The Rich Roll Podcast - Dr. Matthew Nagra Makes The Ultimate Case For A Plant-Based Diet: Busting Nutrition Myths Around Seed Oils, Soy, Protein, & More
Episode Date: June 9, 2025Dr. Matthew Nagra is a Vancouver-based naturopathic doctor and nutrition researcher who tackles misinformation around diet and nutrition on social media. This conversation dismantles nutrition's most... malevolent misconceptions—from seed oil hysteria to carnivore evangelism. We explore how tribal allegiances have replaced science, why plant proteins aren't inferior, and the rise of LDL denialism. Matt systematically debunks myths while exposing the cherry-picked studies fueling dietary tribalism. In doing so, he shows us how to distinguish between legitimate research and algorithmic propaganda. Matt is a myth-busting extraordinaire. This exchange cuts straight through the noise. Enjoy! Show notes + MORE Watch on YouTube Newsletter Sign-Up Seed: Use code RICHROLL25 for 25% OFF your first order 👉seed.com/RichRoll Go Brewing: Use the code Rich Roll for 15% OFF 👉gobrewing.com Lincoln Financial: New 4-part series "The Action Plan"—exploring what it takes to keep doing what we love, Physically, Mentally & Financially 👉 lincolnfinancial.com/richroll iFit: Use the code RICHROLL to get 10% off any purchase of $999+ 👉NordicTrack.com/richroll AG1: Get a FREE bottle of Vitamin D3+K2 AND 5 free AG1 Travel Packs 👉drinkAG1.com/richroll Squarespace: Use the code RichRoll to save 10% off your first purchase of a website or domain 👉Squarespace.com/RichRoll LMNT: Get a free LMNT Sample Pack with any purchase 👉 drinkLMNT.com/richroll On: High-performance shoes & apparel crafted for comfort and style 👉on.com/richroll Check out all of the amazing discounts from our Sponsors 👉 richroll.com/sponsors Find out more about Voicing Change Media at voicingchange.media and follow us @voicingchange
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Shifting 3% of calories from animal protein, especially red meat protein, to plant protein
sources could lower risk of mortality from, it was a ballpark of 10 to 15%.
There is not good evidence to support the carnivore diet.
If we look at messaging from the carnivore community or the animal-based
community, it's often about really quick fixes. We're not considering the long-term
risk and they're promising people immediate results, which is really
enticing. We have so much research now around like what makes up a healthy
dietary pattern that we can make really good informed decisions. Really when it
comes to nutrition, it's pretty simple. At least the foundations are.
Eating a diet that's rich in whole grains, fruits, veggies,
legumes, nuts and seeds.
That is the foundation of a healthy dietary pattern.
Let's control the LDL, let's manage blood glucose,
let's drop that blood pressure,
let's take care of all this stuff.
Hey everybody, welcome to the podcast.
It's been a minute since my last nutrition oriented episode.
So I think it's kind of about time to dip back into a little fact versus fiction myth
busting based upon the best evidence based research out there.
So we can put matters to rights when it comes to understanding the difference between what
is misconception and what matters most
and is meaningful to understand.
My guest for this journey is Dr. Matthew Nagra,
a Vancouver-based clinician with a BS in microbiology
from the University of Victoria,
an ND from the Boucher Institute of Naturopathic Medicine,
and also a guy who is certified in plant-based nutrition
from the T. Colin Campbell Center
for Nutrition Studies at Cornell.
So I first came across Matt from his many appearances
on my friend and frequent pod hero, Simon Hill,
his show, The Proof Podcast,
as well as Matt's presence on social media,
particularly Instagram,
where he does a pretty fantastic job
of translating the latest nutrition research
and tackling misinformation around diet and nutrition.
So today we're gonna cover many popular topics
that seem to have deranged the minds of too many
in my opinion, including seed oils, protein,
specifically animal versus plant protein,
bioavailability, dosage and more.
We address LDL cholesterol and what I would consider
a degree of LDL denialism when it comes to the risk,
elevated LDL poses to cardiovascular disease.
We talk about the arguments that swirl around
the supposed nutritional deficiencies of eating plant-based,
what gets missed in the arguments against processed foods,
how plant-based meat analogs measure up nutritionally
against the real meat counterparts,
as well as everything omegas three and six
and many other topics.
My goal in this discussion is to hopefully resolve
some confusion on these subjects.
And Matthew, to my mind, is very effective
in providing much needed clarity.
So I hope you find this useful.
And with that, this is me and Dr. Matthew Magra.
Mads, great to have you here.
It's been a minute since we've done a plant-based deep dive
and you're just the guy to do it with.
But before we even launch into it,
maybe just share a little bit of your background
and how you got initially interested
in plant-based nutrition to begin with.
Yeah, it goes back to my teenage years.
So when I was younger, I did have some health issues.
I struggled with my weight, my skin, allergies, asthma.
And actually at one point, my asthma got really bad
to the point that
my doctor warned my parents it might be hospitalization and quite serious.
But fortunately made it through that and I had a personal trainer who around that time,
so I was about 15, really pushed more plant-based eating.
He wasn't 100% but predominant and, you know, being a teenage boy,
I didn't care too much about what he had to say for
the longest time until he wanted me to record my food.
And so for about two weeks there, I had to record everything I ate.
And I was thinking, oh my God, he's going to kick my butt once he sees how bad my diet
is compared to his recommendations.
And so for those two weeks, I was like, I'm going to impress him.
I got rid of all of your kind of classic, ultra processed foods, potato chips, sodas. I cut my dairy intake, I reduced my
meat intake, having a lot more fruits and veggies. And just within those couple of weeks,
I started losing weight. My skin was clearing up. I felt like I was breathing easier. And
that's what initially triggered that idea that, hey, you know, diet might actually be
important, which is something that, you know, as a 15 year old, I hadn't really thought about.
And so I really continued with it from then on for the next couple of years until I went to university.
And at that point, I'm back to cafeteria food.
I'm drinking with all my buddies on the weekends.
And after the first four or five months, I kind of noticed, like, you know, I'm not feeling as good as I was just a few months prior.
Maybe I need to go back to what I was doing.
And that was actually the time it was February 24th, 2011.
And I've noted that day that I went a hundred percent
plant-based because for me, it was easier to be that strict
than to give a little bit of leeway and you know,
splurge and then that becomes more of a habit.
So that was the point that I went to 100%.
And initially, maybe I was looking to blogs and YouTube for a lot of information, like
probably a lot of other young men and women do.
But as the years went on and as I got more educated in nutrition and statistics and so
on and started reading the literature, that's when I shifted towards what I would consider
a very balanced plant-based, predominantly whole foods diet.
So there's the personal aspect of this,
but how does that translate into this becoming
a career trajectory for you?
Yeah, so another thing that happened
shortly after I made those changes when I was about 15, 16,
was my dad actually had a cardiovascular issue as well.
And funny enough, I was in the hospital for surgery on my ankle after I'd broken it,
skateboarding. And when I came out of surgery, my dad was in the hospital.
So he was in the waiting room for me and he actually went down with what they thought at the time
might have been a heart attack. Turns out it may not have been, but it was certainly a scare.
And he started finally seeing results
after changing his diet as well,
because initially there was a lot of anxiety
around his health.
He didn't know exactly when he would be,
if he was having a little chest discomfort or something,
is that going to land him in the hospital again?
And when he started actually changing his diet,
taking that same trainer's advice, goes back to him,
that's when he started seeing improvements in his markers,
feeling better and so on as well.
And that led me more into like the long-term chronic disease
sort of prevention area.
Now fast forward, you know, seven, eight, nine years
when I'm in school, seeing patients,
I saw that there was so much misinformation.
People were so confused about what is right for them to do or what is healthy as for them to do.
Even to this day, I get questions about soy and protein and all the common questions that you probably get as well, seed oils.
And that is what led me to wanting to help correct the record and provide this information for people
so that they can actually make informed choices.
You know, it's one thing to choose to smoke
when you know it's bad for you,
but what if you didn't know it was bad for you
or you were convinced that it was maybe good for you, right?
And that's sort of where we are with a lot of nutrition
is just people are confused.
They don't know what's right, what's wrong.
And I wanna help others get the sort of clarity
that I myself and that my dad ultimately got.
So before we dive into the weeds
and start to identify certain subject matter,
I mean, my intention for this is to provide
a basic education, but also to do a little myth busting
or truth versus fiction
with respect to certain nutritional claims.
But before we do that,
I'd like to kind of apply that more broadly.
Like what is true versus hyperbole
when it comes to a plant-based diet
in the context of, you know,
whether it's longevity, performance,
or chronic lifestyle, disease prevention.
You know, my sense is that, you is that it is very real and very powerful
and I've lived it myself and hosted many people
with similar experiences and experts like yourself.
But I think that the vegan and plant-based diet tribe
is not dissimilar from any other diet tribe out there
and has a tendency to overstate claims
or exaggerate or extrapolate
upon the available research to kind of underscore
or overemphasize in a certain way that might not be
in the best interest of the public.
So where do you see that?
And how do you kind of give words to that?
I 100% agree.
I think that there is exaggeration in a lot of areas of the plant-based camp, just like
there is with any other diet tribe.
And what we can say pretty confidently is that a plant-exclusive diet or vegan diet,
if we want to call it that, is associated with great long-term health outcomes, not
necessarily better than but comparable to things like a Mediterranean diet or DASH diet
or these other healthy dietary patterns.
So I view it as there's a range of diets
all centered on plant foods, fruits,
veggies, whole grains, et cetera.
Some include some animal products, some don't,
but they're all predominantly plants
and they all lead to similar outcomes.
The reason to go exclusively plant-based
really is ethical or environmental.
From a health perspective alone, I don't think you can make a strong argument.
And I think that's where there's a bit of an issue sometimes, where people will paint this plant-based approach as the best approach, bar none.
And I like that's a, you know, something that we can conclude really strongly.
And I just don't think that we can because we haven't seen that.
But at the same time, when it comes to athletics,
that was another thing you mentioned,
we see that a plant exclusive diet can lead to the same
sorts of results that you get on an omnivorous diet
richer in animal protein.
So, you know, we don't have to necessarily make the argument
that it is the best and stands above all the rest,
but we can say that it is one of the best options.
And because of these other benefits
like the ethical environmental,
there's a good reason to choose that approach.
I think it's important to, you know, what you just said,
especially in terms of credibility and trust,
if you're gonna talk about this to be grounded in reality,
because if you're overstating claims
or just a little bit out over your skis
because you're an evangelist or an advocate
or perhaps an activist in some regard.
It makes it easier to critique or kind of not pay attention
or dismiss what follows in terms of what you're gonna say.
And the whole movement would kind of be better off
if they were just grounded in greater clarity
around what you just shared.
Yeah, I agree because I look at it as,
if we exaggerate or lie about some of the results,
we actually give fodder to people like the carnivores
or anti-vegans to say like, hey, this person's dishonest
or they're wrong about this.
But if you're accurate and truthful, what do they have?
They're the ones that are gonna have to bend the science
to try to prove their point.
And so if we're just honest and we stick to what we know
and we have really, really good reasons
to choose this approach, then they have nothing.
And I would rather be on that side.
You mentioned a few moments ago
that nutrition is complicated.
It certainly is.
More so than I suspect we realize and for many reasons.
And some of that has to do with, you know,
the limitations of the kind of science
that we can perform on human beings.
But the upshot of this is that it often leaves
even the most earnest of us out there
in search of guidance more confused than informed.
And this is kind of what we're seeing being played out
on the internet, you know, across the world at the moment.
And I think that this is not always
because the science is unclear
as much as it is an unfortunate byproduct
of our information landscape,
which is more and more based on social media
and our kind of, you know,
algorithmically determined informational feeds.
As we know, the internet loves to traffic in trends.
And when it comes to nutrition,
there's more than a few trends that surface,
many of which range from a loose relationship
with evidence to downright wrong or dangerous.
And I think as a public service,
it's important to put matters to rights
with respect to some of these trends,
which is something that you do quite effectively
in the many videos that you share on social media
as kind of an antidote to this infection.
So I'd like to begin as we wander into the wilderness
of this with what you see as the current most onerous
or malevolent misconception that's out there
that our algorithm overlords are favoring at the moment.
There's a number that I could list up there
and I could change this order any day.
So I won't say that this is number one,
but the one that seems to permeate all diet camps,
you can take whole foods, plant-based,
you can take carnivore,
you can take animal-based or whatever.
They pretty much all agree on this idea
that seed oils are toxic and that
they're going to kill us, cause cancer and so on.
But I mean, that's the one case where I would say they're pretty much all wrong based on
the current evidence base.
I think the evidence is very strong and actually quite compelling for the inclusion of seed
oils to lower things like cardiovascular risk and improve mortality risk.
And so that would be one that really stands out.
All right, well, let's dig into this one.
This is quite the topic, you know,
it's being bandied about pretty rigorously on the internet.
And it also is controversial
within the plant-based community.
There are the whole food plant-based OGs,
you know, the Dr. Caldwell Esselstyn strain of whole food plant-based OGs, the Dr. Caldwell Esselstyn strain
of whole food plant-based who are rigorously kind of anti-oil.
And then there are the pro olive oil plant-based people.
And then there are the broader group
of like vigorously anti seed oils, like in extremis.
So why don't you, you know,
kind of paint the picture of this?
How did this issue come about?
What is being argued and what is the truth here?
Yeah, so there's different arguments
presented by different diet camps,
like the plant-based community will talk more about
the oils effects on artery function.
And maybe we can get to that in a moment,
but I think the main argument that's brought up
or one of the main two arguments that's brought up
is that we see this trend through the 80s
and into the 90s where seed oil consumption
was increasing in America
and heart disease rates were increasing in America.
And they sort of draw that correlation
and they'll say that, well, seed oils are the problem.
But there's a serious issue with drawing
that kind of conclusion here.
So that's what we call an ecological association.
You're just taking two variables, tracking them over time,
and ultimately drawing the conclusion that A led to B.
Problem is there are a lot of things that could have changed over that time.
One of them being that we're living longer or the infant mortality has lowered,
and these are things that can lead to chronic disease later in life.
You know, if most people aren't even making it to those ages initially,
then we aren't going to have as many heart attacks, right?
So that's one one possible issue.
Another one is that we are now treating risk factors earlier on
for, say, other diseases that might end up leading you to to living to that point,
or if there's a cardiovascular event.
At the same time, we can look at cross-country comparisons of like smoking, for example, and longevity.
And we see that per capita cigarette consumption
is associated with longevity.
