The Rich Roll Podcast - How Not To Diet With Michael Greger, MD

Episode Date: May 28, 2020

When it comes to reliable nutrition information, the internet is a warn-torn, metastasizing mushroom cloud of toxic half-truths and misinformation. How do we sort through the tribal wars? How do we separate fact from fiction? Let's start with seeking out the experts. And the best, most objective science available. This is the life’s work of today’s guest and my friend, Dr. Michael Greger. Long time listeners are well acquainted with Dr. Greger, one of my very first guests back in 2012 (RRP #007). But it's been almost five years since his second appearance in 2015 (RRP #199). So let's put matters to rights. A graduate of Cornell and Tufts University School of Medicine as well as a founding member and Fellow of the American College of Lifestyle Medicine, Dr. Greger is a nutrition science wizard who with a library of scientific journal publications to his name. He has testified before Congress; lectured at countless symposiums and institutions; and was an expert witness in the infamous Oprah Winfrey meat defamation lawsuit. Appearing everywhere from the Dr. Oz show to The Colbert Report, his books: How Not to Die, the How Not To Die Cookbook, and How Not To Diet — the focus of today's conversation — all became instant New York Times Best Sellers. When Dr. Greger isn’t speaking, crafting high-level policy initiatives or penning bestsellers, he scours thousands of medical journals in search of the world’s best, most objective nutrition research to bring you free videos and articles every single day at NutritionFacts.org — the world’s most authoritative, non-profit, science-based public service destination for all things nutrition, health and disease prevention. Finally, it’s worth noting that 100% of all fees and proceeds he receives from speaking and book sales are donated to charity — his effort to avoid all conflicts of interest. Today’s conversation pivots on the optimal criteria to enable weight loss — and the actionable steps required to create and sustain healthy lifestyle practices. In addition, we explore how commercial influence corrodes nutrition science. How to parse the incredibly conflicting information we are spoon-fed daily by the media and celebrities alike. And finally, it’s about separating evidence-based science from confirmation bias. Note: This conversation was recorded in February, so it's coronavirus free zone. For Dr. G’s take on our current state of affairs, check out his new audiobook released this week, How To Survive A Pandemic — a breakdown on the origins of zoonotic disease, how to protect ourselves, and what we must rectify to reduce the likelihood of future catastrophes. Dr. Greger is truly one of the most delightful, relentless, passionate, and service-minded humans I have ever met. It's an honor to share this conversation. My hope is that it catalyzes a new perspective on nutrition for yourself and your loved ones. Peace + Plants, Rich

The most important decision we make is what we put in our mouths. And so if there's any decision that should be built based on evidence, and we should demand evidence, there's only one diet ever proven to reverse heart disease in the majority of patients, plant-based diet. If there's one thing you need to know, number one killer of men and women, only diet ever proven to reverse in the majority of patients, plant-based diet.

So the only way that wouldn't argue for it being the default diet for everyone is if it so dramatically increased your risk of killers 2 through 15 or something, such that it would overwhelm the heart disease benefit, and instead you tend to see a benefit of neutral effects across the board. It's just the whole system is rigged kind of against us. You know, the CEOs of junk food companies aren't sitting around trying to think of creative ways to contribute to the childhood obesity epidemic. They just need to make money for their shareholders. How do you do that? You don't do that selling something that goes bad, like produce, that you can't brand. You want a snack cake that sits on the shelf, right? I mean,

the system is just set up to reward these behaviors that make people sick. That's Dr. Michael Greger, and this is The Rich Roll Podcast. The Rich Roll Podcast. Hey, everybody, what's good? I'm Rich Roll. This is my podcast. Welcome to it. I can almost promise that today's episode is gonna leave you ready to ramp up your plant-based intake.

So to help you form a new routine, we created an online platform that makes going and most importantly, staying plant-forward easy and delicious. It's called the Plant Power Meal Planner, and it provides you with access to thousands, literally thousands of delicious, nutritious, easy-to-prepare plant-based recipes, thoroughly customized to your specific preferences,

with access to a team of experienced nutrition coaches seven days a week. It also automatically creates simple grocery lists based on selected recipes and even integrates with grocery delivery in most urban areas. So everything you need to eat the way that you deserve magically arrives at your doorstep. To learn more and sign up, visit meals.richroll.com

or click Meal Planner on the top of any page on my website, richroll.com, because one of the most important decisions we make every day, multiple times a day, is what we put in our mouths. But here's the unfortunate thing. The discussion, the information that's swirling around the internet about nutrition

tends to be a toxic stew, a hotly debated, metastasizing mushroom cloud of half truths and misinformation. So how do we sort through the tribal wars? How do we separate fact from fiction? Well, we can start with seeking out the experts. and how about we default to the best, most objective science available to arrive at the facts that live beyond dispute? Well, this is the life's work of today's guest, my friend, Dr. Michael Greger. Longtime listeners are well acquainted with this beautiful man, one of the OG guests on the show all the way back to episode seven. And he also graced us again on RRP 199. But I can't believe it's been five years since I've talked to this treasure of a

man. That's just not right. So today we're going to put matters to rights. A graduate of Cornell and Tufts University School of Medicine, as well as a founding member and fellow of the American College of Lifestyle Medicine, Dr. Greger is a globally lauded nutrition science wizard. He's the guy behind nutritionfacts.org, the world's most authoritative nonprofit science-based public service destination for all things nutrition, health, and disease prevention. He's appeared everywhere from the Dr. Oz Show to the Colbert Report, and his books, How Not to Die, the How Not to Die Cookbook, and How Not to Diet, which is the focus of today's conversation, all became instant New York Times bestsellers. And I think it's worth noting that in an effort for him to remain completely free of conflicts of interest, 100% of all fees and proceeds that he receives from his many speaking engagements and all of his book sales are completely donated to charity. There's a bunch more I want to say about the good Dr. G and the conversation to come.

But first. and the conversation to come, but first... 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, to support, and empower you to find the ideal level of care tailored to your personal needs. They've partnered with the best global behavioral

health providers to cover the full spectrum 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. Okay, Dr. Michael Greger. So today's conversation is about first and foremost, how not to diet, the optimal criteria to enable weight loss, and the actionable steps required

to replace constant weight loss struggles with simple and sustainable lifestyle practices. But it's also about the corrosive corruption of commercial influences within the nutrition space. It's about how to digest the incredibly conflicting information we're spoon-fed every day by the media and celebrities alike. spoon-fed every day by the media and celebrities alike. And it's about separating evidence-based science from confirmation bias. I should note that this was recorded pre-COVID back in February.

So this is a coronavirus-free conversation. However, if you would like Dr. G's take on our current situation, you are in luck as this week, just a couple of days ago, he released a new audio book entitled How to Survive a Pandemic, which is all about the origins of these types of diseases, how to protect ourselves and what we must rectify

to reduce the likelihood of future catastrophes. So check that out. Dr. G is truly one of the most delightful, relentless, passionate, and service-minded humans I've ever met. I think you guys are gonna really dig this one. So without further ado, please meet the inimitable and amazing Michael Greger, MD.

So good to see you. It's been a couple of years, but I think about you all the time, man. You're just, you're out there. You have more energy. You are more relentless than almost anybody I've ever met. It's crazy. You were just saying you're doing how many lectures?

I got 200 cities and sometimes more than one lecture per city. 200 cities? Sometimes, you know, different cities in the same day, you know, over 10 months. Yeah. So when people say, you know, yeah, I'd really like to eat better, but I travel too much. Nobody travels as much as you do. I don't think I've ever met anybody who travels as much as you do. Well, but it's just I'm on like a three-year book cycle.

So it's only one out of three years. So I write a book a year, then I'm on the road for a year. But then I got, you know, and then I got to write three years worth of videos for Nutrition Facts, then I write the next book. So do you whiteboard that all out in advance so you know what your books are down the line and all of that?

Yeah, until like 2042 or something like that, yeah. And when do you, how do you apportion that? So you have all the videos coming out on Nutrition Facts. Right. You got the books, you got the lectures, you're never home. And when you are home, you're on a walking desk. Like, how does this work? Yeah, yeah. No, no. So people were like, well, I love the video. Like, how'd you do the video today? You were on the plane. As if, you know, I'm like, it's like real time. I did that video a year ago. No, literally. Right. So I do, I script three years worth of videos every three years. Wow.

And so you just hope and pray that broccoli is still good for you next year because, you know, it's set in stone. Has that ever happened where the science has changed and you had to pull the video? Yeah, pull the video. Yeah. Yeah. I mean, usually there's even stronger evidence or, you know, in the same kind of direction, but now we finally have something that really clinches it more than anything else. But, yeah. Well, you were one of my very first guests on this show, episode seven, I think, going all the way back.

Then we did a second one where there was a technical snafu. We were at some conference and we did it and it didn't record. That's only happened like three or four times in seven years, but you fell victim to that. You're another trendsetter. I know, I tell you. And then the last time that we did this, I think was four years ago.

So it seems like yesterday because you're in my heart all the time. What is the current lecture all about? Because I know you're constantly up. Do you change it for every audience? Or you have kind of a lockdown thing that you do every year. Yeah, so I used to do a new talk every year because I was traveling every year.

But now I'm only traveling after the new book. So I just have the new book talk. And so for new audiences, they get the last book talk. But for audiences who have already seen it, the How Not to Die audiences, they get the last book talk. But for audiences who've already seen it, the How Not to Die talk, I give the How Not to Diet, the weight loss talk. That's what I'm doing now. So this is the new book. I actually like the old one. I mean, so the last talk, How Not to Die talk is my favorite talk. I mean, it just has more humor than any other. I mean, so my preference, and it's like perfectly

memorized. I can like, you know, think about my grocery list while I'm giving it. Like, I mean, it's just like completely. You've done it so many times. Right. And, but it's so, but, and, and the new, you know, I'm reading off the notes on a podium and it's, you know, it's going to be a while before. And just when I get really good at it, I never give it again. It's like a standup comedian.

You got to do, you tape your special and then you got to retire the material. It's like a stand-up comedian. You tape your special, and then you've got to retire the material. It's all over. But in your case, this material, it has a longer shelf life, though. This stuff doesn't necessarily age. You know, it's crazy. So How Not to Die is selling better now than it did the month after release back in, like, 2016. I mean, that's just insane. You sold over three-quarter of a million copies, right?

Yeah, about that. And 100% of all proceeds go to charity. Good charity for all my books, yeah. We're talking a lot of money. Yeah, yeah, this last one. I donated more than a million dollars this year. Wow. Yeah, very, very cool. And I would suspect that a big part of that, other than just being compassionate in your heart, is to basically rebut the argument that you're conflicted.

