The Checkup with Doctor Mike - “I Can End All Disease” | Confronting Dr. Steven Gundry

Episode Date: December 27, 2023

Watch the full video interview here: https://go.doctormikemedia.com/youtube/GundryVOD Dr. Steven Gundry began his career as a highly-successful cardiologist and heart surgeon. In more recent years, he has pivoted away from surgery and more into preventive medicine at his clinic in souther California. Dr. Gundry is a highly vocal advocate for a wide variety of highly controversial health claims, often centered on the gut microbiome and "lectins", which are found inside foods like tomatoes and bell peppers that he claims have disastrous effects on your health. Over the years, I've had issues with many of the things Dr. Gundry has said, so when his team reached out about having him come on the show to promote his new book "Gut Check", I was eager at the oppurtunity. That being said, I was quickly to communicate to Dr. Gundry's team that not only would this be a contentious discussion, but that I would also bring in my friend Dr. Danielle Belardo, a heart and diet expert in her own right, to join the discussion and get down to the truth about a number of Dr. Gundry's most extreme claims. To his credit, Dr. Gundry accept, and this conversation is what followed. Follow  Dr. Gundry here: Website and pre-orders for Gut Check: https://drgundry.com/ YouTube Podcast: https://www.youtube.com/@DrGundry YouTube channel: https://www.youtube.com/@GundryMDYT Facebook: https://www.facebook.com/GundryMD/ TikTok: https://www.tiktok.com/@gundrymd Follow Dr. Danielle Belardo here: IG: https://www.instagram.com/daniellebelardomd/ Linked In: https://www.linkedin.com/in/danielle-belardo-366369241/ Twitter/X: https://twitter.com/DBelardoMD 00:00 Intro 02:02 Smoking / Blue Zones 17:50 Dr. Gundry's Studies / The Data 37:07 Lyon Heart Study / Autoimmune Disease 45:40 Gut Microbiome 53:30 Are Fruits Unhealthy? 1:05:07 Specific Claims 1:27:27 My Problem With The System 1:31:43 "I Can Eliminate All Disease" Host and Executive Producer: Doctor Mike Produced by Dan Owens and Sam Bowers Art by Caroline Weigum

Don't miss Swiped, a new movie inspired by the provocative real-life story of the visionary founder of online dating platform Bumble. Played by Lily James, Swiped introduces recent college grad Whitney Wolfe as she uses grit and ingenuity to break into the male-dominated tech industry to become the youngest female self-made billionaire. An official selection of the Toronto International Film Festival, the Hulu original film Swiped, is now streaming only on Disney Plus. I have 25 million subscribers of people who listen to every word I say and correct every mistake I make. And I could tell you how your information very confidently lands with them. And it doesn't land in the way you intended to. And I just urge that in your upcoming books and the speeches that you make, just take that into consideration. Because when you make statements like apples are horrible, the worst thing you could do for your mitochondria is a fruit smoothie, it's not just taking a little bit of liberty with information.

it's truly misleading people to make bad decisions for their health. That's all I'll say. Dr. Stephen Gundry is a cardiothoracic surgeon who found success leaving the operating room and shifting his focus to prevention along with writing several bestselling books, including The Plant Paradox and his upcoming book titled Gut Check. You may have seen his content across social media highlighting his very controversial claim that certain healthy foods are actually bad for you. His most popular claim is that foods like beans, tomato,

potatoes, whole grains, and bell peppers are actually unhealthy because they contain proteins called lectins and therefore are destroying your gut. This has drawn sharp criticism from the medical and nutrition community at large. Given the great amount of evidence showing that those who eat those foods are significantly healthier, have lower risk factors, and do not require the removal of such foods. Being fully honest here, I was one of those critics. So when Dr. Gundry's team reached out for him to come on the checkup, I made sure that we stated early and openly that if he were to come on, it would likely be a critical conversation. To his credit, he welcomed the debate. I also mentioned, given that he is a cardiac specialist and I am a family medicine

doc, I would like to bring in Dr. Danielle Bellardo, who is a cardiologist heavily focused on research surrounding disease prevention. In fact, she's on the committee that puts forth new guidelines aiming to decrease the number one killer of all of us, heart disease. Dr. Gundry again agreed, so here we go, the Checkup Podcast. Well, we're talking about heart disease prevention, and it's great to have two people who are passionate about heart disease prevention, because for myself, as a primary care provider, so many of my patients come in too late already with heart disease, and then we're focusing on trying to reverse that and reverse that not just through medication

methods, but also giving them some lifestyle modifications. And that takes a lot of work. Because currently the American Standard Diet is an absolute disaster. The things my patients are consuming, high ultra-processed foods, very, very problematic. But Dr. Gundry, I like to start with you, because part of, I would say, your success on social media and with your books, the plant paradox, has been that the advice doctors, the medical system, gives to patients when it comes to diets, including what we call healthy foods are actually unhealthy. Tell us about that. Yeah, I think that's certainly my observation over the last 50-odd years that I've been doing this.

As a heart surgeon, we knew that if we put a stent in someone or did a bypass, we'd probably see them for their next procedure in five to seven years in general. And we were taught that this was inevitable, and there's not much we could do to slow down the process, statins, blood pressure medications, lifestyle modifications, exercise more. But in fact, those were really piddly little things in the scheme of things. So when I, 28 years ago, watched a gentleman from Miami, Florida, Big Ed in all my books, reverse 50% of the blockages in his coronary arteries, which were basically totally included, in six months' time with a diet

and taking a bunch of supplements willy-nilly from a health food store, I knew that he was on to something and spent the last 28 years figuring out how he did it. That's interesting to me, because in medicine, we always look at anecdotal situations as perhaps not the strongest level of evidence. So why did this one case? Because I have patients that come to me

follow all sorts of unique diets. I have patients who have been smoking for 45 years and they're living a healthy life and they say it's because I smoke. And obviously we laugh about it because we all agree that it's not true. So why did this one case move you so? Actually, let me stop you right there.

Probably it's because he smoked that he's doing so well. Okay, we need to back up. How do we get there? Well, I have a whole chapter in gut check, looking at the healthiest, longest living people. And one of the unique features of most of the blue zones is that, particularly the men, are heavy smokers. And the smoking, actually, the nicotine in cigarettes, is one of the best mitochondrial uncopplers that's ever been discovered. And we've looked at this through the wrong lens.

We said, wow, what other healthy lifestyle things are these guys doing? that's preventing smoking from harming them. In fact, we should have looked at it the other way. What is it about these people who are smokers that allows them to live to 105, 110 years old? And when you do that, then you say, okay, smoking was good for them. Why don't we see the oxidative stress

that smoking, we all know, occurs? Why don't we see the cancers in these people? And it's because the rest of their diet facilitates the absorption of the oxidative stress in these guys. So your state is that if you smoke but eat in this specific way, you can negate the effects of smoking, the negative effects of smoking. Yeah, what's fascinating as a heart surgeon, way back in the good old days, most of our patients were smokers.

And they had specific proximal lesions in their coronary arteries. The rest of their blood vessels were absolutely gorgeous. and they were skinny for the most part. How did you gauge that? Did you... What do you mean? We operate on... But you operate on what other vessels that you saw?

Like, you would do peripheral arterial disease screenings on those patients? And you would find... I used to operate on... Because one of the number one risk factors for peripheral arterial disease of smoking. Correct, because the smoking, the oxidative stress, isn't stopped by our current diet.

let me give you an example okay um we're one of the few animals that don't make vitamin c and vitamin c and i've written about this so normally unfortunately collagen breaks as blood vessels flex and contract and it breaks primarily it bends and when that collagen breaks vitamin C normally rebuilds that collagen. In smokers, they don't have vitamin C because the vitamin C

has been used up in handling the oxidative stress. So they have basically raw collagen that sits out and then we start the process of an inflammatory attack and cholesterol is basically a spackling compound and just keeps spackling that area.

The great news about smoking is that it always happens. at these bends where flexion occurs. If, like these people in the blue zones who live a very long time as smokers, if you have huge amounts of vitamin C containing foods in your diet, and incidentally, olive oil doubles our own vitamin C production,

which is kind of cool, then you mitigate those effects and you don't see the negative effects of smoking, you actually see the positive effects of nicotine. Is there research that backs up where if you change someone's diet to have high vitamin C content that there negates their risk of smoking? Because I've never seen that. Yeah, that's all been done in the blue zones.

Well, blue zones are not research studies. In fact, you've been quite critical of blue zones, even in your book. Yeah. For instance, let's take Sardinia, for example, one of the blue zones. Only of the people who live up in the mountains actually have longevity. The people live down by the water don't. What's different about those people is that they are sheep herders and goat herders. And what they eat is a large amount of fermented sheep cheese, sheep yogurt.

And what makes them have longevity is the men, 95% of the men smoke, and only 25% of the women don't. What's unique is, as we all know, women live about seven years longer than men. the men in Sardinia have seven-year-longer lifespan than the women because they're smokers. That's what brings them up. But that's an incredible conclusion to come to. Same with the Catavans. But I'm saying like there's so many variables that influence one's life.

How are you isolating the one? We have trouble isolating anything in research. Look at the Katavans. Stefan Lindberg spent his lifetime studying the Katavans in Papua New Guinea. they smoke like fiends they've never had a documented case of a stroke or coronary artery disease never had a documented case of lung cancer i'm confused how in this scenario we're using blue zones as an example for this but then in your book you point out that in okinawa you feel that the blue zone is untrue because they may be trying to collect pensions and their family members are not reporting

their deaths appropriately so how on one hand are you using blue zones as a the form of backing up what you're saying versus other times saying it's actually the whole thing. I'm talking about coronary artery disease and longevity. So these people don't have coronary artery disease despite the fact that they're smoking. So I'm saying we should actually look at this backwards and say, wait a minute, all these people are smokers. Is there a benefit to smoking to nicotine? I'm not saying, don't get me wrong.

I've never had a cigarette in my life. But we negate the fact that maybe we're missing a positive benefit. For instance, the reason I pooh-poo the blue zones is because Dan Butner would like to convince us that grains and beans are the secret of longevity of the blue zones. And since you brought up Okinawan, they don't eat grains and beans. They don't eat rice. 85% of their diet is a purple sweet potato. They don't eat soy and soy. unless it's fermented. They don't eat tofu. They eat miso and nato, which are fermented soy,

and they get the benefits of the fermentation. So give you another example in another blue zone, the Nagoya Peninsula in Costa Rica. This is like a gerrymandered district. Everybody in Costa Rica eats beans and corn. That's their staple. But in the Nagayan Peninsula, and only in that part of the country, they're sheep herders. And they eat sheep, cheese, sheep, yogurts, which actually contain large amounts of medium-chain triglycerides, which are great mitochondrial and couplers. And the Nagorian Peninsula, people say that grains and beans are the negative aspect of their diet that's compensated for by their other lifestyle.

