question that's a big gap in current science you have two questions one did you find out if you made an error on this 2010 requirement from the USDA so this came from a study that's that reference said despite a lack of evidence supporting low-fat diets only in 2010 did the Dietary Guidelines Committee stopped recommending limits on total fat but I don't have the full guidelines in front of me and and I'm not sure what the the language says so I could have made an error it's possible so you made it based on that what you just said that was what in another study now in terms of saturated fat isn't there or increased risk when you consume

118:40saturated fat with refined sugars there absolutely is this is another example of where that context matters well let me just even step back a second and say that the the primary sources of saturated fat in and this is important to understand when you're looking at epidemiological data so the sources of saturated fat in the American diet 33 percent comes from pizza desserts candy potato chips pasta tortillas burritos and tacos 24 and a half percent is unaccounted for but most likely processed foods according to the authors and then not ten percent is or almost 10 percent sausages hot dogs bacon ribs and burgers so the vast majority of saturated Oh a 13 percent is chicken and mix chicken dishes think KFC or chicken nuggets and eggs and mixed egg dishes so the vast majority of saturated fat that Americans are eating is coming from junk right so even in an observational even

119:49if we did see an increase in in from saturated fat and observational studies we still couldn't say that that would be true for someone who is eating what I would call like a neutral or diet which is you know whole foods fruits and vegetables nuts and seeds some starchy plants like sweet potatoes and animal products including saturated fat we have no research that suggests that saturated fat in that context is harmful what is the mechanism that makes saturated fat more harmful when it's consumed with sugar well you have there is an interesting study that was done by that showed that in the context of a ketogenic diet where there's no nut no sugar essentially or very low amounts of sugar that dietary saturated fat will actually decrease blood levels of saturated fatty acids and that if you're eating refined carbohydrates then you you see an increase in saturated fatty

120:51acids that comes from the effects of insulin essentially let me find you the specific so if you're eating a high carbohydrate diet it will increase insulin which inhibits the oxidation of saturated fat and so then when insulin levels are high saturated fat tends to be stored rather than being burned as fuel and then high carb diet can put an and I mean refined carbs here not fruits and vegetables can promote the synthesis of saturated fat in the liver so it actually causes the liver to make more saturated fatty acids in in the serum but this study here is this showed that controlled feeding studies have shown that refined carbohydrates will actually increase levels of saturated fat in the blood whereas eating saturated fat in the diet does not if they're if the diet is not high in those carbohydrates Joe what's your take on that you know the only key point I make to answer your

121:56question felt to Cris is why does high sugar diets combine with high saturated fat diets because again I go back to biochemistry this is serious science where saturated fat it's usually found in meat and other animal based products it does exist in plants like summon avocado some and olives and olive oil but anyways there's a pathway get insights but it's real stuff the probe the amino acids found in red meat combined with their saturated fat that's content triggers a pathway that accelerates aging you don't want to age fast that's called mTOR pathway the igf-1 pathway then you eat a diet rich in sugar well we know the biochemistry right here in los angeles university of southern california bio gerontology institute i eat a lot of sugar you activate another aging pathway called PK wrasse and these two pathways mTOR igf-1 PK rest will make you an old man or an

122:46old woman quicker so when you're eating pastries which is high saturated fat and high sugar or you're eating meat with a coke how common is that I mean my god a hamburger and coke you're activating everything we know about science it will make you age faster that sucks so is that true that eating meat and the amino acids accelerate the aging process there's no studies that show that eating meat in the context of a healthy diet shortens your life span and if if so if that were true then we would see that in the data but Joel you're talking about an actual physical mechanism that accelerates the aging process is well know that you know what is it called again well it's mTOR igf-1 is one pathway and PKA rest the Cabal chemistry's no I mean this is like high level science it's not I'm not I'm not stretching on the limb here but you know protein is really

123:42amino acids you know I get this question you're a vegan where'd you get your protein my answers where do you get your amino acids because my body breaks protein down into the building blocks and then I build it back up to whatever the hell I need it for its amino acids in meat there's amino acids in my edamame wherever I want to get them the split of those 20 amino acids is different in meat than it is in edamame there's more methionine and more loose and very technical stuff leucine and there are some you know mixes that branched chain amino acids of leucine I don't know what the hell that does your aging but we do know that meat rich in methionine will activate mTOR and igf-1 and it is a very strong factor and aging you want a low methionine diet it's another reason plant-based eaters need to take b12 to keep their home assistant methionine down that's a

124:26separate topic but yes the amino acid mix found in animal protein is different than the amino acid mix found in vegetable protein which is why when Morgan Levine looks at the question what's your survival what's your cancer risks which are heart risk on animal protein and plant protein plant protein beats the crap out of animal protein this is high level cell metabolism try and publish a paper in some ways it's being the crap out of animal protein because there's a 300 to 400 percent increase in cancer of those that diets concentrate on protein of animal source and there's a 25% reduction in cardiovascular disease salma thousand in 2014 Morgan Levine of Harvard nobody's questioning our work October 1 2016 song at Harvard animal protein plant protein lead to very different outcomes in large database observational studies at the highest level because you can't take six

125:17thousand people and randomize them in that way so if you're waiting for that to resolve the question you know goodness actually not the case see the III RC panel that confirmed that concluded that that processed meat led to an 18% increase in cancer risk which again is like indistinguishable from chance using that low of a relative risk they their conclusion was that the fresh red meat led was point zero to one point zero two that's a two percent increase and many other studies have shown that unprocessed red meat is not associated with increase in cancer risk and is not associated with increase in heart disease risk so again you can talk about these proposed mechanisms all day long but if it's not showing up in actual events that are meaningful to people then you might be missing something maybe red meat does in you know act in certain way that would you might think

126:15would increase the risk of death but maybe it does other things that reduce the risk of death and that's why we can't just focus on mechanistic studies we have to look at actual endpoints that matter to people in terms of the quality of animal deaths in cancer matter christians i know you know what i just said they don't there's no the studies don't show that fresh meat increases the risk fresh red meat increased the risk of death and cancer and heart disease Joel what was the number that you were saying three hundred percent it's right here anybody look March 4th 2014 Selma tassel Morgan Levine right here animal protein 75% increase in death 400% increase in cancer over 18 year follow-up these findings were not found with plant-based protein so let's talk about reviews.reviews Giants no reviews are science dull well you're saying the reviews of observational studies and one

127:06medical reviews of meta analyses are not scientist you would prefer to draw conclusions based on a single study no not I wouldn't want advice from a single say but this is very consistent with the overall high level of mTOR igf-1 PK I was just referring to research that several large reviews that have not found a relationship between red fresh red meat and cancer and fresh red meat and heart disease so reviews that include lots of studies in just a single study that supports a particular viewpoint maybe maybe maybe well we need more than a minute well okay the 300 percent what does that let me let me let it's it's human study these are real lives there's a real deaths and these are real cancer cases this is this is original science and I've in one of the highest said epidemiology where they don't take into account all the other risk factors you know then the rest of their diet

128:00smoking sedentary lifestyle obesity all the burials download the whole paper but you know they do that this they do multiple he's downloading that there's a 2011 meta-analysis of 34 prospective studies on red meat and colorectal cancer which said the event that's 34 studies the available epidemiologic data are not sufficient to support an independent and unequivocal positive association between red meat intake and colorectal cancer 2015 meta-analysis did find a relationship with processed meat but did not find a relationship with fresh red meat there's also an issue of dose response if we if red meat did cause cancer they need to expect to see a continuous increase in cancer rates as the the intake of red meat increase but in many cases you actually see the opposite you can see a decrease in cancer rates and the people who ate the most red meat which cast some doubt

128:58on that association and again you know we come back to the relative risks it like you know even with processed meat it's only 18% and you have to consider the healthy user bias that we talked about before and with fresh red meat it's either nothing zero or maybe like two percent and that's just like that that level in observational research is not distinguishable from chance you cannot draw any conclusions on that and you cannot assume that someone who's eating a neutral or diet with fresh Whole Foods and is including some red meat in that diet is going to have the same response as someone who's eating pizza candy hotdogs and all kinds of other junk food that's just not you know common sense will tell you that hence the problem with these exists Oh exactly Joel Chris you want a low igf-1 or high gf1 you want a low edge if when you know it to say I want to live a long healthy

129:57life I don't I don't want to be I don't want to be obsessing over individual markers I want to live a long healthy life you like a lot of markers when it comes to low-carb studies you want a low igf-1 for survival the science is strong this is LA science so we're not making this stuff up anyways methionine and leucine and meat that raises igf-1 and at least periodically take a break raises insulin growth factor well which will take your prostate in your breast tissue make sure to start growing at age 50 which is the yeah because it's a males or for women for women well just because the frequency of breast cancer women it's women so you know there is a relationship between animal products and breast cancer there's a opposite relation these are relationships there is there is petri dish let me just say go back about chemistry you take breast cancer cells in a petri

130:44dish put plant proteins they stopped growing you put animal proteins they start growing that's that's pretty good science now you say that's a petri dish they happen to be human breast cancer cells but until you do a randomized controlled study of animal versus vegetable it won't be done should a breast cancer patient eat broccoli yeah let's dong the bell there again for sure and I can tell you how to book cook the broccoli so they get the best benefit heat broccoli sprouts you get 50 times more the benefit than broccoli you were gonna respond to that yeah I come back to important end points total mortality or deaths from any causes and diseases I'm not you know not persuaded by mechanisms unless they're tied to real that were that we care about I think mechanisms are interesting but as I said if if you you have to be aware that if red foods have multiple effects

131:36they might you know have one impact that you might think would lead to harm but then they could have several other impacts that would be beneficial and that's why you need to look at the real outcomes because there have been so many examples in the past of of ideas where the mechanism that was originally proposed for the harm doesn't turn out to be what we thought it was and so a total mortality is the most important endpoint deaths from all causes but then also deaths from from specific conditions are important too and you have and I would put that higher in the hierarchy of evidence and mechanisms absolutely Joel I don't know how you abandoned the unbelievable dedication explosion of scientists around the country and around the world you know come up with mechanisms of disease because we're on the verge of this unbelievable breakthrough to change your

