The Rich Roll Podcast - Cardiologist Kim Williams, M.D. Wants To Eradicate Heart Disease

Episode Date: November 6, 2017

Heart health is serious business. Serious as a heart attack, as the saying goes, given that currently 1 out of every 3 people in America die from cardiovascular disease (CVD) – our #1 killer. According to the American College of Cardiology, CVD currently accounts for approximately 800,000 deaths in US. Among Americans, an average of one person dies from CVD every 40 seconds. Right now more than 90 million Americans carry a diagnosis of CVD. And over 45% of non-Hispanic blacks in the United States live with heart disease. But this isn't just an American problem. On a global level, CVD is the single largest cause of death in developed countries and accounts for 31% of all mortalities. If you take a moment to ponder these staggering statistics, you quickly realize just how vast the epidemic of heart disease has become. And yet there is hope. Because this disease that's debilitating and killing millions annually is entirely avoidable. It's completely preventable. And it's even reversible. The solution begins with personal responsibility. It's about what you put in your mouth. It encapsulates your lifestyle choices. And it extends to erecting systemic changes in our health care model to prioritize prevention over symptomatic treatment. To walk us through these important issues I sat down with former American College of Cardiology president Kim Williams, M.D. — one of the most inspiring, intelligent and pioneering leaders in the growing movement to modernize how we think about, treat, avoid, and prevent our most onerous threat to human health. A graduate of the University of Chicago and the Pritzker School of Medicine, Dr. Williams currently serves as Chief of the Division of Cardiology at Rush University Medical Center, and is board certified in Internal Medicine, Cardiovascular Diseases, Nuclear Medicine, Nuclear Cardiology and Cardiovascular Computed Tomography. In addition to his tenure as President of the American College of Cardiology (2015-16), Dr. Williams has also served as the President of the American Society of Nuclear Cardiology and Chairman of the Board of the Association of Black Cardiologists. Tangential fun fact? Dr. Williams was also a teen chess champion before becoming Illinois' No. 3 singles tennis player at 15 years old with no previous background in the sport. Faced with a choice between pursuing professional tennis or medicine, he chose medicine. Back in 2003, Dr. Williams became concerned that his LDL cholesterol — the kind associated with an increased risk of heart disease — was too high. After some research into the positive benefits of adopting a plant-based diet, he decided to give it a shot. It worked, bringing his LDL down to normal levels. He then began prescribing his nutritional protocol to his patients. That worked too. Then an interesting thing happened. Dr. Williams became president of the American College of Cardiology, a 49,000-member medical society that is the professional home base for the entire cardiology profession. This gave him a broad platform of authority to advance awareness and the legitimacy of a plant-based diet as both a treatment and preventive protocol for heart disease. Today we unpack his story and probe the science, economics and politics behind nutrition and cardiovascular health on the road to avoiding, combating and ultimately overcoming America's #1 killer. Peace + Plants, Rich

Everyone's going to get older and they're going to pass away at some point. Wouldn't it be nice if we were as healthy as possible until that happened and not have these chronic diseases that are completely avoidable? Almost everyone has had a family member who suffers from heart disease or has had heart disease or has sudden cardiac death and so just trying to get them to understand that there is a relationship between your lifestyle and your outcome. Just make that connection. If we can do that, we would all be so much better off.

That's Dr. Kim Williams, this week on The Rich Roll Podcast. The Rich Roll Podcast. Greetings, everybody. How are you guys doing? What is the latest? How are you feeling? Happy belated Halloween. Hope you got through it. Hope you had fun. Not too much fun, though. Hopefully not too much candy, not too much high fructose corn syrup. In any event, my name is Rich Roll. Welcome or welcome back to my podcast, the show where I go deep, I go long with the most interesting people I can find to bring you compelling conversations, compelling conversations about things that I think matter, personal health, interpersonal health, planetary health, emotional health, spiritual health. And

in the case of today's guest, cardiovascular health, heart health. And this is serious business, people. I mean, really serious. Serious as a heart attack, as the saying goes, not just figuratively, but I think quite literally, in fact, given that one out of every three people in America die from heart disease, are number one killer. And what's really interesting is that at the beginning of the 20th century, heart disease was a really uncommon cause of death in the United States. It wasn't until mid-century that it had become the most common cause. Currently, according to the American College of Cardiology, cardiovascular disease, CVD, accounts for

approximately 800,000 deaths in the United States. And among Americans, an average of one person dies from CVD every 40 seconds. More than 90 million, 90 million Americans carry a diagnosis of cardiovascular disease. And over 45% of non-Hispanic blacks live with CVD in the US. And this is not just an American thing. Outside the United States on a global level, CVD is the single largest cause of death in developed countries and accounts for 31% of all deaths globally. So let's just stop there for a minute. Let's pause and actually ponder these statistics. I mean, when you do that, it's quite staggering. I mean, it is an absolutely insane epidemic.

And yet, here's the thing. It's entirely preventable. It's avoidable. And it's even reversible with some basic diet and lifestyle changes. And this solution starts with what you put in your mouth. It's about how you move your body. It's about your lifestyle choices. And it extends to erecting systemic changes in our healthcare model to prioritize prevention over symptomatic treatment. This has to change. And we have to change. Unless you want to be that one out of every three, it's really imperative to take personal

responsibility for our diet and our lifestyle choices. And these are decisions that they just can't wait. They have to be made now. One of the most inspiring, intelligent, and pioneering leaders in this growing movement to change how we think about, how we treat, how we avoid, and how we prevent heart disease is none other than the outgoing president of the aforementioned American College of Cardiology, Dr. Kim Williams. Dr. Williams is a graduate of the University of Chicago and the Pritzker School of Medicine. He currently serves as chief of the Division of Cardiology at Rush University Medical Center,

and he's board certified in internal medicine, cardiovascular diseases, nuclear medicine, nuclear cardiology, and cardiovascular computed tomography. Don't ask me what that means, but it sounds impressive. In addition to his tenure as president of the American College of Cardiology, where he served between 2015 and 2016, Dr. Williams has also served as the president of the American Society of Nuclear Cardiology and chairman of the board of the Association of Black Cardiologists. This is an extraordinary conversation with an amazing human being. And I got a bunch more I want to say about Dr. Williams and the extraordinary conversation to come. But real quick.

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Okay. Dr. Williams, this is somebody I've wanted to have on the show for a long time, a number of years. And I was finally able to make it happen during the recent international plant-based nutrition healthcare conference in Anaheim, where we were both keynote speakers, Plant-Based Nutrition Healthcare Conference in Anaheim, where we were both keynote speakers, tracked him down, held him hostage, and we got it done. And what is really cool about Dr. Williams, perhaps unique and compelling, at least compelling to me, is that Dr. Williams himself became a vegan in 2003 because he was concerned that his LDL cholesterol, the kind that's associated with an increased risk of heart disease, was too high, a cardiologist with high LDL. So he adopts a plant-based diet. It

works. He starts putting patients on a plant-based protocol. That works. He begins writing about it, including a piece on MedPage Today. That's something that doctors read, and that kind of went viral, at least for that subculture, that community. Then he becomes president of the American College of Cardiology, which is a 49,000-member medical society that is basically the professional home base for the entire cardiology profession. So here we have a plant-based guy, a vegan as president of the ACC. I mean, that's kind of a big thing. And that really helped to raise awareness around plant-based nutrition as a legitimate

preventative protocol for cardiovascular disease in the eyes of at least the traditional medical establishment. In any event, this is a great conversation. It's a conversation that goes deep into the science, the economics, and the politics behind nutrition and cardiovascular health. We cover all manner of topics, including the politics of industry influence on available information and clinical studies. In other words, who's behind what's being said and who's trying to hide the truth. We dig into the contributing factors behind cardiovascular disease, including heme iron, and we address a few popular myths around cholesterol and the various forms of saturated fats.

