The Rich Roll Podcast - Prevent Disease & Thrive: Michelle McMacken, MD on Holistic Lifestyle Medicine & Promoting Optimal Wellness Through Plant-Based Nutrition

Episode Date: July 27, 2015

We need more doctors like Michelle McMacken, MD. Board certified in internal medicine, Dr. McMacken is an assistant professor at the NYU School of Medicine, an attending primary care physician at New York City's Bellevue Hospital Center and director of the Bellevue Adult Weight Management Clinic, where she specializes in plant-based nutrition and lifestyle medicine. Interestingly, Dr. McMacken wasn't always all that intrigued by nutrition. Not surprisingly, her medical school experience was woefully lacking in this regard. But after eight years of medical practice, she was becoming progressively distressed by her obesity clinic patients' general inability to get — and stay — healthy. Determined to find better, more sustainable solutions for her patients led to a search engine result for “lifestyle change” that prompted Michelle to attend the American College of Lifestyle Medicine Conference– a game-changing experience that enlightened her to a holistic, disease preventive perspective on patient care that ultimately reinvigorated and forever altered her medical practice. Beyond her one on one work with patients, many of which are underprivileged, what is uniquely inspiring about Dr. McMacken is her grant-funded commitment to study evidence-based nutritional protocols and apply the practical knowledge to faculty, colleagues & resident doctors. In other words, she is devoted to educating not only her patients about healthy nutrition, but her fellow medical professionals as well — filling the much needed gap in our current system of medical education. This is an enlightening and highly informative conversation that explores: * the state of medical education with respect to nutrition * the responsibility of doctors to practice holistic, preventive medicine * the significance of a plant-based diet in promoting optimal wellness * Dr. McMacken's personal & professional path to plant-based nutrition * the health impact of high protein diets, ketosis & glycogen depletion * the differences between animal & plant protein * alkaline/acid-forming foods and their impact on metabolism * paleo vs. vegan – finding common ground * the truth behind dietary cholesterol & saturated fat * the importance of aligning actions with values * plant-based patient case studies I sincerely hope you enjoy our discussion. What is preventing you from a more holistic approach to long-term wellness? I'd love to hear about your personal challenges in the comments section below. Peace + Plants, Rich

You know, I have this passion about this way of eating. When you take like the health aspect, the sustainability in the environment, and you take, you know, compassion and concern for other living beings, and you mesh them all together, this is really the only way of eating that brings that all together. So for me, this was finding ultra. This was my ultra. That's Dr. Michelle McMackenen this week on The Rich World Podcast. The Rich World Podcast.

Hey, everybody, how you doing? What are you guys doing? Are you on the treadmill? Are you riding your bike? Are you commuting to work? Maybe you're listening to the show while you're at work. Maybe you're preparing a meal for your family. I don't know. It's Rich Roll. I'm back at you. I am your host. Welcome to my podcast. of the deal. This show is all about conversations with some of the brightest minds out there, people who are inspiring positive culture change, people who are lighting the path so that we can all just live and be better. And the idea is to help all of us unlock and unleash our best, most authentic selves. So thank you for subscribing to the show on iTunes. Thanks

for spreading the word on social media, for gathering around the water cooler and chatting about it. And thank you for always clicking through the Amazon banner ad at richroll.com for all your Amazon purchases. It's a great free way to support the mission, and you can make it super easy on yourself by just bookmarking the link from the banner ad on my site. That way it's right up there at the top of your web browser, and you don't have to go to my website. And everybody wins. Michelle McMacken, she's really great. Michelle is a board-certified internal medicine doctor. She is assistant professor of medicine at the NYU School of Medicine. She is an attending physician at the

Bellevue Hospital Center in New York City, where she practices primary care. And she's also director of the Bellevue Adult Weight Management Clinic, where she specializes in plant-based nutrition and healthy lifestyle medicine. And beyond her one-on-work with patients, many of which, much like the work of her friend and colleague Robert Osfeld, who is a guest on this podcast, Episode 140, a lot of the people that she works with are underprivileged. And what's really inspiring to me is that she is also, on top of her daily practice, secured grant money to aid in educating her fellow doctors and medical professionals about nutrition, something that is sorely lacking in current medical education and, of course, desperately needed. So this is a fun and enlightening conversation about the state of medical education with respect to nutrition, the role of today's doctors in promoting holistic health and disease

prevention, and the significance of diet, and in particular, a plant-based diet in promoting optimal wellness. So let's step into the world of the most delightful Dr. McMacken and prepare to be enlightened. Tell me a little bit about your practice right now. Sure. So I work at Bellevue Hospital. I don't know if you or your listeners are familiar with it. Well, all I know about Bellevue is that was the insane asylum.

That's usually the first conjured image of Bellevue where they lock you up, right? Yeah, that's usually the first thing people think of. So I have to spend time kind of dispelling that right off the bat. Yeah, disabuse me of this idea of the Iron Gate. Yeah. So Bellevue is, it's actually the nation's oldest continuously operating hospital. And it's also the oldest public hospital. So it's- Wow. How old? Like 17 something.

Oh, wow. Yeah. Is the original structure still? Wow. Is the original structure still? Yeah. Wow. Yeah. So, and, you know, I think the key things to know about it are it's an extremely mission-oriented place.

So, in being a safety net hospital, we basically take care of everybody, regardless of ability to pay. Right? And the people that that kind of hospital attracts, like the doctors and the nurses and the other staff that it attracts, are people that I feel like I have a lot in common with. Like more service-oriented. Exactly. Yeah, yeah, yeah. Yeah. But it's right in, it's like on the east side, isn't it? It's on 27th and 1st.

Uh-huh. And so it's, it's, so my practice is, it's a primary care practice. I'm trained in internal medicine, which is basically like, you know, you're the person that takes care of sort of everything. So you're taking care of the whole body. You're taking care of all the organ systems, mental health, you know, so like a lot of social stuff. You're kind of the quarterback of like the healthcare team. Right, right, right.

social stuff, you're kind of the quarterback of like the healthcare team. Right, right, right. So do you have a like a private practice outside of the hospital? Or is your office is in the hospital? All Bellevue, it's not the time. So if somebody comes to see you, is it like, like an acute situation, like an ER situation? Or because I mean, it's not usual for somebody to book an appointment and go to a hospital to see a doctor. Right. So there's a very large ambulatory care practice as part of Bellevue Hospital.

So it's a regular doctor's office. There's internal medicine. There's OBGYN. There's all the medical specialties, surgical specialties. So basically coming to see me is like going to see any visit to the doctor. Right. You're just like your general practitioner sort of situation. Right.

Right. So, I take care of adults only. That's internal medicine. And, yeah, I mean, I basically take care of people from all walks of life. So, you know, I'll have most of my practice is actually Spanish speaking because I speak Spanish. Most of my practice is actually Spanish speaking because I speak Spanish. But really a day doesn't go by where I'm not on the interpreter phone in like Tibetan or West African dialect or Chinese dialect, French, Polish. So it's an extremely diverse patient population. And in terms of education and literacy, there's a huge amount of diversity as well.

But in general, I would imagine kind of lower on the socioeconomic scale, right? I think that's, you know, we have people coming from all walks of life. But yeah, I mean, most of my patients have either no insurance at all or have a government-sponsored insurance like Medicaid. And if somebody comes in with no insurance, you still treat them? That's what we're there for. Right, right. Yeah, it's awesome. So everybody gets basically state-of-the-art care.

They have access to 100% of the same services you'd have anywhere. And are they afraid they're going to get locked up in the loony bin in the padded room and get in a straitjacket? They don't express that to me. Does that aspect of the hospital still exist, though? Or is that just some kind of wives' tale? I mean, that must be rooted in some kind of reality back in the day. Yeah. I mean, it has, I think Bellevue, I don't want to misquote, but I think Bellevue has one of the largest number of inpatient psychiatric beds. And so it has a long tradition of treating mental health issues. But that was what it kind of originally made its name doing, right? But like, you know, Bellevue is also a leader in, you know, TB back in the day,

tuberculosis, and even now, like in the 90s, when TB came back, Ebola, you know, we've done amazing things with treating Ebola patients. Wow, that's interesting. So was that, was Bellevue kind of front and center when that recent sort of scenario? Very front and center. Wow. So what was that like? That was us. That must have been pretty, you know, interesting and heightened. Yeah, it was intense. I think there was a lot of, there was a tremendous amount of fear, obviously, around it. And you'd hear things, I mean, just even being in New York, like you'd hear, you'd overhear conversations on the subway about, oh, you know, this person who had Ebola was in the bowling alley in Brooklyn, and I was there

the day before. And there's just widespread panic. The guy was a doctor, right? Was he a doctor at Bellevue? No. I remember that story. Yeah. Wow. But we treated him, and it was a huge success, obviously. And now we're sort of a flagship hospital for future, potential future Ebola cases. So were there, like, medical practitioners walking around in hazmat suits in the hospital and stuff? Or is that like a closed-off wing?

It was a very, very, yeah, very closed off, very controlled situation, extremely well thought out. Because obviously, the consequences are, of not thinking out well are pretty strong. Right. So how did you end up at Bellevue? Like, where did you go to medical school? And what kind of led you into, you know, towards your path? Yeah. So, um, I went to med school at Columbia here in New York and, uh, then I trained, you know, it's kind of at, during med school, I actually originally set out to do public health work. And then, um, pretty early on in my training realized I wanted to, uh, essentially like treat asthma in the Bronx, like do very basic primary care for people who otherwise may not

have it. And I felt like I could probably have the most impact that way. And it used my own skill set the best. And so I went into training in internal medicine. I trained at Cornell, actually. Cornell here in the city. In Manhattan. Yeah. Yeah. Well, Cornell Medical Center. And then graduating from residency or finishing residency, looking for a job, I knew I wanted to be at an academic center. Basically, you know, for me, it was like the mission of service, but also the mission of teaching. So Bellevue was a really perfect fit because obviously the mission of service. And then Bellevue is a teaching hospital for NYU. So my typical week looks like, you know, half the time I'm seeing patients in the office and then the other half the time I'm teaching. I'm basically residents or doctors in training

are coming to me. They're seeing patients and they're presenting, you know, their plan and their assessment to me and I'm giving them feedback. Right, right, right. Supervising. Yeah, I want to get into all of that, but just sort of sticking with the evolution of Dr. McMacken. My only point of reference is law school. that when you enter law school, there's a lot of people who are kind of service-oriented, and they're like, I'm going to go work for this nonprofit or this pro bono organization or something like that.

