The Rich Roll Podcast - Eradicating Lifestyle Disease with Cardiologist Robert Ostfeld, MD

Episode Date: April 13, 2015

Newsflash: heart disease is still America’s #1 killer. Despite groundswell interest in all things wellness, the incidence of atherosclerotic disease is at an all-time high. One out of every two people in the United States will suffer some form of cardiac ailment. And one out of every three people will actually die of heart disease. Meanwhile, we are exporting the standard American diet overseas like it's the next blockbuster installment of The Avengers. The result? The developing world is now facing rates of lifestyle-related illness unprecedented in the history of humankind. This is a disaster. The great irony of course is that 80-90% of chronic illnesses like atherosclerosis, type-2 diabetes and obesity are preventible and oftentimes even reversible via simple diet and lifestyle alterations. I can preach all day, but to truly capture the attention of the mainstream, catalyze seismic cultural change and put an end to avoidable disease, we desperately need more highly qualified medical professionals who understand the complicated mechanisms that lead to these diseases and are compelled to implement the preventive measures required to combat and avoid them. This is where cardiologist Robert Ostfeld, MD comes in. A summa cum laude graduate of the University of Pennsylvania with a medical degree from Yale and a Masters in Epidemiology from Harvard, Dr. Ostfeld did his internship and residency at prestigious Massachusetts General Hospital and his cardiology fellowship and research fellowship in Preventive Medicine at Brigham and Women's Hospital – both teaching hospitals of Harvard Medical School. An insanely smart dude with mad skills and a bulletproof resume, Robert had his pick of the litter when it came to choosing where to hang his professional hat. Most would have chosen the highest paying, most coveted cardiology department in the country. But this guy had different plans. Instead, Robert headed north of Manhattan to The Bronx to work with underprivileged populations at Montefiore Hospital, while also serving as Associate Professor of Clinical Medicine at the Albert Einstein College of Medicine. That right there says a lot about what kind of guy Robert is. But there's more to the story. Despite training with the best at Yale and Harvard, Robert was nonetheless left with little understanding when it came to nutrition. For years thereafter, he applied evidence-based medicine, recommended a “healthier” lifestyle (which typically included a Mediterranean-style diet), and watched somewhat helplessly as his patients’ diseases all too often progressed. Frustrated and dissatisfied with his patients' consistent inability to achieve true health, he started to search for alternative means of combating chronic disease. This search led him to The China Study* by T. Colin Campbell; 

65% of 12 to 14 year olds in the US have early signs of cholesterol disease in the blood vessels that feed their hearts with blood. And we know that from pathology studies of kids who died for other reasons. This is the Rich Roll Podcast. The Rich Roll Podcast. Hey, everybody. Welcome or welcome back. I am Rich Roll. I am your host, and this is the mission, to help you live and be better. So each week, I sit down with the best and the brightest across all categories of life, health, and excellence to blow the ceiling off your personal potential. Thank you for subscribing to the show on iTunes. Thank you for spreading the word. Thank you for subscribing to my newsletter. Thank you for clicking through the Amazon banner ad at richroll.com for all your Amazon purchases. So I just got back from the USA Olympic Training

Center in Colorado Springs, where I spent about three days. It was a great weekend. It was great. It was amazing. I got to spend time with the fastest young swimmers in the United States, national team members and national junior team members, all of whom are kind of in residence prepping for this summer's world championships or the world university games, or just honing their craft in preparation for Rio 2016. It was really cool to observe. I got to give a cool speech to the kids. I got to hang out with some of the best athletes on the planet. I got to watch them train. I'm talking about guys like Ryan Lochte, Tyler Clary, Connor Dwyer, Katie Ledecky, Jessica Hardy. If you follow swimming,

then you know who these people are. If you don't, trust me, there's a lot of gold medals there, a lot, some serious Olympic glory. And I also got to spend time with some of the best coaches in the world to see how they do things at USA Swimming Headquarters and the USOTC in general. Guys like John Urbanchek, who's been an Olympic team coach and was the coach at University of Michigan. It was an extraordinary privilege to be around him. And also, and most notably, and personally for me, I got to connect with a guy called Jack Roach. He's the one who invited me out for the camp. And he is a legendary figure in the annals of USA swimming. He's been around the sport for a long, long time. In many ways, he is the spirit. He is the soul and some would say the shaman of US swimming. He is beloved by coaches and swimmers of all generations. And it was just such a treat to get to hang out with him, get to know him a

little bit and participate in this national junior team camp. And what's interesting about Jack is he's a longtime plant-based guy. This guy is an original OG in the vegan movement. He's been plant-based since the mid-60s. And he's this extraordinary runner. Every year to celebrate his birthday, he runs his age and distance. And so he turned 67 this year. So he ran 67 miles on his 67th birthday. This guy is as spry as a 35-year-old.

So it was great to hang out with him. And I also got to see one of my coaches from my youth. This guy, Pete Morgan, he was one of my club coaches when I was a kid. I've known him since I was 10 years old, and I hadn't seen him in probably like 20 years. So here's the thing. I was never a good enough swimmer to be invited to attend the Olympic Training Center to train. And at my age, 48, to be able to be invited to participate in one of these camps, to contribute in some small way, to contribute to USA Swimming and the USA Olympic Swimming Movement, that's something I could have never predicted in a million years. I would have never imagined that my life's trajectory would lead me back to swimming in this way. And it just blows my mind. It just blows my mind. It's been this like crazy full circle experience for me. And

I was really emotional about it yesterday. And I'm really in touch with the gratitude of having had that experience. I'm really feeling the gratitude. And I'm really in touch with the gratitude of having had that experience. I'm really feeling the gratitude. And I think it's important to express gratitude when you feel it. And so that's what I'm doing. So thanks for indulging me on that. We're brought to you today by recovery.com. I've been in recovery for a long time. It's not hyperbolic to say that I owe everything good in my life to sobriety. And it all began with treatment and experience that I had that quite literally saved my life. And in the many years since, I've in turn helped many suffering addicts and their loved ones find treatment. And with that, I know all too well just how confusing and how overwhelming and how challenging it can be to find the right place and the right level of care, especially because unfortunately, not all treatment resources adhere to ethical practices.

It's a real problem. A problem I'm now happy and proud to share has been solved by the people at recovery.com who created an online support portal designed to guide, support and empower you to find the ideal level of behavioral health disorders, including substance use disorders, depression, anxiety, eating disorders, gambling addictions, and more. Navigating their site is simple. Search by insurance coverage, location, treatment type, you name it. Plus, you can read reviews from former patients to help you decide. Whether you're a busy exec, a parent of a struggling teen, or battling addiction yourself, I feel you. I empathize with you. I really do. And they have treatment options for you. Life in recovery is wonderful, and recovery.com is your partner in starting that journey. When you or a loved one need help, go to recovery.com and take the first

step towards recovery. To find the best treatment option for you or a loved one, again, go to recovery.com. Newsflash, heart disease is still America's number one killer. In fact, heart disease rates are through the roof. One out of every two people in the US will suffer some form of heart disease, and one out of every three will die from this disease. This has got to stop, you guys. It's insane. And it's guys like Robert Oswald that are going to help put an end to this avoidable disease, a disease we can prevent. We can even reverse through some simple lifestyle and diet alterations. So who is this guy, Robert Osfeld? What do I need to know? Well, the first thing you need to know is he's super smart. He graduated summa cum laude Phi Beta Kappa from Penn. He got his MD from Yale.

He got his master's in epidemiology from Harvard. He went on to do his internship and his residency at MassGen, one of the most prestigious hospitals in the country, and his cardiology fellowship and research fellowship in preventive medicine at Brigham and Women's Hospital, both teaching hospitals of Harvard Medical School. So this dude's got mad skills, right? With his resume, he could have done anything, gone anywhere, cashed in big time. Instead, he made the unlikely choice to head to the Bronx, the Bronx, New York, to work with underprivileged populations at a hospital called Montefiore, where he is now the founder and director of the Montefiore Cardiac Wellness Program, as well as associate professor of clinical medicine at the Albert Einstein College of medicine. In this capacity, Robert started working with his heart patients in new and innovative ways in a preventive capacity, treating them with a prescription of plant-based nutrition and lifestyle alterations that has reaped extraordinary results, extraordinary results.

Robert was gracious enough to sit down with me to talk about the science behind his prescriptive protocols, his practice, and I'm honored to share his powerful insights with you guys today. So without further ado, meet the sagacious, the perspicacious Robert Osfeld, MD. So you said you have a date later on. Do you typically take your dates to a... I'm getting off. I'm going to kick it off strong. Do you typically take your dates to a... I'm going to kick it off strong. Do you make your dates go to a vegan restaurant? Diving right now. Are you flexible with that?

Like, what's the approach? Come on, I've been married a long time. All right. Oh, my gosh. This is great. Well, she's on an airplane right now, so that's good. At least she's not hearing this in real time. It's not live.

It'll be weeks before this is up. Either you guys will be living together by that time or uh or not or not speaking who knows right yeah totally but uh so i i do like to go to the vegan restaurants and i you know but i'll definitely go to ones that are not but you you know usually especially in new york it's really easy to order vegan options on a menu. So easy here, yeah. But no, I think it's an interesting question because, listen, there are a lot of people that listen to this show that are plant-based people or hardcore plant-based people. Maybe they're in relationships with people that aren't. Maybe they're married to people that are less interested or more interested, you know, so navigating, like, I think, I think like your

sort of home life or your relationships or your social life really becomes so determinative of these habits, you know, for the better or for the worse. So it, you know, I didn't mean to put you on the spot with that, but I think I was actually genuinely interested, like, you know, where, where are you kind of, how you, how you, I don't know, broach that subject or kind of ride that fine line, you know, especially with someone who's maybe they're not, you know, into it. Yeah, it's been really interesting, actually. And I found, I guess I've been really lucky, but I find that if you are really passionate about something and, you know, the people that I've gone out with, I won't sort of spring it on them necessarily, but I'll let them know what my thinking is and what I believe in and why.

And it's been great to see sort of people evolve with me. And I found that people are extremely receptive to it and it's not like I'm having a conversation with them. That's, you know, fanatical. I'll really try to explain why I feel like it's a really healthy and wonderful way to live.

And I found that most of the people that I go out with really resonate to it and begin to shift how they're eating. And the person I'm going out with on a date later tonight, she's not vegan, but we've been out to dinner two, three times. And each time it's been a vegan restaurant, she's totally open to it. She wants to cook together vegan meals. So it's really, it's a great adventure. And I found that people are really receptive to it. And I've seen that dichotomy as you're talking about in relationships really manifest in the wellness session that I have that we'll get to, I guess, in a little bit. But, you know, it's when, just like you were

saying, like if the wife is really into it or the husband is really into it and the rest of the family is not, it can be a real hurdle. Of course. Cooking different meals and being supportive or not supportive. So that's a really challenging thing to navigate and kind of bringing people along in regard to the health avenue, at least from my perspective, I found to be extremely helpful. And I often recommend that when there's a real split in regard to the spouses, of course they can bring their spouse with them when they come and see me or to one of our wellness sessions, but also to watch the documentary film Forks Over Knives. I feel like it's such a wonderful intro. Right, right, right. Yeah. I mean, I think, you know, we'll get into, you know, sort of the

specifics of the program that you run and all of that. But while we're on the subject of kind of relationships, I suppose, with respect to health habits, you know, I get that question all the time. Like, I really want to step it up. I want to improve. But my husband, my girlfriend, my whatever, my boyfriend, like, they're just not interested, you know, and just like, what do I do? And like, you know, that's a tough question to answer. Like, what do I do? And like, you know, that's a tough question to answer. That's a tough scenario. And most everyone that I've been out with has been very open minded. And I think it's an attractive thing when someone is passionate and excited about something, whether that be art or politics or plant based eating or what have you.