You're selling a book, so you're anchored in this position. And no matter what the evidence says, you've got to toe this line because you're financially incentivized. Right. Although there's still the ideological kind of conflicts of interest. So even people that aren't necessarily profiting off of their work, I mean, they still may be wedded to some idea. So it doesn't completely divorce me from the concern over bias. But, yeah, I mean, with so much – the corrosive corruption of commercial influences. Well, let's talk about that. Within, I mean, medicine in general, but nutrition in particular,

where, you know, the confirmation bias is just so extreme. In no other field have I ever seen such a thing. It's pretty bananas right now. I feel like there's a mushroom cloud of information. Like if you're in the Twittersphere, it's just, it's insane. The siloed, you know, kind of tribal wars that are going on right now are so emotional and acerbic. It's quite toxic. So how do you, I mean, you post your stuff. I've noticed like you don't engage in any of that. You kind of just stay above the fray. Yeah. No, that, yeah. And that was a conscious decision to be like, look, this is all the science that I could find on this. And so there's, unless, I mean, and so the only, you'll notice

on Nutrition Facts, the only comments I respond to is, what about this study? Or, you know, what about this study? You know, and because it's very possible, maybe I missed that study. I mean, you know, I mean, we got a huge research staff now, but, you know, I want to make sure that I put that into the calculus when I came out with what I consider the best available balance of evidence. And so it's like, this is the science. So there's really nothing anyone can say, you know, I mean, and so, and it's really not like, you know, most of my videos I try really hard to be like, I have no opinion on this. Here's the science. Make up your own mind.

I mean, it convinced me to do X, Y, and Z. But if you're not convinced by the evidence, you know, wait until, you know, something else drops. Well, you must get the criticism that you're cherry-picking studies. Like, you have to make a decision about what studies you're going to highlight in these videos, right? So that's why, that's why it takes me forever to write the videos because I have to make sure. So not just some new study, but where that new study exists in the context of every other study that's ever been published ever, right? I mean, so- How many studies get published a year? How many studies get published a year?

Well, I mean, so just- Like legitimate. Well, so in obesity, just in the field of obesity, there's over 100,000 studies every- So that's like, I mean, so it's like, I go to sleep and I'm already like, I'm way behind. You do sleep. Well, I'm working on it, but- You talk about that in the new book. I know. Do you practice that?

It is so depressing to look at the sleep medicine literature because I just realize, oh, that horrible thing is going to happen to me. Oh, that. This is the one blind spot in your regimen. Oh, God. That's, yeah, yeah. But, I mean, I just, I find myself, I'm so much less productive when I'm unconscious. Yeah. That, you know.

So thousand studies a year on obesity alone. 100,000. 100,000. Oh my God. So how do you even wade through this and figure out, you know, what's worth looking at and, you know, what's really worth exploring and digging into. And ultimately I would imagine deconstructing at times to figure out what holds up to your standards and what doesn't. Yeah. So we have over 100 research

volunteers that churn through. That's how we can get through tens of thousands of studies every year, just because we have all these retired docs that are just sitting around and just have a hobby of helping me out, basically. And so at any one time, we have nearly 200 active volunteers. And so, I mean, we can just churn through so much. And, you know, I have access. I have people in libraries, every major library anywhere, who will pull any study from any, you know, so I have someone that will just go to the NIH, you know,

largest medical library in the world, and pull any old study that isn't even online. So I have someone that will just go to the NIH, you know, largest medical library in the world and pull any old study that isn't even online. So I have access to everything. And I'm just in this incredibly privileged position to be able to, you know. But that's assuming the literature all says one thing. Right. The reason why this new obesity book, the weight loss book, was such a bear. The hardest thing I've ever taken on in my life was because it's incredibly conflicting. And so if, you know, a hundred studies say one thing,

the other hundred studies say another thing, you have to say, what is it about the way they did the studies, the populations, the exclusion criteria? Like, what was it that you could arrive at such disparate conclusions using very similar kind of methods? And that took forever. So simple questions like skip breakfast or not skip breakfast, exercise before or after a meal, or I mean, these like, really, like these are thousand article research questions. There's a thousand articles on, and you're just like, wait a second, this is two pages of the book. Maybe it's a little sidebar. And people just want to know,

should I eat breakfast or shouldn't I? I know. Should I fast? Tell me what to do. I get a lot of that feedback. That's what everyone's like, okay. I don't care. Just give me the thing. I know. Right. Be my guru, right? But anyone fall. I mean, that's the antithesis of what I want to – that's the problem is people just follow what someone says. I mean, when it comes to something as life and death important as what feed yourself and your family, then if there's anything we should, any decision we should make based on evidence, it should be something like that. If you're online buying a toaster, then the random opinions of strangers may actually be really useful. Like, oh, I like this one. Okay.

But, you know, when I was in practice and someone came to me, I said, why are you eating this particular? Someone at the gym told me to eat this. I'm like, really? I mean, the checkout aisle magazine is the reason that you're feeding your kids? I mean, you realize that what we eat is the number one cause of death and disability. I mean, the most important decision we make is what we put in our mouths. And so if there's any decision that should be built based on evidence,

and we should demand evidence, and not just a citation, but show me the evidence. I want to see it for myself to make sure you didn't take it out of context. I mean, this is – and so that's – But you and I both know well that even the most well-intentioned consumer who begins to explore this, whether online or whatever, they're gonna find conflicting information out there.

And it appears to have equal merit. It's like when you turn on the news and there's 10 people yelling at each other at the same time, even if one of them is completely loony tunes, it appears that they're standing on equal footing, right? So, you know, you can find studies that will support whatever perspective or confirmation bias that you have, and it becomes very difficult for that well-meaning, you know, intelligent person to separate, you know, the chaff from, you know, the cream when it comes

to this. So this is where you come in. But even then it's like, all right, well, you're sifting through thousands and thousands of these studies and realizing, well, this is complicated. And even good science seems to conflict. You know, how do you make heads or tails of that? I can't judge somebody who's like, you know, Dr. Greger, just like, what is it? Tell me, give me the thing. Yeah, no, you want to check. You know, it's like that. And there's lots of problems with the, you know, peer-reviewed medical literature. You know, it's like that, I don't know if Winston Churchill actually said it, but attributed to Winston Churchill, you know, a democracy, worst form of government, except for all the others, right? And it's the

same thing. I mean, it's like the peer-reviewed scientific literature, it's the best we have. I mean, it's the worst we have except for all the others. I mean, what else can we do but abide by, you know, what's been, you know, published in the medical literature? But there's lots of problems with industry bias and, you know, funding effects. And so that's why you really need to – the first thing I do when I look at a study, who paid for the study, where is it coming from, just so you can read it with that lens. It doesn't mean it's necessarily a bad study.

Exactly. It'd still be a good study. It'd still be a good study. But you want to read it with that – you want to take it with an extra special grain of salt and look at the materials and methods and really make sure they didn't create this, they didn't produce the study in a way to get some desired result. They were actually coming into it really, you know, looking to learn something. And despite the fact that you've read countless thousands of these studies, you know, you've been on board with the whole food plant

based diet for decades at this point. Do you ever come across a study that contravenes some long-held truth that you've held? Like, have you ever had to mature update your thoughts on things? Like, how has that evolution been? Yeah, no, look, I mean, anyone who's saying the same thing about nutrition that they were saying a few years ago obviously hasn't been keeping track of the literature. I mean, the reason I can do new videos every day forever is just because there's this tremendous wealth of information out there. Now, usually it's just kind of nibbling at the edges. Like after How Not to Die came out, I realized that, oh,

and I was telling people, oh, you've got to toast your walnuts and sesame seeds. It makes your kitchen smell so wonderful, and that's great, and they taste so wonderful. Then this paper came out and talked about these A these agees these advanced glycation in products these glycotoxins found in high fat high protein foods exposed to high dry heat temperatures traditionally it's like frankfurters and stuff and chicken mcnuggets but nuts you put them at those temperatures and they create these nasty and so i now i tell people to eat the raw nuts but that's the nice thing about a video where so i could update as opposed to the book which is already out. But, you know, in reprints, we can get it.

But, I mean, so little things like that. But these are like details. So the nuts are still good, but. But, I mean, you can find studies all the time saying, you know, bacon and butter is good for you, just like the tobacco lobby would come literally with piles of studies to these congressional hearings. Say, this is not the research that says smoking is neutral. This is the literature saying smoking is good for you. It helps with Parkinson's disease and ulcerative colitis. And a lot of this is true because it's immunosuppressive. It's an autoimmune disease. You smoke, you kill your immune system, your autoimmune disease gets better. Inflammatory bowel disease gets better. But I mean, these are legit studies showing smoking beneficial. Now, of course, that's not

the best available balance of evidence because you're going to die a horrific death from lung cancer, but those studies exist and you can cherry pick them out. And that's why, you know, every single, every day a video comes out, I send the video to every single principal investigator of every article I cite and be like, I'm excited to, here's your research, you know, in hopes that one will be like, you misinterpreted or whatever, and I can immediately, you know, kind of. I can immediately, you know, kind of. Right. So when you get, like, what is your response when somebody criticizes you and says, he's just, you know, he's a plant-based guy. He's always going to be a plant-based guy. He's got his own confirmation bias. This is a guy who's really just an animal rights activist who's shrouded himself in a medical frock. I mean, it's like, you know, some, you know, pulmonologist saying, oh, you're just an anti-cigarette guy.

I mean, your only reason you're telling people not to smoke is because you have a well-known record of you were against cigarettes 10 years ago. Before the study comes out, oh, a new study comes out saying smoking is bad for you. Mr. Anti-cigarettes is at it again. I mean, the science is the science. And, you know, the charges of cherry picking. So, for example, there's only one diet ever proven to reverse heart disease in the majority of patients, plant-based diet. Number one killer of men and women. Like, shouldn't that be the default diet until proven otherwise?