132:25genetics and alter your mechanism if you don't understand you can't do it I think Chris has a backwards more commonly basic science drives questioning a human population an epidemiologic study and then maybe a randomized clinical trial that's a usual progression for example we have not even talked cholesterol this literally has been all saturated fat 1975 my mentors in Dallas Texas but this is relevant in 2018 brown and gold seen in basic science identify your liver cell has a receptor called the LDL receptor nobody knew it it completely controls the metabolism of cholesterol in the body they then find that there's a disease where you don't have that receptor in your cholesterol mm and you die before you're 15 and I took care of those children in Dallas Texas in 1986 ninety nine from that came the development of a drug called neva or in Lipitor and lovastatin all the

133:15rest and we were able to test in humans does that basic science make a difference kaboom the forest study says you live longer if you have heart disease you to take a stat yeah there's side effects yeah there's this and that go down to the bottom line you want your LDL cholesterol like Loren Cordain the founder of the modern Palin said 50 to 70 and it's all consistent across epidemiology based on biochemistry randomized clinical studies and what's the average LDL cholesterol and a hunter-gatherer in Okinawa in Loma Linda LDLs are 70 or 80 in fact humans are the only free living animal on the planet with an LDL cholesterol over 80 because we eat and we gorge and we have jacked up saturated fat that drives our cholesterol we're the only animal on the planet and we're suffering terribly posi there does saturated fat raise your cholesterol we need to keep coming back to dietary

134:08cholesterol and dietary saturated fat the evidence is showing that on average they do not raise cholesterol in the blood and even when they do that it doesn't translate into an increased risk of heart disease that's what the data show we've talked about mean I don't know what more I can say why actually we haven't we have an Internet I call on that it's called The Hague aesthetic way ssin in the keys equation I shared their data on controlled feeding you you mentioned metabolic word studies as a high standard of evidence controlled egg feeding studies where 75% of people experience no change in their blood cholesterol from eating two to four eggs a day eggs is an isolated topic because that's a cholesterol topic we have not talked cholesterol we've been talking saturated fat we're talking about right now okay well but you just ask saturated fat cholesterol well does saturated fat

135:02raise blood cholesterol to deny that is is wack and I'm sorry that's called The Hague aesthetic way ssin google it look it up on Wikipedia it's called the keys equation the change in they're saying the change in saturated fat raises cholesterol in the blood yeah it's you're saying it does it's known it's what he's saying Chris is saying that it does know I'd say I say it does sometimes people but on average the studies are saying that it doesn't have a significant rate at a large enough group of people you'll have some aberrations and some people will find a significant raise rising of their cholesterol yeah and again more importantly people that the presumption here is that serum cholesterol we care about it because it will increase your risk of a heart attack right as I said before large studies that have forgotten about cholesterol just analyzed the relationship between

135:57saturated and fat intake and heart attacks which is what everyone cares about right if they're thinking about cholesterol is like the the middle is a mediator in that situation so they remove that and they just say does eating saturated fat increase your risk of heart disease and that large review of 350,000 participants did not show a relationship on average so is the concept that cholesterol is just one factor and that perhaps we've isolated it as more significant than it really is in our typical reductionist paradigm absolutely there are many factors that contribute to heart disease and that's one of them and so that's why again it's important to look at the studies that directly examine the relationship between saturated fat intake and heart disease rather than doing this dance where we go does it increase cholesterol and then assuming that high cholesterol will lead

136:50to heart attack Joel I'm sure you can understand why this is so confusing for me I actually feel really badly for viewers and listeners no no no they're gonna be able to go over this with a fine-tooth this is so important I thank you both for doing this because this is the kind of conversation that you just don't get to have we get to experts with opposing views and you have a decent conversation where you go over all the actual details of it and you get to see how each one of you thinks about these things and how you've drawn these conclusions I agree with that actually I think it's great and all but you know we've had a couple moments of clarity and advice and I just want people to have as many as possible because you know it does matter friend of mine says heart disease is not theoretical I mean we've had many 39 second deaths what we've been doing this

137:36so just to respond I mean does satra two fat rich diets raise cholesterol absolutely it's such a tight relationship there's a line with a correlation that just straight up now can I pause you for a second yeah why what is wrong with these studies that he's showing that's that show that it doesn't in most people know I believe and again their studies that are being referenced but we're not looking at and that's a limitation we can live with that since 2010 the question has come up does an increase saturated fat caused coronary heart disease and that has been questioned in some studies the idea that it doesn't raise blood cholesterol is - you know it's the reason all the guidelines up through 2015-2016 still say limit saturated fat because that science hasn't changed there's such a tight correlation the line is straight up percentage of dietary fats percentage

138:26of dietary saturated fat blood cholesterol blood cholesterol the challenge is how much yours is gonna raise and how much mine is gonna raise gonna depend on your genetics and your microbiome and where you're starting if I ate a steak my cholesterol goes up if I ate an egg this has been shown because I don't eat any dietary cholesterol as a plant eater my cholesterol skyrockets you become habituated eating to 3 eggs a day and the curve flattens out after to 3 eggs a day which is 4 or 500 milligrams of cholesterol day it's like if you smoked 26 and you go to 24 gonna be pretty hard to show much of a difference to 3 eggs a day for a chronic eater is tough to challenge so your body just creates tolerance for it as I wish there's there's a level of absorption that starts to level off but an interesting statistic at toothpick is a hundred milligrams most of us eat 3 to

139:14400 milligrams of cholesterol day three to four - things we're talking about 150 grams so that's why the saturated fat it's like overwhelmingly more of a topic than 3 to put 3 to 4 toothpicks of cholesterol today ok hold on I guess he disputes I just come back to the studies 2 to 4 eggs a day controlled metabolic word feeding studies do not have any impact on blood cholesterol and 75% of people that's pretty that's about as conclusive as the evidence can get well my friend rats Reverend okay I'll give one to you you gotta give it I always have it and then they're always there at Kresser dot co / Rogan ya know and here it is if you if you google Kresser saturated fat you'll dep the first article that comes up so this is dye use from 2009 dietary cholesterol and coronary artery disease a systemic review I'll just show I know your viewers maybe your viewers can see it I don't know

140:22that's called saturated fat in the diet that's called change in your LDL that's called the line going up like a straight rocket and that's pulled up on the back yeah anybody that googles it's called hagstead equation AWG ste d okay he's from the late 1970s I know but the the hagstead equation comes from Hague said who was one of the doctors who was involved with the McGovern report in 1977 which was the original report that led to the limitation on dietary cholesterol and saturated fat so I think that's a little bit outdated perhaps is Chan is human like I said I said one study doesn't you know the exception doesn't make the rule we have a meta-analysis of observational studies including 350,000 participants that found no relationship between saturated fat intake and cardiovascular disease the review of 25 RCTs and 40 observational studies 650,000 people

141:35they concluded that replacing saturated fat with polyunsaturated fat doesn't lower the risk of cardiovascular disease we have to look at the weight of the evidence we can't just choose one study or a mechanistic argument to support our view and so it's your take that this studies flawed and out it's not a study that's a that's a he was that's a an equation that was meant to represent the relationship between saturated fat intake and see a blood cholesterol that was created created by a doctor and this in the late 70s that was originally involved in in this diet heart hypothesis and the McGovern report which led to the restrictions on cholesterol and saturated fat in the first place so yes I am saying that we should be looking at more recent evidence large reviews of metta of observational studies and then meta analyses of randomized controlled trials that's

142:27that's the much more persuasive source of evidence for me Joel it was based on metabolic or carefully done studies at Harvard it was the equation derived from human data where you put people in change their diet dietary change studies drives up LDL cholesterol he just plotted out the plots very clear it's change in cholesterol to dietary saturated fat it's well accepted in the medical community and it's incorporated in the guideline it'll never change human physiology is not going to change LDL receptors don't change it all goes back to basic biochemistry when we understand that we can manipulate it to better health we could do it through pharmacology we can do through diet we'll be doing it through gene therapy stem cell therapy but we don't understand the biochemistry we're cutting out a pillar we have to have for better health Chris I don't know how

143:17many more time I mean I feel like I'm just saying the same thing over and over again we have to look at the research the weight of the evidence we have to look at randomized controlled trials that actually look at what happens when people consume saturated fat and dietary you see these studies measures the Brecon it's not mechanistic arguments are not persuasive if it's not happening in real in real people you're measuring in a randomized controlled trial you're controlling you know you're measuring what happens when people eat saturated fat and cholesterol and then you do a meta-analysis of these controlled trials and you're you're finding what I what I just said that's way more persuasive to me what is your take on that Joel the Royal Academy is saying what did you say the Royal Academy of Science in Sweden gave the Nobel Prize in medicine for what we're talking about

144:05and nobody's changed that I mean I totally disagree with Chris that human physiology didn't change from 1985 Nobel Prize to 2018 that the relationship between eating saturated fat lowering your LDL receptor raising your blood LDL developing atheroma I go into 3:00 in the morning and bust open your plaques we have has not changed well how are these studies made and what's wrong with them that they Yui nothing's change about understanding the biochemistry of our lipid metabolism in cells of course there's always advancements but the LDL receptor has led to the statin field a new class of drugs called pcsk9 inhibitors it's all because of our chemistry that people are living longer living better their plaques are being reduced through lifestyle medicine but thank God we also have pharmacology that's it what is wrong with these studies these studies that are showing