I think I have to back up. Do you think that the Blue Zone project is a valuable thing for us to look at as a form of evidence? No. So why are you using it to describe all these things to me that? Because there are interesting factors that influence these people, but it's not the factors that a certain individual would want us to believe. Interesting. Paul Simon said, a man hears what he wants to hear and disregards the rest.

And if you're... And that's not what you're doing? No, I'm saying, what is it that makes these areas unique? And look, I'm the only nutritionist who spent most of his career living in a Blue Zone, Loma Linda, California. So I ought to have some idea. Were they a ton of beans in Loma Linda? Actually, they don't eat a ton of beans in Loma Linda.

They eat a ton of nuts. Lots of nuts. Lots of nuts. And 50% of their diet is fat, primarily from milk products. What's your take on the Blue Zone project as a whole? So I think Blue Zones are interesting. as an idea to talk about, but when we form dietary recommendations, I'm a believer in evidence-based nutrition, which is synthesizing multiple levels of evidence to be able to come

to a conclusion for what will be a healthy dietary pattern. You know, nutrition is complex because there's no placebo in nutrition studies. So we essentially can't look at one study, one anecdote, to form our recommendations for what's healthiest. You have to look at multiple levels of evidence. So we have preclinical studies, a lot of what Dr. Gundry talks about, things with mitochondria that are very interesting, but they're hypotheses, their mechanisms. We look at those in rats. We look at them in vitro. But then we have to look at, well, what happens in actual human studies? So then we look at outcome trials. So we want to look at randomized controlled trials where you're actually randomizing people to a certain

dietary intervention and then evaluating them based on a placebo control. Then we have a long-term epidemiological studies because you can't randomize someone to something for 15 years. But then we have large cohort data for nutrition EPI where we look at the effects of the intakes at certain doses of foods over time with outcomes evaluating it based on outcomes like cardiovascular disease, autoimmune disease, GI disease, things like that. And so you have to synthesize all multiple levels of evidence to be able to come to a picture and a conclusion of what the recommendations for a diet are. Last year, we published, I was fortunate to be the lead author of our latest cardiovascular

disease and nutrition guidelines for the American Society of Preventive Cardiology. And, you know, we had to evaluate and synthesize multiple levels of evidence looking at, you know, various different kinds of studies. And so, although the blue zones are really interesting, I think they tell us that, you know, you can have a wide variety of diets. Because if you look at Greece, for example, in the blue zones versus you look at Okinawa, Japan, they have different amounts of fat that they intake. They have different amounts of carbohydrate intake, and they have multiple success and longevity

across various different intake ratios of carbohydrates, fat protein. But I think that why the blue zones are interesting, yet not super scientific, is because we have to look at more controlled studies to be able to kind of really synthesize all those levels of evidence to come up with the recommendation. When you were making those guidelines, was there ever talk in between the physicians doing this as to whether or not recommend smoking along with vitamin C. So I will stand on the fact that, you know, I think that it's pretty well established in the scientific literature that smoking is incredibly harmful.

It's probably smoking cessation is probably one of the most important, if not the most important, advice we can give and help patients. Thankfully, we've lots of tools in modern medicine now to help our patients with smoking station because it's certainly not easy. But I think that we don't even have randomized control trials for smoking because the data is so robust, just evaluating how patients do eventually, whether it's peripheral arterial disease, coronary disease, or cancer outcomes, obviously with smoking. So that, I believe, in the scientific community is not really arguable at this point. And so, yes, so smoking cessation, huge recommendation for both cardiovascular

disease prevention, but also probably one of the best things people can do to prevent cancers, dementia, you know, a variety of different diseases. And have you seen evidence of vitamin C negating the risks of smoking? No, but what I do think that Dr. Gundry may be pointing to is that, you know, smoking is one variable, a very, very important variable. But of course, if someone's smoking, but they're also eating an incredibly healthful diet, living in the blue zones where, you know, you you know, they have great relationships because that's also a portion of it. People have great interpersonal relationships, great community, lower stress levels, great satisfaction with

life, exercise, they're active. Smoking doesn't help them, but maybe all of these other factors are contributive to their longevity. Whereas if you're smoking and eating, you know, a highly processed hyper-palatable foods and not exercising, it would have more of a negative impact. But we know all things considered smoking cessation makes a huge impact in health. That's fair. A lot of times there's so many biases when it comes to an individual's lifespan. If they're a vegetarian, they tend to practice more healthful habits. If someone is smoking, their odds are they're also drinking.

They're staying out late at night. So it's contributory in that way. So the takeaway here is that just because you have one bad habit, it doesn't mean that you have all bad habits as exhibited in the blue zone. right um what's your takeaway from the fact that some people in the blue zone do smoke is it to say we should be smoking we should be taking nicotine what's your takeaway from that so what i take away from it is um if you look at nicotine as a drug first first of all it's addictive as any tobacco executive knows so even i don't recommend like dave asprey does taking nicotine drops and put it under your

tongue or wearing a nicotine patch, but I do think we actually have to look at whether or not nicotinic acid is a useful longevity drug. And you don't have to go very far to look at the literature, looking at the various forms of nicotinic acid that are now available, like NNM or NR, nucleicotinide riboside, that these have clinical published studies on their effects on uncoupling mitochondria. So I give you a long, interesting story. I use niacin to treat my patients who make L.P.L.A., lipoprotein little A. It's very effective at lowering L.P. little A.

And I and others think that LP. little A is one of the most important effectors of cardiovascular disease, certainly in family history. What does niacin have to do with the... Niasin lowers L.P. L.A. No, no. How does that connect to the nicotine component? Nicotinic acid isn't niacin. Interesting. I have to jump in on this because this is a very passionate topic of mine.

I just actually moderated the major LPA session at one of our biggest cardiology conferences this year. And what's really fascinating from the experts I've learned from lipoprotein, we no longer recommend niacin for lipoprotein A. The reason being is that the three biggest randomized trials that looked at niacin with heart outcomes. So, you know, there's lots of things that can be great from a mechanistic theory. We have lots of ideas as to why in preclinical research, you think something would be a good idea. You have to test it in actual human outcome trials to see.

And when I talk about outcomes, we talk about the things that are most important, heart attack, stroke, major adverse cardiovascular events. So the three major trials that looked at lowering lipoprotein that looked at lowering any cardiovascular disease risk with niacin, all showed all three show there's absolutely no benefit in cardiovascular risk reduction with niacin. So we no longer in cardiology recommend niacinin for cardiovascular disease risk for lipoprotein because despite the fact that it lowers lipoprotein A, it actually doesn't improve outcomes. And what's interesting is that there's things that are really bad for you that actually also lower lipoprotein A, which is why lipoprotein A is complex.

So the European Society of Cardiology released the latest lipoprotein A guidelines. And the recommendations are to just lower APOB lipoproteins as much as possible through diet, lifestyle, if they need a statin therapy. And for anyone listening, that's like, what is lipoprotein A? What are you guys getting into? It's an atherogenic lipoprotein that I would agree with Dr. Gundry. It's incredibly important. It's now the recommendations are to have everyone screened for their, it's L.P.

Little A, at least once in their lifetime. But we no longer recommend niacin because of the hard outcomes in the trial shows it does not reduce cardiovascular risk. And actually, things that can really lower your LPA that are harmful. So things like thyroid disease, untreated thyroid disease can actually lower your lipoprotein A. Liver disease can actually lower your lipoprotein A. These do not reduce cardiovascular risk. A high saturated fat, high animal-based diet can actually artificially lower your lipoprotein A. And we know that raises your APOB and can also increase cardiovascular risk. So that's why it's so important that as we're looking at different biomarkers,

and evaluating cardiovascular risk that we keep in mind the actual heart outcome trials. And we actually keep in mind what actually matters to our patients, which is heart attack, stroke, and all cause mortality. And so now with lipoprotein A in the pipeline are specific drugs that are not out yet, but that are going to be lipoprotein A targeted specifically, SNPs and various different other modalities. But at this time, all of our cardiac evidence shows niacin doesn't improve it. So even though you can lower the number, it doesn't necessarily improve outcomes. So that's actually a perfect example. I think you illustrated, at least in, you know, in cardiovascular disease prevention, why something may, in theory and in mechanism be really

interesting and useful and we may, and it's worth testing, right? So when you do preclinical research in a rat or in a in vitro model, you know, you may find a really interesting theory and a really interesting mechanism that's worth exploring. That's, That's when you translate it to human studies. And you see, does this improve outcomes in humans? And we found it hasn't. During the Volvo Fall Experience event, discover exceptional offers and thoughtful design

that leaves plenty of room for autumn adventures. And see for yourself how Volvo's legendary safety brings peace of mind to every crisp morning commute. This September, Lisa 2026 X-E-90 plug-in hybrid from $599 biweekly at 3.99% during the Volvo fall experience event. Condition supply, visit your local Volvo retailer or go to explorevolvo.com. Well, that's because you didn't compensate for what was going to happen with niacin in raising

homocysteine and also in raising LPPLA2 levels. And if you treat the LPPLA2 increase and the homocysteine with supplements, which I published at the American Heart Association, then you negate those effects of niacin. Well, I looked up your publications, Dr. Gundry. I couldn't find anything published at AHA. I saw that you had one abstract that was presented at the conference, but it was never a published paper peer review. Well, abstracts are peer reviewed since I've been on the committee.

It wasn't a study, but it's just that I have to be honest. It's just that that's a little misleading. I mean, it goes against our cardiology guidelines. Our cardiology guidelines don't recommend niacin for lipoprotein. I realize that. But the guidelines, for instance, you I'm sure understand that statins increase LP little A levels. Yes.

Statins increase LP.A in a very clinically insignificant way. And the reason why our guidelines recommend that for people with elevated lipoprotein A, that they should be on statins if they have an elevated APOB is because the target of therapy now for lipoprotein A is to keep APOB as low as possible. Right, but the target of therapy of getting apoB as long as possible is oxidized phospholipid EPOB measurements, and that is the only measurement that correlates with LPLA levels. That's a, well, that's a really good theory about oxidize. It's not a theory, it's published by multiple researchers.