Only one. So it's hard to cherry pick when there's only one cherry. Like there's no other. Now, in the future, maybe some new diet will be shown to, but I mean, until that happens, and this happens over and over again with multiple sclerosis and Crohn's disease and on down the list, nothing's been shown to work better. And there's just, I mean, you know, so. Right. Right. I mean, listen, you said it, but the fact that heart disease, you know, basically kills more people than anything else. And this is the one protocol that actually will not only prevent it, but reverse it if you have it. Like, why are we even exploring anything further? And so it's amazing that it's so

controversial. And the fact that can also help prevent, arrest, or reverse other leading killers, type 2 diabetes and high blood pressure. We seem to make the case for plant-based eating just like simply overwhelming at this point, right? I mean, if there's one thing you need to know, number one killer of men and women, only diet ever proven adverse in the majority of patients, plant-based diet. So the only way

that wouldn't argue for it being the default diet for everyone is if it so dramatically increased your risk of, you know, killers two through 15 or something such that it would overwhelm the heart disease benefit. And instead you just see, you tend to see a benefit of neutral effects across the board. Right. Well, you've got to be thrilled to see this movement, this way of eating and living, you know, kind of explode over recent years. I mean, never before in your career, you know, have we seen such a crazy adoption rate, which is super exciting, but there's also a lot of pushback now. And we have these sort of other diets that are rising to the surface and challenging for their moment in the sun. And it makes me realize, or I guess appreciate just how

emotional all of this is. It's really not an information war as much as it is a psychological war. You know what I mean? Like, cause you've spent decades putting information out. I mean, nobody puts out more information about this than you do. And if somebody is resistant to that, that's their choice. But I feel like the battle really needs to be waged on how to win hearts and mind, not just the minds, but the hearts. You know what I mean? Like what is, what, and I mean? And I'm interested in whether you have thought about this with respect to the newest book. It's like weight loss, like everybody wants to lose weight, right? But often it's not the information, it's the implementation of the information. And

what gets in the way of people taking that information and putting it into action has to do with their own psychological makeup and, you know, the emotional landscape and, you know, the social construct in which they live their lives. You know, when I, you know, at some of these, you know, amazing plant-based nutrition healthcare conferences now, which now attract thousands of, I mean, it's just amazing. You know, the number one question I have for everyone is like how did you come across like obviously they didn't learn about it in medical school none of us did like how did you and most frequently the answer i get is because a patient taught them like so they've had these patients forever and they've known their whole families and they've had diabetes and you know they're just trying to slow the rate at which they go blind and lose their kidney function and lower limbs. And then all of a sudden they come in,

they're 20 pounds lighter, they're dramatically over-medicated. All of a sudden they have to pull back all the drugs. And the doctor's like, what happened? And the patient says, oh, I saw folks over knives or, you know, game changers or something. And then all of a sudden, and the doctor in the back of their mind, the doctor's saying, I've got like 2,000 patients just like you. What is going on? And that's so – and so it's just – It's great, but it's upside down.

Oh, my God. And so it drives me crazy. And so I'm like, wait a second. I've got a stack this big of peer-reviewed scientific literature, randomized controlled trials proving reversal of these diseases, yet it was one little anecdote. One person comes to you, and then all of a sudden – but it's that human connection. We're like storied creatures. Like all the data in the world, you know, it'll – some people are open to that, but other people, they just need to see it in front of their face.

And so I don't know. Some people are open to that, but other people, they just need to see it in front of their face. And so I don't know. So that's why I think the more popular it gets, the easier it will be when they see their friends and family, the transformations. Then it'll click. And, of course, I'll be in the background banging my head against the wall saying, here's the 70s. Pinnacle was reversing heart disease in the 70s. How many people have died since then? Needlessly.

Over 100,000 people every year, heart disease in the United States alone. That much suffering, it should anger people, right? I mean, the reaction to someone who just doesn't have to go through open-heart surgery anymore shouldn't be relief. Oh my God, I don't have to get my chest cracked open. And now I get to live a long, happy life and see my grandkids grow up. It should be like, why didn't anyone tell me this before? Outrage. Outrage. Yeah. Yeah. Of these 200 cities that you visit, all the speeches that you give, how many of them are at medical schools or hospitals? Because obviously the way to get to the root of this

is to educate medical students and create a better ecosystem around care. Yeah, train the trainers. That's really what I'm doing now is mostly talking to professional audiences. I'm talking tonight at a medical center and lots of medical schools now. And that's how I actually started out. My kind of speaking career is going. In fact, that was my goal is to speak at every single medical school every two years to hit every single new grad coming out and have a whole new generation of docs learning this. But I realized like, that's too slow. Like they're not, they're still going to be in training for another five years and then they got to get out. And then they, I mean, so like people are dying

now when it comes to safe, simple side effect, free solutions like stop smoking, eat healthier. You don't need your doctor to tell you to do that. We can take this directly to the people with this kind of democratization of information now available. And so I, you know, so then that's how nutritionfacts.org got born. Instead of forget the doctors, you know, let them come around eventually. We got to write. People are dying right now. People need to know. And then, of doctors, let them come around eventually. People are dying right now. People need to know. And then of course, it's up to you. It's your body, your choice. You want to go smoke cigarettes, go bungee jumping, do whatever you want. But at least you should be educated about the predictable consequences of your actions. Other than your unbridled enthusiasm for this,

one of the things that I like about you and that's interesting about you is that you really strive to stand outside of dogma and you're not telling people what to do. You're basically in a very objective way presenting the information and allowing people to do with it as they will. Yeah. I mean, that's always been really important to me is – and look, and for whatever reason, I mean, there's no judgment. I mean, I happen to have the background that enabled me to do this work and to be who I am. I mean, there are people struggling with all sorts of things that you don't know about. And the fact that they're still eating, you know, crap on their way home from work. I mean, you have no idea what's going on in their lives that led them to whatever.

But should they have the opportunity to really, you know, whether it's a health scare or whatever, to be like, I really need to clean up my act, at least there should be a place they can go where here's the information. This is what I wish I learned in medical school and, you know, do with it. Geek out on nutrition. I mean, how many hours of videos do you have on there now? We have thousands, thousands, so over 2000 videos now. Basically you go to the site and you could just search whatever food or

whatever ailments and you've got it covered. Yeah. Yeah. Yeah. Yeah. What's the new video going to be? Oh, there's always new stuff. I'm constantly, I mean, there's just always new, you know. And, you know, so I do it two ways. One through – I run through all the topics actually alphabetically. Anyone who's keeping real close attention will be like, oh, so the olive oil came after the nuts, which came after the, you know. Yeah.

And then I just go through and read every issue of every single English nutrition journal in the world. See, because there may be topics I don't even know to look up. There's this, yeah, I mean, all sorts of new hormones and new receptors and new... I was just working on the plane on this CD36 receptor. Whoa, blew my mind. Videos to become, videos to come, right? We get sidetracked on that. It sounds like an airplane to me, like a C-130. I don't even know what that is. Oh my God, amazing. In terms of taking it to the people, which you've been doing, the real needle mover, I think, has been this slew of documentaries that have come out over the last decade, the most recent of which is, of course, Game Changers. And you were the scientific technical advisor on that movie, right? So

what did that look like? What was your involvement? Well, I mean, just, I mean, certainly to take that first point, when I go around speaking, I ask people on these, you know, four-hour book signing lines, how did the, it's what the hell, it's forks over knives. It's these, these documentaries are now just really, yeah, yeah. Tremendous, oversized effects. And so if people, if they're funders interested in getting this, you know, movement off the, off the ground, I think that's a decent way to go. Yeah. Well, they're probably good investments. These movies do very well. They do. And they, yeah, they do. So, yeah, no. So, so yeah. So I was approached by James Welks, oh God, like seven years So, yeah, no, so, so, yeah, so I was approached by James Welks,

oh God, like seven years ago, you know, when it was just, you know, an idea and, and, you know,

interviewed me for the, for the film and some like, you know, on some highway in Santa Rosa or something in this noisy, like a little, whatever, you know,

like a little camcorder-y kind of thing in a hotel. And it was just an idea, but you can't say no to any opportunity, right? So like poor Dean Orner still kicking himself for not being in Forks Over Knives because he was taking some time off or whatever. You just got to be in everything and hope something helps. And so then he actually started to get some momentum for the film

and invited me back and said, sorry, we've got to throw all that footage away. It was crappy footage. But now we actually have real cameras. And, you know, all right. Right. So then we, you know, do another thing. And that actually happened once or twice more. Then they're like, okay, now we really have money.

Now we have, like, the fancy. So I went through, like, and then, of course, I get cut out completely from the film, which is fine. I wouldn't replace a second of it. I think it's so perfect. But hopefully I'll be in some DVD extra or something down the road. But the role I could play instead was to fact check the film. Because I have an army. I mean, that's what we do.

You're the perfect person for that role. And we actually behind the scenes and open invitation to anyone writing a book, producing a film, TV show, anything, come to me. I'll do it for free. Our whole team. I mean, it's so important to me that we don't say ridiculous stuff and people throw the baby out with the bathwater. I mean, the movement has said just ridiculous, crazy stuff, exaggerated stuff. I mean, why?

Yeah, it doesn't help the movement to do that. Right, and- Because it imperils the credibility. And if you have, and as if we have to exaggerate anything, we should use the industry estimates for everything. The most low ball, you know, oh yeah, it's only 1,500 gallons per pound of beef, whatever, water, you know, according to the National Academy of Beef Association or whatever. gallons per pound of beef, whatever water, you know, according to the National Academy of Beef Association or whatever. I mean, that's what, I mean, yeah, it boggles the mind. So yeah, that's so critical that, so a lot of the books that, you know, are written up and as long as,

and we will do it as long as they're willing to actually. Right. So your job was really vetting all the science so that there was no exaggerations and that everything that was said in every scene kind of, you know, met the scientific muster. In fact, conservative. So not just sticking to the consensus, but like on the conservative side of anything, let's not say anything. The science is so strong. We don't need to exaggerate. We don't need to go anywhere but beyond the solid ground we're standing on. Right.

And the whole erectile dysfunction sequence was your brainchild. I was. So walk us through that. Well, so I had the data. I had the science. But again, you need, a graph, a table, an amazing table with a statistical significance that alone would give you an erection. But that's not going to move a visual audience. That's not cinematic.