144:59these results that he's describing that you're disputing what is wrong with these studies and what is wrong with the results again I would urge everybody to take the broad high-level view of science and not pixels what's the basic biochemistry I know we're circling around what's the epidemiology what's the clinical randomized trials and what's the centenarian studies there there is no new data that you lived a hundred by adding saturated fat your diet you know we're not talking about that we're talking about the actual physical results on human bodies when you consume saturated fat what he's just describing I mean it would take a new metabolic Ward study that negated the keys equation in the heck's that equation that there's a linear relationship 395 met about sighs it doesn't exist what are you saying to that Chris a metabolic word study that says even saturated fat it would not

145:45take that or we have randomized controlled trials which is a very high standard of evidence and observational data large amounts of observational data that have been reviewed that answer this question and we we also we have you know many RC T's of low-carb diets and even ketogenic diets that are not showing significant impacts visual is impossible this is here's a dietary here's a 2018 review of all the previous science on dietary cholesterol and eggs and the conclusion says reefs overall recent intervention studies with eggs recent demonstrate that the additional dietary cholesterol does not negatively affect serum lip and in some cases appears to improve lipoprotein particle profiles like have a beneficial effect and HDL functionality which is the so-called good cholesterol and he talks about here in the conclusion that eggs shift LDL particles to the less sentimental large

146:48buoyant LDL which is less atherogenic he says eggs also typically increase HDL he says that eggs probably have other beneficial impacts on in terms of their phospholipid contacts and that there's no relationship between the consumption of eggs and heart disease so this is a 2018 review it's by Christopher Blessed I eteri cholesterol serum lipids and heart heart disease our eggs working for against you published in nutrients Joel is it possible that that's correct and there's just some misunderstanding about the previous data it's a different topic it's eggs its cholesterol we were talking saturated fat does it raise your cholesterol so the different topics and then we've introduced a very hot topic about LDL particle size which we should break down and talk about so I'm not sure quite how to respond because we got off track by shifting to consistently

147:41low carb and eggs and other things we were talking about cholesterol what we're talking about raised blood cholesterol so I stand by the fact puman physiology will not change we have our understanding of human physiology advanced I don't well I'll give you an example until 20 years ago nobody ever heard a word pcsk9 God or somebody gave us a protein in her blood pcsk9 that goes to your liver sits in a receptor causes the LDL receptor to go internal and your frigging blood cholesterol goes up now there's a class of drugs that's an antibody to pcsk9 lowers your cholesterol dramatically and we're finding it reduces plaque and lower risk of heart attack sure new science amazing totally consistent with what Brown and Goldstein shown that led to statins now we have a new treatment that's a wonderful thing it didn't rock the boat we still don't know to this day why we

148:37have that protein in our blood and if you're lucky enough to be born with a low level of pcsk9 cholesterol is lower you have less disease you live longer that was part of the data I published in 2012 with Brian Ference at Wayne State University so yes we've learned more about human physiology totally consistent didn't disrupt anything and led to better treatments that's great has has human physiology been challenged I'll give you another we've learned and Chris mentioned this I think it's fair to go there's like a cord Allah he opened it up and cross-examining nobody in the world ever heard the word of four letters T Mao 2011 cardiologist sitting at the Cleveland Clinic said there's got to be more in the blood that hurts arteries let's go find him they found this chemical they've learned how to measure it they patent how to measure it TMAO they took 4,000 people on the cath

149:26lab table they said I wonder if the level of T ml and the blood correlates with how clogged up your arteries are but doom it worked perfect then they figured out if you eat red meat that has rich in l-carnitine amino acid g'd exits rich in choline and a nutrient I think amino acid I'm blinkin for a minute those directly led your liver to create TMAO they took studies where they reduced carnitine reduced choline the die to your meal goes down what is T Mao do it stuns your HDL so it doesn't reverse cholesterol transport it causes LDL to enter the cell wall and create foam cells microfibers plaque and you get a heart attack it actually screws up your kidney and causes it to be fibrosis if you have heart failure diabetes or heart disease or hypertension your TMAO is up I've actually drawn more TMAO levels I think any physician United States this is my baby new human

150:13physiology that has not led us to back off the idea that limiting the animal product consumption in this case specifically egg yolk and red meat may have benefits your health we just learned in actually Joe what what increased what in the diet increases TMAO orders of magnitude more because fish has it right in their fish flush along with that mercury in their brain what is the association of seafood intake with heart disease mortality can we use epidemiology studies or that thereof today as I said before we can use epidemiology when we use it wisely but selective Chris use it or don't use that I always use epidemiology 100% of the time just means oh we've been talking about large reviews of epidemiology that that's that suggests that heart that you know saturated fat cholesterol don't increase the risk of heart disease so if you could answer the question well she did well what is the

151:05association of fish with cardiovascular and cardiovascular disease and mortality well since it has saturated fat most high level 2018 advisors are two meals a week of fish balancing out with 19 meals a week to the plant-based is the USDA guidelines answer the question dr. Walter longer you look at the data there are a few things that that are associated with a greater decrease in cardiovascular disease risk than fish consumption and rinse and vegetable TMAO is if you look at a graph and you can if you google let's see maybe Jamie you can pull this up crecer TMAO and you click on that first link red meat and TMAO and you scroll down and there's a picture Oh Jamie where you been there's a picture scroll down there you go so that picture shows the increase in TMAO from eggs beef cheese milk clams and then look at Cod and halibut Wow let me just beef the

152:21references in the article as always you can see it's not chris master john and that's so caught in halibut or increasing TMAO as I said orders of magnitude more than beef or eggs you can't even see eggs and beef there and the data show that fish consumption I think almost every Public Health Authority would recommend you know would agree with this is reducing the risk of heart disease and mortality so TMAO is another mechanism it's another interesting mechanism but not very understand on fully understood and again we have to look at the data on red meat consumption and heart disease and mortality to really figure this out we can't you know it's a speculative mechanism I don't disagree that it's important to look at mechanisms but you can't draw conclusions based on them and this single fact about TMAO just kind of blows the thing apart the other thing

153:24about TMAO to know is that certain types of gut bacteria metabolize choline and carnitine into TMAO whereas others don't and so a lot of scientists have speculated that high TMAO levels are essentially a result of a disrupted gut microbiome and that makes sense if you have 60% of the calories that Americans are consuming are from ultra processed food and we know that that totally screws up the gut microbiome then if you get a person eating a standard American diet then their TMA look TMAO levels may go up with red meat whereas if you take someone who's got a healthy microbiome because they're eating you know lots of plant foods that support healthy gut then you may not see the same Association and part of that what supports that is there's studies showing that a brief Axman which is an antibiotic that treats bacterial overgrowth in the small intestine

154:21reduces CRM TMAO levels which suggests that it's mediated by the gut microbiome so consumption of fish has been universally shown to decrease heart disease the mechanism is interesting but overall it may be very complicated with many factors and we might not know all of them yeah and then that's what takes us back to let's look at the data on whether red meat increases the risk of death or heart disease Joel Chris's reference was giving credit to another bloggers article that's not science you have to go to the blogger's article and look at it was number 16 there's reference it's okay it's just a sloppy referencing it said there that that graph game number 15 is the reference dietary precursors of trimethylamine and men on a pilot study tml was okay so it's not a blog it's actually stuff okay TMAO is a hot topic right now that is largely being research in terms of egg yolk and meat

155:27consumption it doesn't really matter it's not preliminary signs no no it's not play mature science are coming up with pharmacologic agents right now to block it and we'll we'll see a new class of drugs they just reported is that what's significant or is it more important to concentrate on gut biome and healthy diet well why we why we instantly giving the ball to pharmaceuticals what you asked the question is there any new human physiology that's relevant we started with pcsk9 i'm introducing TMAO as new human physiology that's relevant that could lead to improvements and clinical outcomes as suggested by observation talking about what he just showed in the graph okay Smith the graph then he gave you a study for the graph and you just sort of glossed over it right I I the one that contributed fish is a flesh source of tml we can talk about whether fish in 2018 is uniformly healthy

156:19that's not be saying and he's also talking about gut biome I got bacteria then the consumption of red meat being significantly less than the consumption of fish which is universally said to be a good thing for your heart so a bunch of layers there real quick everybody who studies TMAO knows that the microbiome is a critical component to people can either stick its classic study Cleveland Clinic study feed a vegan a steak this is a classic Cleveland Clinic research study in the New England Journal of Medicine I don't make TMAO why because my microbiome is different than yours feed an omnivorous steak they make TMAO within 12 hours eating a standard American diet sure but nonetheless it's it pointed to the fact that it was the microbiome you give a mouse meat and give it an antibiotic the website of microbiome I won't make TMAO the TMAO dependency the microbiome dependency of

157:09T Mayo is well known science so that that is not denigrate the topic I mean it's a side topic is fish always healthy in a world of DDT PCB mercury I don't know about Chris's practice but every patient I see gets blood mercury levels and those that eat routinely heavy are very object no you don't want to you want to look at old data on fish and now I'm bringing up 2018 clinical except that's not what he's doing we're not old date on FEMA beat up old data and I'm bringing relevant clinical material you were taking about the absolute mechanism that's caused by the consumption of meat he brought up fish consumption which vastly elevates this and yet fish consumption is not correlated with heart disease in fact it's correlated with people having healthier hearts so if you're suggesting to me is the recommendation today and this discussion eat fish but limit egg

158:08yolk and meat I'd agree with that that's not what it says because the fish consumption vastly elevates what you were saying was a significant issue he's saying it's not a significant issue that it's a mechanism and it's an interesting mechanism but it's part of a much larger and probably very poorly understood situation I don't think that's completely true what we do know is that true well yeah I would say that's true and I would say it's another proxy marker for a crappy dot crappy diet what we know is that eating red meat in the context of a standard American diet may slightly raise your TMAO but not nearly as much as eating fish will so you brought up this TMAO and he's basically just squashed that argument but I think he's scientifically wrong because again the wealth of the body and I mean is the about TMAO about Gmail because what about the fish because a few specific