It's a really exciting thing to learn and grow with someone like that. I think it's kind of a litmus test for a relationship too because if you really care for somebody, then you want to be supportive of their interests. And if you're not, I think you're going to find out where people stand. And eating habits, food, it's such an emotional thing. It's so much more than the macronutrients and micronutrients on your plate. It's representative of love and how you grew up and how you interact with people socially. And so with all of that, it becomes very complicated,

I think, to kind of unravel. Yeah, I definitely. You know, when, uh, you know, people have limited exposure to it, you know, sometimes when you bring it up, it's as if it's coming from left field, outer space, they'll look at you like you have five heads, um, and you'll get the typical, uh, intro questions, you know, well, where do you get your protein or why, why do you eat this way? But I guess at the end of the day, I've been really lucky that people have been super open minded to it. And when, you know, I have the opportunity to talk with them about it, and you know, why I'm really doing this, they resonate to it. Right, right, right. And, you know, it's not like you're practicing

medicine up in Topanga Canyon, you know, like you're up in the Bronx. And so it would be great if you could kind of paint the picture about, you know, your practice, the wellness center that you're the director of, Montefiore, is that how you say it, hospital, and kind of the neighboring, you know, kind of environment in which you're pursuing your specialty. Yeah, no, thanks. I mean, it's a tough one to pronounce, Montefiore. And I've heard it pronounced in all sorts of different ways. I think the consensus is that it's Montefiore.

Montefiore. Montefiore, yeah. With an E at the end. Exactly. All right. And it's a wonderful health system. It has many hospitals. It's actually quite huge. I think it employs somewhere in the ballpark of like 28,000 people. And it has just an incredible social mission. They really are dedicated to taking care of the people in the Bronx, regardless of what their socioeconomic status may be. regardless of what their socioeconomic status may be.

They reach out a ton to the community in regard to helping kids be healthier in schools. The Green Cart Program, working with the city on that, having farmers markets and tons of initiatives like that. They really put their money where their mouth is, if you will. And that's something that drew me very much to the hospital. And, you know, I guess I can get into how, you know, we kind of got this program going. Right, right. But I think that social mission, you know, coupled with what we're doing with the wellness program was really a nice mix. Right, right.

So did you, I mean, we can kind of get into the origin story here a little bit, but I mean, you came out of Yale Medical School and you got your master's at Harvard in something specific, right? Yeah, epidemiology. Epidemiology, okay. And then you did your residency at Mass Chan. Right. And so from that, did you go directly to Montefiore?

You came back to New York after that experience? Pretty much. I did my cardiology fellowship up in Boston at Brigham and Women's Hospital. Is that another teaching hospital adjunct of Harvard? Yes. And so after that, I came down back to New York City. And I grew up in New Jersey, so it's okay to be jealous. I get that a lot.

But my family's around here, and I always wanted to come back closer to home when I was done with training. And then I looked at a number of different medical centers in the area, and really the social mission of Montefiore. And also just the people there. I just had this, you get this sort of Spidey Sense vibe. And I had this Spidey Sense vibe that their hearts are really in the right place, which is a wonderful group of people. And there's lots of amazing medical centers in New York City. But for whatever reason, Montefiore really resonated with me. And then one thing led to another and came down and started working there.

And I've been there for about 11 years. Wow. I mean, for people that are listening, you know, most people, I don't know most people, but a lot of people probably know, but maybe, you know, quite a few people don't. I mean, to have, to, to, to have the experience that you had to have, you know, gotten your training at such amazing institutions and then to do your resident is at MassGen, I mean, that opens a lot of doors. Like there, you had, I mean, let's be honest, you had a lot of opportunities. You could have done many, many different things and gone to any number of places with your pedigree. Well, I mean, well, thank you for saying that. And I was very lucky. And, you know, I really, I remember walking around Boston while I was in medical lucky and uh you know I really I remember walking around Boston

before while I was in medical school and you know looking over at Mass General and just wishing so hard that I'd have the opportunity to go there and you know I got lucky and things worked out and um those are wonderful wonderful places yeah it's it's like it's the medical equivalent of of clerking for the Supreme Court on some level you know it's it's like it's the medical equivalent of of clerking for the supreme court on some level you know it's a very prestigious thing well i mean so well thank you for saying yeah yeah but i mean the point that i'm making really is that um you know i think it's a testament to your character that you would say listen you know i want to go up to the bronx and i really like what these people are doing and i like the community-minded aspect of this institution, you know, I think that that's not probably typical of some of your

classmates, you know, perspectives. Yeah, well, I mean, well, thank you. And I really wanted to be a part of a system that was taking care of a group of people that really needed it. And, you know, the Bronx, unfortunately, is a pretty unhealthy area, and they need more medical care there. There's probably like maybe 1.5 or 2 million people who live in the Bronx. And for those who aren't, you know, familiar with New York City, it's just one of the boroughs of New York City City and it's, you know, right next to Manhattan. And so in about 1.5 to 2 million people there. And I remember a number of years ago, I think it might've been Time Magazine. They ranked counties, I think it was counties by state in regard to their health. They had a variety of measures that they use. It seemed reasonably scientific. And there were 50 or 51 counties in New York State that they ranked.

And the Bronx was last. Right. And, you know, it is an indigent area. According to the 2000 census, there were a number of zip codes in the Bronx where the per capita income was less than $10,000 a year. And in that kind of context, that can sometimes limit access to care. That's one of the things about Montefiore that I really love because they make tons of outreach efforts to try to help bring health to people.

Interesting. I'm not surprised that Bronx came in last because nutrition, health, these are socioeconomic issues. And despite the Bronx's proximity to Manhattan, I think it's probably fair to characterize it as one of these, quote, unquote, like food deserts that you hear about where really the options available or, you know, the bodega on the corner with package processed foods, you know, that are cheap because of the farm subsidies, etc., which creates this situation where, you know, people are simultaneously malnourished and obese and sick. Yeah, I mean, sometimes the look at obesity as starving in the midst of plenty of tons of calories, but very few nutrients. Yeah, I totally agree. I mean, there are parts of the Bronx that are food deserts, limited access to healthy foods, and there are a variety of hurdles

that can get in the way. In addition to maybe not having access, a handful of my patients live in areas, I don't know the right term to use, but government or societal input to try to help improve things. And so how long were you practicing there before you had this sort of epiphany or idea that you wanted to create this wellness program? Probably about six or so years. Um, and, uh, I guess backing up a little bit. Um, so I'd been interested in health for a long time. And, uh, when I was seven, I had a, uh, a younger brother died from an incurable disease. And, uh, his name was Daniel and he was three at the time. And I remember his funeral and I wanted to throw stamps in so he could write us, you know, but I was too shy to do it. I didn't do it. Um, and ever since then, I've kind of been moving in the direction, uh, toward,

um, health and wanting to help people. And I thought about things a little bit, but by the time I hit college, I was, you know, I started off right away pre-med and, um, health and wanting to help people. And I thought about things a little bit, but by the time I hit college, I was, you know, I started off right away pre-med and, um, that was, uh, that was, uh, it was great. And actually I remember I had this one kind of wild experience when I was volunteering in an emergency room. Um, the, uh, there was this, there was a woman who was there and she went into, and now I was in college and maybe my precise memory of the exact diagnosis could be off, but she, uh, she went into cardiac arrest. The kind of thing like you see on the TV dramas, they have to shock the heart back.

So her heart started beating in a funny way that would be fatal. And so the, you you know the whole emergency room activated and everyone's rushing over uh and they're they're rushing the code cart over to her so they can shock her heart and then the cord of the code cart gets stuck on something and and it flies in the air and it's one of those things where it's like you know probably was like three seconds in real life but it felt like an eternity and like just time seemed to stop and everybody's eyes was on this cart and it's going through the air then boom like crashed on the ground the loudest crash so loud and then the the woman who was in cardiac arrest went out of cardiac arrest.

Oh, my God. Everyone's like, I can't believe it. It was just this loudest crash. Like the ruckus of the crash shocked her out of her arrhythmia or whatever it was. Yeah, yeah. So for all my electrophysiology friends who may be listening to this, I'm certainly not advocating. Yeah, please explain that to me. But I'm certainly not advocating that as a treatment for cardiac arrest. It's just one

of those remarkable experiences. When all else fails. Yeah, loud. So, but the impact of that on you was what? Well, it just reinforced my desire to be in a position to help people. And just that whole many weeks when I was in the ER, seeing people come through and, um, you know, watching the docs and the nurses and the physician's assistants helped them feel better. So that was great. Um, and then one thing led to another and I went to medical school and it actually, um, I guess as a side note, this is really sad. You may have heard the news in Boston. There was a doctor there at Brigham and Women's Hospital, a surgeon named Dr. Michael Davidson, who was just shot and killed last week. He's a medical school classmate of mine.

Oh, wow. Really sweet guy. Yeah. What happened? Well, all I know really is what has been in the press. And so I don't know the details specifically. But from what I've heard from the press is that he had, I guess, done surgery on a patient and the patient's son maybe was unstable or something. I'm not quite sure. But then a couple months later, that patient's son came to Brigham and Women's Hospital. I'm not sure exactly what inspired him to do that.

But he sought out Michael, Dr. Davidson and, and had a gun and, and shot him. And, you know, the idea being like that,

he didn't, he didn't save his father or didn't perform surgery properly. Or I, I mean, I don't know any details about the case and, and I know that Michael was just a tremendous student and trained incredibly well. So, you know, I doubt that that would be the case. And people do, you know, die, you know, as the death rate is still 100 percent, of course.

But I think that, you know, I think the mother may have died a couple of months after the surgery. I don't know if it had anything at all to do with what Michael did, and I would doubt it specifically. But anyway, he was disgruntled, the patient's son, and came in and sought out Michael specifically. And they were talking, and then I guess people heard yelling. And the press is very much about how Michael was such a hero, guess people heard yelling and, and the press is very much about how Michael was such a hero yelling people to get out, get out, and then he was shot and killed. And so my, my heart goes out to his family. That's terrible. I mean, I think that, you know, do incidents like that occur in your hospital? I mean, you're sort of in a, you

know, not relatively high crime area compared to the typical hospital location. hospital? I mean, you're sort of in a, you know, relatively high crime area compared to the typical hospital location. Yeah. I mean, fortunately, no, I haven't seen anything to that extreme, but, um, sometimes situations can get a little uncomfortable. Um, and often, you know, sometimes a patient, we give patients a little more leeway, you know, they're not quite themselves, they're sick and they may act out in ways that are, you know, sometimes a patient, we give patients a little more leeway, you know, they're not quite themselves, they're sick and they may act out in ways that are, you know, if you just met someone over dinner would be highly inappropriate, but we kind of give them, you know, some freedom in that regard. And hospitals have pretty large security services, but obviously it's not perfect. Right. One of the scariest experiences that I've ever had

in that regard is when I was actually a resident in Boston. And a guy came into the emergency room. He had basically already died. And they were coding him. And we continued the code, but he was already dead. And so we did everything we could, but his heart wasn't responding. And so then his son came in, and I needed to tell him that his father died. And so it was me and the son in a very small room.

And his son was a big guy, probably about like 6'2", 250, big guy, young guy. And so, you know, i told him his father passed and then the son stood up took a step an aggressive step right toward me and was literally two feet from me pulls his arm back like he's gonna punch and i just have this spidey sense that he wasn't gonna hit me me. I don't know why. And then he punched the wall right over my head so hard. We had to x-ray his hand. Oh my God. But it was scary. But you know, that's the exception, not the rule. Right, right.

