The Checkup with Doctor Mike - The Truth About Seed Oils, Food As Medicine, and RFK Jr. | Kevin Klatt PhD RD

Episode Date: April 23, 2025

I'll teach you how to become the media's go-to expert in your field. Enroll in The Professional's Media Academy now: https://www.professionalsmediaacademy.com/Huge thanks to Kevin Klatt for appearing on this episode. Follow him here:Instagram: https://www.instagram.com/kcklatt/?hl=enTwitter/X: https://x.com/KCKlattLinkedIn: https://www.linkedin.com/in/kcklatt/00:00 Intro1:23 The Field Of Nutrition Right Now09:34 What We Actually Know14:32 High-Fat Foods/Cholesterol25:50 Food As Medicine36:14 Customization Of Care47:52 Patients Getting Misinformation54:09 Purveyors Of Misinformation1:05:36 Nutritionists vs Dietetics1:16:29 Who Should You Go See?1:34:19 Pharmaceutical Advertising/Influencers1:39:31 Good/Bad Supplements1:47:42 MAHA / RFK Jr.2:11:28 Magic Wand Nutrition Changes2:28:23 Seed Oils2:41:13 TakeawaysHelp us continue the fight against medical misinformation and change the world through charity by becoming a Doctor Mike Resident on Patreon where every month I donate 100% of the proceeds to the charity, organization, or cause of your choice! Residents get access to bonus content, an exclusive discord community, and many other perks for just $10 a month. Become a Resident today: https://www.patreon.com/doctormikeLet’s connect:IG: https://go.doctormikemedia.com/instagram/DMinstagramTwitter: https://go.doctormikemedia.com/twitter/DMTwitterFB: https://go.doctormikemedia.com/facebook/DMFacebookTikTok: https://go.doctormikemedia.com/tiktok/DMTikTokReddit: https://go.doctormikemedia.com/reddit/DMRedditContact Email: [e-mail] Producer: Doctor MikeProduction Director and Editor: Dan OwensManaging Editor and Producer: Sam BowersEditor and Designer: Caroline WeigumEditor: Juan Carlos Zuniga* Select photos/videos provided by Getty Images *** The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional **

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Learn more at scotiabank.com slash banking packages. Conditions apply. Scotia Bank, you're richer than you think. Oh, man, I'm going to piss off some people. I think seeing food is medical. is wrong on several fronts. There's not a great way to look at food on several fronts. In this episode, I sit down with Kevin Klat, Ph.D., and R.D., who is a research scientist and instructor at UC Berkeley's Department of Nutrition Sciences and toxicology. He's earned his PhD

in molecular nutrition from Cornell University and completed his dietetic internship at the National Institutes of Health Clinical Center. Basically, he's the guy who actually reads teaches, and performs the nutrition studies everyone loves to quote. We dive into great detail throughout our conversation, unpacking why nutrition seems messier than ever, focusing specifically on the viral claims around eggs, seed oils, and the food as medicine mantra. Kevin does a great job in laying out the guardrails

you can trust amidst all the noise. What I'd like for you to pay special attention to is how he answers my complex questions. He rarely gives a simple soundbrows, answer like your typical podcast bro guest. Instead, he focuses on the nuance to make sure you're getting the most accurate and unbiased information. That's what experts are supposed to be doing. Anyway, I hope you learn as much as I did throughout this conversation. Please welcome Dr. Kevin Klat to the Checkup podcast. This episode is brought to you by Square. You're not just running a

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Because when you're doing big things, your tools should to. Visit square.ca to get started. Nutrition. Yeah. It's become a bit of a buzzword. At least controversial topic. Right?

Most people agree, nutrition is important, but they agree for vastly different reasons. Participate in vastly different food camps. It used to be left, now it's right, then it's left, then it's right. I think the field of nutrition is the most confusing it's ever been. You're an expert in the field. Ostensible, yeah. Although people don't like the word expert anymore. Don't comment that.

But unlike most podcasters these days or health gurus or health podcast guests, you truly are an expert because you've actually put in the time to do the research to understand what is being said, to understand when someone quotes a research article, what was studied, what was missed, where the limitations are. What's your gut take on the field of nutrition right now if you were to give a banner for it? Oh my goodness. I mean, the field of nutrition, I feel like is often very separate from like the popular understanding of nutrition. Like we have an NIH nutrition roadmap that was released a couple years ago that heavily embraces like precision nutrition, understanding inter-individual variability, understanding more about food composition, how it affects health both in the long-term and crying disease, and then in the short term, like, how in the hospital do we feed patients better to improve outcomes? I think the popular conception of nutrition is very much what we would think of as like nutrition and chronic disease.

So I would, you know, people are like, nutrition doesn't know anything as like a very common perception. And I'm like, well, we know all the essential nutrients. And like we do have like great very evidence based like program like supplementation feeding programs and things in global health and a lot of implementation science there. There's a lot we do know in nutrition. But there is just this, I think the methods and nutrition always leave a little bit of a little bit of a uncertainty more than you'd get with, like, you know, drug trials and these sorts of things. In how does diet, how is what a meeting now affects something that's happening 20 years down the road, you know, long latency periods of chronic diseases before they manifest for the most part.

And so, yeah, nutrition, it's, I think there's a lot that gets lost in translation. And there's a lot of people, I became a dietitian and did my PhD nutrition not because I didn't want to write prescriptions. But then I think the public is always looking. for a prescription of like how many milligrams of this and how many servings of this are eggs good or bad? And it's all like a yes-no thing. And I think anytime your question doesn't have a definitive answer, like it's going to forever fuel media cycle and people putting out information about it that seems contrasting to whatever official dietary guidance is. And it's a

never-ending loop. And so sometimes the questions aren't, I think, adequate. Things like, are eggs good or bad. You know, that's always in the media. And that, like, there's so many first principles in nutrition science that I think are violated by that question on its own. Like, in nutrition, if you're, I always take these questions and turn them into a study design. And you have to ask, like, you know, if you're going to do a trial of, like, are eggs good or bad, you immediately have to ask, like, well, what are people eating instead of the eggs? And so, like, our eggs good or bad are going to be immediately a relativistic answer of, like, are eggs good or bad relative to lentils or to red meat.

And like there's an infinite number of these trials that you can do that I think gets at like a major issue in nutrition. We don't have a placebo in our trials. And so you have essentially infinite pairwise comparisons across foods. And nutrition is inherently interested in the dose response relationship. You know, like in pharma studies, you're trying to do all of your pharmacokinetics early on to optimize for the dose that's going to like lower your target and then not have side effects. In nutrition, we care about high, medium, and low and everything in between there.

And so you have, you can imagine, you know, this egg question. We've got now infinite comparators across many different doses and you can quickly come to a 65 arm trial. It's never going to happen. And so like, and even then, like, that would only be certain for the population that you studied it within. Are they high risk at baseline? Are they going to be somebody who's like a hyper responder to dietary cholesterol and their blood cholesterol levels? there's all these like effect modifiers and but that I think illustrates like the questions that we're asking sometimes are not the right ones um both in the literature and then also kind of in the public sphere so will we never know our eggs good or bad? I think the question is like it's like

are eggs good or bad for like for who um and their eggs are like nutrient dense foods that I think, I mean, I'm not here to endorse any food in particular, but like, the impact of them on dietary cholesterol, like on LDL cholesterol is like quite small. And I think, you know, if you're somebody who's at elevated risk, you might be counseled to consume less. And if you're somebody who's not, like the general population data largely doesn't implicate them as like, at least anywhere near the top of like nutritional priorities, anybody should be coming up with. And they're important sources of nutrients that are, like I did my PhD in Colleen, which eggs are uniquely a rich source of, and that's quite important during pregnancy. And so I think

we lose some of the nuance of like nutrient needs and optimal food patterns and things vary a bit across the lifespan and with different reproductive states, for example. See, I find you as an expert being at a tremendous disadvantage here, because if I ask that question to a carnivore diet expert, I used that term loosely there, someone who's a proponent of the carnivore diet, someone who's a podcast host, they'll give you a very short and simple answer. That doesn't have any of the nuance that you introduced. And to the general public, that feels like they're telling the truth, but almost like as if you as the expert won't tell them the truth. Yeah. Why is that not the reality? I mean, I think we might be at a point

where the public is getting tired. Like, you can go find anybody to say anything is good or bad in a sort of a deterministic way. You know, we're at the point now where you turn on social media and everything from vegan to carnivore is the optimal way. And it's just like, well, that just can't be true. And I think at some point you have to start to bring science to at least provide not a prescription,

but some, like, guidance and guardrails around, like, what we think of as being relatively healthy in the diet. But I think I would like like the public to just be a bit less prescriptive and also look at diet as sort of we can't know the things. Like we don't have the precision in our research tools to know things as like deeply and specified as people would want to. And I think like the general guardrails essentially is what nutrition science is going to provide you and like eating more fruits and vegetables, eat more legumes and nuts and seeds. And then if you have a specific problem, then like tailoring the diet around that with the help

of like a dietitian or physician can like allow for the more specifics. But a lot of the hyper specification of things I think is just to sell you a brand or a product or whatever. And so there's a huge financial incentive to be seen as like offering the way the truth and the light around diet and it for it to be what looks like anti-establishment quite often. And that's not to say that there's nothing wrong. Like there's a lot of nutrition official nutrition advice has a lot of flubs along the way. I understand the lack of like trust in nutrition science and there's polling to show that there's lack of trust in it. I think a lot of that starts with like some humility from the field about like how deeply we can know things. I think there's some people

who think that we just need to like shout it louder and say that the data is stronger than it is and that'll get the public to kind of adhere to what official dietary guidance is. And I'm not, I don't fully appreciate or I don't fully agree with that approach. Yeah, I don't either. I think the more transparent you can be, even though it's flawed, the more. more buy-in long-term you'll get. Yeah. So what, you said that we have made significant strides in nutrition research, what do we know with a higher level of evidence about nutrition that would be valuable

for someone to know? Yeah. I mean, so we know the general, like, essential nutrients, which is great. You know, I'm going to, I think we should stick, like, I always like to couch this as, like, most people care about nutrition and chronic disease, and they're not, like, interested in like acute inpatient nutrition care. We have like RCTs and things, but nutrition knows different things in different sectors. But in nutrition and disease kind of health outcomes, there's things like women of

reproductive age should take folic acid to reduce the likelihood of having a neural tube defect. Like the evidence is pretty solid on that front, not perfect, but solid. There is a lot, you know, early in around the 1950s, 1960s, you start to get the emergence of the basic cardiometabolic disease risk. of elevated body weight, elevated blood cholesterol, elevated blood pressure, and then sort of insulin resistance and blood glucose diabetes sort of emerge beyond that. And so there are a lot of controlled feeding trials where we can, in a short term setting, manipulate the diet under

very controlled like everything weighed on a gram scale to the 0.1 gram precision for anywhere from like two weeks to sometimes you get longer than, you definitely get longer than that for sure like out past six weeks. Some controlling the diet for like up to 12 weeks where we know that changing the diet composition, particularly the fat composition can influence blood cholesterol levels. Changing sodium can influence blood pressure levels. Same with potassium. And then we have, so we know a lot about dietary fat composition and blood lipids basically because they're like a major risk factor that change independent of weight. So just changing the composition of the diet has a pretty substantial effect on lowering total and LDL cholesterol.

We know things like the DASH diet, which sort of takes our knowledge of not only sodium, but other elements of the diet is the dietary approaches to stop hypertension, but there's big New England Journal Medicine landmark trials on the DASH diet, basically showing you can get close to first line pharmacological blood pressure lowering with diet by combining a number of elements. So it's like reduced sodium, elevated potassium, like seven plus servings of fruits and vegetables a day, a few servings of non-fat dairy, and that all these things combined have sort of like an additive effect. On the dash diet, I think it's one of my points I would bring up

with patients is it's like seven or eight things in the diet that all cumulatively add up, but no one of them is like make or break it. Yeah. And it's sort of a good example of like diets effects tend to be really small, but like adding up a bunch of dietary changes and then doing that for a really long period of time cumulatively is like a net win and I think that helps orient people to like expectations around effect sizes because you've got everything you turn on social media and like this supplement or this nutrient that we're all missing is evil yeah and it's like that I those things are great as a researcher who has to do a power calculation for doing the clinical trial like I wish the effect size was so large I needed to enroll six participants

because I'd see this magical effect of a magnesium or whatever but the effect sizes are always quite subtle. Yeah, so we should elaborate on that. In order to see the impact of changing this one ingredient in someone's diet, and then to see the impact, you need to have a significantly higher number of participants in that research. Yeah, or like it needs to be a big intake differential that's occurring. So like some of the work I did in my PhD is on pregnancy, which we think of as like a uniquely stressed state for coline availability. And the Coaline intakes are relatively modest or low and that you can intervene and significantly sort of alleviate that coline stress. So like obviously a vitamin supplementation is going to do

a whole bunch more if somebody is deficient at baseline and you need a lot fewer participants because you just expect a bigger effect. But in like a well-nourished population like the U.S., like I don't think vitamin A supplementation is going to be like a magical necessarily. So you need a huge number of participants. Yeah, you need a lot more participants to see that much smaller effect and to handle all the variation that exists. And so same with chronic diseases. Like, it depends on are you recruiting people with high blood pressure at baseline, how high, the more modest and closer to like a relatively, you know, or homeostasis is maintained, a relatively healthy state. Like to see diet effects, you tend, they tend to be much smaller and you need

a bigger sample size to see them confidently. And so that's a problem for like our nutrition research infrastructure, the ability to like recruit hundreds of patients like you would do for pharmaceutical trial is extremely difficult. You basically can't do it. It's very, very hard to do that in any meaningful time frame with the current way that we fund nutrition science now and the research infrastructure that we have. With

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Discover five days of readings, talks, workshops and more with over 100 authors from around the world, including Rachel Maddow, Ketouru Isaku, and Kieran Desai. The Toronto International Festival of Authors, October 29th to November 2nd. Details and tickets at festivalofauthors.ca. Why do you think there's so much disagreement when it comes to the consumption of, let's say, animal products or saturated, high saturated

fat content foods and its impact on cholesterol and thereby impact on cardiovascular disease? Yeah. I mean, I think there's a few people debate that, like, saturated fat raises LDL cholesterol. There's a bit of an effect modification by the food matrix there. So we talk about these nutrients, but like you can get saturated fat from meats or dairy and different types of dairy and the relative effect of satirates on LDL varies a bit with those foods. But I think most people, you find very few people arguing that like replacing saturated sources with mono and polyunsaturated sources isn't going to reduce LDL.

I think a lot of people question the second part of that. Yeah, does that change in LDL meaningfully reduce cardiovascular events, which can be influenced by its effect size? You know, it can be small in some individuals. It's quite, quite variable. the degree to which somebody, when they change their diet, the effect size that they're going to see. And I think, you know, there's old trials in this literature that are suggestive of that

replacement lowering cardiovascular events, but they're like pre-statin era. People have total cholesterols like in the 200s and 300s. So people question like, is this added LDL lowering really all that beneficial for reducing cardiovascular events? Like calculating a number needed to treat is really tough in this space because you don't have a really rigorous data to do it all that often. And then there's always concerns that just because LDL is lowering, I think medicine, there's a lot of hard learned lessons that you can see the biomarker go down in the direction that you wanted to, but there's like an off target effect.

And so there's always concerns that like particularly in the era of everyone, think seed oils are toxic. And so current recommendations are to replace saturates with more omega-6 rich polyunsaturated vegetable oils, particularly high in linoleic acid. But we recommend. in a mix of omega-3s and omega-6s. And those, you know, there's a concern that, you know, you might see the LDL lowering, but those might have an independent bad effect. And so that's always,

you see that for the past 40 years and guidelines that people don't really recommend more than 10% of total calories coming from PUFA because of theoretical concerns of harm. And there's just not populations that are eating much higher than that that you can go and observe that they're totally fine. So the recommendations are slightly more cautious.

But, yeah, you don't have huge blockbuster trials that say, like, we swapped satrids for PUFAs across a dose response range across these diverse populations and at lower cardiovascular events and all of them. Like, that's really, really high bar for the field to reach. So we know, I think, relatively compliment that satrids being replaced by PUFAs lowers LDL. We don't see a strong evidence of harm in any marker that you look at. There's a little bit of added improvement in blood, glucose, and insulin for that, and liver fat. And you can see this in these small trials that the field has strung together. And then you have epidemiological data. So like the observational evidence where you give out people, either food frequency

questionnaires or in some of it there's 24-hour dietary recalls, but it's mostly food frequency questionnaires. And those you can estimate how many, how much energy you're getting from saturated fat versus polyunsaturated fat and do kind of replacement modeling algorithms that sort of mirror what's happening in the RCTs. and you can see a similar, often, like it's a very analogous that you see a reduction in LDL in the control trials. You see often a reduction in cardiovascular events in most of the epidemiology. And that's sort of the two strongest types of evidence nutrition is going to put forth.