We talk about sugar, high fructose corn syrup, and their damaging effects on heart health. And we talk about how we can do better, Dr. Williams' efforts with the ACC along with others to help the public make healthier choices, how to avoid an unhealthy plant-based diet, the benefits of a whole food plant-based diet on heart health, and the hows and whys behind Dr. Williams' personal choice to adopt a plant-based lifestyle about 15 years ago. And it's just a great conversation. It's super powerful, and I truly believe it's potentially life-saving. So with that, I give you Dr. Kim Williams. All right, you ready to go? Absolutely. All right, let's do it. Okay. Dr. Williams,

it's a pleasure to finally meet you. Thank you for carving out the time to talk to me today. Certainly my pleasure. Is this your first time at this conference or have you presented here before? I actually have presented a couple of years ago and then I think once before that. This is wonderful. I only got in last night, so I missed your talk yesterday. Sorry about that. What was the specific subject matter that you spoke about? So what I normally talk about is heart disease and dying. And in the past, I've always talked about sort of vegan diet versus vegetarian versus pesco-vegetarian versus eating real like beef and pork and the like. And what does the data show? How is processed red meat worse than red meat, which is worse than chicken, which is worse than fish?

And it's sort of the hierarchy of cardiovascular effects. And this one is actually was going to be a fair amount of that from other people. And so what I proposed to the plantrition folks would be that I actually there's just some we're accumulating so much more data on sugar. Probably the the linchpin, even though there's data out there before the linchpin was an article in the Journal of American Medical Association last year. that showed that the Sugar Research Foundation had actually paid some researchers, the influential people, to turn attention away from sugar for cardiac disease and towards saturated fat. Of course, that was a good target, but it left lots of us, people doing plant-based nutrition, eating a high amount of sugar, thinking it grows in the ground.

It's okay. It doesn't have a mother. It doesn't have a face. And it fits our criteria. When it turns out that the data was actually pretty damaging. Well, now there's actually been a fair amount of sugar research and correlation with everything. All the things that you would want. There's a good mechanism. That is the sugar increases your insulin levels.

Insulin increases plaque. Insulin resistance makes it heap up on itself. And the next thing you know, you've got sugar addiction and you've got a lot of sugar marketing. So to the politics, economics, the fact that our country actually does have congressional support for farm subsidies for production of high fructose corn syrup. And so we pay them with tax money to produce things that make them inexpensive so that we eat them more, which increases the amount of disease, which we then pay for with our Medicare system. And it's really a circle that needs to be broken. That was actually pointed out to me by one of the Oregon congressmen. I had no idea until a couple of years ago that this was going on. Oh, it's a huge problem. It's a huge problem. And the repressed pricing of these types of products, including all the processed snacks, et cetera, um, tend to disproportionately

impact the lower socioeconomic strata of our culture further, uh, you know, further, uh, further creating, you know, exaggerating the divide between the haves and the have nots. And, uh, you know, these people end up getting more and more sick and more and more dependent. You did that well. You could have given my talk. So I did talk about that. I talked about the SNAP program, healthy foods and hospitals, how we need to change a lot of things. But the SNAP program has really been sort of the safety net for people. And there was an article published just a couple hours before my talk that I was able to fit in there, talking about the important how having a SNAP program, that is having access where you could actually

go to a grocery store and buy some decent food, actually decreases healthcare costs by $1,400 per person per year. That's incredible numbers. And what is the current scope of how you can spend those SNAP dollars? Because I know traditionally it didn't apply to healthy produce, et cetera. Although I was doing a podcast with, I think it was Dan Buechner the other day, and he was saying that you can now use SNAP dollars at your farmer's market. Is that true? Well, as far as I know, but the other side of it is what we've been after.

That is, we, meaning the American College of Cardiology and the American Medical Association, actually passed a resolution pushing Congress and regulators to change the SNAP program so that you cannot buy unhealthy foods and to try to make preferences. And so I think people are starting to understand the impact of diet on our society. And the more data we accumulate talking about health care costs and the food choices that we make, the better off we're all going to be. Yeah, I think it's happening. I mean, certainly there's a tremendous amount of work to be done that remains, of course.

But let's go back to the sugar thing for a minute. You know, I think we as human beings are reductionist by our very nature. And the scientific method is reductionist as well by necessity, I suppose. But we always want to look for, you know, that one evil culprit, like it's the sugar, it's the saturated fat, it's the this, it's the that. And that's what we should be sort of marshalling all our attention and resources towards. But obviously, you know that this is a incredibly complex matrix of many factors that come into play that contribute to things like heart disease. So when you're thinking about sugar and when you're thinking about saturated fat, how do you explain these ideas to the patients that come to see you?

Well, first of all, there's certainly a lot of data that's impugning and supporting saturated fat. And this is a big fight that people are having. Right. I want to get into this, too. So keep going. Sorry. But the interesting thing about it is that when you're talking about saturated fat or you're talking about cholesterol or the new bad kid on the block, heme iron. That is iron that should be good for you, except it came in a form of a red blood cell and it's very toxic to your blood vessels and making heart attack, stroke, and death. And this is the iron that is contained in animal products.

In blood. Exactly. Exactly right. And so it turns out that you've got all these candidate genes, if you want to call them that, for what is actually causing so much of the differences between plant-based nutrition and the standard American diet, for example. But none of those things I just mentioned are actually taken in isolation. Sugar? Absolutely. I mean, you're putting it in tea. You're putting it in coffee.

The data on tea is good. The data on coffee is even better. But once you put sugar in it and you're doing it in high amounts, which some people do, But once you put sugar in it and you're doing it in high amounts, which some people do, you're actually increasing everything from blood vessel inflammation to atherosclerotic plaque. And so that's the one distinction. And that is it's really difficult to call out saturated versus polyunsaturated versus monounsaturated. And if you're overweight, maybe you really shouldn't. saturated. And, you know, if you're overweight, maybe you really shouldn't. And if you are, you know, running and healthy and, you know, athletic, then you probably can tolerate more because you're going to burn it as fuel. But sugar, it's probably not good for us under

any circumstances. There's an idea out there that there's no distinction between refined sugar and the sugars that you find in fruit, for example. So can you speak to that? Is there a difference in how we metabolize these things and the health impact? When you're talking about sugar, what are you talking about specifically? Well, if I can borrow a term from you, reductionism, we have to think of these things in the absence of like prospective trials. We think of them in terms of mechanisms. And so what I, in preparation for this talk, said the bad guy here is insulin. We know that people would get, when they get central obesity, they get insulin resistant. Their insulin levels are very high and it's promoting more and

more plaque. And therefore, that's the thing that I would like to control is the insulin level. or that's the thing that I would like to control is the insulin level. And so that's what I took the fruit sugar, fructose, the usual blood sugar that we have, glucose, sucrose, of course, is the table sugar. That's the combination of glucose and fructose. And let's see what happens when you have a dose of this and increasing doses of it. What happens to your insulin level? And I was able to find a manuscript that detailed all of this and increasing doses of it, what happens to your insulin level? And I was able to find a manuscript that detailed all of this over time. You take, you know, 50 or 25, 50, 100 grams,

see what happens. And, but they did an interesting thing. They actually had a fourth thing in there and it was actually white bread. And the insulin levels were with all four were about the same. And so the idea that refined carbohydrates, refined grains are pretty much as bad as sugar is pretty much true as far as your pancreas is concerned in production of insulin. Right. when you were talking about that, it made me think of a conversation that I had with Dr. Neil Barnard, who was very adamant that we should be looking more at the fat intake in our diet and the impact of that when it comes in the form of animal products in our diet, and how that relates to the onset of type 2 diabetes, rather than all of this focus on sugar. So, how do you think about that? Or do you have a different point of view on that than Dr. Bernard?

Well, so Neil's a very smart guy. He reads a lot. I try to read as much to catch up with him. But the fact is that I think that they're both bad. We actually, that article that I mentioned, if people look it up, the Sugar Research Foundation, Sugar Industry, in the Journal of American Medical Association, there was actually an accompanying editorial that had this one graph that everybody should see. It's country by country, cardiovascular disease mortality on the one axis, and a dot for sugar and a consumption per capita and a dot for saturated fat.

And the two of them for every country. They're in lockstep. They're in lockstep. It was Japan at the lowest, United States at the highest, and all these countries in between. So I'm not sure that we need to make a distinction. I think we just need to find out all that we can about each element that's not good for us, whether it's heme, iron, or sugar, and then try to avoid them. Right. I mean, looking at that from a correlative point of view, it's hard to parse the distinctions between them, right?

That's right. From a scientific perspective. Well, I think, you know, the average consumer right now, you know, we're in an interesting time. There's so much information available to everybody with all of our devices, etc. But I think it's also never been more important that we become more discerning about the sources of the information that we consume. And there are a lot of vested interests out there that are heavily invested in making sure that you remain confused. And it is confusing unless you're someone like yourself who's really mining the data and rolling up your sleeves and really trying to understand what's going on out here. You can go online and you'll see, oh, it's sugar. Oh, it's fat.