You know, most patients are incredibly grateful. And so where, where along the line do you start to get interested in cardiology as a speciality? In medical school, I really love the pathophysiology of it. And I loved with my hands and stethoscope being able to examine people and try to figure out what was going on without having tons of tests. And being able to use tests as supplements to what your history and physical exam suggests might be going on. And I had some great mentors there. This guy, Jim Arrigi, who's an amazing teacher. And then when I hit residency at Mass General, I had the chance to work with lots of incredible docs.

And there's this one guy, Dr. Roman DeSantis, who in my mind is one of the gods of cardiology, if you will. Just like the wonderful combination of like incredibly gentlemanly and incredibly brilliant and skilled. And he just beloved. Um, and he was, he, I, I got to work with him some, um, and it's experiences like that. And actually I remember the Sentinel moment when I decided, okay, cardiology is, it's going to be, I was deciding between endocrinology, like the hormone stuff and cardiology. And I was on the endocrine consult service to try to like help myself figure it out. And I walked into a patient's room for an endocrine issue, but they went into rapid atrial fibrillation, which is an abnormal heart rhythm and they were feeling short of breath.

And so I was the only one there. So I, you know, dealt with that. And I just enjoyed the cardiac aspect of the case more than I did the endocrine. So I'm like, all right, well, that's a sign. Yeah. You're being sort of guided, I guess. Right. And that was, that was that. Yeah. And then, um, so then went down the path to cardiology and it's, uh, you know, then we have these matches and stuff where you you know apply and it's kind of nerve-wracking and stuff and you you know you get a letter in the mail or maybe it's probably by computer these days but right right and you get a letter it says where you're gonna

go you know these things are it's a big deal because wherever you match it's gonna be where you go and depending on where you apply it could be california it could be florida like you don't know uh so you get this and that's where the letter and that's where you're gonna be for three years so like we're all like all your residents and colleagues. It's a big day. You know, does everybody get the letter at the same time? Yeah, they do. And now that it's on computer, like everyone gets it at exactly the same moment and everyone wants to know, you know, where are you going to be? It's, it's really an exciting, exciting time. I remember reading my letter and it said I was

going to be at Brigham and I was just so excited about that. And that's where you wanted to go. Yeah, very much so. And so there, um, had the, and I became more and more interested in prevention and just incredible people I got to work with there. You know, my fellowship director for a time, uh, uh, Jim Fang and, uh, Lynn Warner Stevenson, a brilliant heart failure doctor and Peter Libby, our chief Paul Ritker really helped me get interested in prevention even more. Um, just lots of incredible people. And, uh, but so then, you know, I graduated fellowship and came down to Montefiore where I work now as now as, as you could say, an academic cardiologist, non-invasive, meaning I don't do invasive procedures like cardiac catheterizations.

And, you know, I did, I worked with incredible people. I did all the things that I was trained to do, guideline-based medications, a healthier lifestyle. But to me at that time, that was maybe Mediterranean style diet. Right. So to be clear, you weren't, you weren't on the plant-based medications, healthier lifestyle. But to me at that time, that was maybe Mediterranean-style diet. Right. So to be clear, you weren't on the plant-based trip yet. No. Yeah, you're a Western diet guy for a long time. Yeah, I mean, I grew up Western diet. And then I was switching to Mediterranean style,, it's certainly healthier than a Western diet.

And that's kind of how I was, how I was taught. And I didn't really, I got to train with great people and at great places, but I didn't really learn about the plant-based diet. Right. Yeah. What I wanted to ask was like, all right, so you do, you do your pre-med undergrad at Penn, then you go to Yale Medical School, and then you're getting your master's at Harvard. And, and, you know, amongst those three, you know, unparalleled institutions, what is the nutrition curriculum, you know, look like? Like, what are you being told during those years about, you know, what the best way to eat is? Well, times are changing. But when I was going through, very little, there was very little... I think most people would be really surprised to hear.

Very little. There was very little. I think most people would be really surprised to hear. Yeah. I mean, in medical school, I mean, maybe we had two or three lectures for four years of medical school devoted to nutrition. Two or three lectures in four years. Yeah. And, you know, it probably like was woven into some other lectures a little bit, but it was mostly like if you had a deficiency in this, a deficiency in that, it wasn't like what's the optimal diet to promote health. It was like, you know, what does a vitamin C deficiency look like or this or that? Things nowadays you almost never see. So in medical school, like scurvy, like scurvy, You know, drink lime juice if you're going out on the high seas.

Right. So barely anything in medical school. And, you know, residency and fellowship, some. But, you know, maybe I missed it. Maybe I missed that day or something. But I certainly didn't learn about the impact of a plant-based diet. And so, but, you know, speaking for, well, I guess we could touch on like education about that stuff in a, in a bit. And, uh, so I'm practicing medicine

for a bunch of years at Montefiore and really enjoying it, but I'm starting to become disillusioned, frankly, because although patients, maybe we're slowing the pace of disease a little bit with medications and Mediterranean style diet, people don't seem to be getting profoundly better, which is why I went into it in the first place. And I was kind of getting a little depressed about it. I'm like, what am I doing? You're just in this sort of diagnose and prescribe modality. Yeah, you know that and encouraging people

to have a Mediterranean-style diet, which in my experience didn't profoundly impact their health. I'm sure it's healthier than a Western diet, but they didn't come back and say, wow, I feel so much better. And then look at their blood panels or whatever and see vast differences. It wasn't vastly different at all, at least in my experience. And then it was right around that time that I stumbled across this book or the book called The China

Study by Drs. Campbell. And I just loved it. It's a book, of course, about the health impact of a plant-based diet and it really, really resonated with me. I'm like, wow, this is amazing. I did more research into it and I used to run Cardiology Grand Rounds at Montefiore for a bunch of years. I thought, wow, this would be great stuff to get out to the faculty

and I want to learn more about it. So I somewhat selfishly invited a bunch of people in this arena, Dr. Esselstyn and the amazing work that he's done. And, of course, Dr. Campbell and others. And we're very fortunate that they came and they gave cardiology grand rounds. And so our faculty got to learn more about it. And Dr. Esselstyn was just so helpful, and I had the chance to go out to his home in Cleveland and visit his wellness program. And with all that information, I approached my chief, Mario Garcia, at Montefiore, and I told him I want to start this wellness program.

And they couldn't have been more supportive. They said, you know, go for it. I just felt really lucky to be there. So I was really inspired by reading that book. That book. That's what catalyzed that whole thing. Absolutely. And I want to get into how that's influenced how you practice medicine and treat your patients.

But just to kind of camp out here on the China study, you know, idea for a minute. When you said you like you did a little bit of your own research and looked around, I mean, what what kind of stuff did you do? Because what I want to kind of get into is this idea that the China study has been debunked, you know, and you sort of talk to people that are of the, you know, Weston Price Foundation mindset, or the Denise Minger, followers kind of tribe, I guess, there's this sort of what I would call faulty consensus that the China study is really no longer relevant and it has been sufficiently debunked.

Well, that's news to a practicing cardiologist who sees hundreds of patients and many, many patients get profoundly better when they embrace a plant-based diet. So that's news to me. But less anecdotally, with any kind of study, you can poke a hole in it. And that's the nature of science. it. And that's the nature of science. And, you know, when you have these big epidemiologic observational studies, they're wonderful, um, to learn things from, but you can't necessarily control for everything. Um, and so, you know, if, if these 15 behaviors are associated with less disease X, Y, or Z, you know, maybe it's not really those 15 behaviors. Maybe they were doing some 16th behavior that was doing the trick, but nobody ever realized.

So there's always some inherent uncertainty with epidemiologic studies or even these, you know, kind of a gold standard would be a randomized controlled trial. Well, even there, there are weaknesses, pluses and minuses of all sorts of studies. And we spend a lot of time in our journal club going through these kinds of strengths and weaknesses of a study so you can try to incorporate it thoughtfully into how you care for patients. But when you kind of look at the totality of the evidence in any given study has its weakness, when you look at the totality of it, there are basic science and mechanistic studies that support the benefits of a plant-based diet.

So on that level, then there are, um, not many, but, uh, certainly the one by Dr. Ornish randomized trial supporting the impact, the highly beneficial impact of a plant-based diet on patients. There are multiple, multiple observational studies or cohort studies where you follow patients over time, like the work of Dr. Esselstyn and his larger cohort with about 200 patients was published just this past July in the Journal of Family Practice, which highlighted the profound benefits that patients have. And let me give you a comparison. Now, I'm going to compare two different studies right now. So it's a little bit of comparing apples and oranges. They're different patient populations. So it's a little bit of comparing apples and oranges.

They're different patient populations. So it's just hypothesis generating, but just as a basis of comparison. And Dr. Esselstyn's work where he filed about 200 people, and I think around 170 or so were compliant with a whole food plant-based diet. And Dr. Esselstyn, of course, also encourages people to not have oil. And in that study, there was about, I think, well, and those patients had what we call stable coronary artery disease, stable blockages in the blood vessels that feed their hearts with blood. So cholesterol blockages in their heart. And then I want to compare that to a study that's called the courage trial, uh, which was a larger randomized control trial. I think about 2000 or so patients where they randomized people also with stable coronary artery disease. So I think the populations are somewhat similar with stable coronary artery disease. They randomized them to maximal medical therapy and encouraging a healthier lifestyle, but nothing like all food plant-based so

maximal medical therapy and healthier lifestyle versus maximal medical therapy healthier lifestyle and stents mm-hmm now this is stable disease if you're having a heart attack right now you want to stand right away this is stable disease and in that study the courage trial there was no difference between those two arms so whether you did or did not get a stent right away. This is stable disease. And in that study, the CURGE trial, there was no difference between those two arms. So whether you did or did not get a stent, you didn't live longer, it didn't make you less likely to have a heart attack. But those patients, to me, seem somewhat similar to those that were in Esselstyn's study. Now, apples and oranges. In the CURGE trial, though, they had about a 19% event rate, meaning around 19% of the patients overall

in the CURGE study had a heart attack or a stroke or something during the three or four years of the study. In Esselstyn's, there was the number, depending on how you define it, but one patient, the formal report is one patient of about 107. So about a 0.6% event rate in Esselstyn study, papal stable coronary disease

versus a 19% event rate. Yes. Super dramatic. And the qualitative difference really is simply the difference between kind of advocating a quote-unquote healthier lifestyle versus a very specific like plant-based diet routine. Exactly right. And if you look at weight gain in those studies, in Courage, the patients gained on average three or four pounds. And in Esselstyn's, they lost about 18 pounds over, this is three or four years of the study. So a healthy lifestyle can take on all kinds of stripes and sizes. And one other kind of related study, there was a study that got a lot of attention called the PREDIMED study of the Mediterranean-style diet out of Spain, now maybe about a year and a half ago.