And then by year three, everybody's shipping off to be associates at big prominent law firms with big salaries. And the rationale is generally like, I'm in so much debt. I'm just going to go do this for a couple years, and then I'm going to go do, you know, what makes my heartbeat. And more often than not, that, you know, sort of doesn't happen. You know, you get stuck into that lifestyle. I mean, is that similar? Is it similar in medical school? I mean, do you see that kind of attrition? Yeah, I think, well, I mean, you brought up the debt issue. And I think that's a real, it's a very real driver of a lot of people's choices in terms of what they specialize in and how they formulate their practice. And it probably should have been an issue for me, but I just, I just said, you know, I just went straight to the, what made my heart beat like. Right, and where does that come from?

I mean, is that, did your parents raise you well? Like, how does it? How do you? They definitely did. You know, where does the kind of compulsion to be in service derive from if you had to articulate that? Yeah, I mean, I'd like to say it's, you know, it's like I'm born with a noble impulse. But really, I just feel like, you know, you can be in service in a lot of different ways, right? I mean, you can be within medicine and you don't have to have a practice at a hospital that serves the underserved to be in service of others, of course. Well, by its very nature, you're in service just by being a doctor.

Right, right. And, but I think for me, there's something about being in, being the person that has the opportunity to offer something where no, where maybe someone else wouldn't have the chance, you know, they wouldn't have the chance to get that. So, for example, a lot of my patients, I'm, you know, I'm the first doctor that has ever sort of called them back with their lab results, for example. I mean, that sounds crazy, right? I mean, you go to the doctor and don't you expect to call saying, you know, like your blood work was good, or this is a problem. And so time after time, when I call my patients back with their lab results, they're like, you're the best doctor ever. I can't believe you called me. And I just think that doing the thing that you're kind of supposed

to do. Right. And so I guess what I'm getting at is it feels really good to be offering that to people. I mean, people deserve that, right? People deserve that kind of relationship. And I'm also, it's just a great platform to educate people about things that are really important to their health and to me, which I know we'll get into. Yeah. I mean, it seems like there's kind of a systemic problem when it comes to just basic patient care and palliative care, right? Like just general rules of human decency seem to get cast aside. And I don't know whether that's because it's a numbers game and you're just seeing so many patients or what kind of happens. But, you know, the typical patient experience is not always so positive, particularly when it comes to, you know, sort of bedside manners and all of that.

Yeah, I think, and we'll probably get into this, but I think the system is broken in a lot of ways. And the system doesn't really allow us as physicians to interact with patients I think the way we probably should and you know you know it takes time to it takes time to deliver individualized care to call people back with their lab results and yet time there's no reimbursement for that and so therefore time isn't carved out for that. And that's understandable at the hospital level or, you know, and it's not just our hospital, it's every medical system for the most part. Right. I think it's, you know, easy to just say, oh, well, you know, they're selfish or there's some kind of God complex with doctors. But I think when you really look at the system and what's driving it and what's pushing them,

like they're just trying to like get through the day. You know, they're good people. It's like you have to be, you know, of a certain mindset that you can get into this to begin with. So that's why, you know, I said it's systemic, I think. I think it's just the structure within, you know, the rules that apply to practicing don't really necessarily provide for that. Yeah, I completely agree. I completely agree. I completely agree. Cool.

So, all right, so you're at Bellevue, but at the same time, you're a professor, right, at NYU. Assistant professor. Well, come on. We can call you professor. Thanks for the promotion. That's just semantics. You're a college professor or a medical school professor.

School of medicine, yeah. And so tell me what you teach at NYU. you're a college professor or a medical school professor. School of medicine, yeah. And so tell me what you teach at NYU. So most of my teaching goes on at the level of the residency. So those are basically people that have graduated from medical school, so the fully-fledged doctors who are in their training program. And some of it is didactic, but the vast majority of it is really just hands-on clinical day-to-day, how do you take care of patients?

Right. So you're walking these new doctors through the kind of daily routine of what it means to be a resident. Yeah. And you're watching what they do with a eagle eye. You are ultimately the one responsible for the care that they're delivering. So you're trying to help them learn and yet make it a beneficial situation for the patient, obviously. And so you're balancing practicing medicine with assistant professor duties. I mean, that's a lot, right? So, I mean, what's a typical day or a typical week look like? Yeah, I mean, it's direct patient care. So me sitting down in my office, in my exam room,

and seeing patients for half a day. And then in the afternoon, for example, I would then move to a larger area where residents or doctors in training come to me and present cases. In other words, they'll see a patient. They'll come up with their own assessment. They'll present the whole situation to me, and I'll say, hey, I think you're on target here. I like your plan. Kind of like a doctor house kind of review. Yeah, only there's not as many mysteries. It's not quite that exciting.

There's definitely some mysteries. But that's in the same – so you're in the same – you're not going to – Oh, no. Like a different building. Same exact area. Uh-huh. Yeah. Interesting.

So, yeah, like I said, I mean, most of the time it's a very hands-on practice. And there is didactic stuff, but it's mostly just hands on practice. And there's, there is didactic stuff, but it's mostly just hands on. And, and so let's get into kind of the plant based. Yeah, slant. Good. Where you're coming from. I mean, where did you know, what's the origin story there? Like, how did you get interested in plant based nutrition? And you know, where did that begin? Like, how did you get interested in plant-based nutrition? And, you know, where did that begin? Yeah, I mean, looking back, I mean, I think it really, there's almost like two parallel roads that I've been on that didn't really converge until fairly recently.

So the professional story, which is a little bit less interesting. We've kind of already gone through some of it, but, you know, I went to college. I was an English major, English literature major. Graduated at the height of the recession in the 90s, like did odd jobs, worked at a used bookstore. Eventually. So you didn't know the doctor thing wasn't part of the college experience? No, that was not at all. You weren't like a driven type A pre-med person? I was a driven type A person, but not pre-med.

But not pre-med. Yeah. Interesting. I mean, I took a semester of chemistry in college because my dad's a biochemist, and I felt like I've got to just honor that. You know? And my mom is, too. So I felt like it's maybe. How did you do?

I actually did well. But then I didn't take the whole year. I just was like, you know, I've done it. I proved that I can take half a science class and excel at it. But I'm a liberal arts person. Yeah, I'm a humanities person. I love, you know, I love novels. I love the story.

But then graduation happened, and I was like, oh, whoops, I need a job. Like, what? So eventually, I lived in Atlanta at the time after graduation, and I eventually just stumbled on a job at the Centers for Disease Control down there as a writer-editor. And I worked there for about three years in my early 20s. And that was the experience that got, like, the gears turning around going to med school. And yet I still had not taken a science class. Right.

Interesting. So at CDC, I mean, that must have been, like, that's a crazy place, right? Yeah. It's an intense place. And that's a crazy place, right? Yeah. Yeah. It's an intense place. Well, it's like a cross between intensity and government, the government environment.

But yeah, I mean, people do amazing stuff. They go out on outbreaks. I mean, they're the folks that are dealing with Ebola, like we were talking about before, and all kinds of stuff. So it was pretty inspiring. And that's where I thought, hey, this is completely unexpected, but maybe I should consider getting involved. And knowing that that kind of decision was at least a 10-year commitment. And I was already at that point, whatever, 25.

Right, and you hadn't taken all the prerequisites in college, right, for med school. So how did you have to – you had to go back and kind of do that, right? Yeah, I did a post-baccalaureate pre-med program. And those programs are great because you're surrounded. It's like you and 24 other humanities majors. Who made this decision. Who are all questioning exactly, like, what am I doing? I can't believe, you you know i'm doing this and um the one i went to it

um in goucher college in baltimore was great because you took every pre-med prerequisite in one year like wow chemistry organic chemistry physics and biology all in one year and uh it's like i like it's like ripping off a band-aid like just get it over with right that's intense and yet i loved it i didn't i you know i actually found out that i was really good at science and um my parents were pretty proud yeah i was gonna say your dad must have been happy right yeah he was oh i finally understood what he did yeah i could finally understand like his publications you know not completely so he's he's like a lab scientist he's an academic biochemist yeah. Yeah. So he does a lot of work with gene replication, DNA replication. Right.

And here you are expressing this recessive gene that now is coming to be expressed, right? Well, my mom has it too. Yeah. Yeah. She's a scientist as well? Yeah. Yeah. She's a biochemist.

That's how they met. So this was inevitable. No doctors. No doctors in the family. So yeah, so then I finished up that program and I moved to New York. Got a great one-year position at the Department of Health as a health educator here in New York. And then that year I applied to med school. And within about a week of moving to New York, I realized I was never going to leave. Like just love it. You love it. Love it here. So, um, enrolled at Columbia and, um,

I like how you just said you just enrolled. Just, just, just enrolled. Yeah. Because I just decided to. Yeah. Well, it's interesting looking back on your resume, like even though you had this, you know, humanities background with the CDC and then working in public health in New York and then having all the prerequisites. I mean, that's a pretty solid basis to get into a good med school. Yeah. And Columbia was great because there were a lot of other postbacs there, too. So it felt like a community and it felt I think there's something about there's a lot of things about being a humanities major and going to med school and starting med school at the age of 27, which to me now sounds young. But at that time, you know, you're whatever, you're six years older than everybody else, which is a big difference at that time in your life.