There's a little bit of primate data that's going to show that replacement of satirates with PUFA is also lowers cholesterol and reduces atherosclerosis size. But yeah, you have all these individual lines of evidence that have like, they're impactful, but they're missed, they're not like a smoking gun sort of thing. So finding trial data where people have reduced saturated fats, replace them with PUFAs and actually follow people to have cardiovascular events, there are older trials that did this. They typically relied upon more captive populations where you had control of the diet already. And so the mental hospitals were big ones. You had like LA, the LA veteran study is one example where

veterans used to be housed and the diet was controlled. So anywhere where somebody was institutionalized and the diet was being controlled, you could do some interventions and people did that back mostly in like the 60s. And they just by modern trial standards weren't always the best. A lot of times they intervene on they changed the intervention diet but didn't really do anything to the control. And so they're like slightly imbalanced. A lot of them are done during the era of trans fats being in the food supply. And so they lowered the intervention group either there's endless debates in the field about this where the intervention group sometimes the intervention reduced saturates at the same time it reduced trans fats

and so people when they like replace it with PUFA and so people are like oh you've overinflated the benefits of replacing saturated fats because you also lowered trans at the same time and then you have other intervention studies that intervened with high PUFA diets but they used a margarine that probably had some trans fats and so they're like ah maybe you didn't see the mortality benefit because you just did a trans fat intervention at the same time. You did a proof intervention. So there are these endless debates from that really limited literature-based. You'll see like the American Heart Association has a position statement on this

where they use like four core trials that they rely upon. Three of them are adequately randomized. And, you know, they point to like what we would expect that mostly soybean oil replacing saturated fats sources in the diet, lower cardiovascular events. it's like a composite of all cardiovascular events, which a lot of the evidence-based medicine people don't like composite endpoints. They want to break it out by individual event type. And again, there's these limitations that I mentioned around.

And the timeline of it all, right? Over what period of time is this? They're like usually like four to four. They're over two years long was the inclusion criteria. The American Heart Association relied upon. But those trials are just, I look at them as being like, they don't point to like a strong signal for harm. but they are not gold standard necessarily.

So it would be amazing if we as a society had like, people who could basically just be like live in paid research participants five years living in some capacity long term where we can control their diet. But that's so hard to do. Can we take the data that we've gotten from statins, their effect on impacting LDL cholesterol and in general the cholesterol profile?

Seeing the reduction in the ASA, CVD risk score and events and then say, well, if we're seeing these substitutions in certain fats lower the LDL cholesterol and the cholesterol profile, shouldn't we expect to see the same or does not, not as simple as that? I think that's one supporting line of evidence, but it's not a direct one-to-one. So all drugs lower LDL, and there's many drugs out there. They lower it different mechanisms. We don't even 100% know the mechanisms by which dietary fat composition changes lower LDL. They do a similar thing of like, obviously there's enhanced clearance of LDL from the plasma compartment by the liver. There's also some debates about whether there's

reduced cholesterol synthesis for the mechanism of how they actually lower blood cholesterol. But we would expect that LDL lowering to produce beneficial effects. I think the big question becomes, like, what are potential off-target effects of the diet? So if you go, like, super high in polyunsaturated fatty acids, you might, at some point. Create a new problem. Yeah, there might be a toxic effect at some point. And finding the dose response data there is pretty limited. You're often relying on epidemiology.

I know the cardiology world is kind of like right now at the point where it's like, the lower the better on LDL. And diet is, like, recommended as a major way to, as a lifestyle way to help control LDL. But that effect size is going to vary quite a bit. And I don't think you can do anything with diet to get down to, like, than 30 or 40. There's these old sort of like simian diet like mirroring this like super high plant-based diets, lots of soy protein, lots of high PUFA oils. And people can get like pretty substantial like 15 plus percent lowering an LDL cholesterol from these diets. But like that's

not getting you down to like below 40 necessarily. Well, it's also the same when I screen people for cholesterol and I find their LDL to be above 200. I'm almost telling to them like, like this is probably not because of your diet. This is a genetic issue because to get it that high is it's, yeah, it's tough. I mean, there are like, we've seen it in the era of kind of keto or something, carnivore keto diets where people are getting like, if you're getting 80% of your calories from fat and you're eschewing poofas, then the natural fat composition of the foods you're eating is getting you like 40 plus percent of calories from satrots.

And so we've seen people get like super really high. And like it comes down with, you know, dietary switches. But apart from those like obscure scenarios, I try and orient people like, let's see if we can get down like 10 to 20 points with a lot of dietary changes. And people vary like the nature of the genetic issue that they have that's leading to their cholesterol being high. Like sometimes it's responsive to diet. Sometimes it's not. There's not like a great way to predict that necessarily. You know, there's random things in diet that can like I had a patient one time who Turkish, like boiled coffee contains.

these plant turpenoid compounds that raise LDL. And they're like good data on this and makes coffee epidemiology really messy because study to study done across different countries, we're showing different relationships to cardiovascular mortality. And it turns out like if you're drinking like six cups a day of a boiled coffee, like a Turkish coffee, you can be like it raises LDL quite a bit. And so I've had patients drinking boiled coffee,

not putting it over a filter that are just ingesting tons of turpines. And they stop that and they're cholesterol. goes down 20 points. Wow. But they were like high consumers of this like obscure things. So every like diet through many different mechanisms. It's mostly fat composition type of fiber, a little effective dietary cholesterol,

obscure things like like turpenoids. Yeah. That can really impact LD. Probably the polyphenols impact LDL a tiny bit. But they all work through potentially slightly different mechanisms and your patients all have LDL being raised for slightly different reasons. So a lot of like when I talk with patients, it's very much setting the scene for like,

you might see magic, you might see nothing. We just, like, I want to be clear that we know the, like, general average effect, but there's quite a bit of variability, which underlies a lot of the academic enthusiasm for precision nutrition of, like, trying to predict why is there so much inter-individual variability in their response to diet. Yeah. I'm going to ask this next question, not with your thinking cap on surrounding acute, hospitalized medical

interventions. Thinking more chronic disease, average person who wants to lower their risk, or perhaps lose weight or something along those lines. Is the notion of food, is the notion of using food as medicine, overrated, and really not very valuable? Oh, man, I'm going to piss off some people. I asked it in this very specific matter specifically. I think seeing food as medicine is wrong on several fronts.

There's not a great way to look at food on several fronts. Like the totality of diet can have medicinal effects for sure. And nobody's denying that. But like we're not studying food as medicine for the most part. Like if you want food, a lot of people say food is medicine. And then you ask them, okay, well, where are the randomized control trials with heart disease endpoints for foods? And it's, I mean, you have like the predate med study is like one single example. but most people don't want to study.

We don't have the level of evidence to back up the statement that food is medicine that we have for actual medicines in almost all cases. And so I think that's a bit of overstating the efficacy of food-based interventions. I think a lot of the food-is-medicine stuff comes from the idea of like we should do healthy food prescriptions and this sort of stuff, which there's active trials ongoing around that. I'm curious to see what the evidence is. I have no idea how it's going to turn out necessarily. But food is medicine also, like, tends, I see a lot of hyperbole around it that makes me quite cautious, like, oh, olive oil polyphenols are going to, like, cure you of breast cancer.

And I'm like, it comes with this, like, weight of having this, like, massive treatment effect. And there is, again, Evans, like, the dash diet having, like, close to first line pharmacological therapy for blood pressure lowering. And, like, I don't want to undersell that at all. And I want people to appreciate the, like, what they're eating on their plate every day. does impact their health. But it's definitely like overstating it. And I think makes it very prescriptive when there is a lot of flexibility. Like we nutrition has not always done a good job of tailoring the diet to an individual's culture or preferences. And there's a lot of ways that you can take dietary interventions and adapt them to whatever your socioeconomic status is, whatever your

religious beliefs are. Food is medicine sort of takes the very small subset of foods that we have studied, which are mostly, like, there's a lot of, like, love for the Mediterranean diet. And there's nothing, like, that we know of that's, like, so uniquely amazing about the Mediterranean diet. It's just that, like, nutrition is, like, science happens to study it. Yeah, science is founded in, like, Western traditions. And so they got interested in the Mediterranean, but, like, you could probably have a Japanese, traditional Japanese diet, traditional African diet, all that if we put the money and resources into understanding those foods, the food composition and design trials around it, that you would find similar benefits

the Mediterranean diet when you look compositionally at the foods. There's no reason to believe that like it's all that magical. So it puts a bit too much mysticism around food for me. It's like it's not about the food. It's about the totality of a number of interventions across their nutrients.

It's like a food lifestyle. Yeah. Yeah. It's I want something like that conveys a similar message but like more timid. Food almost is medicine. Because I, you clinically you see the dark side. of this. And so I did my clinical training at the NIH clinical center, which you don't get there

until you've gone through many specialists, particularly to, like, there's a lot of oncology patients. And they are there on like a carty cell therapy as like a last ditch treatment after several others have failed. And you see patients, family members, spending their last dollar on food and supplements that they fan, magical dietary regimens, green juice, fasting. And they have really bought into this like food is medicine. And, it's, I can't tell a patient, like, there's no randomized control trial data to support really any of this. And I think that's a, I can't tell you the number needed to treat, number needed to harm. I've seen harms of it like anecdotally as a clinician where patients who definitely

did not need to lose weight were already wasting away, got put on a green juice fast. And they are now emaciated even more three months later than they probably would have been if they had drank an insurer. And so, yeah, I think that is where, I know you said don't go to the impatient setting and I just went to the inpatient setting. No, no, no. I think that's a very concrete, clear example. I just meant don't go into the inpatient setting because I know it's very easy to start saying, well, someone congestive heart failure, or you want to put strict limitations on their sodium, or you have someone who has calcium oxalate stones, you want to tell them to avoid spinach. You know, like, there are sometimes we're like, because we just did

a video with a famous chef where I presented a case to him, and he had to guess, I guess, because he's not a doctor or anything, what the presentation was and what the treatment would be with his cooking. So we used food as medicine there. Oh, nice. Okay. But it was, I presented him a pirate story who had scurvy and he created a citrusy meal

or a celiac patient where he took out, used specific noodles that didn't have wheat in them. Right, like a patient with PQU that's on a restricted phenylalanine diet. That's like real, where really food is the medicine. Yeah. I think there's like food has beneficial effects for health, but this is where I worry about calling it medicine. I think if you go ask dietitians who work in different areas, like inpatient dietitians love to say food

is medicine, but they mean the insure that is preventing the malnutrition in the patient is the medicine, which if you go out to the, you know, the regular general population, they think insure is poison because it's seed oils and corn syrup solids or whatever, or multidextrin. And so I think the vibes of food is medicine are good. If you got people in a room and ask them to define, okay, well, which foods are medicine at which dose is, and for which populations, you'd come up with 85,000 different answers, unlike if you ask, what is a staten? It's pretty obvious. It's standardized. Yeah. Yeah, I think those two schools of thought really need to be hammered into the minds of people when they watch content surrounding nutrition,

because food is medicine for someone working on the inpatient side, which is why I want to avoid that. Not avoid it, but like initially in that answer was because it's different then food is medicine as it's talked about colloquially, like amongst friends. Right, yeah. So I think that that is an important takeaway, because what does it mean that food is medicine? Can you really eat an anti-cancer diet? Like, what the hell does that mean? I would love for the U.S. to fund research to know if there is a diet, we should be feeding one,

patients have specific types of cancer and doesn't have any of that. And even that. It's very hard to do. It's hard to do. And that's in a specific population. Now, extrapolate that even further. For a person that is healthy, almost not having cancer in a screening way. So you're taking a healthy population, you're saying prevent them from getting cancer.

Talk about making it 10 times more complicated than already the complex picture you try to do. And that's where I think general guardrails are fine without getting hyper-prescriptive, like high fruit and vegetable diets, maintaining a healthy body weight. It was like general guidance from the world, Cancer Research Fund, than the IACR that put together these like monographs of diet for cancer. And it's overwhelmingly prospective cohort data. We don't have like for cancer, it's a bad one because we don't have like biomarkers really that we can readily

control the diet and assess. And people come up with ones, but they have kind of questionable prognostic capacity. So for certain outcomes, we have like, I think just naturally more robust evidence where you can measure blood pressure. You know, blood lipids take only a couple weeks to reach a new sort of homeostasis.

And so like you can, do a dietary intervention study in just a few weeks and see, okay, blood cholesterol dropped like 15% or whatever, great. And that persists over time with those changes. And so there's different biomarkers, different diseases that we can say a bit more confidently that like the totality of dietary changes has a effect that is potentially relevant for prevention. And in other disease states, we don't have as much data or we only have one type of data. So it's, yeah, I don't want to undersell, like people get really in the weeds and a lot of stuff. And it's like, we've had the diabetes prevention program, like landmark trial that

used the supposedly poisonous low-fat diet if you go on the internet. But there's a low-fat diet to counsel on weight loss, get like an average of around 7% weight loss. And you see huge improvements in people who were pre-diabetic at baseline kind of not progressing to type 2 diabetes diagnosis. So like we- Which is something you spoke about with my recent interview with Dr. Jason Fung where he said that it wasn't part of diabetes sort of management. Yes, that was an interesting history that was told. Well, because I wasn't around then. It was hard for me to understand that.

But what is the actual reality when it came to the early 2000s of management of type two diabetes? Yeah, you get the diabetes prevention program in the trial in the 90s and a few publications that come out from it that start to show that like, you know, the degree of adherence to the low fat diet and the weight loss is like highly predictive of not progressing onto type 2 diabetes, like to late 90s, early 2000s. you see these publications pop out. So by like 2002, 2004, ADA is putting out their position statements.

And you can track it across the 90s. They always kind of said, beyond the evidence, at least with the way that we look at it now, like lifestyle is important. And weight is probably a risk factor, like counsel on weight loss. But it gets more, I think the impetus for it and to focus and the guidance, like, really starts to get hammered in in around 2002 where they're like, we've got the DPP trial now, which is still a super landmark trial you look back on. And like, we know that, you know, it randomized either to lifestyle or to Metformin or just to

control. And the lifestyle and metformin do quite similarly and quite well in preventing a number of individuals, a large majority of individuals from progressing from pre-diabetes to diabetes. And like, that's Prevention 101. If you want to call that food is medicine, but all those people are eating different foods. They were all had sort of their lifestyle counseling individualized to what their current state was. And just, again, it focused a lot on weight loss. And there were like other dietary goals. But this was like even pre the era where like there was a big focus on like reducing sugar

sweet beverages. Like that was not like a major component of the DPP per se. So yeah, like the people I think want it's like fine-tuned hyper prescriptive, super granular. And that's fine. If you've done all the big think things leading up to it, I think people have to realize there's like diminishing returns for the most part. Okay, flights on Air Canada. Oh, wow. Majorca, that's new. Oh, nice.

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supplement. That's great. And I'm not here trying to, like, gaslight you if you think something does something amazing. But for the population at large, the tools of nutrition research can, at best, for the most part, give you some of the broader guardrails that you should be following. And then it's, you know, takes more and more trialing and of one type stuff if you want to, like, fine-tune the details later on. And then you should be seeing a medical professional if you have like very specific issues or concerns yeah yeah this is where doctors take a lot of smack talk where they say doctors don't know anything about nutrition or my doctor has never talked to me about nutrition and i'll talk to a patient and i'll give the general guardrails about

like increasing fruit and vegetable intake lean cuts of meat if they do consume meat you know like just some very basic things, trying to get some fish into the diet to get omega-3s. And then people say, well, it sounds like you're just telling me to eat in moderation. And I'm like, I kind am. Very sexy. Yeah. And I know that's like what grandma used to say. And, you know, a patient will come in and say, like, is it terrible that I have ice cream once a month? Or I have a hot dog because I saw this study from some classification that said process meets increased rates of colon cancer by X percent. And I'm like, look, it kind of is in moderation, but like what moderation means to you might not be what moderation means to someone else. So we have to be careful about

how we say it. But in reality, when I'm talking to patients who are living in real life, and when I say real life, I mean not the concierge medical population that are millionaires and billionaires that have a chef traveling with them. Yeah, exactly. So that is kind of a unique population because it's not real life like i'm talking to people who have jobs who have children who have multiple jobs multiple children and are stressed out and what is right for them yeah and for me it's more about trying to remove some of the bad habits or limit some of the bad habits rather than think about boosting immune system or boosting health or health hacking and people view that negatively on social media because they say oh it's because you're not as advanced as the experts

on the Huberman podcast. You don't understand the research that they're looking at and you're just being simplistic. What is the counter to that? So I can use it in the future. Yeah. Oh, I mean, there's not like a quick counter, which I think it gets back to this problem.

But I mean, to like unpack that, I think, you know, people are, I guess, the other experts that are providing hyper prescriptive advice, I would just always encourage people like, real, in real, like, clinical nutrition where, I mean, you're getting five minutes to talk about diet, maybe max. Like, even where in nutrition you have an hour, like to, like a real dietitian has an hour with a consult for a patient. Like, you're doing like a whole diet history, a whole assessment of all of their, whatever they've had to clinically done to them, their biochemical labs, their

body, what we call anthropometrics of body waves or waist circumference, anything that might inform upon their nutritional status. Before we then talk about like, what are your values and preferences and what foods do you even have available to you and then thinking about like what changes can we make. And so I'm always... And even with all that data, how drastic are the changes that you're making? Well, so they're just super tailored.