And they basically randomized people with no known heart disease. They had no known heart disease. Now, keep in mind, at Esselstyn's, they had heart disease. No known heart disease. They randomized them to a Mediterranean-style diet versus a typical Western diet. And shocker, the Mediterranean- style diet did better than the Western but those in the Mediterranean arms still had about a three point five three and a half percent event rate mm-hmm so still statistically so much dramatically higher than than the Esselstyn population

exactly and they didn't have known heart disease hmm so to me that speaks to the profound impact of this lifestyle and that's just one of many studies mechanistic. So basic, basic, basic science, mechanistic, observational, small number of randomized trials, um, pointing all in the same direction. And it's not just for heart disease. direction. And it's not just for heart disease. There's this thing that I like to do called the kale scan. And so we've all, we're all familiar with cat scans, you know, where they do a big radiologic picture, looking at looking for a problem in your body, whether it's the chest or the belly or something like that. Well, I thought, wouldn't it be cool if we could do a kale scan, which instead of looking for a problem, can look for ways that a plant-based diet might be beneficial for you. And so I looked through some of the studies. And so like we were talking about, a healthier diet doesn't just point to

heart disease. So if I could, I'll go through the Cal scan. And these are things that a plant-based diet has been associated, not necessarily unequivocally proven, but just other things pointing in the right direction associated with improving. So first of all, it's been associated with less mortality, less death. And so I'll start from the top down. Many of us are on social media, on Facebook. We were talking about Facebook just before. So a lot of us saw the ice bucket challenge. book just before. So a lot of us saw the ice bucket challenge. While a plant-based diet, elements of that have been associated with less ALS, less stroke, less depression,

less cognitive decline over time, less Alzheimer's, improved skin complexion, less acne. acne. In fact, some investigators suggest that acne is so tightly linked to the Western diet that it's not actually a vestige of teenage angst, but actually your body crying out for help from lack of nutrition, fewer ear infections, less periodontal disease, less laryngeal cancer, less heartburn, less lung disease, less lung cancer, less heartburn, less lung disease, less lung cancer, less breast cancer, less heart disease, of course, less obesity. And the former surgeon general, Dr. Carmona said that this generation will be the first to live fewer years than its parents because of sequelae of obesity. 70% of our population is overweight or obese. Less high blood pressure.

We call high blood pressure the silent killer because you don't feel it, but it can kill you. And it's important that all listeners get screened for high blood pressure. But, you know, there's a statistic that I read that blows my mind. If you're a 55-year-old adult in adult in the U S your lifetime risk of developing heart disease is about 90%. And that's based on information from the Framingham heart study. And every time I read it, I have to reread it. It's just so high. That's unbelievable. And, but if you eat a plant-based diet, you are anything but the average adult. And, you know, for example, blueberries can lower blood pressure. There's less diabetes. There's less colon cancer, less inflammation, less constipation, less prostate cancer associated with less prostatic hypertrophy.

And so guys may recognize that if having to wake up four or five times during the night to pee because they can't pee all the urine out because the prostate's big. Improved sexual function in men and women. And we call, of course, erectile dysfunction the canary in the coal mine for heart disease. And getting an erection is a psychological event. It's a neurologic event. And it's a vascular event. And by the time you have a blockage

in the artery to the penis, because the artery to the penis is smaller than that to the heart, and by the time you have a blockage in the artery to the penis, because the artery to the penis is smaller than that to the heart. And by the time you have a blockage in the artery of the penis, giving erectile dysfunction, it's extremely likely you have such blockages in your heart that just have not yet clinically manifest. Right. Your body's just trying to tell you that you have something that you need to deal with. Exactly. And the solution is not to take a small blue pill so that you can forget about it, but rather to do the opposite, which is to heat it and try to, you know, take a look at what you're eating and how you're moving your body and maybe make some changes. Totally agree. So when I look at, I mean, a couple of observations.

First of all, it's, you know, thank you for that rundown. I mean, it's so compelling. And when I hear that and I think, I put it in context of heart disease is America's number one killer. And thinking of that study and the 90% figure, it's just astonishing. And I wonder, why isn't everybody doing this? What is the impediment to people adopting this? That's the sort of frustration that I experienced, and kind of what I was getting at with the people that are out there trying to, you know, sort of debunk the China study or poo poo the, you know, the, the, the fantastic benefits of eating a plant based diet. So when you see that, whether

it's on Facebook, or, you know, some blog on the internet or whatever, like, how do you, you know, what do you do? What is that? How does that make you feel? What do you think? Well, it's very frustrating to me, um, having some background in, in some of the science of it. And we're ramping up our research arm of our wellness program too. research arm of our wellness program too. But, um, and, but I, I think that people oftentimes like to have the, um, the behaviors that they're doing, whether they be good or bad, reinforce people kind of like to get praise about their bad habits. Yeah, exactly. Right. Exactly. Yeah. You know, eating that animal product. Yeah. That's great for you. Go for it. Um, well right now we're seeing, you know we're seeing some really interesting things happening that I wrote down, jotted down.

I wanted to make sure that I asked you about, which is this sort of rising popularity of the high-fat diet, this idea that everything you ever thought you knew about saturated fat is wrong. This idea that dietary cholesterol does not contribute to heart disease. The idea that butter is somehow a health food. Butter is back on the cover of Time magazine. All of these ideas kind of flying in the face of some of the things that you're saying. Yeah, I mean, I think those things are misguided. And so why do I think that?

Well, the study that kind of put, there was a meta-analysis, I think, looking at saturated fat. And the meta-analysis is where they take a lot of studies looking at, you know, I think it may have been low-carb versus more higher-fat diet. And that, actually, I'm mixing that up. But in this meta-analysis where they looked at the saturated fat, it was so resoundingly debunked. In fact, the head of the Department of the Harvard School of Public Health Nutrition, Dr. Walter Willett, said that this meta-analysis should not only be retracted, but its findings should be publicly denounced by the authors. This is the study that's being pointed to as sort of supporting this idea. That's the study that's being pointed to that's supporting butter is back. And, but, you know, it didn't get that, that kind of reduction thing didn't get much attention at all. And, you know.

Because that's not a, you know, that's not clickbait on the internet, right? Exactly. And it's also a little bit reductionist. Now, I don't know anyone who just isolates and eats saturated fat. And some of it is the company that it keeps. And when you eat saturated fat, you know, that is almost exclusively in animal products with the animal protein, with the animal protein, which has been widely demonstrated in basic science studies to promote atherosclerosis or cholesterol blockages. And all of the things that we ran through before with the CAL scan, it's switching to a plant-based diet is associated with improving and not having the animal protein with its cholesterol, with its saturated fat, with the endotoxins that are in it.

So it's, I think, very important to the isolated nutrient studies are very interesting mechanistically. And there are actually some older studies that show the more saturated fat you have that's associated with higher cholesterol. But those are interesting mechanistically. But nobody just eats saturated fat. You eat a whole diet. And so if you eat saturated fat, which typically comes in animal products, that means you're getting all the other associated unhealthy things. We can get into how it's pro-inflammatory for the body. Mechanistic studies supporting how it is associated with increased risk of cancer.

I'll get into it now. There's a relatively very new study. There's a carbohydrate moiety in animal products. It's NEU5G GC. What does that mean? Uh, compound. It's a carbohydrate compound in, uh, animal protein called any you five GC that has just been described to be highly inflammatory, um, uh, for humans. Uh, and when they may, but other animals, we don't have that in our body. When we eat the new five GC and animal protein, um, it creates inflammation. And when they built a mouse model of not having the new five GC,

and then they exposed them to that, they had a profound increase in cancer formation. So that's one of multiple mechanisms. So when you're eating the saturated fat, you're getting a whole variety of things that are unhealthy for your body. And you're also excluding the incredibly nutrient dense plant products. So it's really kind of a global holistic picture, if you will, and to isolate it down to a nutrient here, nutrient there is can be highly misleading. And so I think the focus on saturated fat, although interesting academically, is somewhat misguided because it so doesn't take the bigger picture of the overall health. And here's another really interesting thing in terms of another way that eating animal products might be unhealthy for you. There's a relatively recently identified compound called trimethylamine oxide, TMAO. Some of your listeners may be

familiar with that. And there was this really interesting study where they took people who were either omnivores or vegans for a year, and they fed them a steak. And the people who were omnivores, they ultimately made something called trimethylamine oxide or TMAO. Who cares? Well, TMAO is toxic for your blood vessels. It helps cholesterol deposit there. And we know the higher your levels of TMAO, the worse your vascular outcomes. But when they fed the vegans the steak, they made virtually no TMAO. So what's going on?

Well, what's going on is your gut bacteria. We've got like a trillion. So you and I are here. There's two trillion gut bacteria hanging out with us right now. And so the difference is the gut bacteria. And when you eat a plant-based diet, you select for gut bacteria that make virtually no TMAO. But when you have an animal-based diet, you select for bacteria that do. And if you switch from a plant-based diet to an animal-based diet, that change in gut bacteria can happen very quickly.

So even in just a couple of days, you can start making TMAO. That's amazing. I mean, this is, you know, the gut biome and everything that's going on with that is so incredibly fascinating and the impact that it has on your overall health. I mean, that's just amazing. I totally agree. And it's, you know, we're at the tip of the iceberg with that. There's going to be so much to learn about that. You know, there was a study that various artificial sweeteners by selecting for gut bacteria may promote diabetes. And it's just the tip of the iceberg. And one thing that I found kind of – so I guess getting back, I think that the whole saturated fat is back. And I think these are just fads.

What about this idea that dietary cholesterol does not contribute to heart disease? I mean, that's kind of a subset argument, I suppose, of the saturated fat argument, but that's the one that really seems to carry. Yeah. So I don't agree with that either. And it is a little reductionist too. But look, I mean, there are so many observational and interventional studies that basically show the higher your cholesterol level, the higher your LDL, bad cholesterol, the worse your vascular outcomes are. And when we lower that level through lifestyle, through medications, and don't get me wrong, like a lot of the patients in my clinic are on medications. I mean, there's a time and a place for them and they, some of them work incredibly, incredibly well. Um, but when we lower those LDL cholesterol levels through a variety of different mechanisms, patients do a

heck of a lot better. And it seems it's nearly a linear line, how that works. And with different medications, whether it be from a, um, a, uh, a statin type, uh type of medication or an oral absorption type blocking cholesterol, blocking absorption medication, gets you to the same place. So I think that to, sure, there's a little bit of reductionism with looking at it, you know, focusing just on cholesterol, but there's so much science behind that. just like cholesterol, but there's so much science behind that. The deleterious effect of LDL cholesterol on your body that I don't buy that it has nothing to do with it at all. I think that that's just very, very misleading. It can lead people down a very dangerous path. I mean, if you think about it mechanistically, when simply from my myopic focus on heart disease, when your endothelial cell gets damaged,

the LDL cholesterol particles can then burrow into the wall of your blood vessel where it's sort of like a splinter. It's very irritating. And when they're there, that irritation creates inflammation and calls in more cells. Various white blood cells go in, it weakens the blood vessel. Second by second, every day, the plaque can grow and grow. And eventually some random Tuesday afternoon manifest as a heart attack. And cholesterol is one of the key drivers of that. So to me, I don't think saturated fat should be back. I do think cholesterol is intimately involved in the pathophysiologic process of the promotion of atherosclerosis, which can lead to heart attack, stroke, erectile dysfunction, peripheral arterial disease, gut ischemia, fill in the blank issue.

And I think it's very misleading and can do real harm to people. But it's important, as we're talking about, to take a holistic approach to it, because when you have the meat product, then you're not having the plant product and all this other stuff. So it kind of crowds that out to the extent that, yeah, we can avoid being as reductionist as possible about it, you know, and still be talking about these important things. I mean, when you kind of did your rundown, your litany of all of these, you know, deleterious conditions for everything from acne to arthritis, and the alleviation of them by way of a plant based diet. I was thinking, well, what's the common denominator in all of these things, and something that keeps coming up. And I've heard

you say it a couple times already is inflammation, right? So, and it seems to me in my sort of layperson, you know, kind of an armchair, you know, quarterback analysis that that does seem to be something that kind of runs through as a common theme in all of these things. The, you know, the extent to which inflammation, inflammation provoking foods or lifestyle habits are significant contributants to all of these negative health impacts. I, I totally agree. And ever since I started doing this, I look at disease a little bit differently. You know, we, in medicine, we are somewhat siloized or we were live in different silos. You know, there's the belly doctor and the cancer doctor and the heart doctor.

Um, and when, because it's reductionist, our whole scientific method is based upon that. That's a great point. And you know, it's, uh, it's really the Renaissance doc who knows multiple silos, and those are fewer and farther between these days. But I look at it now as when we pound away at our body in a negative way with an unhealthy, sad, or standard American diet, pounding and pounding away, it's, you know, we're making ourselves unhealthier every second of every day. But I look at it, what is our resistance for the weakest? What is our weakest link? And I feel like when you eat that way, you bring out that weakest link. Is your weakest link cancer?