It's a theory because we don't have actual assays that can really disertain that. We know the research for lowering APOB and we know for cardiovascular mortality is incredibly sound. There's no cardiovascular organization across the board, whether it's E-S-C, AHA, A-C, A-C, A-C, that even recommend checking oxidized levels of anything because we know that lowering APO-B is the gold standard for reducing cardiovascular risk for patients with elevated labor opportunity. So why wouldn't you want to measure oxidized fossil dividend APB? Because we don't have, because, I mean, you could, but truthfully, it doesn't change. It doesn't alter management because management is going to be the lower, because it's going to, the management is going to be the lower, it will be as low as possible.

Well, Dr. Gondra, I think what's interesting for me here is a primary care doctor who follows guidelines like these is how do you decide? Because some of the things you're proposing have really strong mechanism background, right? You can explain how it works. You can explain the theory of how you can get from point A to point B. But in so many times in medicine, when we start with mechanisms, once we bring it to human data, we find the complete opposite. I mean, like the simple example that my viewers probably think about is like Viagra. Initially, we started to treat pulmonary hypertension, and then now we found out it's a great erectile medication. So it started mechanistically to treat one thing, and then it ends up going in a different direction. So we still use Viagra

to treat pH, but we call it just still down a film. Yeah, it's the chocolate chip cookie mistake where we thought the chocolate chips would melt and they did it. And then we've also seen the same with beta blockers and cardiomyopathy. Initially, we thought that it would be something that would be problematic. And now we see that it actually reduces mortality. So how do you make the decision of when to go from a mechanistic model where you say, look, this oxidative measurement works? I can explain to you why it works. But then if we're lacking the actual endpoints of people having less strokes by following your model, how do we prove that what you're saying is actually true? Well, again, that's going to take a very long time, but I see patients six days a week.

I even see them on Saturdays and Sundays, and I don't need to at this point in my career. I draw blood on them every three months in multiple labs looking at, among other things, oxidize phospholipid ampopee as a marker of therapy. And a lot of my patients see other physicians as well, family practice, other cardiologists. and we watch a manipulation and say, let's say somebody decides to increase a statin drug to drive down APOB. That's one idea.

But when I see then the oxidized phospholipid APOB go up even as the APOB goes down and then I intervene. Can I ask you a question on that? Because that's so important where you just pointed out. If their APOB goes down, but their oxidized level goes down, up and they have less heart attacks. Do you care? They don't have less heart attacks.

But we do. We have the hard end data to show it. We have tons of data that they have less heart. For instance, you brought up beta blockers. The most recent recommendations are we should not be using beta blockers as a treatment for coronary artery. No, for hypertension. Yeah. So, so, so. As first line for hypertension. Yeah. And so for and exactly. And for coronary artery disease, we no longer put people standardly on beta blockers if they haven't had an M.I. within, you know, in that time period. And yet that was standard of care. Right, right.

But the reason it changed was because human models showed it to be that way. That's exactly right. But the human models initially made beta blocker therapy after an MI or after a standard or after a coronary bypass, standard of care. And then it changed why? I couldn't send anyone out of the hospital and get dinged from Medicare if I didn't put them on a beta blocker, right? But similarly, human trials are why, you know, initially we didn't recommend beta blockers in heart failure, right? It was believed to be, the mechanisms were believed to be, this is going

to be so dangerous for heart failure, et cetera. And now it's the standard of guideline directive medical therapy for systolic heart failure with the quadruple therapy for GDMT. And so it's so important. This is why, you know, the multiple levels of evidence, why preclinical data is important to generate ideas, but then testing it in human outcomes. And so I'm not saying that people shouldn't be researching oxidized lipoprotein. So I am a huge fan of lipids. I very much am a very lipid-focused physician and lipid science. And Thomas Dayspring, who's like a world-renowned lipidologist, is one of my mentors. And I have huge respect for the research going on in that space. But the thing is, is that we already know with regards to, you know, across the cardiovascular disease

field and across every major medical organization worldwide, that reducing apobel lowers your risk of cardiovascular disease. And so although these other biomarkers are interesting, you know, we don't have the correlation, the hard outcome data that we have with lowering APOB. Also, the assays vary depending on which labs you're looking at, which we can really get into the weeds of it. But there's plenty of people who believe that the assays that are even evaluating those markers aren't even correct. So there's not even a lot of validity and a lot of the advanced lipid testing, you know, that that is exciting to talk about. about in theory, but for clinical utility, you know, I believe with evidence-based medicine,

we have to use the best available of evidence to date. And that includes looking at a variety level of evidence, especially most importantly, randomized controlled trials with hard outcomes to give our patients the option to do things that are best for them that we have the best outcome data for. To summarize your positions for people watching, it seems like the reason you make the decision to treat in the way that you're treating your patients is you're seeing good outcomes in your patients. You are finding this mechanistic approach that makes very logical sense, and you could follow it along a pathway. And you could track it. And you could track you with your patients. And Dr. Bellardo is using sort of heart endpoints of heart disease stroke

for lowering APOB. My question is, I have plenty of doctors that I have ended up having to treat patients after they've fallen out of their care that have made, you know, wild recommendations that you would firmly disagree with, that say you should only eat beef or some very hard, hard carnivore stance type diet. And they claim the same improvements with their patients. So how do I distinguish as a family medicine doctor between your recommendations that are lacking this hard endpoint data versus the carnivore diets? So I can have a patient on a carnivore diet. And I have a number of patients who choose to do a carnivore diet. I'll have patients that will do an elimination diet to treat their leaky gut. And at the end of the day, three months,

six months, we begin to see their inflammatory markers go up. We see their PLA2 markers go up. We see their HSCRP markers go up. We see their IL-6 go up. And so, TNF alpha go up. And so, and TNF alpha go up. And so we'll say, hey, guys, you know, look, you may feel really good and here's, here's what's happening, you know, underneath the surface. It's like, you know, the girl in jaws swimming at the top of the ocean doesn't realize a great white's underneath her. When they see that, they go, ooh, okay, you got my attention now. They don't feel it yet. In fact, a lot of them feel really good. So there's also, you know, there's this entire group of a sect of dietary tribes. There's a whole food plant based no oil group, right? And I personally, I happen to be vegan. I believe that you don't have to be vegan. I, you only should be vegan for ethical reasons. She's actually been canceled by vegans. Yes, because I, the whole food plant based, no oil individuals, vegans don't necessarily like my viewpoint because I believe olive oil is incredibly healthy. Why? Because of a lot of

our hard outcome evidence. Yeah. Anyway, but the, the low-fat, whole-food plant-based vegans, actually, who believe olive oil is toxic, they have the exact same claims as you, identical. They reverse autoimmune disease. They claim to reverse heart disease, which I've gone up against quite a lot of them in debates. They claim to reverse every sort of disease inflammation.

They lower high-rest CRP on these incredibly high lectin. know olive oil diets, and they claim that olive oil is incredibly toxic, and they can cite a thousand endothelial studies that will tell you olive oil is toxic. And my argument against that is that when you look at the multiple levels of evidence and you look at the randomized controlled trials, we know that olive oil is not harmful. It's actually beneficial and it's healthful. But I think that one of the points Mike and I discussed as well is that for, you know, when you are a consumer of this information and our patients who are listening, well, do I follow these low-fat plant-based people? Or do I follow, you know, because they have just as many

anecdotes as you have? And so how do we sort out and differentiate the evidence? And this is where my belief is the evidence is looking at evidence-based medicine, looking at the hierarchy of evidence, looking at meta-analysis, and then looking at systematic reviews, and then looking at randomized control trials, and then being able to synthesize that into our dietary recommendations, which are eating a diet filled with fruits, vegetables, whole grains, legumes, lean protein, fatty fish, olive oils, great, you know, higher in poly and saturate fat. Because otherwise, if we're just going anecdote to anecdote, then we really have a lot of different dietary tribes making the exact same claims. And everyone has really believable stories, and it's really, I totally

understand, and it's moving. I've seen patients improve, even though I'm vegan, I've seen patients improve drastically on a carnivore diet, you know, because in many ways, it's a elimination diet. Of course, carnivore diet I highly recommend against because it can raise your risk for colorectal cancer and heart disease and raises APOB and they're missing out on lots of vitamins, minerals, and important things. But that being said, you know, we can see the carnivore group has tons of anecdotes where they can reverse X, Y, or Z disease. And so I think that's where it's tricky for the general consumer of the dietary information is how do they sort out whose anecdotes are best, and which is why anecdotes are the lowest form of evidence, and we have

to kind of go by looking at all the levels, from long-ranging epidemiology to randomize control trials and free living studies that are over two years, like the Leonhardt study, or like studies that are looking at two weeks, metabolic board, highly controlled by my friend Kevin Hall at the NIH. So we have multiple levels of evidence to synthesize that come to our guidelines. Otherwise, it can be confusing for the consumer. Do you agree with that that we need multiple layers of evidence and not anecdotal mechanism only? Oh, absolutely. So what's your takeaway about the evidence that Dr. Bellardo uses for her guidelines? Do you think the evidence is wrong? Do you think it's incorrect? Do you think it's incomplete? I think it's incomplete. Let's put it that way.

How so? For instance, and I've talked about this in the plant paradox, the potential reason why a low-fat diet is effective in those believers is that you no longer have a mechanism for lipopolysaccharides to ride on chylomicrons through the wall of the gut and create inflammation. And I love the lipopolysaccharide theory of inflammation. And if you do not have fat carrying fat across the wall of the gut, unless you have leaky gut from other causes, lectins, then you're not going to have LPSs getting into circulation. But those low-fat plant-based, no-oil group, which I don't endorse, I love olive oil. Nor do I.

But, right, of course, that's what I'm saying, because I know you're a huge, we agree on olive oil. We think olive oil is great. And so what I'm saying is that they believe, you know, they're on high, high, high, lectin diets with the exact same results as you. So I think what we're saying is that how do you differentiate that, which is why I think the levels. Well, and I treat a lot of orniquette. failures, Esselton failures, who have progressive coronary artery disease on those programs.

And I'm sure they have gendry failures that they see. Exactly. So how do I then decide what I should do? What should I teach my residents to do? So, for instance, I don't have, I think the best controlled trial of a low-fat diet versus a high-fat diet was the Leonhard diet. I think it was very well-designed. It's my favorite study.

