30 Years of Diet Trials: What a Stanford Scientist Is Most (and Least) Sure About | Dr Christopher Gardner

0:22Thank you.

0:30today. I think we'll also explore some new territory. And I would like to challenge some of these positions because I think you and I, we share pretty much all, we say things very similarly. So along the way, just to give a voice to perhaps some of the counter arguments that are out there, I want to throw some of those at you and just see how you think about them. And that was part of the book too. Like after all that time, how do I approach that new paper? it's based on other studies. I think most people know you as a Stanford nutrition professor, someone who conducts these really interesting, highly relevant topical studies, clinical trials that answer interesting questions like the fermented food study that you did and the low fat versus low carb diet fits trial and all these kind of clinical studies, which the media love to write about.

1:26We love to talk about it on the podcast. But what people might not appreciate is you started in philosophy. I did. Absolutely. How does your understanding of philosophy and that study of philosophy influence the way that you see nutrition and communicate nutrition today? Oh, hugely. And it's actually been super satisfying to come full circle, right so I attended Colgate University in upstate New York and all it had a great philosophy department and all the freshmen were required to take philosophy and I kind of loved it because there was no right answer what is truth what is beauty what is good and you had to come up with these compelling arguments and read all these different philosophers how they approach things and really always made me look at the big picture like wow there's there's actually no key to this exam.

2:22You can't just be right. You have to have a compelling argument and the next person can have a different compelling argument and you can both get an A in class. So the end of that, I didn't really want to go to school anymore. I thought, ah, I don't even know why I went to school. I don't want to be a doctor or a lawyer. I think maybe I'll just go see the world and I'll work in restaurants. And I worked in a lot of restaurants, six years worth of restaurants, at which point I thought, wow, I'm going to have to get a real job and grow up at some point. And I think I've told the story here before.

2:57I had a vegetarian girlfriend at that point that dumped me. Thought if I went vegetarian, she'd get me back, take me back. She didn't. There were more issues than that. Stayed vegetarian. Thought I would open a vegetarian restaurant. Was sick and tired of people asking me where I got my protein. So I thought I would get maybe a master's degree in nutrition. so that when I opened the restaurant and had a lot of plant food, I could tell them where their protein was coming from. I got a PhD by mistake, and then the Stanford faculty positioned by mistake, and started studying phytochemicals. At first, I was really interested in the allicin in garlic, or the genestine in soy, or the anthocyanins in blueberries.

3:41I really thought that was, oh, this is a niche area. They're not vitamins and they're not minerals. They're things that look healthful, and not seem to find any in animal foods. It's usually always in a fruit or a berry or a nut or a legume. So then started doing some of those really isolated trials, even supplement trials, because that's the best way to isolate those. And those are actually cleaner studies than food studies. Then I really got interested in the more practical studies and the philosophy started bleeding back into my life. Like, so what if this one pill and this one nutrient works?

4:16What food is it from? What different foods is it from? What different cultures would eat that food? What different cultures would avoid that food? Oh, let's look at the whole food diet. Oh my God, if you look at the whole food diet, then you've strayed from this old medical model of the randomized double-blind placebo-controlled trial. You can't do that with food. You can do that with genestine or anthocyanins or allicin if it's in a pill versus placebo. So it's not as clean and definitive. But it's more practical. And so then philosophically, I was juggling between the rigor of science and the generalizability of here's what somebody should do with it.

4:58Thinking that it doesn't actually have to be one or the other. You could try to maximize rigor and maximize generalizability. And I really feel like that's what I've done a lot of my life. And it's very humbling because it's never perfectly rigorous and it's never perfectly generalizable. If you want to hit both, you have to give a little in each area. Just isn't possible with food. And you're on record saying that if you were to distill nutrition science down into a single phrase or sentence, you'd refer to or defer to Michael Pollan. Absolutely. Eat food, not too much. Mostly plants. Oh, we should have said it in unison.