Is your weakest link heart disease? Is your weakest link lung disease? You know, is it arthritis? Whatever the weakest link is, is promoted by the healthier diet. And just because you necessarily, unhealthier diet, and just because you get cancer, excuse me, unhealthy, just because you get cancer, unfortunately,

but it doesn't mean that heart disease is all that far behind. It's probably running neck and neck. It's just that the weaker link in terms of your own body's protective mechanisms may be cancer. So I really look at it as kind of a, like you were saying, a similar pathophysiologic driver to multiple, multiple chronic diseases. And along the lines

of what you're saying, you know, we know that if you embrace a handful, just a handful of healthier lifestyle measures, such as exercising better, not being obese being obese not smoking you can lower chronic disease rates by about 80 percent and what is the impact of you know people say to me all the time well it's like well i'll do you know i'm mostly plant-based but i like that i gotta have my you know wild salmon or I need to have that once a week, or, you know, I do most of it. Is it, I mean, how does the sort of evidence bear out in terms of the health impacts of doing it a hundred percent versus the guy who's doing it 70 or 80%? You know, a lot of times people, when people say like, I do, I'm mostly plant-based,

like, well, if you actually wrote down what they're doing, it's maybe not so mostly. Exactly. Some people will say, I mean, Dr. Esselstyn will say, well. Well, he's the hardcore of the hardcore. He doesn't suffer fools on this kind of thing at all. He'll say, well, do you want a moderately sized heart attack or a moderately sized stroke? Exactly. And, you know, I think it's a continuum. And we lack lots of studies looking at, well,

this group of people are 60%, and this group is 70%. But I look at it as a continuum. And if you look at the PREDIMED study, Mediterranean style diet did better than a typical Western diet. And then if you extrapolate- But does anything do worse than a typical Western diet? Wow. I don't know if you smoke. Western diet plus smoking, I guess. Yeah, that's the slight, yeah. With a dusting of alcoholism. Yeah.

It's like slow suicide. But so I can speak better to that anecdotally. I mean, there certainly are various studies that you can piece together that the more you embrace this healthier diet, the better you do. But at least anecdotally with my patients, which is the most experience that I have seeing varying degrees, I ask them all the time, you know, what percentage are you embracing the lifestyle? Is it 20%? Is it 80%? Whatever it is. And, you know, maybe they're going to give me a little higher number because they want to,

you know, be nice. But I found that even if patients go part of the way there, it's better than nothing. Something is better than nothing. And I don't want, you know, Dr. Asselstyn, if you're listening, close your ears. He's probably not listening. I doubt he's listening to a podcast. Well, so I don't want perfection to be the enemy of really good. And yes, I would unequivocally love it if my patients would go all in. And I really ask them all to. But, you know, not everybody's going to do that. And if they're going to go 70% of the way there, hey, I'll take it.

It's better than 20% of the way there. And that's fantastic. And, you know, patients do have improvements when they go, you know, 70% of the way there. Their medication doses may come down. Their cholesterol comes down. Their blood pressure gets better. Their symptoms get better. So I'll take it. And there's this one example of a patient I have who is literally the picture of compliance, picture of compliance,

has heart disease, was having symptoms, went on a plant-based diet, got much, much better, now rides bike for two, three hours, no symptoms. But once a month has to have a meat-based sandwich, and that's what keeps him otherwise fully adherent to the lifestyle. Just psychologically, he needs to hang his hat on that. Exactly. So once a month has a meat-based sandwich. And then the rest of the time... Is it because he thinks he needs it for biological reasons or it's a psychological thing? It's more psychological.

He really likes the taste of it. Even though your taste buds can change and you start to like other things. But for him, he really likes it. And also, there's a family dynamic issue there as well, that his family is not really all that on board with it. And so it lets him, um, you know, partake and they have, they really look forward to these monthly. Right. He doesn't have to wear the scarlet letter. He does that at least does that. Exactly. Interesting. That's really interesting. Uh, what about this idea that you know i need to have i

need to i need my omega-3s like i've got to get it from the fish or i have to take fish oil or you know there's no way that i could be 100 plant-based because because it's nutrient deficient or it's it's deficient in some sort of important uh you know whatever yeah no i mean me, it's the most nutrient-dense way to eat. More nutrients per calorie than any other way that I know of eating. A whole food plant-based diet. And the omega-3s are incredibly important. But I encourage my patients to get them through a couple heaping tablespoons of hemp seeds,

chia seeds, or flaxseed meal each day. And your body has to convert that, uh, to the omega-3s. And if you take a little turmeric, it turns out that that can even help the conversion process. And I've never seen anyone have a deficiency. Um, and when I initially started doing this, uh, the, our, our wellness program, I screened for, you know, omega-3, omega-6 deficiencies in a number of patients. Never found it. And it's a test that's a little challenging to get, and sometimes patients have to pay out of pocket. So since I never saw it time and time again, I just stopped ordering it, and I've never seen anyone have any issue with it.

stopped ordering it. And I've never seen anyone have any issue with it. Um, and, uh, so there's, you can get it through, through that, you know, through walnuts and healthy fats that are in a plant-based diet. Um, and in regard to, you know, the fish oil specifically, there are newer studies that suggest it does not have incremental benefit on top of modern medical therapy in people with heart disease. Omega-3s, fish oil or fish oil? I don't know of a vegan omega-3 study specifically looking at heart disease. So if my patient is particularly worried about it, I'll say, okay, fine, have a vegan omega-3. Like an algae-based version of that. But I don't think it's

necessary. The only supplement that we recommend having is vitamin B12, and that's important. As you know, and I'm sure your listeners well know, you need to supplement that because B12 lives in the soil. And now that we wash our vegetables so much, we don't get it. But animals get it because they eat the soil or other animals eat soil. much we don't get it. But animals get it because they eat the soil or other animals eat soil. And so, and it's important for DNA and for vascular health. But you know, I usually just have my patients take 500 micrograms three times a week and periodically check levels, and it's never been an issue. Beyond B12, is there any other supplement that you're supportive of? Or are you like a no supplement guy?

Pretty much no supplement. What about D, vitamin D people talk about? Yeah, that's a big one, and it's very controversial. There are a variety of studies that suggest it may be helpful, and we certainly know that particularly in the more northern places where we're wearing coats and stuff, like we've got our coats draped over the couch right now, we're not getting a lot of sun. And that's a really great way to get it. And with a plant-based diet, maybe fortified milks, maybe mushrooms, but there's not a ton of ways to get outside of the skin and sunlight exposure. But there are a couple of randomized trials going on right now looking at

vitamin D supplementation. I think one is called VitaTops and sponsored by the NIH. So I don't really know the answer to that yet. And I'm kind of waiting to have that information from these ongoing studies before I come down and make a more formal recommendation. So I don't really check it. You know what? it. You know what? I got to tell you that it's super refreshing to hear you say that you don't know or that you're waiting to hear what the evidence or the research bears out as opposed to just having some kind of hardcore opinion because you feel like you have to. Oh, well,

thank you. I mean, I just, I'm honestly not sure. And it kind of like, if you look back at the story of vitamin E or beta carotene, other supplements, there was lots of observational studies supporting it. But it's back to this reductionist approach to sort of analyzing the impact of those in isolation. Exactly right. And maybe vitamin D will turn out to be awesome. Maybe not. I don't know. Vitamin E, beta carotene, those studies found them not to be helpful and in some situations may be harmful. And there's separate reasons to think that vitamin D might be helpful because... A lot of people are deficient, right? Like when they run these panels and they realize that they are.

So why wouldn't you just, if that's the case and you're living in Chicago in the wintertime, you know? Yeah, I mean, I don't actively look for it, but if my patient has a very low level, what is very low? I don't really know. Maybe less than 20. Then, you know, I will supplement it, but I don't know if I'm doing the right thing. Right. And this is not a plant-based thing. This is like everybody.

Yeah. That's a great point. Yeah. It's everybody. It's not plant-based. So, all right. So, let's get into kind of, you know, what a typical day is like for you at the clinic. I mean, you're also a professor, right?

You're teaching at the medical school. Yeah, yeah. And I want to hear what the typical sort of patient is, if you could so generalize. What would be normal for you to see in somebody who's like new to coming into you, see you for the first time? Fair enough. Um, yeah, there's a lot of really exciting things about, about my job. And, um, so I'll give you any, for our typical week, there's a lot of variety. I'm, I'm, I'm lucky. And, you know, I'll get a chance to teach medical students, residents, fellows, see patients in the clinic, which means like if you go to a doc and you're sitting in the waiting room reading whatever magazine and

you go in and see them, that's clinic. One day a week, I'll read ultrasound pictures of the heart and other weeks I'll be on service. And I was on service a number of weeks ago. And what that means is the patient's admitted to the hospital. And if someone has a question, they'll consult the cardiac service. So I thought to myself, okay, on any given day, I'm going to count how many patients I see. These are new patients coming into the hospital with some sort of cardiac complaint. So they're a little bit enriched for cardiac issues, but I'm like, okay, I'm going to count how many I see. And then I'm going to pick these four disease process. I'm going to pick diabetes, hypertension, high cholesterol, or obesity. And I'm going to just see how many of them have one of those four problems on just one day. And so I saw 20 patients that day in the hospital,

and not 12, not 15, but all 20 of them had at least one of those diseases that may have been prevented or reversed with a plant-based diet. And then the very next day, a patient in their early 20s came in with a garden variety heart attack. Early 20s. Early 20s. Came in with a garden variety heart attack. There wasn't some peculiar, very uncommon genetic predisposition. Obese? No.

A little overweight, but not obese. And there weren't any illicit substances involved. It was just a garden variety heart attack. And I'm going to ask the listeners that what percentage of 12 to 14 year olds in the Western world of the US do you think have early signs of cholesterol disease in the blood vessels in their heart? Want me to answer that? Yeah, sure. I would say very high percentage. Okay.

Yeah, so you're definitely on it. And someone will be thinking 1% because they're going to do like the price is right thing. Oh, the price is right. You know, get that low number. Yeah, you got to go low, right? So, but you're absolutely right. It's about 65. 65% of 12 to 14 year olds in the US have early signs of cholesterol disease in the blood vessels that feed their hearts with blood.

And we know that from pathology studies of kids who died for other reasons. And then, I mean, you don't have to worry because it gets worse. Because as you were pointing out, heart and blood vessel disease is the number one killer of adult men and women. And there are about two heart attacks every minute in the US. So maybe we've been talking for 60 minutes, that's 120 heart attacks have occurred in the US during this one hour that we've been speaking. So a typical patient that I'll see... Hold on one second. Let's break that down a little bit because that's so shocking and extraordinary. And simply, I want to emphasize this idea that heart disease begins at a very young age with the habits that you form as a youngster with respect to your lifestyle and your diet. And we have lots of friends that are super healthy parents, they love

their kids. And they struggle with trying to trying to implement healthy eating habits in their kids, you know, like, you know, we eat so great, but you know, I just can't get my kid off the chicken McNuggets, you know. And part of that is like, there's an innocence to that, like, just let them have them, you know, like, it's I'm tired. I've worked all day. Like, I just want to just let them have the Chicken McNuggets. You know, I can't deal right now. But when you think of what you just said, that really reframes that discussion. And I think it really turns the volume up on the level to which that needs to be a priority in parenting our children.