Like what you're paying for essentially with the dietitian is to be like, let's think about, let's triage of all the, like, there's thousands of products out there. Right. And thousands of influencers who, if you went out and did every single thing that they confidently told you to do, you'd be broke. Even the like rich millionaires are probably,

be spending $10,000 a month on supplement because there's always, I mean, there are, I've had patients taking more than 45 supplements. And like that is not an upper limit by any means. And so if you actually want to like figure out, well, what is the most likely to benefit me? It takes a pretty detailed assessment and then really tailored to you as the individual. And that's what I think you should want out of it. Somebody who at baseline is cookie cutter saying take 250 milligrams of magnesium, take 200 milligrams of turmeric, 95% cucuminoyates, or whatever, that they're going to say, like, over and over to every single person, that's not, it might seem hyper-specific, but it's the least individualized thing as possible. It's just as generic

to me as the general guidelines. I agree, but this is how people get tricked, and I see this in the real world play out a lot. They go see a doctor or specialist someone. They do some kind of tests. Yes. Because you're doing tests that are validated, that have some logic behind them. They'll do some tests and they'll say, I tested you. I'm the expert. Here's what you need. Almost, I'm probably going to get in trouble for saying this, people will watch a lot of chiropractor videos. You've seen them online? Yeah. The thing to me that's most interesting is the people who very much support, let's say, chiropractic medicine for relief of pain, for relief of symptoms are usually people who are interested in natural remedies, natural cures, don't want to be on

medications. Totally reasonable. I think that's a good general standpoint to start on. But then those people also want individualized care because they want to be treated like an individual. They understand human bodies are different and pharma oftentimes misses that and in the day and age where it's run like an assembly line, all those negative things that they say about modern medicine. Agree. Now we're on the same page. But then if you watch any chiropractor video on TikTok, whatever, they're always doing the same three things. It doesn't matter if you have knee pain. It doesn't matter if you have toe pain. It doesn't matter if you have neck pain. Doesn't matter if you've been in an accident, not been in an accident. Play sports. Don't play sports. They're doing the same three things.

And that's what it comes down to some of these influencers where it's like, yeah, they evaluated you. But was that evaluation actually valuable enough for them to specify what treatment they're telling you. How do we decide that? How does it how is a reasonable person supposed to know? I think that's a million dollar. If I knew the answer to that, we would, I would be much wealthier than I am. Yeah. I mean, the nutrition world has eight million versions of that where it's like everybody's got a gut reset program and they've got in nutrition like laboratory testing. It's so hyper context and specific that like sometimes a plasma nutrient, like, level does or doesn't inform and it depends upon your state and all these sorts of things that

like I as a PhD trained dietitian need. I'm like, I know what the DRI said. I know the validation data. But you can go out. I've had patients come to me with IGG food sensitivity testing, a spectra cell micronutrient lab from white blood cells, like all these things that are being used by other practitioners to like guide their diet. And I think it just kind of hooks people in for longer because you do the baseline testing. Do a follow up test. And then you make tweaks. And And then when things don't move in the right direction, you do another change. And it hooks people in for a much longer consultation with that practitioner, which helps them build up rapport.

And I get a lot of patients who are five years in having tried various of these practitioners and are just frustrated and tired of people selling them like a quick and easy solution. Because I think they start, right, the skeptical of modern medicines, like hiding something from them about like a quick and easy solution. And then eventually kind of to come to be frustrated with the alternatives that are all very confidently providing them with, I know the way the truth in the light about diet and supplements and natural medicines. All I try and do is arm people with like, what should make you skeptical? I encourage folks to be skeptical of pan practitioners as in they practice

and everything, like pan as an all. And I get people coming to me as a dietitian who are like, okay, well, what's my exercise plan? And I'm like, that isn't, that's, do it. That's exercise. But they're going to people who are giving them entire like lifestyle overhauls on this is your supplement routine this is your diet routine this is your you know exercise routine and it's just at some point I think folks need to realize that like very few people are experts in all those things I am very big on scope of practice even within nutrition there are domains I try not to touch on it all because it's just outside my feel and I'm not up to date with the most the most relevant data and so but we're seeing that everywhere on social media where people are

pretending that they can walk in five lanes and be an expert and everything and that's just not possible. I would always encourage people to look at the totality of what's out there. Like, it's fine to want to get somebody's opinion on a single supplement, but just also realizing that there are many, many other practitioners you could go see that are going to tell you with the same level of impotence and confidence that impetus and confidence that this other supplement's going to do the same thing and that there's dozens and dozens of dozens of supplements out there on the marketplace. And just so going in, being skeptical and having, trying to think about like, okay,

I'm going to, if I'm going to try something, I need to know, how am I going to decide when I'm going to try, work with a practitioner who's willing to kind of do that with you and not is just like confidently selling you one thing that they're also doing for every other patient that walks in through the door. And having like some sort of test set up to like, okay, what do I need to know a priori needs to improve? I need to, how am I going to objectively know that I feel better, sleep better, whatever it is, whether it's like through a log or something that you're doing, and give it three months and see

if anything meaningfully changes and be real with yourself. Because that's, if you're not walking in skeptical of the practitioner and the products that they're selling you, you're going to end up on selling tons of money, seeing a bunch of different people on 45 different things and having no idea at the end, you're going to be in this soup of like, well, maybe I feel better, but I don't know which of these 45 products was doing it. But we are sort of in this, like, wellness capitalized, the capitalist health game out there where you can just sell anything.

You know, if we allowed pharma to make the claims that supplement makers are doing, and supplement makers aren't even making it themselves, it's not illegal to have your influencers who have an affiliate code doing all the illegal marketing for you nowadays. So I don't know that there's a way to combat the one-on-one, like, good feeling you get when a practitioner is listening to you, you start to trust them, and then they have, the answer for you other than to convince people that like that's not real yeah it's it's a good feeling in the moment and I wish modern medicine could combat this by not having six minutes spent with your doctor trying to address everything um I wish there was referrals for dietitians

you can't most insurances will not cover dietitians or maybe just a couple visits at best a lot of times you have to have type 2 diabetes or chronic kidney disease but like we as practitioners I think are, you know, we get the 30 minutes to an hour to sit and develop a rapport and trust and individualize with patients. But a lot of people are looking to their doctors who have six minutes to cover their entire everything clinically they need to cover to somehow cover nutrition in that. It's just, it's an impossible task that until things change and you can actually go see a nutrition practitioner and it's accessible and affordable to people. It's, I think it's a big losing battle for folks. I have a specific question and a very interesting question.

that I don't understand the nuance of. Specific question is your patients that were jumping around from those providers that were encouraging to take 45 supplements or follow their protocol, what have you. If you can, and you've seen them harmed by it, right? Yes. So you can go back. It's usually why they're at my door. Exactly.

They're like, I have all these nonspecific symptoms that we can't figure out which of the 45 supplements is the problem. So if you can go back to before, that person went to see those providers and say something to them in order to prevent them from falling into this trap. What would you tell them? I don't think I would tell them anything specific. I would just listen to them hear what their problems are and talk about, like, I will talk about any data, diet you want to talk about that you want to try, support you in it. That's what I like. Nutrition guidance for the public is like almost a losing battle because everybody has

different reasons that they eat. Whereas like with a patient, it's just a matter of, I think a lot of people go to alternative practitioners because they just don't feel heard by their doctor. And sitting down and saying, what are you feeling? What have you heard? What have you read? Let's talk about it. And I've a very select patient population, but this is from my experience of folks coming and they're like frustrated and just, I think, feel relief from somebody listening to them, explaining the nuances, the logic behind and the data, you know, because everybody's now as a PubMed ID and their Instagram bios or in their Instagram posts saying like there's science to back this up taking a little bit of time to walk through well this is what the science said this is

where there's uncertainty in it where there's not uncertainty in it and what it might suggest and doing that for all the things that they're hearing about just to make them feel empowered and know going in whether something is likely to work or likely to not and they can call it quits in three months if they don't like it I think is most of the solution here is just listening to patients and helping them feel empowered in a situation where when you turn on Instagram, it's like the least empowering thing in the world. You have a dozen people who are telling you that you can take control of your life and they all have different solutions for it. Again, vegan to carnivore. And that puts this pressure on to patients. I think people feel

it more and more that there's just pressure on the general population that like they have to put in the work to try out everything. And then when they fail, when it doesn't address their symptoms, like they feel like they've failed somehow and the next person in line is going to tell them well it's because you did this diet and you should have been doing this diet and then it's on them to again undertake a new diet and so it's this perfect cycle where you keep spending money

and it's always your fault when things don't work out and I think kind of flipping the script on that and just being like I will I will tell you the uncertainties in the data which there are a lot and we can come to like a you and me together and hopefully led by you as the patient like what you want to do, what you want to try out, how we're going to think about setting up some sort of a protocol essentially for whether this is going to help your symptoms

or not. But going in clear-headed where I'm never going to lie to a patient and be like, yeah, every single person needs 300 milligrams might need of me or sleep will be like massively improved. I'm like, because the data just isn't there for that despite it being repeated across all of social media a lot. I think you need to have people who are also ready to hear that. There are people who are like very much in the true believers of specific things. That's totally fine.

Everybody's diet has always, you go back for thousands of years in every culture, every culture has beliefs about diets. There's a ritualistic element of it that almost fulfills like a religious thing. I think that's, for the most part, good until you start getting people with like xanthomas from their carnivore diet and you're like, okay, it's gone a little bit too far. But I think autonomy and choice around food is something that we should promote and use the sciences is a garden rail to nudge people in directions that we think are helpful and then just be honest about when there's not data for stuff. But that is something that does not make you a lot

of money as a practitioner. I can tell you. Yes. And tying to not making it a lot of money, it's hard to get that information out because the algorithm is sharing things people instinctively lizard brain want to click on and share. And they're not instinctively clicking and sharing content from you saying, uh, food, let food be thy medicine is not as cool. outside of the hospital as you think it is, they're thinking more, I want the person who says there is a cure for what ails me. And they share that. That gets all the love. Therefore, the good evidence kind of gets put into the background. Yeah. And I think it wouldn't be really, like, one, all those sites are e-commerce sites at the end of the day. If you think social media is just

for interaction with your friends, like everything is e-commerce nowadays. They're all trying to sell you something. But like I have like weird autoimmune stuff that doesn't fit into any textbook diagnosis. And so, like, I have been there being like, I will buy anything that might be helpful. But I think that is, like, the most, the vulnerable populations that need to be the most skeptical. And I'm saying that from my own experience of, like, having spent money on random stuff that I hope to be helpful. And, like, sometimes you have to learn through experience of, like, I try this and try this and try this. And then five years later, I still have the same autoimmune symptoms, maybe slightly better. But helping people set that, like, realistic expectations about what you're getting.

we have so much skepticism around like how is big pharma and big food influenced food nutrition guidance and i think realizing that that doesn't make the little guy on instagram like somehow free of conflicts of interest if anything they often have more they're like directly um benefiting and their whole livelihood is dependent upon selling stuff so it's 2025 people lie on the internet I think it's kind of like a theme that we all need to just embrace and then navigate that wellness landscape. And even if you do have something like a serious condition that doesn't have a clear medical treatment for it, I've had those patients. I'm like, I will talk you through the theory if you want to try something, the safety associated with it, noting that there's no randomized

control trials that show that this is helpful. I think you need more practitioners who are just open to listening to patients with where they're at, which modern medicine is in no way helping patients in that sense. Hit pause on whatever you're listening to. and hit play on your next adventure. This fall, get double points on every qualified stay. Life's the trip. Make the most of it at BestWestern. Visit bestwestern.com for complete terms and conditions.

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Like that woman over there with the designer jeans. Are those from winners? Ooh, are those beautiful gold earrings? Did she pay full price, or that leather tote, or that cashmere sweater, or those knee-high boots, that dress, that jacket, those shoes. Is anyone paying full price for anything? Stop wondering, start winning. Winners, find fabulous for less. You said people lie on the internet, especially in this healthcare space. Are you comfortable naming any of your worst offenders? Or perhaps if you don't want to name names, the theories that they've put forward. I, I, I, that have tricked the most patients of yours or perhaps you've seen the biggest impact on.

Yeah, I mean, you might have interviewed some of the podcast. I don't know that like there, I see themes. I like truly try not to track. When I'm most concerned with this healthcare practitioners on the internet that are like just repeating things that they've heard uncritically, like there's a lot of both dietitians, physicians, nurse practitioners, you know, dancing to cute TikTok videos of like these are the five foods to avoid or whatever. That's what I get sent a lot and what I like am most likely to criticize.

The big sort of people who have a. brand and are obviously selling something, I think the public just needs to be skeptical and there's not, I don't spend too much time like critiquing those things all that much. I think there is general, what I focus on are like themes to be skeptical of over people because all these top influencers have a PCOS nutrition guideline and now they all have menopause supplement lines and then they all have a gut health thing. And so I think the public being aware that like these are sort of like hot gimmicky things that sure there's a bunch of microbiome data and nobody's doubting that the microbiome is like related in some way to health but that doesn't

mean that there's testing it is going to give you any valuable testing is not going to give it a therapy that someone claims works through the microbiome works on the microbiome isn't doesn't mean it's clinically efficacious for anything um and at the end of day for nutrition always comes back to like eat a high fiber diet that's what i find hilarious about those send in microbiome tests patients will ask me if they should do them and I'm like, I can just give you the advice for free right now and it's the same advice and it'll be the same advice no matter what bacteria

is in your microbiome. Yep. And if you tested it tomorrow, it would be very different. Yeah, exactly. And all those things are like 16 S RNA based for the most part and it's what does that mean? So it's above my it's how they sequence who is there essentially in your gut microbes. But it tells you like the relative

abundance of specific bacterial species essentially like it doesn't capture fungi and viruses even so it's not even all the microbiota there. It doesn't tell you what genes they have. So you need whole genome sequencing to do that. And then it doesn't tell you about their function, which you can start to get at from looking at their transcriptum or at their metabolism. And so there were like many different metrics you can lay out for the microbiome. But knowing the relative abundance of which bacterial species are there versus not is like minimally informative. Like it was hot

early on as an early microbiome method. But like a lot of like top researchers in the field who all are saying, we don't know the best probiotics, we don't know the best diet to individualize around your microbiome. Don't buy these tests. They're like not even using these things in research because it's not as advanced as it needs to be nearly as much as they were because they were relying on early. But these, there's a lot of gimmicks out there. Things that are like, I think people want the feeling of being on the cutting edge. But the cutting edge often means we know very limited about it. And that's fine if you want to do a diet or a supplement. or something.

Yeah, but being real with yourself, but like, cutting edge means high uncertainty. Yeah. And I think that gets left out a lot of times in the marketing and the hype of things. And that cutting edge doesn't mean that everything that happened before is necessarily wrong. Like, there are, there are blockbuster trials and nutrition that change nutrition recommendations that are like, like, with peanut allergy prevention and young kids. It used to be said, like, delay. And then that, then blockbuster trials, like, actually, no, earlier isn't.

much better. And when there is definitive evidence like that out there, there was like a huge full court press for changing. Yeah. Like no one's secretly hiding this like this top information from you. Again, like in chronic disease kind of stuff, it's uncertain. I think often you'll see people overstating the relative confidence we have in the data. And I understand why that degrades trust. But there is not like secret blockbuster studies out there that people are hiding from you. We don't fund nutrition research seriously enough to have those blockbusters, like things. So yeah, it's, I don't remember where we're talking about. No, no, that makes a lot of sense. If I was your patient and like we're sitting side by side like this and I say, doctor, like this,

this microbiome test came or this blood test came. They told me like if I do this, they'll be able to tailor my nutrition around that. Should I do this? I would say no. Well, I'm curious what the conversation would look like. Why would you say no? I would just say, like, you know, currently no medical guidance recommends this. These tests are, like, have limited evidence sort of backing them up. So something general to that effect of, like, there's not really data for it.

And I usually ask patients, do you want to go into, like, what the theory is and why people are pushing it? And some patients want, like, the deep dive. And some people just want to hear no. And there's various shapes. What's the deep dive of why those things in general? fail. Failure sniff test, I mean. Yeah, one of the ones that you see the most common is the food sensitivity tests, which you can buy now and like target from everly well or whatever. And so they're like

IGG based food sensitivity tests that get sold as like the more IGG you have and reactivity to a specific food, the more like you are to be like sensitive to it. And they're not really defining sensitive. It's just like this nebulous concept of I feel bad after eating something maybe. but those are like the science of IGG is a secure immune system is constantly you have immune cells all along your gut and they're interacting with food-derived proteins and it's more of IGG is like a marker of a tolerance like you make antibodies to foods that you've eaten recently and so I've had patients who like and I use this story a lot like where they eat something and it scores high on their IGG test and

then they cut it out of their diet and then they come back and then now they get totally new foods that they're supposedly sensitive to like there's not really a time at which you're not going to have high IGG to something because that's just a normal so why are these companies why is every every well every well yeah every well why are they selling this if it's clearly disproven and doesn't work I think there's like is it hope that it might work or like there was early in like attempts at using It's like a, for just anybody who knows about diagnostics, it's like the worst thing in the world, has very poor sensitivity and specificity for uncovering anything. And nobody wants a diagnostic test that never gives you an answer of no. Like if you're always diagnosed with like you're sensitive to something, that is like a grifter's dream and not a great sensitivity test. So yeah, I, I got the people are making money out of it. There is anecdotal like evidence that people are saying like, I told me I was high on this and I cut it out. And like those. the action taken from it may well be real.