5:40Okay. So what is it about that phrase that you like so much? It's what people want to know. So let me go back. I actually start out my new book, Food Sense, with this garlic study that I did. And the garlic study, I am super proud of that publication. It has not been cited as much as many of my others because it was a null finding. But I was really excited. I had I can't remember if I've talked about the garlic study on your show before is that okay I don't think you have but if I think I recall is it related to cholesterol yeah so there's all kinds of garlic supplements that say they lower cholesterol and there's this putative active agent in it called allicin and I started learning about it and the actual garlic has a molecule called allion and there's an enzyme called allionase that converts allion to allicin and you don't get the conversion until you've mashed it or chopped it or blended it or something.

6:43And I actually started with a supplement trial and I had a company make a garlic supplement and a placebo and then wait till you hear how clever this is. We actually took the little cotton swabs that go in pill bottles and we put garlic oil on the cotton swab of the placebo thinking, oh, when they open the cap and they smell it, they'll say, oh, I didn't get the placebo. I must've got the garlic. I can't tell you how pleased I was with that. I don't think it was my idea, but I can't tell you how pleased I was like, oh, I'm doing double blind garlic studies. And it didn't work. Cholesterol didn't go down in people with high cholesterol, but it was sort of an underfunded, small study.

7:23One of my first ones. And I got criticized by somebody out there who read my paper. First, I was really cocky. They said, are you the gardener who published that? And I said, yeah, I publish clinical trials. He said, my name's Larry Lawson. I've studied the biochemistry of garlic my entire life. Did you use an enterically coated tablet? And my face just went white. And I thought, no, I'm just a postdoc and I'm new and I wasn't sure what I was doing. Tell me why. And he said, oh, that conversion from Allian to Allison doesn't take place until you solubilize the garlic powder, which happens in your gut, and at a low pH, it would inactivate the enzyme, and you'd never get the conversion, and you'd never get the allicin.

8:08That might be why your trial didn't work. So he was saying that the enzyme would be destroyed in the stomach? In the acidic environment of the stomach. That's what the stomach does, denatures enzymes. So he said, I'm humbled, and would you write a grant with me? And he did, and I actually got a $1.4 million NIH grant. And we had, oh, had this whole gig set up. So I actually went to Gilroy, California and bought four cases of fresh garlic. Eight people peeled it. For two days, we mashed it. We put it in 10 ,000 containers, like one garlic clove in each one. And we had to say what a garlic clove was.

8:47I think it was like 4.2 grams. As a garlic chemist, he had averaged garlic clove size. And then we got two supplements made different ways. One had an enteric coating and one was an aged garlic. So we had four study groups. So one got real garlic in the condiments of the sandwiches and a placebo trial. All the other ones got no garlic in the condiment and one got the aged garlic, one got the enterically coated garlic, and one got a total placebo. So one had like a a placebo sandwich and a placebo pill. Oh, I was so proud. And this garlic chemist took the garlic back with him to Utah where his lab was.

9:33And we were providing it in condiments. So he put it in a yogurt condiment, in an oil condiment, in a salsa condiment. And we put it in the fridge for three days because we were giving participants heart-healthy sandwiches with condiments. and he measured the stability of the allicin in the condiment, in the fridge, served with sandwiches. And we published a whole separate paper on the stability of the allicin used in the study. And we actually tossed a couple condiments because they inactivated the allicin. So after we narrowed it down, I think we made like 35 ,000 sandwiches, recruited 200 people, fed them for six months.

10:14And at the end of the day, the average LDL cholesterol in these adults with modestly elevated LDL did not lower their LDL cholesterol. Not the real garlic, not either of the commercial supplements that said on them that they lower cholesterol. If anything, in actual numbers, the placebo group went down just a little. And so... What's the mechanism that Larry thought the garlic would lower cholesterol via? Was it Through like bile or in the cycle? No, it's like an HMD-CoA reductase inhibitor. Interesting. It was like a liver enzyme. So it stops cholesterol synthesis. There were publications of like taking a liver cell and pipetting allicin onto it in culture and seeing that it would inhibit the enzyme.