I agree. I think it's, I mean, I'm an adult doctor, so I refrain from making specific recommendations in pediatrics, but I believe it's never too early to start and it's never too late. And when I, you know, see kids eating those kinds of foods, the animal-based products, the nutrient not dense, the processed foods, it just really bums me out. And I know at the end of the day, sometimes you just kind of get the kid to eat. But I wish that they would be plant based. And there's just every reason to believe that taking that approach from as early as possible is going

to be the most healthful for the kid. And I'm not, I don't want to get specific into pediatric recommendations. And just along those lines, I have some friends who, um, have raised their kids plant-based and, you know, it takes some work, but now when the kids are hungry and they want a snack, they're like, Oh mom, could I have some cantaloupe? And I'm like, wow. Like what you've taken on, you know, you are taking on the onslaught from society of, you know, eat this animal product, eat this process chip, just the marketing machine alone. When you turn the television on exactly right is overpowering. And they've been able, and the,. And the influence from their friends and stuff, they've been able to counter that,

I think is so impressive. Yeah, it's difficult. It's not easy, but it also is doable. It's not impossible. And it's not an overnight thing either. But I think to use the example of the kid who's eating the chicken McNuggets, it's about a lot more than that one instance of that person eating that thing. Because every time you make that choice, you're reinforcing a habit. And when

you're young, those habits, you know, are fluid, but they quickly become cemented. And then, as you and I both know, when you're, you know, later in life, it's a lot harder, you know, it's like, try to learn a language now versus when you're 12, you know what I mean? Like, it's a different thing. So it's that precious time where you have that kind of influence over your children and you can set them on, you know, a better trajectory. And I think it deserves, you know, like hitting the pause button on, you know, the timeline of what we were going through with you to kind of just bear witness to that. I totally agree. And I mean, like, especially when the kid's really young, that's a lot of brain development. I mean, from a 10,000 foot view level, it sure makes sense to me that you want to bathe that kid

in as many phytonutrients and antioxidants as you possibly can to maximize their brain development and their vascular development as much as you can. Yeah. And I mean, I want to acknowledge that it is difficult and challenging, especially with school lunch. And, you know, I mean, it's, you know, what you have to say no to throughout the day is, can be overwhelming. You know, not everybody is out in Queens at PS 123, 122.

What is it? 144? 144? I don't know. They're doing it right there, though. Yeah, it's just amazing. And Muse. Do you know Muse?

Is that the one in LA? Yeah, yeah. I heard about that. It's kind of like right in our backyard. I had lunch there the other day, and it was incredible. That's so great. Fully plant-based, they just prepared it all organic, uh, organic produce in their kitchen. You know, it's a private school, so it's not, this is not something that's widely available, but at least it's a start and hopefully will, you know, is the beginning of catalyzing some kind of

change in momentum. Agreed. I mean, that's one of the reasons that, you know, your podcast is so great. It's helping to get the word out there about this. And, you know, from a medical perspective, you know, patients and families can push for this, docs can push for it. You can come at it from all sorts of directions. And it's, you know, big platforms like this that are just incredibly helpful. Well, at least, you know, sort of breaking down the barrier of access to information and democratizing that, you know, is, is important. And, you know, that's what we're doing here today. All right. So the typical, the typical patient, the typical patient I'll say I see in clinic is now the, the Bronx is a, um,, now the Bronx is a lot of people there,

so all kinds of races, ethnicities, walks of life. But there's a very large Hispanic population there. So on average, a typical patient that I'll see is from the Dominican Republic or from Puerto Rico. And they typically have not had much exposure to a plant-based diet. And so when I bring, they come in to see me for the first time, many patients will come to see me just because they're referred for whatever cardiac issue. Maybe they have high blood pressure or some palpitations or something. They're not sent specifically for the wellness program. And many patients are sent for that too, but many are not. So the typical patient who's not,

you know, and I'll go into their medical issues just like you would when you see your doc, and I'll start to then bring up the plant-based diet and how that may impact their health. And a lot of times they look at me like I'm from Mars. Yeah, I would think so. I mean, this has got to be the most foreign thing ever, right? Yep. Probably no one's ever talked to them ever about nutrition or anything. Well, certainly not a plant-based diet. I mean, they, they look at me like I'm nuts. Um, and it's a, it's a process. And, and so I'll keep seeing them. And I've had patients give me the

Heisman for like two years about a plant-based diet. And then for whatever reason, it clicks for them. And then they come reason, it clicks for them. And then they come back and I'll look at them and be like, you know, they've lost 20 pounds or LDL cholesterol has plummeted. They're coming off their medications. It's just awesome. I mean, I literally have patients crying tears of joy in my office because they feel so much better. You know, nobody cried a tear of joy when I wrote them a script for a cholesterol medication, but they do when, you know, and I just, you know, I'm like just a cheerleader. They're the one doing the work. They're the one in control of it, but they're so happy because they're feeling better. So the typical patient would be, uh, you know, someone

with some kind of cardiac issue, high blood pressure, high cholesterol, uh, maybe obese or something, uh, and coming to see me without having any background in a plant-based diet and what we'll do then is for anyone who i'll see anyone 21 and over who wants to be healthier whether they have a cardiac issue or not and well then what we'll do is we have these i'll talk about the the plant-based diet in clinic clinic is, we spend a lot of time on it. I probably spend more time than the average doc on this in clinic. It's a major focus of mine. But we have these periodic Saturday morning sessions, which I modeled after Dr. Esselstyn's in Cleveland, where they're four to five hours.

And I speak for a while about why eating this way is good. I do the Cal scan there. There's a nutritionist. I work with Lauren graph who speaks about, you know, practically living this way. We have a patient who's living this way speak. And I'd love to share some patient examples. And we serve a whole food, whole food, plant-based lunch. We have some handouts. We encourage patients to come with a friend or significant other to kind of help them along the journey. We set specific goals. And we don't charge patients for this. I fund it all through tax-deductible donations.

I'm not reimbursed for it. And like you were saying, I want to democratize the information. I want to democratize the information about this. So the program itself functions like a nonprofit. Yes, exactly like a nonprofit. And it's donation-based. And that's amazing. That's fantastic.

So it's sort of this induction process, slowly sort of indoctrinating people into these radical ideas for a lot of people, I would think. Indeed. And sometimes it can take – some people come and see me. They've already read every book. They've seen every movie. They're like 90% of the way there already.

That's the minority. The majority have almost no or no exposure to it at all, and we kind of work with them to try to bring them along. And your prescription pad is not going to really do very much in terms of prescribing willingness, right? They gotta, they gotta come, you know, come to you with that on their own. Exactly. I mean, it's definitely a two way street. If they just have no interest, it's just, you know, what can you do?

You know, it's free will. People can live however they, however they wish, but you just hope that by educating them. And what I try to do in clinic is I try to get a sense about what's going to motivate this person, you know, and, you know, is there a kid about to get married? Do you want to walk? Do you want to see your grandkids? Um, you know, did, did dad have a heart attack and, you know, you're on that path, you know, I'll talk with them them how their behaviors are making them sicker every second of every day. I try to find something that will resonate with any specific person. Do they have this particular medical issue?

Maybe we can make that a go away. Do they want to come off their meds? You need an on-staff psychologist to help you crack that nut open. I'll take a lot more donations. All right. So share with me some of the success stories. I'm sure, I know you've had a couple of super dramatic ones. Yeah. I mean, it's just, it's totally rejuvenated me as a physician. I just love it. And that, you know, I hear, I talked to a lot of doctors, friends of mine I went to school with that are doctors and they're just like, it's not what I thought it was going to be, and they don't like it, or they've already changed careers.

So it's cool to hear you say that. Oh, thank you. Yeah, I mean, I've definitely heard about what you're saying, and there are larger forces above the single doc like me that are shifting things in a way that make it not really as fun. You know, there's all this kind of time pressure and there's a certain kind of documentation pressure and a variety of other pressures that can suck some of the joy out of it. And actually, I mean, to be perfectly frank, I spend a good bit of extra time with my patients going through this, and I personally take a financial hit, if you will, for it. But to me, I love it, and it's the right thing to do, so I'm happy to do it. And the patients get turned around.

that those kinds of changes aren't currently as strongly reinforced as they might be by the larger medical system. And maybe we can get into that. But in terms of patient examples, there's so many. There's one story that is so dramatic, but there's so many. But one comes to mind right now. And there was this guy, he was in his fifties and he had heart disease. I know he has had a family history of heart disease and he understandably wanted to avoid it. And the guy loved sports. And so he would play two or three hours a day, you know,

with the thought of preventing heart disease. And he was thin. Um, but then he started getting this tightness in his neck and it got worse and worse. So he would get it only after exercising for like 30 or 45 seconds. And this guy could do two hours before. So he went to his doc, they did a stress test. It was so wildly abnormal that they sent him straight to the hospital for a cardiac catheterization where we take a, it's an invasive test where we look at the blood vessels that feed the heart with blood. So they did that. His was so wildly abnormal that they admitted him directly to the

hospital to wait for coronary artery bypass graft surgery. So he woke up in the morning at home. He's going to sleep at night in the hospital waiting for surgery. And you know, it's boring in the hospital. And he goes online and he's like, maybe there's another way. And he reads about the plant-based diet. And he's like, that's what I want to do. And just sitting in the lobby at the hospital, like on his phone or something like that. On his bed. Yeah. In the hospital bed, either on his laptop or his phone. And it's like, wow, that's what I want to do. And so I'm not recommending that anyone do this. I'm not recommending anyone do this.

Every case is different. But he signed himself out of the hospital against medical advice hours before his bypass surgery and decided to go plant-based, somehow found our clinic. And one thing I should touch on is there was an incredibly dedicated nurse who was seeing him who begged him, begged him to stay, called him up at home after he got home, begging him to come back, and the patient politely declined. I'll circle back to that. So he came to see us, and he went, the picture of compliance, whole food, plant-based, no oil. And when I first saw him, he could walk a block, and then he would get the tightness in his neck. And now this is the most remarkable turnaround I've ever seen. They're not always this fast.

But on a combination of meds and a whole food, plant-based diet, no oil, he was walking 25 blocks after one week. One week. I didn't actually believe him at first, and I just kept asking him in all kinds of random different ways. And he was completely consistent every time. believe him at first. And I just kept asking him in all kinds of random different ways to just, and he was completely consistent every time. He now actually speaks on occasion at our wellness program session. Fast forward three, four months, he is back to playing sports two or three hours a day, no stent, no bypass surgery. He feels great. Wow. That's amazing. And so the pain in the neck

or the tightness in the neck, that's a result of some kind of arterial blockage or what causes that? diffuse, if you will, and they don't hyperlocalize necessarily right over the chest. So symptoms, typical symptoms of angina, angina is poor blood flow to the heart muscle, can be chest pressure, can be radiating to the neck or jaw or down the arm. So it's not necessarily right over the heart. So neck tightness would be a classic example of angina. And in his case, it was reinforced by the invasive data that we had from his coronary angiogram. Wow, that's just amazing. You know, that's just amazing. And I mean, obviously, you know, being sort of, you know, on the front lines of facilitating these kinds of experiences, you must feel like, I gotta shout this from the mountaintops, you know.

that shout is from the mountaintops, you know. How is what you do perceived by your colleagues, not just at your hospital, but sort of, you know, the Manhattan medical community and maybe your medical school classmates? Like, how do they perceive what you're doing? Because it, it's different, right? But you're, but you know, you're seeing these results, like, you know, the impact that you're having. Yeah. It's disappointing to me. It's not further embraced and actually guidelines like the cholesterol, the American college of cardiology, cholesterol guidelines highlight that lifestyle change is the first line of therapy. Now their lifestyle isn't necessarily quite as, um as whole food plant-based as mine, but it's certainly healthier than a Western diet.

And the reaction where I work has actually been quite good, and it's probably just because I know the people there. I'm sure sometimes they're chuckling a little bit behind my back about, oh, there's Dr. Kale or whatever it is. But not only are you sort of undercutting the bottom line of the hospital, like you're doing this nonprofit thing. Like, how does, you know, like, come on. Well, there are some.