Oh, it's this. Saturated fat is back. All this discussion about saturated fat and heart disease is back. You know, all this discussion about saturated fat and heart disease is nonsense. And now we know that saturated fat has no impact on arterial cholesterol levels increasing, all of this. So can you just help me make sense of this for the listener who's just trying to like make better choices? Well, it's not easy um you know i recall several years ago um 14 years ago when the portfolio diet came out which and which is david jenkins it's a marvelous work and again journal of american medical medical association so not you know vegan propaganda rag

i mean this was a peer-reviewed, high-quality manuscript. And it talked just about inflammation and cholesterol, your LDL cholesterol and your C-reactive protein. What is the response to a statin versus a plant-based diet? Wonderful article. And I figured that after you saw that the LDL cholesterol, the bad guy, goes down dramatically within two weeks with both the statin and the diet, the plant-based diet. And it had almonds. It had plant sterols and soluble fiber, et cetera. And then you looked at the inflammation. And they both went down, but the plant-based diet lowered it faster than the statin did. Okay. I figured that that would take every capture everyone's imagination.

Sure. It's biochemical. It's not outcomes, heart attack, stroke, and death, but it's pretty, pretty important. Well, the response was actually not as much as we would like. And one of the reason was, uh, one of the reasons was that at the bottom you could see that it was supported by the California almond industry. And part of the diet was to do three handfuls of almonds every day. Doesn't mean it wasn't right. I'm sure it was right. I think that Jenkins is a wonderful guy. But it was a good lesson to me early on to try to stay away from industry influence as much as possible.

And so we have had just what you're saying, confusion. If I were going to pick one, I'd be concerned about the egg board and saying that cholesterol is not a nutrient of concern, which actually came out in the dietaryary Guidelines for Americans early in 2015. We were able to show them, that is Health and Human Services and the USDA, who sort of partnered together to put that document together and run the Dietary Advisory Group. We did get them to change it. We showed them all the literature. Neil Barnard was very helpful there. But you're realizing that you've got to have science that's pure, that's independent, so that no one's vested interest.

It's interesting. Everybody asks me, well, when is your book coming out? And that's one of the reasons I don't want to. I mean, there's plenty of books out there. A, great books. And the other is I never want somebody to say that I have a vested interest other than my own. Right. You're just trying to shill books. Exactly. Right. Never that. It's

always going to be about my patients, about my family, about my country. And that's, that's what it's about. Yeah. Well, I think, you know, first two things, first of all, that was a, quite a victory for the ACC when you were president, right. Getting the, the, you know, getting those nutritional guidelines shifted with respect to cholesterol so you know thank you for that i left out the punch line yeah what the bottom line of in the document it actually says uh which is a quote from the institute of medicine not acc it said that people should eat as little cholesterol as zero oh i'm sorry a little class of cholesterol as possible which of course i my brain, as I just did, as zero, which means you pretty much have to be a vegan because there's only, you know, how many animal products don't have cholesterol?

I think egg whites, jello, and honey. That's about it. Right. Well, let's talk a little bit about, I mean, the second point I was going to make was that, you know, we're in a capitalist society. And, you know, it costs money to perform this research. And somebody's got to pay for that, you know, we're in a capitalist society and, you know, it costs money to perform this research and somebody's got to pay for it, right? So, aside from grant money or however else, you know, these studies get funded, industry is sitting there, you know, willing and ready to fund these things. And that comes with its whole, you know, bag of compromises, obviously.

But to see our way forward, I mean, do we need new ways of funding these studies? Like how can objective studies get performed in a way such that they're not compromised by industry interests? A lot has occurred over the last few years. The development of data safety monitoring boards, for example, where people who are completely independent of the study, they are paid by industry, which is a funny thing because they're paid to block them if things are going badly in the study. And yet that's considered a relationship with industry. It was something we ought to think through, I think. But we also have clinicaltrials.gov,

where people, if they're going to do a big clinical trial, they should submit it. Everyone can review it. And so there's more of a truth than there was before. If I could point to one issue with the industry-sponsored trials in the past, and it's really not just industry, it's all of us, is the positive publication bias. We see, for example, heme iron.

Suppose there were five investigators out there and four of them found that there was no relationship between heme iron and heart attack, stroke, and death, and one of them did. The four, if they submit it as a negative study, it may not get published because it's not scintillating. But also, us as investigators, when we do a negative trial and say, oh, well, that didn't work, and we move on to the next thing, they might not even submit it. Whereas the one that found the relationship, they're going to publish it. So it brings up the whole question of this positive publication bias

really brings up the question of all of the things that we're doing and why we would like to have large, prospective, registered, randomized trials. So since that's been happening, we actually are getting data in pretty much every area, everyone knows the acronym for the trial and you will wait for the results. You know, you have a presentation on what the methodology is and then two or five years later, you get a big result and it's positive or negative and everybody knows about it now. So that's, I think has been an improvement and it's, it mitigates the industry influence because they can't cherry pick what's going to get published and what's not. Much ado has been made over the past year about this idea that saturated fat is back.

Lots of articles being written about everything you thought about saturated fat is wrong. We don't need to worry about this anymore. It's your new best friend. Knock yourself out with the bacon and eggs. So when you read that, when you see that, what happens with you? So there's so many responses, but I'll try not to recap too much of what I said already, but just a couple of highlights. One is we just don't take the Crisco, put it in a pan, heat it up and then drink it. Okay. So whenever we're getting saturated fat, it's with something else that probably isn't good for you. And it might be heme iron,

it might be cholesterol, it might be just animal protein itself. And it's, you know, the fact that that promotes cancer growth. So we have to take everything, I started to say with a grain of salt, but that might not be the best thing to do either. But we have to try to look at the research that, you know, that what they're really doing typically is, is doing food frequency questionnaires and then analyzing the components of what people said they ate and then trying to correlate that with outcomes. And that is just very difficult. You're making several assumptions along the way and you're not really capturing the whole team of things that are potentially damaging. And so to pick out each one and then get reliable

results every time may be difficult. So the best example, I think, is the PURE trial. And that's the one that everyone's talking about. Salim Yusuf is a good friend of mine. And we happen to be at a dinner at the European Society society of cardiology and the day that his article came out i sat and talked to him for a while about this and my concerns that you really weren't capturing the vegetarian population which meant that you were actually comparing things that were not healthy necessarily from one population to the next and then 19 different countries and that is not not the same kind of fat that we're getting in the United States. Okay, so he defended it well.

He said there were some small vegetarian populations in the 19 countries, but they don't overwhelm the data. So my biggest concern about the peer trial is that, and I probably should have, I might run it by him the next time I see him, is they actually did a pretty darn good job of categorizing the fat saturated, polyunsaturated, monounsaturated, but the carbohydrates were not characterized that I could find in any way. I bet he has an appendix somewhere where he can explain that because just as you know know from my interest in

sugar carbohydrates are not all carbohydrates and so when you're talking about complex carbohydrates that are not going to drive up your insulin levels you're probably doing something that you you can burn as fuel it's not going to be you know anti it's not going to be inflammatory it's not promoting a rise in your cholesterol and increasing plaque formation. That is completely different than having a sugary, refined flour type of body response. And so it wouldn't surprise me that saturated fat falls second to carbohydrates if they're refined carbohydrates in terms of the damages that they can do. And so we really need to have good comparisons of healthy foods. So none of that was talking about whole food plant-based diet. And the last comment is, I borrowed from, I think from Juliana Heaver, you probably know who said

it. Tell me who said this originally, but the fat you eat is the fat you wear. That is such an important concept that, and I know the American Heart Association did a wonderful job, by the way, a few months, I think last May, of doing a presidential advisory where they reviewed all of the available literature on saturated fat and came to the conclusion that you really shouldn't eat it based on the literature. They also actually made a slightly controversial statement, which was that you probably shouldn't eat coconut fat either because that has so much saturated fat in it compared to other vegetables. And I know they got a lot of pushback from it. And it's interesting that the presidential advisory was one guy, Dr. Stephen Hauser, who's a wonderful guy.

And then John Warner, who took over as president, sort of got the blame just because of the timing that they switched in. But what can you do about that? They have the right to review all of the literature and make an expert opinion and say that that's what it is. It's an expert opinion, nothing definitive. And all that does is invite us to do studies. And if there are people, I know David Katz at Yale thinks that coconut oil is really good. I don't have enough data to make a conclusion myself.