I'm glad you said that. Because the Leonhardt study has a statistically significant increase in, so the Leonhardtite for your listeners who aren't familiar. One of the best randomized controlled trials, we cite it in all of our guidelines, where they looked at people, they randomized them to, they were on a baseline diet, and then they randomized them to a diet that increased legumes, statistically significant increase, drastic increase in legumes, increase in whole grains, a decrease in saturated fat, increase in polyunsaturate bed. So pretty much everything we recommend in our latest cardiology recommendations and our nutrition

statement for the ASPC is in the Leonhardt study. So you increase beans, you increase whole grains. And what do they find in Leonhardt study? Within a year of the study, and I believe it was a four-year answer. It was five-year study. They stopped it at three years. Because they had 50 to 70 percent reduction in cardiovascular disease risk. And so that was actually one of the questions. Yeah, everything. in events, in heart outcomes of events, heart attack, stroke, major. And so I was going to ask you, with them, you know, quadrupling their lectin intake,

what is your counter to how some study like that? Oh, that's easy. It turns out the only, what she's not mentioning is that the study group, they were compared to a low-fat American Heart Association, low-fat diet. It wasn't a low-fat diet, the original moment. But it was the...

So they actually just replaced, they replaced the saturated fat with poly. Yeah, but it wasn't low-fat. We replaced it with basically rapeseed oil, which is, quote, canola oil. It's incredibly high in alpha-linolinic acid, which is a short-chain omega-3 fat. What's fascinating is when the researchers broke down every possible change what the factor was that made the difference, the only one, was the blood level of alpha-linolinic acid predicted the outcome. And I write a lot about that.

In my previous books, I go back into it and gut check. It's the alpha linoinic acid that is actually making the difference. So I would highly disagree. Oh, it's published data. Go ahead, look it up. Because they also, it's similar. There was multiple variables that were impacted. But that's the only one that impacted it.

No, because how can you decide that? Because that was the only difference between the two groups. Is that true? No, because they also had, they had the Leonhardt. The Leonhardt group, the intervention group also had higher antioxidant intake because they had higher fruits and vegetables. That's true, but those were all compensated for in the final analysis, and it was only, it surprised me. It was only alpha-linolinic acid. So I had a feeling you were going to say that the polyunsaturated fat intake, which I'm a huge fan, biggest fan of polyunsaturated fat.

I mean, I love that. I love canola, a big fan of canola as well. Organic canola. But there were a multitude of factors that improved the outcomes. And so your theory is then that the polyunsaturated fat intake makes up for the lectins. Yeah, absolutely. Because polyunsaturated fats, alpha linoleinic acid actually prevents lowers LPS levels. Okay, so let's work off that theory because I think that's very valuable.

There's a whole list of your, in your books, of foods that you say don't eat. eat, high in lectins. Some of them are common foods that doctors even label as healthy. Why not instead of saying stop eating these foods that are rich in antioxidants, vitamins, minerals, et cetera, and instead tell them to consume these fatty acids that are healthy? Well, I do tell them that. But what I do, most of my patients who I see, about 80% of my patients now are autoimmune patients who are not getting any better despite. Why do you think that is? Well, because for whatever reason, my program, if you follow it, your autoimmune disease, 90% of the time, will be gone.

We'll be in remission in nine months to a year. So you. So people end up in my office. Specifically for autoimmune. What about people who are looking to lose weight? People who have cardiac disease. Are those people in your practice as well? Oh, absolutely.

But why is it so skewed towards the autoimmune? Because, well, we have... Because I treat a diverse population, and I can't get to an 80%... We have an epidemic of autoimmune disease in this country, and I, among others, think that all diseases, coronary artery disease, is in fact an autoimmune disease. And so if you fix the underlying problem of autoimmune disease, which I and others happen to think is intestinal permeability, leaky gut,

then that autoimmune disease resolves. That's very powerful that you say that because when you say it's the leaky gut that causes the autoimmune disease and you say, I think this, I as a skeptic, because I try not be a cynic, I want to be a healthy skeptic, hear that you think this and I think it's wonderful and I think we need to research it more. Well, Lesio Fazzano from Harvard not only thinks, this, but has it done a pretty good job proving this, that all disease comes from a leaky gut. But that's not true.

But property said that 2,500 years ago. Yeah, but 2,500 years ago, we would balance the humors and make people vomit and bleed them out. There's a lot of things we did in the past. It doesn't mean we should look at that as a guide. So the question is, how do we go from individuals saying this as theory versus to modern practice? Because we can measure these things. But measurement doesn't yield outcomes in every scenario. Sure, it does.

It doesn't because I have patients who have abnormal thyroid levels and yet feel perfectly fine, and the second that I try and change them with medication, they develop symptoms. Did I help or hurt this patient? Why would I try to change somebody who's feeling fine? Because their levels are off. As you said, levels are more important. No, no, no. I'm talking about we can measure the degree of intestinal permeability with good blood tests.

And we can watch intestinal permeability change. and we can watch it heal. You do that with your patients? Exactly. How do you measure intestinal permeability with your patients? So we use vibrant wellness. We use anti-Zonulin IgG, anti-Actin IgG, and anti-LPS IGG. Are these the food sensitivity tests that measure IGG?

Food sensitivity does, but this looks at intestinal permeability. And this is actually what Alessio Fizano worked out as the way to measure intestinal permeability. I didn't devise the test. Yeah, I'm just confused because when I work with gastroenterologists, gastroenterologists teach me, I go to some of their meetings, this is not, the only time the concept of leaky gut, and it's not leaky gut syndrome, comes up, is in autoimmune diseases like celiac disease where there's actual damage, blunting of villi, immune complex damage.

How do we get from there? That's the tip of the iceberg. Right. So the tip of the iceberg has data behind it, data that we can act upon. Yeah, there's good data behind leaky gut and reversing leaky gut. For instance, I mean, what shocked me when I started looking at this is every one of my patients with coronary artery disease had leaky gut when they walked through the door. Every one of my patients with an autoimmune disease, let's take Hashimoto's, had leaky gut. Every one of my patients with rheumatoid arthritis, and these are blood markers that we can measure, had leaky gut. So when we put them on a program and re-measure their leaky gut every three months,

we can watch it go away and it will resolve. And what's interesting is that the markers will resolve. They will go away. But that's not the interesting part. The interesting part would be to treat their leaky gut. That's what we do. So, for example, in gut check, you know, I'm really excited about the microbiome, right? There holds a lot of untapped potential that we still have a lot of work to do to figure out.

And then I've seen on a certain podcast, there's statements that you've mentioned about, you know, if you take the microbiome of a depressed mouse and you implant that into a happy mouse, the mouse gets depressed. Or you mentioned a study where, I couldn't quite find the study, where there was an individual. back in the day when people were institutionalized for their depression, they would give them a colonic and then give them a fecal enema and 66% of them would improve. That was a statement that I've seen you made. Like, what do I do with that information? Because put yourself in my shoes for a second.

I have a patient that comes into my office who's depressed. They heard you say that. They wonder why I'm not giving them the fecal enema. I wouldn't give them a fecal enema. Why not? You just said you have ever. evidence of 66% cure rate. That's the last thing I would give them.

But how if you said a study did this? Back in the 1930s. For one thing, believe it or not, when I went to medical school back in the dark ages, we were actually the first people at the Medical College of Georgia to use fecal animals from medical students to treat C. difficil. We didn't even know it was C. diff back then. It was pseudo-memoridus enterocolitis. And my professor, Arlene Mansberger, said, you know, and this is a lot of

was when broad spectrum of antibiotics first came out in the mid-70s. He says, you know, I think there's something going on in the gut, and we've got to reconstitute the gut. So once a week, medical students took a crap in what we called the honey bucket, went into Arlene Mansberger's lab, put it in a wearing blender, homogenize it, and shoved it up the rear ends of people with pseudomomomorous anaclytis, and it cured it, cured it. And we went, son of a gun, this is nuts. And we do that now.

We do that now. Not to that degree, but obviously we do use fecal transplants. But we don't need to do that. We can reconstitute the microbiome. For one thing, we've killed off our microbiome because of all the antibiotics we take. Well, that's why we put it in. All the antibiotics we give are animals. and the best most potent antibiotic there is is glyphosate roundup it was patented as an antibiotic by montanto

and so if you wanted to do a number on your microbiome we've created the perfect storm for killing off our microbiome and what's really interesting is glyphosate in particular kills off the triptophan pathway making bugs that makes serotonin so if you wanted to make someone and depressed, you would kill off that triptophan pathway of the microbiome. So what you do is you eat organically and you stop taking antibiotics unless there's a life-threatening problem. And the good news is if you stop eating animals, you'll lose those antibiotics. The bad news is that most of our grains are contaminated with glyphosate. Stellist lenses do more than just correct your child's vision.

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happens here. Conditions apply. Visit rbc.com slash avion. My question, I don't think we got the answer here yet because I think it's important. When we found that fecal transplants work specifically in the case of C. diff, but not in the case of depression, right? I'm not advocating that. Correct. In fact, I don't know if maybe over in Europe it's being used for that, but certainly not in the United States because the FDA would not allow it. Yeah, I just don't know what's the use of them stating that study. because there's chapter after chapter and gut check

showing the correlation between a diverse microbiome and lack of depression and lack of anxiety. And we're getting closer and closer to understanding which bugs do what. But we're not there yet. We're getting close. I just want to put that on the record. We're not there yet.