It's the same type of correlation,
but the issue there is that, yeah,
countries where there's more cigarette consumption,
they're also more affluent.
There's other factors that are leading to a better life.
So we need to look at studies that actually adjust
for those other variables and sort of level the playing
field.
And we have plenty of those where you're looking
at seed oil consumption or polyunsaturated fat consumption
over time within a defined population and you're adjusting
or sort of equalizing factors like smoking status,
exercise and so on.
And you find that those with the highest consumption
do have a lower risk of
cardiovascular disease and a lower risk of mortality. So the question then is, well, why do we see this trend in seed oils and heart attack at least over time? One of the factors there,
and not the only factor, is potentially that most people get their seed oils from ultra processed
foods. So as ultra processed foods become more prevalent in the food supply and people are eating more
and getting too many calories and gaining excess body fat
and developing cardiometabolic diseases,
we can't then say it's the seed oil specifically
that are the problem.
It would be like pointing to Coca-Cola
and saying that water is detrimental
because it's the main ingredient in Coca-Cola.
Or the cola ingredient in it as opposed to,
yeah, so in the context of ultra processed foods,
there are seed oils, but there's also refined grains
and salt and sugar and all these other kind of additives
and preservatives that enhance the unhealthy nature
of these foods.
Exactly, and they're hyper palatable.
So that combination of the fats with the salt especially
gets people to eat more and more and more.
And food scientists are very aware of this
when they design their products,
because they want you to eat more of those products, right?
And so they sort of prey on those senses.
Now, moving past these sort of gross kind of correlations,
we can look at the mechanisms at play.
So one of the arguments that's brought up
is that these omega-6 fats in seed oils are
inflammatory.
So the linoleic acid, which is one of the polyunsaturated fats.
And the theory goes that linoleic acid could be converted into arachidonic acid, which
is another omega-6 fat, and that is pro-inflammatory.
The problem with that is it's been studied in humans numerous times and in numerous randomized
controlled trials and has never been shown to raise arachidonic acid levels or inflammatory
markers with the exception of a case where they put oils through 20 repeated cooling
and heating cycles over and over and over again and then had people eat them.
But at that point, you're really kind of destroying or damaging the oils there.
But in normal use, whether it's for a stir fry
or in salads or whatever, they appear to be health promoting.
And then finally, we have actually long-term
randomized controlled trials showing this.
One great example is the LA Veterans Administration
Hospital Study.
So they had about 850 people that were split in half
and they were living in an institution.
And half of them were randomized to one cafeteria, half to the other cafeteria,
and they didn't know what they were getting. But what the researchers had done in the seed oil group
was they actually extracted saturated fats from the foods and infused vegetable oils.
So they're getting essentially the same food, but different fat.
And they found about a 30 percent, if I recall, reduction in cardiovascular disease,
like atherosclerotic cardiovascular disease
over the course of eight years.
That's massive when you're considering an old population
where the number one killer is cardiovascular disease.
Yeah, there's studies out there that show,
you know, the people who are,
have the highest intake of plant oils
see significantly lower risk in total mortality,
cancer mortality, et cetera, this veteran study.
But it's always in the context
of what these seed oils are replacing, right?
If they're replacing foods high in saturated fat,
then you're gonna see these reductions.
But it's not the plant oil itself
that is leading to the reduction in mortality
or cancer rates, right?
Like it's, I mean, so like I tease that out a little bit
because is the oil the panacea
or is it what the oil is replacing
that makes it the healthier option,
leading to these better health outcomes?
So compared to saturated fat,
like you said, butter, tallow, et cetera,
then the seed oils are better because they lower LDL cholesterol and ApoB
and they lower risk of cardiovascular events, as we see in these longer term studies.
However, if we look at comparisons between even these seed oils and things like avocado,
there was the nurses health study and health professionals follow up study
where they looked at the substitution of avocado for different types of foods,
including seed oils.
There was no significant difference in cardiovascular risk
between whether it was avocado or seed oils that were,
and it was about a quarter of an avocado,
I believe that they substitute
for equivalent amounts of the oil.
There's also the Predimed study.
Now this is looking at olive oil,
but I'll bring it to seed oils in a second,
where they compared a Mediterranean diet with olive oil
to a Mediterranean diet with nuts and seeds, and there was no significant difference. Both were beneficial. And the reason I Mediterranean diet with olive oil to a Mediterranean diet with nuts and seeds.
And there was no significant difference.
Both were beneficial.
And the reason I bring up the olive oil is that we also have comparisons
between olive oil and seed oils, and they're roughly similar.
So we don't have a good reason to conclude that the seed oils would be worse
than these other healthy foods.
They're just one of those healthy foods.
But I wouldn't say that if you were to replace olive oil or nuts or whatever with seed oils
that you're going to be better off,
they're just, it's not worse.
And that's really what we could conclude there.
So articulate the best argument
for those that are advancing the seed oils
are the root of all evil argument.
The best argument I think that anyone can make
around oils period is that they're calorie dense
So in about a tablespoon you're getting 120 calories right there compare that to like a whole banana
You know you're getting even a bit less than 120 calories
so if you were to use tons of oils just pouring it on your foods or
You know frying with a whole bunch or deep-frying perhaps where there's a lot of calories being added, that could be problematic for sure.
I would agree with that.
Now we don't see that in trials, in clinical trials,
probably because of the way that they're used.
If you're using oils to stir fry some veggies,
the calorie density of that meal is still very low.
But if you're just throwing oils on everything,
you're having six, seven, eight tablespoons a day,
I mean, that's a ton of calories
and that could be a problem,
especially if it's leading to fat gain.
In the health hierarchy of seed oils,
my understanding is that olive oil stands above.
Is that true?
Is there a qualitative difference?
Does it have to do with polyphenols?
Like, how do you think about this
in terms of like parsing all the various seed oils
from canola to,
you know, sesame and everything else.
So it's interesting when we look at outcomes.
So again, like actual heart attacks or strokes, we see that olive oil and canola oil are pretty
comparable.
Actually, even for total mortality.
Now that I'm jogging my memory, I'm old enough to remember when everything was canola oil
and canola oil was like was the root of all evil. Like you need to stop, you know, putting canola oil and then canola oil was like, was the root of all evil.
Like you need to stop putting canola oil in food.
Yeah, and that's largely because of concerns
over the fact that they're, how they're extracted
or processed or concerns over the omega-6 content.
Again, comes back to those mechanistic concerns.
But when we step back and look at actual heart attacks,
actual strokes, mortality risks,
or the actual deaths that occur during a study,
there doesn't seem to be a meaningful difference between olive and canola.
And there's a couple possible reasons for that.
So olive oil is richer in certain polyphenols, especially if it's extra virgin.
However, canola actually lowers LDL cholesterol a bit more.
So maybe you're getting a bit of an advantage with the canola oil with LDL cholesterol,
but then the polyphenols and the olive oil exert other benefits on say arterial function.
So the net result is about the same.
And this is why I always advocate for people stepping back
and looking at the final outcomes,
not just a certain marker,
but does it lead to less heart attacks?
Does it lead to less strokes, less cancer diagnoses, et cetera?
That's ultimately what matters
because you could have a million different mechanisms
working in different ways.
We wanna see the net result.
Is there something special about the health promoting
aspects of extra virgin olive oil that does separate it?
It seems like very much a health benefiting oil.
Yeah, one of the things that I've seen with olive oil,
but I haven't seen many comparisons to others.
So I can't say it's necessarily better,
but I would say there's more evidence for is actually blood pressure lowering.
There does seem to be something there and that could be again due to the polyphenols in there.
When it comes to neurodegenerative disorders, we see that while not statistically significantly different,
there was a study, I believe it was also the nurses health and health professionals follow up study where olive oil did tend to be a bit better in that regard but then canola actually tended to be a little bit better or vegetable rather
oil tended to be a bit better for cardiovascular events but they weren't statistically significant
the differences there. So it's hard to say is that a chance finding or is that true?
Like there might be some unique properties either direction but they don't seem to be
very larger or super meaningful.
You mentioned the omega-6 fats
and the sort of deleterious health impact
that those can have.
My understanding has always been that
we're eating way too much of the omega-6 fats
and not enough of the omega-3.
So while we need to reduce our omega-6 intake, we also need to buttress our omega-3. So while we need to reduce our omega-6 intake,
we also need to buttress our omega-3 intake
and that there's something about enhancing the omega-3s
that buffers the negative impact of those sixes.
Is that true or how do you describe that?
So I used to be very much in that camp.
Yeah, I mean, that was the idea, right?
And I believe that this is,
that wisdom has now shifted on this.
Yeah, so that was because the omega-3 fat ALA,
which is found in things like flax and chia
and walnuts and soy products,
that competes for the same enzyme
that this omega-6 fat linoleic acid does
for conversion into, you know, the case of the omega-3,
it's EPA and DHA, which we typically get from like
fish or algae-based supplements.
And then linoleic acid can get converted
into that arachidonic acid,
that inflammatory omega-6, theoretically.
It doesn't end up happening, but that could be the case.
Now, the theory was that if you're having more omega-6
and less omega-3s, that the omega-6s
are going to take that over and you're not going to convert
the omega-3s into the EPA and DAJ.
The issue with that is, now as we have more research and actually monitoring how much
gets converted, the differences are not very big. It seems to be the absolute amounts that
matter. So if you're consuming enough ALA or the omega-3 to meet your needs, it doesn't
really matter too much how much omega-6 you're having. It doesn't seem to impact the conversion
to any sort of meaningful degree.
And something else that's come out very recently,
this was last year, there was a really good study on this
that looked at the actual health outcomes,
again, going back to things like cardiovascular risk.
And they found that both are beneficial.
So the omega-3 are beneficial
and the omega-6 are beneficial.
However, the omega-3 are more beneficial.
So if you look at the ratio,
a better ratio of omega-3 to 6 is going to look better
because the omega-3s are more beneficial than the omega-6s.
That doesn't mean that the omega-6s are harmful.
They can still be beneficial
and we need a certain amount of them,
but more people would benefit from placing emphasis
on the omega-3s simply because people don't get as much
of them in their diet and they might exert additional benefits.
Well, and the omega-6s that we're getting
are all in these ultra-processed foods.
That's the problem.
Yeah, so it's the package that they're coming in, of course.
So if you're using them, again, in cooking,
stir-frying, et cetera, that's fine,
but I wouldn't be getting the majority of my calories
from these ultra-processed foods.
Well, with respect to cooking with them,
whether it's stir-fry or something else,
talk a little bit about oxidation points
because when you heat these things,
they become something different, right?
There's a difference between putting olive oil
on your salad right out of the bottle
versus the stir fry version.
And these oils vary in their oxidation points, yes.
So in the process of heating them,
like is there something that we need to be aware of
or a preference that we need to make
in order to make the best, healthiest choice?
Yeah, so it's actually funny.
The olive oil, because it's rich in monounsaturated fats,
but lower in polyunsaturated fats,
it's often sort of separated from the vegetable oils
because they're richer in the polyunsaturated fats.
And it's thought that those polyunsaturated fats
are the ones that can oxidize at high temperatures
and cause problems.
And that might be true to a degree,
but it doesn't seem to be meaningful.
It doesn't seem to actually lead to a meaningful increase
in these reactive species.
However, if you were to put them through
several repeated cycles of heating and cooling,
which might be practiced in certain fast food restaurants
or where they're frying with them all day,
that could potentially lead to an increase
in these compounds.
And there is a study showing that it can increase
inflammatory markers when consumed.
We do not see that with more typical cooking patterns
of stir frying for 30 minutes or something.
So I don't actually put a lot of weight
into those concerns at this point.
And I would say that they're fine to use for cooking.
And in fact, there was the NIH AARP study
where they looked at different cooking fats
and they had over 400,000 Americans in that study.
And they found that, again, these vegetable oils,
they had canola, corn,
and then they also looked at olive oil.
They all led to benefits for a number of different outcomes,
cardiometabolic outcomes.
Is there any oil out there that's commonly used
that you would say, yeah, stay away from that one,
opt for this one?
I would say the, not necessarily of those groups
of the vegetable oils and olive oil,
but the saturated fat rich oils.
So things like coconut oil or butter on the animal fat side.
Yeah, coconut oil is oil does have considerable saturated fat
in it, which does distinguish it.
It does have a higher heat point though,
which I had always thought like that makes for
a healthier option in terms of cooking.
And there's something about the saturated fat,
like the composition of the saturated fat
that makes it more readily available as an energy source
and less likely to kind of do the negative things
that saturated fat tends to do.
Like, is that a myth that has been debunked now
or is that true?
So there's some truth to that.
So the fatty acid composition,
even the saturated fat composition is different
than something like butter.
And we have trials showing that coconut oil
can actually lower LDL cholesterol compared to butter.
So it does appear to be a better choice there.
That's strange because it's like the intake of saturated fat
in a reductive sense should elevate your LDL.
Yeah, so there's three main types of saturated fat
that raise LDL, but there's others that are neutral.
So for example, stearic acid,
which is the main saturated fat in raise LDL, but there's others that are neutral. So for example, stearic acid, which is the main saturated fat in cocoa in chocolate,
that actually doesn't have an impact.
It's neutral for LDL cholesterol.
But then things like palmitic acid being one of the primary fats in butter that can raise
LDL cholesterol.
So that composition actually does really matter.
Now I wouldn't take that and say that we have to look at the composition of every different
food.
Most of the ones that are rich in saturated fat
are rich in those ones that can raise LDL.
There are very few exceptions, the chocolate being one
and to a lesser degree, cheese might have less
of an impact on LDL cholesterol
than other high fat sources.
So when you understand the differences
between the different types of saturated fats,
it's not that surprising really to see differences.
Butter is sort of back, right?
And there's a lot of people celebrating this.
Finally, you know, we're putting seed oils
in their rightful place.
And we're going back to what our grandmother
always cooked with, which is butter.
And we're all better because of it.
Yeah, so that came from the butter is back headline
from Time Magazine.
I think it was in 2014 or somewhere in that ballpark.
And that was based on a meta-analysis
of observational studies that did not identify
an association between butter and cardiovascular disease.
And this is actually something really important
to understand about a lot of the research on nutrition
and cardiovascular disease is they did something called over adjustment.
So when we're conducting research, we'll adjust for confounding variables.
As I mentioned earlier, right?
We want to level the playing field, make sure that like exercise habits
aren't impacting the results, make sure that smoking habits aren't
alcohol intake and so on.
But they adjusted for LDL cholesterol levels or other markers that are
similar to LDL cholesterol level.
The reason that that's problematic is that you and I,
if we ate the exact same diet,
we might have different LDL cholesterol levels
just based on genetics, right?