We make money off these surgeries. It's true. I mean, if we get too big, then they might not like me anymore. But it's, you know, I think there are a handful of things at play. And when education about this for doctors is extremely limited, like we were talking about during my training, and now things are changing. But there's really, as far as I know, only a handful of medical schools that teach docs about this. And actually I bugged one of my colleagues who runs the cardiac block for the second year medical students at Albert Einstein college of medicine, where we have our academic affiliation. I bugged him. I'm like, I want to give a preventive cardiology talk. I want

to give a preventive cardiology talk. I didn't say exactly what I was going to talk about. And so he's like, okay, fine. Then they needed one. So for the last three years, I've been giving a plant based lecture to the-year medical students at Einstein. And then they go on and graduate and go to all sorts of other places. And hopefully they're remembering a little bit about what I said. And then there's other medical schools that have larger, more formal programs. I think Loma Linda and Tulane have excellent programs. And with our cardiology fellows, before they start fellowship, they don't

know that they don't have to be scared of me. Like once they meet me, they're like not scared of me anymore, but they don't know that before they start. So I write a sternly worded email and I'm like, you know, I expect you guys to read such and I send them one of Esselstyn's short editorials. I expect you guys to read this and we'll discuss this during the first week of orientation. So then, you know, then our, you know, we have, we have eight fellows a year, which by fellowships, cardiology fellowships, that's a big program.

And so they all know about it and then they make fun of me every year in the skit. So it just kind of keeps coming. Right, right, right. So there's an educational barrier, but that's, that's changing. I mean, on the educational front, I would think that a huge leap forward could be made by the AMA or whatever sort of governing organization kind of has a say in terms of medical school curriculum to just make that a mandatory aspect of your medical education. I mean, is it that there's too much disagreement about these things? Or, you know, what is preventing that from, you know, as a consumer, you go to your doctor, you just assume they know everything, you know, you don't, you don't know that they don't,

you know what I mean? And so, and you're giving your power over, you know, you just, you intuitively just hand your power over to your doctor and assume that whatever they're telling you, they know best. Right. Well, there's some good news afoot because the incoming president of the American College of Cardiology, Kim Eagle, is, oh, no, I got it wrong, Kim Williams. I know, it's Kim something. There's a very well-known cardiologist, Kim Eagle. Kim Williams, excuse me, sorry about that. He's vegan.

That in and of itself is a pretty powerful factoid. Indeed. There's the two main governing bodies of cardiology in the U.S. are the American Heart Association and the American College of Cardiology. There are many others, but the two big ones are those. And so that's a big deal. That's a big deal, and he's spoken out in favor of the health of that. The research isn't unequivocal ironclad, and there is some debate

about exactly which diet would be better. But the way I see it at this point is there's so much evidence and support of a plant-based diet that that should be our de facto diet that we approach patients with. Our Hippocratic oath is first, do no harm. Let's approach them with a diet that appears to be the best for protecting you from heart health and health and all sorts of issues. And then you know what? Fine, let's prove it wrong. Maybe we're wrong. Maybe Woody Allen is right.

Maybe fried chicken and ice cream really are the way to go. But let's prove that. And the strongest amount of evidence to me supports a whole food plant-based diet. And then, you know, if it's proven wrong, okay. But go with what I think is right now, there isn't any other dietary protocol that can show these before and after angiograms, nothing that I've ever seen. I've never seen any, I've never seen any medication, anything come close to those pictures, you know, that Dr. Esselstyn shows and that, you know, that, um, you know, Dr. Ornish can show with his highly compliant patients. And I mean, look, you're a Yale and Harvard educated cardiologist.

Like if you don't know, who does know? You know what I mean? You're the guy who would know. Well, would you not? I mean, you're not a research scientist, but... Yeah. I mean, we do do some research as part of our program but it's a small small part of it um but yeah i mean based on my interpretation look there i understand there is some debate about what is the most optimal but the venn diagrams are so overlapping they're like 90 overlap and people quibble about 10 here or the other and the large part of the overlap is the whole food plant-based part. Right. So the quibbling is over the minutiae and talking about some of the things we were talking about earlier, the omega-3s or things like that. But the preponderance of kind of overall diet, you know, vegetables, like sort of macronutrient, micronutrients, there's agreement.

Exactly. And there still is a good bit of support for a Mediterranean style diet, but like we were talking about with the PretiMed versus the Esselstyn outcomes, you know, to me, we're comparing different studies, but the Esselstyn or the whole food plant-based approach is just so much more powerful. But yeah, you know, there's not a big randomized trial comparing whole food plant-based versus Mediterranean style. So I can see why people, you know, have some degree of uncertainty. Right. Here's one for you. And this might not come from one of your patients up in the Bronx, but it might happen at a typical Manhattan cocktail

party. What about the paleo diet? Everyone's talking about the paleo diet. So I'm sure you get this question, so you probably have an answer to that, or you've formed an opinion. Yeah, I mean, there is some overlap. Paleo, they do recommend,

I may be missing a little bit of it, but they recommend vegetables. I think they recommend fruit. So that's you know, that's no processed food, no dairy. So there's, there's a lot of overlap with, with that, which is, which is good, but I don't agree with the animal products for a variety of reasons. I don't agree that our ancestors were primarily eating animal products. I know that they had a little bit, but if you look at the anthropologic records, there was root vegetables on their tools, in their dental plaques,

which obviously supports the fact that they ate that. If you look at us anatomically, our snouts look different than carnivores. We have salivary amylase that's made by our mouth that helps to digest carbohydrates, not animal protein. The pH of our gut is not as low as a typical carnivore. We don't have as many of the incisor teeth. Our guts, our intestines are much longer than a carnivore because it takes a little more work to digest the plant product. So I don't necessarily agree with that evolutionarily.

I would think the common sense also, how about just it's a lot harder to catch an animal to eat than to pull something out of the ground. So, you know, I'm not an anthropologist. and out of the ground. So, you know, I'm not an anthropologist and I certainly, I would imagine it was dictated by where you lived and what was readily available and what was difficult to get and what was easy to get. Right. But overall, like sort of persistent hunting was probably a little bit more difficult than, you know, I don't know, planting a sapling. I totally agree. It's hard to catch a cheetah. Yeah so um yeah i don't know but anyway go ahead i interrupted you i don't know i mean i totally agree i mean so yeah it's like more like not hunter-gatherer but gatherer sometimes hunting you know yeah like the random

thing that they would sometimes catch uh and you're right at the extremes of weather like way northern eskimos probably had way more uh animal products because they just it's hard to grow a tree the inuit thing always comes up in this in this discussion and we can i think there's reason to not support that and i can explain and to to make it clear though that the idea that the inuits basically ate a very high fat meat-based diet because it's just fish is that's basically what's available to them, right? And the argument is that there was very low incidence of heart disease. Is that right?

There was a study from many decades ago that suggested that they had a very low rate of heart disease, and they were eating primarily fish because that's really all they could get. And at the end of the day, I mean, you've got to eat. There's no kale up in there. And so, you know, that was a real, like, how do you reconcile that with all this other data? Like, what's going on? So these Canadian investigators have the same question. And so they investigated the primary data.

And they found out that, I'm going to have the exact numbers wrong, but I think at least 50% of the medical records weren't even available. These people lived in such remote areas that the investigators from decades ago didn't even have access to the medical records. And these patients, some of them would die and they wouldn't be seen by a doctor for three, four days later. So the underpinning of how they died, it's not known. And if I were to submit an article for consideration to an academic journal now, and I said, okay, these hundred people died and I don't know why 60 of them died, but I think that eating fish is good. They laugh in my face. And so that has, I think, you know, cut, I don't know the rhyme. I don't mean this in an aggressive way, but, you know,

cut the legs out. Right. It's not that it's been disproved. It's just that it's the methodology has been called into question to establish that result. Exactly right. Interesting. And, um, so then along the lines of the paleo, you know, when you eat the animal protein, you, uh, make TMAO, you create inflammation, you acidify your, uh, body just a little bit. You don't feel it, but your body does. And it can leach calcium. It may leach calcium from bones to help buffer that acid. There are some people who speculate that acidic milieu may be cancer-promoting. And then, of course, there is saturated fat and cholesterol with it, and we could just put those things aside for now. And there's evidence that eating a more, an animal-based protein diet can lead to more atherosclerosis and, you know, the whole kale scan and

various other studies we talked support how, when you replace those things with a plant-based diet, you do better. And, you know, for athletic performance, you know, right up your alley, there is evidence that athletic performance is improved on a plant-based diet. We all run on fuel. Cars run on gas, and you're like liquid dinosaurs. And we run on ATP. That's our fuel. And our mitochondria are our energy plants that make the ATP. And they have to use nutrients to make it. And there are elements of a plant-based diet that make that ATP and they have to use nutrients to make it. And if you, there are elements of a plant-based diet that make that mitochondria more efficient. So with the same

amount of fuel, they'll make more ATP. You're a more efficient machine. And then also with all the, um, uh, antioxidants and anti-inflammatory components of a plant-based diet, uh, I think particularly watercress and blueberries, that you can reduce delayed onset muscle soreness after exercising so you can get back at it sooner than you might have been able to otherwise. You're cutting your recovery time down considerably. I mean, that's been my experience and I'm not running a double blind study on myself, but my anecd know evidence is compelling enough to me to continue to to do it to do it that way and it's it's i say the same thing to everybody i mean on a related note what about the what about the ketosis thing like the this whole like high kind of high fat like low carb you know super

low carb diet being you know in this ketogenic state. I mean, we don't have to get too clinical about it, but it's very popular right now, and certainly my understanding is it's quite effective in weight loss. But it seems to me that it's kind of an emergency state for your body to be in, and it's not something that I can imagine would be a healthy lifestyle choice long term. But there's a lot of people that are doing this, talking about it, sort of espousing the health benefits of eating this food. Do you mean like a low-carb diet or do you just mean lots of animal products so that you get into a ketotic state?

I don't know specifically. I mean, I hear that word sort of thrown out a lot, you know, and there's people like Peter Attia and Gary Taubes who are kind of, you know, part of this movement of espousing this way of living for health and athletic performance, actually, like sort of training your body to be fat adapted. I don't know of any study that supports reversal of atherosclerosis on an animal-based diet. I don't think that anyone has ever been published. I'm not the only one to say that. Multiple other investigators have said that. I'll be happy to see one that has. And to me, those kinds of diets really are some version of paleo. It's like Atkins or paleo, where you're having a ton of animal protein, which will make you acidemic. And that's not a healthful state. You're right to be in like,

there's a reason that we have a very narrow range for the pH of our body. It's so that our enzymes can work appropriately and our electrolytes can be in the appropriate range. and our electrolytes can be in the appropriate range. And I should make the caveat of that. I'm not an expert in the ketotic state. But I would, and since I look at it as so much as just a Atkins diet in different clothes, that I don't see how it could possibly be healthy. I can't get more specific. I think that's pretty unequivocal.