Like if you score high on wheat and then you have like IBS and you cut out wheat, which is like a major source of FODMAPs. Like you might feel better. Like there's biological plausibility for how these things could work in a way for somebody that didn't ever really require the test. But they also didn't get maybe they didn't have access to a dietitian or a physician who knew something. So you can stumble into, I think, something that works.

But that's like the clock being right twice a day when it's broken. The broken clock right twice a day. Yes. But, like, I don't want to gaslight people who have done it and say that they've had a benefit from it. But it doesn't mean that it's indicated for the entire population. And there are ways to find out about foods not working well with your body that are not that on scientific. Well, yeah, I mean, the gold standard in GI, like, clinical diet practice is just like food logging and then, like, symptom logging and then trying to, like, review that after some time and then trialing elimination diets. So it's not, it's like not high tech.

I think it's just very sexy. But, like, there are other diagnostic tests out there. Like, everyone wants to optimize around, like, micronutrients. And so people will measure micronutrient. Like, there's, like, I think it's spectra cell. But you can, and there's probably others now at this point. But I've had patients come to me with, like, I got my micronutrient panel and all the amino acids.

And it's all from their white blood cells, which white blood cells are not, like, a validated matrix to measure any of these things and say, like, when you measure something in the blood, you don't really care about the blood, usually. You care about, like, how much is in a tick. tissue, and whether that nutrient is performing the function that it's supposed to perform for your physical, your health and maintaining your physiology. And so measuring the amino acid levels of white blood cell isn't really telling you about whether you have enough amino acids in your liver, but it's- Or your muscle tissue. Or your muscle, yeah, like, it's, but it's implied

that it's somehow useful. I think this is something for, like, laboratory testing in America. Like, there's more regulations around making sure that you get the same answer twice than there is about whether the answer is meaningful. And so we have a lot of laboratory tests that like I've had patients come to me with full cardiovascular risk panels with all these like cytokines and things I've never even like heard of. And I go look up the reference from the laboratory test. And it's like one study shows that it's slightly improved specificity and sensitivity in predicting who would have a 30 day readmission in patients. Patients who were like at risk of it who had just had a heart attack inpatient.

patient, whether they be readmitted 30 days later, is now being measured on somebody who's like just a normal, generally healthy population. And like even in those inpatient people, like your blood cholesterol and your BMI and the majority of the bulk of it. And so there's no added value even in the setting it was tested. But you have to go to PubMed and understand diagnostic testing. So you're just getting it sold to you as a product. Yeah. And I think a lot of practitioners are not nearly as like a lot of alternative practitioners sell this stuff and they're either not being skeptical or know that it sort of is a buy-end to hook people in for longer. It gives them something to do. I think patients leave always wanting to feel like

they, this is the classic. They got a parting gift, right? Yeah, the antibiotics for viruses, yeah. And nutrition, I think, it's something similar. And often, it's a huge problem with the scope of practice of dietitians of like a lot of it is education. Like, I mean, inpatient stuff, you're like, you have specific prescriptions for formulas and whatnot. But like, if you're just educating people on based off of like what they told you and you're telling them what you think the diet should look like. And I think it's always it should for good dietitians that we really need to be trying to like deliver something. Like I try and have spreadsheets available for patients where they can see the math that I have and like just to feel like they're getting

something and do like a little meal plan. I teach people how to meal plan with like a coded Excel spreadsheet if they want that. But to feel like you're delivering something because that's often a lot with the alternative practitioners have and they get a ton of money out of like you have to pay for those tests and then they're coming back again and again to review it and but none of them are really indicative of like they're not doing what they say they're doing of like they're measuring the status of a nutrient in your body and then there's no trial showing that like randomizing people to getting this test versus not are actually improving any clinical outcome for the field of nutrition outside of doctors there exists a field of

nutritionists and dietetics. What is the difference? Why do I get so much hate in the comments when I say it wrong? What is, what do I need to know? In America, there are, there's not like really as many like federal regulations as you might think. So there are,

it's like very state by state. Dietitians is like a, typically it's a protected title in a state. And so you have to have gone through, A specific series of, like, now it's a graduate curriculum that we call the didactic program in dietetics, so your didactic courses, and then like a thousand hours of supervised practice and then pass an exam, and then you can be a dietitian. Nutritionist is not. And that's like a master's?

Now it's a master's. It used to be bachelor's entry level, so you'll see a mix out there, but it's increasingly all masters. So I teach in one of the master's programs at Berkeley. So, yeah, your goal is to train people who are meeting specific educational, thresholds and clinical thresholds and get exposure to the general population, everything through like, you know, people doing nutrition support where they're either tube feeding or IV nutrition, like TPN on patients. And so that's like a protected title and that you should not be using the, saying you're an RD if you're not actually an RD. Yeah. Nutritionist is not a predicted title. And so I want to be clear this is specific to America. Other countries have more protected terminology around like the UK has like a registered nutritionist and they have a registered nutritionist. And they have a registered. or dietitian credential. We don't have anything on nutrition. So when someone says they're a nutritionist, what does that mean? You can't, gives you zero information about the person's training, background. So Sam could be a nutritionist? You're a nutritionist. Congratulations. No, but literally like you don't eat anything. I see people like they did a two-day workshop on like on the weekend and then they're

like, I'm a nutritionist, a career changer. And like some of the people who are like the most influential nutritionist online have no like formal training in any of this. A lot of it's like people coming up like got into bodybuilding and they have like the physique that somebody wants and then they sell nutrition plans and we'll call themselves a nutritionist over time but don't have any like formal training. We are actually bad at understanding this as doctors. Yes. Because we have like in my program, we have nutrition students. I have no idea what that means. I don't know where they're a student from. I know that they help me talk with my patients when I don't have enough time in order to give them education about what a carbohydrate is.

But I have no idea, are they studying to be an RD or are they taking some course? I mean, I'm sure they're not, but. I mean, I have met like, deans and heads of endocrinology programs who go, Kevin, what's the RD after your PhD team? And I'm like, you probably shouldn't tell me about an endocrinologist. You don't know what the dietitian is. But this is a problem, I think, for dietitians, too, is like, and nutrition becomes its own little insular world.

I mean, it's like a, you know, we have the EARs and the RDAs and the DRIs. it's the DGAs, we're like a whole acronym soup that is not really accessible unless you've trained in it that doesn't help us. And even just like what is an RD? It's a full acronym soup. But we, I think RDs need to get out there and interface more like a lot of what inpatient RD is even like you might, how many times do you interact with an RD in your medical training? So there was someone from nutrition that actually came with us on rounds. Yeah. Yeah. So that was a thing. But I just didn't know that they were an RD. Yes. I would have probably.

accidentally called them a nutritionist by accident. And you might have gotten a tongue lashing. I'm like less cage about it. I'm like, call me whatever. The fact you know I exist, great for me. I always have a problem because dietetics is like 90% female. And so I always got mistaken. They were like, oh, the medical resident.

I'm like, no, I'm the dietetic intern. Okay, got it. But yeah, dietitians, I think, you know, are humble, quiet, you know, they've fought to be recognized as like a clinical profession. You know, there's a lot of historical sexism. I mean, the field is 90% female for a reason. It comes out of the field of home economics. And then it really gets launched by like the wartime, like World War II in particular,

where there was like high rates of malnutrition, lots of concerns about the readiness of soldiers, making sure the food supply was adequate for both feeding people adequately at home and soldiers. And so dietetics got like a big launch there. But it's, I think, struggled. Back in biochemistry just was nutrition in like the 1940s. and so there was a very gendered like if you are interested in nutrition and you're a man you go become a nutritional biochemist and then if you're a woman you go into dietetics and a lot of like really badass women like fought that and you see like PhDs at various institutions who have done great work but I think in general the field still struggles to like be recognized taken as like a serious STEM major a lot of people like when you're in undergrad you don't think at least in America you don't think like I might be premed or it might be pre-nursing or might be like pre-dietetics. Like, that's just not, it's not a thing.

So you have to have heard about dietetics in some way. I'm glad we're giving it a commercial right now. Yeah, yeah, exactly. So should people, if they are listening to someone for nutrition advice, they find out their nutritionist, should they stop listening? No, no. I don't, I mean, so dietitians are like, probably, it would be great to go to dietitians. Dietitians are also, like, overkill.

Like, we're, like, medically trained professionals who are, like, can go and feed a baby with, like, short gut. in the NICU who just survived neck and needs TPN. There's like a really advanced skill set of dietitians and like not everybody needs that. I think you should go to people that you trust, that you have a rapport with that are not selling you a bunch of stuff at every angle. You feel like you're getting good coaching motivation experience out of. I want to hammer home because I know that message is so important.

I know people will, it won't land correctly. The idea of not paying for something. You're not saying that because you're anti them making money or that you're anti-capitalistic or something of that. You're saying it because there's nothing really to sell. Well, you should pay for, you should pay to talk to the person. Of course, yeah, but I'm saying like product-wise.

Yeah. There's nothing that exists that's proven that people can sell to make money, but also help you. Is that a fair, like, general statement to make? I think for the general population, yes. Like, you might run into something where it's like your diet is really low and something, you have a restricted diet, you're vegan or whatever. Like, they might tell you take a B12 supplement. That's like totally fine. General. You might not have much of dairy and I might recommend like a calcium supplement. I think when it's like this person seems to be pushing their

affiliate code link on every single person that they're in interacting with that you should become a bit skeptical. But like I've had patients like I with meal planning takes a lot of time. I'm not going to do that for free. So if somebody wants to pay for like a full meal plan. That's paying for the service of the thing. But when they're selling you the products, I think or the testing. that's when like red flag should pop up not because again we're anti them telling those things it's just because there isn't even one that i can think of you found like some very specific examples with vegans in b12 or folic acid yeah in those who are trying to conceive or of reproductive age but in general there isn't much to sell and that's why people judge the doctors are not

selling something i'm like no no no those are the people telling you the truth in the least sexy way possible, but it's the truth. So I think that that was just an important thing to call out. Yeah, no, I don't think there's anything that I would like think of every patient that I'm like, oh yeah, they needed that. Like, every single one of them needed that. Like it has to be individualized and it should be like, even in patients, unless it's like you eat zero B12 and you need B12. Like I'm medically saying do this. Also like how rare is that? Like, no, no, meaning rare is a specific incident of that being valuable. Yeah, it's definitely the minor case. But, like, I think

if somebody is trying to, like, it recommends a product to you once. Like, I'm definitely when people walk away, it's like, it's not a crazy thing to recommend a product once. It's when somebody's like giving you a cookie cutter thing. They're not being on it. They're telling you it's like magical benefits. Like, these are the red

flags. I usually encourage people to look for. Because you telling someone with folic acid or that's like such a specific thing. You're not pushing a line of B12 formulas. Like, that's where it starts getting weird. For sure. I mean, I even, I have to be careful about this. I've done work in like control trials in coline. And it's like one of the nutrients I'm like have the most perceived expertise in. And we had industry funding for it. But I get all these patients referred to me to talk about coline. And like, I have to be careful to be like, let me not like I'm, they want me to come tell them take coline. And I'm like, I want you to go see someone else to be honest. So like somebody, you should work with somebody that again, you trust is clearly minimizing conflicts of interest is not. kind of like push something on you. It depends, like pregnant women.

Like your practice probably should be saying to take a prenatal and an omega-3 because that's what's standard of care. So the product, like a single product being recommended. I think maybe this is where like nutrition and drugs are really different. Like often patients are coming to me asking for a problem. They want my take on like this specific brand of yogurt. Do I buy it or not? And so a lot of what nutrition is there being,

you have to interface with the marketplace. way that, like, is not behind a prescription pad. And so people are going to tell you about products all the time if you're talking to a dietitian or anybody in nutrition. And that alone isn't a red flag. It's somebody who's, like, dying in the hill of like, Follier is better than Chobani. Like, those are the red flags I want people looking for a bit more of, like, this feels off. They're married to this one thing. There's no flexibility for me. Because outside of the PQU patient where you need to restrict phenyliality, nutrition, nutrition, isn't very hyper prescriptive.

And even on things where you might think it's prescriptive of like calorie counts and everything, there's so much error in our estimates, there's an error in the amount that's in food. Like all of it is, is again, guardrails over prescriptions. And so, yeah, I... That should be the title of a book for you. Guard rails over prescription. Oh, I like academic so much more.

I'm like, I want to write my, the book I want to write is an entire history of like nutrition. Like, you know, something overly wonky that 12 people will buy. What do you mean? That would be in hype demand right now. I just wrote a 20-page review article on all nutritional guidance in America, dietary guidelines, nutrient reference, all the things that shaped their evolution over time. And so that'll be out eventually. But I was like spending hours on Internet archive, like reading 1890s like dietary plans from the USDA. And like, that's the nerdy stuff that I like more so, which again makes no money. In due time.

Yes. So if I'm a person that's interested. in learning what I can do with my diet, should I see I'm trying to lose weight or I'm trying to accomplish some goal. Who should I see? I mean, a lot of times with a dietitian, it's going to depend on whether you know somebody

or can find somebody locally. Oftentimes, like, ideally, you would be referred by a physician. So your primary care that you trust and have a rapport with, I think, is a good place to lead you in the right direction of, like, if it's just weight loss, do we have you, they'll know about,

what you've done lifestyle-wise, and I think there's more and more of realization. Lifestyles are going to be a small impact in starting, you know, something like the GOP-1s. So they might be able to start you on that. And then you might go see nutrition counseling on the side as needed. But it depends, I think, a little bit on what your specific concerns are. I would love to say, like, go see a dietitian. But I'm also aware that there are like 100,000 dietitians in the country. There's not that many of us. We don't get referral. Well, that's because it seems like Everyone sends someone to a nutritionist because there's so many more of them.

Because you doctors don't get taught in medical school. This is why I want, there's a lot of talk about nutrition being taught in medical school. And those ACGME hours are like fought after. And like the five hours that you guys end up getting of nutrition, I think are to be great. Because you're not going to become nutrition experts in that time. But somebody will tell you at some point, like, this is a difference between RD and a nutritionist. So some of the, I did my postdoc at Baylor College of Medicine. And they have like, they already had a nutrition education for a while.

And the RDs like teach it. And I know that they explain those basic differences of like when you do run into a nutrition problem inpatient, outpatient, whatever it is, whatever your specialty is, like, this is who to refer to. And oftentimes it would be a dietitian if you want somebody who needs like a full nutrition assessment basically. And it's not a bad place like to, if you're going to spend 200 bucks on the supplement for a couple months, like you might as well just talk to somebody who's going to like actually

take a deep look into your diet and talk about what are some like high level goals that you want to set maybe some swaps that would be high impact for whatever your concerns are and just orient you to like this kind of landscape that we're focused in but why are you skeptical when doctors say that they talk nutrition with their patients well because you have like three minutes to do it and so it's always a bit of a sound bite I mean I as a patient have had doctors like I usually hide that what I do because otherwise I get like half of the appointment I'm paying for is talked about the nutrition element of things. but I have a patient like doctors like my rheumatologist was like yeah you should go gluten-free

and then I was like you know that's like a lot of work are you going to provide me any like resources on that and she's like oh no I just tell patients to do that and I'm like maybe don't like there's no trial evidence for that being helpful for you like I get that there's anecdotal evidence of it but I'm like actually avoiding all gluten in the diet is like you have to know highly educated on all the different ingredients and whether they might be gluten-containing or not It's not just like a throwaway advice, but I think that's what happens with doctors. It's throwaway advice. You guys get training, like you'll touch on vitamins and stuff in your biochemistry classes

and your sort of like early MS1, MS2, like didactic training. You touch on nutrition in different ways, but you never get education in food, which is the basis of nutrition. Like you talk to doctors about like what food compositions are, how much B12 is there in different foods, like with the fatty acid compositions to different oils. Like this is all coursework in becoming a dietitian where you have to know the food science. you do food preparation, like you're taking, it's a hodgepodge career path of like, it's like you're taking anatomy and physiology and organic chemistry and then you're taking a food science chemistry type class and then you're preparing food and you're taking a community nutrition class.

It's just you get like a broad array of like everything and that's like a full four year degree. The idea that doctors can do that. And then like there is data randomizing people to like counseling from a dietitian versus with other practitioners, dietitian versus nothing, how much frequency of dietetic visits do you need? And it's like typically like six visits a year, hour long, like, so every couple months basically coming back up. And that improves like blood lipids and blood pressure and weight like meaningfully but

marginally. So the idea to me that like in those hour long counseling sessions that are hyper individualized with like an assessment and follow up that like dietitians are producing solid but like not massive effects, that it does. Doctor is like giving out a pamphlet and it's throwaway. And you have people who like obviously like we both know Danielle Ballardo and her patients I think do wonderfully and she's got like tons of information for them and she's got real people really like hyped up that are hyper motivated about lifestyle. But for the most part for the average doctor that's out there like just a throwaway comment like it's unlikely to do a lot of good. And I've also seen it do harm where like people misinterpret the advice in some way or they say oh this person told me I. I mean, I get on a scary amount of people, physicians calculating what it would take to be a normal BMI and what their current BMI is. And they tell them, like, how many calories to eat badee being like some super low number. And it's like some 1,200 calorie restricts of things.