I think for me, being a humanities major really kept me on my edge because I always thought, you know, how am I going to compete as far as like passing tests and with people that were, you know, molecular biology majors? And the first couple of years were, you know, I did well, but it was I really put a lot of work in. And then towards the clinical years, which are the third and fourth years of med school, where you actually start talking to patients, that's where everything just kind of like blew up in a great way. Like, I was like, this has really been the right decision. And yeah, you just realize like, this is what you're made to do. Yeah. Yeah.

So, so that's sort of the, we kind of covered the professional, how we got here, how we got here. Um, and then I think the personal story, you know, just leading up to, to where I am now, as far as nutrition and plant-based, you know, plant-based eating, you know, I think I'm, I'm one of those people who probably like a lot of, you know, a lot of people or kids are sort of don't have the, um, it seems a little strange to make a distinction between, you know, the food on our plate and the animals that we see. Right. And so I was kind of like one of those people that never lost, like that just kind of, it seemed a little bit strange, like that the food on my plate used to be an animal that was running around. I never kind of lost that sense that it was weird.

And but you weren't like somebody who was like, you know, a vegan animal rights activist in high school or something. I was a vegetarian at a really young age, like 13, mostly because it just intuitively felt like I just couldn't imagine that I was eating the food that, you know, like I was eating an actual being that used to run around. It just didn't seem right, and it just didn't resonate with me. So I was a vegetarian for, I've been a vegetarian for a very long time. I've been a vegetarian for a very long time. And I think when you're a vegetarian in the 1980s, very quickly you realize you've got to learn something about nutrition because you're going to be asked a lot of stuff. And it's not like you're a parent. Do you have brothers and sisters?

I do. You do? I have two sisters. I think three of us, my mom and my youngest sister and I sort of all made this leap around the same time. So I had a lot of support. Yeah. Yeah. In support of you or it was like a collective decision?

It was a collective sort of, you know, just we all kind of, I may have been the first one, but they followed pretty quickly after and not necessarily in support of me, but just where did you grow up? Baltimore, Baltimore. Okay. Yeah. Interesting. So, all right. So you had some support in the house, but maybe not, you know, in the, in the hallways at, in high school, not a lot of support in the hallways of high school, but not, not like, I'm not going to, I'm not going to say I had, I was excessively ridiculed or, you know, it was just kind of like, I think for people, it was just kind of a, an anomaly that was curious, but not, people kind of let me do my thing. Right. But it wasn't driven by health considerations at that time. It was just sort of an ethical glitch that you felt like needed to.

Yeah. It was just, you know, it was just being, just living sort of, living in line with my values, I guess. And so where does that, at what point does that, you know, lifestyle sort of intersect with, you know, your medical education? Where I am now? Yeah. So it did not intersect for a very long time. And actually, I was, you know, continued being a vegetarian and went through college and all this stuff in between before med school and med school. And then residency training and all this time

didn't really change my eating pattern, didn't really use what I knew about sort of the growing understanding of health benefits around being vegetarian to translate that to my patients. It was just kind of like, this is a personal choice. I'm going to kind of keep it to myself and just, you know, like keep working. Right. But along the way, you had mentioned like early on, you started to, you took it upon yourself to kind of educate yourself about how to do it in a healthy way. Yeah. Yeah, absolutely. I mean, you had to, I mean, you really, I think at that point, you really had to, I mean, I definitely had my like, you know, nadirs where I would be eating like white rice and cheese at, you know, in the college dorm, but things weren't like they are

today, but I definitely educated myself a lot. What were the sources of education back then? Like what were the books that were available? Yeah, you're right. I mean, there certainly wasn't the Internet. And I think there were like a couple of guides out, but kind of winging it. But then as I got to med school and residency, there was more stuff out there. But again, it really wasn't a huge priority in the sense of something that I took upon myself to learn a great deal and then translate to my patients. I think, you know, at the same time, I was starting to realize, you know, how little I knew about nutrition in general and how little doctors are trained because, A, we didn't have any nutrition classes in med school. And then in residency, I remember, you know, for example, having, you know, seeing a patient that had a new diagnosis of diabetes and then going back to present the case to my supervisor back then and saying, you know, this is the situation.

And they would say, okay, well, why don't you just talk to them about, like, what to eat so that they don't have to go on pills. And I would go back to the room and, like, knock on the door and go in and say hi and not have any idea what to tell them. Like, I have no idea. And that struck me as being really bad. Right. And that struck me as being really bad. Right. So let's park it here for a minute because it brings up so much about our system of medical education and how we train doctors.

And it's something that I've talked about quite a bit on the podcast, which is this kind of appalling scenario in which we're not training doctors on nutrition. Like irrespective of whatever your dietary proclivity is. The simple fact that there is no formal education in nutrition whatsoever for aspiring doctors is just such a gaping hole. Like it's so crazy. It really is. You know, I think so zero, there was, there was some, did you have electives? Like I've talked to other doctors like, Oh, maybe a couple hours, or I had to take this one thing, but it was really nothing. Unless I'm completely like just repressing it or not remembering it, I don't think we had any.

And I think the figure is something like 25% of med schools or one in every four med school does not meet the recommended number of hours of nutrition. And the recommended number of hours is something like 25 for your whole four years. Yeah. But that recommendation isn't like set in, it's not like a prerequisite, right? It's just recommended. Right. So the medical schools don't they can choose to follow that or not. Is that how it works? I believe so. I believe so. I think that's starting to change. But I think the other issue is that what is taught in those nutrition classes or those hours of nutrition teaching, I'm not really sure. I mean, I know that a lot of med schools teach people and even residency programs teach people about vitamin deficiencies and stuff that you're probably

never going to see unless you practice somewhere outside of the United States. Right. That's what Garth Davis was telling me. Like, oh, you know, for scenarios that arise, like if someone has gout or like just rare, super rare conditions where they have like an extreme deficiency. Yeah. I mean, I'm not like, I haven't seen scurvy in my whole career. Like, you know, I mean, I, or maybe I haven't, I just didn't recognize it. But I think that I think, I think the most of I mean, what my mission is, and what I think people with doctors need to learn is just nutrition to prevent and treat the chronic diseases that we're taking care of all the time. I mean, you have to understand that like a typical day for me is diabetes, high blood pressure, high cholesterol, gout, kidney stones, heart disease, Alzheimer's, you know, everything is related to diet. So the fact that we just to echo what you're saying, I mean, the fact that we don't, we're not given the training to use what is almost universally acknowledged as probably the most powerful tool is crazy. That is crazy.

That is crazy. But you are doing something interesting to change that. Yeah. So you have this grant, right, to, or to do a study and then teach medical profession professionals about nutrition. Is that accurate? Yeah, that's accurate. So let's talk about that. Yeah. So if I could back up, I'll tell you sort of what got me to that point, which is, yeah, we're all over the place in the time. That's okay. I'm sure everyone's keeping up. Just press rewind. So yeah, I mean, I think that, you know, it wasn't, my practice was still, even though I value this stuff so much, my practice was still very like pill based and very treating symptoms based until a couple years ago.

And I have to talk about this because it was such a breakthrough moment for me. I went to, I don't know, I had some conference money and I was like, what's a great medical conference I can go to? And I Googled lifestyle change on a whim. And the first hit was American College of Lifestyle Medicine was having their annual meeting. And as I signed up for it, I went to the conference, and it was a huge turning point in my career because it was a group of, I don't know, 400 or 500 other health professionals, mostly doctors, that are interested in using lifestyle to prevent and treat disease. And then the speakers at the conference were so inspiring. You know, I heard Dean Ornish, Neil Barnard, Michael Greger, who's hilarious and so smart and just captivating.

And, you know, a number of other great speakers. And I remember the first day of the conference being just feeling like I was zinging. Like I went back to my hotel room after the conference and just like was reading articles and emailing stuff and felt like a manic episode was coming on. I mean, it just, it was like I finally had found, it took me realizing there's a whole community of people interested in the same thing and seeing these inspiring speakers. And I think the second day I sat down for lunch, like the conference lunch, and I sat down and looked across the table and it was Caldwell Esselstyn was sitting there

and like T. Colin Campbell's son who co-wrote the China study. So it was just one inspiration after another. How many years had you been a doctor at that point? I want to say eight. Wow. Well, eight after my training. So a lot of years. Many, many, many years.

And in some respect, you're already living this lifestyle. You're interested in these things, and yet, completely unaware that this world with all of these, you know, incredible people exists out there who are, you know, trying I run it on lifestyle change. But I think that when I'd gone to national obesity conferences, I remember one that I went to, there was not a single mention of food. Not a single mention. How is that even possible? I know, right? Well, I mean, to be fair, I think it was a bariatric, you know, a weight loss surgery based conference, but still, you still have to eat and

it still matters. Right. I mean, Garth always talks about all those he, cause he goes to all those, those conferences on bariatric surgery and obesity. And I guess, you know, what he says is that they're, they're really pushing kind of the,-protein, high-fat, low-carb diet. But then he always takes pictures of the breakfast at the conference. And it's just massive amounts of bacon and eggs and all kinds of crazy high-saturated fat foods and all this sort of stuff. And he's like, this is what they're serving at the conference on obesity and bariatric surgery. serving at the conference on obesity and bariatric surgery. Why are people unpacking weight loss from chronic disease?

Like, I don't understand it. Why are you using foods that promote chronic disease just because in the short term they might help with weight loss? And they don't even necessarily always do that either. Right. Yeah, I think there's confusion about the difference between weight loss and health. Yeah. You think? Well, I think that certainly there's an argument to be made that if you are obese and probably if you're overweight, losing weight is beneficial.