11:01But that doesn't mean you eat it and it gets to the liver and it's still intact and it still has that impact. So that was a surprise. I really thought the real garlic's going to work. I think the enterically coated garlic is going to work. I don't know about the aged garlic extract, but no one, on average, it was a total null finding that nobody's cholesterol went down. And to your point previously, I am so proud of that paper. Like we had that whole side paper on the stability in the fridge of the condiment, and yet we were serving sandwiches and real garlic from Gilroy in condiments. We didn't ask people to eat raw garlic, put it in food the way people would have it.

11:48And so I was trying to balance the rigor and the generalizability. If you've been listening to me or some of my guests talk about the gut microbiome, you'll know that it thrives on very specific types of fiber and polyphenols and resistant starch, many of which the average person falls short on, despite the very best of intentions. That's why Dr. Will Balsowitz and I founded 38Terra, a gut health company where science meets supplementation. An independently conducted 15-day M. Scheim study found that our first product, Daily Microbiome Nutrition, or DMN for short, significantly increased short-chain fatty acid production and encouraged the growth of beneficial microbes linked to better gut and metabolic health.

12:33It's a simple daily scoop that you can add to water or your smoothie, no sugar, no fillers, just clinically backed ingredients that make your gut bugs happy. So if you want to support your microbiome in a meaningful science backed way, check out 38terra.com and use the code THEPROOF to save 20 % off your first order.

12:56And was the overall purpose of that, like if you zoom out, was to see if garlic could through LDL, through cholesterol, influence someone's risk of cardiovascular disease? Is that the big picture, what you're looking at? I'm so glad you framed it that way. Really, we wanted everybody to live a long, healthy life, but we only had them for six months. So you can't see who lives or dies in six months. So you can see LDL cholesterol, an established risk factor. And if you lowered it, you could extrapolate and say, hopefully we saved somebody's life if they kept doing this and if they kept the LDL cholesterol down.

13:34But the most humbling moment of the whole experience was that the results got published in 400 different media outlets. And I egotistically read every one of them every time I saw one. And one of them said, the headline was, Stanford, not Gardner, finds garlic, not the specific kinds, just garlic, isn't good for you. holy crap like okay it wasn't Stanford it was me it wasn't just garlic it was three very specific types of garlic it wasn't good for you I was trying to figure out if it was good for you let's see if it lowered LDL cholesterol in a very specific population which is a really narrow question but I can understand that the headline of approximately one clove of garlic delivered three different ways to 200 people with moderately LDL cholesterol over a period of six months failed to meaningfully differentiate any LDL change between or within groups.

14:38That would be a horrible headline. It's easier just to be overly simplistic and write the food off because it generates a better headline. But there are many, I mean, I think everyone can appreciate this. there are potentially many other ways that garlic could influence someone's physiology, for the better or worse. Yeah, what about blood pressure? What about inflammation? What about acne? What about vampires? I still think it works for vampires. And I still know to this day, people still talk about aged garlic extract. Yeah, it's still out there. And other outcomes like plaque morphology, does it maybe independent of LDL cholesterol, does it affect the health of the blood vessels?

15:20or if you have existing plaques. So there are interesting things, I guess, outside of what was measured. And this applies to many studies. Can we go one step further and let's go back to philosophy because that's kind of where you started. So let's say it worked. Let's say the header was, gardener at Stanford finds garlic is good for you. Okay, so what do you think would go up more in sales? garlic fries and garlic ice cream and garlic wine, which all featured at the garlic festival in Gilroy, California, or hummus and pesto and things that have garlic in them. Like if you say that - We want, we're looking for an excuse to eat our favorite foods.

16:08Right. So what if like sales of French fries skyrocketed and I had to hide my head thinking that's not what I meant. I studied garlic to maybe lower cholesterol, thinking that if you ate it, not by itself, but in foods that were good for you, oh no, it's backfired, but it didn't work. So I don't, I didn't lose any sleep at night because of that. But it wouldn't be the first time that nutrition science has backfired or there's been unintended consequences. Yeah. And because it's because people eat food according to their culture and their budget and what's available and what tastes good. And isolating that particular nutrient or component is not the answer to the whole question.