Super low calories and saying, well, your BMI is 32 right now. And you need to lose this number of pounds to be a BMI less than 25. And it's like defeating for the patient. Right. They're like, I got no support or evidence. all he did was tell me that I need to lose a ton of weight that I have no idea how to lose. And so that sort of stuff has like off side effects that I think we don't want. And so I want doctors to be advocates for nutrition, like in the inpatient setting.

And to be aware of the field. Yeah, yeah. We should be able to have a conversation and it should be not me teaching you the acronyms and you being like, what is an RD? Who are you? And sort of like kind of what the state of nutrition, physician interaction is. And so I've talked with a lot of nutrition. nutrition physicians who they themselves are like outlier people because you guys don't have

formal fellowship training and nutrition. They're often Peds G.I. Or endocrinology that do like some nutrition fellowship training or like a one year of like nutrition focus afterwards. But they're just a handful. And so we need more dietitian, physician kind of interaction. You know, position statements should be written together. I think there needs to be more advocacy from the AMA for coverage of dietetic services. There's a little bit more that's happened with having like a big push for diagnosing malnutrition and like the inpatient setting that requires more physician dietitian interaction and so I have hope for the future for sure but like we have this entire career path that is like you we want nutritionists in society we have

a like legislated you know standardized way of doing that as the RD and for some reason we just like don't use it as a society like you don't well because I feel like they found a short with nutritionist getting a two-day course you don't even need the two-day course like I mean and so this gets into like there's a huge political battle here because like you both from a right and a left perspective you don't have support for like having some sort of credential around nutrition because like even if dietitians have a title act they don't always have a practice act per state that like so that there's not legislation around you as an RD like in California I don't have to have a license as an RD we don't even have a licensure

because the left once historically has been more friendly to like alternative medicine type stuff and the sort of alternative practitioners are huge opponents of dietetic licensure. And then on the right there's sort of like typically like a freedom to practice, freedom of choice

of who your provider is. There's kind of some overlap on the extremes. Yeah, but I think it's just in general that hasn't been like support for state or federal like broad saying like just like physicians are like we are the physicians and then they're all these alternative practitioners. And it took things like the DO is a while to kind of get recognized at the same level as MDs.

There's not a lot of like strong political capital fighting for like we need to have like this is the credential nutrition practitioner that people should see and should be referred to and should be covered in insurance. So it's a huge mess. There was an attempt to get dietetic coverage for the, it was called a Medical Nutrition Therapy Act and it was submitted in 2020. But it was never really, obviously, 2020 was a busy year. So I know that there's effort now to get a new, something submitted before Congress so that it can be pushed through. Because right now, Medicaid only reimburses for dietetic services once you already have type 2 diabetes or chronic kidney disease. It's like the least prevention focus thing that you can matter. You have to have the disease.

So if you have pre-diabetes, it's not going to get reimbursed and different insurances cover different amounts of dietetic visits. But like if you have like cancer and you losing excessive amounts of weight and struggling, to get, you know, if you're a family member with somebody with cancer and you're like, I have no idea how to feed them. You can't just like go see a dietitian who have lots of knowledge and strategies about that. So like as a society, we need to like take nutrition so much

more seriously and actually like funded. Yeah, you're talking about nutrition from I think the side that social media doesn't talk about it. Yeah. They talk about it like Dana White goes to see a dude and I say a dude because there's no real license there. And he says, I'm never seeing

a regular doctor again because they're only talking about diseases that they can diagnose now, but not about preventing those diseases. And I'm like, well, that sounds like great in theory, but what proven way are you going to change these people's lives outside of helping them maintain a healthy weight, you know, the basics that put people to sleep these days? What is that person telling you? Because I don't know. I don't know what miracle potions they're discussing, but I'm unaware that they exist. Yeah, I mean, when I talk about dietetic like reimbursement and coverage, it's like the landmark trials like the diabetes prevention program that were just like, study dietitians were involved in individualizing the lifestyle intervention arm of the DPP. Like we need to nationalize that trial basically.

And it's not there was no turmeric, there was no magnesium stuff. Like there was no gut microbiome testing. It was just like dietitians, you know, a little bit. more intensively and then sort of phased out in the DPP and then the look ahead trial was sort of the follow-up at the DPP that was a bit more intensive. But we need those style interventions rolled out at like national levels that have coverage and you should be able to get involved in this. And America's just never funded prevention seriously. And so it's left open to people who have the resources to go see alternative practitioners who are kind of getting

sold magic in a pill that may or may not feel like magic to them at the end of the day. But like is not clearly not producing broad scale societal level improvements and rates of obesity and things like that. We just got the newest numbers in August for 2021 to 2023 and the levels of obesity are still like 40%. And so, yeah, there's a lot. I mean, I don't think I'm not selling this as like dietetic reimbursement to like fix all ales. Like we need policy at every single level. But I think in the societal inaction around nutrition and prevention, both from we barely fund it research, research-wise. We barely reimburse it on the care side of things. We don't really take policy around legislating what the food industry can do and formulation, everything from formulation

to advertising. Like, just nutrition is not taking seriously at every single level. And that totally allow, and coupled that with physicians not getting much time with patients and people feeling not hurt or like they have any spent time with them, alternative practitioners are going to like have a field day. Totally thrive in that space. And it's obviously like a unique subset that can actually afford that. But I increasingly see patients who come to me and they're like, oh yeah, I used to, I used to see this practitioner and they told me all these things. They're also telling me about how financially stressed they are. And I'm like, gosh, how are you paying for like 200 bucks a pop to see a chiropractor and all these supplements and things?

And so I think it used to be, I think that there has been a thought like from more than a national level and from like thought leaders in the field. Oh, supplements are just, we don't to like regulate them beyond the DeShay act from the 90s like it's just a rich people thing are not really harming themselves but like now we are in a totally different world where everybody from every walk of life is dealing with these e-commerce based um social media platforms where they're being sold tons and tons of products and I think it's it's concerning for the general population that's being basically lied to about the efficacy of products and oftentimes isn't even buying what they we think they're buying but I often think about the lens too of like you know

you might think saying, oh, whatever is anti-inflammatory is harmless for the general population. But you have a highly motivated subset of the population that has chronic inflammatory diseases. So we actually want to know, like, do those supposed anti-inflammatory things work? But they're the first ones buying them. And I am always worried about, like, protecting the vulnerable subpopulations that are going to be preyed upon, essentially, by people making ridiculous claims without evidence. behind them, which becomes like this chicken and egg issue.

Like you have to fund the research infrastructure and the studies to get data to say whether things work or don't work. And I think at the federal level, we've just never, we've funded some nutrition. And you'll see like numbers quoted about how much of the like NIH budget is nutrition. But like that includes like if you knock out a neuronal population and a mouse model and study how it affects food intake. So those are like massively overinflated. If you actually like look at the number of clinical.

trials, intervening with food or supplements across a range of things that people care about, it's minimal data, if any. We've sunk a lot into like vitamin D and omega-3s for like antioxidants for cardiovascular disease. But I think a lot of people nowadays, and this is a good thing. And I think interfacing more what the general population wants is important to drive research agendas. People just want to feel good. They want to feel energized. They want to feel like their quality of life has been improved. And when you go look in the literature for like, does this supplement actually like improve people's quality of life? Does it improve their sleep? Do they feel less groggy? Do they feel like, is their mental health better?

We are just scratching the surface on that and don't have the research investments, the research money to even seriously investigate the things that the public cares about and is asking of nutrition. And yet the claims are being made. Yes. And the claims are out there in abundance. And it's up to you as an individual, even like you and I. Like, I mean, I have a lot of knowledge. I still don't have, I can't just know things that we don't have trial data for. And so it is up to me to decide if, you know, the internet, my algorithm thinks I am both a pregnant woman because I do pregnancy research, so I got a lot of interesting things.

But also knows I have like chronic autoimmune issues. And so I get everything. Like there are 50 supplements a week that are pushed to me that are a cure all. And I'm like, I could not afford to try all of those. And it would take years to try. all of them. And so it's just any, I think a lot of people are like, oh, I love the supplement. This guy is saying that there's no evidence for it. Like, yada, yada. I don't want it to be supplement by supplement at a time when you look at it. But like, when you look at the totality

of what is marketed to people, there is not the data to back up any of these things or the majority of the claims that they're making. And I think we as a society, like, taxpayer dollars are funding research. We should be seriously thinking, you know, for the current administration, like about, we should fund things that people care about and it not just be like, you know, antioxidants for cardiovascular disease. But like mental health is a big one. Like how does diet impact mental health? If I wanted to do a study on that right now,

I don't even know who would fund it. Like I'd have to write a really compelling grant at the NIH to maybe fund it. It would be hard to find the infrastructure to do it as well as I'd want to do it. The food industry may or may not chip in some dollars for it. But the funding model in research is very much like NIH does a lot of the basic stuff, a little tiny bit of clinical trials, very little in nutrition. And then you have pharma as outsourced to do all the clinical research. And a lot of the non-pharmaceutical intervention space is just starved.

I mean, we saw this during COVID. Like we couldn't like, I would love it if we lived in a research environment where you could just do a mask RCT in sort of a pragmatic way. But we don't have a nationalized health care system. It's there's not like clinical research infrastructure. set up within our medical system. So there's huge limitations for understanding any non-pharmaceutical intervention, including nutrition, including supplements that are always going to hold us back from ever having like the evidence base to say what works and what doesn't. Yeah, the two groups that I feel

are preyed upon most often with social media kind of overlap to some degree because of genetic distribution for demographics, women and those with autoimmune conditions. Because oftentimes times their presentations that occur with certain conditions are non-specific in nature, meaning they don't fall neatly into a category of a diagnosis, which leads doctors to misdiagnose often, doctors to be short with them, because it requires significantly more time input, multiple visits, which they can't get. And as a result, they're harmed by the system, therefore they're seeking the alternative. Alternative sounds very promising because there's a lot of certainty in their promises, which then kind of can have.

help at times because some of these nonspecific symptoms can be treated by placebo. So they get some improvement. They then become spokespeople for the product inadvertently in many cases. And the cycle just keeps going, which is why I actually view a problem that was a huge problem 20 years ago as less of a problem today. In the United States, everyone always says we're one of two countries, New Zealand, the United States, to allow direct-to-consumer advertising. I don't even know if that's true.

We just repeated so often that I still say it. And it is true that the United States does allow it. And we see the commercials on TV. But I think that impact is now gone. And the reason why I think it's gone is because the most effective advertisement for a pharmaceutical is no longer a commercial that is played on television, but some person saying they took substance X and it did affect Y and that going viral on social media. And there is no rule preventing that.

And how do you limit free speech in general to prevent a person? from doing that. The FTC does not have the budget to enforce. And how do you enforce like a person saying I did this and it helped me? They're not even telling people to take it. Free advertising. Yeah. So that sort of messaging is very influential. And I'm not necessarily saying pharma is pushing people to do that because they don't need to. People will naturally do it. And it's only risk for them to encourage people to do it. So I think that's an interesting shift in our media model. I don't know if you've seen that play out. Yeah. I mean, I think that's like the way that supplements kind of. taken over and work, but I definitely agree that it's in like women, anything that affects women in general, menopause and pregnancy are two big areas, but also like endometriosis. I see more and more content around that. And you just, also the diet optimized optimized for what phase of the menstrual cycle you're in has been like a really big thing that I'm like, I wish there was, I mean, there's like, I think one randomized controlled trial looking at this that finds no results, but you find people out there like, you're doing seed cycling, that you need to eat

different types of seeds during the ludial phase. And I'm like, yeah, nobody has funded that study. It feels, you know, once you, this is one thing I, it takes some investment, but that's why these long form podcasts are good. But like, once you start and think, like, did we fund a well-powered, randomized, controlled trial to ask whether. But see, I think these statements that you're saying, these words you're using, I don't think most people knows what that means. Just an intervention, that like, like, asking yourself whether a claim someone's making, it has been actually tested. It's likely that someone has tested this.

To the degree needs to be tested, which is usually a tons of people. Beyond an anecdote. Like, did researchers get together? Even if you don't fully understand, like, the research process because it can be quite nebula, like a very black box. But like, like, basic question, like, who would have funded this study? Like, I encourage patients who are interfacing with all of this to just, just ask questions, like, what study showed that? Can you send me the link? And obviously it's like for

very motivated patient populations that are going to do this. And even then it's hard to decipher what the heck. A lot of times people can't tell you. Like I'm happy to tell you the like, I can name the study, the citation the year, like for the things I'm telling folks that I feel very uncomfortable like giving a recommendation based off of data that I don't like, you know, primarily at least the guideline that summarize that data. But all these practitioners that are out there just like making up wild claims, like they're genuinely just making stuff up or repeating things that they heard. Yeah, or they'll give you a study, but that's not what the study has said. Yes, yes. Like that happened on my podcast with Dr. Fung, where he was talking about how

the treatment of diabetes with insulin and lowering hemoglobin A1C didn't help people. But really, like, the study was looking at to what endpoint were they treating it? So, like, treating it was never in question. Yeah. It's to the degree which we need to treat. Yeah, it was like insulin-intensive Yeah, like lowering below 6.5 versus to like 7 or 7.5. Yeah, with like old school drug. Like with insulin, not with like modern new drugs. So the takeaway from those studies

was not like, let's not treat people's hemoglobin anyone sees. It was like, let's be a little bit more relaxed, but still treat. Yeah, no, I just on Twitter there was the most rigorous diet trial ever done was being talked about as a Minnesota coronary experiment, which is like, in reality, the most failed diet trial that was ever done. Like, it was in mental hospitals when they were

de-institutionalized. People and got the intervention for like a year. It was like 80% dropout rate, like every violation of a rigorous randomized control trial, but it was being presented to people was like, this is the most rigorous trial. So yeah, like somebody can certainly send you a PubMed ID and that, that alone is not enough to say whether something works or not or whether they're an expert or not. But I mean, some of this, it's like so like gosh to say nowadays, I guess, but like you need to have some expertise and like some training in it. Like if somebody didn't, hasn't done clinical trials themselves or hasn't done extensive

training that they should understand what a clinical trial is and they're like giving you specific recommendations and health advice that's like a red flag on its own but i understand why there is sort of like anti-expertice sentiment and distrust of medicine so it is at some point people in medicine are going to have to like address this the fact that we have turned medicine into a business and limited people's times to get to know we're like so far beyond the like i know my local primary care position and see them at like the grocery store or whatever like it's so divorced and kind of inhumane feeling and I think what people are seeking is just like someone who makes them feel human yeah the human connection of it all the the idea that we need to work backwards in this

situation of from the human standpoint then how do we help someone is the right mindset that we need to have we you know we talked about supplements and I want to ask you as an evidence based RD, what supplements do you think do have good evidence that you routinely recommend to people? So I think of supplements as doing what the name implies. So like there are supplements, the phrase dietary supplement is regulated in a way that includes many, many things, everything from like protein powders and meal replacements, nutrient supplementation. And then you've got like bioactives where people are playing naturopath where they're like

treating chronic diseases with like bioactive extracts. you've got probiotics. And so it is, when people say supplements, like it is kind of like what supplement. There are things that dietitians are using all the time. Like in the hospital, we're like regular. We have a whole category of things like oral nutrition supplements that we use to help people to get their calories and protein up. And that is common in outpatient nutrition for somebody who's like at risk of malnutrition.

It's not uncommon to like recommend protein powder for folks that have some sort of goal and are struggling to meet that food. For a healthy population or general population. or general population. Even for the general population, like a protein powder, I think is like a very common supplement that is not,

it's not evidence-based. Like, again, like- For what purpose, I guess, is the question. Yeah, and this is where food is not a prescription. So there's like a lot of choice, like the level of evidence impetus you need for a drug to prescribe something. It's a lot higher than like,

yeah, you're not reaching, like we estimate your protein goals between 1.2 grams per kilo, 1.6 grams per kilo for the type of exercise that you're doing. ACSM recommends that. you're not getting that easily or struggling to get that or bored from eating too much great yogurt and chicken breast or whatever.

And, you know, we could incorporate a protein powder in that. Like, I don't see anything wrong with that. I think it's within the evidence. But is there like a definitive randomized control trial showing that this is amazing. Like, no. So general guardrail in that regard. Yeah.