But I think, A, it's about – we'll probably get into this – but you, you know, losing weight is beneficial. But I, I think, you know, a it's about, we'll probably get into this, but a it's about sustainability, right? And B it's about what are, you know, what you're doing to lose weight. All those approaches are not equal in terms of chronic disease prevention. So for some people, I mean, there's such a desperation around weight loss, which is completely understandable that I do think people separate that out. Well, I guess if you're, you know, if you're in a, in a critical situation that weight loss takes priority over everything else, right? Like critical, meaning like you have a wedding coming up or something? No, I mean, if you weigh 400 pounds and you're looking at,

you know, blood markers that are really bad, it's like, you got to get the weight off, right? So, you know, listen, you know, Atkins or those kind of protocols are very effective at doing that. But, but that's not necessarily the healthiest way or the most sustainable way to do it. But you'll lose the weight, right? Well, unless you switch your lifestyle to something that you can sustain, you're going to gain it back. Right. And I've seen that many, like literally hundreds of times. So yeah, I went to this, you know, I went to this conference, I was completely energized. I remember coming back that Monday morning after the conference, like my first, my nine o'clock patient was this patient with uncontrolled diabetes, and her sugars were, you know,

in the 200s all the time, which is very high. And she was already maxed out on all her pills. And I think literally four days before, I probably would have said, okay, you got to go on insulin. But that morning, I just remember feeling so empowered to say to her, let's sit down and talk about what you're eating and go through it. And it sounds so obvious, right? like, let's sit down and talk about what you're eating and go through it. And it sounds so obvious, right? But, but it, the paradigm that we that most doctors practice in is, is it doesn't a it doesn't support that. And we're not, we're just not trained to think about it that way. So, so as I started incorporating this stuff more and more into my practice with great success, and, and, you know, started thinking like this is not,

you know, I'm just one person. And I'm doing this with my patients, but I have obviously a fraction of the patients that are being cared for at this hospital. I have a, you know, we have to spread this, like other people have to find out about this. And I'm in a great position to teach people because I'm teaching people 50% of the week. So that's why I decided to apply for that grant. And the grant is, it's a very small grant. And it's, it's a colleague and I who's also interested in this stuff. It's the idea is to study, like take the first year of the grant to

just study all the evidence behind different nutritional approaches. And then in the second year to translate that out to people in a way that's really practical and usable. And we're going to offer it to our faculty colleagues and to the resident doctors as well. Right. So the idea is to actually teach medical professionals, not average people, right? not average people, right? It is. Our primary goal is that, but I think that what I hope is that in their learning about it,

then they'll teach it back to their patients. That's obviously the ultimate goal. Right, right. But the idea is to create a different kind of culture around diet and food and lifestyle within the profession. Exactly. Right? And so how do you approach the, you know, daunting prospect of studying different nutritional protocols and their impact on health?

Because certainly there's no shortage of these kinds of studies out there. And we could go down the rabbit hole on, you know, that whole world. Right. But, you know, how are you kind of approaching that? Yeah. I mean, it really is a rabbit hole. and I feel overwhelmed a lot of the time. And I think if I feel healthiest ways of eating. And so I want to understand where that consensus came from.

And I want to look to the literature and see, you know, why do people say, for example, that, you know, whole grains are so important? Why does everyone agree that vegetables and fruits are so important? I mean, people who are kind of in the know take that for granted, but I think when you're sitting down and talking to a bunch of medical professionals, they're going to want to know some of the evidence. Well, and I also think I would say that there is a consumer notion out there right now that is gaining popularity that would contravene that and say, you shouldn't eat grains. And, you know, fruit is just as bad as candy and you shouldn't eat that too. I mean, there's so many crazy ideas out there.

Right. So it becomes difficult to even begin to approach, you know, any of it. Yeah, I mean, I think, I think that, you know, the, the media and popular culture sort of hang on to the tensions, right, and the differences. But if, if you really start looking at most of the literature, it really, it, it really does, there is broad consensus around what we should be eating. And there is a lot of overlap between paleo and vegan or plant-based. And we can get into why, you know, reasons why I think plant-based is my approach, and I think is a better approach. But there is consensus. And I think that's the main message.

You know, that is one message I want to impart to my colleagues and the trainees. And I think just the power that this has to affect change is the other message. cut through all the, you know, crazy ideas on both sides of the equation and all the warring and infighting and all of that? Like, what are the, you know, I don't know, five or six things that, you know, basically the studies that you've looked at all kind of agree on? Okay. Number one, eliminating processed foods. So by processed, because this question comes up a lot, you know, when I talk to patients, what is a processed food? So what I tell my patients is just eat as close to its natural form, eat food as close to its natural form as you can. So I tell them, you know, if you're if you're if it's a if it's a piece of bread, did it you know, think about the food in front of you? Did it grow in a tree or from the earth, you know, in that format? And just keep reminding yourself of eating in the format that's closest to the earth.

So processed foods, there's a tremendous amount of evidence around eliminating those because what we're saying when we're saying processed foods are refined carbohydrates and processed meat. And processed meat probably trumps everything. If you had to tell somebody to just eliminate one thing, it would be processed meat. And again, there's broad consensus on that. Right. So that's hot dogs, cold cuts. What are the other things?

Yeah, I'm glad you said cold cuts because a lot of people don't even realize that. Like you get a, like a deli, like deli turkey slices on like whole grain and they you know people are that that is a processed meat um so bacon salami sausage hot dogs right like you said um so these are very there's there's nearly unequivocal data that these are increased the risk of cancer and heart disease and early death. So that's kind of a slam dunk, refined carbohydrates, probably as bad for you as saturated fat, you know, if you're going to look at the studies. And the top of the list on that would be what, like crackers and, you know, kind of snack foods or, you know, what are the worst processed carbohydrate foods?

I mean... Like white bread, things like that? Yeah, I mean, a lot of the, like... Where does pasta fall on that? Yeah, I mean, I think that, you know, the white, you know, sort of you take a whole grain, you remove the outer layers that has fiber and B vitamins and phytonutrients, you're left with a product that's rapidly gets converted into sugar in your blood, and causes insulin spikes. And that's the idea. So examples are, you know, a lot of like breakfast cereals, anything where the first ingredient is flour or milled rice or,

um, you know, the white bread, all the pastries, the white rolls. Um, of course, like,

you know, soda is the ultimate example. Um, right. Beverage, like, you know, all the bottled beverages that people drink and ice sweetened ice teas and things like that.

Okay. So processed meats, processed carbs. Yeah. Then there's broad consensus that we should be eating more fiber. And, you know, I think like you talk about all the, you know, things that were really the deficiency that Americans have that we should be learning about. It's not the vitamin deficiencies you may learn about in med school if you're lucky. It's fiber. I mean, the average American, I think it's like 15 grams of fiber a day.

And that's a pretty pathetic amount. Yeah, there's some crazy stat out there that like, I don't know what it is, you know, 80 plus percent of people are fiber deficient. Right. I think it's even higher. Yeah. Yeah. But we're all worried about protein, but like nobody's protein. Right. Right. Right. I, uh, you know, you're protein deficient if you're like not eating enough calories, right. You're, if you're starving, it's a starvation thing. That's right. That's absolutely right. But the protein thing is really the big barrier, I think, you know, mentally for people to

kind of, you know, grapple with the idea of going plant-based. I mean, they get a lot of messages to make them concerned. Yeah. Everywhere you turn. Right. And I think people have this magical idea that you more protein you eat, the more muscles you're going to have and more built. And I see patients all the time who are drinking protein shakes and they're sort of adding that on to their normal diet and gaining tons of weight and it's not muscle. I mean, it's going to turn to fat.

Right, so let's talk about that. Like, what is the implication of, you know, exceeding your recommended, well, first of all, what is the recommended daily allowance of protein, and what is the impact of exceeding that in the health context? Yeah, so, you know, I think when you look at, when the Institute of Medicine came up with recommendations on how much protein we need, it was based on nitrogen balance studies where you kind of feed people protein and you see how much nitrogen comes out in the urine and you're trying to find a place where you're neither in negative balance or positive balance. So you're getting the protein that you need for your normal cellular activities in your day. So the number that they came up with for most people was about 0.6 grams for every kilogram of body weight for the average person. And then they decided, you know, let's

round this up just to make sure we cover everybody. It's a bell curve. You know, there's going to be people at either end. So let's make it 0.8. And so I think people, to be people at either end. So let's make it 0.8. And so I think people, people who look at that number, if you even look at that number, think that that's the minimum amount, but really it's actually the amount where everyone will be getting, you know, the 90, I think it's like 95% of people will be getting the amount of protein that they need. So it's more of an, it's, you should think of it more as an optimal amount. Of course, there are special situations, you know, in athletes and bodybuilders and so forth, where you may need a little bit more. But I think that what the overestimation that people do is so great, and, and they're already eating more protein than they

need to begin with. So I think it really, for most people, it's a midpoint. And the average, the average person that I take care of, and the average person, I think, in this country is, I think the statistics are that they're getting, you know, 70% more protein than they need. And so what happens when you're exceeding that, you know, limit? So, you know, the average person, I'm not talking about a bodybuilder or an endurance athlete. Sure, sure. So for the average person, I mean, the extra protein is extra calories. And if you don't need them, they'll turn to fat or you will either metabolize them by your kidney or your liver and get rid of them, some combination of that. And there is such a wealth of data around what happens when you eat an excess of protein and particularly animal protein. This has not been shown for plant protein specifically. And the things that the totality

of the data show are that your risk of diabetes goes way up. And I mean, this is data from studies of hundreds of thousands of people over years. It's not like one small study. And it's been replicated in numerous studies. So that's a big one. Almost all studies show that your risk of heart disease goes up with higher doses of animal protein. There are studies showing that mortality goes up. There's a pretty concerning link with cancer.