16:54So when you approach nutrition science and you're appreciating the context and the messiness that exists within nutrition and the gray, when you are looking through that lens with your years of experience and you think about that phrase of eat food not too much mostly plants and then we we we go let's go a layer underneath that okay what aspects of nutrition or or food or food groups with respect to human health would you say that you are most certain about that you have the highest level of conviction This is my position about this food or this food group. And with all of the messiness, the gray and the context that's out there, these are the ones where I would plant my flag.

17:46I would say whole foods, seasonal local, fiber rich. I might start with a little more specific than that. And part of that, though, isn't traditional science. Part of that is, oh, for thousands of years, people evolved on those foods. If you go back to the Paleolithic period, they died when they were 30 of some kind of infection or a saber-toothed tiger ate them or a mastodon stepped on them. But, you know, once we didn't have to worry about getting enough food, really, if you go back to the hunter-gatherer, tribal-type things, those folks, so the ones who do live to 70 or 80, don't have heart disease, don't have cancer, don't have diabetes, but they've been foraging and hunting for their own food.

18:33And it wasn't hardly ever vegan or vegetarian. It was a mix of the animals they could catch and kill and eat and the plants they could grow and gather. And it was simpler. But you can't go back. What would your level of conviction be on dietary patterns, let's say comparing a ketogenic a low-carb style dietary pattern to a plant-rich dietary pattern whether that's Mediterranean or vegetarian and I'm thinking about your research with with diet fits but really this the totality of evidence if that's not in that top top bucket of you know almost near certainty. How certain would you be about, I'm presuming given eat food, not too much, mostly plants, that you believe there's more evidence towards those plant-rich dietary patterns supporting them.

19:33But how certain, how much conviction would you say you have in that position? Almost as certain as I could be because the next level of scientific studies that would reveal more are really never going to be done. So the idea of, oh, I'm an influencer, and there aren't any randomized controlled trials on that. I'm going to wait until there are because the rest is association, not causation, is ridiculous. So here's one of my favorite examples for your listeners. So imagine two diets more different than, and I can't, low-fat vegan and carnivore. Or let's just say keto to make it a little more realistic.

20:12Okay, keto being super high in fat, little fiber, and the low-fat vegan being super low in fat. So in my kind of study, so I've now done more than 24 of these studies, I always have to ask people, are you willing to be randomly assigned to either one for the duration of the study? If you aren't, like one of the things I always start with, I say, okay, you know what the study is going to compare. We've been as honest as we can. Pick the one that you want the most and imagine your luck sucks and you get the one that you really didn't want. If you would quit just because you didn't get the one that you wanted when you got randomized, please don't sign up for the study.

20:53That ruins the science. And I have to say our retention rates are great. Historically, our retention rates are about 90 % in our study. So I think I do a good job. Actually, I have a fun story to tell you. One of my first studies with Justin Sonnenberg doing the microbiome, he sat in as I was giving a pitch to the first group of potential participants and I said you know if you aren't willing to do both of them just don't do it just walk away read about it later and at that point he sort of lost his shit and he thought oh my god is this what you do for a living Christopher you're you're practically telling them not to do the study and a couple did walk away and the rest stayed and the retention was high and later he said ah Set the expectations.

21:39Now I see why you said that. Okay, but if you can imagine, can you imagine finding people who would be willing, okay, wait, let's go back to carnivore. It makes it more fun. I'd be willing to do vegan or carnivore. Sure. Randomly assign me. I'm such an altruist and I'm such a believer in science and I want the rest of the public to know this. I'd be willing to do that. Really? For a week? yeah for a month yeah how about for five or ten years or 20 or 30 if you wanted to see if somebody lived or died on one diet versus another and you randomly assigned them you could never get people to sign up for some of the really interesting questions that are out there even if you did it then you'd be obligated to check the adherence of all those people.