It's not cinematic. And so they kept asking me, how do we make it visual? How do we make it alive? And so I said, well, let's do the lactestines, the cloudiness of fat after eating a meal and the serum. And I knew just from reading the literature on blood flow and endothelial function that they had these Ridgescan machines with a name like Ridgescan. It's got to be good. And now it's actually being done legit. I mean, in a real study, in fact, I think by Osfeld. Dr. Osfeld is now, has the funding. He's actually going to put it

to the test in a really tightly controlled, randomized fashion with a cadre of folks. Again, it was just, they wanted to show the example to, you know, anyway. Right. So latest book, How Not to Diet. How dare you write a book about weight loss? I can't believe this, right? So How Not to Diet is really about sort of tackling, preventing, reversing the sort of top ailments,

chronic ailments that people suffer from. But of course, obesity is an ailment in and of itself or a contributor to a variety of ailments, right? So without sort of confronting obesity head on, you're not really getting, you're not gonna move the needle for people, right? So you got to get them to lose weight. So I did the, yeah, yeah. So how not to die, 15 leading causes of death, just went through one through 15 chapter on each, talking about the role of diet, many plant preventing, resting,

reversing. So there's a type two diabetes chapter, obviously, but never took obesity on directly. And it really required its own thing. So that, I mean, yeah. So you have to then turn your focus into how to help people lose weight, right? Like what is the science of weight loss? And I would imagine, you know, you had to confront like a lot of things that we sort of assume or take for granted that perhaps maybe didn't turn out to be true, like, oh, calorie in, calorie out, or three meals a day. There's so much conventional wisdom around like, here's how you lose weight, ABC. So by immersing yourself in all of this research, like what surprised you the most or what did you discover that perhaps, you know, you didn't expect? Yeah. So in both ways, some of the conventional wisdom actually has a real scientific basis,

and only recently does it have a real scientific basis. So for years, we've just been saying, talking out of our butt. But now, oh, that's actually true. We should, you know, breakfast like a king, you know, lunch like a prince, dinner like a pauper kind of thing. Some of this, or, you know, drink water before a meal, very common kind of thing. Oh, now we actually have signs. It really does show beneficial effects. But I think the biggest challenge for me, just because this is not my field. I mean, you know, I just know from what I learned in med school and this concept that a calorie is a calorie, right? A calorie from one source is just as fattening as a calorie from any other source. I mean, this is kind of a trope broadcast

by the food industry to kind of absolve itself of culpability, but it's just not true. Like, you know, 100 calories of chickpeas has a different effect on body weight than 100 calories of chicken or chicklets based on absorption, based on fiber content, based on all sorts. And even if you absorb the same amount,

even a calorie may still not be a calorie. It depends when you eat it, in what context you eat it, how fast you eat it, all sorts. I mean, so, I mean, that just kind of exploded, like, my concepts of kind of what we had learned in med school. So, like, this chronobiology, I have a whole chapter on the whole circadian rhythm. Walk us through this, because this is because I had never heard anything about this. So what I had known, what we learned about in medical training is what's called chronotherapeutics, where if you give chemotherapy at the right time of day, you actually have fewer side effects, and it's more effective than giving it at a different time of day.

Same dose, same drug, which is fascinating. But I hadn't taken it to the logical conclusion. What about chronoprevention? Might exercise and sleep patterns and meal patterns also play a role if it has such a dramatic effect? And indeed, calories eaten in the morning are less fattening than the exact same food eaten at night. The fewer calories after sundown, the better. So they do these studies. How is that?

Why is that? Well, it's because, so for example, in the morning, your body has to make glycogen stores for the rest of the day. And instead of just using the energy, if you take the little chains of sugars and starches and make them the glycogen in your muscles and liver, that's an energy-intensive process. And then you break it back down to be used later on. And so the fact that you're using energy to basically get the energy right back is kind of energy-intensive process. That's one of the small

reasons why eating in the morning when your body knows it's got a whole day ahead of it, where you have that glycogen-building signal earlier in the day. But a lot of the chronobiology stuff we just don't know in terms of what exactly is going on. But everything from body temperature to, you know, testosterone to cortisol levels, everything, you know, goes on this wild daily cycle. And then there's seasonal cycles, weight loss, you know, it's the weight you put on in the kind of winter months for the holidays,

may have a role to play. Depends upon how far the earth is from the sun. It's crazy, right? The rotation. So that was, I mean, that just blew me away. So you can put people on 2,000 calories, the exact same 2,000 calories as one meal at breakfast or one meal at supper. The army did this. And the evening group, same calories, gains weight. And the breakfast group loses weight.

That's such a trip. It's crazy. And so then that really opened my eye. Okay, well, now anything's possible. And so then really kind of dug deep and, you know, came up just, you know, what are the criteria for optimum weight loss? Like, what would the optimum weight loss diet look like from kind of from the ground up? Just because originally, How Not to Diet, it was going to be a chapter on each of the latest diet trends and just going through what's the science behind each.

But I realized the book's going to be out of date before it even comes out. I'm part of the US News and World Report diet panel. And so we get dozens of new diets I've never heard about every year that we have to go through. And I just realized, well, wait a second. That's not the... Right. It's like whack-a-mole.

So instead, let's just – here's the criteria against which you can look at any future diet and see kind of where it would fall among this range. And then the second half of the book is regardless of what you eat, there are kind of tips and tricks that can – and tweaks that can get you to accelerate. Right, like the water thing and focusing on nutritional density and caloric dilution, things like that. So yeah, nutritional density, that's really the first part. I mean, that's part of a good weight loss diet. It's weight loss techniques, but like the water, right? Water preloading. So if you drink two cups of water before eating a Whopper, you'll gain less weight. I mean, so it's regardless of what you eat. That's the whole second half.

And the hope is people won't just kind of jump to the second half and they'll actually do a safe, sustainable, nutritious, healthy diet. In terms of the foods to eat, though, I mean, it harkens back to the previous book and it kind of orients around the daily dozen. It ended up. I mean, it ended up that way based on those criteria. Like you want to be fiber-rich and low in added sugars and low in added fat and water rich and all the same vegetables and kind of on down the list.

And that was the criticism we got from the Daily Doesn't app that we released. It had a million downloads. And there's two camps of criticism. One is, oh my God, it's too much food. I can't eat at all. In which case, I'm like, look, too much. Oh my God, I can't go through all this stuff. You got to make sure you get all of that in a day. Well, I mean, but look, it's aspirational. And you can make a game and see how many you can get. And if you don't do good one day, you can try better the next day. And that was actually this... I mean, I'm hoping to... After you checked off those boxes, there's only so much room for pepperoni pizza at the end of the day. I mean, it's this kind of eat more approach, but it's really hoping to kind of push out some of the less healthy options.

But the other group of criticisms came in and says not enough calories. It's like, look, I'm training. There's no way I'm going'm getting enough calories eating this kind of stuff. I was like, well, look, this is the minimum. You can eat more food. I'm not saying this is all you can eat. I just want people to hit this. But then I realized, well, wait a second. Oh, too much food, too few calories. That sounds like a good weight loss diet. And the fact that these are some of the healthiest foods on the planet is a good bonus as well. Right. Did you come across some interesting research on intermittent fasting? Because that seems to be the thing that a lot of people are talking about and thinking about and practicing right now. And I've had a couple of people on the podcast speak to it.

That's the biggest chapter is the fasting chapter. So much information. I remember looking to fasting because it's been a common interest for years. People ask me about it. And anytime, I only want to say, I don't know once ever, even if it's the most esoteric question in the world. The next time someone asks me that, I'm going to know an answer to it. And so people can ask me about fasting and there just was no data. And so that's why if there's a condition or food that you can't find on nutritionfacts.org, the number one reason is probably because there's just no good data out there. I mean, it's not like, you know, I'm trying to ignore it.

It's just like we don't know. But just in the last few years, there's been an explosion of research into intermittent fasting, water-only fasting, you know, 5-2, 25-5, time-restricted feeding, all these. And so tremendous literature. And what's interesting about the intermittent fasting literature, well, so in terms of intermittent fasting, no benefit in terms of compliance or lean mass conservation or weight loss compared to continuous caloric restriction. And the longest, largest studies to date shows increasing cholesterol for people that have the same caloric restriction doing alternate day modified fasting. And so I would encourage people not to do it or at least get their cholesterol checked.

But the time-restricted feeding where you try to narrow your eating window to 12 hours or less and so you're fasting at least half the day. This was one of the research areas where there was diametrically opposed... Some studies show it's great for you. Other studies show it's terrible for you. It has all these negative metabolic consequences. And so it was my job to like, what is going on here? And it turns out it's timing, early versus late. So when do you break the fast? So your window, right? So if your window is late, you get the negative biological consequences of eating at night and shifting your calories towards later

in the day. And so people that skip breakfast had these negative metabolic effects of time-restricted feeding, whereas people that did early time-restricted feeding not only got the chronobiological benefits of shifting their calories towards the beginning of the day, they also got the time-restricted feeding benefits. And so that is really the... That's one of the things in the book that actually changed the way my family eats. Yeah, you just rocked me with that because I do it where I eat at night and I don't eat during the day. If you miss any meal, it should be supper, not breakfast. Right. Absolutely.

Breakfast is called break fast for a reason. Yeah. I mean, that – Wow. Yeah. And that actually may be one of the reasons that the seven-day Adventist vegetarians live the longest living population in the world, right? Okinawa Japanese was the number two, and now they're eating KFC. There's really only one blue zone that continues to this day.

It's in Loma Linda, California, the seven-day Adventist vegetarians, longest living formerly studied population in the world. But one of the reasons may be because they practice this early time restricted feeding, often skipping supper. The teachings of the church are like two meals a day and make lunch the biggest meal of the day. It hasn't been put to the test, but given all this short-term data, that may be – Yeah, that's super interesting. I don't know. That'll be the next book, How Not to Age. I'll look deep into that.

Is it? Is that the next? It is? That should be, wow. Starting January 21, it'll be the next book, How Not to Age. I'll look deep into that. Is it? Is that the next? It is? That should be, wow. Starting January 21. Wow. It'll be out December 22. Oh, my God.

What's the book after that? I think it's going to be How Not to Die from Cancer for Cancer Survivors. Unfortunately, you know, the advice people with cancer diagnosis get is eat whatever you want or just keep weight on or whatever terrible advice. And now we actually have some decent data on cancer survival, not just prevent. I mean, so how not to die, how to prevent cancer. What if you already have cancer?

What can we do to slow down, stop, or burst? So that'll be next. And then I'm going to do one on mental health after that. How not to age, though. That's a good one. I just had David Sinclair in here the other day. Oh, great, great. Fantastic. I got Dan Buettner coming back here tomorrow. Oh, nice. So I'm all about the longevity. Give him a big hug for me.

Aging stuff. That's super interesting. I mean, I think the work that David is doing, obviously, that's in the genetic field. It's not nutrition per se, but I think there's so much emerging science that's happening right there. It's pretty fascinating. You know, in fact, there was this one seminal paper that really inspired me to write the whole book. And that was basically the big pharma got together, the top researchers in the world, flew them to some luxury resort somewhere. And so Sinclair was there and Falter Longo and everybody who's anyone in the field got paid enough money to all come together to list the most potentially, the most druggable longevity pathways in the body. Like if we wanted to make a longevity drug, how would we do it?

So they all sat down. They came up with these five biochemical pathways for longevity. And I looked at these and I said, wait a second, every single one of these we can modify with diet. So we talked about like mTOR and IGF-1 and all the, wait a second, we could all do, you know. So I was like, oh, that's the whole book. Like one chapter at each we can, yeah. So I'm really excited about digging in. Yeah, very cool. So I imagine you probably get this from time to time. Dr. Greger, love the new book, but I gotta tell you, I've been on the keto diet. I've lost all this weight.

I feel good. Or I'm on the carnivore diet. I'm on this diet. I'm on that diet. So, you know, like you can't tell me that your way is better than my way. Right, and I mean, I can say, let's see your lab work or let me see your arteries, let me see your calcium score.