And so let's say my baseline,
my genetic baseline is lower than yours.
I could eat a bunch of butter
and end up with the same levels as you.
And by adjusting for LDL, that's essentially what that study would be comparing.
It would be comparing people with the same LDL, but different levels of butter intake.
And if butter increases cardiovascular risk by increasing LDL cholesterol levels,
you're removing that variable, right?
If A leads to B and B leads to C, but you make sure B is identical for everybody,
you won't link A to C.
And so we can't over adjust for variables
that are literally on that pathway.
And that was unfortunately what was done in that study.
Now, when we don't do that
and we do proper adjustment models here,
we see very consistently that saturated fat
or butter intake increases risk.
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There's something anthropologically interesting about the way in which we as tribal beings tend to kind of champion the arguments or the ideas that reinforce our tribal view.
And this is across the board, like I said at the outset,
but there is something weirdly like when people are like,
yes, it's like our team is winning kind of thing.
You know what I mean?
When it should just be like, what's true, what's not.
Like this should be a dispassionate, you know,
sort of pursuit to understand what's in our best interest.
But the culture has really shifted quite a bit.
I mean, you know, I don't know, six or eight years ago, interest, but the culture has really shifted quite a bit.
I don't know, six or eight years ago,
there was this real rise in interest
in plant-based nutrition.
And we were seeing all these new food products
come on the market and plant-based restaurants.
And even today, now, of course,
most restaurants have plant-based options, et cetera.
But there has been a precipitous sort of decline
in enthusiasm in recent years, the culture has shifted.
And it is very much about butter is back right now.
This seems to be kind of the predominant paradigm.
And within that, we've seen this very strange,
kind of celebration of beef tallow, right?
Like we all saw RFK,
I can't remember what fast food chain restaurant,
yeah, like they've now,
they're now gonna make their fries with beef tallow.
Like let's put matters to rights on what beef tallow is
and what happens when you eat it.
Like, is this a move in the right direction, Matt?
What are we doing?
It is a saturated fat rich animal fat.
It's very similar in composition to butter
with small differences.
And from now we don't have a lot of long-term trials
or long-term observational studies on beef tallow
and outcomes.
So someone could throw their hands up and say,
hey, we don't know.
We don't know if it's necessarily harmful,
but we can draw conclusions based on our prior knowledge.
We know that saturated animal fats raise LDL prior knowledge. We know that saturated animal fats
raise LDL cholesterol levels.
We know that they ultimately lead to cardiovascular events,
especially with that rise in LDL cholesterol levels.
And if we were to replace something
that has been shown to do the opposite with those foods,
chances are it's going to be worse for us.
Now, am I going to say that having ultra processed foods
with beef tallow, especially hyper-palatable
ultra-processed foods with beef tallow is going to be significantly worse than having
hyper-palatable ultra-processed foods with vegetable oils?
Probably not because there's a lot of other factors that are going to be the same between
them.
I mean, if you're going to a Steak and Shake or a McDonald's or whatever, whether it's
beef tallow or seed oils, I don't think is gonna make the biggest impact.
But if anything, I think we can expect it
to be even worse for you, which is sort of the irony there.
The message really should be like,
stop eating at these fast food chains,
not like, oh, now it's great,
you can go get fries with beef tallow.
Like this doesn't seem to be moving the ball
in any positive direction forward.
Exactly, that was the biggest issue,
I think with that whole sort of campaign was,
I mean, you have RFK Jr. going in there
and like advertising this fast food joint
and eating their meals.
And I think that's gonna send the message that like,
hey, you should go here, it's good stuff,
where, you know, it's still going to be problematic
if you're having that regularly.
So the reason we're talking about seed oils
or maybe before we kind of pivot here,
talk a little bit about the controversy
within the plant-based community.
Why is it that there is that cohort I referenced earlier
that is so adamantly against seed oils in any regard?
It seems to me that the emergent evidence
since that became kind of the paradigm has changed.
And perhaps there's a resistance to really objectively
looking at that library of evidence.
What's going on there?
Yeah, I mean, that's been kind of the status quo
in the community for many years since I first got into it,
which was over a decade now.
And it comes from a couple things.
So one of the studies that they often reference was by Vogel and colleagues.
And this looked at a rather large dose of oil and it was actually olive oil.
So it wasn't even your traditional seed oils, but they looked at about a quarter cup of
olive oil along with bread and there were some other foods served with it.
And then they measured artery function.
So the ability of the arteries to dilate after consumption.
And they found that temporarily there was an impairment
in the arteries ability to dilate fully.
And from that, they drew the conclusion that,
hey, you aren't able to get what's called,
or as good of what's called flow mediated dilation,
therefore it's gonna be worse for your cardiovascular risk.
The problem is this is a temporary reduction in that dilation through a very
high intake of fat in that meal.
And that has never been shown to translate to actual cardiovascular events.
We know that in a fasted state,
so if you measure first thing in the morning without food and you're not able to
dilate correctly or to that same degree,
that can increase your risk of cardiovascular disease.
But these short-term changes after a meal
have not been shown to do so.
And then again, we can step back further and look at,
well, what does the broader evidence say
about actual heart attacks and strokes,
and we see a reduction in risk, right?
So that goes back to the outcome versus mechanism argument.
So that was one of the things
that they sort of based their argument on.
The second thing that they come to is they look at,
say the work of Dr. Dean Ornish or Dr. Caldwell Esselstyn
and displaying these positive results in people
adopting a low fat plant based or plant predominant diet.
And I would say, yeah, you see reductions in risk
of cardiovascular events.
In the case of Ornish's trial, it was a diet plus,
you know, some exercise and other lifestyle factors.
And that's great.
But we also see similar reductions in trials
on say the Mediterranean diet,
where there is a lot more olive oil and other things.
So we can't say that those results are better
than necessarily including oils,
because they weren't directly compared to each other, right?
Ornish didn't compare a low-fat plant-based to one
that's richer in olive oil or other oils.
It was standard care versus the lifestyle.
Right, and I mean, Ornish got amazing results,
but there's co-founding variables there
that involve lifestyle shifts.
Exactly.
But when we look at the evidence we have on oil specifically,
including substituting oils for healthier or whole foods,
like say avocado, we see that they're comparable,
as I mentioned earlier.
So I don't think there's any good evidence
to point towards this oil-free approach
being better than the oil-inclusive approach.
In fairness, one thing is true though,
which is that polyphenols aside,
oils are very calorically dense
and not necessarily nutritionally dense.
And a lot of the people who are at highest risk
for a cardiovascular event are also obese.
Like obesity is driving, you know,
so many of these poor health outcomes.
And the first thing you need to do is, you know,
get these people down to a reasonable weight
and removing oil from the diet
is an effective way to do that.
So I think there is a decent rationale for eliminating
or at least reducing oil in acute cases.
But I know personally, when I try to go oil-free,
it becomes very difficult and hard to sustain over time.
Yeah, and that's one of the things
that I think we see with oils
is that they make like vegetable consumption more appealing.
If you're cooking them up with some oils
and you're adding spices and stuff
and the oil will help soak up some of those spices,
like that makes it a lot more fun
to consume those healthy foods.
Whereas, without the oils, maybe not so much.
But I agree with you that yes, they are calorie dense
and that could possibly be a reason to limit intake
if needed, if it is a case of potentially needing
to lose some excess body fat.
But outside of those cases, I think it's fine to include
and it can be an absolutely-
Yeah.
Well, the reason we're talking about oils
and butter and beef tallow is because
the number one killer is cardiovascular disease.
This is what is the reason behind why most people die.
And to the extent that we can make lifestyle changes
to circumvent falling into that trap, we should all do so.
And in order to do that,
we need to understand our blood markers.
Like you mentioned LDL.
So let's talk about LDL.
Like what is LDL?
Because I think this is another misconception out there. There's a lot of LDL because I think this is another misconception
out there, there's a lot of LDL denialism
in terms of its relationship to cardiovascular disease,
particularly from the more carnivorous food tribes out there
who would have you to believe that,
this is something you needn't worry about
and just because your LDL is elevated,
it's not necessarily related to that cardiovascular risk.
So here we go.
Once again, like set matters to rights here.
Like what does the science say?
What is your perspective and how should we understand this?
And so LDL stands for low density lipoprotein.
And when we have cholesterol in the bloodstream,
it needs to be carried by something.
You know, I have a glass of water here.
If I poured oil in it, the oil wouldn't dissolve.
It would separate from the water, right?
And so fats in our bloodstream are kind of the same.
So they need some sort of carrier
to transport them through.
And LDL is one of the transporters
for cholesterol and other fats.
And now what's unique about LDL
and a few other lipoproteins
is that they contain a protein called ApoB.
And I know this has been brought up
when you've spoken with Simon Hill.
Yes, Simon and I have talked about it,
but it's been a minute and not everybody
listens to everything.
And I always think, well, we already talked about this,
but like, you know, we need to keep talking about it.
So continue please.
Yeah, so ApoB, it's sort of like a protein tag
and it has a charge on it,
like, you know how a magnet will have a positive
and negative charge. Well, it has a charge that it, like, you know, how a magnet will have a positive and negative charge.
Well, it has a charge that interacts with the opposite charge
on proteins inside the artery wall.
So when that LDL particle slides in,
because it can slide in and out of that outer lining
of the artery, it can sort of bind due to that charge
and it gets held in that,
what's called subendothelial space.
And when it's there, it triggers an immune response.
Our white blood cells come in.
They eat it up.
And that initiates the progression to a plaque.
And over several decades, obviously, that plaque grows
and can eventually rupture and cause a heart attack.
So that's the very quick version of ultimately what that does.
Now, the more of these LDL and other APOB-containing lipoproteins
that we have in our blood, the more are going to end up in there and cause problems down the road.
So that's sort of the mechanistic understanding.
But how do we know that it actually leads to cardiovascular disease?
Well, we have multiple lines of evidence here.
We have observational studies where you measure people's levels, follow them for many years,
and you see that those with higher levels have higher risk of cardiovascular events.
We also have drug trials and different types of drugs.
We have statins that might lower LDL cholesterol from like 30 to 45%.
You have PCSK9 inhibitors, which just abolish your levels down to very low levels.
And then you have other medications that lower them less and you have diet as well.
So we've shown that lowering LDL cholesterol through pretty much any of these means leads to a reduction in cardiovascular events. And the reduction that we see in events
is dependent on how much we lower LDL. So the more you lower LDL, the lower your risk
gets. And then finally, we have genetic studies. So Mendelian randomization studies, where
they'll look at people with genetic variants that lead to higher or lower levels throughout
their entire lives. And in those with lower levels, we see significantly lower risks of cardiovascular disease because
that's carried out through the entire life and isn't influenced by, you know, a change
in medications down the road or, or diet and so on.
The evidence is incredibly clear and consistent there.
And that's independent of other variables because we're talking randomized trials and
genetic studies
where it's not gonna be influenced by so much of,
you know, differences between people's exercise habits
or whatever.
So what is the best version of the argument
that LDL is a red herring?
Like how are people advancing this argument
and, you know, getting mind share around this?
So a couple of the things that are brought up
is people often compare, say the risk
of having elevated LDL cholesterol
to the risk of having insulin resistance
or the risk of other markers being either elevated
or too low.
And the problem with that is that these are often
compounding issues.
So if you look at elevated LDL cholesterol alone,
and you can take, again, yourself or myself,
relatively healthy individual,
but let's say genetically you have just a higher LDL.
You can take that by itself,
and it's going to increase your risk to a certain degree,
but you exercise, you eat well,
you do all these other things that are going to lower your risk.
So that elevation might not be sky high, but it's still there.
But then you take, say, a group of people
with insulin resistance.
They're insulin resistant, and they often have high LDL
and other lipoproteins with that,
and they have high blood pressure,
and they have all these other things going on,
and so the risk of that individual is going to be higher.
That is one argument that's often used,
is like, oh, LDL, small impact, don't worry about it,
compared to all of these other bad things.
Well, why not care about all of them?
That's how I would look at it.
It's like, let's control the LDL,
let's manage blood glucose, let's drop that blood pressure,
let's take care of all this stuff.
And so that is what I see is most often the argument,
but I just don't think it's a very good one.
Right, so from a mechanistic point of view though,
is there an argument that LDL and CVD is an overstated correlation that is more
red herring than alarm?
So one of the arguments there is that it's either inflammation or oxidation of the LDL
particle that is the problem and not LDL itself.
There's an issue with that though, is once that LDL ends in the subendothelial
space and it's held there, it triggers inflammation and will be oxidized. It's going to happen.
Now the reason it's happening is because you had too much LDL and ended up in that space
in the first place. So it's still the too much LDL that was initially the problem. And
how we actually know that it's the concentration that matters more so than whether or not it
was oxidized or whatever,
is because you can do studies where you adjust for oxidized LDL,
and in that case, ApoB concentrations, so having elevated ApoB, again, that protein on LDL,
that still is associated with risk even after you adjust for oxidation.
Whereas if you do the opposite, if you adjust for ApoB but you look at oxidation,
it's not associated with risk. or oxidation, whereas if you do the opposite, if you adjust for APOB, but you look at oxidation,
it's not associated with risk.
So that tells us that what matters is the amount
of APOB containing lipoproteins of which LDL
is the main one matters most.
So in other words, this is given voice
by saying something like, when you measure LDL,
that's just measuring basically like serum levels of it,
right, and serum levels don't necessarily correlate
to cardiovascular disease.
What we need to look at is cholesterol
that becomes oxidized and therefore adheres
to the arterial wall and creates these blockages
or hardened.
Yeah, sort of.
Is that like, you know,
but like armchair, you know, attempt to like parse this.
But it doesn't make sense
because it's the LDL concentration
that does correlate very strongly with risk.
And we can see that manipulating the amount
in your bloodstream has a significant impact, right?
That's what leads to it being in the artery wall
and ultimately oxidizing and progressing onto a plaque.
So yeah, you're kind of getting the right idea there,
but it still comes back to like,
we have very strong evidence for the actual concentration
of LDL being a problem.
So we should get our blood tested.
We wanna know what our LDL is, but more importantly,
we wanna know what our APO-B is.
That is a more definitive marker of our situation.
as a more definitive marker of our situation.
It seems like you used to have to kind of ask for APOB. This is a new marker,
but is that now being mainstreamed
where if you go in for a typical blood panel,
they're just gonna do it as a matter of course?
It's not standard.
I've seen it a lot, like patients of mine
who are also being managed by a cardiologist,
I'll see that the cardiologist does do it quite often
if I hadn't already.