22:32And if you say vegan, sugar and white flour is vegan, so are Oreos and French fries. And if you say carnivore... There's carnivore chips today. Right, and so that part's wrong, right? And so you have to make sure that people understand what you mean. I think the longest dietary intervention studies I can think of like Predimed and CordioProv, which are like five to seven. But the diets in those studies are by no means extreme versions. And if you look at Predimed, really they handed out the nuts and the oils. And that was the biggest thing that was different. In fact, if you look Predimed versus the control, which is supposed to be a low-fat diet and it was not a low-fat diet, as I recall, there were 13 different components of the two diets and seven of them were identical.

23:25because they both said in the controlled diet, eat fruits and veggies. In predament, eat fruits and veggies. Well, that's another thing as well, that the low fat and low carb kind of can mean something different between research groups. Yeah, yes. Oh, that part's so frustrating that this name of a diet means something that everybody agrees on. It really doesn't. Keto is never meant to be a high meat diet. It's supposed to be a high fat diet. and if you just have meat, there's so much protein, you can't get enough fat. So you get kicked out of ketosis. Yeah, when you turn your proteins into carbs, wasn't the whole point to avoid the carbs.

24:04So to avoid that, you really have to eat fat. So that part's always hard. Again, so this is, I want to study a diet. I want to study a diet that's popular so I can answer a question the public is interested about. I'm going to define it. I might not define it the same way as the other person. And they got to follow it. And they never follow it the same way once we're past pill and placebo. Okay, and if they're not following it the same way, I'm going to have to ask them questions about it throughout the whole study. I'm going to have to get to be as honest as they can about it. Another thing we've done in our studies is we have often, because we do a lot of diet assessment in our studies.

24:47And we say, if you aren't following it, don't lie. Like that'll just mess up the whole science. If you aren't following it, there might be a reason you're not following it. Don't feel bad. Don't feel like you've ruined the study. I do want you to eat what we asked you to eat. That's a valid finding in and of itself, adherence. And so we want to address both issues. One, we assigned you to the diet. And two, there's a range of adherence. So in most of our recent papers or studies, we've published a separate paper on adherence to show that you can't just call it low-fat or vegan or Mediterranean or keto.

25:28That's what we said, and here's how we said and defined it. But here's how we saw people were eating it, and that's relevant to the question. It's like, oh, a whole bunch of the people couldn't do it. So when you see the headline, and group A did better than B or whatever, keep in mind that we didn't lock them up in a room and videotape them. These were people living in the real world and they couldn't follow it. So is that a crappy study or isn't that a more generalizable study? And so if you can try to maximize the generalizability nature of it and the rigor, that's like the golden ticket. But then it's hard to explain to the public what you did.

26:13I don't know if your eyes are rolling over in the back. And it looks like you're still looking at me, but you could be getting bored already. No, I'm following. I run into the same challenge because you can sometimes see different results between a very tightly controlled study, right? Like where, you know, Kevin Hall studies where they give them all the food and lock them up like we've spoken about before versus your free living studies where you tell them how to eat, but they prepare their own food, and human behavior is all of a sudden introduced. So now, you know, diet A that performed a certain way in the metabolic chamber maybe doesn't perform exactly the same in the real world.

26:56But I think to the, I agree with you that to the listener or the person reading your book, what really matters is when human behavior is introduced, if they take that advice and go away and do it, how is it going to affect or most likely affect an outcome they care about? Their risk of having a heart attack or a stroke or their risk of developing dementia. Whilst all of those different study designs have merit and contribute to our understanding, appreciating the difference in generalizability is important, I think, in terms of developing recommendations for people. So one of my favorite examples of this is not one of my studies.