Let me see, I mean, you know, I'll just say what's in there. Blood work doesn't mean anything. That's a sort of common retort from the low-carb carnivore camp that the blood work is misleading because it doesn't necessarily mean what it says. Well, I mean, if you have science to support that, but that's not what the, I mean, the science shows. I mean, so, you know, there's, you know, the presidential advisory from the American Heart

Association came out, you know, because of these crazy myths out there that they have to write these papers saying, yes, saturated fat is bad for you. Yes, coconut oil is bad for you. And, I mean, and yes, LDL is a leading predictor of heart disease. I mean, you know, I mean, things that have been settled science for decades, but in the internet age of flat earthers, we have to come out and explicitly say it. Right. And so, I mean, yeah. And we don't just have, you know, short-term biomarkers. We have, you know, large populations of people who follow diets, even trending in that direction, living significantly shorter lives.

It is interesting that the carnivore diet has caught the attention of so many people and seems to be like a trending thing right now. It's like a, yeah, it's like if an internet troll were a diet, it would be the... Right? I mean, it's just like that, right? But I mean, look, you can imagine someone with food intolerance, whether it's celiac disease or anything. It's the ultimate elimination diet. It's an elimination diet, right? And so people go on elimination diets. I mean, typically you put someone on like water, sweet potatoes, and tapioca, like three things no one's allergic to. And then all of a sudden their joints feel better.

They have more energy. All of a sudden their chronic indigestion goes away. Okay. And then you add back, what was it? What was it about your diet that, you know, was causing a problem? And so, I mean, it's the same thing. I mean, you're just basically, you know, excluding. And so if you did have some kind of intolerance, well then, you know, but obviously, then you'd want to add healthy foods back into your diet to find out what it is.

And so you can actually live a long, healthy life. is the fact that now there is this proliferation of amazing tasting plant-based analogs to every food imaginable, right? And it all tastes great. And I'll find myself indulging in that a little bit more than I should and kind of selling the lie to myself like, oh, it's plant-based, it's cool.

And knowing of course, like this isn't the healthiest thing. This is not Dr. Greger's daily dozen. And then I follow that up with another kind of layer of denial, which is that because I'm an athlete, that I can kind of outrun it. I can burn it off. And as long as I'm trim and I feel good,

that I'm not necessarily paying the same toll that somebody else is. And I know that's not true. And so there's always like, yeah, I'm plant-based, but I can certainly iterate and evolve to do better than I'm doing. Yeah, yeah. No, and that, right, it's a process and it's harder.

I mean, but what I see, when I see an ad from Burger King bragging that it's 100% Whopper, 0% beef, they're bragging that there's no beef in their new burger. I mean, that just speaks to me to the tremendous surge in interest in plant-based eating. Of course. I'm not, I don't mean to be. Right. Right. So when I say, right, but nutritionally, right, if you look at these things, often more sodium, usually coconut oil-based, so may have as much or more saturated fat even sometimes.

So these are, right, not healthy foods, step in the right direction, stepping stone foods, I like to call them. You know, not everyone could go, you know, kale chemo overnight, but transition foods to get people in the direction of eating healthier. So I see a tremendously kind of optimistic social phenomenon, but my concern is that people will stop there. People will just kind of switch over their milkshakes, their cheeseburgers and milkshakes, and then stall there and not capture the full benefits of plant-based eating. Yeah. It's never been easier to eat. You can go to Burger King and get fries in a burger, and you can then go get coconut ice cream and knock yourself out and then wonder,

how come I'm not losing weight? How come I'm getting fatter? Yeah. I moved to Philly recently. There are multiple all-vegan donut shops. Like, oh, which all-vegan donut shop do you want to go? I mean, that's right. And so, right. I mean, you can have a terrible, terrible vegan diet. I know that if I'm eating whole food plant-based and I'm adhering to that pretty strictly,

that I don't really have to, like the idea of needing to diet, it just doesn't, I don't have to worry about it, right? So how not to diet. I know that's tricky, right? How to diet not, as Yoda would say, would have retitled it. So knowing that then it is how not to diet. And yet it is a program that extends beyond just eat these foods. Like you have these strategies and things to kind of accelerate that aspect of it. Right. And because I wanted to, I mean, with so much kind of nutritional noise and nonsense out there,

I just wanted there to finally be not only an evidence-based diet book, but, you know, I cite thousands of studies digging up every possible, you know, tip, trick, tweak, technique proven to accelerate the loss of body fat, to give people every possible advantage and kind of, you know, build them an optimal weight loss solution from the ground up. Basically, my criteria is if, I mean, if it's been proven to cause weight loss and it's not, I mean, ahead of low bar, like, I don't have a chapter on which cigarettes are best to smoke. And we know nicotine is, I mean, proven, you know. But so I say, look, we can eat nicotine-containing foods

and maybe get similar benefits. But – and there were some things I actually cut out. Like, there was a licorice root chapter I took out because the therapeutic index of you could get too much licorice really easily and hurt yourself. But there were some things, there was some base level of safety. But beyond that, if it caused weight loss in a randomized control trial, it's in the book. And I want to give people every possible kind of advantage. And so that's where I came to this kind of 21 tweaks thing to add on to their daily dozen. Now they've got like 40 check marks every day, you

know, if you really wanted to go all out. So if somebody comes to you and says, listen, I'm 50, 60 pounds overweight, I gotta drop this weight. My life hangs in the balance. Like, how do you kickstart that person? Like, walk me through, like, if you had, you know, five or 10 minutes to speak to this person, how do you kind of get them sorted and on their way? Yeah. So get them the right information, right? I mean, so, yeah. So, you know, I could share them the app, Dr. Various Daily does, and free app. Obviously, everything I do, everything I produce is available free. And then, you know, tell them about something like 21 Day Kickstart Program from PCRM, Physicians Community for Responsible Medicine. First of every month,

it's totally free. Bunch of different languages, hundreds of thousands of people have done it. You do this kind of social media group together and you get daily advice and tips and things like that. Again, just to stick with it long enough so you can see the benefits yourself and then it's no longer some doctor wagging their finger at you, but you have that internal motivation to stick with it because you feel so much better, your digestion is better, your sleep is better, your energy is better. Oh, and you're losing weight and, you know, without thinking about it.

What are some of the crazier turnaround stories that you've heard or experienced? Oh, well, I mean, the most exciting things is diseases for which there's nothing in the literature that suggests it's possible. So people come to me and say, I have Hashimoto's thyroiditis, hypothyroidism. And I tell them, you're going to be on thyroid hormone replacement the rest of your life. Your thyroid cells scarred up. It's over. And we can help prevent it.

But, you know, and they say, no, no, I had it. I was diagnosed. I was on this for years. And then I went plant-based. And all of a sudden, I'm off my thyroid medication. Here's my TSH. Here's my lab values. And I tell them, your doctor has to write you up as a case study. I want to see this published and I'll do a video about it. I mean, so they'll,

you know, someone comes to me with ankylosing spondylitis or some, one of these, you know, horrible inflammatory autoimmune diseases. I'm like, look, we have great data on Crohn's and multiple sclerosis and ulcerative colitis and other similar rheumatoid arthritis, similar inflammatory. I'm not surprised it helps with your disease, but there hasn't been anything published yet. And so quick, we got to get you, we have to, you know, it doesn't exist in the scientific world unless it's published in peer-reviewed scientific literature. And so I encourage them to get it out there. And actually there was just a case series on ankylosing spondylitis, I'm excited to say. But I mean, you expect that you, I no longer have diabetes, I no longer have heart disease, I mean, all these things. And teary-eyed and, I mean, they're out of their wheelchair,

they're walking again, they have their lives back and they have a future again. That, old hat, that's what I've been seeing for years. But what some of these new, you know, where someone says, you know, I have some, you know, some disease I have to look up and help with that too. And you say, wait a second, it's a little snake oily panacea, right? I mean, that's a red flag when someone says my thing can help with X, Y, and Z. But you realize, look, we're talking about a diet that improves arterial health. Every single one of our organs needs blood flow to get rid of waste products, get oxygen, nutrients. And so

no wonder that a heart-healthy diet is a brain-healthy diet, is a liver-healthy diet, is a kidney-healthy diet, right? And a whole food plant-based diet is basically synonymous with an anti-inflammatory diet. And since inflammation plays a role in so many chronic diseases, no wonder an anti-inflammatory diet is going to help kind of across the board with all these things. And so, I mean, there's these kind of underlying, you know, mechanisms by which, you know, you can imagine. And look, even someone will ask me, does it work for disease, you know, Z that, you know, and I say, well, I don't know, but a healthy diet can only help, right? I mean, look, probably people with disease Z probably still die of heart disease, number one, right? So for example,

breast cancer, postmenopausal breast cancer, number one killer of older women with breast cancer is heart disease. Still kills them more than breast cancer. And so whether or not a whole food, blood-based diet reverses breast cancer, you're still more likely to die from heart disease. And we know we can reverse heart disease. So of course, everyone with breast cancer, of course, everyone should be on this healthy diet. And then if there's side benefits, well, then great. I mean, you know, as we've seen with prostate cancer and some other conditions. Well, when you look at, yeah, like what you said, I mean, what's killing people? Heart disease, stroke, obesity, you know, in terms of brain health, Alzheimer's is exploding right now.

And to the extent that you're eating in a way that's improving arterial function and reducing inflammation. Right. The downstream domino impact of that, you know, has all kinds of positive consequences. Even if it doesn't help, it helps, right? Even if it doesn't help that particular thing, I mean, right? That's like that meme of, what if it turned out that global warming is a hoax? We just improved the planet for no reason, you know? There we go, right? Right. I mean, like, well, does stopping smoking help this disease? I don't know, but it's probably a good idea to stop smoking, right? I mean, it's just, I mean, it's just kind of, yeah.

What is a day in your personal life with food? Like, how do you make it work? Well, on the, well, yeah. No, I mean, on planes. And how do you deal with the airports and all of that? Yeah, airport food courts. Yeah, well, look, it's getting easier. Now you can get, like, brown rice in an airport.

I mean, that's great. Like, you see, like,. Yeah, airport food courts. Yeah, well, look, it's getting easier. Now you can get like brown rice in an airport. I mean, that's great. Like these, you know, fast casual places. Like, you know, things you never expect to see before. And look, there's, you know, I've grown better, you know, if I can, you know, land someplace and find Whole Foods and have a hot bar and grab some food. And, you know, first few days I have snacks and then slowly it's all gone. You know what I've been doing recently is I, we tell the organizers, you got to bring me food. You know, I mean, there's only so many microwaves. Put it in the rider. There's only so many sweet potatoes I can get on my plane.