And, you know, the thinking behind that, there's this molecule called IGF-1. I don't know if, you know, it's insulin-like growth factor one. And protein, animal protein, very clearly increases this growth factor. And you do need some of this growth factor. But you'll make it if you eat, you know, in a recommended way. And so if you make extra of it, it's very closely linked with cancer. So I think that, and then of course obesity, which I alluded to before, if you had to select out, the studies show that if you have to select out one type of food that is most associated with waking, both cross-sectionally, so like at one point in time, and prospectively over the course of a number of years, it's meat. Interesting. Because right now, everybody thinks that it's sugar. It's all about sugar right now. In our reductionist culture of trying to pinpoint one thing, I would say that's

enemy number one right now. So when somebody comes in to your office and that's their notion, I mean, I'm not defending sugar. I mean, sugar is a huge problem. How do you usually kind of discuss that? Yeah, I'm not a fan of sugar either. I think that I try to put it in perspective for people. So a typical scenario might be a person comes to me and they're concerned about preventing diabetes because they have a family history or whatever. And so the first thing they'll ask me is, should I use Splenda instead of a teaspoon of sugar in my morning coffee? And if that's all the sugar they're having in their whole day, I'm not that worried about it. That's a very small amount of sugar. And I think there's a miss, people completely miss the boat because the message

isn't out there that it's other things that they're doing, like the animal proteins, or refined carbohydrates that are driving that disease risk. So that said, I also have plenty of patients that are, you know, guzzling soda. And that's a pretty, you know, I would say in terms of lifestyle changes to target, it's actually a pretty easy one to help people change. So it is kind of the low hanging fruit of the nutrition counseling world. Just saying, you know, stop drinking soda. Yeah, yeah, yeah. Specific thing that everyone can kind of understand. Yeah, and people don't realize, I mean, people are starting to realize about soda, but then I think, you know, people don't realize about all the other sugary drinks

that are out there that are just tantalizing you all the time, like everywhere, the delis and the, you know, the grocery stores, and they taste good and people like them, and they don't realize how many calories they're getting and what they're doing to their metabolism with those. So that's kind of the low-hanging fruit and I always target that. Right. All right. Well, back to the protein thing.

You're sort of, we're talking about the difference between animal protein and plant protein. I mean, what about this idea that plant protein is inferior to animal protein? That, you know, especially for, you know, if you're athletic or you want to be fit or you want to perform at your peak, or you want to be fit or you want to perform at your peak, there's this idea that if you're only eating plant proteins that you're really not getting what you need in order to build muscle, recover quickly, all these sorts of things. I mean, people like you are, it's awesome that you guys are spreading that message and really showing people that that's not true.

Biochemically, that's not true. Is there any difference? Other than the fact that animal protein comes with all sorts of other things, like saturated fat, et cetera, and depending upon where you get the meat. But with respect to just the protein aspect of it, are there differences in bioavailability? I mean, there's going to be differences in the percentage of, you know, you know, essential amino acids and all of that. Like, I understand that. But like, what are these differences? And should we care? No, I mean, we should, we should, well,

we should care to the extent that when you again, when you look at studies, the evidence just trumps the fact that we have to, like animal protein is not conducive to long-term health. And the, you know, if you're going to look at the biochemical level and absorption and synthesis and cellular function, you know, you do need to get all your essential amino acids, but on a plant-based diet, you get them. And it's not, you know, I think there's this tendency to think that we need to make it as easy as possible for our bodies to get the food. But you know what, sometimes it's not good to make it as easy as possible. So if you take, if you eat a steak, yeah, you know, you're

getting what we call a complete protein, it has all the essential amino acids, because it's muscle, right? It's, it's an animal's flesh. And so you are necessarily getting all the essential amino acids, but we are able to group them together. And if we get, you know, some of them, if we have a bowl of, you know, beans, and then later on, we have a whole grain, you can, your body has the ability to pull it all together. And in a way that long term studies show actually promotes health rather than so I know you're just crazy talking. Sorry about that. So all right. So I mean, basically, what you're saying is, this is a non issue. It's a non issue. I don't want to mischaracterize your words, but. No, that was a fair characterization.

It's 100% a non-issue. I think if you're trying to build a lot of muscle and you're training and you're a bodybuilder, and you've featured on your podcast and we all know about the huge movement around vegan bodybuilding and NFL stars and so forth. I mean, yes, you do need more protein, but there's no evidence to say that it's, to my knowledge, that it's better in the short term even to have animal protein. And certainly in the long term, it's not better. Yeah, I mean, all I have to go on is my experience and then the testimony of the people that I've spoken to or I've had on the podcast. And, you know, when I talked to all these plant-based athletes, I mean, they're basically echoing what you're saying. And my experience is that it just, it doesn't really seem to, I don't feel like it's impeded me. You know, I feel like eating plant-based has allowed my body

to recover more quickly. I feel like I repair myself more quickly in between workouts. Right. And, and if it's impeded you, I'd like, I'd like to know what else you could possibly do other than what you've already done. You know, I, I, I think that, um, you bring up a great point, which is it's not, you know, people tend to reduce it all to, to protein, but what about, um, other things that are essential to recovery and to performance that you'd find in other plant foods? How do you feel about this idea of, you know, alkaline forming foods versus acid forming foods and the impact on metabolism? To be honest, I've never, like, I've never been in that. I've never gotten swayed by that whole acid versus alkaline argument. But to me, it's just, again, another marker for

the benefits of eating plant based because plant foods tend to be alkaline. And, again, looking at the evidence, we know that the foods that tend to be acidic, which are animal proteins, tend to cause harm. So if that helps you, if that's a framework that helps people understand a healthy way to eat, then great. They can use that framework. But to me, it's just a marker for the same concept. Right. I mean, the idea is that by eating alkaline-forming foods, it's very anti-inflammatory, right, as opposed to eating acid-forming foods, which provoke inflammation. And then there's this nexus between chronic inflammation and all the lifestyle disease that you alluded to before. Right. the lifestyle disease that you alluded to before. And when you're kind of reducing that inflammation in an athletic context, it expedites your body's ability to kind of bounce back and heal itself.

There's definitely a connection between chronic inflammation and illness and probably lack of performance in athletic endeavors. But I think that there's more than just the acid-based status of the food that drives inflammation. And there's a lot we don't understand, but we know that, you know, even oil, for example, you know, they've shown that after a very high-fat meal that's mostly animal fats, but even also with vegetable oils that your blood vessels ability to dilate or to open up is impaired for about six hours. So, you know, there's a lot of different ways that food can cause inflammation. And I think, you know, the acid base theory or argument is just one of them. Interesting. Well, I want to segue a little bit into kind of

diet philosophies and in a more macro sense. And, you know, you said earlier that, you know, there's a lot of similarities between eating plant based and eating paleo. And there's a lot of paleo people that listen to this podcast. And so let's talk about what those similarities are and what that common ground is. Yeah, I mean, I think the common ground is lack of processing of food. So, you know, eating foods as close to their origin as possible. And focusing on vegetables and hopefully fruits. You know, and eliminating dairy, obviously, that's a common thread there. You know, the whole grain argument is one that I don't really buy into because I think the evidence is so strong that eating what we call cereal fiber, which doesn't, it's not like Special K. You know, it's fiber that comes from grains.

That's the, when people do big studies, that's what they're referring to when they say cereal fiber. The evidence is so potent for these, for this in preventing disease, for example, you know, when you look at what, what is the number one, you know, the foods, the food category that's best at preventing diabetes, it's actually whole grains. And so it kind of turns our conventional understanding of, you know, what a diabetic should avoid or what someone should avoid on its head, right? I mean, because everyone always thinks right away carbs, but really those are some of the most protective foods. So to me, eliminating that whole category is a problem. Well, it seems like there's a lot of – when you say grains, I mean that's sort of an umbrella term for many, many things.

I mean that could mean wonder bread or it could mean some kind of heirloom millet. So there's a whole panoply of subcategories within that. you know, subcategories within that. And I think, you know, I think it is, you know, okay to say, or, you know, fair to say that today's wheat is, you know, not our grandmother's wheat, that it's highly hybridized. And, you know, in certain respects, it's been stripped of much of its nutritional value, and it's growing in soil that is not as nutritionally dense as it once was, and it's higher in gluten and all these other things. So it's different, you know, it's different than it once was. So what grain are we talking about? Where did it grow? Is it sprouted? Is it whole? Or is it, you know, stripped and

refined? You know, your point is well taken. But I think, I think we need to remember that really very little that we eat now is what it used to be. I mean, right. I mean, everything, that's true. Everything is hybridized meats, not the same. Yeah, certainly we're, we're breeding, we're breeding animals to be the way that they're most profitable and have the highest fat, you know, now they have very high fat contents, they grow quickly and so forth. So the meat that we eat is not the same. Even and even, you know, we can get into the whole like grass fed movement. But even then, it's still not the same as, you know, what people argue, we used to eat. And so nothing's the same. So, you know, again, I just have to keep coming back to what the evidence shows. And there are a lot of different kinds of grains, you know, again, I just have to keep coming back to what the evidence shows.

And there are a lot of different kinds of grains, but no one like, at the end of the day, we're talking about grains in their most intact form, I think it would be optimal to eat food that's, as close to nature as possible. You know, the whole GMO overlay is another thing. But when you just strictly look at the evidence, I think there's a lot of evidence for just eating whole grains. And, and I think we also have to remember, and I, you know, I, because I'm such a nutrition nerd and I'm reading stuff online all the time, like it is very anchoring for me to go back to my practice on, you know, a Monday morning at nine o'clock after reading nutrition stuff all the time, all weekend.

And then, I mean, I do other things too.'clock after reading nutrition stuff all the time, all weekend. And then, I mean, I do other things, too. I was going to say, is this your Saturday night? I do other things, too. What did you do last night? It's Sunday morning here, so what, how, you know, how did you spend last night? No, no, that's funny. So, yeah, but I mean, I think it's very anchoring to walk into, to talk to real people that are living their lives and have stressful lives and go to work and, you know, and don't don't necessarily think about all the stuff that we're talking

about at a really high level. And they're just trying to make like affordable, healthy choices for themselves. So they're not gonna, you know, it would be great if everyone could have, like, some, you know, artisanal millet. But I think that at the end of the day, like they have to, they're going to go to the grocery store in their neighborhood, you know, and there's a lot of issues with food access there too. And they're going to have to make choices and they're going to have to be taught what are the healthiest choices there. So I keep it pretty simple. And I think I try to stay out of the, you know, I try to keep pulling myself back to reality.