27:40It's the Women's Health Initiative and calcium. Is it okay if we go there for a minute? Let's go. Okay. So the Women's Health Initiative was originally designed to test an estrogen or a hormone replacement therapy hypothesis. It looked like women taking hormone replacement therapy were having fewer cardiovascular events. And some people said, yeah, but there's actually, there's more higher SES women taking hormone replacement therapy than the general population. And they said, no, no, no, we've accounted for that with statistics. And we've, okay, well, we really need to randomize people to that.

28:14So they did. And it was the biggest NIH study ever funded because they had underfunded women's studies before then. And they said, wow, I've got all these women here. We should do a low-fat breast cancer study at the same time. So we'll take the same participants getting estrogen hormone replacement therapy or placebo and re-randomize them to diets. And then somebody said, oh, and we've never answered that calcium and bone question. Can we please also insert a third randomization in here? So it was very complicated. And a weird thing about the third part was when they asked the women if they'd be willing to be randomized a third time.

28:58Quite a few of them had been willing to give up their hormone replacement therapy, which was addressing their hot flashes and their night sweats for the sake of science and women all over the world. But they thought it was too much to ask them to give up their calcium to be re-randomized. So they didn't ask them to give up their calcium. And the majority of women were already taking a calcium supplement and kept taking a calcium supplement and got randomized. So if you can imagine, some are getting a supplement and then another supplement. And some weren't, and now they're getting a supplement.

29:30But there's very few people who are just not getting a calcium supplement. Yeah. And at the end of the day, they said, wow, it looks like the calcium did not stop bone fractures. And all these women were taking calcium to prevent osteoporosis. Even in the control group. So really they're comparing supplementing to more supplementing. So what they had to do at that point, when everybody was mixed said, well, there were people taking supplements the whole time before and after, and that's problematic. So we'll only take the ones who weren't taking it. And we'll only take the women's who are older.

30:05And we're only taking the one who took at least 80 % of the placebo and the real thing, which was a smaller and smaller and smaller group. And when they did that, it was like, these are the most relevant women. They were old enough and they weren't taking it beforehand and they weren't getting enough anyway. and there was a 30 % reduction in bone fractures. And part of the scientific - By taking the calcium supplement. Under all the right conditions. Right. And some of the public or scientific community said that was not the original question. You're data dredging. You need to do a whole new study to start that.

30:42You have to recruit differently. You have to do this other thing. And what was really amazing was another study came out almost two months later that said, oh, we did something similar. We actually started with women who were older, who were more at risk, and we assigned them to calcium or placebo. And there was a 16 % overall reduction in bone fracture, and between them, there wasn't, no, sorry, 13%. There wasn't a difference between them, but we decided to do one separate analysis, just the women who did take the pills, at least 80%, and the ones who took less and weren't adherent. And we did find a significant reduction in bone fractures in the women taking the pills.

31:29And so the conclusion in the abstract of this paper was, as a general public health intervention, calcium supplements don't work. However, among those who are adherent, they work. And so can I boil that down to one sentence? If you take them. they work. And if you don't take them, they don't work. I do this to my students every year. I tell this whole long story and then they look at me, they say, is it really just if you take them, they work. And if you don't take them, they don't work. Yes. But the way science is, they elaborated and they subdivided the groups. And the true thing was a lot of women don't take them.

32:12So if If you were a public health official and you wanted to reduce bone fractures, education, it is not an effective public health approach to make calcium supplements available. It didn't work. That's a really important answer to a question. If the question was, is this an effective public health strategy? You'd have to say, no, it's not enough. You mentioned data dredging. As a scientist, this comes back to that null finding. a scientist guilty of data dredging to avoid a null result? Oh, yeah. Oh, it's so hard to not do that. It's much better these days, though, because of clinicaltrials.gov.

32:56Explain what data dredging looks like in practice. Yeah, absolutely. Okay, so here would be, let me give you the FIFO study, okay? So our very own study looking at fermented food and fiber. I had kimchi earlier today. Cool. we are involved with Mark Davis and Holden Maker, who are really amazing immunologists at Stanford, and they run this human immune monitoring center, state of the art. And unfortunately, and fortunately, they can measure hundreds of inflammatory markers. So the good news is you can get lots of data. The bad news is there isn't one clinically validated measure of inflammation.