We know a diversity is good. But we don't know which ones, don't know exactly which ones. There's still room to be explored here. Yeah. I mean, for instance, there are now bugs that make oxytocin, the love hormone. And you can actually swallow some of these and make more oxytocin. That may be a good thing. Maybe. So I would like to counter that with the fact that. So I think the gut microbiome is fascinating. And I think we're at the, you know, beginning of, I think if you talk to the world's renowned gut microbiome researchers,

they will humbly tell you that we are at the very, very beginning of the, of elucidating the answers to the questions of how important. I don't think anyone doubts that the gut microbiome is an important facet of health, but we don't really have those answers yet. And I think that that can be the most, you know, world-renowned gut microbiome researchers will tell you that, You know, we're not even sure the exact population of and what percentage of what colonies of which bacteria are more beneficial. So we can't even prescribe right now exactly what is most beneficial for the gut microbiome at this time because we don't even know that's why probiotics, that's why the American College of Gastroenterology, which you'll know this because as a family provider, I'm sure

you are asked all the time about probiotics. And this is why the ACG does not recommend probiotic use for people. generally outside of very few clinical conditions that require it, because we don't even know what strains at what doses in which scenario are going to be beneficial. And we know that with lots of the probiotic research, that it doesn't have benefits and it can have harms and risks, which is why the ACG looks at it that way. And so I think that we're at the infancy of gut microbiome research. And I do agree that it's important, but we don't have enough of that hard outcome data yet to give us, you should be, you know, eating this exact kind of food to improve your

gut microbiome. I think that in general, you know, most of the things with a healthy dietary eating a diverse, you know, plant predominant diet, of course, we believe can help gut health in general with eating fiber and short chain fatty acids and all of the things that happen in the gut microbiome. But I do think we're at the infancy of that research and not knowing it's not quite as prescriptive yet, which is why the probiotic trials have failed and why we don't, we recommend probiotics only in very certain small clinical scenarios because we don't fully understand. And there's tons of research to be done in that space. And I also just wanted to counter on glyphosate quickly. Organic, when we look at organic versus non-organic, and I have

no dog in this fight personally, because sometimes I buy organic. If it's convenient for me, sometimes I buy conventional. But I do think it's really important to make this clear to your audience that when we're looking at research with heart outcomes, meaning you're looking at cancer risk, you're looking at heart disease risk. The reason why no guidelines that make recommendations for diet, including the American Cancer Society, that recommend eating organic is because all of the research with heart outcomes, there's two main studies that looked at it, Bradbury, and I forget the other one, they show no difference with organic versus conventional produce. So although the mechanisms and the ideas of glyphosate may be interesting, it hasn't borne out to

being any difference in outcomes with regards to cancer risk, cardiovascular disease risk, or other heart outcomes that have been evaluated in the cohorts. All that is interesting. Here's my takeaway for me as a primary care doctor. The reason why America is sick, the world is sick, we have an obesity epidemic, we have people consuming ultra-processed foods at rates unheard of. My patients overeat ultra-processed foods. They eat tons of unnecessary added sugars. And as a result, they're very sick. Cardiovascular disease, strokes, diabetes, etc. None of my patients are overeating fruits.

And yet within your book and your podcast, you make fruits almost an enemy. They're not an enemy. They should be our food. friend when they would have been available. No Great Ape eats fruit all year round. They eat in season, and Great Apes actually only gain weight during fruit season. And we don't, we'll take a trip to the Central Park Zoo. But why do we need to go to the Central Park Zoo? None of my patients overeat fruits. Why are we talking about that? There's no juices in the Central Park Zoo. But do you feel like generally across the United States, fruit consumption is an issue? No, fruit products are an issue, totally different.

What's a food product? Like apple juice, like orange juice. Yeah, we're not recommending juice. We agree with that. We're not talking about. But that's not what we're talking about. You're saying an apple is not ideal to eat. You said grapes are sugar bombs that are problematic.

They are sugar moms. There's as much sugar in a cup of grapes as in a Hershey's candy. Yeah, but that requires new ones because I would never tell a child to eat. Hershey bar over a grape. That will never happen in my practice. No, but you might allow the mother to give them apple juices their drink. We're not talking about apple juice. We're saying grapes.

It just, it's a child hears, a mother hears, grapes or a sugar bomb, might as well give them Hershey's. They will give them Hershey's. Might as well. And your example. But why might as well? Don't you think grapes have more nutrients than Hershey's? Well, believe it or not, extra dark chocolate has some of the highest polyphenol

content. But we're talking about milk chocolate. Yeah, I wouldn't give anyone milk chocolate. Exactly. So why even bring the comparison? You have great animated examples, Dr. Gundry. They're quite, I appreciate you. There's textbooks written about Great Apes and Fruit.

But I will say, I believe you. But what's interesting is that because in this modern day and age, we don't actually need to look. The guidelines, how much did you guys take into consideration Great Ape? We zero consider Great Apes because the good news is that we have multiple levels of evidence that look at fruit. intake in humans, like in actual human species. So we don't need to look at great apes to help us indicate how much fruit is healthy. And if you look at the epidemiological data over time, I mean, it is without question that individuals who are in the higher turtiles of fruit consumption are always, always, always associated with lower risks of cardiovascular

disease, autoimmune disease, cancers in human beings. So, you know, although the great ape theory is great, but there's, we're not apes, you know. So you think fructose is good for us. I think that's what I'm here. Well, I'm saying that I don't recommend apple juice. And I actually think that all major medical organizations do not, actually in, in cardiology guidelines, we do not recommend sugar, sweeten beverages. And apple juice is not beneficial.

Neither is orange juice. But fruit in its whole form. Shoot, thank goodness. Yeah. Fruit in its whole form, you know, comes with a lot of other things besides just glucose, fructose. It comes with, you know, nutrients, polyphenols, vitamins, minerals, fiber, things that are really healthy for us. And so, you know, the comparison of fruit to, you know, a candy bar is just a little disingenuous. And I do think that the ape example, while it's interesting, we have so much human data we can look at that shows us how beneficial and healthful fruit can be.

And I'm not saying everyone needs to eat a ton of fruit. I'm not here recommending a frutarian diet by any means. But, you know, we do know that, like, as Mike mentioned, that, you know, the vast majority of our patients who are having difficulty with diet, it's not from a banana overdose. It's not from eating too many grapes. You know, I think that we can all agree, at least all three of us, I think, can be on the same page here that the major problems with diet in our current time, a lot of it has to do with these hyper-palatable processed foods that are super convenient and, you know, ubiquitous in society. Yeah, Dr. Gondra, I think what we're pointing out is we're on the same page with being anti-processed foods. We're pro-olove oil, pro-Mediterranean diet. We're all on the same page here.

The issue is that folks are overeating these over-processed foods. They're not consuming enough fruits and vegetables. The Leonhardt study showed that if you increase legumes and whole grains, and your major stance in your books is remove whole grains, limit legumes, fruits are your enemy. How? So, whoa, I eat beans multiple times per week as long as their pressure cook. I think ancient societies always fermented their legumes. When you put beans in a pot, you soak them for 24 hours. You ever notice the scum coming to the top?

But who's advocating to eat raw beans here? Nobody, but regular cooked beans, you have not destroyed the lectins. That's well proven. fermentation will destroy them. And yet when these people in the own heart study ate those non-fermented beans, they're great. They were fermented. You're not hearing me.

No, you know, if you cook beans appropriately, like even in a pot, you can remove like 95 plus percent of the lectins. And I agree, none of us are advocating for raw beans. But cooked beans, and also, by the way, canned beans, huge fan for anyone listening that wants something convenient. Canned beans, as long as there's no sodium, wash them, they're already pre-cooked. Elections are minimized. And only two companies that pressure cook their canned beans, Eden Brand and Jovial.

Now, I'm not a consultant to either of them. So it's so easy. The problem in our society is people aren't eating whole foods. And here we are making a list of whole foods they should avoid. I'm not telling them to avoid them. Whole grains, if you have millet and sorghum, which do not have a haul, they're perfectly safe. But you can even eat these in excess. And let's get back to fruit.

Everything in excess. You have enough parrots, you turn orange. Let's get back to a fruit for a second. I can watch my patients, you know, go to Costco and load up on the grapes or the blueberries, and I can watch their triglycerides go up. And you might agree with me that the triglyceride HDL ratio might be very useful. Actually, so in cardiology, we no longer focus on triglyceride to HDL ratio, because now we know that the most important prognostic factors, APOB.

The cheat-cheat-way for that is looking at your non-HDL cholesterol. Triglisteride is incredibly important, but triglycerides are only a temporary measure. Do you three days. Exactly. And so we actually don't look at your triglyceride HDL ratio anymore as a... Well, as triglycerides go up. In general, your apobeal-wok-a-wobar. Well, yes, for sure, but the H-TL ratio, not a super huge part.

But fruit, actually, you will know this, Dr. Gundry. All the research shows us that people eat higher amounts of fruit actually have a significantly lower APOB in all randomized control trials across the board due to dietary fiber and low saturated fat content. So actually eating tons of fruit, especially not in the form for juice, fruit in terms of whole fruits, can actually reduce APOB significantly and cardiovascular risk subsequently. All of this is valuable. But why are we arguing about fruit when it's not the enemy? The enemy is people thinking that fruit, we should not have 360. days of endless summer.

But who's over-eating fruit? Americans are overeating ultra-processed foods. Americans are reading burgers, hot dogs. Totally agree with that. I can't get my patients to eat fruit. What research shows us that people shouldn't be eating fruit? When I just mentioned that every, like if you look at N. Haines data, if you look at the nurse cell city.

I'm not saying don't eat fruit. I'm saying eat fruit in season. Yeah, that's what she's saying. I'm trying to ask you, there's no research. available year-round normally. There's no research that shows us that fruit has to be eaten in season for it to be healthful. All of the research shows us that in a dose-dependent manner, people who eat more fruit in the highest hurtiles of consumption of fruit, people who eat a varied diet of fruits and vegetables and whole grains and all these things have every marker of lower

disease risk, whether it's cardiovascular disease risk, obesity, weight control, diabetes. And so my question to you is besides the seasonality you're discussing with regards to apes, or not. When we have all this human outcome data showing us that there is no seasonality to fruit consumption, it's just eating a varied plant predominant diet that's most helpful. How do you make that leap from animals to when we have all this human data showing the opposite of what you're saying? So in the Mediterranean, people do eat fruit seasonally? People eat for year-round in the Mediterranean as well. Do you not respect the research that Dr. Bellardo is pointing out saying that people who eat fruits in the highest amounts have lower

risk factors and better outcomes. Because they're following people primarily in the Mediterranean, and they do. But that's not true. No, no, no, the N. Haynes, I'm talking about the major cohort that is in the United States. That's the nurse's health study. We're talking about the physicians study, like all of these cohorts are in the United States. And even in the Mediterranean, I mean, we live in a modern society now where fruit is accessible, most people in modern society year round, and a lot of people are not eating seasonally.

So, you know, the seasonal idea, I think, you know, based on the animal studies and things, although an interesting thought, it doesn't bear out in human outcome data, which shows us that you can eat fruit healthfully year-round, not only without there being no adverse events in any, at least, cardiovascular disease, or all-cause mortality or cancer research, you know, but there's a multitude of benefits of a higher amount of fruit consumption. And I'm not telling anyone to eat all fruit all day, every day, but there is no reason for it to be limited seasonality. And the reason why also, I think, is really important, too, is there's a reason why the American Cancer Society guidelines,

the American College of Cardiology guidelines are, ASPC guidelines are all for nutrition that are very similar, as well as the Endocrine Society guidelines. All of the guidelines to prevent cancer, to prevent diabetes, to prevent cardiovascular disease, all of the recommendations for nutrition are similar because the science is similar. So eating a diet with varied fruits, vegetables,

whole grains, legumes, lean proteins, fish, things like that have proven to reduce the risk of the variety of diseases, which is why we have so much synergy across the various specialties. As a spectator of listening to two experts speak, Dr. Gundry, your reason for not recommending fruit year round, you reference apes. She references longitudinal studies here in the United States. How can I possibly side with you? Come to my clinic and watch what happens when somebody... But a lot of people can do that.