Right, right. Okay, so back to the original question, which is like finding similarities between paleo and vegan. But actually grains is a difference, right? Right. Paleo is no grains. Right. So you're saying grains. So we talked about grains.

And so in terms of other similarities, I mean, no processed food, no dairy, you know, whole foods, lots of vegetables. I don't know if it's, we agree on the fruit thing. Right, right. I, that's a good question. It depends on what subset of paleo you're ascribing to. But, but I think overall, yeah, I mean, it's basically whole foods close to their natural state, you know, and then you can get granular from that. But then kind of, you know, sort of sidestepping away from that, you know, I thought it would be informative to kind of look at some of the nutritional trends that are seemingly getting a lot of traction in public awareness right now. And, you know, the number one thing that always comes to my mind is like the Time Magazine cover of, you know, butter is back. And, you know, within that kind of framework is this idea that, you know, everything you heard about saturated fat is incorrect.

You know, saturated fat is your new best friend. It's really all about sugar being evil and, you know, eating a high fat, low carb diet is really the way to go. I mean, there's a lot of, that's kind of what's in the zeitgeist at the moment. So, and I'm sure that you have patients coming to you who, you know, perhaps are, are, you know, ascribing to this because this is what they're seeing and hearing. Right. Yeah. I mean, I think that, as I was saying earlier, I think that, you know, it's very titillating for the media to take a headline like that, right. And people, I think a lot of people would love to hear that butter is back. And so it makes headlines, people, you know, want to hear that. I think that, you know, specifically to address the saturated fat issue, and I know, Garth Davis talked about this a lot,

too. But the two studies that sort of drove those headlines, there's been a tremendous amount of controversy and at the level of nutrition nutrition research and the medical community about those studies and how they were designed, some sort of gross errors in data abstraction. There were a lot of concerns raised about industry ties, particularly with the dairy industry. And there were concerns that key studies were left out of because they were meta analyses, you know, they were they were sort of grouping together the results of previously published studies. So they had left out key studies. So I think I think Garth also said that

even under, you know, the most, you know, sort of positive reading of it, it never said that saturated fat is good. Correct. It wasn't drawing that conclusion. That's right. That's right. Even if you found no problems with the methodology and you took those studies' results at face value, you would not be able to conclude that saturated fat is actually good for you. You're absolutely right.

And he's right. saturated fat is actually good for you. That is, you're absolutely right. And he's right. It was more a factor of how, or not being as harmful as we once thought or something like that. Right. And it's always relative. So whatever, it depends, you know, if you're eliminating saturated fat from your diet, and first of all, nobody has like bowls of like protein, saturated fat or whatever, like they eat food, right? So if you're eliminating stuff that has saturated fat, what are you replacing it with? And They eat food, right? So if you're eliminating stuff that has saturated fat, what are you replacing it with? And that's the key question.

So if you take a study like that low-carb, there was a low-carb, low-fat versus low-fat study published last year, about 150 people, and they randomized them to either eat a low-carb diet or a low-fat diet. The people in the low- fat arm were replacing the fat with refined carbohydrates. So sure, that's not going to, they're never going to win out.

So it's always a question of that. And it's always a question of how much people adhere to the actual diet, like the low fat arm didn't, they didn't even really reduce their fat that much. It wasn't that low fat, right? Exactly. So that's the whole thing, too. Sorry for interrupting, but there's this idea that, oh, for the last 30 however many years, it was all about low fat.

Well, that didn't work. But it's like, no, it's just that no one did it. Right, right, right. People are always really surprised to learn that. Right, right. People are always really surprised to learn that. You know, we, I think that if I'm understanding the numbers correctly, as a percentage of total calories, we've decreased fat over the, in like 1% or some very small number, but we're just eating more calories. So in terms of grams of fat, we haven't cut back at all. So the other big issue with those saturated fat studies was, and I think Garth mentioned this, was that in one of them, about half the studies controlled for people's cholesterol levels.

So, if you take out the major way in which saturated fat creates heart disease and disease in general, if you control for that, of course, you're not going to find a difference. Wait, so let me understand that. So when you say control for cholesterol, that means that they selected for people that were already within a certain cholesterol range, or I'm not sure I understand. So basically, because we know that our blood levels of cholesterol are highly correlated with how much saturated fat we eat. In these in about half or I think maybe like 40 percent of the studies that were included in the big meta analysis, they had actually statistically adjusted for people's cholesterol levels. So for example, if my total cholesterol was 250, and somebody else's was 120, they statistically have a way of eliminating that as a variable. I see. So therefore, if mine is 250, and yours is 120, and I'm eating a lot of saturated fat,

and you're not, but we control for the intermediate risk factor, which is cholesterol levels in the blood, then it's going to, you know, you're not going to see, you're not going to necessarily see a big difference between the two groups. I see. Interesting. Well, one thing you said right there is being kind of contested by certain people out there, which is the relationship between saturated fat intake and serum cholesterol, right? So in other words, dietary cholesterol is not as related to serum cholesterol as we once thought. This is this idea out there, right? So that eating saturated fat doesn't necessarily impact your cholesterol levels. So separating out dietary saturated fat and dietary cholesterol, that is an important distinction to make because dietary cholesterol does not have such a predictable effect on

our blood levels of cholesterol as saturated fat does. effect on our blood levels of cholesterol as saturated fat does. I don't know that there's too much evidence to support saturated fat not driving up cholesterol levels. That's pretty much universally acknowledged. So both in terms of like laboratory, like controlled laboratory experiments where they infuse, you know, where they have people eat a lot of saturated fat and they measure their blood levels of cholesterol, you can see it like in a linear fashion increasing. So I don't think that there's that much contest around that. But yes, that people's response to dietary cholesterol is more variable. And the problem is those things go together in food. Right. So how do you eat dietary cholesterol and not eat saturated fat?

That's my homework. That's my homework. I'll try to figure it out. You can't. Exactly. So, again, at the end of the day, people are not choosing foods based on calories from saturated fat. They're just choosing food. And, you know, most people and I don't think it's a useful construct to talk to people about, please get, you know, this percentage of calories from this nutrient and avoid, you know, I think we have to talk to people about foods that promote health and foods that don't and take it back to like, the bird's eye understanding. Well, that kind of brings up this issue of ketosis and sort of setting aside the fact that like eating this way probably is, you're probably not getting a lot of fiber. Well, I guess if you ate

a lot of vegetables, perhaps you could. But, you know, I got beat up a little bit on the internet because I was on a podcast and I happened to say that I wasn't so sure that ketosis was a lifestyle that I really aspired to and that it seemed to me to be – and not being a scientist or a doctor or someone with any kind of medical or formal nutrition education, that my understanding was that ketosis was kind of an emergency state of the body where your body has to kind of, you know, scramble and shift the way that it metabolizes nutrients for energy to, you know, sort of accommodate the fact that you're glycogen deprived and that, you know, the brain runs on glycogen and that, you know, I just didn't think that this seemed to be something that, you know, the brain runs on glycogen and that, you know, I just didn't think that this seemed to be something that, you know, you shouldn't like natural man's not going around measuring their ketones all the time. Like I, it just doesn't

seem to me to be kind of a healthy way of living. And, you know, I got blasted by a bunch of, Oh, you don't know what you're talking about. And, you know, you don't understand. What was the, what, what was the criticism specifically? The criticism was that I didn't know the first thing about ketosis. I mean, what you've just described is my medical understanding. Okay, good. I'm glad to hear that. So you did pretty well without any formula. All right.

Well, so, because listen, there's a, you know, there's a subset of, you know, maybe it's not paleo. It gets all confusing. Yeah. There's a subset of, maybe it's not paleo, it gets all confusing, but of the kind of high-fat, low-carb diet protocol that a lot of athletes are kind of getting on board with. They're actually kind of really trying to get into that ketosis state and testing how their body performs athletically. Maybe they're looking at performance goals and not necessarily at longevity goals or long-term health goals. But, um, but, you know, let me explain to me what ketosis is and what the kind of health implications of kind of being in that metabolic state are. Yeah.

I mean, it's a, it's an unnatural, it's an unnatural state in that it's not the state that our bodies were designed to live in. We're designed to closely regulate our body's pH for optimal cellular function. you don't have, you know, you don't have the nutrients you need that feed your brain normally, that is not a good, that is not an optimal state. That is an emergency state. It's like a backup generator. And no one wants to live on like a backup generator. That's not an optimal state. Now, I can't tell you, I don't think I've looked at, I don't even know if there are studies, but I haven't looked at studies showing that in the very short term, how that affects athletic performance. I can't really speak to that. Yeah, I mean, the idea is that it helps with being fat adapted.

So if you're an endurance athlete, it's all about efficiency. And the more that you can become reliant upon your fat stores for fuel as opposed to glycogen, then you can go longer and et cetera. Right. I mean, I would question, you know, all I can tell you is that when you see human beings in ketosis and you take care of people in ketotic states, they don't feel well. They're very, very sick. And maybe this is just a milder form, but I can only really speak to like long-term optimal health. There is no way that that can be and can produce an optimal situation long-term. So when you say like they're very sick, like what is that sickness? Yeah, I mean they have mental fogginess.

They feel nauseous. They're often dehydrated, you know, they're just, you know, they're fatigued. So again, because of the type of practice that I have, I'm not necessarily talking about if you're doing it in a milder form for athletic performance, but I'm talking about more extreme cases. But I just can't imagine that that's a good long-term strategy. And again, just, again, taking it back to the big picture, the foods that put you in that state, you know, or depriving yourself of the foods to get yourself in that state is not evidence-based at all. Interesting. So, yeah, because there's, what are the names?

Is it not David Perlmutter, but Professor Tim Noakes? Are you familiar with his work? No. He's one of the people out there that talks a lot about this. All right. Anyway, so let's get back to your practice. And we kind of diverted way off the timeline there. But where we left it off was that you had gone to this conference.