159:05fish number one the way that egg yolk and red meat Cleveland Clinic New England Journal Medicine is is this a step of Eden justing the precursor going through your microbiome going through an enzyme called lice in your small intestine going to your liver is TMA and grain metabolized at TMAO that process is correlated with atherosclerosis that process is correlated with increased activity of LDL within your cell wall correlated by epidemiology Emmis tree biochemistry we know how it works in the petri dish that was the brilliance of this rapid development from 2011 to 2013 to now so it's not in fish what hasn't been studied is if fish flesh already has preformed TMAO we don't know if it activates a LDL activation we don't know if it stuns HDL no but he's looked at the correlation of fish flesh preformed TMAO and a four thousand patient study in the cath lab

159:58table we don't know they're wonderful questions to ask but until they're done there is reason to be concerned that there's a new pathway that might be involved in talking about a totally different thing yeah exactly if if consuming food that raises your TMAO increase the risk of heart disease and you'd see people who are eating the most fish having the most heart attacks and that's the opposite of what you see that's I think that's reductionist because what does fish have it isn't reductionist to bring up TMAO in the first place because you brought what I just said because I zoomed out a little bit to look at the actual relationship with mortality well that was a blood level that's not atherosclerosis that's not outcome that's not kidney function that's not stroke risk and harvest which happens you're talking about TMAO I am talking about what that graph showed was

160:48TMAO back it up you eat red meat you make TMAO if your microbiome is of a certain Constitution you eat egg yolk you make TMAO if that's a certain Constitution is it good to have high levels of TMAO in the blood whether they're from fish egg yolk or red meat the science suggests it's not good what can you do to lower your let me pause you let me pause how does a sign suggest it's no good if there's large levels of TMAO that come from fish and when you eat that fish it's directly correlated with less heart disease well it would take an evaluation what's the calorie content in the United States that's from Cod halibut red meat and egg yolk I would think the calorie content of egg yolk and red meat is higher than cotton helmet I don't have that data and that's a global perspective but if you are up to date on the scientists say I'd like to lead a low TMAO life which again I'm

161:35gonna say with all boldness I've drawn more blood levels on anybody the United States I believe according to Cleveland heart labs you will want to do all steps to lower it and maybe you want to leave fish in because the complimentary benefit that fish has shown may be from Omega understand if you're but you were talking about TMI team TMAO as a mechanism right it's purely speculative to say that the TMAO from fish is healthy but the TMAO from beef and eggs is not no I don't think it's speculative I don't think we know the answer because it's seven year sian you're stating it though now I'm not saying you're stating that TMAO is a massive concern that is scientifically true but how is it scientifically true if there's so much TMAO and fish and there's no concern what there's two species of fish that have the highest levels you saw the other levels what are

162:21the other ones we're not we're not talking about higher we're talking about like beef and eggs barely even register on that graph sensationally orders of magnitude higher like what percentage was higher yeah I probably 20 fold higher 20 fold 20 times higher like I might've even mentioned that in my in my original article Joe the problem is you brought up TMAO in the first place like it was this well but let me just tell you okay let's let's everybody look at molecular nutrition food research 2016 does fish protein when it elevates TMAO accelerated atherosclerosis according to a research study when fish raised tml they accelerate atherosclerosis anybody can check the reference lead author I cannot say the name yaz dekosky conclusive reached a a petri dish data is a petri dish I'm looking for a minute it's basic biochemistry what happens to atherosclerosis in arteries when you

163:26feed this was a mouse data that's how you generate hypotheses well it hasn't been done in humans yet bringing up as pure fact well the assumption is the fish is a superfood I've already knocked it down for several reasons one the fish intake is associated with increased risk of diabetes I'm sorry that's epidemiology fish is associated with increased risk of diabetes yes Peppa dee me ology studies so the question is is there a randomized study basic biochemistry you'd understand it from the saturated fat content of fish it would be largely epidemiologic states things like here but when you're saying epidemiology studies you're asking people what do you eat on a regular basis and they say fish and french fries and hot dogs right you say oh the fish is associated with an increase that's where and it's not isolated it's connected all these other things with that isolated

164:24well you try and isolate out things by multivariate analysis Emme it's not one study it's many straights but diabetes and fish really yeah is that real it's real it's one review that said that and was a review because there's a 2012 review that does not find any association between fish consumption and diabetes so you're thinking this was four four hundred and forty thousand people with an average of eleven year follow-up published in the American Diabetes Association diabetes care Journal so yeah I don't think you know it's it's hard I think to make a claim that fish consumption is is harmful for yourself there have been the enormous weight of evidence and yes there are concerns now about toxins and it might change over time and there are also issues with overfishing and all of that one story story we're talking about just the association of fish consumption and

165:22health and longevity and I think if you got a hundred scientists in the room maybe ninety nine of them would agree that that's that you know there are a few things in nutritional research that are less controversial than that well maybe I mean I'm just I'm not making this up Journal American College of nutrition intake of fish was correlated positive with the increased risk of diabetes I mean the science is out there is it crystal clear as is as well-defined as the heck of stead equation dietary saturated fat changing cholesterol no is it an association that could be of concern and basic biochemistry said fish have saturated fat that could possibly cause something called lipo toxicity fish have animal protein we've already talked where animal proteins very different than plant protein the concept is plausible sure is it resolved it's not resolved is fish a better choice than eating fried

166:10chicken or a piece of Philly hoagie steak absolutely it's a cherry just pulled something up here it says the findings do not support a beneficial effect of total fish type of fish or epa and DHA in take on the risk of type 2 diabetes alternatively other dietary components such as selenium and unmeasured contaminants present present in fish might explain our results Jamie dude read the sentence total fish intake was associated positively with the risk of type 2 diabetes that says there's epidemiology that should be further studied but maybe somebody wants to cut back their fish but we're looking at a single study here I get to look at the weight of evidence Jamie you're bad man it says findings do not support a beneficial effect of total fish type of fish or EPA DPA on the intake on the risk of type 2 diabetes like it even lean fish was associated with developing type 2 diabetes fatty

167:15fish was not because you probably want that omega-3 but you know it's I'm not telling anybody it's a resolved issue is that you were saying TMAO animal protein is what causes this problem it's actually more specific it's choline and carnitine you know egg yolk it's not really animal protein it's but you said TMAO yeah TMAO TMAO is okay so what's in meat that's not good for you although if you're hungry on an island and you're dying eat meat we all recognize it but if you're looking for optimal health you should be concerned about a saturated fat content you should be concerned that animal protein accelerates aging through the night if one is it been proven that animal protein accelerates aging well if he says no we should just stop because that's why it's world-class science I mean just because you say it doesn't mean that high intakes of methionine which isn't one of the amino acids in

168:16animal protein in the absence of sufficient intakes of glycine which is another amino acid that's in animal proteins and an intake of nutrients like b12 and b6 and B 9 which is full eight could some of the animal studies suggest that that has an effect on longevity but this is why I've always been an advocate of eating nose to tail so not just eating lean meats that are very high in methionine make sure you're getting enough of the glycine rich foods the bone broth etc and then you're also eating plenty of you know a mixed diet that contains b12 and folate and b6 and the other nutrients that balance out the effects of excess methionine as well as fiber for a healthy gut absolutely and when you pull up that that conclusion no fiber in meat no fiber in me yeah will you accept Shaun Baker well there's a whole nother ball of wax with that whole carnivore diet conclusions that

169:20accumulated evidence generated from this meta-analysis does not support the overall inverse association of fish or fish oil intake with incidents of diabetes that's that's saying that it couldn't confirm increase fish intake doesn't lower the risk of diabetes it's not saying that it increases the risk so it says it's not there's no relationship there I'm taking an exam alongs yeah so it's not there no one's saying that it causes diabetes so whatever it does when where where does it say that it causes diabetes and what does this study nobody said it causes this is classic Association because you don't know if it's the protein the fat the mercury the PCBs the DDT or the people that are in fish they're eating fish TV absolutely this is clearly not to the level of saying process red meat cause cancer this is saying fish consumption in some studies is associated with type

170:152 diabetes but these are heavily flawed studies with you know I wouldn't throw them all under the bus you know that's how science works I mean it slowly plods forward smiling you know I mean I we were starting brought up TMAO and that's how we got onto fish yeah and diabetes I think there is no strong evidence that fish causes diabetes fish causes diabetes there's a lot of evidence that suggests that eating seafood reduces significantly the incidence of cardiovascular disease and again if TMAO or a problem then eating a lot of fish should should not have that impact and you believe that this is probably well I shouldn't say you believe this is from essential fatty acids that are found in fish particularly fatty fish yeah I think that's plausible given what we know about EPA and DHA which are the long-chain essential fatty acids and their benefits and it could be fish is

171:10also a really great source of selenium as that one study said yes 16 of the 25 top sources of selenium come from ocean fish fish is a great source of bioavailable protein there are lots of reasons why why fish consumption could be beneficial so in your opinion this sort of highlights that there's a lot of complex different moving parts that we don't totally understand and that this is why you don't want to rely completely on just the mechanisms and these things that are occurring in Petri dishes or my studies or things on those lines yeah so going back to the Bradford Hill criteria that we mentioned before which are ways of kind of determining whether associations that show up in observational studies might be causal the plausibility one of one of the criterias mechanism is there a plausible mechanism that could explain the relationship between this variable

172:09and that variable but there are other criteria strength consistency specificity temporality plot biological gradient like a dose response coherence experiment analogy so yes mechanisms are great it's important to study them I'm all for that and we absolutely need to correlate them with real outcomes and real human beings to see both in observational studies that are well-designed and in randomized control trials to see if it makes sense in the MT Mao I think is a great example of that does it is it fair to say that we really just are looking at a puzzle and we don't have all the pieces I think you can say in many cases and in this case for sure yeah I disagree there's a tremendous group and you can pull us up if you want Jamie called true health initiative it's more than 4-hundred I call world experts on nutrition ferried just divergent food philosophies paleo