I have nothing against fruit. Maybe you don't hear me. I need to read some of your statements. Fruit in season is great. Fruit contains polyphenols. They're one of the best ways to get polyphenols in the diet. In fact, what I recommend is reverse juicing. Go buy all your organic fruit, put it in a juicer, throw the juice away, take the pulp,

and put it in plain coconut yogurt. I love fiber. There you go. Polyphenol. On Lewis House podcast. Oh, I love that, yes. Apples are horrible for you. Yeah, they are.

I mean. Why? Because an apple is not an apple anymore. And in fact, on Instagram. But that's not true. It's not an apple anymore. Yes, it's bigger. It's as big as a great truth.

It's been hybridized for sugar. Yes. But it has high fiber content. It has polyphenols. All the things you just said are healthy. It doesn't anymore. But it does. It does.

No, it's been totally changed. It has less vitamin C than 50 years. But it still has. vitamin C. It has a little bit. So how can you say, small apple? But how can you say apples are horrible from you from that deduction? From that big grapefruit size apple. Correct. And then when we look at research of people who consume apples, they live great lives. My patients who are unhealthy don't eat apples. When they eat an apple that's the right size, and guess what? Apples are not available year round. Normally. Again, all those statements you can stand behind, that apples are different,

that apples are not the same size. that they're not, shouldn't be available year-round. How does that bring you to the deduction of apples are horrible for you? Apples in this size are not great. You said a fruit smoothie is the worst possible thing you can do for your mitochondria. I think that's true. You don't think cyanide is worse for your mitochondria. That blocks oxygen and kills it.

Well, you're not going to eat cyanide unless you eat the apple core. Exactly. So how can fruit smoothie be the worst thing? A fruit smoothie is a pure fructose bomb. And if you want to... Well, it's not pure fructose. I'll argue that you on that because when you smooth. So when you smoothie, by the way, when you make a smoothie, the reason why I think

smoothies can be beneficial, not for weight management because, you know, often drinking your calories can be not super helpful. But in general, why smoothies are helpful is that when you blend, this is why I'm anti-juicing, pro-s smoothie, when you actually blend a fruit, vegetable, et cetera, to put it in a smoothie, you actually preserve the fiber matrix. And so the fiber remains in the smoothie. So when you're blending a blackberry, raspberry, apple smoothie, you're getting tons of fiber, tons of phytonutrients, tons of amazing healthful benefits. The only downfall, I would say, in my opinion, is that for weight management, maybe you're not going to get as much satiety as you would chewing it.

But that's an entirely different discussion. But I did have to, you know, step in with the smoothie, give smoothies a little defense because you do, maintain, the research shows you do maintain the fiber matrix when you do a smoothie. Now, juicing, on the other hand, not beneficial because you're removing the important parts of the fiber and the pulp. We all agree on that. Yeah. I want to read you a statement and you tell me if you agree.

Dr. Gundry states, my research along with the research of others, has shown that year-round fruit consumption is associated with kidney damage and diabetes among other diseases. So not only does this not bore out at all in human data, it doesn't even, we have multiple levels of evidence of research that disagree with this drastically. So you could start with the epi research, as I mentioned. So prospective cohort research is where you're observing someone over years and years in time. We're looking 20, 30 years, you're evaluating someone's dietary intake. And, you know, that is only one level of evidence, right? You can't make every decision off of nutrition epidemiology. In that one area and level of evidence, we see, as I mentioned, in the higher

turtiles of consumption of fruits, people have less diabetes. This is very very. very well known. Less heart disease, less cancer risk, et cetera. Then you look at the randomized controlled trials. There's numerous randomized controlled trials that when you replace a standard American diet for a diet that's higher in fruits, vegetables, and fruit included in that variety of fruits, we know we can reduce diabetes risk, heart disease risk, cancer risk, et cetera, in shorter term randomized control trials. Even my friend Kevin Hall at the NIH did a, you want to go to even more meticulously controlled trial. You look at Kevin. Evan Hall's study at the NIH where people went to live in the metabolic ward at the NIH in two

weeks. And he did a really low-fat plant-based, and I'm not even a huge proponent for low-fat by any means. I think there's multiple different dietary compositions that can work for people. But he looked at a low-fat, 100% plant-based diet, high tons of fruits, tons of lectins, versus a high-fat fat animal-based. Ketogenic diet. And he found that when he tightly controlled over two weeks, they lived at the end. NIH, every molecule that the eight was measured, you know, evaluated, and, you know, everything improved in the... They got Willa.

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And I think that I think the point you're trying to make is that, you know, we have bigger fish to fry in the world of unhealthy eating than fruit being the issue. And I think that, unfortunately, I think that discouraging people against eating fruit can give people the mixed message that they're, you know, that a food that's helpful for them may not be as beneficial and then they may even find something that's even less healthy to stick with. Do you think that that could be a reasonable thing a person can deduct? First of all, if I have somebody with kidney failure and they have an elevated geric acid, the first thing I do is modulate their fruit intake. Why not meat intake, given that? Why don't dilate their meat? Yeah. You forget, I'm kind of anti-meat.

Well, I'm not necessarily anti- Well, you're not anti-meet either. I am very much so. But you said small amounts of meat is small amounts, but. I agree small amounts. That's why I'm saying you guys are. I agree, small amounts of meat, too. I've been going after a new 5GC now for a very long time,

and there's more evidence that scares me to death about new 5GC. But back to fruit. So uric acid, I think we would agree fructose is a big driver of uric acid. Fruitose. Animal proteins, particularly fish and shellfish, will drive uric acid. Anyhow, in my patient population, and I'm talking about my patients, that I do their blood work every three months when I reduce their fruit intake, look for other sources of fructose in their diet, high fructose, corn syrup, etc.

We see their uric acid fall, and we see their cystatin C and EGFR based on C satin C rise. And that to me, and then if we change and allow their uric acid to come back, it'll go the exact opposite way. How do we generalize what you are doing with a select population of patients? David Bromier said, did the same thing. He even wrote a book about it, you know, drop acid. I'm not as strong a proponent of drop acid and cute cute name

only boomers get the joke it's called drop acid but like all of these things are individual cases versus generalized advice this is generalized advice I give to a patient who I see with renal failure wanting to stay off but when you write your book your book is not targeted

to people with renal failure yeah no even people with renal failure by the way I just step and jump in. So even people with renal failure very much can eat fruit. There's actually no limitation. I mean, people with renal failure may have specific dietary potassium or protein restrictions at hand. But in general, we know that all of the cohort data and the RCT data shows that people are less likely to develop renal failure if they eat a diet with a variety of fruits and vegetables and whole grains and legumes. So I think the issue is that Dr. Gundra, going back to kind of like the other dietary group, like the low-fat plant-based, no olive oil group,

I mean, they will say that they can reverse kidney disease on their exact cohort. I mean, if you had Dr. Esselton sitting here, you know, he'd be saying that he've reversed every single disease you say you reverse with your dietary plan. He will say he does on a high lectin zero olive oil diet. And I'm here in the middle saying that there's a variety of different dietary paradigms that can be healthful, but where we have to get that evidence can't be from an individual cohort. It has to be from a variety of levels of evidence in order to inform our decisions because your anecdotes are, of course, they're going to be meaningful to you and his anecdotes

are meaningful to him. And we've all seen patients that have improved on a variety of different dietary paradigms. But how we inform our patients in the general public has to be based on good sound scientific evidence. Yeah. I think it's just, it becomes more confusing when we start picking certain biomarkers to look at and nitpicking certain problems. And then we create this very confusing picture where patients come into my office and say, I no longer eat fruits because I heard this and this on Lewis House podcast. And that scares the life out of me because I, every patient. Why don't you see what happens to their blood work when they do that, which is what I do?

They don't, because what they do is they switch off fruits to Milky Ways per your, statement. I did never tell anybody eat a Milky Way. You say if you're going to eat grapes, you might as well eat a Milky Way. It was actually a Hershey Scandy Bar. So if people who eat fruit in all of the research, how do you explain that if people who eat more amounts of fruit in all the research have lower APOB,

lower weight, lower risk of diabetes, lower high-res CRP, like in multitude of evidence, then how do you explain away it being so dangerous? Wait, wait, wait, wait. Fruit is one of the best sources for polyphenols. And if you want to

feed your gut microbiome, it turns out that polyphenols are the best prebiotic there is. But not year-round. Not year-round. Look at the hansas. But why the hanses? I'll give you a perfect example. We want to change our gut microbiome on a seasonal basis based on the food that's being eaten. During the wet season, when the hazas just eat fruit and honey, they have a real

interesting diverse gut microbiome. In the dry season, when all they're eating is meat, their microbiome changes 180 degrees. And I think, and other people think, that that change per seasonal was built in. Perfect. You think it, it's a theory, but how can we generalize this that everyone should follow it from this theory? Because it's a theory. Because that's how we came about.

Well, that's how they came about. But there's people that live. They're one of the last hunter-gatherers that we can study. If you talk to Herman Ponsor, do you know who Herman is? He's studied the Hotsa probably more than any individual. He's a good friend of mine. I just texted him before our debate today to ask him a few questions. You know, if you talk to Herman about it, you know, he would never advocate for seasonal

only for eating because, you know, the evidence doesn't support that. And he studies the Hatsa in great detail because, you know, the hatsa eat the way they do because they are a hunter-gathering population. They're stuck. And we have so much to learn from them. But we live in the United States where things are ubiquitous and available. We have data that looks at people who eat for year-round

and shows positive outcomes for every cardiac, I mean, for diabetes, for hypertension, for weight, for inflammation, for cancer risk. That's because of the polyphenols. Right. So I feel like we are circling a bit. Yeah. So it sounds like you agree.

that fruits are good for you because of polyphenols. Right. There's a whole lot easier ways to get polyphenols than eating fruit, which is my point. What's the whole lot easier way? I think fruit dose is a mitochondrial poison. Do you think it's more beneficial to take your polyphenol supplements than it is to eat whole fruit? Depends on the season. For instance, I had a cute little apple a couple days ago that I got at the Santa Barbara Farmers Market.