Let's do some trials and come up with whether or not it's damaging or not. Yeah, I think a lot of people would like to know the answer to that. correct me if this is incorrect, is that the saturated fat in coconut oil is comprised in large part by lauric acid, which is a more easily metabolized version of saturated fat, a more readily available source of energy burning fuel versus the sat. So there's different kinds, there's not just one saturated, there's different kinds of this right like that's right This is not clickbaity stuff Like you got to really you know dig into it and understand that this is highly nuanced and you devoted your whole life to this Well, this part is I'm much more of a nuclear guy

So I thought I was gonna spend my life doing cardiology and nuclear physics at the same time and now I'm in nutrition but I am a fan of all of that and yes the AHA report actually goes into that and talks about something that I didn't know that the fat you eat is the fat you wear but more so if it's animal fat that is the vegetable saturated fat for the reasons you said the shorter chains there's less

calories in it so it actually is better for you but is it good for you? That's the question that we don't know. Yeah. Interesting. So you are the outgoing president of the ACC. There was a one-year tenure. Yep. 2015 to 2016. So let's talk a little bit about that organization and what the kind of mission statement and purpose of it is and, you know, what your, your, your goals were during that period of time. And, and other than what we

already mentioned, you know, what was accomplished? Well, it's, it certainly is a growing organization. It is dedicated to making sure that people do better in terms of their heart health. So the mission actually is to improve heart health and transform cardiovascular care, and the two go hand in hand. What we really are meaning is to try and add more members, add more member varieties. And so we have 53,000 members or so right now. It used to be cardiologists. Now it's, then it became cardiologists and nurse practitioners.

And then it became pharmacists. And then we started doing international. And so anyone who's interested in improving heart health and is part of the team. And we work right now on a lot of issues that are facing the cardiovascular field. Prevention is one of them. And so I would say that during my year, we focused a little more than we had in the past on population health. It was interesting to have meetings on population health, have experts come from all over to Washington, D.C., to the Hart House, and discuss how we can make things better. And it's, you know, everyone's sort of looking kind of, you know, out of the corner of their

eyes saying, why are cardiologists trying to decrease their income? Just because we feel like this is our job. Isn't that the core goal here? I think you said there was, I saw a quote from you, like, my job is to put cardiologists out of business. That's exactly right. And, I saw a quote from you, like, my job is to put cardiologists out of business. That's exactly right. And, you know, it would take a while. And I have to say that it's timely. It would be great if other organizations were focused on these things as much as we do because, you know, inside and outside of medicine. Because last year was the first time in 40 years that cardiovascular disease deaths in the country went up.

And that is just something that we just can't abide by. And, you know, they've, you know, we're always bragging about this decreasing curve. It's about 50% over 40 years in cardiovascular mortality and it's bypass surgery and statins and beta bloggers and AIDS and all these medications for heart failure and decreasing sudden death because we put into fibrillators that shock people when they when they have a fatal arrhythmia and they come back to life and we were so proud of all the stuff and then the american population somehow has overcome finding an end run around this no matter what you do exactly yeah and when the cdc put those numbers out there they said it was obesity and diabetes that's driving it.

And that's a nutrition. And so the fundamental issue that we've been dealing with for the last so many years is really at the core of all we do. And it will uproot and undo any success that we can do with devices and medications. we can do with devices and medications. Yeah, it's got to be a shift in priorities and focus because it is amazing to reduce by 50% the mortality rate of people who are suffering from heart disease as a result of all this amazing science and technology. But if that comes at the cost of really addressing the fact that the incidence of people who are, you know, becoming patients in the first place, then you're waging a losing war. Well, ultimately, yeah, everyone's going to get older and they're going to pass away at some point.

Wouldn't it be nice if we were as healthy as possible until that happened and not have these chronic diseases that are completely avoidable by lifestyle. Yeah. I mean, we need to be talking about prevention and we need to be creating systems that promote prevention. I mean, we're seeing it with the rise of functional medicine clinics and doctors who really are up to speed and paying attention to these things. But, you know, it's tough when we have a structure that's set up that allows

well-intentioned doctors only 15 minutes with the patient and they're incentivized to just diagnose and prescribe and move on to the next thing. Like we're never going to, you know, crack the code until we really get to the core of how the whole, you know, system functions. That's right. So, but getting back to what the college does, the population health is just one small aspect. We actually are a global organization. We have 40 chapters, international chapters, where a chapter can be formed whenever there's members who have attained a high level of proficiency. They're called fellows of the American College of Cardiology. If you have 20 fellows in any area, you can have a chapter. And then that has a governor, which then

participates in the governance of the college. No taxation without representation, right? And so it turns out that we have collectively learned a lot. You know, we have our members in Lebanon, for example, are dealing with smoking and very young people. Heart failure in Brazil. And it's not just the Chagas disease infection that people can Google and say, oh, my gosh, these people get an infection. Their heart, you know, disappears. They also have hypertension at a high rate. The diabetes in Mexico. And then the obesity in the United States. And we can all

learn from each other about how to improve outcomes. So the international mission, I think, is key to success for us. We also do a lot of hospital accreditation in terms of making sure that if you're going to go in for an angiogram and you're going to places that knows what they're doing and they've demonstrated it. And probably our biggest product nowadays is the registries, the National Cardiovascular Data Registry, NCDR. It collects information on all the important diseases. You have a defibrillator. Are your people putting in defibrillators when they need it? If you have atrial fibrillation, are you getting the right medication for it? And so a lot of disease management. So with that, you would

think that we cover the globe literally and geographically as well as figuratively. But we do feel that all of these things should be reduced and we're managing things that can be prevented. And so let's continue to focus on that and we'll try to continue putting that influence out there. Right. Very good. And was your presidency, is that like an appointed thing or an elected thing? Like how does that, how did that work? It actually is an election, but it's an election by a nomination committee that reviews all the people who are applicants, who have been leaders, who, and in my case, it was other people asking me to run. And I'm saying, I don't know if I can do this. Just physical.

You're a politician? Well, the politics was fine, actually. You know, there was a time when I was very much interested in the political side. I've been an advocacy person for a while, always going to Congress, talking about how to improve outcomes for everything. And, you know, like hospital food, that's one of our, that's the thing we're on right now. Let's legislate that hospital food has to be healthy.

And we actually got that through the American Medical Association. So I know I'm tangenting here, but to give you an example. And it was such an impressive outpouring. We were a little nervous as a college. It was actually Neil Barnard who started it in the Washington, D.C. chapter of the AMA. And there were people at the college who were nervous that we were going to step on going to step on everyone's toes, but ultimately we went on ahead and supported it and pushed it. And what's the resistance to that? So the issue is that you're going to make an enemy somewhere. And so you're always looking for unintended consequences. It's politics in a way,

right? Okay. And suppose, for example, and I don't think this would happen, but suppose, for example, the American Hospital Association said that, you know, the this, you know, this program you're doing is disenfranchising our hospitals. Therefore, we're not going to use any more ACC products, which is then going to hurt our patients. OK, so I mean, so you're trying to balance everything. And so but at the end of the day, you realize that it's just the right thing to do, you know, and damn the torpedoes were going to go ahead. And so, so I, you know, along with Neil and I thought we were going to be alone at the microphone. And sure enough, AMA delegates were lined up outside the door trying to talk about the ravages of the hospital food. Now, there were most of them were actually plant food. Most of them were actually plant-based. All of them

were concerned. Cardiologists coming up to the mic saying, I just put a stent. I just put three stents in this person. I'm bringing them back to the CCU. I'm coming around on them, and you've given them bacon and eggs. And what are you doing? It's unbelievable. And the McDonald's in the lobby, right? Absolutely. And so this is something that we really are taking on. And we'd like to improve. I know it's going to decrease our income, but it's going to improve the outcomes of our patients. And that's what we're really about. Yeah, that's great.

Have you had similar initiatives with school lunch? Or is that outside your... You know, there's two things that happened. One about five years ago. There was a pilot in our Northern California chapter of the ACC, a pilot that they were supporting that they were very proud of, where they had gone to the schools and removed the junk food and put carrots and celery. And it said that it had an amazing impact. And the kids actually started to like more healthy foods.