173:05Mediterranean plant specifically what disagreeing well so that there's no consensus to advise the public on a healthy diet for humans a district that's not what we said that's what we what we said was that there's it's a complex puzzle and we don't have all the pieces well I agree with that but we have enough to make Renoir is agreeing because we have enough we have enough to make recommendations to the public and the true Health Initiative has crystallized that okay but that's not what we were discussing right there about recommendations to the public we were talking about mechanisms and whether or not it's understood all the different moving pieces in terms of how your body absorbs nutrients and food it's it's an endless flow of new knowledge that's what I said but why did you disagree with that I didn't disagree that I disagree when he said that that's an accurate

173:55assessment that we don't have all the pieces to the puzzle we definitely go to have all the pieces we have enough to make recommendations and then we'll reevaluate and all do you want another new meat problem it's coulis latest science sure okay Jamie will you go to please meet allergy on Google University of Virginia atherosclerosis it's a little taller meat allergy weights aside and go to the second tick oh you got a baby you're so good Jo lactose oh my jaw I am so overwhelmed by your science and I mean that sincerely you see the one that says NIH it's a number two hit and Google but this is something that's caused by an adverse reaction so you've got a listener here who's in Virginia maybe you see a segment the average person should eat meat though well go ahead so this is I don't know go to the second one I'll have the picture just real quick okay here you live in Virginia you

174:57should end up punting right you end up you end up on my cath lab table because you're in the emergency room for whatever reason okay I draw a blood sample on you 24 percent of those people have a antibody to alpha-gal which is a carbohydrate found in meat and that shocks people there are carbohydrates and only red meat specifically and only red meat specifically 24 percent of Virginians so the antibody so that interesting and some are now developing anaphylaxis caring EpiPens because they have a meteorology that isn't 2.4 percent as 24% have the antibody but what was discovered university of virginia is if you then look at their heart arteries by ultrasound the more plaque they have the higher is their titer the antibody brand new science it's an association nobody knows there is of course the possibility of inflammation from immune activation that's wild data now i don't wish that

175:50on people I wish we live in a world but people didn't have nut allergies didn't have lactose intolerance and didn't have meat allergies but the reality is there may be a pathway previously unknown that is hot and this all goes back to your question is there any new physiology about this can I stop you right there this is a pathogen activated allergy that's pretty severe people don't walk around with this without knowing that they have it they have severe allergic reactions it's you know we're not talking about like a mild GI just comfort right talking about us I don't think this is a mechanism that has existed for a long time this is something that's only been discovered over the last couple decades yeah of those 24 percent that have the antibody very few had the full clinical syndrome but it's still correlated with heart disease the point is keep an open mind I

176:42don't see the data accumulating that means can I ask you this do you think that it's because they've have a mild case of this tick-borne disease or this tick-borne disease is like because it is fairly recent yeah it turns our discovery of it is it advancing and evolving and getting more potent I doubt you know the basic biochemistry of meat and the carbohydrates and meat have changed it has the has the Lone Star tick become more frequent there across reaction between glyphosate and being bit by tick and our intestinal permeability there's all kinds of crazy ideas that need to be pursued because some which is Santos round off we that's right it's all bear correlation is not causation we we know you agree with this Joey I have to keep that in mind I mean it's that there is a great study done one of my favorites it was purposely done to illustrate the danger of assuming that correlation

177:42equals causation it was a study done of the most common diagnosis for hospitalization in Canada ten point six million people and they found that 24 diagnoses were significantly associated with the participants astrological science so people who were born under the sign of Leo had a 15% higher risk of being hospitalized for gastrointestinal hemorrhage and Sagittarians had a 38% higher risk of being hospitalized for an arm fracture now remember that the candidates the proposed increase in risk for processed meat and cancer is 18% so the these risks are on you know that's process and the same process me at that same level so the Sagittarian has a higher risk of being if we believe in this correlation data you know you can't assume correlations or causation I mean that's basic and I and it doesn't again there are extent you can use Bradford Hill and other things to strengthen the

178:45association but you need to test it with an experiment or the association needs to be strong it needs to be over 100 percent at least to really rise out of the noise and say okay we're really seeing a signal let me give you another example there was a recent study just published that showed that women pregnant women with the highest maternal consumption of gluten had a to full risk of type 1 diabetes in their offspring and their children that was a double that was over a hundred percent so that is actually worth paying attention to because that's so such a large you know increase in risk that it doesn't confirm it by any stretch but it does mean to read yeah maybe we should look into this further if that was a 5 percent increased risk I mean you you you you might as well say that a Sagittarian 's have a higher risk of arm fracture is it fair to say that were when we're doing

179:39all these nutritional studies that you're looking at a poverty of data yeah I mean johny johny and it is how to quote I let's see if I can quickly find it because we're comparing all these different studies and mean obviously Joel thinks one thing you think another thing so so here's the here's the Unitas quote moreover given the complicated associations of eating behaviors and patterns oops lost my place given the complicated associations of eating behaviors and patterns with many time varying social and behavioral factors that also affect health no currently available cohort includes sufficient information to address confounding in nutritional Association so he's saying you know layperson translation there's so many factors that affect our health from our sleep to our physical activity to our weather we smoke weather we drink yarks our social relationships there was

180:37a study that I think I talked about on one of my previous appearances that shows that having not having enough good relationships will increase your risk of death more than smoking 15 cigarettes a day no studies are controlling for that right gut microbiome we now know is really important for our overall health are any studies comparing for people you know actually controlling for people's the state of people's got microbiome absolutely not which is a problem with the TMAO research so again it doesn't mean that observational studies are not useful it means we have to take them with a huge grain of salt and the fewer things that are actually controlled for the bigger the grain of salt will be Joel I kind of hear a sense that it's so overwhelming and there's so many spots in the data that were unable to advise the public again I don't agree with that I think we have more than enough data

181:31you can go to Michael Pollan eat food not too much mostly plants everybody loves it because it's consistent with the overwhelming 50,000 level look you can go to true health initiative that says 50,000 level though yeah you know the whole level of biology basic science centenarian randomized clinical trials epidemiology you got to talk to a patient Monday morning I don't want to get what mired in confusion I'm gonna tell that patient eat real food don't eat too much and eat mostly plants because that is a synthesis of fifty years in nutritional research are we gonna evolve that to something more brilliant you might add now fast five days a month or don't eat 12 hours a day we might be able to refine it with some of the new science on using fasting intelligently but that's pretty strong when I go to a true Health Initiative and say it's all confusing but 400

182:22scientific international experts say eat locally source close to the ground plant predominant with water 400 scientists say that's pretty reasonable that I can tell my patient on Monday is something they can actually activate and we'll figure out TMAO with a blocker with fish or with eggs with choline or whether this tick allergy ends up spreading into Michigan or California and there's a way to deal with it for now these are critically simple lessons to the pup I'd actually agree with that including the part about plants I mean I recommendation is your plate should be you know two-thirds or three-quarters plants and and then then animal products animal foods so the the question here is not that should we eat you know a healthy Whole Foods diet we both agree on that 100% the question is whether animal foods should be a part of the diet based on their nutrient density

183:17which unfortunately we haven't had a chance to get into yet and their bioavailability and the fact that humans and our hominid ancestors have been consuming them for over two-and-a-half million years you know that's my argument is that on that plate for most people they're going to benefit from having some animal foods how much you know what proportions of carbohydrate fat protein and all that that depends on the person and you're going to see big differences actually from person to person but you know I I think today is made it clear there's no convincing data that shows that completely removing animal products from that plate is going to lead to a longer lifespan or significant reductions in disease let me put it this way what is the benefit of putting that one quarter of your plate putting animal protein like what what is the nutrient density of it that makes

184:15lots of benefits um yeah so animal protein is more nutrient-dense in essential nutrients so so making it clear that I I support eating both plants and for animal foods so animals are animal foods are higher in b12 bioavailable zinc iron calcium choline taurine creatine and not just higher in terms of the actual amounts but higher in the amount that you that you absorb and that's a very key point whereas plant foods tend to be higher in carotenoids polyphenols flavonoids dye a little sulfides which are in cruciferous vegetables and fiber and those are important as well and so to get the best of you know the the mote the widest spectrum of nutrient density we want to eat the animals for those nutrients and animal foods and then the plant foods for those other nutrients and what would be negative about removing the animal products from that one quarter of your

185:20plate what what could you not fill in with plant protein clearly some people get by with just plant protein b12 is the is the biggest issue for sure it's not really found in plant foods except for some exotic species of wild mushrooms and and nori and we're plants and mushrooms aren't really plants right but yeah in non animal foods yes you could say but if it's it's not just a question of what's theoretically possible it's a question of looking at the studies that show us what are the average you know how common are nutrient deficiencies on omnivorous versus vegetarian and vegan diets and if you go to crecer co / Rogan there's a whole section on that that links to a very in-depth article that shows that for example vegetarians and vegans the abdominal or the rate of b12 depletion is 11% and then for vegetarians it's 77% and for vegans it's 92% 92% of depletion

186:27which is the first stage there's four stage the b12 deficiency and that's the first stage and the earlier studies that showed less of a difference used only serum b12 as a marker but it turns out that serum b12 is not a very accurate marker of b12 deficiency and we need to be using more accurate markers like holo Transco Ballymun methylmalonic acid and homocysteine and when you use those newer markers you see those broad brought you know very big differences in deficiency rates and furthermore there was a study done in vegans and vegetarians in the Netherlands that were at a like summer camp so these were people who were educated vegetarians and vegans they were really into it and the average serum b12 level for them even what was below 200 which is in a deficiency State and even the people who were supplementing had significant levels of b12 deficiency and that's