Four bites and the apple was gone. Do you think our disease epidemic, our cancer, our cold? chronic disease epidemic, our cardiovascular disease or diabetes epidemic, the cancer risk, the autoimmune disease. Do you think fruit is an issue there or do you think that it has to do with everything else? I mean, because I don't think that it's... It's our highly processed food among other things. Right. Agreed. But a lot of our highly processed food is loaded with fructose. But that's not fruit. That's different than fruit. I'm just saying fructose is a problem. And please correct me if you think fructose is good for you.

It's not about thinking of fructose. I don't want to take apart an ingredient and villainize the ingredient because that's not helpful in real life. If I start villainizing individual ingredients, I can't give my patients good guidance that is universally valuable. It's the same way that any restrictive diet, if you restrict patients to eating toilet paper, they'll lose weight, but it doesn't mean they have a nutritious. diet. So when I tell someone, fructose is bad for you, they can get fructose from a Hershey's

candy bar or a grape. I'd much rather they get it from a grape. And fructose can be turned into glucose and the brain works off glucose. And yet too much glucose is a problem. Inflammation can be a very big problem in the intestinal area causing permeability. We know this. You say this quite often. But inflammation could also be a wonderful thing. When we exercise, we have spikes in blood sugar, we have spikes in inflammation. So to generalize saying fructose is terrible is not a valuable thing to the general public. Do you see what I'm saying with that? Yeah, but the problem is fructose is now ubiquitous in our diet.

And the more we can identify where it's hiding, then the better off we all are. And your proposed statement is that it's in hiding in all these fruits people are consuming. All these large fruits out of season, yeah. But no one's eating fruits. None of my patients can't possibly think of it. I live in California. We eat fruit in California, sorry. But in America, we talk about how much fruit is in the American Standard Diet?

It depends on where you live. No, I'm asking about the American Standard Diet. Very little. So then why are we talking about it? Because, and even, give you another example, Joseph McCullough recently has gone kind of on a high fruit kick, and which is hilarious because he was one of the original high fat guys. And he says, man, I feel so much better.

All I do is eat fruit all day long. I mean, I don't care what someone says. Wait a minute. Then he says, hey, but wait a minute. I notice that when I'm really going crazy on fruit, my triglycerides start going through the roof. And my insulin starts going through the roof. And you've got to be careful.

Well, that's also, listen, that's also not a randomized controlled trial where you're controlling calories, right? I just don't know what to do with that because it's not generalizable what Dr. McCola does or doesn't do with his insulin. It's not a controlled feeding study where you're looking at, of course, if you're increasing calories and you're increasing, you're going to make shifts in lipoproteins and you're going to see a variety of shifts. But overall, on balance, when we look at all of the data, we know the people who eat,

I just don't want your listeners to be confused, that when we look at all of the research, the totality of evidence, people who eat more higher amounts of fruit consumption on balance have a much lower risk of obesity, diabetes, hypertension, and then, you know, I don't think you can honestly sit here and think that fruit is the major problem of our obesity epidemic or our disease epidemic. You know, it's just, it's, it's, it's. Dr. Gondry, I'll simplify it to a metaphor. It's like we're sitting here and we're saying evidence shows eating carrots is healthy and carrots are a health food. And you sit here and you say, but if you eat enough of them, you'll turn orange. No one's debating that.

Yeah, carrots are really good for you. Yeah, I know. But you see how I'm saying that we say that in general, this food is healthy. Fruits are healthy year out. And you say, but in some instances, fruits can be bad. Yeah, great. But why say that? Because if fruits are picked out of season, they're picked unripe.

And they are actually loaded with lectins. And then we ripen them when they arrive here. Are there any times lectins are good for you? Oh, yeah. There's a couple nice really good lectins. So why are we generally? generalizing lectins to be terrible. Because most of them are part of the plant defense system against being eaten.

But there's many of them that are research for good things. We used to have a great defense system against lectins in our microbiome. There are bugs that enjoy eating gluten. Most people, they're gone, unfortunately. There are bugs that eat oxalate. And interestingly enough, people who have oxalate kidney stones or who, or oxalate sensitive, they don't have those oxalate bacteria, eating bacteria in their gut microbiome. If you re-foster those guys, the oxalates don't become a problem anymore. So again,

I guess we're circling back around, the gut microbiome, which has been decimated by everything we've done, is part and parcel of all this. And getting back to the Hansas, I think the idea that maybe we should have shifts in a microbiome on a seasonal basis is built into our evolutionary fiber. That's a fair theory. Okay. But we have to be humble enough to say it's a theory. Yeah.

Didn't say it's proven. That's great. Then would you say that you, in general, villainize lectins? In general, yeah. In our American diet. So do you see the problem with simplifying something is all good or all bad in health care, how it could become a problem? I started doing this because I asked patients to eliminate certain foods out of their diet

and let me see what happens to their blood work. Let me see what happens to their intestinal permeability. When you were a heart surgeon or practicing as a heart surgeon because you still are a a heart surgeon, did you make those recommendations to eat fruits, vegetables, all those things. Yeah. And what do you think the reason for the failure of those patients' diets leading to them coming back every few years was?

Was it A, the fact that they couldn't stick to it or they didn't stick to it or they didn't stick to it or they couldn't afford it or the fact that they ate fruits and vegetables and still got sick? Well, there's a new paper out just this past week looking at a basically a vegan diet versus a well proportion. Chris Gardner's. I just read it. And it turns out the vegan diet did wonderful things

in terms of cholesterol markers, inflammatory markers. The other diet did well, but not anything as good as a vegan diet, right? What's interesting if you actually, if you read the paper, is they go, yeah, this is all true. but the compliance with the vegan diet is so difficult that it's unsustainable. And the compliance behind your yes and no list is easier. It's actually much easier. 90% of my patients follow that list. But that doesn't...

There's a little selection bias. Well, they're interested. That's like saying my followers watch 90% of my videos. Well, they're my followers. Because if they see, if their autoimmune disease goes away, they're really interested. Or they support what you do. They don't support what I do. What do you mean?

They're your patients. My followers watch my videos because they've selected to subscribe to me. They wouldn't be my patients if they didn't see a change in their autoimmune disease. I'm not saying the recommendations you make about eliminating processed foods is all bad. That's not where our debate comes from. In fact, there's so many things you do very well for your patients that lead them to have good outcomes. The danger comes in when we start generalizing as foods as being evil or bad, apples are horrible for you. Those statements mislead patients into making bad decisions because when you say apples are terrible for you,

you're making this statement from a very knowledgeable position of the polyphenol change, this change, and you wish that they were a little bit smaller. The patient hears, I might as well eat her Hershey's kiss. Do you get how that happens? Yes. And that's a big problem because your books are bestsellers. And then patients go, I don't want to eat apples anymore. Great, because the apple they're eating is the wrong apple.

That's so hard to say. That makes me very happy. That's so hard to say. What's your takeaway? My takeaway is that there's many different dietary patterns that patients can be healthy on. Although there's much research that informs our recommendations and guidelines, patients have to find what works best for them, and that eating a plant predominant diet filled with fruits, vegetables, legumes, whole grains, lean protein, you know, there's a reason why I believe there's synergy across all of our major medical society guidelines for cardiology, cancer, endocrine society, etc. And in reality, there is no one perfect diet. No one food in one dose is going to cause disease and that it's really patients finding

something that's sustainable and works for them long term. I'm going to say something borderline controversial. When we talk about leaky gut syndrome, not the concept of leaky gut, leaky gut syndrome, I feel like patients who have gastrointestinal conditions, a lot of times have non-specific vague symptoms. And our health care system is trash at helping those people. True. For many reasons.

One, our system is flawed so doctors don't have enough time to spend with their patients to properly hear them out. Two, we don't have enough research to figure out exactly what's going on so that we don't have every diagnosed disease already on the ICD-10 classification. And then three, so many of these patients then fall. into the bucket of seeking an answer elsewhere, usually in the form of supplements that are being for sale to them, diets that promise them solutions to their things that are largely unproven. And as a result, those patients and why I suspect 80% of your patients are autoimmune

patients because they've been hurt by our system. But that's not because there's some kind of definitive proof in the solution for all autoimmune conditions. It's simply because you're often offering them a solution that our health care system doesn't have. Oh, that's absolutely true. Most of my patients in the autoimmune spectrum have been to six, eight, ten different centers, different physicians looking for an answer and not getting it. And that's actually how they end up in my office. Do you, like zooming out, do you find it strange that patients that have a GI disorder,

an autoimmune condition, a rheumatologic condition, go to many GI centers, rheumatology centers, don't get helped, but then a cardiothoracic surgeon is helping them. Not anymore, because I actually... What do you know that the rheumatologists don't know? Quite a bit. What?

So, for instance, all of this comes from intestinal permeability. How do I know that? Because when the intestinal permeability stops, by whatever mechanism you want to do it and there are multiple ways i haven't like my way because it works when that stops the the autoimmune condition goes away and the rheumatologists don't want to help their patients and follow your mantra they want to believe in the system of using a biologic to treat what is treatable with food so you're saying a rheumatologist who's went through 15 years of higher education yeah has such strong faith

in other methods of treatments, that they refuse to see the very simple solution that you have laid out. An example from the plant paradox, a young lady with Crohn's disease, who was taken care of by the head of GI at the Mayo Clinic, who believes that Crohn's as a genetic component,

has some, but not much, went on my program, resolved her Crohn's disease, called her gastroenterologist, said I'm cured by following this diet and he says that's just a bunch of bull this is all in your head he's a charlatan she got off the phone her mother was baking Christmas cookies she had a couple Christmas cookies two hours later she was in the bathroom severe GI distress doctor on the phone she said why won't my doctor you know learn from this I said look you can't

see unless your eyes were open when i met big ed 28 years ago luckily for some reason my eyes were open and for instance dale brettison from the end of Alzheimer's and david promoter grain brain and drop acid we joke that people from you know the neurology community and the people from cardiology and cardiac surgery, all we talk about is the gut because everything comes from the gut, just like Apocriti said. And I'm learning that. Remember, sickness is good for business. Sickness will exist whether or not we follow the Dr. Gundry diet. Do you agree? Depends. You're saying you could eliminate all disease?

Apoccrates believed it. I see it every day. I'm not asking Hippocrates. You know, yeah, I think... I mean, just think about the statement you make. You're saying you can eliminate all disease. Yeah. I mean, then we're in the midst of a profit. Why do you think I keep working six days a week at my age when I don't have to?