But from like a standard kind of GP practice,
I don't think most will measure APOB.
It's not really a part of clinical guidelines yet.
I do suspect it will be.
But what is a part of that normal lipid panel
is your total cholesterol, your LDL cholesterol,
which is a pretty good marker, andid panel is your total cholesterol, your LDL cholesterol, which is a pretty good marker,
and your non-HDL cholesterol.
So it's your total cholesterol minus HDL,
which is very closely approximated to ApoB.
It's a pretty good alternative if you can't get the ApoB.
And in most cases, just to be honest here, the LDL is good.
It's a pretty good approximation in most cases,
but in people with metabolic syndrome
and people with elevated triglycerides,
it's not necessarily going to be accurate.
It can be underestimated
because if your triglycerides go up,
they start taking up some of the,
or they start being taken up by the LDL.
And so you kind of get a skewed measure there,
but by and large, LDL is pretty good.
Non-HDL is better. APO-B is the best.
What about having an elevated LDL,
but also having a very healthy high HDL,
the so-called good cholesterol?
Does that buffer that?
How should we think about that?
Like you get the test, you get your LDL,
you get your HDL and you get your total cholesterol.
So you have these three things, you want APO-B in there, of course, but in case you get your HDL, and you get your total cholesterol. So you have these three things.
You want APO-B in there, of course,
but in case you didn't get it,
like how do we make sense of how those numbers
interact with each other to decode how to move forward?
Yeah, so we used to think HDL was important,
at least the concentration was important.
And that's because high HDL does associate
with good outcomes in the long term
in most observational studies. However, things like exercise raise HDL does associate with good outcomes in the longterm in most observational studies.
However, things like exercise raise HDL,
not smoking leads to higher than if you were smoking
and other healthy behaviors increase that HDL.
Also genetics impact HDL.
So with LDL, like I said, we have the genetic studies,
we have the randomized trials,
we have a lot of evidence pointing towards modifying LDL
and how that can impact risk. But they've tried drug trials to raise HDL. They didn't seem to lower risk of cardiovascular
disease. People with genetically higher HDL cholesterol don't appear to be protected from
cardiovascular disease. So the HDL concentration isn't actually a great marker. It generally
associates with good outcomes because it's associated with healthier behaviors, but it
doesn't, if you were to modify that number, it's associated with healthier behaviors, but it doesn't,
if you were to modify that number,
it's not necessarily going to translate
into better outcomes, if that makes sense.
LDL is important.
APO-B is the marker to pay most close attention to,
but in terms of assessing your overall CVD risk,
you wanna look at family history, of course,
and in the context of that,
like where does getting a calcium scan fall?
Like, you know, what are other things
that we should be doing to really know exactly
where we're at?
Yeah, so to first off, estimate risk based
on those measures that you can get through a blood test
or family history or blood pressure.
There's some great calculators online.
I know the American College of Cardiology has one. I actually really like the European atherosclerosis
society calculator and these are free to use online if you wanted to kind of plug and check
your own numbers and see where it comes out. So that's one thing. But when it comes to say
coronary artery calcium scans, one problem with those, and I think it can be a useful tool,
especially in elderly individuals who are higher risk, is that if you measure at a younger age, say in your 30s or 40s as we see a lot
of people in the carnivore community they'll measure and be like, hey, it's zero. Well,
it's probably going to be zero because that's the late stage plaque. That's the calcified
plaque that's been there for decades before it finally did calcify. Just because you have
a calcium score of zero does not mean you don't have plaque. In fact, the non-calcified plaque
is the most dangerous plaque.
That's the one that's going to break off and cause a clot
and ultimately leading to a heart attack or stroke.
The calcified plaque is actually more stable.
In fact, medications like statins,
while they lower LDL cholesterol,
they actually can lead to an increase in calcified plaque,
which stabilizes them.
And that's one reason that you might not have as high
of a risk of a cardiovascular disease
or a cardiovascular event after that.
So it can be useful in certain high-risk individuals,
especially those like over 60, 65,
but at a younger age, it's not super useful
unless you are a very high-risk individual.
And if you pick up on some calcified plaque there,
that's really problematic
because that means you probably have a whole lot
of uncalcified plaque. Are there any other scanning techniques that are coming or would be good to explore? It seems like
there should be some imaging that would be helpful here.
I mean, there's some studies looking at like certain ultrasound techniques. There's a recent
keto study maybe we want to get into that used CT angiograms.
But these aren't very easy to get.
These aren't things that are going to be widespread, whereas something like a calcium score is actually pretty easy to get.
There's a lot of private labs that do them.
So unfortunately, I'm not aware of what would be a really easy, simple test like that to do for most people.
But you can make good decisions around treatment
based on risk factors as well.
And if you were a high risk individual,
then you can maybe get a referral
to one of these more advanced tests.
All right, so cliff notes on seed oils,
like not so bad, but not too much,
like better than butter and beef tallow,
nothing to get too crazy about,
but certainly not something to overindulge
in.
LDL, once again, important, APOB, et cetera.
What's next in the hierarchy of misinformation or topics that you feel it's important for
people that kind of understand truth versus fiction?
I think a big one is the whole plant animal protein debate.
I think it's one of the most powerful changes
you can make in your diet
to actually improve your long-term health.
But then there's so much misinformation around like,
well, plant protein doesn't work as well as animal protein
or basically name your fallacy when it comes to those.
Amino acid deficient, lower absorption rates.
You're gonna have to eat so much food
just to meet your daily requirements, et cetera, et cetera.
Animal protein is superior, is basically the bottom line here.
Yeah, I think maybe before the health stuff,
yeah, let's talk about the whole muscle and strength aspect.
I think there's three sort of questions
that we have to ask there.
One is, can you get the same amount of protein
from plant foods as you could from animal foods? That's maybe the main concern for most people. And
I would say it depends on what you're replacing. So if you just go to a buffet and you decide
that you're going to eat plant based now and you just load up on whatever is labeled as
vegan, you're probably going to end up with less protein if you're having a lot of rice
and veggies and things like that. But if you swap out meat, let's say your standard 80% lean beef for tofu, and you eat the same amount
of calories, which would be a bit of a larger serving for the tofu, but the same amount of
calories, you get about the same amount of protein. Now, if you replaced even extra lean beef with say
seitan, which is a wheat-based protein for those who aren't familiar, and really nicely mimics sort
of a meaty texture, you can match lean beef.
So actually have more than your standard beef.
If you use textured vegetable protein,
which is like soy without,
or with much of the fat removed,
that also has a meaty texture
and matches roughly the lean beef for protein content.
So that's easy enough.
Now we can also look at dairy.
If you replace your say 2% or 1% milk with soy milk
or pea milk, you get about the same amount of protein. Skim milk has slightly more, but it's
it's not too far off. Now if you were to choose oat or almond milk, yeah, you're getting less
protein there. So that's where that sort of decision making comes in. If you look at eggs
and replace that with a tofu scramble, you get more protein. So I just like to emphasize a bit
of focus on those higher protein plant foods.
It doesn't have to make up your whole diet,
but where you would normally have some beef
or some chicken or some fish,
make sure you're replacing that
with some of those higher protein plant foods
and you can get around the same amount of protein.
Yeah, but Matt, leucine, this is the thing, right?
Leucine, most plant foods are insufficient sources
of leucine and without leucine,
you can't form complete proteins.
So leucine, one of the amino acids that's important
for triggering muscle protein synthesis.
It is found in quite significant amounts
in certain plant foods like seitan is actually very high.
Yeah, but nobody eats seitan.
Sure, I just mentioned one example,
but soy is also quite a good source. Yeah, but that's estrogenic. We, I just mentioned one example, but soy is also quite a good source.
Yeah, but that's estrogenic.
We'll get to that.
Okay, keep going.
But yeah, so like that can be a good source.
I believe azuki beans are pretty good,
but I wanna also highlight that we don't need
to necessarily hyper-focus on leucine
because there's a threshold
to how much is actually beneficial at a meal.
So it's about two to three grams.
And that's the amount you can get through
a pretty simple meal with some grains, some tofu and veg.
Like the tofu alone can often provide about that amount
depending on the proportions that you're having.
So you can meet that leucine threshold relatively easily.
And I don't want to jump too far ahead to the outcomes part
but we actually have a trial where they monitored
leucine intake as well. And I will definitely touch on that in a second.
But the point being here is that on the amounts of protein,
you can get roughly the same amount. Then it comes to a question of amino acid
content, right? Do plants contain all of the essential amino acids?
So there are nine essential amino acids,
meaning these are the nine building blocks of protein that we cannot make
ourselves. We need to get from food and all plants contain all of the essential amino acids
full stop. So that that's one of the biggest myths out there is that plants
don't contain all of them. Now the pushback there would be, well,
they don't all contain a lot of all of them. And that's fair.
But if you're eating a varied diet throughout your day, if,
and not even at every meal, but if you're having, you know,
certain things for breakfast, let's say you're having some oats with whatever nuts and seeds you're
throwing in there, and then for lunch you have some beans or lentils with rice or whatever,
those will all combine and complement each other. You don't necessarily have to have
this variety at every single meal. And we don't see that that's a problem at all with
getting enough of the essential amino acids
throughout the day,
as long as you're eating some variety
and not focusing on a single food.
And then the third thing that gets brought up,
so the last thing before we get to the actual outcomes
is digestibility.
So do we absorb much plant protein
relative to animal protein?
And the concerns over that are stemming primarily
from two measuring systems or scoring systems for protein digestibility.
I'll try not to get too in the weeds on this, but just roughly or briefly describe them.
So one of them is called the protein digestibility corrected amino acid score or the PDCAS.
And the other one is called the digestible indispensable amino acid score or the DIAAS.
Don't you don't have to remember them. Don't worry about it, I'm just throwing it up.
Now, you will find that based on these measuring systems,
a lot of plant foods will score lower 60, 70% maybe
in that ballpark, except soy scores in the 90s.
The score is quite high
and maybe one or two other plant proteins.
Whereas animal proteins score very consistently
in the 80s to 90s, or sometimes even higher.
Now the problem with those scoring systems
is that, I'll start with the PD-CAS,
for one it's typically measured in rodents,
in animal models.
We aren't rodents.
We have different digestive tracts,
we have different growth rates,
we have different protein needs,
and so we can't necessarily translate that to humans.
And in fact, this goes across the board. So when people are making nutrition claims online,
I would always look at, are they talking about humans or are they talking about animals?
Because a recent review found that only about 5% of results from animal trials translate to humans.
So most of the time they either don't work, there's unwanted adverse effects, or they just
don't work as good as other things that are already out there. So animal trials, it's a starting point. It's not necessarily translatable to humans.
The second issue is that they don't just measure digestibility. They measure the digestibility
of the lowest available amino acid. And this is critical. So let's say you had a report card and
let's say there were nine subjects, we'll call them the nine amino acids. And let's say you had a report card, and let's say there were nine subjects,
we'll call them the nine amino acids.
And let's say you score straight A's on eight of them,
but you got a C on one of them.
Your score on the PD-CAS for the aggregate would be a C.
It wouldn't be like a B plus or whatever
the actual average would be,
they would score you based on the lowest number.
So if you take a plant food like beans
that have low amounts of methionine,
but are higher in the other amino acids,
you'll get scored based on how much methionine is there.
Right, so that's a huge disadvantage to plant foods
when it's not even a problem
if you're eating multiple foods, right?
They'll complement anyway.
So that's a big-
So you'll be eating something else
that is high in methionine.
Exactly.
Whereas an animal source of protein may be more complete in the sense that all of those things
are in equal proportion.
Exactly, yeah.
And that's a point that I've never seen somebody mention
when citing the PD-CAS or the DIAAS
to support their view on the animal proteins.
The third issue with the PD-CAS,
it's not maybe as big of an issue,
but they measure digestibility from mouth
all the way through the other end. So basically they feed foods, they measure
how much protein goes in and how much comes out. And the difference is presumably what's
absorbed. But near the end of the small intestine, or sorry, the large intestine, there's some
bacteria that will chew up some of the protein so it can skew results a little bit as well.
So that there's issues around that. Now moving on to the dias and I'll go through it quickly
because it's largely the same, but is typically measured in pigs. It has that same issue with the limiting amino acids, so it
docks points based on amino acid profiles. They do overcome the whole issue with the bacteria and
the digestive tract because they insert a tube through the abdomen to the end of the small
intestine and they suck out the protein from there versus going all the way through. But then the
other problem is they typically use raw foods.
So they use raw beans, raw lentils, raw grains.
And by cooking those foods, you make the protein more digestible.
So they're also skewing results, particularly for plant protein sources that do become more
digestible with cooking.
And when we look at the limited research we have in humans, where they're looking at the
digestibility of the whole protein, so not the individual amino acids,
we see that high quality plant protein sources
like soy, pea, or wheat-based proteins,
they have about a 90 or even above a 90% digestibility
that's only a few percent off
even the highest digestible animal proteins.
So the difference is we're talking a few percent here.
It's hardly anything.
With that, we can speculate that, well,
maybe the results will be the same.
Maybe plant protein will be slightly worse,
but not too far off.
But that's why we ultimately test these
in the clinical trials where you pit a vegan
or plant predominant diet against an omnivorous diet
and measure actual strength and muscle gains.
And we now have two trials that have done that.
And in both cases, the plant protein,
as long as they're eating the same amount of protein,
led to the same muscle and strength gains as the animal protein with no significant differences
in any outcome.
So if at the end of the day, let's just for sake of argument say, yes, plant proteins
somewhat less digestible.
Let's say that it doesn't have as balanced of an amino acid profile.
If at the end of the day, you get this same result, same muscle gain, same strength gains, who cares? Who cares about these individual mechanisms? Maybe there's
mechanisms working in the opposite direction for plants. Maybe the carbohydrates that are
packaged with plant foods a lot of the time help spare some of that protein so it can be used and
integrated into your muscle. Like there's a possible mechanism there. Ultimately I don't want to
speculate too much about what these mechanisms could be because I don't think we know for certain, but who cares?
The results are the same.
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Do those findings extend to when you isolate the proteins in powder form?
So if you do a pea, you know, soy blend of protein powder
versus like a whey, is there an argument
or any substantiation to the idea that like whey is better
by definition than these plant-based protein powders?
It was funny because I feel like these trials,
these more recent ones, were sort of responses
to those initial criticisms around the powders.
So when we look at trials on pea, rice, or soy protein
in comparison to whey protein,
we see no significant differences there.
But one of the criticisms was always that,
well, maybe when you isolate the protein,
it's more digestible.