They were making more healthy food choices. And by their assessment, they were making more healthy choices at home. So that actually, I think, may have influenced FLOTUS, the First Lady of the United States. And they were actually, she sent a representative to our population health meeting at the American College of Cardiology to talk specifically about the FNV program. And I did see that Jimmy Kimmel sort of, they had a good joking relationship. And Kimmel would say, well, you tried Let's Move and nobody did. So let's go with the FNB, except you got to change the name because it doesn't sound right. And so they go back and forth. But I think they got the point across that fruits and vegetables were the way that people

were supposed to go. And so it would have been nice to have that program, that kind of program. I think they were starting in Norfolk, Virginia. I haven't seen an outcome from it. Deb Eschmeyer was her food czar, who was very helpful in getting that and very helpful to us when we were fighting this dietary guideline thing. I don't know where that's going to go. I know a lot of the things in the Obama administration are being reversed. And it would be good to see what actually happens in terms of school foods so you famously adopt a plant-based diet in 2003 spent about 15 years right so so let's talk about that like what prompted that you know how did you make that decision so it's interesting that this

in retrospect i mean you make a decision and then you can look back on it later and try to figure out what led to that. And I was able to identify a few key things. One that I don't talk about very much was my affiliation with the Association of Black Cardiologists. And there was one cardiologist in that organization. His name was Tazewell Banks. And Tazewell was always talking about diet. And he was always talking about Dean Ornish. And he had seen the life trials and read them, paid attention to them, changed his diet. And he was director of the coronary care unit at DC General Hospital, part of Howard University.

And he claimed, he made this outlandish claim claim that every person came in there with a heart attack. He changed their diet that moment to vegetarian diet. He made sure that they understood it before they left. And then they'd stick to it. And he had followed everyone for at least one year and no one had a recurrent heart attack. This was back in the days when recurrent heart attacks was actually quite frequent. So how many years ago was this? So that would have been probably the mid-1980s. It was not too long after some of Dean Ornish's first studies were out there. So that was in the back of my mind because I had actually heard that. And then being a nuclear cardiologist, I had actually seen the land-schooled Dean Ornish PET scans with rubidium 82 rubidium 82 is an isotope that you do PET scanning with it turns out that that actually was

My research when I was a cardiology fellow was in rubidium 82 So everything with rubidium might always take a look at it And so I'd seen those images where and three months, the blood flow dramatically improves. And, you know, can that really happen? So I put it in the back of my mind. And then right before I went to that American College of Cardiology meeting where I had the cholesterol test in the context of getting a little older and having my son who was a nationally ranked tennis player, and I was his coach, and he had aged out, and he was going to play baseball at Valparaiso University, and I wasn't on the tennis court twice a day every day.

That change in lifestyle and continuing that diet of chicken and fish, which we thought were healthy back then, but if I had just done the literature search, I would have seen that that actually was high in cholesterol. Right, that's a common misunderstanding. Exactly. And, you know, there are some relative benefits. If you compare it to processed red meat, it's way better.

It's a little better than red meat, but it's still not vegetables in terms of mortality. Right, so you're eating this diet. Look, I'm eating good. I'm not eating processed meats. I'm eating red meat. I'm eating my chicken and my fish and I'm keeping it clean and you know, I'm doing what I'm supposed to do. That's right. And so in that context, I was on my way to this meeting and where this is about to happen to me, where I get the blood test done. And there was a lady who came to my lab, where I get the blood test done. And there was a lady who came to my lab, my nuclear lab, and I was the reader that day, who actually had a scan that looked pretty good. But as usual, I look through the chart and I see that there's an old scan. So I pull it up and I'm comparing it. And it's

dramatically improved. This was a study, the first one, which had been about six months earlier, This was a study, the first one, which had been about six months earlier, had a tremendous amount of blood flow problems. She must have had, I figured, three vessel disease and that those vessels were pretty tight. Okay, so I'm looking on our little worksheet because my nuclear lab that I created at the University of Chicago, we just collected data on every little thing that was in the report that you would ever want to know. And there was something missing. It was the bypass surgery. What happened to the bypass surgery?

What happened to the stenting? You would have had to stent probably five vessels. I figured no one would do that. She probably went to bypass surgery. How did it get so much better? And so in the absence of any data that they collected, I actually called the patient. I said, sorry to bother you, but I think my lab left out something. Okay, did you get, when was the bypass surgery or the stent?

And she says, no, they told me about it. They told me I needed it, but I refused. I looked on the line and I found Dean Ornish's program and I went on this diet and started exercising. And it took about six weeks for my chest pain to go away. I would never do that, by the way. I would do the Dean Ornish and the stenting. Six weeks of chest pain is probably not what we're recommending. But she lost a lot of weight, and she was exercising so well that she was training for like a 5K or a 10K.

She was just doing so well. And she tripped on a curb and broke her ankle. And so that's why she was back in the lab because she's refusing an angiogram, had not gotten the standard treatment. And now she's got to go to the operating room for an elective surgery. And everyone's afraid. They're not going to put- Problem patient. Oh, Mike.

Well, it goes- Anesthesia does not want to put you to sleep with untreated heart disease. And so it really was a fantastic story. And the idea that the Ornish diet could be just as good as the scans that I was seeing routinely after bypass surgery or after stenting was very impressive. And then, fortunately, I had my cholesterol done in the next couple of days after that. But then, fortunately, I had my cholesterol done in the next couple of days after that. Right. So your LDL was like 170.

It was 170. I didn't actually believe it. I thought this was back in the day where we had the exhibitors on the floor in the meeting. And you go into the exhibit hall and you stand in line. You get your cholesterol tested for free. Great. I thought it was a plot to sell cardiologists statins. i went to their competitor and it was 169 so then i fasted all night okay i came in the next morning that's so funny that now it's wrong exactly figure this out exactly so after fasting all night it was still 169. And so I stopped eating animals right at that day and never went back.

Wow, that's amazing. And you wrote about this. You wrote this. It was on like, what's that site called? Like MedPage today or something like that. I actually couldn't read it because I'm not a member or what I can log in to read it. But you kind of talk about why you made this decision, the reasons that supported it, the history leading up to it.

And it caused quite a stir. You had as many fans as detractors, right? And there's been a lot of think pieces written about this. And given your position as president of the American College of Cardiology, kind of foisted you into the spotlight in a big way. So there was a, there was a very bright light being shined upon you and this decision. What is he actually saying? He's a member of this vegan propaganda unit. He's advancing some industry, you know, interest. I don't know what's going on here. Um, but there was a lot of, you know, there's a lot of discussion about this.

So how did you weather that, navigate that, and how do you kind of perceive that now in retrospect? Well, it's an interesting story in that it was actually a staffer in the American College of Cardiology PR department, the media department, who noticed that I was eating different and always asking for different food at the meetings and said, well, why are you doing this? I said, heart attack, stroke, and death. And she said, well, why don't we put that in our blog and do a little nutrition prevention page? So I said, okay, that's fine. And then that got picked up by MedPage Today.

I see. Then that got picked up by the New York Times. And then the next thing you know, it's all over the place. And Dean Ornish came to my rescue at MedPage today and asked them if he couldn't write a, because there's like a 400 word limit. He says, can I write a substantial piece to talk about the data that made him do this? And so that became a wonderful companion piece. And a lot of people looked at it and you're quite correct. I was accused of, um, you know, industry influence and pushing some, you know, agenda. That's really just about my LDL cholesterol. Then I found out

all the other stuff that, that happens because a lot of the publications weren't out there in 2003, but the data's out there now. Animal protein is bad for you. Heme iron is bad for you. The cholesterol, the IGF-1 in the animal protein, this is all science. And so the difference is now I read it. Now, the other major controversy, which I probably shouldn't repeat one more time, but I guess I'm going to do it, more time, but I guess I'm going to do it, was making that comment, which was completely half joking, but I was making a statement about cardiovascular research and the fact that nutrition research is typically in the American Journal of Clinical Nutrition.

It's not in the Journal of American College of Cardiology so much. And so it's not in front of the cardiologists. And so I made that statement, again, more than half joking. The statement that there's two kinds of cardiologists. Yeah, why don't you say it? Right. Two kinds of cardiologists, vegans and those who haven't read the data. I got you into a little trouble. It did. Well, the interesting part is that, like they say, if you take the text out of the context, then all you're left with is the con. And so people were misunderstanding.