I think almost everything in these guardrails. There are like, again, the B12 for vegans, but also for older adults that you have much higher incidence of B12 deficiency above. the age of 50. It's recommended to get crystalline B12, either through fortified foods or supplements beyond that age because the gastric absorption decreases. Calcium and vitamin D is one that you'll see quite commonly, particularly in postmenopausal women who are not eating that many calories to begin with. It's kind of hard to reach recommended levels. So like when you're below sort of a benchmark kind of a target nutrient that we go for, it's very common for a dietitian to recommend a supplement to

truly supplement the diet. I think when you get into like bioactive, it's a whole, it's a wild. Fletic greens? What about it? I'm asking you. You want to get sued with this podcast. I have never purchased athletic greens personally or ever recommended it. Green powders in general are like, you know, they have, this is a classic labeling thing that people do where it will be a blend and they have to legally like list it by weight but you don't know what their proprietary blend is like and they'll be like oh it has clorella and spirulina and all these like magical sounding algae but then the first ingredient's like spinach like it's like freeze dried spinach and then they put it in milligrams instead of grams so it sounds like there's a ton of it

like there like if you gut out a scale and try and weigh freeze dried spinach powder at five grams you're like wait that's all that's in this per serving um so there there is a lot of these products that are just like hodgepages where they throw it's a multi it's a very expensive multivitamin with like a bit of a soluble fiber maybe a probiotic a bunch of bioactives it's never been tested in the formulation that it's in are there 14 person randomized control trials from some university study that showed that it changed some marker for an individual ingredient that's common yeah but like it's not really what we think of is like rigorous evidence that says the whole general population.

What about for someone who has a really terrible diet? They eat American Standard Diet. They eat burgers, hot dogs. I'm like, I just need something to make sure I'm getting some nutrients. I recommend a multivitamin as an insurance. I orient people are like, this is an insurance policy. You're probably low in a lot of things. But like, I'm not going to go order a bunch of somewhat non-specific labs.

You're trying to assess that. A lot of diet and nutrition counseling is like using the DRIs as sort of like, so the dietary reference intakes. there are like estimated average requirements essentially for the nutrients. And so we use those as like a benchmark to like, again, as guardrails. It's not hyper-specific. But if people are super low in it, you might be recommending a nutrient supplement. Iron, of course, is very common.

But doctors are more involved in the iron than just the RDs are. Yeah. And I don't really come in hitting it hard with supplements. I get, again, I get a lot of the pregnant patients that come to me and they want me to tell them to take a colonel supplement. I'm like, which is like a genuine, I think that's a great example of like, I was involved in the research of it, but had like industry funding and the, I want professional medical organizations to take a much bigger role than they are taking in some of the hot topic things that are out there. I can't point to guidance from the American College of such as in gynecology on choline supplementation because they haven't, the evidence is at a point where it's like

You could make a statement, yeah. Practitioners are talking about it. I know a lot of OBG ones who are already recommending it. And I'm like, I want an authoritative guideline. Like that's why you guys exist. Right now they just sort of talk about it as like eat enough from the diet and this is what the adequate intake value from the National Academies is. but that doesn't tell you anything about supplements.

That's just a food-based thing. And so if Danielle Blardo led the American Society of Preventive Cardiology, practice paper on, like, you know, it's a consensus for a lifestyle and diet. And we had a long talk and ended up including, like, a bit in there about supplements. Because it's amazing how much every major guideline committee, because there's not much evidence for it, they just sort of like ignore it and say, like, oh, we don't even talk about this in our guidelines.

I'm like, but that's a problem. You should be talking about it in your guidelines and you should be saying, you know, and there are some supplements with like much more data. I guess one I should have mentioned was like a cillium husk fiber has some good data in IBS. And so like potential relief of symptoms there, otherwise relatively harmless. That's one I like will commonly recommend for both constipation and for IBS symptoms. And for potential cholesterol effect.

Well, so it lowers LDL, but the cardiology society is like don't say much about that because there's no cardiovascular endpoint trial with cillium husk fiber. that's like the situation where it's like you're getting other benefits and like this could be an added one with limited risks so yeah i mean it's one though we're like i you have to have a very tempered i think guideline committees are holding back from providing any guidance on a individual practitioners that are left without the guideline committee to like kind of refer to and it sort of just ends up being whatever that practitioner but they're happy to put a heart on a chiro's box you know all right supplements are a weird because it's like there's no stand like there's no like there's there's minimal standards around, like they have to be safe, what's supposed to be in there. On the label is supposed to be what's in there, but like we know that these things get violated all the time. There's also concerns about like the evening for Sillium, like the heavy metal content of

them, depending on where it's grown, soil it's grown in. There's not as much regulation as you think there should be or enforcement of the regulation that exists. And so like I would, I would love it if we had more regulation of supplements around. So I could say like, oh yeah, you'll get like, it's good for your respiration. you might lower LDL a little bit with Cillium and know in the back of my mind that if I tell you to do this every day

for the next six years and you actually do it that you're not like slowly accumulating. Yeah, some heavy metal poised. Yes, yes. Fair. Which is a hot topic that consumers ask about all the time. Yeah, this is a perfect segue actually

for the next topic. We're trying to make America healthy. We are. I don't think again, because I don't know when America was healthy. Like if you really think about our progression, it's like we could always be healthier. So right now with RFK Jr. at the helm of HHS, Dr. Oz coming in for CMS, there's a whole new

team coming in. With this new team, there's a lot of focus on the field of nutrition. Should be really exciting for you, right? Like you have someone who's on your side. Are you as excited or am I mistaken here? There was excitement in the field, for sure. I'm putting on my politician hat right now. There are, it's a mixed bag. I know some people who are aligned with the administration and around it who are operating in good faith and want to change things. And I understand that there was a national conversation around diet that I would argue

has never been this loud. Michelle Obama tried. Like I just want to give it up to her. Many people have tried over the years. It hasn't always taken off and it's gotten partisan. Like Michelle Obama's attempts to like lower sodium in the school lunch program alone was just like, totally pilloried. But yeah, so, like, now I understand the enthusiasm.

I do have a lot of concerns about our bedfellows in this situation. And so, like, there is a lot of false dichotomies around, like, infectious disease versus metabolic health as though you can't do both. Like, there's nothing that says you can't take a vaccine and also improve diet. And, like, it's like, we don't need to say, like, you know, there's, like, a recent enthusiasm about vitamin A for measles. And I was like, just endorse the MMR. And then like, there's no trials in the developed world for vitamin A.

Like there's some of these things that are frustrating from enthusiasm for things that don't have evidence. And then skepticism about things that do like vaccines. And then there's, I think, a lot of like a vibe around the chemicals in food are bad, which at a high level we can have conversations about food additives and things. But there has been a lot of overstatement of the risk. of like food dyes as a like tartrazine. I think there was a video about saying that it's linked to all these issues. And I think the effect size of like we remove tartazine and wait 20 years to what happens to population metrics all else staying the same. Like I don't think we will detect any differences in really anything. And so that is a concern that like the things that there's so much enthusiasm and action around are not the most high impact interventions. And they sort of are like the easy things. Like yeah, you. Just remove the approval, the ability for the food industry to add this. Well, because it scores political points.

So, like, I think what? Which might have some utility on its own, but yeah. What, scoring the political points? Yeah, like maybe you do a low-hanging fruit thing. I'm waiting to see whether they go for the high impact stuff that's actually hard. Like the moment you have to start thinking about, well, how do we get less of whether you know, ultra-processed foods, sodas, sodium and things, like things where industry is going to have to substantially reformulate and change their products.

the level of advertising that's done to people, especially kids, is going to have to be reduced. These are the big hills that are labeling on the front. So front of package labeling is being explored right now. From the last administration, there was a lot advanced forward, but everywhere else in the world is front of package labeling that calls out like high levels of things. But quote-unquote warning labels on foods have always been close to a no-go. And so maybe now there's political will for that kind of stuff. But there is going to be a bloodbath behind the scenes of industry,

fighting against us. I don't know that the will is really there at the end of the day. Like, time will tell. I'm skeptical a bit because I know it's easy to score political points by finding a villain like high fructose corn syrup that people already in their head have classified as a villain and say, I'm replacing that in all our sodas and putting cane sugar in there. And it sounds like you're addressing what people want. But in reality, you're not changing anything and steak and shake just announced they're replacing seed oils or with a tallow and it's I'm like this is not a health way yeah so like none of these things are actually changing anything and people are like well in totality you're lowering your chemical burden I'm like that's great

but if you really want to have an impact in people's lives like when I talk about with my patients about why ultra processed foods are unhealthy I'm not pointing to some chemical inside them that's unhealthy it's not a nutrient issue it's strictly because that they're hyper palatable, you eat a lot of them, you're hungry quicker after, and it's kind of a big macro view of why I try to get them to eat less of them. But then you'll have people are like, no, it's because of ingredient X, because if you look at the petri dish or the rodent model, when we feed 100x the amount that's in your food to this rodent, they did get cancer, it's like, but that's not useful for us. And I view it as a lot of posturing without a lot

of actual succeeding of doing anything. So I get very skeptical that any real change will happen because, you know, I look at the RFK Jr. situation. I have conversations for such a wide variety of people because I'm exposed where I work at a community health center where you have people who are barely making ends meet full below the poverty line. But at the same time, I live in the celebrity world

to some degree with social media, and I'm at these events with very wealthy people, ultra-connected people, and yet their ideas are not so different in their beliefs where they both believe that RFK is doing the right thing. And why don't we try something new? Why don't we just break it? Why are you against using food as medicine?

And my answer to that is, and I'm curious where your answer is in comparison to mine, when we think of food as medicine, there's very few interventions that have been tested to the degree where they could actually act as medicine. The ones that we do have good evidence for, no one really wants to hear or no one actually wants to do because they require real work and they're annoying, and they are.

I totally agree because I fail to do most of them as a health care hypocrite myself. And what most people are actually selling you or are achieving on the political front are just points being scored but not actually changing any real outcomes for people. Do you feel that way or do you feel slightly different? I think I feel pretty much the same. Like there's enthusiasm from many political angles. The vibes are right. I mean, I worry about the vibes of like, you know, we're trading in infections for

removing food additives. that's where it's like I'm curious whether we will see any serious big action that actually like makes it across the finish line I feel totally the same about like taking on a food additive that is fed a thousand times to rat like a thousand fold of consideration of rats and seeing cancer um is not all that relevant to human exposures and if you are getting enough of that food additive from those foods it's probably coming with a whole bunch of other things that we don't want so it's the package that's coming in Like we're all, I think everybody wants more spinach and less Pop-Tarts.

Like that's, but I don't know what actually wants to do that. Except the corner horse, but yeah, but like the serious thinking about how do we as a society shift our current food environment? Like you go out and things are getting maybe slightly better, although there's questions about that. But it's 80% of things that we probably shouldn't make up the majority of our diet. It's just the readily accessible, easy things are the things that are like extremely unlikely to be eaten in a way that maintains your body weight, extremely high in sodium, not the greatest fat composition, not very much fiber, process to hell, which might influence a whole much of other things or at least strip away some other protective components. So you can like list out all the things that might be the problem. But thinking about how do we as a society totally transformational change the food system requires thinking about like what we grow, the economics of what we. we grow, how it's produced, stored, processed, makes it into, it formulated into what things

that people are actually going to buy. And where you like break the chain of the current system that we have that is somewhat self-reinforcing is it's going to take serious regulation. And there's going to be winners and losers in that. I don't trust that. I don't think that this administration has thought about that and knows the point at which it's going to go and take action. Like even if you have this big think idea of like let's just ban all the ultra-processed foods, where are you going to get a database of all the foods in society? How are you going to make sure that every company adheres that it's not a UPF? How are you going to make sure that they don't just reformulate things, which industry is amazing at doing? I've been watching

the yogurt industry, the yogurt aisle change so much over time as people think whole fat dairy is good again. The sugar hasn't dropped at all in most of these foods. And they take out some additive so it looks more natural. I'm like, that's still a 250 calorie dessert posing is a breakfast food. And so we could see a ton of reformulation that is not the direction that we want things to go in. I don't think the administration has picked who the winners and losers are going to be if they do anything dramatic with the policy. I don't even think they have the policy in mind of how things are going to change. Yeah, there are so many layers. I was part of a Texas A&M like big panel as far as like re-envisioning the food system. And it just at every layer, every, you know,

all the societal actors involved from what is grown to the growing of the food, the packaging, processing, formulation, and selling it. There are all like interventions you could sit across that entire life cycle there. I haven't seen a plan. Maybe there will be one from the administration of all the policies they are thinking about because I don't think there's going to be one thing that solves it. It's going to be a confluence of many shifts, you know, some carrots, some sticks that have to start to shift the food supply and ultimately incentivize produce.

to make food that is concordant with healthy body weight, healthy disease risk factors. Access to RDs. Yeah. I mean, and that's a very small piece of it. But I don't, I mean, it's like education is a starting point for all this stuff. For sure. And I don't, I think we have to also, as much as we've talked about evidence here, I think we need to get very exploratory because you're going to run into the fact that we don't

have, like, where is the randomized like cluster trials that have tested out different policies in different states? They don't exist. Like, we're going to have to take a leap of face. I think in some ways and test things out. I mean, I think one of the politicians said lately, but they want to see, like, states be legal testing grounds for policies and seeing whether they work or not.

I think it was in the context, like, building more housing or whatever. But I think nutrition could take something similar that, like, it's not just about, I would love more research funding to understand nutrient requirements and pregnancy and the composition of processed foods and how they drive intake and what. And I think we need all that. We need to invest in it. We also need to be thinking about, like,

the community level and the state level, what policies, what programs, what incentive programs there are for like buying more fruits and vegetables. There's things that have been lightly played around with with like farmers market two for one bucks or whatever if you buy fruits and vegetables with your snap dollars. And so all these things, we need to get like super creative and actually testing and measuring like, did this make an impact or not? Yes, no, move on from it if not. And doing it in a way that it doesn't take the current pace of research. We are so underinvested in nutrition research. It is too slow. We will know in 45 years how the composition of ultra-processed foods drives food intake behavior at the rate that we are able

to produce data now. And by that point, we will be economically sunk from the cost of health care related to obesity and associated chronic disease. And the solutions to get more funding for the research. Absolutely. Yes. I mean, we have never taken nutrition research seriously. We currently have six USDA human nutrition research centers that have applauded for all that they are able to do. But we need to like massively invest in that. There's always nutrition been kind of weird. Like started in the under the USDA umbrella and then it's like sort of gotten NIH funding. But we need like a cohesive federal mission and tons of funding for everything from understanding what about our food drives food intake behavior and how we can.

allow that to be more aligned with our biology and weight regulation to what's the optimal diet for pregnant women. You know, we talked about this off the pod, but other things the administration is interested in. I've written some substack articles on this, like the fluoride and IQ issue, you know, the splashy meta-analysis that came out most recently and Jammah Pediatrics had zero studies from America. Yeah, did not apply at all. And it got painted in the media as though like you need to be worried about fluorida products when in reality it was like the naturally high levels of fluoride in China largely compared to lower levels and weak ecological study designs. And so like there was an effort to have a national children's study in the US in about

2000. It never got off the ground, unfortunately. But it was recognized in the year 2000 that we needed better data on environmental exposures and kids development. When people are exposed during pregnancy, how's that influence kid, childhood development, which there's a ton of interest in that now from like the Maha Commission executive order is all about protecting people from chemicals and contaminants. If you go look for large cohort data that has like, that has either stored urine or store blood and has assessed developmental outcomes and IQ and all these things, it doesn't exist. Or it's these tiny little thrown together cohorts like what we did for lead and legislated lead around, which there's still big questions about because we don't have good nationally represented

data. So we need to like, we have pharma doing tons of awesome clinical trials that like I don't want to pit the food versus farmer or anything. It's great that we have GLP ones and things. But we need to have unless, I don't know how you get a private version of that level investment in food, which means you need government. And right now we have government research being cut, not amplified. So if the Mahad commission and that those vibes are really going to do anything, they need to get really serious about funding the research, they're really serious about laying out, like, what are all the issues preventing what finally ends up on our fork being things that are more aligned with our biology and reducing disease risk. Yeah, there's so much potential and excitement that could

happen from this, but I could see it as equally going in the complete wild direction of like spending money to research, whether or not removing high fructose corn syrup and replacing it with cane sugar makes an impact. Like, I don't want to know the answer to that study. That study's already done, unfortunately. Okay, good. There you go. But I'm just saying in principle, the idea of that. And I just hope that they pair people who are interested in getting to the bottom of some of these questions because they deserve answers and it has been tragically underfunded. I actually did a debate with individuals who are on the vaccine skeptical side. And the thing that I related to a lot with the

people that were almost taking the opposite stance that I was, was that their system is broken. And I agree with all the problems that they talk about. Like, I completely agree. But then where they then land from the problems and where they want to go with the problematic system that we have is not reasonable. It's not based on accuracy or signs, which how can you expect an average person to think critically as if they're a researcher? So, I hope there are people put in charge that actually put forth the budgeting, the theorizing of what the money should be spent on and make it valuable. Because I think there is an opportunity to make a big change when it comes to nutrition

and environmental research. But I'm very skeptical. And this is where I think government failed us. During the questioning of RFK Jr., like they hammered him on the measles stuff. And like, I'm glad they did, obviously, because I think it's an important question. And we're seeing the implications of that right now. but not one person asked like you want like celebrate him for a second and say okay you're very interested in fixing environmental exposures and nutrition how yeah do you have an outline of a plan

so that's been that's been my approach is to like people are probably going to think I'm naive like but I'm like I would rather say this is how to do it I am not hearing the how this is what I would like to nudge you in the how direction whether that will be actualized actualized behind the scenes I highly doubt especially like we're doging the entire research infrastructure like and I have a lot of friends and nutrition who now don't have jobs because global health has been totally decimated. And I think we should absolutely condemn that kind of stuff. We need be principled about like, I will tell you what I think needs to happen on nutrition and I will turn around and critique you for your stance on vaccines if you're not coming out, guns blazing on it. But