Right. Okay, good. You know, where we left it off was that you had gone to this conference and you were so inspired. And then you began to sort of incorporate some of these tools that you learned into helping your patients. But at this point, were you completely plant-based yourself? Or is that what pushed you into kind of, you know, adopting a lifestyle in your own personal life? Yeah, no, I mean, I think I'm glad you came back to that. your own personal life or? Yeah, no, I mean, I think I'm, I'm glad you came back to that. Um, so around 2007, I want to say, um, a shift, like a, like a switch went off for me around, um, awareness of the foods that I was eating and what, what happened, like what was going on for me to be able to eat, like cheese and yogurt. And, you know, as I mentioned, I was already a vegetarian,

but I think I really internalized the information around, you know, what actually necessarily has to happen to animals for me to eat dairy and cheese and, um, and I think that an eggs and I, and I think when you, I still believe that for a lot of people, if you actually internalize that information, if you actually like don't shut it out and you take it in and you, you see it, it is very hard to eat those foods. Like that's the bottom line. And I was, I was like that. Right. Well, the system set up to prevent you from understanding that they work very hard to create that iron curtain. Very hard. Yeah. Yeah. I mean, it's coming down. Yeah, not in North Carolina. Well, there's a lot of I mean, there's for every, you know, for every new ag gag law, there's a new drone that's, you know, with a GoPro on it. Have you watched that stuff? Will Potter's like a hero. He's amazing. Mark DeVries and his films, his drone stuff is great.

But so, yes, Switch went off for me. I internalized the information and I just felt like, you know, I mean, I think Gene Bauer really says it best. And, you know, I don't know if you're listeners. I know you had him on the podcast, but he's the founder, one of the founders of Farm Sanctuary. I mean, he really says it best when you, you know, the point is living in alignment with your values, right? And I'm not, to me, the values are very simple, and it's the same values I'm practicing when I'm a doctor.

You know, I value compassion, and I value connection, and I value not causing harm. And to me, it's like, why am I separating that out? I mean, we're all interconnected. I'm not, I don't want to cause harm to the planet. I don't want to cause harm to other living beings. So to me, that was, that was a very sentinel moment. I made another, yet another dietary shift and went plant-based, flesh, vegan. But again, I didn't, I wasn't, I didn't incorporate it into my practice until after this conference that I've been talking about. This way of eating that is, you know, when you take like the health aspect, the sustainability in the environment, and you take, you know, compassion and concern for other living beings, and you mesh them all together. This is really the only way of eating that brings that all together.

So for me, like you talk about finding ultra, right? For me, this was finding ultra. This was my ultra. You found your ultra. I found my ultra. It was a long time coming, but I think it's... It was for me, too. I think you actually got a couple of years on me.

But no, I mean, for me, it's like it's renewed my passion around and, and around life in general. I feel like I, my purpose, I'm authentic. I'm living like there's no dissonance between how I, the choices I'm making and how, what I'm putting out there in the world. Yeah. That's a really cool thing when you can kind of like, I feel that now too. And if you told me many years ago, like that, that was even something that is important, like, I would have been like, what are you talking about? But there really is something intangible but very real about aligning your values with your actions, you know? And when you don't have that dissonance or that, like, you know, when you're saying one thing and doing another, and we all, to some extent, because we live in the modern world and nobody's perfect, there's some level of that in all of us. And it's like, look, I fly in airplanes and I drive a car and I do all these kinds of things that harm the planet.

It's like I'm not standing up on a pedestal like I'm some superior being. I'm very much not. But when I make that choice to say, well, this is important to me and I'm going going to make sure that my actions line up with that. Like, there's a self esteem that comes with that. And there's, I don't know, there's something about that, that really changes the quality of your life. It absolutely does. And I am far from perfect either. And I think that recognizing that is actually is actually beneficial, because, you know, it doesn't mean do nothing. It just means get started. You know, just get started.

Just see, like, what are the changes that are possible for you to start with that are in alignment with your values? And you don't have to – you can decide where you're going to draw the line. For me, the line's at one place. And I feel great about living within that line. For me, the line's at one place. And I feel great about living within that line. And what I think is really cool about it is that it's not like making that choice has a negative impact on some other aspect of your life. Like you can be an athlete, you can do what's right for the planet, and you can take out an insurance policy against disease. You can even reverse diseases that you've had or things that have been, you know, bothersome for you your whole

life, whether it's like skin problems, like all these sorts of things. So it's like, yeah, maybe you crave a certain food that you like to eat. Like that's basically the biggest negative aspect of the whole thing. But if you kind of can weather through that, you know, short term discomfort and get to the other side of it, there's a certain freedom that comes with that, that I think is a really beautiful thing. It's actually been pretty eye opening in terms of like the just the diversity of foods that i eat now compared to before i went plant-based slash vegan um people don't they don't believe that i know i don't know why they don't they don't buy well i mean again i can only speak for myself but i and you know

when i talk to my patients and i i do a lot of um surveys, I mean, informally when I, because it's such a big part of my practice. And when I hear what people eat, there's a lot of repetition, a lot of repetition. So I think an argument can be made that you can actually broaden. Right. Like people think they're eating a larger diversity of foods than they actually are. They're having eggs in the morning. They're having a turkey sandwich, you know, at lunch, they're having a roasted chicken at night, and blood pressure, diabetes, obesity, heart disease, things like that. Walk me through some of the success stories that you've had through things about being an internist is that you are looking at all the organ systems and the whole person at once from like mental health on down to like their, just general fatigue, bad sleep, high blood pressure, and wants to lose weight. That's basically everybody. And it's kind of one-stop shopping in the sense that I will prescribe the same way of eating for all of those conditions.

Because all of those things, right? Because all of those things get better with eating a whole food plant-based diet. And so I think some specific examples, and these are happening all the time and it's so rewarding to see. I'll meet a new patient. I met this gentleman from Mexico last December and checked his cholesterol. And I think his LDL, which is the bad form of cholesterol, was around 140. And so I called him up and I said, hey, you've got to make some changes and here's what I'd recommend that you do. And I told him to basically cut back on animal products and focus more on plant foods. And I have a speech. I have a way of saying that.

And I can do it across a bunch of different languages now. How many languages do you speak? No, sorry. Through the interpreter. Oh, okay. You have an interpreter. No, I speak Spanish and English. Well, what is the general strategy that you employ to connect?

Because people will say, and doctors will say, well, I can tell them to eat better, but they're not going to do it. Like that's the conventional wisdom, right? Yeah. I have not had that experience at all. I mean, sure. There's, there's lots of people that aren't ready to make changes, but there are lots of people that are and just need, like, they just need support.

And they, some of them are, it's as basic as they just need the information. Like, so my strategy is, you know, I, I kind of follow this motivational interviewing approach, which is a, you know, a way of practicing where you're kind of meeting the person where they're at. So that's my first question always is like, do you, are you interested in hearing about some things that you can change in your food choices that might help you feel better? So depending on how interested they are, then I start giving out the information and then I start figuring out like what, you know, I strategize with them, like what are they ready to start working on? And I know there's a whole, you know, when you listen to podcasts and you talk to experts, you know, there's a whole thing in the plant-based community about whether you should take small steps or dive in. And that's a really interesting

dichotomy to me. But in my reality, I am helping people take small steps because it's not everybody that's ready to dive in. And so maybe one day they will be ready. But for now, even with some small changes, they can start getting benefits. So, yeah, I'll kind of identify, you know, what are you, here are some things I think you could work on. Which one of these broad categories are you ready to start working on? Yeah. And then we kind of take it from there. So I have a bunch of tools. Right.

I think small steps is great because, like, if you told people, look, you've got to do this completely right now, 100%, and then a week later they mess up, then they're just going to give up. Right. And if you're talking about the goal being sustainability, like, give them one thing to master. Right. And then let them get on top of that, and then they'll create that connection. Oh, that actually made me feel better, and I'm drinking almond milk now and not, you know, not dairy. And like, I can do it. Right. So then they feel empowered. Yeah, they feel empowered to do the next thing. You know, that is that is the basis of my practice. And I've seen it work. I, I think the argument for

diving right in is also compelling in the sense that, you know, when you're in an environment where you do have a lot of support, like in John McDougall's program or something, where you're actually, like, you're immersed, you're in an immersion situation, people feel so much better so quickly when they transition that that might keep them going. But I don't have the, I don't have those resources. So for me, this is a more... Right. Unless somebody's just hugely internally motivated. Right. And there are those people. Or their health is in such disrepair that it's really critical.

Right. But people need a lot of help because, I mean, as we all know, our food system and our society does not make it easy for people to make this switch. I mean, you really have to be proactive and aggressive about making the changes. Okay, so high cholesterol goes down. Yeah, I mean, he's just one example. So, no, it was really great because I said, here's what I want you to do. It was really great because I said, here's what I want you to do.

I want you to crowd. I use the crowding out thing a lot where instead of making it so negative, like stop eating this, stop eating that, I just say, can you eat a bowl of bean soup or lentil soup before whatever you would normally eat for dinner? And just start crowding it out gradually. So I gave him all that advice. And I said, come back in two months and you know we'll check your cholesterol so a couple months later his results came in like popped up in my computer queue and I looked at them and his LDL was 80 so it was one went from 140 to 80 yeah almost in half and I just thought and I looked at my, I like started opening my note to remember

what I had done. And I thought, well, which statin did I put him on? Because this is a great response to a statin, you know? And then I looked at my note and I, and I realized I hadn't put him on any drugs at all. I was so, it was so incredible. Not just, and that, and that, I mean, that was very simple dietary advice and he, he was ready to run with it and did it.