33:37There's CRP, there's TMAO, there's interleukin-6. So Mark Davis had come up with this idea of a cytokine response score. And he had just published a paper on this. And he said, given that we have decades of data from thousands of people, we sort of, this isn't the data dredging part. We used that existing data to say which compilation would make a composite factor that would be the most effective. So it's like it's looking at a kind of overall inflammatory signature and saying people that are sick or unwell or have a disease are more likely to have this kind of overall inflammatory signature. Profile, composite, signature.

34:24And there were 14 of them. And so when we applied for the grant, we wrote this composite score down, and it's listed on clinicaltrials.gov. okay so we ran the study and the cytokine response score didn't change we did have 90 different inflammatory markers and we looked through all of those and 20 of them improved in the group getting fermented food and said that they can't they got lower they got lower which we presume means lower inflammation which we again is it is that a presumption that it's a presumption because inflammation is so complex but you would have thought if it was random chance some would have gone up and some would have gone down and the rest would have stayed the same but at this point lower always mean like just coming back to calcium that you you said it wasn't surprising that women that were already supplementing with calcium you put more on it doesn't necessarily lead to a better outcome if people already have a healthy level of inflammation and it goes down, is that clinically, is that meaningful?

35:31Good point, good point. So they really have been, most of them, many of them have been separated out into some that are pro-inflammatory and some that are anti-inflammatory. So at the end of the day, the ones that were considered to be pro-inflammatory, 20 of them went down and the rest didn't move. And because of that, when we published our paper, we had to say the primary outcome didn't work. but because we had 90 other ones we looked and 20 went down and none went up and 70 stayed the same this is a pretty interesting finding in this field which is pretty novel and that paper has already been cited a thousand times and should that be considered secondary and exploratory or is that presented that way it was yeah yeah so the data dredging part would be to not acknowledge the cytokine response score.

36:24So when we got reviews back, one of the reviewers said, your primary outcome didn't work. And we said, we acknowledge that, and this is a ton of work, and we had all kinds of data. And so we're acknowledging that the primary outcome did not change, but we looked at all these secondary outcomes, and this is what happened. And that's the kind of thing you put in the limitations. So in the old days before this thing, so let me explain it. I don't think I explained it. For clinicaltrials.gov, if you want to get published in the scientific world, as you start your study, you're supposed to say what your primary interest is.

37:00Before that, you could look at a hundred things and find that the thing you really thought was going to change didn't change. And you said, well, I got 99 others. Let me see. So the problem with that is that just by chance, you'll find something. Absolutely. Yeah. And so it's so discouraging after all that work to say it didn't, nothing happened. And it's so tempting to say, did anything happen? Can I find something that changed? And then what's really important in science is just to be as transparent as you can about that and say, this is a secondary to really figure this out. Somebody should start a new trial and do that.

37:40So with that in mind, if we come back to this idea of certainty and uncertainty, and we think about fermented foods, and we'll think about this study in the way that I guess media speaks about it, or you speak about it the way I speak about it, I use it to recommend the consumption of fermented foods. But if we just objectively kind of sit on this study for a moment and look at what was measured, so I think microbiome diversity was measured. Yes. Which associates with good health. I don't know that anyone's shown experimentally if you improve microbiome diversity, it directly affects a health outcome.

38:15No, because it's always stated in the limitation that if diversity increased, but it was the pathogenic ones that increased more, that would be counterproductive to what we were trying to say. So we don't know for sure, but it's usually associated with an improvement. So to what degree of certainty could we say, Well, this study proves that fermented foods are going to improve your health if you have six serves a day. Right. Yeah, then you have to figure out how many servings. And for what? For who? And were they high sodium and they raised your blood pressure? Because some fermented foods are high in sodium.