So it's going to function better than a whole food.
It's sort of the opposite of what you're suggesting there.
And so when they conducted this,
we'll say the first of these two new trials in Brazil
is published, I believe in 2021.
They, yes, they supplemented the vegan group
with some soy protein and they supplemented the animal group
or the omnivorous group with some whey protein, most of the food or most of the protein in
both groups came from food. And that's, that's critical. So if there is a difference between
plant food consumption and the say protein quality there and animal foods, we should
see a difference in that trial since the majority of their protein came from those sources and
we did not in any outcome. So I think that's pretty compelling evidence
that no, you can get the job done with plant protein
as long as you're eating sufficient protein,
which in this case was 1.6 grams of protein
per kilogram of body weight,
which is typically recommended
for those looking to pack on muscle.
The argument that generally follows this is,
okay, yeah, but if you're going to be making sure
that you're eating enough protein on a plant-based diet,
then this is gonna be difficult
and you're gonna have to eat like tons of food
and be hyper vigilant about what those foods are.
I would say you do have to probably spend
or pay a little more attention,
especially if you're coming from an omnivorous diet.
As I mentioned earlier, there are certain plant foods
that are higher in protein and certain ones that are lower.
But to be hyper vigilant, I think that's an exaggeration.
If you monitor pretty much anyone's protein intake
on a plant-based diet,
where they're centering their meals around protein,
and this is what I advocate to patients as well,
is when you're designing a meal,
focus it on the protein components.
So if you're having lentils and rice or some veggies, make sure that centerpiece is the lentil dish, you know,
or if you're using tofu, make sure that's the center.
And then build around that, add the fruits and veggies
and other things around that.
And if you're doing that,
it's pretty easy to hit those targets.
If you're aiming for that high, high end
of 1.6 grams per kilogram,
you could probably do well by adding a protein supplement.
It doesn't mean that you need to,
but it can help you get there without thinking about it much.
And I do that and I never think about my protein intake
anymore because it's so easy.
And look, every gym bro who's using,
or who's going to the gym is using whey protein anyway.
So it's not like it's really different
than what the omnivores are doing.
It's just a different type of protein.
Sure, if their omnivorous diet was so exceptional,
there would be no need to be drinking these protein
smoothies all the time.
Yeah, and even if they were already meeting their needs,
like there's not really harm in taking an extra shake
or something either.
And I would say the same about people on a plant-based diet.
Well, in terms of meeting your needs,
like even in a performance context,
what does the science say is required in order to,
to produce the muscle synthesis that you want?
And what does excess protein intake do for that
or not do for that?
Because look, if our friend Garth Davis will say that,
we're obsessed with protein
and it's not helpful to us,
the recommended daily allowance is what?
0.8 grams per kilogram, which really isn't very much.
But right now there's a lot of promotion
of really doubling down on your protein.
And perhaps there's a reason for that as we age,
like at my age, it becomes more important
than it was 10 or 15 years ago.
But what do you make of that argument
and how we think about the amount of protein
that we're intaking?
Yeah, I mean, I know the RDA, I would say,
is a little bit low and there's been an argument
for that now based on newer data that's come out
than the last five, six, seven years
around especially
bone health parameters and risk of frailty in older age.
And so I do actually advocate for a little bit of a higher intake around 1.2 grams per
kilogram is a pretty safe number for most people.
And for most athletic endeavors, that's going to be enough as well.
It's for those who are looking to squeeze out every ounce of muscle and strength gains
that going up to 1.5
or 1.6 grams per kilogram is a reasonable thing to do.
And there was a really good trial,
or sorry, meta analysis of trials
that was published just a couple of years ago
by Tagawa and colleagues.
And they looked at protein intake
with and without resistance training.
So in trials where they didn't add resistance training,
but they just up their protein,
pretty much nothing happened, very little.
So you're not just going to sit on your butt,
slam protein shakes and hope to gain much muscle.
It's just not going to happen.
But in those who were resistance training,
even in those with very low protein intakes,
like 0.8 grams per kilogram or less,
they still gain muscle.
So that's the biggest lever to pull
is actually lifting some heavy things, right?
But in those who up their protein
to about 1.5 grams per kilogram,
they experienced the largest benefits
and then there was no further benefit after that.
So again, it kind of depends on your goal.
I think resistance training is really important,
but especially for bone health and so on,
I would advocate for a little bit of a higher protein
than that RDA of we'll say about 1.2,
maybe 1.1 grams per kilogram.
Well, this brings us to the point
in the podcast conversation where we have to talk about
Nagra versus Norton.
You've had some colossal beefs with our friendly Norton.
Norton claims nagged by Nagra.
Talk about like the,
can we talk about this a little bit?
Yeah, fine.
Where do you guys disagree on this stuff?
What led to some loggerheads here?
I would imagine it has something to do with protein.
Actually more with red meat.
I mean, protein to a degree as well, but it was red meat.
I'll give some background on that.
So there's a study that he and other people,
I don't wanna just single him out,
often cite to suggest that red meat,
unprocessed red meat is not problematic in the diet. And this is a study out of Canada where they meat, unprocessed red meat is not problematic in the diet.
And this is a study out of Canada where they looked at unprocessed red meat consumption and the risk of cancer,
but they did something interesting where they separated people into those who eat little fruits and veggies,
moderate fruits and veggies, and then high fruits and veggies.
And they found that in those with a lower intake of fruits and veggies,
unprocessed red meat was associated with cancer risk, but in those with the highest intake,
it was not significantly associated with higher risk.
So Lane takes that to say that,
well, at even a regular intake of unprocessed red meat,
if you're eating fruits and veggies
and have a good diet quality, it's not problematic.
But my criticism of that study,
or rather that conclusion from that study,
is that if we look at the amount of red meat that they were consuming the
High consumers were having
We'll say a little above 500 grams a week. That's less than a serving a day. So a hundred grams is a typical serving
That's about you know a deck of cards size per day
And so these people were consuming less than that and and that's sort of the threshold for where we typically see risk
So I would argue that the men in that study weren't even consuming enough and the women in that study were consuming even half as much
So even less so that's problem one
The second problem is they lumped all the cancers together or they did another analysis where they lumped 15 cancers together
The issue with that is if let's say unprocessed red meat increases colorectal cancer risk
But doesn't impact these other cancers or most of these other cancers, well then if you're looking at overall cancer risk,
you're not going to see much.
Even if you get an uptick in one cancer, it's going to be sort of washed out by the other
ones.
So I don't think it's fair to consume that there's no risk there.
And then the third problem is, it's just cancer.
What about cardiovascular disease or other outcomes?
We can't conclude that it's safe for all of these other issues.
So that is sort of what I made a post on,
and this is back a few years ago now.
It's funny, I'm surprised he even commented.
I didn't have much of a following or anything at the time,
but somebody tagged him and was like,
hey, Lane talks about this.
What do you think?
Or they were maybe a bit concerned
about the conclusions they'd heard from him.
And he just commented saying that I'm biased
and cherry picking and there's other data
that supports his position.
And so I just replied, well, can you share that data?
Because I haven't seen other data like that.
And in fact, he often talks about that study
because of its uniqueness and the way
that they did the analysis.
So it doesn't make sense that there would be
other data that supports it.
Lane is somebody who's also going to say,
you're going to want to begin taking more protein
than this RDA.
Yeah, and I think we agree.
And that's the other thing I really want to be clear of.
I think a lot of the information he puts out is good, right?
I'm not to be super critical of him in general.
I just think around the animal protein
versus plant protein debate and the red meat stuff,
I think there's maybe a bit of bias there or something.
But yeah, I would very much agree with him
on going a bit higher than the RDA.
Most people believe that red meat is perfectly fine
and appropriate as a part of a healthy diet.
This could be a semester, you know, course here,
but perhaps that's true.
I'm interested in your perspective,
but my sense is that we're just eating altogether
way too much of it.
And when you consider the fact that,
cardiovascular disease is the number one,
reason why most people are gonna die
and the relationship between CVD and saturated fat
and cholesterol and LDL, red meat intake
is only gonna drive
you in the direction of that rather than in the reverse.
Yeah, and I think a really important variable here is dose.
You mentioned eating too much of it.
Do I think that someone, and I'll say this as a vegan,
even when it comes to health,
do I think you can include red meat,
especially lean red meats once, twice a week,
something like that?
Yeah, I don't think it'll have a meaningful impact.
The problem is where you're averaging serving a day.
Like that's where really the problems start to creep up.
And even with lean meats, we see, and there's a trial by Bergeron in 2019
where they actually compared red meat, lean red meat, white meat, and plant protein,
and they matched saturated fat, they matched fiber intake,
and still the plant protein lowered APOB
relative to the animal proteins.
And so there's still a benefit there.
What do you make of that?
Like what would drive that differential?
I think a part of it is gonna be the dietary cholesterol.
So that's one thing that wasn't matched
because it's inherent to the meat.
And I know there's a lot of debate
around dietary cholesterol and the impact that it has,
and there's some nuance there.
So if you take somebody who eats no dietary cholesterol and the impact that it has. And there's some nuance there. So if you take somebody who eats no dietary cholesterol,
you take a vegan and you start feeding them cholesterol
through eggs or other foods,
their LDL is going to shoot up more.
Whereas if you take somebody who's already eating
about 400 milligrams of cholesterol a day
and you add more, it doesn't do anything.
There's a plateau effect.
There's also genetic differences person to person,
but that wouldn't show up in a trial like that
because everyone was doing every diet.
So it could be that little bit of a bump in APOB
could be due to the dietary cholesterol
or potentially due to some of the phytochemicals
and the plant foods maybe having a little bit of impact
or something as well.
The exact mechanisms, I mean, I don't know
that will tease out exactly what proportion
each one contributes to, but those can all be factors.
Let's talk about plant meats, so-called fake meats,
the plant analogs to our favorite meat and dairy products.
This is a low-hanging fruit for the more omnivorously
or carnivorously inclined
to point a finger and say,
plant-based diets are terrible.
They're rife with processed foods.
They want you eating bugs
and all of these processed foods.
And this is what's destroying our health.
Yeah, I actually, if you're,
I don't know if you're aware,
published a paper on this last summer in the Canadian Journal of Cardiology, where we actually reviewed the research on plant-based meats and cardiovascular risk in particular.
And we looked at both the nutritional profiles of the plant-based meats across the literature and the, at the time, available randomized controlled trials, of which now there are a couple of additional ones. And with nutritional profile,
what we found was that compared to the meats,
they're designed to replace.
They were lower in saturated fat on average,
obviously lower in cholesterol
because that comes from animal products,
a bit higher in fiber,
and ultimately aligned with better cardiovascular profile.
Then when we looked at the six randomized controlled trials
on the topic, we saw that they consistently lowered
LDL cholesterol compared to meat, total cholesterol as well,
no negative impacts on blood pressure,
which was maybe a bit surprising because of the salt content
of a lot of these products.
And then there was also a little bit of weight loss
in a couple of the trials.
So from a simple swap of just replacing the meat with the plant-based meats, we actually
saw improvements in a number of markers.
Now, I'd love to see long-term data on outcomes as well down the road, and hopefully we get
that.
But the data currently does point towards them being at least a more heart-healthy choice,
yet there's still this very strong opposition to these products around like their processed nature or, you know,
name again, your appeal to nature fallacy.
Yeah, I mean, it's a Franken food.
It's filled with all of these, you know,
fillers and additives and preservatives.
You know, I'm looking at the nutrition label.
I don't know what these things are.
I can't pronounce these words.
The studies show that in comparison to its meat variant
that it actually is healthier.
So it really is about what it's replacing.
Like if you're just gorging on these plant-based meats
all the time and forsaking your more nutritious vegetables
and fruit and whole grains, et cetera,
like this is not a good choice.
But if it truly is replacing what you were eating prior,
the evidence seems to suggest
that it actually is a healthy alternative,
although it is processed by comparison.
Although the meat you might be eating
might be filled with hormones and you know,
all kinds of other stuff.
And of course it comes in a package
that's higher in saturated fat.
And you know, we've already talked
about what that drives.
I think a lot of, especially competing interests
have really jumped on the consumer fear
around things like processing or ingredients you can't list.
So for example, there's this organization
called the Center for Consumer Freedom
and they are backed by meat industry and other industries,
as well as many individual donors of whom are anonymous.
But they have taken out plenty of ad campaigns.
They took out ads in the Wall Street Journal,
bashing plant-based meats.
They took out a Super Bowl ad,
of which I'm assuming they paid $5 to $8 million
to kind of create fear around.
In the ad, it was children at a spelling bee
who couldn't spell certain words
that were in the ingredients.
And so there have been like these campaigns,
I think to a degree have been quite effective
at sort of inducing fear around these products
or at least capitalizing on the already existing fears.
Yeah, I mean, certainly these products could be healthier
and hopefully they will become healthier
than their current versions.
Like for example, I know Beyond Meat is working on
a new version that will address the concerns
that people have about the less than healthy aspects
of that product and I think that's great.
But there is no doubt and I know this for a fact,
like with inside sources that there was indeed an incredibly well-funded
and well-coordinated attack against the sort of
plant-based meat, fledgling, industrial complex,
for lack of a better word, to really create this idea
that these were really unhealthy foods
and that people should avoid them at all costs.
Like that didn't happen by accident.
That was very purposeful to get us from where we were
when there was a lot of enthusiasm about these products
to kind of where we are today.
And I think what is really fascinating within that
is really sort of a social experiment.
Like it is the more conspiracy minded folks
who are most vehemently against these products.
And these are people who have been, you know,
manipulated by an actual conspiracy
to believe what they believe.
Yeah, I've actually never heard it put that way,
but that's perfect.
And yeah, I think you also hit the nail on the head
with like say Beyond Meat trying
to reformulate their products.
One of the underappreciated aspects
of these plant-based meats and just processed foods
in general is that we can reformulate them, right?
You can't just do that with a cow overnight.
That's many generations of selective breeding and everything.
So when you see companies like Beyond Meat
or even Impossible Foods,
now they have light versions of their products
that are like lower in saturated fat.
They're modifying these foods to actually be healthier.
Now we have data on the older products
showing that they're already healthier than the alternative
and with the SWAT meat trial,
they compared Beyond Meat to even organic
and grass-fed meat products
and the Beyond Meat fared better.
So...
But Matt, you're a paid shill of Beyond Meat, right?
I've not received a penny.
I did, I will say-
Didn't Christopher Gardner get accused of that
with the Netflix series?
Well, I think he got accused of it
because they had funded, or at least partly funded,
one of the trials that he did.