He's the guy with the crazy rider. Right, right, right. Who does he think he is, Van Halen? Not only no green M&Ms, no M&Ms, period. It's all, right. And so, right. And so look, I, you know, I need to, I, yeah. And typically I don't even have time, even if I could, I mean, right. Even if there's healthy food around, here I am, Southern California, I could get healthy food, but I don't have time. I mean, it's just- And on the rare days that you're at home. Oh, now then, once I have control over my life-

I love how excited you are. And no, that's a beautiful thing. Well, I mean, I just, yeah, this is my first day of this few-week stint. And so I'm feeling the leaving home thing. It was hard to get up this morning. But, yeah, then I can eat this beautiful diet. And it's like a game. Like, how healthy can I get? I mean, it's really.

And you know what helps? So I do a lot of food delivery, like whole foods delivery. And then, then you're not even tempted to buy junk because it's not in front of you grabbing. And so it's like everything I eat. So my house just has healthy food. And so if you get hungry enough, you're going to eat an apple, right? I mean, there's nothing, you will eventually eat that apple, right? And so with only healthy stuff, you know, I can, I can build up my healthy immune system. Always making the healthy choice the most convenient. Right. Oh yeah. I could go out in the Philadelphia winter and bike someplace to get something,

to bike to the donut shop, but so much easier when I have a fridge full of yummy food. And do you prepare stuff ahead of time? I do a lot of batch cooking. Yeah. Yeah. Yeah. Particularly now I'm doing a lot of this prebiotic mix. I talked about my, when I, in studying the, improving your microbiome for the big microbiome chapter in the, in the diet book. And just learning how, again, how important microbiome is and where are the most concentrated source of prebiotics. And so I discovered sorghum for the first time, discovered all these weird millets that I had no idea that have poorly digested starch. And so they are fed to animals, but poorly digested starch is exactly what we want because it's poorly digested in our small intestine, makes it down to our lower intestine where our good gut bugs can have a bounty of

prebiotics and then has all those knock-on benefits. And so that's the kind of thing where I just instant pot a huge amount and just, you know, tupperware in the fridge and, you know, take out one every day since it's over. And, you know, so I always have my intact grains and a whole bunch of wonderful black lentils. And then it's a matter of just getting greens in the house. What else did you learn about the gut biome in prepping for this book? What's neat is now we have these interventional trials. So we've always known you can...

So flashback a few years ago, it was a black hole, almost no pun intended, where because most gut bugs are actually unculturable in laboratory conditions. Like we can't grow them outside of the human colon. We don't know what the gas, we don't know. And so it was a black bug. We had no idea what was going on there until we had genetic fingerprinting techniques. And all of a sudden, for the first time, we'd be like, oh, okay, we can actually

track people's microbiome over time, compare people's different microbiomes, and we can correlate diseases with different bugs in our gut and change people's diets, change the microbiome, see the beneficial or adverse effects. But that's the problem. If you improve someone's diet, all of a sudden you give people lots of whole grains and legumes, beans, split peas, chickpeas, and lentils, lots of prebiotics. They get these beneficial changes in their microbiome and all of a sudden they have amazing health benefits. Yeah, but you just fed them a whole bunch of healthy food. How do we know microbiome has anything to do with it? That's where fecal transplants come along, right? Then we

can prove it's the microbiome because we can take those gut buffs and put it into somebody who's continuously the crappy diet and see if we can get those same metabolic benefits. And that's what we're seeing. So we're seeing, so someone gets a fecal transplant for someone who's overweight, all of a sudden they start packing on pounds, eating the same food. Or there's- That's crazy. Mental health changes, all sorts of crazy things. And then we can prove it's the gut bug. Now, what happens is, of course, it's temporary because, right, you infuse the gut bugs, but then you keep starving them by not eating any fiber and then they die away. But you see

initially those same benefits, of course, you got to feed those bugs or they're going to die off. But so what went from a correlation science, now we have a causation science. And it's just fascinating that we can transfer the benefits of healthy diet. So I mean, so the black market rich roll stool, you could, I mean, you know, the, I mean, yeah. Start selling that shit. Exactly. I mean, who wouldn't pay?

It is fascinating. I mean, the links to cravings as well, like the nature of the gut flora impacts the foods that you crave. Immunity, yeah, yeah, yeah, yeah. And it also, I think, is because it's so complex that it's rife for confusion and people kind of making claims about what you should and you shouldn't do that we don't necessarily have the ability to really back up at this point. Particularly this kind of personalized nutrition. People all the time are sending me things. I sent my stool sample in to this company and gave me back a thing and said,

I should be eating this and I shouldn't be eating this. We don't have that kind of granularity. It does not. Same thing with DNA testing, right? People, they get back their genome and say, oh, well, I'm whatever. I shouldn't be eating the X, Y, and Z. We don't have that kind of biological understanding. But is it true we should be eating fermented foods and we should be eating the X, Y, and Z. We don't have that kind of biological understanding. But is it true we should be eating fermented foods and we should be eating a variety of nutritionally dense foods to be kind of seeding that gut flora with a diversity of bacteria? So it's the three, right? It's prebiotics, probiotics, and polyphenols,

which are these kind of tend to be brightly colored pigments in fruits and vegetables. These are kind of the three things that benefit a good microbiome. And you can use all three of them or just two of them. I mean, the problem with probiotics is you take them and then they just die off. You don't continue to eat healthy. And so if you just have like antibiotic-associated diarrhea or something, you wipe out your gut bugs, then I see a therapeutic role of something like probiotics. But otherwise, taking probiotics is useless because they'll just die off. If you put them in the same environment that didn't grow good gut bugs in the first place, putting in some good acidophilus, they're just going to die off because you're not feeding the

acidophilus because good gut bugs are by definition fiber feeders, resistant starch eaters. I mean, that's what makes good gut bugs grow. And so what we really need is we just need to feed our good gut bugs, prebiotics. And people are like, oh, I eat so many fruits and vegetables. But let's realize fruits and vegetables are almost all water. Like, you know, fruits are like 80% water. Some water-rich vegetables, 90%, 95% water. They're water in vegetable form. Not actually a lot of fiber.

You can actually have a pretty deficient, fiber deficient diet if you're not including whole grains and legumes, some of these drier foods into your daily diet. Wow. That's good to know. Because I just thought, well, as long as I'm eating a lot of high fiber foods, like I'm basically taking care of my prebiotic needs. All right. But it's actually not... So the fruits and vegetables are not high, I mean, they're high fiber foods compared to what 99% of the population eats. But if you're really trying to build, you know, 70 grams a day, you know, 80 grams a day, or like 120 grams, which is how we probably evolved, you know, based on human coprolites, you know,

fossilized feces, then, I mean, and you do the math, people don't even close. So, you know, Ornish, you know, really healthy, you know, whole food plant-based diet, you got to like 60, which is, you know, average is about 15, recommended minimum is about 30. And so getting 60, but I mean, that's a remarkably healthy diet to shoot up there. And then these population studies where they have essentially no heart disease, no diabetes, no breast cancer, like sub-Saharan Africa a half century ago, they were getting the triple-digit fiber consumption every day. And so part of that benefit may actually have been the microbiome.

And that was the benefit of the fiber as opposed to, you know, dropping one's cholesterol or something. Right. More will be revealed though. I think there's got to be like lots of crazy studies being performed right now. Oh, fascinating. No. And so there are vegan fecal transplant studies. What can we, will you give someone a, you know, they do it through tubes, they do it through capsules. You know, you just don't want to burp after that, you know, they do it through tubes. They do it through capsules. You just don't want to burp after that, you know, that kind of thing. Do you know Robin Shutkan, Dr. Robin Shutkan? She's a D.C. physician who specializes in the microbiome.

And she was on the show a long time ago, but she was predicting not only fecal transplants becoming like a booming business, but actual spas, like high-end spas where you could go and have your artisanal transplants. Right, right. What you want them to eat for the week before you show up. Yeah, exactly. Right, right. I want that. Right. That's funny.

Oh, that's great. Well, let's shift gears. I want to talk about sitting for a minute, because you did some interesting stuff here in the book around that. I know you're... We're sitting now, but sitting is... Unless you're on an airplane or in a car. Yeah, yeah.

I'm stuck in my butt all day in a plane, typically. But yeah, so I mean, there's this myth that sitting's the new smoking. Not by any stretch of the imagination, at least 10 times more deadly to smoke than to sit. But prolonged sitting, defined typically over six hours a day, is associated with increased mortality, even if you then go out to the gym and work out hard for an hour a day after work. And so it does, I mean, that helps, but doesn't completely counterbalance the fact that you're sitting all day. We think a lot of that has to do with the venous stasis, the coagulability of your blood,

the fact that you're not actually having movement of blood through your veins in your lower legs, affects endothelial function and affects your systemic arterial tree. But even something like bobbing your knee up and down has been shown to completely eliminate those effects. That's wild. And they have someone just bob one knee up and down versus the other, and you can measure the differences in what's going on in their legs. And that is what's correlated with this increased cardiovascular disease morbidity and mortality. So there's a way. So even if you're a truck driver, even if you're stuck inside all day sitting down, there are things you can do. And so, yeah, and there's

all sorts of... I go through all the various different little bars and things that you can put under your desk and which ones work, which ones are just fads. And so there are ways you can counterbalance the effect. Or you can do ways you can, I kind of bounce effect, but, or you can, you know, do a standing desk, walking desk. I love getting back to my walking desk. I'm addicted to the thing. Wasn't there a study that you looked at where they put people on basically, you know, a standardized amount of calories every day and said, you can exercise this much. And there was a difference in between, you know, some of them lost weight, some of them didn't. And it came down to how much they were sitting. And then there was this realization that there are certain people that

are walking around all the time, kind of casually throughout the day. And they were having amazing benefits that the people who were just eating the same and working out the same, who were sitting more, weren't able to realize. Yeah, these neat benefits, right? These non-exercise thermogenesis. So what they realized is that we typically, you know, this whole calories in, calories out, and you ask people what matters, and people actually either say they're the same or calories out matters more, and that's completely not true. We have almost total control over calories in. In fact, we can eat nothing.

out matters more. And that's completely not true. We have almost total control over calories in. In fact, we could eat nothing. Although in calories out, typical exercise, like casual exerciser, it's only like 5% of calories out. Most of our calories out are our energy intensive brains. Most wild animals, movement is their number one calories out. For us, it's our brains. We could lie down in bed, chained to a bed all day, still burn over a thousand calories. our brains. We could lie down in bed, chained to a bed all day, still burn over a thousand calories. The most of the, and so that's why it's so hard to outrun a bad diet because, you know, even a moderately obese person, moderately intensely exercising for an hour burns 350 calories. I mean, most snacks, drinks, processed foods have like 70, are consumed at 70 calories a minute. So five minutes eating just wiped out a whole hour of exercise. That's why it's so difficult. But what they learned is because,

and so there's a, you know, like a 60% slice that's just like, you know, basal metabolic, you know, activity, keeping your breathing, your heart pumping, your brain going. And then there's a small sliver, unless you're a mountain climber, an army ranger or something really doing intense exercise, you just have a small fraction of voluntary exercise. But then there's this non-exercise thermogenesis, which is fidgeting, which is just moving around, walking around, you know, standing rather than sitting. And so now we have these accelerometers we can put on people. And so it really revolutionized our understanding of where

these calories are going and why you put people on the same calorie diet, the same enforced exercise schedule, and some people lose vastly more amounts of weight than others. And most of that had to do with, it's not like some people just, you know, had metabolic slowing or there's some biochemical thing going on. No, it was the amount of this, you know, non, you know, typical kind of exercise, you know, where you're setting out a half an hour to do any kind of exercise. It was just that they're just moving around more during the day. And so how can we enforce that? Well, being at a standing desk, you have postural muscles, otherwise you collapse to your floor. You know, anything you can do to get you to just move yourself more and, you know, bouncing your knees, that kind of stuff.