Because I get to see these things happen. And the more I see of it, the more I firmly believe that Hippocrates was right. Do you see why... Do you see why... Do you see why I see that? a lack of humility in a statement where you- This is not. I get to watch miracles every day.

That's why I show up for work. But so do why. When I start my patient, I'm at Foreman and their hemoglobin A1C drops, I see a miracle too. Yeah, but you're trying to patch up the underlying cause. Sure, but my patients don't always follow

the lifestyle guidance. But your patient-I like Metformin? But do you know why your patients follow your guidance versus mine don't always follow mine? Because usually they're at their wits end. Yes, and because you've pre-selected the patients who want to follow your guidance. I don't call them up. No, they call you.

They've pre-selected you. So if I took your model and then started doing it on my patients, it would not have the same effect. Let's try. Because it's not a pre-selected, but we have tried it. We've tried it with all the research that Dr. Bellardo has proven that if you eat high fruit concentrations, you live longer. Leonhardt study, you eat grains, you live longer. And these are all the things you advocate against. No, you get alpha lino-like acid in your body.

And lagoons. But you also live longer. No one's arguing about the ALA. What we're saying is that you live longer by consuming a high-green diet in the Leonhardt study. And you're arguing against those things. And you live longer if you smoke in some of these areas. But that's not because if you smoke. It's in spite of smoke.

No, you're wrong. But how? You are wrong. You know smoking is pro-inflammatory. Nicotinic acid is one of the best. mitochondrial and car. Dr. Gudge, we have to end this conversation. The British doctor's study showed that British smokers, British doctors who smoke have a 30% less incidence of Parkinson's and dementia. Yeah, because they die of 10 other diseases beforehand. So Dr. Gunger, I have one

anecdote to share with you. I had a patient in residency who reversed their, I actually don't like using the word reverse, sorry, put their diabetes into remission, improve their hemoglobin A1C. This was not on the advice of myself. This is just something I observed that the patient told me. This patient went from eating just a ton of processed foods, whatever, and went on a cocaine binge for a few months, okay, literally a cocaine binge and eating Twinkies, candy bars, but low calorie, and their hemoglobin A1C and their high-risk CRP totally normalized. Yeah. From that anecdote, would we be universally recommending cocaine and Twinkies as a diet?

Of course not, right? We can't extrapolate from anecdotes. that individual lost a substantial amount of weight, which is why that happened in a really negative way, right? They lost weight because they weren't eating because they were using cocaine. That is something I would ever recommend to patients. So a lot of the anecdotes, we can all have anecdotes that we see. I mean, I have patients that are fully plant-based that go on these really extremely restrictive diets that improve all of their biomarkers.

And the reason why I don't recommend someone follows a no olive oil, whole food plant-based diet, even though it's been recommended by tons of people with tons of anecdotal evidence is because when you look at multiple levels of evidence, we know that eating olive oil can be healthy. We know that eating fruit can be healthy. We know that, you know, all fat is not necessarily bad by any means, polyunsaturated fat, incredibly healthy. And so this is why I believe anecdotes, while they're interesting, we have to base our recommendations off of the most robust outcome data with evaluating various levels of evidence. I was lost when we're saying lectins are pro-inflammatory, so we should stop eating them.

And smoking is pro-inflammatory, but it extends life in some conditions. No, the pro-inflammatory of smoking can be countered by a high polyphenol diet, period. I can't. Well, then how do these guys make it so long? How does my grandpa who eats the most unhealthy, low-vitamin-C diet live to 95 when he smoked? Yeah, that's what I'm asking you. Yeah, in medicine, we have to have the humility to say, I don't know. And my answer to you is, I don't know.

And I could state that. But let's find that out. We should. Well, that's why I do what I do. Let's find out how this works. But there's a difference between saying let's find out versus I'm the prophet with the answer. Not a prophet. But when you say you could end all disease, that's prophetic.

No, all disease comes from the gut. and all disease can end from the gut. That's all I'm saying. How does AIDS happen from the gut? Well, actually, there's some interesting evidence that the microbiome in AIDS patients is totally different. Well, yeah, because they have an autoimmune disease. And you can change their microbiome.

How does herpes on the lip happen from the gut? I mean, some of these say, how does a blocked gland in my eye happen? We have to be humble here. Believe it or not, there's now really cool evidence that hearing loss is because of dysbiosis in the gut, period. When you say really great evidence, I'm curious what goes through your mind. What goes through my mind is in the next book, believe it or not, there's really strong correlation between mitochondrial dysbiosis and hearing loss. There's a really good correlation between ice cream cells and shark attacks as well, and I found that to be not very valuable. So why not manipulate the gut microbiome and find out, which is what I do.

If there was quality evidence, I would. You don't, look, I have a channel here with 12 million subscribers. I can sell them probiotics and make a ton of money. I could tell them your probiotics. In fact, you'd probably sell me your probiotics. I could sell it to my audience and make millions of dollars and help people. I'd much rather you sell prebiotics and post-biotics. Deal, okay.

How's that? I would sell those to my audience. You think I'm withholding making money. You think I'm withholding helping patients be out of principle? No. Then why do you think I'm not selling those things? Because maybe you don't believe the evidence that they work like I do. How's that?

But the evidence that you believe they do is not based on human outcomes. That's the problem. They're actually. You just said that you found some correlational data and it leads you to make this sweeping recommendation Not just me? Yes, not just you. But you're the person in the room that I'm discussing. Why don't you read Lesio Fizano, professor at Harvard, if you don't believe me.

Well, it's called authority bias. Yeah. I mean, no, I just don't want to talk to those people because I'm talking to you. And we're seeing correlations and we're seeing mechanisms and we're seeing your theories, which you admitted are unproven. That was your statement from earlier. They are theories. And if they're theories. Just like the cholesterol hypothesis of coronary artery disease is a hypothesis.

There are multiple other hypothesis. But it's not. Oh, no, no, no. It is a hypothesis. We know that elevated LDL cholesterol is causative, without a doubt. But why? But why? We know that.

Why? Yeah, we do know why. Why? Are you asking like from like a God sense why? No, I mean, in other words, what is it about having a high LDL cholesterol that's so bad for? because I have patients, quite frankly, who have LDL cholesterols of 400 and have an absolutely normal CT coronary engine. And that is not typical, and that is a very, that is you were talking about a unicorn,

that is very rare. We know from all the research of people with actual, with familial hypercholestrolemia, we know that regardless of some, we know that there's factors of metabolic health that lead to increase ASCVD, we know that diabetes increases risk, we know hypertension increases risk, but all of that completely controlled for, irrespective, isolated, elevated APOB in and of itself causes ASCVD, which is why are all of our, all of our, um, but most of us are not measuring LPPLA2 levels. Because it's clinically insignificant. Well, it is clinically significant.

And the assays are not validated. It's funny. The Cleveland Clinic uses it. It's, a Cleveland Clinic does a lot of things that, um, uh, uh, uh, it's, uh, Cleveland Clinic does a lot of things that, um, uh, I would think they'd be very interested in heart disease. Well, I mean, I'm not aware of any Cleveland Clinic physicians personally that recommend that because it's not in our guidelines, because those assays aren't validated and don't have outcomes. But anyway, ASCVD, we do have an answer to at least, and we at least agree APOB is causative.

We don't have answers for everything, and in medicine, you're aware of this. As more evidence comes out, we update our changes in practice. Like you used to poop in a body. as a med student, and now we actually have, in Harvard, they freeze dried capsules in order to deliver these fecal transplants. So we literally will take what we learned and we update our guidance. And from there, we need to have a strong layer of skepticism before we accept something as a changing of the way we do things. I completely agree with you. And I do not feel the caliber of the evidence that you use to make certain statements reach the level that we should make

generalized claims that apples are horrible, that smoking isn't bad as long as you have high antioxidant levels, because those are dangerous statements to make because they mislead people into thinking that smoking is safe, that apples are bad, and that might as well eat a Milky Way. And ultimately, I know that's not what you want. I know you genuinely want to help people. You want to help people off of ultra-processed foods. You want to help people get to a healthy weight, higher muscle mass, lower fat. Those are the things you want. It's the mechanism by which we're talking about mechanisms.

The mechanism by which you chose to get here is very dangerous. And I'm telling you this because while you're an expertise with your patients, I'm an expertise at mass communication. I have 25 million subscribers of people who listen to every word I say and correct every mistake I make. And I could tell you how your information very confidently lands. with them. And it doesn't land in the way you intended to. And I just urge that in your upcoming books and the speeches that you make, just take that into consideration. Because when you make

statements like apples are horrible, the worst thing you could do for your mitochondria is a fruit smoothie, it's not just taking a little bit of liberty with information. It's truly misleading people to make bad decisions for their health. That's all I'll say. In every one of my books, I tell people if you do not smoke. Smoking is bad for you, but we should learn what is it in cigarettes. We should learn. That is a factor in these people who are long lived. We should learn. Okay. That's what I'm saying. And if you want to raise triglycerides, one of the best ways to do it is fructose. And I happen to think triglycerides are a real problem in cardiovascular disease. And we might agree about that. Triglosterols are a problem, but fruit does not,

fruit in and of itself, does not, in the whole food form, doesn't raise triglycerides by itself. And I say reverse juice. Get all the fruit you want, put it in a juicer, throw the juice away, and eat the pulp. Well, I agree. We all agree. We all, I love the pulp.

We all agree that juicing is a bad idea. So, again, just that's my only word of caution. Yeah, I think there's a lot we agree upon. I think it's the mechanism by which we disagreed. I hope the audience got something out of it. I appreciate you taking the time to have a critical. debate because a lot of people wouldn't take that conversation. So I'm first and foremost very grateful that you're willing to have this debate. And thank you, Dr. Bellardo, for the feedback and

all the work that you do with the cardiology associations across the globe. Got check. We're looking forward to January 9th. Got check. Thank you, Dr. Ventry. Dr. Bellardo. Oh boy, how I love myself a good quality debate. I think that's solid. And the reason why I think it's good quality is no personal attacks here really just focused on talking about the information and logic a huge thanks to my two guests dr ballardo and dr gungry for being respectful and sharing their ideas openly and willing to hear feedback on it if you enjoyed this conversation in this podcast episode please please leave us a five-star review it goes a long way in helping others find this podcast so they too can learn more about health and their own bodies if you want a fun conversation

a conversation about happiness, which we all need more of these days, check out my conversation with Dr. Robert Waldinger, who is the director of the longest running study of happiness in Harvard. As always, stay happy and healthy.