I thought I'm throwing all my colleagues under the bus when I'm really claiming or asking for more research, more review articles, more data to go into cardiology journals so that people are actually seeing it and it can influence their lives and their patients. But then two things started to happen. One is, you know, the pushback from that was actually, I think most people understood that I was saying that if they know me at all, if they don't know me, they wouldn't say anything to me. If they did know me, they knew that I was, you know, saying that in a jocular manner. But there were some people who took it seriously, particularly at Rush, where I'm the chief of cardiology. And we now have nine vegan cardiologists because people looked at the data and they saw that this is probably something I shouldn't be eating. And they've changed their own lifestyle, which is wonderful because it gives us a good cadre of people who work on prevention.

The other thing that happened, though, I have to say is that I'd spent six years on the American Board of Internal Medicine doing the cardiology exam and then the ACC leadership position. So I'm seeing a lot of cardiologists. Then my time at the American site of nuclear cardiology, I was president 12 years ago. Each one of those organizations has had some luminary person who died of heart disease. And I'm kind of saying that's where we really need to start. That is in order to fix the population through all the powers of our ACCHA guidelines, the people who are actually getting that data out there and putting it in the hands of patients and the prescriptions

and telling people how they should live is cardiology. So at this point, I've had enough of the sudden cardiac deaths. I'm actually, my new goal is to not retire until the leading cause of death in cardiologists is no longer heart disease. Yeah, it's amazing that it precipitates at that level amongst, you know, amongst your peers. On some level, it's like you can't transmit something you haven't got. Like if you're not living this life in a certain way where you're, you know, where you're an embodiment of the message that you're promoting, that's inherently problematic. Right. So I, it really has affected me in terms of, uh, the guilt when one of my friends would pass away, you know, they knew that I was eating different. I ate with

them. They knew that I was eating different. And did I say anything? And did I say it loud enough? I was eating different? And did I say anything? And did I say it loud enough? And so now any quip that I can come up with that gets on my page today or Twitter, I'm fine with. I'll take the backlash if it's going to save some of my colleagues' lives. Ultimately, that will help our country. That will help reduce this terrible epidemic of heart disease, even if it makes me unpopular. We should point out that your LDL went down from 170 to 90, right? It did. Yeah. How long did that take?

Well, you know, according to David Jenkins, it probably took two weeks, but I measured it at six weeks. But, you know, and nothing. Yeah. Yeah. It's interesting. And, you know, statins do work that fast. Diet works that fast.

They both can precipitously drop the cholesterol in a matter of days, really. And so it's interesting that there's a lot of confusion about the amount of research on diet and cholesterol that people really need to understand. And so why was I so, people say, oh, you're that one of those 25% who are hyper-responders. Well, that may be true, but more than likely, it's just the fact that I was eating a certain amount of high cholesterol food, and then I decreased it dramatically, and you could see that fall. The thing that has confused most of the diet research on this is the idea of saturation

of the receptors, meaning you can only absorb so much cholesterol. You're making some in your liver and then you eat some and you can only absorb so much. And so when someone tests a regular American diet, which has a lot of cholesterol in it, and then they say, I'm going to give you zero or one egg. And then, uh, for, and then we're going to do a crossover in you know three weeks or something and you're going to do two eggs every day the cholesterol difference of those two diets is tremendously different okay but the amount of absorption of that extra cholesterol is small because you already got all this baseline cholesterol. So what I think everyone would see is that we're all pretty much human

and that saturation of the receptor phenomenon, that is you can only take up so much. If you're eating a lot of cholesterol, you eat more, it makes very little difference. If you're not eating a lot of cholesterol and you eat and you stop, your cholesterol goes down. Right. Yeah, so it's not a one-to-one ratio of dietary cholesterol to blood cholesterol. Right, right, right.

Yeah, that's interesting. I think what you said about the responsibility that you feel to kind of speak to these, you know, having colleagues that have passed away is an interesting one. It's like, how do you, like, what is the best strategy to be as helpful as possible to people who are in need? You know, are you the person who's going to like browbeat somebody? Are you just going to be a lighthouse and stand in the light and wait for people to come to you? Is it some, you know, somewhere in between those two things? But I think being mindful or having an understanding of how you best communicate is really important, right? Like, you know, yourself being somebody who, you know, is somebody of high stature within, you know, within this field that is directly relevant to this problem, I would assume that that makes you feel compelled to,

you know, speak a little bit louder than perhaps somebody else. I think you're right, you know, being compelled now. But what compels me really is the bad outcomes. And that's for patients, that's for family, it's for colleagues. Well, and I really am a believer that every person, and that's whether I'm in the clinic dealing with patients or talking to colleagues, everyone's different. You have to kind of deal with people where they are. And there are some people who are interested, some people who are not interested. Our job is to try to increase their interest and their investment in changing their health outcome. And so I think it takes a wide variety

of strategies. And some people, you just hand them an article, Journal of American Medical Association, August 1st, 2016, animal protein kills you. It doesn't matter which kind in terms of increasing death, but each one kills you in a different rate processor at meat much worse than the cetera cetera that article is so easy to hand out to people then it can change their behavior right one person will just be like that's all I need I'm making the changes the other person's like well I might just prefer to go to my grave eating unhealthy food and I've heard that multiple times with that guy oh well you know actually I sat next to him, you know, three nights ago at the Inter-American Congress of Cardiology in Panama City. And he's a wonderful cardiologist.

I won't say his name, of course. And he won't listen to this podcast, I think. Probably not, yeah. But he was saying that, you know, he saw my talk in Panama City on diet and mortality and eating animals. And he says, no, I will never change that. I just won't do it. And I've had patients say that to me. The mortality rate of people saying that to me is pretty high,

but that's talking about people who have disease in a clinic. So I would say that everyone is going to require something different, and you're not going to get 100%. But I could say two things. One is the groundswell of everyone coming together from different points of view. So I know you've been in Australia, right? What I noticed about our plant-based nutrition colleagues in Australia is that there's a little less cardiology, a little more animal rights, okay? A little more environment. And we have that in the United States as well. And I think everyone coming from different angles to try to solve this,

we're going to help each other. The other observation is the power of media, like what you're doing right now. The number of people who have walked up to me and I saw your 20 seconds in What the Health, or I saw your 90 seconds in Eating You Alive, and I saw your 90 seconds and eating you alive. And I really appreciate what you did. And I haven't eaten an animal since I saw that movie. And that really, it's really encouraging. I think it's going to make a difference. So I should be interviewing you and congratulating you on getting out there and getting the message to people.

Well, I appreciate that. But, you know, you're doing the hard work. You know, you're doing the hard work, you know, you're doing the important work and, and, you know, and you're the man behind the science that supports all of this. And I, but I think you're right. We need all voices. You know, you need the hardcore protester who's, you know, storming in the streets and you need the quiet person in the corner. Like all of these voices are important, the environmental, the animal, right? Like they all, there's an interplay here. And I think the more variation we have, then the more opportunity you have for somebody to connect with one of those voices, right?

Because everybody is different, like you said. So when you have these patients come into your office and you do an intake or whatever, and you're trying to figure out like, what's gonna motivate this person you know I've spoken to doctors like Robert Osfeld or you know dr. McMacken and they'll actually even Joel Kahn like though they'll actually you know write out a prescription pad like eat vegetables and they'll hand them a DVD of what the health or forks over knives or something like that like how do you you know what is your protocol so this interesting that I we have the you, you know, what is your protocol?

So this interesting that I, we have the benefit, which I know a lot of physicians, my age do not like this benefit of electronic electronic health record. Everything has to go in this electronic system. So I'm sitting in front of the patient, I'm sitting at 45 degrees, but they can see the screen too. And so I actually pull up the same. I sometimes will actually, if it's someone particularly highly educated, I actually stick in my jump drive with the slides on it and I start giving them my talk. I know it's the luxury of being chief of cardiology. Let me give you my

keynote. Exactly. And it really resonates with people to see the data because most of my talk is just this article and then that article and the other. It's all data and they can choose to not respond to it. But while I'm giving them this data and after I've assessed where they are educationally, which is important to try to make sure that you're speaking and where they can understand. One of the things that we have to do is we take a food intake questionnaire and find out where they are right now and how much change do they really need to make. And then, you know, I have to admit, I do a lot of transition diet stuff because I've seen just, you know, I don't have randomized trials on it. But it started off with the fact that the transition diet, by that I mean like veggie burgers, veggie hot dogs, veggie stuff, the kind of stuff you get at Tiger Stadium. Right, right, right.