there is a sort of like, you know, I think there's a perception that experts got us into the bad situations that we are in. And there's some arguments for that in individual cases. But I think profiting off of people has gotten us into like where health care is the way that it is and the lack of the ability to profit off of diet and reducing environmental exposures is like a whole reason you need government investment in research because there's no private interest that's going to fund any of this stuff to the degree that needs to be funded and it's harder to study than drugs are yeah and so yeah I think people the anti-expertise vibe that people have should really be like anti-MBAs, no offense to the MBAs. But like, they've looked at how to turn

every single thing that we're into and to Uber. It's the Uberization of the healthcare market. And if you really think about it, it solved a lot of problems. But it created a lot of problems. Like malnutrition used to be not enough food. Now it's too much food, depending on what part of the world you find yourself in. So it's very interesting how we constantly with capitalism create new problems, but we shouldn't stop looking for the solution. Yeah. Because it's a hamster wheel, but if we stop the hamster wheel, those problems will just become worse. And you just, you need, you should hold government to a high standard to be confident. Like, we should interrogate past failures, like, why we did, why the National Children's

study failed should be used as a model to have the 2.0 version of it so that we get the data that we needed 25 years ago. And in 25 years, we don't look back and not have it, but completely losing all faith in government and expertise and thinking that like, you're just going to, you're going to rely on the goodwill of massive industries to change the food supply. Good luck. And you're going to rely on the good, like we're privatizing everything about research right now. And I've had these conversations with other nutrition researchers. Almost all the younger folks I know who are like, you're like hyped up about nutrition have gone off to jobs in industry because they don't see it as a career path. Like really promising researchers who have done folks studying

how food impacts the microbiome, food impacts the childhood IQ. Like all these things that people care about. Everyone's looking at the landscape and saying, I'm not going to have a job in five years if I invest in this. We should be concerned as a population that we don't have people going to nutrition research because they think it's a viable career path because it's something that's going to be funded. I think about this all the time. I'm like, do I want to string together a little bit of USDA money, a little bit of foundation money, maybe some NIH grants and some food industry money to have like a coherent lab? And will that actually advance our understanding of human nutrition in a way that impacts people's health, I seriously doubt, unless this is kind of like

my swan song of like, if this administration wants to seriously change things, that would be amazing. But the field has seen retireings that haven't been replaced by people. And we are very much at the risk of just having like minimal nutrition research infrastructure. So it's something, it's an easy win, I think. Like I'm like kind of shouting the easy wins out for the administration now. And they're on the right path. they're saying the right things you're saying the right politically motivated statements but now just back them up with some actions right saying it is the easy part do you have a plan behind the scenes to make the wheels of government turn to fund the research that needs to be done i don't know and i and

hearing like about we're just going to privatize everything we're like the federal workforce needs to get out into high productivity private industry jobs i'm like there there there is that does not exist the food industry is not going to seriously fund and regulate itself like there's no incentive for them to produce products that are like supposedly. And if you raise their cost of production by incorporating this mandate into them, what do you think is going to happen to food prices that are already skyrocket? But we've had a wellness section of the food supermarket for decades. Like industry is meeting the need of the desire that is there. It is just like human biology is driving people to eat things that are not the greatest for our health necessarily.

And it's easy to hijack that biology by formulating foods that are, you know, that are readily available all the time and easily overconsumed. And there's great work happening, like, in the intramural program in Kevin Hall's lab, like trying to at a very slow pace, not to his fault, but because of not being resourced adequately to understand what it is about processing that influences food intake, how it's like they're measuring what's happening with dopamine signaling in the brain through there's an amazing PhD, Val Darcy, who's doing work on that.

Like, we should be having, I should be able to name dozens and dozens and dozens these researchers across the United States, they're doing everything they can to understand food, how to formulate it, how to best combat the poor state of health that we're in basically right now. I can't. I can point to like a small handful of people

that are really struggling to take what little resources we have to understand how food impacts health. And I get the vibes of like, people just need to eat less ultra-processed foods. But the moment you go to industry and you have zero science and you say, you need to change,

Energy is going to fight you tooth and nail and all of that. And so will people. I mean, we saw it here in New York City where they tried to put attacks on the big sodas. People got very upset about it and it didn't happen. And that would have been a thing that people talk about wanting, like less soda consumption. Oh, this would have created it, but they didn't want it. I'd be so curious how that would go now. 10 years ago, that was a nanny state thing.

But I think all the political parties have realigned to that. I'm not sure who would be accusing who of being the nanny state in that situation. It's very messy. Yeah, and you have to affect food access issues. I mean, I'm from the East Coast and have academically drifted all by driving all the way out to the West Coast. I've seen all of Middle America. I've seen huge parts of America where, like, there are more Davita, like, dialysis clinics than there are supermarkets in the area. And so, you know, you have a lot of places I stop towards like, oh, this gas station is the grocery store.

And so there are huge issues like that that we need to have a government that seriously thinks about these people in, parts of America that feel left behind. I mean, NAFTA ruined a lot of things, but like people feel left behind rightly so. We need to think about like addressing the health crises in rural America and making sure that people feel listened to and heard. And it's not just, a lot of this stuff sounds like crunchy granola, like, typically like Portland-esque eating patterns. And I don't see that getting a high uptake. Like we don't need to air Juan more of the urban areas in America. Like we need to really seriously be thinking about the types of foods that are available, access to those, whether they're affordable, and I think we need to get

innovative and creative and play around with state policy and things. But we could only do that with good research. Good research and political will and a plan. Yeah, exactly. We're very curious to see that plan. Well, I'm hopeful for that. If I was to give you a wand, what are you changing three things about our current nutrition state? Like about the food itself? or your choice you could change food you can change policy you can change can I change our brains to not over consider the human you cannot change free will well I mean just I would change something about food so that it is not I think there will always be some percentage of individuals who are like genetically predisposed to overeat but I would we need to change the majority of food composition

in a way and what is people are eating out more regularly we need to change the food that has served to people and able to be bought in the food environment. Specifically, what are you changing? Oh, specific. I mean, this is something I honestly feel like we don't have the research to know. We have done a really good job in nutrition research understanding like we've done a decent job. I try to understand like what your total energy expenditure is, how many calories.

We have non-nationally representative data for that. So I don't want to say it's great. Like please fund doubly labeled water studies and Hanes. So we understand what people's like the general population's energy expenditure is. but like the why people eat has gotten much less funding. And I think it's getting more funding now. You hear people talking about concepts like food addiction and things. But how to formulate food, other than feeding people bland lentils and brown rice

and making that the only food option. Like how do you formulate food so that it is still taste good, still culturally acceptable, and is not hijacking our reward systems and things to lead to overeating? Whether we can even do that is, like, still an outstanding question. And I think is something that we need to answer, like, very quickly to understand, can we reformulate food? So I think the reducing the energy density of foods is, like, the easiest likely thing, although there's more factors that drive food intake there.

There's a lot going on down to, like, how soft versus hard food is, that drive, potentially drive intake beyond even, like, what palatibility does. And so it's going to be reformulating across some mix of these metrics to find the sweet spot, that people eat enough, but not too much. We're not there yet. So the changes I would make, I mean, like getting sodium down is a really, people have been trying to do that for decades now. It's gotten held up, even voluntary sodium reductions have gotten held up because of political

reasons. But trying out alternative preservatives and getting sodium much lower, I think is one of the highest bang for your bucks. I think, you know, there's always a big focus on reducing saturates, but intakes are not super high right now on the population. Like there's still a little bit more room and there's definitely still subsets to the population. So you might think I'm going to say like

eat less saturated fat, but like people just need to eat less calories. I think the saturated fat would tend to fall in line a little bit more. Sugar sweet beverages are still a big one. And I think all these things I should say have modest effects. Like again, diet is a cumulative of a lot of small

things. So I don't want to overstate that like we'll stop. There's a lot of old stuff of like, we'll stop obesity. People just stop drinking sodas. That's massively overstating it. But we've seen, I don't know if this is true for you, but in the Berkeley area, I'm like, I don't see people drinking sodas anymore. And there was like soda taxes locally and things. But I see like prepared drinks that like we traded in sodas for like cream and sugar sweetened Starbucks beverages, um, bobas. Lemonades and things. Yeah, there's tons and I don't know that we've made as much progress on sugar sweet beverages as

I don't think that at all. Yeah. We've done a lot of swaps, like vitamin waters, all these sorts of things. So I think a ton of progress on. I think there's been a lot of distractions with like alkaline water and all this nonsense. So like made people think, oh, I'm being healthy, but like, are you? Yeah. I mean, fruit juices is always an issue too.

And like especially non-100% fruit juice. But even the serving sizes of fruit, 100% fruit juices they sell are like three servings a day. Nutrition recommendations are like, you can have like four to six ounces for little kids. And I'm like, where are you finding four to six pounds? That's very hard. Exactly. So broad progress on like liquid sources of calories, I think in general would be a major one. I think like people eat, what you see in USDA data and the dietary guidelines

always pointed out they say like replace whole grains with refined grains. Or sorry, replace refined grains with whole grains. But like we just eat a ton of grains already as it is. And if you replace all the refined with whole, like you'd still clear the recommended amount of grains. We're talking about the food pyramid before we got on and like sort of led people to think that grains should be the base of the diet. And so not that I think people need to like avoid whole grains by any means,

but there's so many grain-based pre-prepared essentially desserts. But like I still know people who think a dog can donuts muffin is like their breakfast in the morning. I'm like, that's just eating cake for breakfast. This is like a cultural norm. that we need to, like, I think, be a bit more critical of. And so a lot of the grain-based beverages or grain-based desserts and mixed meal, like frozen prepackaged meals are like major things. I think we need to make progress on it.

They're like a major source of calories in the American diet. And they tend to be refined grains, a lot of solid fats, and then a lot of added sugars. And whether we can reformulate those, I think, is a huge challenge. There are some big food culture things in America that, like, We don't have a culture of like tons of spices as like what we think of as American food. Lots of ethnic groups have their way of cooking things that includes lots of spices. But like we very much of a society that the palate is salt, fat, sugar, starch. And that is you can do that in 8 million ways to create delicious things, many of which were like holiday foods at one point that are now daily foods.

And I think there is a reasonable conversation to have be had around like what is our food culture. I don't want to make any individual feel guilty or shameful about what they're eating. But like, we as a collective have normalized so many things that are clearly not good for our health. And we need to think about that as much as we're thinking about the what of what we're eating. Like, sure, no Pop-Tarts for breakfast, but also, like, why when you go out into the food environment is it not the norm that you can get, like, a relatively nutrient-dense, healthy bowl that contains some legumes and whole grains and fruits and vegetables, whatever. But you can easily get- Like the green powder, but in a food form. Yeah, yeah.

I'm going to sprinkle spiraling on everything is what I meant to say. Yeah, I probably sound like I'm like aimlessly wandering for folks, but they're like low hanging fruit things, but they're not like, people are going to rightly point out, like they're not going to fix everything. They're not. And I don't think we have the data or the evidence to say exactly like what transformational food system changes are going to look like. And those go beyond the science.

They go to like culture and values and economic. And, like, as a society, if the Maha folks do one thing, I think it's like opening up that Pandora's box and being like, what are we going to do? Who are, who, like, somebody's going to lose money in this process. We need to be seriously thinking about that. Well, that was always my statement on these podcasts, which is like, what industry benefits for societal weight loss? And I couldn't find one.

Someone said the airline industry, but they're like... Novenoros? Well, that's very specific. Eli Lilley, yeah. yeah and I don't actually what does actually I actually I think they end up losing money once everyone I guess because they need to be on the medications for life but yeah and I don't think like I think you're just going to always run into like there's never been a selective pressure that we know of in humans that have ever said like oh no no stop overeating I mean I guess like maybe you could

get in his prehistoric times like too big that you can't chase after the hunting the game and then you but that's unlikely to have been a significant selective pressure if anything It's been, we, like, clearly there's a large portion of Americans that don't just self-regulate on eating food when it's widely abundantly available. And so, like, I'm very pro-medication. It's just a matter of, like, of the number of individuals right now who are indicated to be on a GOP-1, can we change food policy to, like, decrease that at all? Is a big question that I think we have high-intensity interventions like the diabetes prevention program or the look-ahead trial that, like, if we scaled up, we could. cut into that but it would need to be like sustained funding and it's probably only going to be a subset of individuals that are going to like really be thinking about food nutrition and like a

lifestyle intervention all the time and those will probably taper over time um but if you with those trials you always see like a bunch of weight loss in the first year and then like people getting it back but they also are only really intense interventions where you're like regularly meeting with dietitians and exercise physiologists for that first year also. So I don't think society has ever played around with. If we provide broad access to people that mirror those interventions and really funded them, one, it might not be cheap with the GFI ones. But, you know, from the people that want it, what percentage of people can we get, like,

uptake on this? How many medications can we cut back on? Can we sustain this for a 10-year period? Like, we are 20 plus years post the DPP and have never seen, like, a massive national rollout. Like, there's been sort of statewide DPP programs, and I think there's one in the Veterans Association and things. But, like, if we as a society now are going to be serious about nutrition, thinking about scaling up and intervening with something like that is something that we need to really consider and at least pilot more aggressively than we have and try it out and see. I mean, though, I think there are always going to be medication that's needed.

But the degree to which we can cut into it with lifestyle staff, there's a lot of what I see on, I meant to say this earlier, like a lot of what. I see on Instagram as like very much a hustle culture. Like if you don't want it, like if you're not going to work hard for it, like that's some very moralized tone to like lifestyle. And I think that's like the opposite of what the data says. Like you are not convincing any meaningful swath of the population by shaming them into diet and exercise. All the day that's out there. Except the population that they need to, to, people who are already super fit. Like I mean, like, most of the people I think could buy into that are people who are like just want to feel good about muscle mass. It's an aesthetic thing most often. But like the data. The data,

is all, like, providing people intense support, counseling, motivation. Like, the DPP wasn't shaming people around food. I hope not, at least, what the dietitians actually did. You never know. But, like, they're just, it's resourcing people to lower the bar of, like, we're already, you know, the everyday person is, like, working a ton, raising kids, trying to make ends meet financially. The idea of, like, fitting in multiple hours at the gym is just like,

and then meal planning and all this kind of stuff is just like an added burden on top of everything when you can't afford your rent. Like that is real public health is addressing people in those situations. And so like I think look ahead like gave like exercise equipment and also gave access to exercise physiologists and nutritionists and like we need to be thinking about supplementing people with relatively healthy foods like in a pretty men style type intervention where you're just giving people tons of nuts and seeds. We have never as a society done that really seriously.

And I would like to see like basically playing around with at a policy level and like being like yeah we have enough data to think this is a good idea now let's pilot it and we need the political will do that industry is probably going to fight it to some degree but you need to push through and actually get these things at local and state levels and see whether there's something to ramp up to a national level but whether that will be funded and happen I don't know yeah those I like I agree the idea of RD's working with doctors like everyone's like get doctors more nutrition tank I don't think that's going to be a huge payoff I think getting access so that I can refer my patients to an RD and making sure there's access to them.

So training more of them and paying. Yeah, we're going to run into an RD shortage real quick. Exactly. We're already at a primary care shortage. So it's a disaster that at front. Then paying for the research that needs to be done for us to understand what things we should even be doing when it comes to giving nutrition guidance and changing someone's life, supplementation, chemical exposure, all that. The idea of doing these unique intervention trials where you give people food or gym access. Things like that have always been frowned upon because they always require a huge ton of money. Yeah. Yeah. So like I even introduced a program in my hospital system during my residency. We had to do like a pilot project. And I had the residence exercise with

patients meeting on a day to day, I don't know, every other week basis, I believe it was. And after a period of time, the patients who were sedentary, never exercised before, but got some excitement by the doctor of training them like some basic things to do at home i mean like they weren't teaching them how to bench and squat yeah we were doing like uh squat with a chair in front of you while holding onto the chair because you have knee arthritis and we had three variations for each potential uh issue that they can run into those patients continued after we did a check-in after a period of time that they were still doing some of the things and granted okay they didn't change their lives where they became mr limpia athletes but those are not the things that are mandatory for even

somewhat good health intervention. So I hope more people start paying attention to that basic stuff from the Maha movement. I hope the Maha movement serves as a positive front of this as opposed to a distraction and getting people to look at the other hand and they're getting robbed on the other side. Yeah, yeah. People are like thinking, oh, I can eat the steak and shake fries now because they've like as much as I want because they've got, yeah, they've got seed oils out and like a beef tallow. And I'm like, there's like 650 calories for a large and 1400 milligrams.

So it's probably not something you want to eat a lot of. But if we can change, if the vibes right now can shift culture and then we can actually get policy that lowers the barrier to accessing and implementing things that we know are likely to improve markers of health or quality of life, like that would be amazing. But that's a big A to Z kind of look at it. That's like A to D. And how you even get from A to B, I haven't seen really cogent plans laid out of how that's going to happen. And I think time will tell. Like I don't get enthusiastic about much, but like I'm just, I'm not enthusiastic that it's going to happen.