187:22probably because studies have shown that the amount that you need to supplement with is about a hundred times higher than the RDA so the Rd is 2.5 micrograms and you really need 250 micrograms to get your levels up and if you're deficient you need 200 times more than the RDA 500 micrograms and this all the studies are there on my site so it is a problem that b12 is non-existent and plant-based foods or that it's not as bioavailable it's it doesn't exist the true true cobalamin absorbable b12 doesn't exist in in plant foods you can't you can get other Co amides other alarms of in in plant even algae even algae yeah must be most vegans who are well who are educated about this know this and they take a b12 supplement so but the b12 supplement is probably based on what like what's it coming from well it's not that that that doesn't necessarily make the difference it's are

188:20they taking enough to meet your needs so I'm hope that anyone who is listening to this make sure that they're getting enough b12 you know right but what is it coming from if it's not bacteria bacteria make b12 cows they're eating dirty ground they get bacteria cows stored in their stomach plants if you don't wash will give you b12 but it's the bacteria hanging on the carrot and we make b12 too but it's in a colon and we can orbit in the small intestine right so but yeah just making sure that if someone is following this diet they're getting enough b12 and that they're using the right markers to assess their status serum b12 only goes out of range in the final stages of b12 deficiency and by then it can be too late some of the effects of b12 deficiency are irreversible so it's a pretty serious thing and it's a really important thing for any vegetarian or

189:07vegan to be aware of given those big differences in depletion between the populations so gel if you've been a vegan since you've been eighteen obviously you must have been on top of all the supplementation and making sure that you get your right nutrients well it's out number one it's responsible for a health care practitioner to advise somebody eating plant-based to take vitamin b12 absolutely there are people that do it because it's fortified in many foods and nori if you eat sushi and nutritional yeast I don't advise my patients to rely on food because there's a neurologic in hematologic potential for trouble if you don't b12 it actually takes years to deplete your b12 it's an interesting statistic I want to come back to humans 90% of all b12 right now is being given to feedlot cows because they don't eat dirt anymore they're inside a building that has no

189:56dirt they don't get b12 but the public wants b12 rich meat so they give b12 to cows to make b12 there is there there little vegans these cows they don't have a source anymore no animal you're usually talking about factory farm factory farming you know if you're out there eating dirt in the field they're gonna have a cop a job that stopped you right here yeah when you say that so is it impossible to live a healthy plant-based lifestyle without supplementation no many many people do but if you don't remem end it I don't recommend it but they should get bloodwork know your vitamin D know your omega-3 and know your b12 I'm all for optimal health and I'm practicing high level medicine but I have friends that adamantly show me their blood work I don't take pills and look at my blood work I mean they may sneak by it's not my medical recommendation the official

190:45recommendations is every everybody over age 50 in the United States take b12 for brain and mental health whatever your diet and that's a wise advice whether you take a multivitamin every cup days like dr. Longo recommends there's you know this is a real problem nobody's denying it chris has laid it out well it's such a simple solution I'm gonna demonstrate my b12 and what's the source of your b12 it's synthesized methyl cobalamin I just got one thousand micrograms of vitamin b12 with four hundred micro with four hundred milligrams of DHA with two thousand international units of vitamin d3 and that's all vegan I just did that once a day and I'm done you know and it's all vegan and has nothing to living organisms yeah it's made synthesized b12 is synthesized in labs methyl cobalamin some people live is the preferred choice which I think Chris would agree with so

191:37contrary to popular belief it can be gotten by completely humane and ethical ways if you're a vol.8 sal g4 DHA it's synthesized for b12 and vitamin d3 is synthesized too it used to be made from cows secretion called sheep secretion called lanolin but synthesized now but it does beg the question of whether we should be following a diet that can't meet our essential nutrient needs and that leads to deficiencies of many other nutrients much more commonly than an omnivorous diet and you know my position has always been we should get as many nutrients as food as we as we can because that's the way that humans are adapted to getting nutrients there's issues with supplementation sometimes you know both like getting too much of a nutrient is can be a problem in several cases that's not the case in b12 which is great because means people could take really high doses and it won't be a

192:32problem but as I mentioned a lot of vegetarians and vegans who are supplementing are still at risk and still deficient because serum b12 is the main marker that is used in this country and not even most physicians don't test for serum b12 I know this you probably know this Joel from people come in they've never had a b12 test but then when they do get the serum b12 test it's gonna miss a large percentage of people who are already on stage do I do a methylmalonic methylmalonic yeah so methylmalonic acid and and and homocysteine are much more important markers and i great if you look at average homocysteine levels in vegans and vegetarians are significantly higher than in omnivores because of this issue because of the high prevalence of b12 deficiency and what's ironic about that is a lot of people turn to a plant-based I don't even want to say plant-based because I would consider

193:26neutral or paleo diet to be plant-based too but run to a no animal product diet to improve their cardiovascular health and yet you're seeing much higher rates your rates of homocysteine like the average in vegans is 16 which is a rate that's clearly associated with increased risk of not only cardiovascular disease but also dementia and Alzheimer's Chris I couldn't agree more I've written many articles don't be a dumb vegan and I don't mean no fan but you know what you know you you we are prone and may there's no here this is too important for people we are prone to have a few holes in the wall that an intelligent person knows how to plug it it's vitamin D it's DHA its b12 you might go on to say iodine taurine vanadium chromium I just got those that's what I do every other day I'm totally complete my patients are totally complete the industry has provided

194:17solutions to a relatively simple problem I don't want to get a mouthful I don't let me ask you questions is it fair to say that you believe that what the vegan diet is it's like you can essentially hack your way to a better healthier life by just adding a few things like b12 a few other nutrients that you're not going to get from the diet but with those together you feel like you're far healthier well because what I didn't get I substituted what I don't want I'm not taking in which is animal saturated fat animal protein I'm not taking it the main disagreement here the two of you is whether or not saturated fat Kristin I would both agree as educators all the public and specifically plant eaters should be aware of nutritional deficiencies a two-year Paleo follow-up study said the people were deficient in iodine on the Paleo diet but things have much higher but you know it's common in

195:12the midst of much higher rates of iodine deficiency than paleo P unless you eat some nori some kelp unless use iodized salt it just works argument the Paleo diet is the issue deficiency Paleo diet goes back 10 to 12 years in the literature 2009 is about the first good Paleo Sciences showed up and I honor the Paleo diet there is good reason to consider it as a food option the US News and World Report does not agree with that but to say they are they basing it on they're not scientists well they're panelists scientists the bigger question is just what you know what's gonna happen for the average person who's following these diets and I agree 100% with Joel that you know we have to educate people on whatever diet they're on I've I've said this to people that's why I'm not i've never advocated strict paleo be I mean I think that can work for some people but

196:07I've never been ideological about that because I actually think that full fat fermented dairy how is really beneficial when it's well tolerated and one of the reasons for it is iodine dairy is actually one of the best sources of iodine in the diet and it's not because the dairy products contain iodine but they're stored in tanks that we wrote afore is the cleanser that's used for the tanks which is basically pure just pure interesting and yeah and it's gross it's not it's just it's like you know the iodine you used to clean it's just it's a natural nutrient where do you get it from food though so the three top sources of iodine would be well iodized salt is the main one that's why it was added to salt in the first place but a lot of people on a healthy diet remove iodized salt in favor of sea salt which i think is a good choice overall but one of the downsides of that is that they're

196:59no longer consuming the main source of iodine then dairy products and then sea vegetables as Joel mentioned what kelp and hijiki and RMA and nori not as much which is the only sea vegetable that most Americans consume them in the form of sushi right so if you take someone on a on a vegan diet or a Paleo diet for that matter and they remove dairy seat iodized salt and they're not eating sea vegetables and yes that is a risk for iodine deficiency I have written about that but let's look at things like calcium let's look at iron let's look at zinc let's look at choline let's look at took a creatine let's look at retinol which is preformed vitamin A let's look at EPA and DHA all of these are shown to be lower in vegetarians and vegans and they are in omnivores and it just yes you can supplement but it just you know are the supplements have the same effect

197:52like look at calcium dietary calcium has inversely related to heart disease and kidney stones meaning the more dietary calcium you eat the lower risk of those conditions but when you look at Studies on calcium supplements the opposite is true calcium supplements are associated with an increase in heart disease and an increase in kidney stones so associated by epidemiology studies yes yes so but the theory is that because you went with the supplemental calcium it's not the same as dietary calcium you can get a large bolus of calcium that goes into your blood all at once and then it can get into the soft tissues which you know can make them stiffer which is Joel will tell you is not good for your heart health and so my point is that supplements don't always affect the body in the same way that's why I just think it's better to get nutrients from food if you can because that's the way we've

198:46been getting them for millions of years you know let's talk about something I think you guys can both agree on because I am baffled by this carnivore diet yes and baffled yeah I'm baffled by how many people are are clinging to it as a panacea I'm baffled by whether or not it's a physiological effect or whether there's a placebo effect going on I have a theory please yeah so my theory is that it mimics some of the benefits of fasting but allows people to persist for longer because it's providing some nutrition you know most if you look in the scientific literature fasting is like the cure-all for everything I agree with you I mean like you can look at any condition and fasting is the cure but time water fasting so you can do it for two three four the problem is try that for a year that will be the cure for life in that case the longest example is a year of water fast so most people are

199:45glad that lost he was extremely obese energy stores fat stores right same thing about that was he actually is skin shrank to right which is really a which doesn't usually happen with weight loss so this is just a theory I have nothing to ok you know I don't have any evidence but when meat is absorbed very high up in the digestive tract and so when you only eat meat it's a low residue diet and there's nothing left over to irritate or inflame the gut my theory is a lot of people who are benefiting from this have a really disrupted gut microbiome Alessio Fasano has argued that leaky gut is kind of a precondition for autoimmunity and this the carnivore diet is essentially like a gut rest or a fast and so I don't you know the out that people are benefiting from it the question is what is the long-term implication well there is no I mean there's a few people that have been