I don't think he received anything.
Oh, yeah, yeah, yeah, yeah.
I don't want to speak too much on that
because I'm not sure of the specifics,
but that was my understanding.
I received zero to be clear.
I mean, people are gonna say that regardless.
I think we just have to stand by the science
and make sure the methodology is good.
And if that's the case,
who cares where the funding is even coming from
as long as that stuff is all in line.
But I know that there's obviously gonna be concerns
around that regardless.
Right, it's really hard to shift people's minds around this.
And I'm not saying like, listen,
you should just knock yourself out with these products.
You should be sourcing your nutrition from whole foods
close to their natural state as often
and as much as possible.
But I just wanted to shift people's perceptions
of how they might be
perceiving these products and to think about it
a little bit more clearly and critically in terms of
like maybe what they're reading and hearing
when it comes to these things.
Yeah, and I think you can ask the CEOs of these companies
if they think people should center their diets
around those products or beans.
And I think they would side with the beans.
These are supplemental things that can be included
to enjoy once in a while.
If you sit down with Ethan Brown,
who is the CEO and founder of Beyond Meat,
incredibly smart guy, really has his heart
in the right place, is trying to do good in the world
and has a very big mission.
He could fill your brain with, just a million facts about,
why this is a healthier option
and how they crafted it in the way that they did, et cetera.
But I think the problem, one of the big problems here
is that whether it's Beyond Meat
or any of these other companies,
they've never been able to be in control of the narrative.
And they've allowed that narrative to be created for them.
And they're always responding to it
rather than basically being in front of it.
And I mean, that's like a PR thing, I guess,
or like a branding thing.
But the story that Ethan wants to tell
isn't really penetrating culture
in the way that all the stories about,
that are sort of anti beyond meat are,
find their way across the internet, I guess.
Yeah, I mean, I've seen like the latest little
short documentary they made, Planting Change,
and a few other things that they're trying
to get that message out there,
but I think it is a question of,
is it permeating those circles outside our own, right?
Like we are seeing this stuff,
but is it getting to those people that really need to hear
it and I don't know.
I mean, I mean, time will tell.
I mean, there isn't a lot of cultural receptivity right now,
at least, you know, I don't know what's going on
up in Canada.
It's like, yeah, you know, it is what it is.
But it does raise another kind of ripple here,
which is the difference between processed foods
and ultra processed foods.
So when we hear the word processed food, processed bad,
and certainly we wanna avoid processed foods
and most definitely ultra processed foods in our diet,
but there is a little bit of confusion
when it comes to that word, which is very loaded
because pretty much everything short of fruits, vegetables,
and I don't know, like meat, meat also,
like so many foods are processed
and there's a whole spectrum here of health and harm.
Yeah, the most used sort of classification
is called the Nova system for classifying foods
as like unprocessed, processed, ultra processed.
And this came out of Brazil.
And basically they have four different levels
or four different groups.
So group one foods are the unprocessed
or minimally processed foods.
Fruits, veggies, meats would be included
in their certain dairy products.
And then group two foods are the ingredients.
So like the culinary ingredients like sugar, salt, oil.
Group three are foods where you add
those culinary ingredients
to the unprocessed, minimally processed foods.
So even canned vegetables because of the salt and the liquid,
that is considered now a processed food.
And then you have, you know, breads, certain types of breads
and things that would factor into there as well.
And then ultra-processed foods are foods that are essentially made in processing,
like facility or factory, used primarily
of industrial ingredients.
And these can range widely from these plant-based meat
alternatives to sodas to sausages and bacon to pastries
and on and on and on.
And something to understand is that even
within that group
of ultra processed foods,
there are wild differences in the types of foods.
Like a can of soda is not the same as a Beyond Meat,
which is not the same as an animal based sausage,
which is not the same as a donut.
You know, like they're all very different.
And what we've seen out of the last few years,
and this is really interesting research,
is that when they separate out the different types
of ultra processed foods,
it's mostly the processed animal foods.
So the like processed meats and the sodas
that are the worst.
Those are the ones driving most of the risks.
What about all the refined grain processed foods?
So then when you get to the grains,
refined grains are sort of in the middle of that spectrum,
but then the whole grain products,
so even whole grain cereals or whole grain breads
are associated with lower risks.
So we have some foods in this ultra-process category that can actually improve risk, and
then we have some foods that worsen risk and some that are kind of in the middle.
Now refined grains in general, I tend to put them sort of at the middle of the spectrum
because you always have to compare it to something, right?
Because refined grains make up such a wide or a large part of the American diet,
it's good to have that as sort of the centerpiece
that you compare everything to, at least in my view.
And that's not to say that it's nearly as good
as like whole grains or other foods.
And they tend to only really increase risk
at least significantly if they're leading to weight gain.
So if you're adjusting for things like weight change
over time, they're just pretty neutral. They don't seem to increase risk. But they're leading to weight gain. So if you're adjusting for things like weight change over time, they're just pretty neutral.
They don't seem to increase risk.
But they're always going to,
because we're talking about like Oreos and saltine crackers.
Like the hyper palatability aspect of it
is going to cause you to overindulge on them.
Yeah, and so that's a possible criticism, right,
for making the claim that, you know,
in a calorically balanced state,
these refined grains are fine.
Yeah, like who are those people?
Yeah, the guy who eats one Oreo
and walks away and says, I'm good.
Not necessarily even Oreos and things,
but even like white rice or white bread,
like those would fall in that category too.
So even within that, there's a bit of a range,
but yeah, I agree with you that generally speaking,
refined grains are probably going to promote
more of an over consumption pattern than otherwise.
So generally gonna be worse off with those.
Did we say everything we need to say about that?
I think so.
I mean, there's this fear around the fact
that things are processed,
but even just because something's processed,
I mean, there's such a wide range of those types of products
and there can be differing effects, right?
So just because something's processed doesn't mean bad.
On average, we can say, yes, they're less healthy. Extra virgin olive oil
is a processed food.
Yeah, exactly. Tofu is a processed food,
which I think we still haven't gotten to.
That's a loaded.
Maybe that's coming up, I don't know.
So you just exposed yourself as a target by saying that.
Yeah, there you go.
But even like whole wheat pasta or whole wheat breads,
I know there was some people that are concerned
about the- Well, that's also like,
that gets a lot of people in a lot of trouble, those foods.
It does, at least in the social media space,
but generally speaking,
those are associated with good outcomes.
It's just a matter of, again,
like we talked about earlier,
stepping back and looking at the final outcomes,
what are the results that we see with these foods?
And we see generally,
those foods are associated with better outcomes.
Right, all right, soy boy,
defend your estrogenetic food, favorite food.
Yeah, so soy does contain isoflavones,
these are a type of flavonoid,
and they're commonly referred to as phytoestrogens,
phyto mean plant, estrogen, obviously estrogen.
And the reason they are termed that
is because they have some similar structural
characteristics to the estrogens that we create, but they are not identical. But because they have
some similarities, they can interact with estrogen receptors in our bodies. And so they can have some
sort of a hormone modulating effect. The question is, what is that effect? Is it something that we're
worried about? And when we look at randomized controlled trials, in fact, a meta-analysis by Reid et al,
I want to say in 2020, maybe 2019, not 2029. When we look at that meta-analysis of, it was like 41
randomized controlled trials, we see no clinically significant effects on testosterone, estrogen,
or other sex hormones. We see similar data. There was recently a study on, or a meta-analysis on
trials on women, pretty
much the same results, no clinically significant effect on hormone levels or measures of estrogenicity,
things like uterine lining thickness, for example.
And so we have really good data consistently pointing towards there's no real impact on
hormone related outcomes.
Now where does the concern come from then?
Well, for one, it's just an extrapolation
of the word estrogen, phytoestrogen,
and thinking that that is then estrogenic.
And two, there were a couple pretty extreme case studies
that were published a number of years back
where there was like an individual who consumed 14
or plus servings of soy milk a day
and like pretty much a soy diet.
And he may have experienced some breast growth,
breast tissue growth.
So he's patient zero for the soy boy phenomenon.
Pretty much, yeah.
Yeah, pretty much.
But here's the thing, we can't even based on that conclude
that it was the soy necessarily.
We weren't adjusting for any other factors.
He's eating a very monotonous diet.
Maybe there's other things that are lacking or in excess,
we don't really know,
but even if we granted that it was the soy,
I mean, that's a ridiculous amount.
Nobody's recommending that amount.
The randomized trials we have go up to five servings a day
or something, which is still quite a lot,
and we don't see any meaningful impact there.
So on that basis, the soy foods are quite safe.
And then we can look at the long-term data
on breast cancer risk, for example, and we see that those with the soy foods are quite safe. And then we can look at the long-term data on breast cancer risk, for example,
and we see that those with the highest soy consumption
consistently have lower risks of breast cancer.
In men, we see lower risk of prostate cancer as well,
and then we see lower risks of cardiovascular diseases
on top of that.
So it's quite beneficial sort of across the board.
And we see improvements in bone health parameters.
So lower risk of osteoporosis in older age,
largely because the specific receptors
that the phytoestrogens will bind to,
they're concentrated in bone tissue amongst other tissues
and they have proestrogenic effects in bone tissue,
which is good, that actually helps maintain
bone mineral density.
Whereas in breast tissue, they have antiestrogenic effects,
which is potentially one reason why we see
a lower risk of breast cancer.
People are very resistant to the idea
that soy might be a healthy food product.
And in thinking about like why that might be the case,
there's a number of options.
Either everything you said is incorrect
and you're just wrong, right?
Or people just don't like soy
and they wanna keep eating what they wanna eat.
And so they're just not gonna hear it.
Like there's just a, people tune out around this.
But I think that latter explanation
gets to notions of identity like that we form
that have something to do with what we eat
and the association between being a meat eater
and how you think about your role of manhood
in our culture, which is a whole like,
kind of other podcast, which is not your expertise.
But I spend a lot of time thinking about,
time and time again, I have people like yourself on
who say some version of what you just shared
and have been sharing over the course of this podcast.
And then I kind of cast my gaze out onto the world
and wonder like, why is this message so difficult to hear
or why is it so challenged in kind of penetrating
the mind share of people
when you're trying to help people be healthier.
Like, do you have like a working theory of that
or do you spend time thinking about that at all?
I do, but I don't know that I have a good answer.
I feel like part of it is really what you said
as the second sort of example,
and that I think people are really attached
to the status quo of the meat consumption
and to a degree,
the soy sort of counters that.
And on top of that, there is this sense of
needing to be manly and masculine.
And when you hear the estrogen word,
maybe there's some fears that are created there.
Like there's a number of possible explanations,
at least on the individual level.
And then I also wonder about an industry level,
like we talked about the plant-based meats.
I wouldn't be surprised if there's, you know, some,
there are some maybe campaigns or have been in the past
to really, you know, counter that more pro plant-based.
Follow the money.
Yeah. Follow the money.
Let's talk about deficiencies.
There is this idea that a plant-based diet
is inherently deficient in nutrients, it's nutrient poor.
It also contains plant toxins that, you know,
these plants are out to kill you.
You're not getting any B12 and you're not,
like we mentioned, leucine already.
It's leucine deficient,
might not be the best way to get your omega-3s.
So if you need to supplement,
then doesn't that have something to say
about the overall viability of this way of eating?
So I'm met with this all the time.
And I actually had a debate
with a prominent carnivore proponent, Anthony Chafee. It was quite a, it got heated up at points near the time. And I actually had a debate with a prominent carnivore proponent, Anthony Chafee.
It was quite, it got heated up points near the end.
And I should say, sorry to interject,
but like the carnivore will say,
the carnivore diet is optimal
because it is the most nutritionally complete
and dense of all diets.
So I was part of that narrative, isn't it?
Sure.
On that note, I mean, there was a recent study
that looked at four different iterations
of the carnivore diet,
and they consistently fell short in thiamine,
vitamin C, a couple other nutrients.
I think iron was in some cases short, potassium was short.
How could it be short in iron?
Yeah, so animal foods,
while they aren't super rich in iron,
so like per serving,
like something like lentils is actually higher in iron.
It's just the bioavailability of the iron
is somewhat different.
So as far as hitting the dose of iron,
it is potentially a little bit harder,
at least for the standard recs.
But it has the, what are the two types of iron?
It has the mix of the heme.
You're gonna get your heme iron and,
the lentils are the non heme iron.
There's a whole other thing about that.
Yeah, so, but just as far as hitting the recommended intake,
the absolute intake,
forgetting the different types and everything,
it did in some cases fall short.
And then, like I said, there were,
I believe eight nutrients that they listed as falling short.
And this was a very recent paper that came out.
So that's to tackle the whole carnivore
is the most nutrient dense.
I mean, I haven't seen a single iteration
of a carnivore diet that meets all nutritional needs yet.
Right.
And I've analyzed a few people's like what I eat in a day and haven't seen anything.
But that aside, I really want to tackle this idea of, well, if you need to supplement,
clearly it's an insufficient diet or there's a problem with that diet. So in this debate
I had with Anthony Chafee, I actually, I did this thought experiment, I'm going to do it
with you in a moment, where I sort of challenged that notion and he did
not want to answer my question.
He dodged it eight times.
We counted it.
And that's because it really, I think, pokes a hole in this ideology.
So let's say that there's two diets.
There's diet A and diet B. Now let's say diet A provides most of the nutrients you need,
but you might need to supplement one or two things,
but it leads to a long and healthy life, lower risk of
cardiovascular disease, cancer, lower risk of frailty
and older age.
And then there's Diet B.
Diet B provides all of the essential nutrients you need.
You don't need to supplement anything,
but it leads to a higher risk of cardiovascular disease,
cancer, higher risk of frailty and older age.
Which one would you choose?
Of course, A.
Yeah, so he didn't want to answer that.
And the reason is because it tells me
that what you care about are the health outcomes.
To you, the deciding factor between following a diet
or not following a diet is not whether or not
you need to supplement, it's whether or not
you get good results at the end of the day.
So if a vegan diet with appropriate supplementation
like B12, obviously, if it leads to good long-term
health outcomes,
then who cares if you need to take one supplement
or whatever a day or maybe you take a multivitamin
to cover your bases.
It doesn't matter.
What we care about are those health outcomes.
So that sort of gets rid of that argument
around supplementation,
as long as you're honest enough to answer that question.
Well, it's also a red herring
because omnivores and carnivores are supplementing anyway.
Oh yeah, carnivores are all on electrolytes.
And they tend to be more obsessed
with optimizing their nutrition
through strategic supplementation.
Like, it's like, it's a thing.