Yeah, the bridges to just get them used to a different way. Well, it actually, what it really does is just it stops the animals. And so these, you know, I know I get a lot of friends and even family saying, you know, you really shouldn't be eating veggie bacon. It's like it's processed. Well, we have a lot of data on processed meat. I'm still looking for the data on processed vegetables. Every time I hear something processed, it seems to get absorbed a little better. But you might be missing nutrients and stuff like that that you could be.

I would hope that somebody does that research. In the meantime, what's happening is their cholesterol is going down, their weight is going down, their blood pressure is going down because all of these veggie products are full of veggie protein, which lowers blood pressure. So I'm reaching my goals in terms of their healthcare and specifically for cardiology. That seems to be the easiest switch to pull. That is to find whatever it is, you tell me an animal product and I will find a vegetarian substitute. And it could be the veggie cheese made out of chickpeas, which is fairly common. And we'll obviously,

down the road, these products will be out there because they're increasing so rapidly, which means the uptake must be good because the capitalistic society, they wouldn't if they weren't successful products, they wouldn't do well. So I'm saying that we should be researching them and finding out if there's benefits or not or to all this process stuff. It doesn't sound like the best thing to do, but I can tell you it's better than animals. Yeah, yeah, yeah. Well, it's never been easier to find these products. That's right. And it's getting better every day. Every store has them.

Yeah. Which also means it's never been easier to be an unhealthy vegan. Right. Well, we're very particular about that. I'm glad you mentioned that. There's been loads of literature coming out. We had a recent high-profile article in the Journal of American Cardiology talking specifically about unhealthful plant-based diet. And they actually made an index of how many of these refined carbs and sugar and the like.

And there was a correlation with death. And so let's try and have more fruits and vegetables and less of this stuff. I don't know how you would characterize a veggie hot dog, you know, I mean, or a veggie burger. Right, like what food group does this fall under? Well, you know, but is it healthy or is it not healthy? We don't actually have data. We have data that says, you know, you can get a vegan donut. That is not healthy.

It doesn't matter if it's vegan or not. It's not healthy. But we don't have good data on, you know, sure, you can say potato chips, it's fried. And so, you know, there's a certain amount of data that we have and then data that we don't. Right. Right. And then data that we don't. Right.

How are we going to better address serving the people that need this information the most? You know, we touched on earlier this socioeconomic divide. And we're in a culture in which, you know, wellness or being vegan, quote unquote, vegan seems to be the purview of the well-heeled who can do all their shopping at Whole Foods. And meanwhile, we have millions of people living in food deserts. And these are the people who are suffering the most from these chronic ailments. And we need to figure out strategies and ways for penetrating these communities and serving them better. And I know this is something that you care a lot about and have put a lot of thought into. Well, it's not an easy issue.

These are the areas that I grew up in, the south side of Chicago and the west side of Chicago. It's where I work now at Rush University. I have to mention, I have to shout out to Rush. Even before I got there, there was an interest in the community that is not financially motivated. They're actually spending hard-earned dollars to go and set up programs to try to take care of people, do primary care in places that you probably wouldn't want to walk at night in the neighborhoods on the west side, particularly as a South Sider. But as it turns out, all of this hard work is going to be improved even further if we can have programs where people will get education.

And so I've actually gone to the West Side community centers and given talks, and I've been in the churches giving informational talks about diet that have improved some of their outcomes on the one hand. Then we have a couple other major programs, one of them in cardiology called the HEART program, HEART standing for Helping Everyone Assess Risk Today. Okay, I got it. I wonder what Jimmy Kimmel would think of that one. I tried hard coming up with that algorithm. It's pretty good.

So it actually is playing off of the fact that the American College of Cardiology and the American Heart Association put out a risk calculator. It's an app that anybody can get off of the App Store. And you put in all your numbers, and it tells you what your 10-year risk of having a cardiac event is. And so we'll go into a church, and we will set up booths where we measure a finger stick cholesterol and a finger stick hemoglobin A1C. That's the fancy way of telling you whether or not you have diabetes or prediabetes and do the blood pressure, fill out the form, you know, age, gender, black or white. And once you have that data in there, it comes up with a number of what your risk is. And then you can have a discussion. You can have a real discussion. If you change that data in there, it comes up with a number of what your risk is. And then you can have a discussion.

You can have a real discussion. If you change these things in your lifestyle, you can reduce that risk. If you don't reduce that risk, you probably should be on a statin or medication until you can because you're at, you know, if your risk is high. Now, the other program that's very popular at Rush is called the Alive program. And that is run by our prevention colleagues. And they actually go into churches. They've been doing it mostly on the west side of Chicago. And they actually do six weeks of study, sort of a Bible-based health food approach.

I'm hoping that we can partner with them. I can see this heart alive, heart sandwich where we go in, see what the risk is, see what the effect of their educational program is by measuring it after the fact. So anyway, obviously when I'm describing sort of granular details about our overall strategy of trying to impact the community. It's not just sitting there on the West side, you know, hoping that, you know, everybody will come in from the suburbs. We are actually, we do want people to come in from the suburbs and they do because Rush is highly ranked and it's a top clinical program. There's, you know, great academic programs in the city of Chicago, but the one with the best rankings in the University Health Consortium every year for clinical programs, clinical care, is actually Rush University.

So we're able to, so far, we've been able to bring in the business that allows us to take care of the community. Yeah, that's great i mean basically what i'm hearing is you have to you have to be boots on the ground and engage these you know these communities by meeting them where they're at like they're they're at their churches they're at their wherever the community centers are and like and it's a one-on-one thing really absolutely that's how you erect change that's beautiful yeah well your own personal story is is super as well. I mean, you grew up Southside, right? Grew up relatively poor and have, you know, made quite a life for yourself. But what I thought was really interesting is, like, you were a tennis superstar, right? You were thinking about becoming a professional tennis player?

Well, it was actually my coach that was thinking. Tell me this story. Well, it was actually my coach that was thinking. Tell me this story. Well, you know, it's interesting that I was a championship chess player, one of the top in the state of Illinois. And at the end of my junior year, I was a captain of the chess team. And my guys who were on the team at the end of chess season said they were going out for tennis. And I just went with them. So it turns out that I learned enough in a short amount of time to actually become the number three singles player, even though I'd never picked up a racket. Your friends were like,

is this guy good at everything? Well, no, this is, I mean, it would have been nice to have been exposed to tennis at an early age because most people are starting at age four and five and six. And here I was 15. And so as it turns out, one of the schools that we played, Chicago Vocational, only had one player. And that one player actually told us that there was a program designed for inner city poor kids at the University of Chicago. You can see what's going to happen, right? And so I said, well, I should just go over there. So I got on a bus and went to this program, and I learned to play tennis on a court with 60 kids.

And I didn't really have rackets or anything like that, but I talked to the coach, who turns out he was African American, who turned out he was African-American. And he was actually a sort of part-time minority recruiter for the University of Chicago. And he was the varsity tennis coach. And so he had a tremendous impact on me. He actually got me an interview, which I didn't know was an interview at the time,

until I applied to the University of Chicago and I couldn't get an interview. And I called up and they said, no, you had it back in July. And I was shocked. I'm trying to remember everything I said. Anyway, I ended up getting into the University of Chicago. I learned enough tennis there to go back and play number one in my high school, but I still, this wasn't real tennis.

So I went to the University of Chicago and talked to the coach. He says, no, you're not going to make this tennis team, but you're welcome to come to practices. And I was so determined. It was sort of two things. One was making that leap from Chicago public schools with the reading skills to the University of Chicago was a big difficulty. And the one thing that would make me sit and read Plato for hours is if I played about six hours of tennis, then I could sit. And so that actually worked for me. And of course, playing six hours of tennis, you actually get pretty good. So barely made the tennis team at the starting lineup, but I just barely beat out the number six guy on the day before the matches began. And so I actually did play that

year. But I had gone to college a little early, so I was still 17. And that would have been my first year of the 18 and unders if I had known that there were tournaments, which I didn't. But I found out about these tournaments and I started playing them and I lost in the first round of every tournament in the Chicago district. And so after the first couple, rather than just, you know, going back home, I figured out that what I should do is figure out why I'm losing. And I actually would go to the draw after after my match. I would go to the draw, look at the top two seeds, see who they were, see where they were playing, and hang around until I watched them play their matches. And what was the difference? How were they constructing points? How did they hit the tennis ball? Everything. And it turns out that I learned so much by the losses and the observation

that I went back to the University of Chicago with nobody graduating, and I won. I beat everybody, so I played number one. So then my tennis career started taking off. Once you're the number one singles player, then you can teach lessons on the side. Then you've actually got a stream of income. And so one thing led to another. So my coach really, after I got applied to medical school, and there's this sort of the last free summer of your life is between freshman and sophomore year. There's this sort of the last free summer of your life is between freshman and sophomore year. And I had had a tough year right between college and med school in terms of not understanding what you understand very well. The intensity of playing pro tennis was not something that I was ready for. And I would cramp up, be up a break in the third set after my fourth match.