200:40doing there's some anecdotal evidence we've been doing it for a few decades well you know it's pretty cool I'm actually going on my homeboy Shawn Baker's podcasts in a few weeks where we started Shawn and I started as enemies we love each other Shawn I love your brother we're gonna have an honest discussion as much as you can to say why is Makayla Petersen feeling good and you got to love that and honor that if she had done water fasting transitioning to an ultra clean diet which she have done as well who knows but to look at Shawn Baker's labs and say pre-diabetic low testosterone high Eun I'm concerned although he just published his coronary calcium scan of 0 and I honor that he's got little kids I don't want the guy to drop dead but you know there's its way preliminary for the bandwagon that's a low testosterone thing though is he said that he had been dead lifting the day

201:28before and the day before he took his test could that have significantly decreased testosterone he said he repeated it a few times and it stayed low but if you're sure it was it's - it was like 237 I can't memorize his labs but though there's plenty of data if your serum total testosterone was less than 250 it's an adverse mortality predictor and you know he wants to be alive he doesn't need to do it Michaela Peterson and Jordan might need to do it until they find a better path mm-hmm Shawn's is you know opted it so there's you know the biggest puzzle is let the quickly quick one of the things that plant-based eaters and people that fill three-quarters of their plate with fruit and vegetables get way more than everybody else's lots of vitamin C and vitamin C builds healthy walls and builds healthy immune systems you love vitamin C I love vitamin C I

202:17love it from foods I don't mind it as a supplement I don't mind it intravenous vitamin C is bought Linus Pauling there's so many benefits of the body where are these people when every chart says that meat has no vitamin C are they eating raw meat which might have vitamin C are they eating organ meat which might have some vitamin E so let me stop you there because I'll tell you what the explanations been doing the explanation to me there's been that there is a decrease in absorption of vitamin C when you're consuming vitamin C with all these other things cruciferous vegetables carbohydrates all these different things that there's some sort of there's an adverse effect is that is that a fact well if you take a thousand milligrams of vitamin C absorb a lot of it you take ten thousand milligrams on percentage you won't absorb as much but you still get more than a thousand

203:03milligrams but there's also this theory that since they're eating basically a no added glucose diet that there's some kind of competition in us between glucose and C so even if they get a touch of C they're absorbing it hyper efficiently nobody knows they haven't developed or very close from Google Genesis internally right cuz they're adding you know certainly it's a low carb diet about a little alpha gal in there maybe that's popular I think I mean the point is we just don't know we don't run and it seems so risky I mean as a as a practitioner myself and as someone who's dealt with chronic illness who wasn't able to find help anywhere else I mean I do not begrudge people for sticking with some writing that were and they've tried everything and nothing has worked and they do this and they feel good I mean who can blame them it's really to dinner with Jordan Jordan

203:54Peterson he's eating his big giant steaks and he looks great well he knows lighter than he's been since he was I'm 100% empathetic with that because I've been through something like that myself but to then take that and say that we're certain that it's safe is a big leo as you know my field atherosclerosis takes years develop and I wish him well he's contributing amazing things the world but unless he's tracking carotid and coronary and doing a year after year you know it's an experiment you might not want to run but you run those tests some nutrient deficiencies also take many years there's another guy that I follow online I'm sorry forget the Jones name but he advocates organ meat and he's saying that organ meat if you're just eating steak that you've got an issue but if you take into account liver and heart kidneys that you're gonna get all these essential nutrients from that yes

204:48you're still not getting vitamin C that I'm aware of in a significant amount you're not getting Krotz annoyed and flavonoids how these people phenols we don't know we don't know yeah so ma'am yeah we don't know is a good summation of is it possible that there's some mechanism that's going on I mean is the picture using steak and cheese so it's apparently not an all me diet and I'm not slamming him I really wish him well and he can do what he wants I don't know very nice guy yeah important though because the organ meats and then like fattier cuts that you have glycine and other nutrients that are really important if you're only eating lean meat I think yeah I would be very concerned about that children do not try this at home someone tried to get me they were saying you should try a carnivore diet for 90 days and I said well the real problem with that be I eat

205:41game and that's extremely lame it's not smart and I like vegetables I like to eat them I mean I eat vegetables with essentially every single meal yeah that's very smart it's an antidote of something else I mean it's awesome I do think that it's entirely possible that maybe it's people that have this disrupted MUC gut microbiome but that some people might be alert like one of the things that Michaela Peterson brought up when she was in the podcast that it might very well be that she's allergic to almost everything she has some sort of an allergic reaction you I think you both think that that could be because of a up God absolutely she just hasn't had evaluated she she started to laugh when I talked to my naturopath that's what she should have kept undoing and gotten her analyzed and got in her gut healed I mean maybe that would have helped her it's you know can top them with those

206:31naturopaths it's like good psychics okay try to find one I'll tell you it's also look not all problems are solvable right that's we that's a really hard thing to accept yeah but let's say you get in a car accident and your spine is crushed you know most in short of a miracle you know that's not that person's not gonna regain their 100% of their you know musculoskeletal capabilities right but we don't have that same understanding with other conditions like health conditions let's say I go you know to Indonesia and I get ten parasites and you know like and then I have to take tons of antibiotics to deal with that is my god ever gonna return to 100% of the function that it that it had before that even with all the right things maybe not and so I'm not saying that they the people should give up hope and I'm saying that like there we have to separate between this is helping me and

207:32it's making me feel great and nothing else worked right and we know with a hundred percent certainty that this is safe for the long-term those are two very different questions and again I'm totally empathetic to that you know and I would probably do the same thing especially self that has gone through this process of being even say hey you know if I maybe I'll die five years earlier but I'll enjoy the RET you know those years of my life I won't be in pain and discomfort the entire time then sign me up or I might I might say to myself well wait it can't be that good for me to be inflamed all the time and like right you know it that can't be good for me so maybe even though the all meat diet might have some downsides it actually might be reducing inflammation and and therefore that will cancel out we just don't know what about all meat died the thing that gets me is there's

208:22no vitamin supplementation I'm like what about an army diet with good supplementation a multivitamin pretty smart idea well that fiber where's the omega-3 coming fine it's being questioned I mean it is it as central to health in the medical literature dr. Denis Burkitt from England went to Africa described fiber described it reduced all kinds of chronic diseases he wrote a book called the fiber man and all it's being questioned now it's so entrenched have we got it all wrong and only plants have fiber is a good question where they get their fiber their meat is sticking in their colon it's called putrefaction for days and days that's is it yeah well it's it that is what happens jaimé died there's a process 100% and with every single person when you chew it well and drink water does it always get stuck it's generally thought that it's fiber that is the process of moving

209:15abdominal contents whether you eat on all plans I you know I think there's there's definitely controversy about fiber but I I think the weight of the evidence still does suggest at fermentable carbohydrates fiber essentially computer is beneficial because they're very important for the microbiome and we have you know people like Justin Sonnenberg at Stanford he's done a lot of good work here do we know with hundred percent certainty no but we also know that virtually every human population that's ever been studied had significant amounts of fiber in their diet zoom so if we Masai right they consumed the Warriors consumed milk and meat and blood at certain times of year when they were you know and other times you they did eat more plant foods why the wiser plans been that even the Inuit the traditional Inuit you know they had during time certain times a year like

210:15the winter when the ground was covered with snow they had a very low intake of plant foods but they would still trade for them and then during the winter summer when when they were able to collect berries and things like that they would definitely do that so every culture that we know of that's been studied ate some combination of animal and plant foods you know what ratio what amount you know that varies from place to place depending on where they are but that's that's what the anthropological data show there's actually you know we need to talk about this - super super cool piece of data I'll go quick there's a professor University of Pittsburgh Stephen O'Keefe who took 20 african-americans in Pittsburgh eating an inner-city not healthy diet and 20 rural Africans in South Africa eating from the bush and largely plants and they switched them for 20 days and they measured every

211:05single thing they can measure in the microbiome in their stool metabolites TMAO and all the rest your body is so amazing that 20 days on a better diet what I would call the rural African diet a better diet you know there was incredible changes towards health making butyric acid having Bacteroides in Prevotella I mean the changes and the the rural Africans suffered American illness in terms of what you can measure within two weeks now there's data I just learned yesterday in Los Angeles that our microbiome changes in five days you go to a low sugar low protein plant diet this is university of southern california I can tell you in five days Michaela Peterson's microbiome would change would she feel better I don't know I'm just pointing out just the remarkable resiliency and that's part of the issue you can feed a human a whole lot of diets and make it through

211:51procreation which is our main purpose of evolutionary biology to be here we're talking about from procreation to death for optimal health longevity health span there's more than one path but let's not beat on our plant-based people out there because we've shown you can reverse atherosclerosis we've shown you can reverse prostate cancer University of California self does UCSF and we've shown you can lengthen your telomeres which may have implications for longevity so you know I've done through ketogenic diet as well doesn't that lengthen your telomeres I don't think that's been published it should be an interesting project you know it takes about three to six months so you'd have to nobody know it's not been looked at yeah and there's been say the same thing about a diet there's rich in you know vegetables and fruits and animal foods you know the benefits you can't reverse

212:46heart disease with the way you just said don't touch that you cannot reverse atherosclerosis with animal products it's never been studied the only thing so then how can you say you cannot do it what do we have studies what would you tell a patient with the 99 blockages have come to me going meat that's the acid we have studies that that showed that switching from a standard American diet to a neutral or diet this is a new word neutral or this is you coined this Sarah ballantine okay and this is the idea is just plant base with meat yeah yeah yeah it's it's whole foods diet with fruits vegetables nuts and seeds some starchy plants and animal foods why don't you call that paleo well the problem with Palio's Paleolithic people didn't really eat like that they had a lot of grains so when I don't think they're for me for me neutral or is a more inclusive term that just means what