I mean, that dovetails pretty perfectly with the Blue Zones findings, right? That these people that live so long and live so healthy are people that are just kind of in constant low-grade motion throughout the day. Right, they're not going to the gym, right? Because their whole life is just, we were built to move. And so, I mean, that's what some of that sitting data suggests. What about the person who has struggled

to lose weight their whole life, and no matter what they do, they just continue to gain or they stay at a certain point? Is there validity to this being hormonal or an endocrine problem? You hear people say like, oh, it's my genetic makeup or I just have a slow metabolism. Right. So there are some conditions. So for example, hypothyroidism, where it does slow down your metabolism by about 15%. And indeed, it's just harder for them to lose weight.

But there's no such thing as someone who's basically obesity resistant. There are people who claim, no matter what, even if I don't eat anything, I gain weight or don't lose weight. And so scientists locked them in a lab. And when you do that, everybody, everybody, everybody with, there's never been a single published case, they lose weight. In fact, exactly as they should in terms of body fat. Some of them, and this is where this comes from, start retaining water such that they lose no weight after not eating for four days. And so the bathroom scale says they haven't lost a pound. But if you actually do CT scans, DEXA scans, actually see what's going on inside their body, they're losing body fat exactly as predicted, but they're retaining all this water. And then finally, when the diuresis happens,

all of a sudden they plunge down and match exactly onto the curve. But it can take days for you to reach that. And so you can imagine people who are like, I'm starving myself for literally days, not losing a pound. There's something wrong with me. No, you are actually losing body fat every single day. It's just your scale doesn't tell you what compartments you're losing that weight from. Wow. That's interesting because I feel like that does come up quite a bit.

People will say just, there's something different about my genetic makeup that makes me immune from these positive experiences that other people have. So they just have to get enough time. Yeah. One of the things that I hear quite frequently is, Rich, I've been listening to you,

I read your book, blah, blah, blah, blah, whatever, I saw the movies. I went plant-based for a while and now I'm pretty much there, but I went back to some fish and a little bit of meat here and there. So I'm kinda 90% in your direction. Like, is that good?

Like, how does the evidence and the science break down in terms of somebody who is predominantly plant-based? I guess the word plant-based, I mean, how do you define that? If you're plant-based, it doesn't mean you're plant-perfect or you're plant 100%. What is the difference between somebody who is adhering to your optimal protocol versus the person who is indulging in a little bit of meat and dairy products on the side. I think the body has a remarkable ability to bounce back from insults. In fact, that's what this kind of this heart disease reversal data shows is that you can have, you can eat a lifetime of this horrible food. And then even, I mean, the average age is like in the 60s, some of these

reversal studies. And even after a lifetime of that, you can clean out the areas the body was just waiting for you to stop, you know, attacking your arteries with these foods. And you could rapidly reversal. And you get more reversal the more compliance you get. But the compliance wasn't perfect in most of these studies. And so people were eating those kind of 90% type diets and seeing the remarkable benefits. so people were eating those kind of 90% type diets and seeing the remarkable benefits. You know, it's like there's no study in the world that suggests someone who's like a social smoker who picks up a few cigarettes at a party once a year is going to have any greater, you know, lung cancer risk than someone who doesn't smoke at all.

Of course, we tell people don't smoke at all because we're afraid this is going to kind of, you know, lead down that path. And some people are easier or ironically more compliant with strict rules, black and white rules. So if you're like, there's no cheese in the house versus a little cheese in there, I'm just going to have a little bit. The concern, I think, with a lot of these plant-based physicians who are like, absolutely be strict, zero, you know, we don't want you to eat any of this. It's not that they think, it's not that the science supports, we need that level of

compliance to get the benefits, but the concern is you won't, is that you'll slip back down to your old ways. I mean, so it's a psychological, you know, it's easier for an alcoholic to completely be a teetotaler than it is to- Yeah, yeah, trust me. I mean, a couple observations on that. I mean, I certainly fall into that camp. Like I have to have ardent, strict rules around this stuff because if I, you know, partake a little bit, that just opens the door for more. Like I just know myself well enough to know,

like if I could have a little bit of cheese here and there, that I could maintain that for a little while. But six months later, there'd probably be a lot more cheese happening. Like it just leaves me down the line. That would be the harm. It wouldn't be that cheese once in a while. That wouldn't be the harm. It's that it triggers, it basically keeps that craving alive rather than allowing me to transcend it. And it doesn't allow your taste buds to adapt, right? I mean, our taste buds have been so deadened by the hyper salty, hyper, hyper-sweet,

hyper-fatty foods such that natural foods don't taste any good. And so then you feel like some kind of aesthetic monk where you're just eating it, but give it a few weeks and all of a sudden, you know, the soup salted to taste weeks ago, we have these great studies. So it's actually too salty. You prefer lower salt soup. And the same thing happens with, you know, but look, the ripest peach in the world tastes sour after a bowl of Froot Loops. Like, I mean, natural food. But all of a sudden, you get to a point where if you start – if you get rid of all that crap, then all of a sudden, you know, corn on the cob, no butter, no salt, tastes delicious. Like, natural, healthy, whole food. Then you get the best of both worlds.

Wait a second. Tastes delicious and you get to live longer. That's what plant-based eating is all about. But you may never get there if you, you know, well, I'll have a little cheese here, a little cheese there. You maintain that palate. Yeah, because you can't make that. Yeah, exactly.

And then, okay, I'm going to be good, eat that salad. And the salad tastes like cardboard because, you know, it doesn't have the same kind of, yeah. Right. I know that to be true because I've experienced that in my life. But I think people hearing that think it's bullshit. Like, they're like, they can't believe,

they can't believe that that's true. They're like, that sounds great, but there's no way. Yeah. No, yeah. It's got to have the face. And the other observation that I have about this is that I don't think people are very good objective. They're not objective about what they're truly doing. Like when they say, oh, I'm having a little bit of this, or I have a moderate amount of this. I think their perception of that moderation is generally, in my experience, completely out of whack. No, in fact, there's a great study that I talked about in the new book where, and this is the reason why moderation, why food industry loves moderation. They asked people what they thought a moderate amount of chocolate would be, moderate

amount of processed meat, moderate amount. They go through all these foods, right? And what was the definition of moderate? Exactly how much they themselves were eating. No matter how much they're eating, that was defined as moderate based on their own intake. They're eating a chocolate bar every day. That's moderate intake. And so when the food industry says in moderation, that's basically giving people license so when the food industry says in moderation, that's basically giving people license to do exactly what they were doing before because everyone thinks that they're eating moderate amounts of bad food. Amazing. And it goes back to the psychology of all of this. It really isn't about the information.

It's about people's emotional baggage around all of this stuff. And I really think that that is the biggest barrier. Like when somebody says, I can't lose weight or whatever, there's a whole, you know, package there that needs to be, you know, really deconstructed in order to get that person, you know, acclimated towards a new way of living and eating. And I have a chapter in the book talking about those psychological, we have these glitches, right? So I talk about in psychology, literacy, they call it the what the hell effect. That's the, you eat one cookie and you eat the whole bag because, well, I already screwed up. Which makes absolutely no sense. Just take a step back, wait a second.

So I made one step away from what my plan. So I'm just going to go out. That makes absolutely no sense. In fact, you eat that one, then you definitely shouldn't eat the whole. But our psychology goes in the absolute wrong direction. And the same thing, then there's the flip side is making progress towards a goal actually gives people license. So losing weight one week is correlated with gaining weight the next week.

But just the understanding of that, knowing that that's a glitch, the hope is that you can catch yourself, right? And so, you know, I find myself, you know, after some four-hour book signing, you know, jet lag to heck, you know, staring at whatever goodies are in my hotel minibar, right? And have this, my first reaction is like, I deserve this. Like, oh my God, I've been, what I went through today. But then I just, what the hell? You know, I just, the self-licensing. And I say, no, what I deserve, of course, is to be healthy. And so, yeah. I think momentum is underrated too. Once people get a little practice with this and they're

starting to see even the smallest amount of result, positive result, then it really like enforces, you know, that drive to keep going. And it's almost like an insurance policy or a barrier against those kind of slips. And I think- There's something mystical about that. And that does argue towards the more, if you're going to try it, go all in, as opposed to the 80, 90%, right? If you're going to try it like a free sample, right? That's what I used to tell my patients, right? Try it like a free, look, you can eat anything for a few weeks. You can eat nothing

for a few weeks. I mean, let's just, let's try it. Let's go all in just for, you know, and because people can't stomach the thought of I'm never going to eat another pepperoni pizza the rest of my life. Like, it's just unthinkable. But like, no, no, no, just a couple of weeks. Then we can go right back to eating whatever you want. You know, just give it a try. But the hope is that they go well and they start to feel the benefits, right? So their less painful periods, their chronic migraines, whatever it is, such that then have that internal motivation, even if they don't take advantage. And they do slip back to their old ways. They know, at least in the back of their mind, they know how good they could feel at any time if they just moved in that direction,

but you don't know how good you're going to feel till you give it a try. What changes would you make to our system of healthcare if you were in charge? I mean, listen, nobody goes into medicine to just be a vehicle for diagnosis and prescription, you know, just be a vehicle for diagnosis and prescription, you know. But the system is set up to create a dynamic that forces medical practitioners into this kind of practice that, you know, isn't really necessarily, I would imagine, what they thought they were signing up for. Yeah. I mean, it's really, I mean, in fact, if you look at mental health statistics of practitioners these days, particularly in the United States, this is not what we kind of signed up for because most of what comes in our door, about 80% in primary care, are these chronic diseases for which we have very

little to offer our patients in kind of the traditional medical model, right? We can slow down the rate at which you go blind, at which you lose your kidney function. We can slow down the rate at which, you know, your arteries clog off by, you know, prescribing these drugs. We only have a little time, so we give these prescriptions. But instead of giving fully informed consent that, well, here's your other options that I don't have time to tell you about and may work better and less side effects. But I mean, the system is set up to kind of reward bad behavior. The most profitable doctor visit in North America is a blood pressure check. Doctors love it. Everybody loves it. You can bill for it. They come in, they're on a blood pressure medication, they come in, and then you tweak the drug a little bit and they come back.