And I just couldn't, I never got beyond the quarters of any of those pro tournaments. So then that next year, I focused on the fitness. I really did. And I was training every day. I incorporated into my teaching. I was teaching big junior development groups. And I would try to win that three-mile race every single day. Needless to say, I did not lose based on fitness anymore.

And I had a really good year. And at the end of that year, at the American Tennis Association National Championships, after I had beaten the number one seed, my coach was just pressuring me, don't go back to medical school. Go on the pro circuit. And I look back at that and say, who would I? Because it was a tough decision. The good fortune for me is that I got injured in my semifinal match.

And so I really couldn't play for about six weeks. And so I would have missed the US Open. This was a qualifier for the US Open, which would have launched me into I don't know what, no sponsorship. You eat what you kill, essentially. And without the prize money, you don't do very well. So as it turns out, I did go back to medical school. And when I think about it, I really wouldn't give up one year of practice, not one, which for pro tennis, I love tennis. It's a wonderful sport. British Journal of Medicine says that it has a 47% decrease in cardiovascular mortality.

There you go. To be a tennis player. So it's really been a benefit to me. It kept me focused and kept me exercising. But it's not something that I would have given up medicine for. You made the right choice. I think so. It sounds like your son became quite the player.

He did. He did. And my son is a Marine, and he actually feels very strongly about coming out of high school, going into college soon after 2009-11. He wanted to actually go into the Marines. And I say that he'd used all that tennis training, the idea of getting up at 5 o'clock in the morning. It might have been foreign to the rest of the guys in the room, but not for him. That's because he had been doing that since he was 8, 9 years old as a tennis player. but not for him because that's because he had been doing that since he was eight nine years old as a tennis player um you know being able to think strategically and do hard physical tasks

that's i think it's you know i don't know if he'll admit that but i think that's what made him the marine that he is and so he's uh he's he's a great guy very cool well uh i know i gotta let you go here soon but i can't let you go without asking a couple last ones. The first question I wanted to ask is, you know, I always like to give people some simple takeaways. So if somebody's listening to this, you know, they're one of those people who's been mired in the confusing morass of conflicting information that's available out there. They're just looking to make like, just tell me, just give me, like, the thing I should do first. Or what's the most important thing? Is it exercise? Is it diet? Is it dairy? Is it meat? Is it processed? Like, just give me a couple marching steps

that I can easily digest and implement into my life. I really, we would like to have more comparative data, but we have some. we would like to have more comparative data, but we have some. And it does say that that principle that you can't exercise your way out of a bad diet, there's some truth to that. I mean, you can mitigate a bad diet, but you can't, you're going to have a bad outcome ultimately. It's not going to absolve you. And so I would say that nutrition is the most important decision that we can make. If we could change one thing, it would be to have heart-healthy information coming out and have that be a real definition. create more and more diseases similar to what brought them to my office in the first place. And I understand that this is not primary care. This is not family practice. These are people who already have heart disease when they're seeing me. And so I have a little easier job because they're already motivated. The fact that they're in my office means that they're motivated to try to make some kind of change. They're expecting to come out of there with something

different that's going to change their outcome. Not every physician has that advantage, but it's something that we all should take advantage of because almost everyone has had a family member who suffers from heart disease or has had heart disease or has sudden cardiac death. And so just trying to get them to understand that there is a relationship between your lifestyle and your outcome. Just make that connection. If we could do that, we would all be so much better off. Right. It's a great answer. And the final one, if you were to wake up in some strange parallel universe to find yourself the new surgeon general, what's the first thing that you put in motion? That's a good one. The previous Surgeon General was a good friend of mine, Regina Benjamin. She was very concerned about, she's African American, as you might recall, and she was

very concerned about delivery of healthcare and getting health equity, I would really want to continue the momentum that she had started in terms of getting people to understand the whole impact of healthcare disparities. We actually, and it's interesting that, it's racial segregation and educational depression and all sorts of things that led to these health care disparities, not just genes. OK, all of this can actually be improved by lifestyle. And if we could get that word out there, there was a wonderful analysis of this published in Circulation in 2015 called the Regards Trial.

published in circulation in 2015 called the REGARDS trial. If you look on their website and try to find the paper, it's buried in like 200 publications that they did. They're just so good at getting stuff out there. But the REGARDS study was looking at racial and ethnic risk for stroke. And what they found is not just stroke, it's stroke, heart attack, and death. And it is related to diet. And that southern diet, the African-American, southern meaning the south side of Chicago as far as I'm concerned, because that's what we were eating there.

That diet is so damaging that if you could just fix the nutrition, the gap in health care disparities would change almost on a dime. Dr. Kim Williams, you're an inspiration, sir. My pleasure. I really appreciate your having me. Yeah. Thank you so much. Please keep doing what you're doing, spreading the healthy, powerful message that you do.

We need you and we need more people like you. So thank you very much. And thank you for all that you're doing ah it's my pleasure if people want to connect with you online where's the best place to find out information I mean you know the the rush website I would imagine the rush website has each of the faculty members and you know there's actually a one of our faculty members just so we'll just put up a whole thing on plant-based nutrition. It was really wonderful to see that.

And we have a big presence there. If they just Google Kim A. Williams, MD, you'll get a few million hits. And a couple of them are my son, who's a neurosurgeon, first out in practice. Oh, wow. I'm sure in the next few years, he'll be taking over those Google hits. Yeah, it's Kim kim williams senior kim williams senior right and you're on twitter at cardio 10s that's right tennis number 10s right so you can hit them up there absolutely all right thank you so much well uh hopefully we can have a

will you come back and talk to me some other time absolutely sure i'm sure there'll be more data. I'm hoping so. All right. Thank you. Peace. All right. That was fantastic. That was so much fun. Thank you very much. All right. I hope you guys found that not just enjoyable, but impactful. out to wrestle with, to really ponder in the context of your own personal health journey and the choices that we make every single day around diet, nutrition, and lifestyle. As always, please check out the show notes to take your edification and your infotainment beyond the earbuds. We've got tons of links and resources there to dig deeper into this important issue of

cardiovascular health. And if you found Dr. Williams so compelling that you're finally ready to take that leap into plant-based nutrition, but you're just not quite sure how to do it, well, I got good news for you. Our Plant Power Meal Planner is just the thing. It's this incredibly powerful, robust, online, mobile-friendly resource that takes all the guesswork out of making this transition to a more plant-centric lifestyle. When you sign up, you get thousands of plant-based recipes right at your fingertips, unlimited meal plans and grocery lists. Everything is metric system compliant as well. And it's also totally personalized and customized based on your goals

and your food preferences, your allergies, your time constraints. We have an amazing team of customer support experts that are available to you seven days a week. These are people with graduate degrees, athletes, moms, people that live and breathe this stuff. We even have grocery delivery in I think up to 60 metropolitan areas at the moment. Life-changing stuff, a really powerful, compelling tool. is at the moment. Life-changing stuff, a really powerful, compelling tool. And it's also incredibly affordable, just $1.90 a week when you sign up for a year. So for more information and to sign up, go to meals.richroll.com or click on Meal Planner at the top menu at richroll.com. If you would like to support this show and my work, share it with your friends and on social media. You know

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I want to thank everybody who helped put on the show today. Jason Camiello for audio engineering, production, interstitial music, and help on the show notes. Sean Patterson for all his graphic wizardry, David Zammett for his portrait photos. And for now conveying the podcast in visual format on YouTube. All the podcasts going forward are now available in full video on YouTube at youtube.com forward slash rich roll. And that is David's work. He's doing a great job and theme music as always by Annalima. Thanks for the love you guys. As of today, it's Halloween on the day that I'm recording this Tuesday, doing it early because

getting on a plane tomorrow morning, heading to Miami for the Seed Food and Wine Festival. So hopefully I will see some of you guys there. And until next week, be well, live well, and take care of yourself. Go easy on yourself. Peace plants. Namaste. Thank you.