So it's not really relevant in my mind.
And sure, take a B12 supplement,
but maybe take a vitamin D supplement and a multivit sure, you know, take a B12 supplement, but, you know, maybe take a vitamin D supplement
and a multivitamin and all these, you know,
like we all have certain deficiencies that occur
depending upon our environment and, you know,
the circumstances of our daily life.
I think even the most well-intentioned
and rigorous people with their nutrition,
if you get a blood panel, there's gonna be,
even if you're within the healthy range,
you're gonna be on one side of it more or less.
And so that suggests that,
we're not always like hitting the bullseye every single day
with everything that we're doing,
regardless of how optimized your diet is.
Yeah, it's like-
It's a distraction.
Yeah, and it's like when we talked about protein earlier,
it's like every guy going to the gym
almost is taking away protein,
but when you're on a plant-based diet,
all of a sudden it's an issue
that you need to take a protein supplement
or maybe you are taking it to maximize your intake.
Like it just seems to be a really easy thing to bring up
when sort of faced with that idea of a plant-based diet.
Right, well, it's that thing that happens
when the argument suits you, you'll serve it up,
but when it's directed in your direction,
then you don't wanna talk about it.
And I suppose on some level, everybody's guilty of this
and we all have our blind spots,
but this comes up a lot in terms of the research cited
or the research dismissed within the hierarchy of kind of,
I mean, there's a lot of cherry picking going on,
but you can cherry pick anything
because there's so much research out there
and you're gonna be able to find something
that substantiates whatever claim you're trying to make.
And this is something that you're always kind of banging
on about in your videos,
because somebody will make a video and say,
well, so-and-so said this,
but like that research is nonsense, you know,
it's worthless and you shouldn't pay attention to it.
And then that same person will make a video and say,
this new study came out and says exactly
what I've been saying all along.
I'm like, suddenly, you know, the library of research
is now valid and worthy of your attention.
Yeah, I do that a lot and actually try to point out these sort of double standards in
a lot of my videos because I think and maybe maybe I'm wrong, but I think it's much easier
to understand when someone's being perhaps dishonest or a bit shady and how they're presenting
evidence than to actually go into all the methodological issues all the time.
I try to do that too.
I'll try to explain why one studies better than the other, but I really want to hammer home like,
hey, this person is citing this type of,
say observational research when just last week
they were saying that all of this research is trash.
So why are they citing it now?
Because it supports their view
and you can go on and on and on
whether they're picking anecdotes or whatever.
And I think that's really easy for people to understand
just the double standard versus necessarily getting
all of the little intricacies of the research itself.
Was there anything else that came up
in your debate with Shafi?
Oh man, there was a lot.
Oh, there was a couple of times, this was kind of brutal.
There were times where he'd cite research
and I'd ask him very basic details
about his own research that he's citing
and he wouldn't know.
Like I say, how did they track meat intake,
or what were the results for this or whatever,
and he wouldn't really know any of it.
And that was really an example of somebody
who's sort of maybe reading an abstract
or cherry picking a result and wanting to showcase it,
but not really looking at the research in depth.
And I've seen that a lot with his content.
I'm trying to think,
he came up with the appeal to nature
a lot, so appealing to, well, historically humans
have ate meat, so that should be good for us.
Or I mean, there's a lot of things that are natural
that aren't good for us.
A lot of, whether it's natural plants or certain animals,
there's exposure to a lot of heavy metals
that are naturally derived.
I mean, just because something's natural
doesn't mean it's good.
Well, also we, you know, we developed to be incredibly
resilient and able to eat many, many different things.
So what we used to eat isn't necessarily determinative
of what we should eat when we have the option to choose.
Yeah, I absolutely agree.
And we have so much research now around like,
what makes up a healthy dietary pattern
that we can make really good informed decisions
regarding those outcomes versus relying on,
well, historically we've done this, so it should be good.
I mean, you're kind of guessing in that case.
It seems like the carnivore diet has been around long enough.
I mean, we need obviously more long-term studies
on what's actually happening.
So we can actually point to like,
here's a canon of understanding that tells us
what happens when you do this for 20 years
or 10 years or whatnot.
But it's been around long enough where we're now seeing
even some of the OG influencers
making adaptations to their diet.
I mean, most famously Paul Saladino now eats fruit
and honey and I guess a couple of other things or whatever.
So it's like, he went from, you know, exclusively,
like his whole thing was like nose to tail
and now he's adapted and we'll see where that goes.
I don't know who's still hanging on tooth and nail,
but you probably know better than I.
There's a couple, there's a couple,
like Sean Baker, Anthony Chafee,
they're a couple that I can think of
who are apparently strict, but then yeah, there's a couple. There's a couple like Sean Baker, Anthony Chafee. They're a couple that I can think of who are apparently strict,
but then yeah, there's Paul.
Sean's got like a really high hemoglobin A1C.
He did.
You would think like, oh, that would come
from eating processed food and sugar.
But like when you're eating,
you're seeing like the consequence
of a very high saturated fat diet
on his type two diabetes risk.
Yeah, and I believe he had low testosterone
on that earlier test as well.
Which is really weird, right?
You would think like, well, testosterone is one thing
that's gonna take care of itself
if you're gonna eat this way.
Well, funny enough, when Paul Saladino was on Carnivore,
he posted his blood test results.
And if you pause the screen,
you see that his estrogen was actually elevated
above the range.
He didn't talk about it.
He skipped right past that
when he was reviewing his blood works, but it's in there.
What does that tell you?
I don't know if it says much about the diet
or something else that they're doing,
but it's just interesting that you're seeing
these people who are always fear-mongering over soy
and estrogen and whatnot,
you're seeing that their hormones are a bit off
and they aren't providing any explanations around that
or attempting to, and they're just kind of glazing over.
I just thought it was really interesting
that that was still in the video and maybe he didn't
catch that it was there, but it was on his blood work.
But yeah, I mean, a lot of people have fallen off.
There's Paul, there's Frank Taffano, there's a YouTube channel, 50 Plus Beauty recently
had a stroke while on the carnivore diet, as of a number of other people.
There's the carnivore kid he went by, Michael something, I can't recall his name. He had, I believe, his 95% occlusion or something like that of his LAD.
So like the the widow maker artery, and he was freaking out. And I'm not going to say
that, you know, their time on the carnivore diet, because it may have been a matter of
a couple of years is what led to that. But it's, you know, it's still a problem that
occurred while on the carnivore diet. And you'll often see these same people cite anecdotes in a matter of a couple of years is what led to that. But it's still a problem that occurred
while on the carnivore diet.
And you'll often see these same people cite anecdotes
of something even subjectively improving
while on a carnivore diet
and claiming that it was definitely the carnivore diet.
Whereas, well, why don't you ever highlight
these negative issues that come up?
And then there's a lot of them.
So yeah, there's an Instagram account.
Carnivore cringe.
Yeah, carnivore cringe.
And it basically posts like people's comments
on like forums and Reddit subreddits and stuff like that.
Like, hey, I haven't had a bowel movement in like 14 days.
Like, is this normal?
Yeah, no, there's tons.
It's actually wild.
Some of the stuff that comes up on there,
whether it's around blood work or hair falling out
or insert whatever issue you can imagine
and they're on there somewhere.
All right, so here's your second opportunity
to look to camera and address
the carnivore enthusiast out there.
What's your PSA?
My PSA is that there is not good evidence
to support the carnivore diet.
The recent Keto CTA trial showed
that those following a ketogenic high animal-based diet
with high LDL
had rapid progression of atherosclerosis.
There's plenty of anecdotes for those who cite anecdotes
suggesting potential harm.
And until we have better data
to support this dietary pattern,
the existing data that we have on red meat consumption
or the plant foods that are eliminated
suggest that it is not a smart idea.
Conclusion of PSA.
When you mentioned the diet A, diet B a few moments ago,
there's also the diet C,
whatever composition that might take,
which is the diet that drives short-term results
with long-term detriments, right?
So in the context of anecdotal evidence,
like I feel so much better,
my autoimmune symptoms have disappeared.
Like this is something that happens
in the plant-based community too.
I'm guilty of it.
Like I have plenty of anecdotal evidence
of how I felt better and it changed my life, et cetera.
The weight of that is dubious, obviously,
but when it's you, it's very personal and it's emotional
and it has valence, right?
But I think what's lost in that is that
this positive experience that you're having
in the context of carnivore diet is at the cost
of the long-term consequences
that humans aren't so good about
kind of like gazing into the future and evaluating that
when in the current moment, they're like, this is working.
Why shouldn't I keep doing this?
Yeah, and I mean, like you initially,
when I made the change was largely
because I was experiencing these anecdotal benefits.
And so I understand how powerful that can be, both for myself and my dad, as I talked about.
But we always have to consider that these are generally going to be short term things.
You aren't going to notice that you're developing cardiovascular disease until you have it.
And if we look at messaging from the carnivore community or the animal based community,
it's often about really quick fixes. It's often
about your gut health, weight loss, joint pains, it's things
like that. It's rarely going to be a lower risk of heart attack
or whatever, like that's something that they'll throw in
once in a while, but it's not super common. And now they don't
have good evidence to support those claims either. I want to
be clear, there isn't good evidence that it's going to
improve all of these things, at least in the majority of
people. But even if it did, we're not considering the long-term risk
and they're promising people immediate results,
which is really enticing.
On the gut health piece, how do they substantiate that,
knowing what we know about the importance of fiber intake
and plant diversity in terms of developing
and cultivating a healthy microbiome.
Like how does, you know, eliminating fiber
and eliminating diversity in your diet
contribute to gut health?
Like the argument that, how do they make that argument?
Again, I wanna be clear that when it comes
to these anecdotal experiences,
which is largely what they cite
to promote the improvements in gut health.
It's not clear, and we can't conclude based on anecdotes, if that diet specifically is
what's leading to benefit, if other similar or other elimination diets would also lead
to those benefits, or if it was just chance and they were going to get better anyway.
All of these are possible explanations.
But let's just say, for sake of argument, that it was the carnivore diet or the elimination
of fiber. We know that in certain conditions,
especially certain inflammatory bowel diseases,
that when there's a flare actually reducing fiber intake
or certain types of fibers can improve symptoms.
That's not necessarily something you wanna carry on
through a lifetime, but during a flare,
that could be a really good idea.
Certain types of strict elimination diets
that are low in fiber, like elemental diet, for example, usually
around meal replacement shakes or the certain types of shakes
that adhere to that protocol.
That can improve symptoms in certain cases, too.
But that's not necessarily a preventative diet.
And it's not something that you necessarily want to keep up all
the time. But you may need to shift towards, you know,
intermittently when there is maybe a flare
or acting up of these symptoms.
Yeah, from an elimination diet perspective,
there is certainly the chance that you were eating something
that was contributing or inflaming
whatever underlying gut condition you were having.
And by removing it, it settles down.
But over time to deprive the body of fiber
is going to lead to some kind of poor outcome.
Yeah, exactly.
And we have actually studies looking at eliminations
in people, say again, with inflammatory bowel disease.
And we see that different people respond to different foods.
So there's, let's say you ate a pretty balanced diet
and you removed everything,
you're just eating animal foods,
if for whatever reason, I don't know, wheat was bothering you.
Well, yeah, you're going to see improvements,
but you didn't need to eliminate all the fruits and veggies
and everything else that came along with it.
You could have isolated that food.
And that's why it's really nice to, or a really good idea,
to work with, say, a dietician where you can do a proper elimination,
trial those foods one at a time,
and there can be a strict protocol
that could be catered to the individual
and really tease out what is the problem here
or can we even figure out the problem?
And then you don't have to do something that's so extreme
and that might come to your long-term detriment.
Yeah.
The next thing I wanna turn to is bone health.
There was this epic Oxford study that came out
that seemed to suggest that plant-based enthusiasts
and vegans fared less well or fared poorly
in comparison to omnivores in terms of bone health
and bone, like avoiding bone breaks.
So help me make sense of this.
Yeah, so that one really spurred headlines.
I was in 2019, I think it was.
And the main headlines I saw were
43% higher risk of fracture.
And that's actually true based on the findings,
but there is some really important nuance here.
So they looked at, in the Epic Oxford study,
so these are people in the UK following different diets.
They looked at vegans, vegetarians, meat eaters.
There might've been a pescatarian group, I can't recall.
And they found that the vegans had a higher risk of fracture,
but the vegans also tended to weigh less.
They had less vitamin D and calcium intake.
And they did a bunch of analyses to sort of rule in
and rule out different potential explanations
or components that were maybe missing.
And it didn't look like vitamin D or calcium
explained the totality of the results, maybe a little bit.
But no.
Why were they lower in those?
You have to remember that with Epic Oxford,
they were enrolled back in like the 90s.
This might be before widespread fortification
of like plant-based milks and things like that.
So their calcium intake might be much lower
because that is gonna be the main source for a lot of plant-based eaters.
And then also with vitamin D, maybe it's a supplementation thing.
I mean, they're living in the UK.
It's not super sunny.
Hard to say.
They didn't actually track vitamin D levels in that study or vitamin D intake in that
study.
But past studies from that same cohort found that vegans did have lower vitamin D levels.
So that's a possible contributor.
But what I believe ultimately explains it is the difference in weight.
So being a heavier weight reduces your risk of osteoporosis
because you have more weight on the bones and your bones are going to be stronger.
And when they separated the analysis to those with a BMI below 22.5,
which is sort of middle of what's considered the healthy range or the normal range,
and then those above 22.5, those in the higher range did not have a higher risk of fracture
compared to meat eaters. So the vegans in that group seem to be protected. But in those with a
lower BMI, there was a higher risk. And because of the way that the weight skewed between groups,
it looks like it's quite possible that there were a number of actually clinically
underweight vegans.
And especially once you get below that bottom cutoff
for BMI, your risk of osteoporosis goes up a lot
or your risk of fracture goes up quite substantially.
And so it looks like in the study,
they were probably comparing a number
of quite significantly underweight vegans
to some that might, some omnivores who might just be skirting that kind
of border of what's considered underweight. And that would skew
the results largely. But to further support the conclusion
that it wasn't something inherent to the diet, and it
might be that was the Adventist Health Study 2, which came out
just a few months later, and this looks specifically at hip
fracture risk. They found that there was a higher risk of hip
fracture in women. This was not the case for men.
And I want to highlight that with Epic Oxford,
we didn't see that in men either.
It was specific to women.
But they did another analysis
where they looked at supplementation practices.
So in those who didn't supplement any vitamin D or calcium,
there was a higher risk of fracture in the vegans.