It's the easiest. You fit it in a few minutes, you get to bill for it. And it's the most common primary care visit. And for a condition that need not happen at all, it's the lifestyle disease. High blood pressure is a lifestyle disease. But that entire sector of the field would be gone, both big pharma and big medicine. I mean, no one benefits from people eating healthier. I mean, if you go down the list, like the junk food industry, name one industry that would benefit from people eating healthier. And you say, well, what about the health food industry, name one industry that would benefit from people eating healthier. And you say, well, what about the health insurance industry? Don't they benefit from people eating,

because they have to pay for it all. No, they get a slice of the pie. And the bigger the pie, the bigger the slice. I mean, you know, when I get to talk to these, you know, healthcare executives at these conferences, first of all, they'll say, well, they're only going to be on my insurance for a few years. People switch insurance so frequently. Why am I going to prevent their diabetes and have some other company benefit from my preventing their diabetes? And it's just so expensive. And they get their cut. And the more expensive it is, the bigger the cut. And it's just the whole system is rigged kind of against us. You know, the CEOs of junk food companies aren't sitting around trying to think of creative ways to contribute to the childhood obesity epidemic. They just need to make money for their shareholders.

How do you do that? You don't do that selling something that goes bad like produce that you can't brand, you can't make it. You want a snack cake that sits on the shelf, right? I mean, the system is just set up to reward these behaviors that make people sick. Yeah, so how do we change the incentivization so that we get more Robert Osfelds and Michelle McMackens who have created practices where they have follow-up and accountability

and they're providing that kind of extra level of care to help people make these lifestyle shifts. Like there has to be an economic structure that makes it attractive for young doctors to enter into this. Yeah, so I mean, it's a reimbursement. I mean, Dean Ornish had this famous quote saying that, he thought it was the research,

but no, it's all about reimbursement. So he proved back in 1990, right? Decades ago, you could reverse heart disease, number one killer. And, you know, as, you know, hundreds of thousands of people continue to die every year needlessly because the lifestyle purchase isn't reimbursed. buck the trend and find creative ways to, like these shared medical visits where you can bill insurance. There's actually no technical maximum for the number of people you can get. So you can get 30 people in a room and you can bill insurance for each of those 30 people and give the same little speech that you'd give for a group of diabetics or a group of people with obesity. And so that's one of the kind of ways that within the system, doctors have been able to get reimbursed. But yeah, I mean, we just need to change the incentives. Like, why do U.S. taxpayers subsidize by the billions the sugar

industry, the corn syrup industry, make cheap livestock feed for dollar menu burgers. Why are we paying a quarter billion dollars to the sorghum industry? I'm buying some sorghum now because I love it, but I didn't even know about it a few months ago, right? No, it's all fed to livestock. And so, I mean, now you can argue we shouldn't be subsidizing, the government shouldn't be subsidizing foods at all. But if you're going to subsidize foods, how about subsidizing fruits and vegetables, making them cheaper, even free? You're going to subsidize foods. How about subsidizing fruits and vegetables, making them cheaper, even free, and because then they'll have all sorts of knock-on benefits in terms of lower costs across the board. Yeah, or taking those subsidies and channeling them into improving health care or creating those incentives. But the controversy is who's going to pay for health care, not what the fundamental health care is going to be.

Right. I think Ornish did create a reimbursable program, though. Absolutely. Paid for, reimbursed by Medicare. There's two programs now, him and Pritikin. And I speak at Ornish programs across the country. That's often my in into a medical system to kind of promote the program, saying that this option exists. Yeah. Speaking of Pritikin, Pritikin, you know, your entry point to this whole thing begins with

Pritikin. Yeah. Yeah. Amazing. Right. And not a doctor, right? People always think Dr. Pritikin, no, he's an engineer, came from the outside, diagnosed with serious heart disease in his early 40s, and was basically told, you go home and die. There's nothing we can do about it. Back then, we didn't even have drugs. I mean, couldn't even put anybody on anything. And people just get worse and worse, and you die. Heart disease reversible? No.

But then he looked around the world, found these populations. He's a data guy. He just went and said, there's a population around the world that don't suffer from epidemic heart disease. Like, it's unknown. People just don't have heart attacks. In rural China, sub-Saharan Africa. Wait a second.

What was it about these populations? He figured, oh, maybe it's cholesterol and started experimenting around how we can lower people's cholesterol, came plant-based diet and reversed heart disease by the thousands. But back then we didn't have angiography. We didn't have this ability to visualize inside what the arteries were looking like. And so it was a clinical diagnosis. They had angina, they had such bad heart disease, they couldn't walk up the steps. But you just had to trust that the patient had angina. And all of a sudden, they go on a plant-based diet. And all of a sudden, they're running marathons. And the response in the medical community is, well, you never had heart disease in the first place. If you had a heart disease, you wouldn't be running

marathons. Well, it's because it was simple. But all of a sudden, what Ornish brought to the table is we could prove with something called quantitative angiography. Oh, we can actually see the arteries open up, get bigger, improve blood flow, reversal proof in black and white. It's published in some of the most prestigious medical journals in the world. But one of those people that pretty can reverse their heart disease was Francis Greger, my grandmother, who, you know, in a wheelchair after so many bypass surgeries, basically run out of plumbing. And there she was and saw about Pritikin on 60 Minutes. Pritikin was featured on 60 Minutes, somehow made the cross-country track, one of his earliest

patients. She's featured in Pritikin's biography. And she, you know, they wheeled her in and she walked out. Within a few weeks, she was walking 10 miles a day, went on to live another 31 years to age 96 after her medical death sentence at age 65. And that's what changed our whole family. I mean, now as a kid, this was all happening when I was... I mean, I just... Well, yeah, duh, you go to the doctor, you get better. That's what doctors do, right? Little did I know what revolution... Back then, the thought that heart disease was reversible, completely revolutionary. Only later in life did I realize what had happened and what my grandma was part of.

Was Pritikin kind of perceived as a quack in his time? Well, he was putting doctors to shame because he knew the science. I mean, because he had read all the primary literature and so would just demolish. There's actually some old YouTube of his debates. He would just demolish opponents because they thought they knew what they were talking about. Of course, I mean, they were just doctors. They weren't taught anything about nutrition. And so, I mean, he was just kind of untouchable when he was actually presenting the science, but they didn't believe his results.

His results were too miraculous. And he couldn't prove it beyond these amazing patient testimonials. But how far does that really go? It doesn't until we have good data to back it up. And he inspired everything that you've done, right? That's why I went to medicine. That's why I started Nutrition Facts. That's why I wrote How Not to Die.

That's why all the proceeds I received from all my books are done into the charity. I just want to do what everyone, for everyone's family, what Pritikin did for my family. Right. Well, let's round this down. Maybe provide a few starting points for somebody that's listening to this. This information is totally new to that person. They're overweight. They're ready for a change. What's the first thing they do? Go to your local public library and grab How Not to Diet, check it out. And nutritionfacts.org, all my work is free there, no ads, no corporate sponsorship, strictly non-commercial, not selling anything, just put it up as a public service, as a labor of love, as a tribute to my grandmother. I like how you mentioned the library and not the bookstore. Free. Books are free. Literally in your neighborhood. They're just sitting there.

But if you had to tell them, like, look, I'm staring at my next meal. Like, what should I focus on? What are a couple foods or some like thumbnail rules that I can wrap my head around. Yeah. So there's these 17 criteria, which make for the first part of the book, like being rich in fiber, water-rich vegetables, things like that, that through calorie density mechanisms and improving microbiome health and et cetera, can, you know, can achieve that satiety without calorie restriction or portion control. I mean, that's the magic of plant-based eating, as opposed to traditional weight loss approaches, is that, you know, people are told to eat ad libitum, meaning eat as much as you want. And that's because, you know, you take people, put people on a whole food plant-based diet, and you can

slash a thousand calories out of their daily diet, cut their caloric intake in half, they don't notice. Because, I mean, they have these crazy, cut their caloric intake in half, they don't notice. I mean, they have these crazy, it put people healthy enough to actually, you just couldn't, some food's impossible to overeat. 2,000 calories of strawberries, 44 cups of strawberries. You couldn't fit them all in your stomach. Like, you know, I mean, that's just, you know, there's, yeah. You know me. I go on and on.

Listen, man, I love you. You know, I can go out and on listen man I love you I can go out and run really far distances but I aspire to your level of energy you know what I mean whatever you got I want it and you've been so inspiring to me in my journey and I just

I love the impact that you're having on the world and it's massive it's no small thing. You've devoted your life to this cause and you've changed so many other people's lives and it's to be commended. It's an honor to talk to you today. Well, you know what I hear beyond just the documentaries?

I heard you on the Rich Roll podcast and that's why I changed my life. And that's why I'm here. Good, man. Come back again sometime anytime and you're going to speak at a hospital tonight that's right where am I going what's the pitch you don't even know do you know what state you're in I just looked at my phone like oh I'm going to the airport I wonder where yeah what's the pitch at the hospital tonight

um we're gonna do weight loss uh-huh we're gonna do weight loss good We're gonna do weight loss. Good. All right, my friend. Let's get you out of here. Peace. Peace. Mind-blowing stuff. Am I right? Hope you guys enjoyed that. If you have any questions or feedback for Dr. G, you can shoot him his way on Instagram at MichaelGregorMD

and at nutrition underscore facts on Twitter. Pick up How Not to Diet and his newest audio book, How to Survive a Pandemic, which are, of course, all linked up in the show notes on the episode page at richroll.com. If you'd like to support our work here on the show, subscribe, rate, and comment on it on Apple Podcasts, on Spotify, and on YouTube. Share the show or your favorite episodes with friends or on social media. And you can support us on Patreon at richroll.com forward slash donate. Thank you to everybody who helped put on this show today. Jason Camiello for audio engineering, production, show notes, and interstitial music. Blake Curtis and Margo Lubin for videoing today's show and creating all the social media clips that I share. Jessica Miranda for graphics, Allie Rogers for portraits,

Georgia Whaley for copywriting, and DK for advertiser relationships. Theme music, as always, by Tyler Pyatt, Trapper Pyatt, and Hari Mathis. Thanks for the love, you guys. See you back here in a couple days with another cool episode. To be determined.

Until then, peace, plants, namaste. Thank you.