Right. Like he did it, though. Like that's the thing, right? Right. Like he was a partner in this relationship and did the work as if, you know, you're the coach and he's the athlete. Like, you know, the coach can say whatever, but if the athlete doesn't show up for workout, it's not going to happen. And there's a lot of great reasons why people don't show up for, for their workout. You know, I mean, there's, I, I take care of people that are, you know, facing a huge number of barriers, like people that, you know, live in the shelter system or

people that are dealing with, you know, single parents, they're single parents or they're in fixed incomes. And so I feel like my role and what I can best offer to my patients is to be a troubleshooter and to be obviously as nonjudgmental as I can and kind of help them work through it. Well, that brings up another important thing, which is, you know, this unfortunate situation that we're in where, you know, wellness is kind of being aligned with elitism, you know, and particularly plant-based or being vegan. It's like, oh, well, if you're going to do that, then you're going to be spending all your money at Whole Foods and you're going to be spending all day in the kitchen creating these crazy recipes and, you know, who can afford that and who's got the time. And yet here you are, you know, treating, you know, for the most part, like, you know, an underprivileged community of people who are in dire health and who don't have the means and most

likely don't have the time to, you know, live that lifestyle. So how do they navigate it? And what's your perspective on that? Yeah, I mean, I actually specifically tell people that you don't have to shop at a like a high end grocery store to get, you know, healthy food. And I go as far as and I have a little more time when I'm running my in the obesity clinic setting than I do in my normal primary care practice. But I will literally like we'll sit down, we'll go on Google Maps, and we'll we'll just figure stuff out. And, you know, I would love to have like a health coach working with me who could do that. But for now, it's me. And I think the message is that, you know, I would love to have like a health coach working with me who could do that. But for now, it's me. And I think the message is that, you know, we can, you know, we can brainstorm this together. And there are definitely always options.

There are always options. Yeah, it's really similar to what Robert Ausfeld's doing. Yeah. I'm sure you know. Yeah. Yeah, we're friends. Yeah. It's great.

And yeah, he's now he has those health coaches now because he's created this program. So yeah, I could see you doing something like that. Yeah. I can't tell you what it how good it feels to be able to connect with people on this level. Because when you talk to people about food, and lifestyle in general, but when you talk to people about food, you start you have a window into their life that I don't think you really have when you're just saying like, hi, how you doing? I'm going to, you know, I'm going to get out my prescription pad and, um, are you taking your medicines or not? And it's like very binary. Like this is just an expansive understanding of people and you get to connect with them in a way that you might not otherwise. So if somebody is on a super low budget, like what is the, you know, what's the first thing, like what are the first things you're telling them to go to them? Like, what is the you know, what's the first thing like, what are the first things you're telling them to go to them? Like, are you telling them to buy certain things in bulk? Or like, how does that work? Yeah, I mean, like, it's a it's a cross product of time, money and access. Right. So, you know, people that have that don't have a lot of money,

but have more time have certain options. And then we work on the access together because there almost always is access. They just don't, people don't realize. But if you're limited on time and money, then it gets a little harder. It's still not impossible. People have this perception that, like, if you can't buy organic, like, farmer's market fruits vegetables, that you shouldn't bother, that it's worse for you to be eating normal. And I don't think that's true, and I don't think the data support that. So I talk to people about, especially in the winter, getting frozen vegetables.

They're not expensive. They don't go bad. Keep them in your freezer, and then you don't have an excuse for not putting them on your plate. Beans and legumes like lentils and chickpeas are not only culturally very applicable across a wide range of cultures, but they're obviously pretty cheap, especially in the dried form. in the dried form. And people are spending, people are spending money on things that don't promote health, like soda and Snapple and obviously, you know, and frozen meals and deli sandwich, deli, like turkey sandwiches, McDonald's, Wendy's, and right, you know, whatever. Right, right. And, and, and, you know, obviously, those are artificially cheap. And

that's another whole conversation, because of subsidies, but I, and, and, you know, obviously those are artificially cheap and that's another whole conversation, um, because of subsidies. But I talked to people about, you know, just start diverting some of that money. Um, and maybe they won't be able to afford the most expensive vegetables out of season, but it is progress and people can make huge strides in their health in terms of just starting to navigate a little bit, pushing the needle. We've got to wrap it up here in a few minutes, but there's a couple things I still want to ask you. And I think it would be really helpful for people if you could just leave them with,

I don't know, two, three really simple but powerful prescriptions for living healthier. Sure. I mean, I think that I think the number one would be to, to, to find the joy in eating in a way and keep yourself open to eating in a way that's sustainable and compassionate and health promoting. So I know that's not that's like at the high level, that's not a practical tip. But that's what drives me. And again, that that I think is the message that I'd like to spread. When you think about eating across the diversity of colors of the rainbow, and that's what I tell my patients a lot, too. I think you can get a lot of mileage out of that because as long as it's not Skittles. If you're eating—

Eat the rainbow. Yeah. I mean, I use that PCRM poster all the time with people, but that gets you a lot of mileage because if you're doing a diversity of colors and fruits and vegetables in the course of three or four days, you're getting a lot of fruits and vegetables or you're getting more than you were before. Finding, you know, focusing on foods that are as close to their natural state as possible and foods that come from the ground and from trees. Those are the foods that we know promote longevity and reduce disease. These are just all crazy ideas. I mean, who are you? You know, and there's great, there are crazy ideas out there. And you know, there's, I love, this is, this is by the way,

the same message that I give when I give nutrition lectures to doctors. You know, and you can't believe some of the ideas that are out there because people have just have not been trained in nutrition at all, doctors. And so it's a powerful message, and I think keeping it simple. Yeah. Well, I'm really excited about what you're doing with within the profession, you know, educating other doctors and medical professionals. I think that's super powerful. Thank you. That's exciting. And, you know, more people should be doing that. You know, it's like if the medical schools aren't going to do it, somebody's got to take responsibility for

it. And the fact that you're investing in that, I think is really a special thing. Thank you. It's fun. Yeah, it's great. And, you know, at the top level, like the first thing that you mentioned, just, you know, living more sustainably, eating more sustainably. I mean, it's just incumbent upon all of us to, you know, really grab that mantle of educating ourselves about where our food comes from, like however you're eating. You know what I mean? Like we deserve to know where our food's coming from. Get interested in that, learn how to read a nutrition facts label and, you know, find out who these companies are that are producing these foods, how they're producing them, how they're shipped and manufactured and packaged and marketed and all of that, because that knowledge

is power and that power will help drive your consumer choices. And a lot of people feel – we feel disenfranchised. We feel like we can't make a difference or we just – let's just do what everyone else is doing and live this kind of matrix lifestyle. And it's easy to do that. It's easy to do that. And I did it for most of my life. But when you finally say, no, I'm going to, you know, I'm going to do what's best for me and I'm going to educate myself

and make the right choice for myself. It's incredibly empowering and enlightening and it will change your life and it can change the life of the people around you and your loved ones in doing so. Right. Well said.

Yeah. I mean, it's really powerful. And, you know, I just encourage everybody to go on their own, you know, version of your adventure and my adventure and have their own experience with it. Yeah. All right. So I'm going to wrap this up with the final question.

It's the same question that I asked Garth at the end. So have you listened to that? I did, but I don't remember. You don't remember? Well, you will remember in a moment. If you were Surgeon General, what would you do? Yeah. Oh, I loved his answer.

I loved his answer. I loved his answer. And so, well, I don't know that the Surgeon General has the power to do this. Well, let's just, we're imagining a crazy universe where actually like this official actually could actually do things. Okay. Sounds like a great deal. Sign me up. Yeah.

Great deal. Sign me up. I think the number one thing would be to stop artificially subsidizing the foods that are least healthy for us. I mean, I think that is where the number one driver, you know, that's one of the first things I would do because people don't realize how much their food should cost. And that doesn't take into account like the healthcare costs that are that stem from those foods. So that'd be the first thing. Have you read David Simon's book, Metanomics? It's one of my favorite books I've ever read. And for people that are listening, I had him on the podcast. It was quite a while ago. I don't remember what episode number it is, but I'll put a link up in the show notes to that. But basically his whole book really looks into how subsidies drive the economic machine behind kind of fast food and all of that. So in other words, that $0.99 McDonald's burger is really like a $7 burger because of everything that goes into it politically. Exactly.

And then there's also the stepchild of that is the advertising. And so that we're actually, our taxes are going to advertising for those foods, not just paying at the level of subsidizing the production of the food, but actually paying for the advertisement for that food. So you'll be watching TV

and you'll see an ad, you know, you'll see an ad for like, a pepperoni cheese pizza, and then the next ad is for, you know, Viagra. And it's like, we can't, you know, we really have to start making the connection. So that would be the first, that would be the first rung. And, and I think that I would also, I think that there has to be a way to start educating people about what the healthiest foods are and to use an evidence based approach. Because there's a lot of evidence, like I said, for a common consensus. And I would use that platform to get the message out in a way that's really clear and get people to understand that, you know, it's not it may not necessarily be in the headlines and just have a broad consensus around that. That's a good answer. I think that's a beautiful way to wrap it up.

Thank you. So, yeah, thanks so much for spending some time with me today. Thank you. Your work is really inspiring and I really appreciate what you do. And I hope that you continue to do it, and I hope that your work inspires many others to follow in your footsteps. Thank you. So thanks. Likewise.

Thanks for being here. Peace. Blance. That was great, right? She's awesome. I really like her. I hope you guys enjoyed the episode. Let me know what you thought of our conversation in the comments section on the episode page at richroll.com.

Keep sending your questions for future Q&A podcasts to info at richroll.com. I'm going to be doing more and more of these, of course. And I love getting all your questions for future Q&A podcasts to info at richroll.com. I'm going to be doing more and more of these, of course. And I love getting all your questions. So let me know what you want me and Julie and other guest hosts that I'm going to be having on the show, what you guys want us to talk about. For all your plant power needs, visit richroll.com. We've got nutrition products. We've got signed copies of our books. We've got garments, 100% organic cotton garments,

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greatly, greatly appreciate that. All right, you guys, I'll see you in a few days. Peace. Thank you.