But in terms of the doctors and stuff embracing it, there's the educational barriers. And then docs tend to be pretty conservative. And rightly so. They want to be proven that something is or isn't right to a reasonable degree. And, and like, you know, if, if there's a new medication or new procedure, that's kind of in their wheel box, you know, Oh, okay. This medication is a little different, but I kind of get it. This procedure is a little different, but I kind of get it. But if I were to say, well, this patient doesn't want to have bypass surgery,

let's use medications and some kale. Like, you know, they'll look at me like I'm nuts. Right. Because it's just so different and doesn't play into that whole, it's so out of the box, it doesn't play into a conservative approach. Right, right, right. There are, I don't know the right term to use, but maybe social engineering components of it as well, as we were touching on, you know, the whole like, and doctors see this too, advertising, you know,

the studly tough guy has meat. And, you know, I want to be as strong as an ox, so I'm going to eat ox meat. But, you know, ox, of course, eat grass. And, you know, gorillas and elephants are pretty big but they eat plants it's it's it's so ridiculous right it's almost like what no think this through here you know just because you're eating that doesn't make you that exactly it's like you walk down the street yeah i like like you see you walk down the street you

see this like jack bodybuilder guy you're like i want to be just like that. So I'm going to eat him. Like it's just ludicrous. That's so funny. I haven't thought of it like that. That's so true though. All right. Well, we got to wrap it up and you got a date to go tonight. What restaurant are you going to? Well, we haven't finalized it yet, but there's so many great ones. I love the candles. I love blossom, but I think we might go to Peace Food tonight. Oh, nice. Somebody was just mentioning that to me yesterday.

I haven't been there yet. There's a candle. I went to Candle 79 last night though. So great. It's so great. Really good. Really good. All right.

But if somebody is listening to this and they were on the fence before and now you've made such a compelling case for you know adopting this way of eating or at least stepping more in the direction of it like what is your recommendation for taking that first step like what's what's one or two things that people can take away from this and and incorporate into their lives to begin their own journey um well thank you for asking that and i I would try to set, you know, touch base with why it resonates with you.

Do you want to live a little longer? Do you want to be, or potentially live a little longer? Do you want to be healthier? Do you want to lose some weight? Do you have a big reunion coming up and you want your skin complexion to look better? You know, pick a pretty specific goal. Um, and then, you know, think about the things that we talked about, how it might be able to help you accomplish that goal. And I found that when people

become more goal or target oriented, it helps, especially in the beginning. Uh, so that's, that's important. Uh, having someone to talk to it about with, you know, whether it's a friend or a family member, um, who can help support you along the way. And it's useful. Yeah. And it's, it's useful to get reminders cause you're going to hit about why it's helpful. Cause you're going to hit up against so many naysayers, so many people who are suddenly experts and say, oh, you have to have animal protein. Translation, everybody. Everybody becomes an expert.

It's really incredible. And watching the documentary Forks Over Knives, I found that to be a wonderful intro. And I actually ask when there's a divergent in the family, like let's say the the husband's forward and the wife isn't, I'll ask them to watch that together. And that's, that's the documentary about the health impact. There are great books to, to read about it, you know, whether it's John Joseph's books or Dr. Esselstyn's books. Of which you contributed so eloquently. Oh, thank you. That's, that's great. Like on your forward is fantastic. Um, and, uh, you know, so having those things to, to remind you why it's, why it's good. I got near forward. It's fantastic. And so having those things to remind you why it's good.

And people get to a plant-based diet from different directions, whether it's health or environmental or ethical. And it's great. They all eat in the same place. So there's the incredibly powerful documentary Earthlings. That is, you will cry when you watch it is so amazing and powerful and that touches on the ethical aspects of it and i've heard that cowspiracy is amazing touching on the environmental aspects i haven't yet i can vouch for that yeah yeah i had those guys on the podcast and i'm sort of tangentially involved in that movie so it's going to be coming soon to everybody's

computer screen. Oh, that's, that's fantastic. So all of those things. Yeah. Like, so yeah. So like if the ethics speak to you, if the health aspect speaks to you, if the environmental issues are what's important to you, there's a, there's a, there's sort of a way to emotionally connect with it through any variety of means. Yeah. I wish I could have said it anywhere near that eloquently, but that's exactly right. Um, cool. So, so how about like one, you know, like one or two, like, okay, I'm going home tonight. Like, or I'm going to the grocery store right now, like a real tactile, as opposed to like an ephemeral, like sort of habit, like, but like, what's something I can do today? Okay. So what I would do, and one thing that I love, So what I would do, and one thing that I love, I love to make it easy and tasty.

So there is a, I will go to the store and I get, I don't know if I'm supposed to say this or not, but I get, there's a Garden of Eden. It's a brand of rice and beans that's vegan. And I get, there's a variety of flavors. I get that. I dump a couple of the cans into a pot. I toss in some kale, keeping the stems in because it's great crunch and texture. I'll toss the nutritional yeast and spices. I heat it up for five minutes.

That's an amazingly delicious and filling dinner. Cheap, quick, fast, nutritious. It takes all, you know, why it's too difficult or too expensive or not accessible. Exactly right. And you know, even if you live in a food desert, it's quite, if you can go just a little bit to a store, you can get a big sack of brown rice, a big bag of frozen vegetables and some hot sauce, some beans that can be incredibly inexpensive and really easy to make. So you, you can,. So you can eat for two weeks on that. Yeah, and it's real tasty. You can walk out of the store for like under $10.

Absolutely. It's amazing when you start to realize. And Darshana Thakkar wrote this great blog post on the Forks Over Knives site about, I forget the exact details, but basically living plant-based on like $1.50 a day or something like that. I didn't see that post. I'd like to read that. Yeah, it's really good. In addition to that, you've written four or five articles for them, right? Yeah, I've been really lucky and some patient stories and kind of how I got into it in the

first place. And they're just such a wonderful platform, much like your podcast to, you know, help people learn about it. Yeah, of course. So as in addition to the documentaries, Forks Over Knives, the website, the blog, are there other online resources that you direct people to? Yeah, nutritionfacts.org is amazing. And what that is, there's this guy, Dr. Greger, who's the best. He's a total rock star. He's been on the podcast, by the way, I gotta get him on again. I just, I love that guy. And he's got, as you well know, these three to five minute, highly entertaining, highly educational videos about any number of medical issues. He's got like over a thousand videos about why a plant-based diet is good for issue X, Y, or Z.

And they're just incredibly well done. And they're all rooted in the science and in the medical journals and in the studies. It's not, you know, it's very fact-based. Exactly. He quotes articles. He has them up there. He shows you the references, the authors, everything. So, yes, it is evidence-driven completely. just like the China study book is evidence-driven, in my opinion.

Okay. Okay, because I wasn't sure if you were clear about that. And other websites, I know I'm blanking on some right now. Gosh, Dr. Esselstyn's site, Dr. McDougall's site. We'll put them up in the show notes. If you think of any other ones, I don't want to put you on spot, but if you think of a few, you could email me and I'll put them in the show notes for the episode. It would be good. I think that's pretty good, man. Thank you.

When's your book coming out? Oh, I don't know. Come on, man. You you. When are you, when's your book coming out? Oh, I don't know. Come on, man. You gotta, you gotta, you gotta write a book. I would love to. And people have approached me about it and you know, there's just only so much bandwidth in life and you know, I, I love, I love my program, but it's on top of a lot of, of my job as a full-time cardiologist. So there's, I'm going to get to it. Uh. It's going to happen. That's a good answer. That's the right answer for not doing it right now.

Well, it's time will come. And if anyone's interested in learning about our program, I'll give you the website for the notes. But it's www.montefiore.org forward slash cardiac wellness program. We've got to shorten that URL for people. All right. So Montefiore is M-O-N-T-E-F-O-R-E. Close.

F-I-O-R-E. I forgot the I. Yeah, it's a hard one. Dot org forward slash cardiac wellness program. Yeah, I know. That's a tough one. Right. And it gets into a little bit about our, uh,

our program. And are there other, like you're not on, you're not like a big social media guy, are you? Not really. I'm on Twitter at Dr. Ostfeld.

Okay. I just said, Oh, of course, PCRM. Amazing. I just did a Twitter chat with them. They're amazing.

Um, with Dr. Barnard and that whole group. Um, so I'm on Twitter. PCRM.org. Yes. Thank you. At Dr. Ostfeld is'm on Twitter. PCRM.org. Yes, thank you. At Dr. Ostfeld is me on Twitter.

That's your main thing, Twitter. And Facebook. Oh, you're there too. All right. I don't do it a ton, though. But you don't have your own website right now, do you? No. Yeah.

No, it's not going to happen? I think it might, but I love doing it with Montefiore and as part of Montefiore, and they've been so supportive of it. So I like being part of that system. Have you written articles elsewhere beyond the Forks Over Knives site? Yeah. And contributing to John's book, obviously.

Yeah, that was great. There's this book called Rethink Food, Shoshana Castle. And, oh, my gosh, I can't believe I'm blanking on the other woman's name. I speak with her so many times, Amy Lee Goodwin. Their book, I was really lucky to be able to write a chapter for that. And we submitted a case report, our first academic article from our wellness program to an academic journal. It's under review right now, and there's others that we have in the pipeline. And so what I'm hoping to do is grow the clinical arm, the PR arm, if you will, just trying to help spread the word, but also the research arm of our program to help fill in whatever gaps there might be and take people who may very reasonably

and understandably be skeptical, help fill some gaps in this so they may be better able to embrace it. So we have some stuff in the pipeline that we're working on, but time and resources, there are limits, so we're doing our best. Yeah, I like that, I like that.

And if somebody's listening and they're inspired and they want to contribute to the clinic, can they do that through that URL? Is there a way for them to donate? That would be incredibly helpful. And, and, you know, I like to keep it so the patients aren't charged and the more resources I have, the more I'm able to grow the research and PR about it. And just, I'm not reimbursed for it. Um, yeah. so if they go to www.montefiore.org for slash Cardiac Wellness Program, on that page, in teeny tiny little blue letters,

is support the program. And if they click on that, it's a tax-deductible donation. All right, so they have to wear their reading glasses to find it on there? Yeah, well. Read is on the webpage. Yeah, that's on the list. Yeah.

All right, final question. I'm going to let you go on your webpage. Yeah, that's on the list. Yeah. All right, final question. I'm going to let you go on your date. Okay. If you woke up tomorrow morning and suddenly found yourself to be the Surgeon General, what kind of changes are you making day one? I would be screaming from the rafters about the myriad of benefits of a whole food plant-based diet from a health perspective, how it can lower all the things we went through in the Cal scan and more, and from an environmental aspect, because for many of us, that's a health issue too. Like

it's hard to live when Manhattan's underwater. And so I'd approach it from those two angles. And I would use that platform to talk about that. All right, man. I think you can go on your date now. I'm going to let you go. Thank you. Thanks so much for talking to me. That was a pleasure.

You're a hero, man. And I don't say that lightly. Like what you do is really important. And I appreciate it. And I have nothing but the utmost respect for you. And please keep doing what you're doing. Thank you very much. It's an honor to be here.

And when you do find a way to write that book, you're going to come back on the podcast and tell us all about it, won't you? Cool. I'd love to. All right, man. Thanks. Peace. Plants. All right. How'd you guys like that? I would say that was a pretty powerful, potentially life-changing conversation. I hope you enjoyed Robert. I hope that he gave you some things to ponder and ultimately some things to implement into your life. Keep sending me the questions for future Q&A podcasts to info at richroll.com. We're going to post up another one of those this Wednesday night, April 15th. So look forward to that. I'm coming at you twice this week. For all the information, education, products, tools,

resources, and inspiration you need to take your health, wellness, fitness, and self-actualization to the next level. Go to richroll.com, peruse our nutrition products, our education products, and yes, our garments. We've got some awesome stuff made with 100% organic cotton. Also, if you're into online courses, I got two of those. Go to mindbodygreen.com and check that out, The Ultimate Guide to Plant-Based Nutrition, and also The Art of Living with Purpose. If you like this podcast, give us a review on iTunes. Pick up the free app in the App Store to listen to episodes older than the most recent 50 that you can find on iTunes. And thank you for supporting the show.

Keep telling your friends using the Amazon banner ad and share it on your social media. Keep Instagramming you guys. Don't forget to tag me, Rich Roll and I'll see you in a couple days. Thanks. Peace. Plants.