But I'm like fully on board. I think a lot of people to like advise on these sorts of things. But also nobody's going to put up with BS. Like if I'm not going to sit here and be like, yeah, we're like anti-vaccine. Like the same time. Like so it needs to be like a concerted multi-pronged society-wide reorientation around health. And I think they could lead. if they really wanted to and they can align all their coalitions because I know behind the scenes

everybody's not aligned in the same way. I mean, this administration was good at getting a lot of people with disparate thoughts on things, all behind sort of one person. But then whether that will actually lead to like, whether RFK Jr. has the power. Yeah, but also if you get enough political pressure from the general public, they'll change their tune. Yeah. Because, you know, the vaccine, The vaccine, the COVID vaccine, the operation warp speed was a Trump hailed victory. Yeah, yeah. And now we're introducing members into the power positions, the HHS secretary, now being someone who's like, oh, vaccines are maybe questionable.

It's like you can clearly see that there's flexibility in their thought process, which a lot of people view as a negatively, and I understand why. but we could also use the power of the people. Yeah, I mean, in a democracy, you're supposed to reflect your constituents, not your own personal views. So I think, yeah, there needs to be pressure for it. And I think it needs,

but there needs to be clear guidance on what it is. A lot of what I've seen is like people who shop at Erhuan that are like, get the chemicals out of our food. And like, that is, I encourage everybody who's a food advocate. get to drive across the United States and see the current state of things. It's very different in rural versus urban and different rural areas.

There's huge access issues. There's resourcing issues. There's issues of what we just grow in America and how things are priced. The list goes on and on and on. And all of us under the umbrella of like you have freedom of choice and that we respect. And that's an important thing. But how do we nudge consumers is going to, I think consumers can nudge other consumers, I guess.

But it'll be interesting to see how all this plays out. Is there one claim that sticks out in your mind from the nutrition space that you've recently seen on social media that really irks you? Just one. Three, if you'd like. Interesting. I mean, it's one of the things where there's like a thousand things and there's also like my brains. like just one seed oils like everywhere right now. Yeah, so tell us about seed oils.

What are the claims that you've seen? Oh, my gosh. So they drive inflammatory. They drive cardiovascular disease. They're toxic. They cause cancer. Just the list kind of goes on and on. What does the evidence say?

So the evidence says that like, yeah, these are seed oils. It's hard to say anything about a seed oil. oil. I want to be clear on this because the chemical composition of the seed oil, there's lots of different types of fats that can exist in seed oils, whether they come with antioxidants, all this kind of stuff. But like when you say seed oil, like everyone just immediately assumes that there are high omega-6, specifically linoleic acid, which is an 18 carbon omega-6 fatty acid with two double bonds. And so people started hating seed oils because of that. But now like seed oils have been through plant breeding techniques, how there are like 18, the linoleic acid, like, dramatically lowered. Also, the omega-3 is dramatically lowered in a lot of them. And then the monos. And they're, like, taking over the marketplace. So when you say a seed oil, like, a lot of the seed oil that you're buying and eating is just, like,

not even high in the omega-6s that were the original reason for the concern. And that marketplace is taking over because they're more stable at room temperature and under frying conditions when they're more high in the mono-insaturates. And it's basically they've been upscale to replace the trans fats that used to be in the food supply were banned. So yeah, you can't even guarantee that they're high omega-6, but seed oil claims tend to be rooted in the fact that omega-6 is because they have those double bonds, they're more susceptible to oxidation. And oxidation, as we know from the 90s fanfare around like any oxidants is thought to, like tissue oxidation is thought to contribute to disease in some way.

Because these fats get incorporated into all the membranes across all your organs, you can basically argue that more linoleic acid in any organ is going to cause a dysfunction of that at some point. And it's very vibes-based. It's not talking about like doses of how much you're eating or anything like that. So yeah, there's just innumerable claims. Everything from like it causes autoimmune diseases. It's bad for kids IQ. It causes cardiometabolic disease and cancer. And the data just isn't really there for any of that. To be clear, we don't again have blockbuster randomized controlled trials for the most part. We have short-term studies where you replace the food oil. Sometimes it's high oleic, which is a monosaturated fetus, sometimes it's high

saturates with these more high linoleic acid. Typically we focus on oils that are high in omega-3s at the same time. But when you replace them, you get lower, you see lowering in LDL cholesterol levels. You typically see slight improvements in blood glucose levels. So those are surrogate risk factors for disease. think they're just risk factors, they're not the endpoint itself. So we would expect that LDL lowering to lower myocardial infarction or heart attack, but it's not like 100% on that evidence where you can go look at the relationship to disease endpoints, things like in prospective cohort studies. And so with seed oils, that fatty acid, because it's essential, your body can't make it

itself, the level that's actually circulating in your cell membrane, so the red blood cell membrane is the biomarker that's used is reasonably correlated with what your diet is. You can actually measure people's blood and because the red blood cell has a longer half-life like around six months or so, three six months, you can measure that as sort of a marker of what's the usual diet and how much of this linoleic acid it contains in it. And overwhelmingly across like every prospective cohort study, higher levels in your red blood cell membranes which are correlated with higher levels in your tissues are like associated with good outcomes I think there's like one off study that suggests maybe it's negative for bone, but it's a really

tiny cohort. But like the large cohort study is looking at cardiometabolic diseases, all show improvements in cardiovascular events and mortality. And so the self-reported dietary intake data says the same thing. So the three highest levels of evidence we get nutrition all don't really point to seed oils being a huge concern for any risk factor that we think has meaningful prognostic capacities of like causally related to disease. or in the actual disease endpoints in the more observational literature.

And all of that evidence has its own slight flaws. But when you ask for people to come up with, well, what's this blockbuster evidence that it's like pro-inflammatory and things? You get typically mouse models that are fed, high-fat diets that are obesogenic for the mice. They will get obese regardless of the fatty acid composition. Right. And that you use ones that are higher in polyunsaturated fatty acids, and they, like, do slightly worse on metabolic parameters there.

and that is usually the blockbuster take-home evidence. And they completely ignore all the other evidence and then point out the flaws in it. Yes. And because mice are better than humans. And they'll rightly point out, we don't have good biomarkers of like tissue oxidative stress and things, which is like true. Oh,

that's the other one. Inflammatory biomarkers, which we have, you know this clinically. We have very nonspecific inflammatory biomarkers like HSCRP and ESR. But you can measure like, IL-6 and TNF Alpha. In the few studies that people have looked at this, they don't change in a negative way with

seed oils. There's even a few trials that suggest that we're- I don't even know clinically, I mean, what are you checking those things for, some rare, immunos? This is all research clinical trials. Yeah, I was about to say, I've never checked someone's TNF Alpha or IL-6. It doesn't happen. I mean, now you can measure IL-1 beta and things that, I think, kind of kinemab is and targets

that. So, like, in research studies, you can start to tease this out a little bit more. But there's always the concern that the circulating inflammatory markers don't reflect what's happening at, like, a tissue level. There is a tissue that's stressed by its high linoleic acid content. Like, it's hard to tell on a human. So even in the research models, it's not panning out in that way. No, in humans, it's really tough. But all the caveats are like, we're not feeding like super, super duper high levels of this. There was enthusiasm back in like the 1960s for feeding like up to like 20% of calories from these polyunsetrate fatty acids. Our like cap is typically at about. 10% of calories now for this theoretical risk that like really like we don't have 25 year randomized controlled trials looking at like cancer in every single way that you can look at cancer as an outcome so like there are like barriers in place on this the major rationale though

is a biochemical rationale so not even relying on like mouse studies so much but that when you eat high omega-6s you they compete with the omega-3s for elongation and saturations. Your body needs these essential fatty acids in the diet to turn them into longer chain forms that are enriched in your tissues and are beneficial for a whole host of reasons for the tissue. But when you eat a lot of omega-6s, it competes with all the omega-3s and you're not eating an equivalent amount and even adding a whole bunch more doesn't reduce the competition. So you don't elongate those omega-3s into the longer chain ones that we think, those are the fatty acids that are in like fish oil. And we think, and there's like primate data, there's rodent data,

there's rodent data on this, that this competition exists. We think the competition likely exists in humans, too. And you basically, in animal models, to achieve, like, efficient elongation of omega-3s relative omega-6, you need like a one-to-one ratio, which in humans would be, like, dropping omega-6, like, linoleic acid intakes down to, like, one to two percent of calories, which there's only one research study that's tried to do this at the NIH, and it's, like, extremely hard to feed people diets that don't contain, like, in the modern food supply, it's a you have to use even lift a limit kind of the amount of oils and you have to avoid

things like walnuts because they contain a lot of linoleic acid so it's it has this appeal because people think ancestrally we ate this like one to one ratio of omega-3s to omega-6 is most of the modern nutrition community just says like we don't have to worry about the like your body's ability to elongate this omega-3 is just eat fish that's why like you get the best of both worlds you get the linoleic acid that lowers ldl improve some other biomarkers as well. Associated Reduced risk of cardiovascular mortality, independent of omega-3s. And then you also get the omega-3s, which are associated with improved outcomes as well,

independent of the omega-6s. And you kind of get a best of both worlds. But despite decades of recommendations around eating fatty fish, there is, it doesn't happen. Like America's an omega-3 status indicators where you measure that amount in the red blood cell. When you look at the couple times that we've measured it in more nationally representative samples, the levels are still really low below what we would want them to be for thinking they're cardio protective and so there are people out there eating a lot of omega-6s that are not making a ton of their own omega-3s and they're not eating it and so people think that that's like a risk

it's very hard to find cohort data linking that to outcomes but it's based on this notion that you want a healthy amount of omega-3s and meg6s in the body but yeah I don't like the data to support really links between these fatty acids and any major disease outcome is just not there. And it's one of the topics in nutrition where we have that biomarker is actually pretty good of exposure. It's not perfect, but it's good. It seems quite similar to hemoglobin A1C. Yeah, it's a somewhat similar principle. Instead of the like non-enzymatic modification of the protein by glucosate glycation, it's just the sort of natural incorporation of the fatty acids into the red blood cell membrane.

And so it has a similar kind of principle. That's the best biomarkers in nutrition tend to be like essential things that your body's not making itself. And then you can measure in a red blood cell or in a slow turnover tissue like adipose where you can take a biopsy and measure it and it's reflective of like longer term dietary.

That's like the perfect biomarker of omega-6 intake is adipose because it's stored for relatively long periods of time. This gets back to, are like you can, you can buy all these like diagnostic tests online and micronutrient tests, but they're measuring it in plasma. The half-life of nutrients and plasma is so short, like on the order of hours from any of them, but like it often reflects what you ate yesterday, like not what is actually you've been eating long term. And so you could order those tests, but it'll just tell you what you ate yesterday maybe and how fast your tissues sucked it

out of the plasma. Exactly. And then your body's ability to like keep a slow, steady, you know, a supply for tissues that need it. And so, Yeah, nutrition research is hard is kind of what it comes down to. I understand people who look at it and they go, this is all crap. I'm just like it's, there's so many, so much uncertainty in each line of evidence that we should just eat how we think our grandparents ate or everybody's got their romanticized time in history that they're going to eat at. But I think we have enough data that you typically look along like when do the controlled trials measuring, you know, surrogate risk factors, our epidemiology measuring disease endpoints. a little bit of animal model data and our understanding of the path of physiology

of the disease when they all align and that's like our best case scenario where it's like would you typically you see that in things like sodium and saturated fat where it's like that's a good guardrail can come out of that yes it's a decent guardrail I'm not going to sit here and say we have like statin level

evidence but it's it's enough that like particularly for somebody who's a high risk of cardiovascular disease like these are this is reasonable guidance that we want to look at and for sodium we actually do have some better randomized controlled trials back from, like, the 80s, the trials of hypertension prevention. It's actually the first nutrient that we have a chronic disease risk reduction,

so a CDR, DRI value for it's a new value. The National Academy has finally made a separate category for like a nutrient benchmark called the CDRR in 2019. So chronic disease nutrition started getting hot and controversial in like 1977, and it took until 2019 for us to get like a solid value. from our DRIs. So it's a slow process and why we need to like massively invest in nutrition research to increase the speed with which we do these things and take chronic disease nutrition seriously. Yeah. Well, I'm glad we figured out the healthiest diet today. I think that was very valuable.

Yes. That quick soundbite that I gave you that you can all go follow up on. Yes. No, this is this is why I like I like long form stuff because you really have to like dive into the weeds. But if anything, I hope that people walk away with the ability to rebuff like overhyped, oversold cure all things that you're going to interface with on every single app and that you're that you're interacting with on a daily basis. Yeah, I hope they see how much care you put into answering each question and the amount of hedging and nuance you have to present to everything you say because you're trying to actually give an accurate picture as opposed to selling them a potion.

and I hope that when they see a commercial of Huberman on TikTok with AG1 that I'm getting flooded with right now of him saying like this is the way to accomplish good like it's just it's not like those things are being sold to you and there are distraction from things you could actually invest in in your life that would give better outcomes and I know some of those things are hard exercising sleeping while focusing on your mental health like in my eyes as a primary care physician. If everyone in America had $200 to spend a month on some green potion or to see a therapist once a month, like see a therapist once a month all day long is the right medical answer, almost irrespective of your medical or mental health condition. Right. Because that will

go in the long run to actually giving you something meaningful. Oh, we got a new randomized controlled trial. We have AG1 versus once a month therapy. Oh, yeah. That's going to play well with our I know, goodness. I won't say any more about that because you're already at a high risk of getting easier. Well, we'll just have to mute every time we say AG once. No, but seriously, thank you for taking the amount of care that you do and actually spending the time to put in the research. I think your line of work is greatly underappreciated. And I feel like the dream I had when I started, not the podcast, but the YouTube channel, the engaging

content on YouTube, I guess you could say. The purpose of it was not for me to show what I know because I know so little and I have to know of so many fields and trying to help my patients, but it was to give a platform to people like you who are putting in the effort, who are doing the unsexy work of calculating the CCRI-I-D-R-R-R-R-R-R. What was it? CDR-R-R-D-R-D-R-D-S risk reduction. Yeah, like who are calculating those figures. and actually putting pen to paper and figuring out what I need to recommend to my patients to actually make an impact, because a lot of the people on these podcasts that get interviewed are not doing that.

They're distracting people from that work. And again, I'm just grateful that you're doing this. And what I would like to do is I'm going to allow people, or I'm going to encourage people to leave comments and questions in this YouTube video or Spotify or however you're getting this. And we could do an episode two where we have. answer a lot of those questions. Yeah, that'd be great. Because that'd be fun. Yeah. And I, I just want to, like, it's kind of you to say, but I, um, you know, there are so many,

like, unsung heroes of nutrition research and practice that are out there that I think you don't see many PhDs or RDs. Like, if you, everybody can name a PhDs in the health influence of space, but like how many nutrition PhDs are doing research that are out there talking about it. And so they're the folks doing boots on the ground stuff. And I mean, I'm right in the trenches with them. But there is amazing research. it's happening out there, then I hope people get inspired to, like, think about nutrition research as a career path, encourage their Congress people to fund it. Like, this is a, it's a really cool field that not only impacts your health, but just the

biology of how your body handles food. I, like, that's actually, I didn't say it, but it's what got me into nutrition research. Like, when I end up doing my PhD in coline, because the methyl groups that are on chlorine ultimately end up tagging the genome, the method groups of the colon, they're in mom's diet, end up tagging. the genome in the fetus and regulating its gene expression. I just thought that was like so profound and cool. And what are the implications of that? Like how do we study this more? And so I hope that people get not just like what do I need to do for my health today in which I put on my

plate, but just getting to know the methods of nutrition research and understand a little bit more about it, I think can empower people as they go and interact within the food environment that we have. But we really need that groundswell of social, political. capital supporting nutrition research so that we can really actualize all of its benefits. I understand why a lot of the PhDs are discouraged these days. Because I know that if you go out and you say the things that you're saying that are very scientifically accurate, they're going to get a lot of pushback and say, but Dr. Fung told me otherwise, but Dr. Gundry told me otherwise. But this doctor told me otherwise. And they're like,

why would I bother when I'm just going to get all of these different groups attacking me? I've actually had maybe not in the nutrition space, but I could say in the women's health space, I've had experts who I want to come on the show to debate someone else or have a conversation with someone else. They don't want to because they don't want the negativity that comes with being online. And I totally get it because it's a terrible space when people are attacking you for no reason. Yeah, hopefully I didn't say anything too controversial. They'll get me attacked, but we'll see. Time will tell. Yeah, let me not sign up for episode two quite enough.

well thank you so much for your time hope you had fun yep thank you so much for listening i think this was a fantastic and eye-opening conversation with kevin clatt we really need to support the work that he's doing in fact next i'd like for you to listen to a podcast that will create the paradox in your mind of how experts shouldn't sound check out my conversation with dr gunnery where he makes all sorts of claims that he struggles to back up with facts really great to look at that conversation and compare it to this one. I appreciate you listening. If you enjoyed this conversation, please don't hesitate to give us five stars. It helps the podcast find and reach new audiences. And as always, stay happy and healthy.