For those who just supplemented calcium, but no vitamin D,
there may have been, it was not statistically significant,
but we'll say for sake of argument,
there may still be a risk there.
But then in those who supplemented both vitamin D
and calcium, there was not a significant increase in risk
over the meat eaters, and in fact,
there might even be a bit of a lower risk.
And in this group, there isn't a clear signal
that there was a lot of people who were maybe
in that underweight category.
So this would suggest that if you're maintaining
a healthy weight, if you're making sure
you're getting adequate calcium and vitamin D,
and that doesn't need to be through supplementation,
it can be fortified foods.
If you're taking care of those things,
you can do just fine.
Of course, exercise is also very important,
weight bearing exercise,
we wanna take care of those things as well.
And I would say that that's probably
the most important factor, but nutritionally speaking,
I think we can take care of it.
What do you say when people come at you and just say,
well, you're just a biased vegan activist.
You know, your whole worldview is skewed by, you know,
whatever vegan propaganda you have consumed
over the course of your life.
So I, for one, I wasn't always vegan.
And in fact, a lot of the myths that we've sort of debunked
today around seed oils and things,
these are things that I did once upon a time believe.
But I think ultimately the most,
maybe the most convincing argument I can make for me
being able to set my bias aside when it comes to
at least looking at the nutritional literature
is I can look you in the eye and say that fish
is a health promoting food, that certain dairy products,
especially fermented and low fat products
can be a regular part of a healthy diet,
that having meat once in a while
isn't gonna be to your detriment.
I think there are other reasons
to avoid consuming those foods,
but I'm not going to lie or exaggerate
on what the research says about their health value.
So now at the same time, I think there are a lot of people
in the online nutrition space who will claim that they aren't biased because they are omnivorous and they eat a little bit of everything.
But I just want to point out that your bias could be for that.
So when someone like myself maybe challenges the healthfulness of red meat or the superiority of animal protein or their inclusion, like, say, with Lane, for example, it might be the person in the middle ground who has a bias for that.
And they want to counter
this more exclusionary argument that I might present.
So I think I'm pretty good at setting aside the bias
when it comes to the nutrition literature,
but I do have a bias in that, yes, I am vegan.
And ideally I would like to see the world shift that way.
Right, and you're relying on the anecdotal evidence
of your own experience to inform
why this is the best way to go.
No, I'm not just saying.
Okay.
I'm just, you know, I know, like,
I'm just, I'm thinking about my,
like what the kind of things that I have to field
and just, you know, how you internalize that
and respond to it.
Yeah, I mean, like, ultimately,
I don't think there's anything I can say or do
that would be better at convincing someone
that maybe I'm able to set that aside
other than what I said about like fish and dairy
and meat to a degree.
Like I can't see how someone who has that strong of a bias
would be able to say those things very openly.
You know, so, but I don't know.
There's some people I'm not gonna convince.
What is a point of confusion in nutrition science
that you wish we could glean clarity on?
And like, if you have in your mind,
like the ultimate study, if funding was no problem,
what would that look like
and what would you be trying to gain clarity on?
So it depends on if you're asking more
from like a overall health longevity standpoint,
which I think we know the foundations quite well,
but there are some very nuanced questions
or things that I would like to see further researched.
So is there a specific kind of angle you're looking for?
No, I'm thinking in terms of,
people are really confused about this.
I'm not sure I even really understand this.
And if we could just figure this out
by testing this against this, then we would know this
and that would allow us,
that would like, there's a domino effect to that
that I think would be really helpful for people.
Yeah, okay.
I think one, and if I thought about this longer,
I might come up with five other ones
that I think are more important.
But one that I would really like to see
is around the long chain omega-3 fats
in vegans in particular.
So the long chain omega-3 fats are theans in particular. So the long chain omega-3
fats are the ones that people can often get from fish, they're in other animal foods, and then algae
based supplements for vegans. Now there's debate over-
And that goes to the deficiency thing, right? Like, you know, yeah, you can do the algae based omega-3s,
but they're not really as good as the fish oil versions.
So they are. They've been studied and they're nutritionally equivalent. But where we don't have research is on
if they're even beneficial or necessary in this population.
So vegans are unique because we don't consume
any of those long chain omega-3s in their final form.
We consume ALA from things like flax
and then we convert them to a degree,
to a modest degree we'll say.
And so a question I would have is like,
how would say a vegan cohort who's supplementing
compared to a vegan cohort who is not
compared to maybe a pescatarian cohort?
I think that would be really interesting
to have those three-
It's kind of amazing that study hasn't been run, right?
Because this is a common question we have.
Yeah, we actually don't have outcome,
like actual long-term outcomes in that sort of a common question we have. Yeah, we actually don't have outcome, like actual long-term outcomes
in that sort of a study at this point.
We have studies showing that you can raise omega-3 status
in vegans by supplementing algae-based oils.
We have research comparing vegans to pescatarians,
and they generally fare similarly
in say the Adventist Health Study too.
You can argue one slightly above the other
for certain outcomes, but it's comparable.
But we don't have the long-term outcomes comparing vegans
without supplements to vegans with supplements.
And then I would like a third sort of group there
of the pescatarians just for comparison sake.
That's something I would love to see
because I think it would really help put to bed
the debate or discussion around,
do you even need to supplement these things?
Paging Dr. Christopher Gardner.
He's like the perfect guy to do that.
Yeah, I mean, he does a lot of the clinical trials.
I don't know if he does a lot of the long-term
like prospective cohort stuff.
I don't think he does, but I am sure you know somebody.
Who wants to do that?
That sounds like a lot of work.
It takes a lot of time.
You're gonna be in it for the long haul, right?
Well, it depends.
So what will often happen is you have cohorts
like the Nurses Health Study, for example,
it's been running for like four decades.
And you have all this data collection over that time. And then you can then analyze that data.
So, you know what they were eating and to a degree what they were
supplementing. I just don't think they've tracked omega three intake.
And I don't think there were a lot of vegans in that cohort.
So that makes it challenging in that case.
Maybe you can do that type of analysis with like the Adventist health studies.
Maybe they have that data on supplementation.
I don't know.
So it's not like you necessarily need to wait
another 15, 20 years and start a new cohort,
you might have that existing data, I just don't know.
But it would be a really cool thing to see, I think.
What is your sense of how AI is impacting
our ability to synthesize these massive data sets
and draw interesting conclusions from them.
So I was actually just talking with some colleagues
the other day about this,
who one of them is actually using it
for a study they're running.
And it's really impressive on how you can get it to do
a lot of the sort of calculations and things
like power calculations and that.
You probably at this point still want to double check
a lot of that.
I've definitely noticed issues with or mistakes
with certain things when I'm using some of the AI software.
But I think it's possible that in the coming years,
we really use that to advance our knowledge
and to conduct research that maybe we couldn't do before.
I know they used it for a couple of recent studies
looking at like
plaque measurements on a CT scan and things like that.
So looking forward to it,
but don't have too much experience with it yet.
Yeah.
Is there anyone who comes to mind
when you think of people that are doing interesting research
out there at the cutting edge
of our understanding of nutrition?
I mean, Chris Gardner, you mentioned,
I think he's doing some really cool stuff.
I know Robert Osfeld's working on a really cool trial.
Oh, he is, I didn't know that.
Yeah, he's working on a, I don't know.
I didn't even know that he was doing that kind of
like research work at all.
Yeah, so before COVID, he was starting work on a trial
and then it kind of got sidelined
because they couldn't enroll people for a while.
And then I think they just finished with enrollment.
I don't think I can say too much about the trial, but I think it's going to be really,
really cool, really interesting.
And if they are done enrollment now, hopefully it's sooner than later that we get those final
results.
So he's doing some really cool, interesting stuff.
I would say, and this is sort of a really unfortunate thing now, is Kevin Hall.
I don't know if you're familiar with him.
I know who he is, yeah.
Yeah, NIH researcher.
He's recently stepped down early retirement, it seems.
I saw that.
Which is really, it's such a massive hit
to the nutrition community.
He was doing so much research around ultra-processed foods.
He was helping us understand not just
what ultra-processed foods impact our health,
but like what components are responsible for that.
So like, is it the hyper-palliability?
Is it the fat content?
Does the protein content matter?
Like figuring out all those things,
because again, if we understand those variables,
we can make healthier products.
And so that's a massive, massive hit.
And I think he was really on the forefront of a lot of that.
My understanding is that he resigned
because he was put into position
where he was gonna be restricted
in what he could study and what he could say.
It wasn't that they were firing him,
but he was being reined in in a way
that was making him deeply uncomfortable.
Yeah, he said that there was some form of censorship
and he ultimately had to report on certain things or report differently
than he wanted to on results.
And obviously, I mean, he's a very, very honest,
world renowned researcher.
Like, I would have loved to see what else he had coming
down the pike here, but.
I mean, you know, thanks a lot, Doge.
You know, it's this interesting thing
with the the Maha movement, right?
Like, you know, on paper, Maha is all about,
like, let's get rid of the ultra processed foods.
And here's the guy who's like doing the heavy lifting
and helping us understand this,
but for, you know, political expediency or whatever,
you know, perhaps he just, you know,
didn't fit the bill in every single category
to make him palatable.
It's not awesome.
That was sort of the irony of the whole thing
that I saw a lot of people posting about it.
It's like, this is literally the guy
that's helping us figure out
what's wrong with ulcerative colitis.
He should be waving the flag of this whole thing.
Anyway, that's a whole other thing.
Last thing I wanna ask you, six days from today,
I'm getting a pretty significant back surgery,
L5S1 fusion for an advanced spondylolisthesis
that is unstable.
So I'd be remiss if I, you know,
didn't take advantage of the opportunity to ask you
how I should be thinking about my nutrition leading up
to this and my nutrition in the aftermath
to be as healing, promoting as possible.
I mean, really the foundations are gonna be adequate
protein intake, obviously for the structural components, hydration, there's no magic bullet there. It's just gonna be really the foundations are gonna be adequate protein intake, obviously for the structural components, hydration.
There's no magic bullet there.
It's just gonna be really the foundations
of making sure you're having a nutrient rich, healthy diet,
make sure you're getting adequate protein,
hydrate appropriately.
You know, there's some-
Anti-inflammatory foods, yeah.
And there's some research around certain like supplements,
glucose, things like that,
but I wouldn't say any of the research is super impressive. So it's definitely not something I necessarily advocate for in these cases, glucose means things like that. But I wouldn't say any other research is super impressive.
So it's definitely not something I necessarily advocate
for in these cases, but-
I'm gonna be taking all the supplements, trust me.
Yeah.
I've already got like momentous creating.
I'm like, okay, tell me, you know, and like they,
now I'm in communication with their chief research
scientist to kind of help me, you know,
make good decisions around
like what I can do to,
I mean, not that they're magic bullets
or anything like that,
but I don't wanna make any mistakes
and I wanna put myself in a position to heal as best I can.
As long as you're not doing anything crazy
and they're checking for interactions and stuff like that,
maybe there's some benefit there at worst,
maybe there isn't.
All right, cool. Well, this was know, so. All right, cool.
Well, this was great, man.
Thank you so much.
I feel smarter than I was two hours ago.
Is there anything else you wanna add?
Did we miss anything or, you know,
I guess it would be good to give you,
to like allow you to, you know,
sort of end this with a thesis or a call to action
for anybody who's listening or watching who maybe has been tip-telling
around eating more plant-based or going all in on it,
but for whatever reason hasn't been able to pull the trigger
or has been under the influence of other influences
and is now having a moment of clarity around this.
Yeah, I think there's sort of two take home messages
that I can give.
One of them is that I know it's enticing and I know there's a lot of information online that could,
it might seem like a silver bullet or a magic bullet, but might over complicate things.
And really when it comes to nutrition, it's pretty simple, at least the foundations are.
Eating a diet that's rich in whole grains, fruits, veggies, legumes, nuts and seeds.
That is the foundation of a healthy dietary pattern.
Whether you include certain animal foods, some fish, certain dairy products,
small amounts of meats, you can take it or leave it.
But those foundations are incredibly consistent across the literature, across populations.
The second thing I want to emphasize, and this is maybe for people who are looking to make small shifts,
is that shifting even a little bit of your animal protein towards more plant protein can have profound impacts on your long-term health.
So if we look at even a small shift of about 3% of calories, based on the NIH AARP study as well,
shifting 3% of calories from animal protein, especially red meat protein, to plant protein sources,
could lower risk of mortality from, it was a ballpark of 10 to 15%.
So during the course of that study, 10 to 15% lower risk of dying over those years.
And so this is a really, really powerful change that someone can make
for what is ultimately maybe a deck of cards size piece of meat for some plants.
So just think about those two things.
Like keep it simple, focus on those foundations.
And if you can shift a little more towards plant protein.
Amazing.
You can find all of Matt's stuff online
at where's the best place to direct people.
Instagram is definitely where I'm most active.
So drmaththinagra, dr.maththinagra.
And then I'm on all the other socials and everything.
I love your videos, man.
You're like, you do the, what is it called?
Where it's just your head
and then there's all this stuff going on in the background.
Here's what he said.
And like, here's the study that actually kind of,
you know, it's like, it's fascinating.
I don't even know how you make those things, but I love it.
Also, Matthew has been on Simon Hills,
the proof podcast many, many times.
I don't know how many times, like six or seven or something like that.
Recurring, you know, popular guests there
where they go more in depth
on this sort of myth busting exercise
that we've been doing
among, you know, many other interesting topics.
So, you know, if you wanna go deeper,
I would suggest that's a good place to go.
And you have your own YouTube channel
where you put the videos up and stuff like that as well.
Yeah, it's the same.
You just search my name on YouTube or TikTok
or Facebook or Instagram or whatever.
It's pretty much the same.
And we'll put links up to all of that stuff
in the show notes.
So again, thanks, man.
I think you're an important voice in this ecosystem
of effective health and science communication
online and not everybody is great
with their communication skills.
The people that know a lot about what's true
and what's false, et cetera.
But it takes somebody to figure out how to synthesize that
and relate it in a way that the public can digest it
and understand it.
And I think you're really exceptional at that.
And there's a real need for that. So I appreciate you doing it. And I think you're really exceptional at that. And there's a real need for that.
So I appreciate you doing it.
And then thanks for having me on here too.
I know it's been a dream for a while.
So it's good to finally be here.
It's an honor.
It's an honor, man.
Thanks a lot.
You're welcome back anytime.
All right.
Peace plants.
That's it for today.
Thank you for today.
Thank you for listening.
I truly hope you enjoyed the conversation.
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Namaste. Namaste. Namaste. Namaste.