213:46that what I said it doesn't necessarily include some dairy products they might include some grains or legumes but what they're eating whole real foods and they're including animal foods there to distinguish that from vegan or vegetarian isn't the criticism of the Paleolithic diet are calling it the Paleolithic diet that people in the Paleolithic era actually did experience at least some form of Agriculture people there's been recent data that suggests that grain consumption and legume consumption went back further than it was originally thought it was now whether those were parts of the diet or fallback foods is another question and does that even matter I mean that this is why I've argued that the evolutionary perspective is important it's just a way of generating hypotheses kind of like observational research right it's not an you can't look at what our ancestors ate

214:42and say that therefore that's what we should eat right you can look at it and say oh that's interesting let's test this out Joel how does it reverse heart disease okay ketogenic diet and telomeres there's no science studies out there just to fellow okay I mean didn't know how does it reverse heart disease you go back to Los Angeles California in 1948 dr. Lester Morrison internist it's real answer saw that in the country of Norway in World War two where they dropped our animal food consumption because of the Nazis heart disease slowed those two three years he said I wonder what happens with my heart patients in Los Angeles he had a hundred of them there was no treatment in 1948 he put half of them on a low animal diet with very high plants let half of meat Lake Los Angeles people eight years later 50% on the high plant low-fat diet were alive zero percent on the standard Los

215:32Angeles diet and then a series of people said let's start doing that more routinely ultimately there were randomized clinical studies using cath lab techniques using ultrasound techniques using PET scanning this shows it actually causes small decreases in the amount of plaque and your heart arteries which results in tripling a blood flow because it's it's fluid physiology that is for our squared so small decreases in plaque nobody ever thought you could decrease plaque with diet and lifestyle but you can't cause this big increase in flow so within 3-4 weeks chest pain goes away within 3-4 months stress does get better and as you keep going a number of hospitalizations procedures go down dramatically to the point initially small studies got big enough in 2010 Medicare said we'll pay for patients to learn how to do this reversal lifestyle they don't pay for

216:19Mediterranean diet they don't pay for - tight they don't pay for paleo keto nutreve or they pay for plant-based diets for advanced that's only because though these concepts of neutral or and paleo have not been around for very long so all you said study okay do rigorous so all that you have said which I agree with is that a plant a vegan or plant-based kind of diet compared to a standard American diet will reverse some markers of responses just like wow number one in the world I agree with that statement but we there's no we don't have research it's not like studies have been done taking people from standard American to neutral or paleo and we haven't seen benefits we have RCTs that have shown significant benefits in cardiovascular markers are neutral for diets and paleo and low-carb for that matter and ketogenic I guess your recession is that the real issues

217:22of standard American diet is killing people Oh lack of evidence is not evidence against its it's day we don't we don't how long have long had these concepts been around neutral or paleo how many studies have been done looking comparing for example let's do that it would be great if we had a study where you had standard American diet and then you had two different groups you had or a control group of standard American diet and then you had you know vegan diet and then you had neutral or paleo we don't have that study so we can't say that that eating a diet that's rich in Whole Foods but contains some animal foods isn't going to reverse author sclerosis we can't say that so I think one thing that we can absolutely agree on is that standard American diet socks and that a vegan diet is superior to the standard American diet these these two men these two things are agree if the vegan sighs

218:16I just tell you and this is very subtle but vegan diet says what you can't do you can't eat dairy you can do eggs you can eat fish candy meat whole food plant-based is really the proper medical term what do you eat is what John Joseph talks about - yeah because it's all with a whole food plant-based because yeah you know you don't want to be just eating pasta all day so the dispute is whether or not animal protein and organ meats will advance your health and and and make in that it's a superior diet when you add that one quarter of your plate yeah I'm one of the ways to answer this is to look at nutrient density so I have this study on my website it's my yo I think Milo and my French is terrible ma I ll ot and it's cress Sergio's slash Rogan and he looked at nutrient density of foods and in categorized them based on nutrient density and he was only looking at he was looking at essential

219:18nutrients so all the vitamins and minerals that we absolutely need for health he wasn't looking at polyphenols and flavonoids and things like that which are beneficial but we don't absolutely need so the the number one food in terms of nutrient density do you want to guess what organ meats organ score of 750 for next highest shellfish 6:43 and I've often said this to my patients like there's kale you could be a vegetarian or and only eat organ meats and shellfish you'd be doing really well because of just how nutrient-dense they are and that's not really a controversy me let me come to me here fatty fish 622 lean fish is 375 and then vegetables are 352 so that you know vegetables are on there but organ meat shellfish fatty fish lean fish are all higher than than vegetables and you know grains and legumes don't even really make the the you know they're nowhere close in terms of density I

220:22think we can all agree that when someone goes from the standard American diet to the vegan diet there's a real reason why they're experiencing significant health benefits particularly if they supplement yeah yeah that's right our highly processed and refined assuming they're eating a Whole Foods right vegan diet not just subsisting on baguettes and vegan cookies and stuff like that crunch unfortunately people do just like people eat the standard American diet bran you know for that matter just like people who go paleo and eat and and are getting like paleo doughnuts and paleo right ice cream whatever you know like you can do it on any dietary approach no foods gonna say you know I never have proposed except for one small subset that everybody needs to eat a completely plant-based diet but if they do they're probably going to have good health there's a concept called the spectrum dr. Dean

221:11Ornish some people beat up on but he's done all these studies on reversal of atherosclerosis and he's celebrating around the world has a book called the spectrum go as far towards it as you can I'll love you wherever you're at you choose we're not judging you and that's I think the message for your listeners I mean it what you're eating vegetables or fruit or maybe it's just vegetables every meal that's the example people need to hear and they don't need to abandon everything else just don't do it with a doughnut don't do it with a bagel don't throw these calorie empty and also the time restricted eating I think we all see on awesome 12 hours 14 hours a day I'm a big fan of four or five days a month lowering calories with low protein low sugar now the science is coming out unbelievable it's right here from Los Angeles now I mean so I want to say this we're

221:54talking about helping people and I was a vegan at one point and a vegetarian and I have friends they're vegans and vegetarians again I'm not actually logical about this and so I want to say like someone who is a vegetarian or vegan and just to show how nutrient-dense organ meats and shellfish are if you want it to be a vegan but you're not you know ideologically opposed to eating some small amount of animal product or animal food you could eat one clam one moister and four grams which is a tiny amount of liver a day and you would completely meet your needs for b12 zinc copper choline and many other nutrients with no other consumption of animal foods beyond that so this is what I said before like the spectrum is large you know some people might consume much a higher percentage of animal food some people could consume just that much and they would still

222:47improve their health and well-being by doing that from then eating a strictly plant diet and one thing that I do have to tell you Joel unfortunately is that you keep saying that Nick and Nate Diaz are vegan and they're not I know they they've gone back I don't keep saying it but they fall back well yeah we brought it up a bunch time he was when he when he won the fight he was that I worry about steam a level but it's cool I'm serious but you know the explosion the Tennessee Titans in Kyrie Irving and Serena Williams I mean Serena Williams is a vegan as well yes she reversed an autoimmune disease called Sjogren's yeah so is it is it necessary to be plant-based to be a world-class athlete obviously not is it compatible to be a you know Patrick boob ami and as he holds a world record for powerlifting he's been plant-based his whole life big stocky little guy up

223:42Patrick PEP Rik I mean is this big stocky German but he lives 1,200 pounds and he has the world record he has an ending piece of meat Nick Delgado NEMA Delgado nikto got a point is it's an option to be a super athlete without animal products we're seeing it more and more recovery roots roll on your that but you know it happens just stop beating on us because we're doing pretty well but yeah FDS has gone back to eating fish and vegetables it's a whole lot better than the crap American diet that I think they say they just cut out all the land animals yeah start doing it to make weight okay yeah I got it got it got it but a lot of people are talking about quicker recovery that there is some that mean there's some like Alex casseras he's a world-class fighter he's completely vegan Sean O'Malley was for a while but he found himself to have much more energy when he started eating meat

224:38but he might have been he might have been doing it wrong or not microbiome and supplementation yeah believe it you know but it's really cool this I figured name right now the chef that cooked for 15 Tennessee Titans and you know they're just kicking ass and Griff Whelan used to be with a mammy dolphins hi forgot where he is now Oakland Raiders you know a great great tight end and such I mean it's possible that we can say Scott Jurek set the world record for the Appalachian Trail faster neither person eating beans I mean insane a level of athletic fitness the Appalachian Trail yes 2,400 miles fastest human to ever accomplish in non beans I mean pretty cool I mean this was such a amazing thing to watch a documentary mm-hmm yeah should we wrap this up yeah I think we you know we obviously we've left a lot on the table this is still logged at that's disputed but I think one thing

225:29that we came to a really solid conclusion I was the standard American diet sucks and any deviation from it that's a whole food based diet and especially with proper nutrients that are supplemented if you're vegan or what-have-you is going to be better than standard American diet the dispute is whether or not the nutrient-dense organ meats shellfish meat fish these things would that these would benefit you significantly and I think that's we got through it very peacefully just just eat real food I actually prefer people in San Francisco to Chris I honor what he's doing I mean we may have this dispute about saturated fat cholesterol it's not unimportant but he's a prime practitioner he's treating people at the right level I believe I'm doing that in Detroit and the people that come to see me you know we're the solution we're not the problem despite the differences and you're a

226:22good man to bring this on and you know point oh that no you both handled yourself admirably I mean this is a very emotional tightly contested sort of a dispute and III thank you both very much for being here well thanks for the opportunity I mean this that have the chance to do this for what almost four hours now that's amazing and it serves people because on most TV segments it's like five minutes and you just get the headlines and there's no depth so you get these clickbait articles so thanks for giving us the chance to really dive deeply on it anybody that wants more download Chris's references go to my website the Rogen references you know read more study dr. Joel con-com big red button Rogan references you can keep yourself busy Twitter which is on my page but at we couldn't at dr j ke ahn dr. J Khan and Chris my Chris Kresser comm / Rogen for all the research yes you are es ser

227:22/ Rogen and then Chris crecer Twitter all right beautiful thank you guys thank you really a lot of fun thank you