38:56And at that point, everybody gives up and goes and eats whatever they want. Because there's too many caveats. So when Michael Pollan said, eat food not too much, mostly plants. I can't tell you how annoyingly I took that, but how pleased I was. Like, how many citations does he have after he says that? None. He's a journalist. He just thought, you know, I've looked at everything and this is what I can boil it down to. To have more certainty in a food like fermented foods comes back to the point you're making earlier. You're not going to randomize people to fermented foods and track them, healthy people, for long enough to see their risk of developing a chronic disease.

39:35Maybe you could with a group of people that have digestive symptoms, but that wasn't the purpose of the trial. And how many kinds of fermented foods are there? And how many levels of servings could you have? And you could, okay, so this guy, Larry Lawson, who had spent his entire life studying garlic. I mean, you really have to admire his relentless nature of focusing on one thing. And that's the only thing he focused on. you could spend your whole life and not do all the possible garlic studies. You could spend your whole life and not do all the kimchi studies. And if you expand kimchi to fermented vegetables, now you're not even touching on kombucha or yogurt or kefir.

40:22And so how do you narrow in on the thing so that the person hearing about the study says, oh, I am or I am not going to buy that bottle of kombucha. I am or I am not going to start fermenting foods at home. So how do you think about fermented foods today? How would you distill findings from that study, the rest of the literature, other clinical trials, the observational research to a friend, a family member who says, just tell me what to do? Yeah. And then I would go back to part of our conversation in the beginning that, oh, for thousands of years, people ate fermented food. That was like before refrigeration, that was a way to keep foods edible longer.

41:09And now from a culinary perspective, we actually had, oh my gosh, I'm going to forget the name, chefs in residence. So there's a lot of interest in the microbiome at Stanford. And we have a new faculty member who, if you haven't interviewed him yet, oh, I should recommend this, Vayu Hilmeni. He's like six foot seven, and he was a professional chef, and then he got a PhD in bioengineering. Anyway, he is making food by using a fungus to chew up the waste stream from soybeans making soy milk and from beer, the grains from making beer. And he's making edible, tasty foods out of those, borrowing some of the ideas and concepts of fermentation.

41:59And he somehow worked with Stanford University and got two chefs in residence from Spain to come to Stanford for a whole year. And they were famous for being in this restaurant that they ferment the crap out of everything. They're super experimentalists, and some of them fail horribly. but they're discovering all kinds of amazing flavors by playing with food it's not science but it's this idea of ah the fermentation process is creating microbes and we're eating them like let's walk away from science for a bit and let's just do the culinary side of this what new tastes could we come up with? What combinations?

42:45How much fun could we have with food without killing anyone? And maybe we'll help them. But it was pretty funny that this whole group of scientists embraced these Spanish chefs in residence because it's food. And, you know, we've started to move too far away from the joy and the pleasure and the experimentation and the social connection of food. So, oh my God, I'm back at philosophy again. It's like the bigger picture is, oh, food means so many things to so many people. Let's play with science. I love playing with science. I love balancing generalizability and rigor. I love thinking about dose and duration and narrowing the question.

43:30But at the end of the day, I'm going to go home and eat dinner with my family. Is that why you finished the book with the recipes? Yeah. Yeah. I've taken creatine daily for years now. On a plant-based diet, you start from lower muscle creatine stores than someone who's eating meat. So it's one of a few supplements that I feel really adds something to my diet. And the evidence on strength and power is about as solid as it gets when it comes to supplements with emerging data on cognition, which raises a question that most of us never ask. Do we actually know what's in the creatine that we take every day?

44:07The category has exploded and most brands have competed on flavors and formats rather than the quality of the creatine itself. Momentus went the other way. Signature-spec creatine is made in a pharmaceutical facility using reverse osmosis water purification, verified through a six-stage testing process with four independent agencies. Ten times fewer impurities, heavy metal limits two to five times tighter, screening for PFAS, and microplastics. it's also ultra fine so it actually dissolves no grit no clumping at the bottom of the glass if we're taking something every day for our health i think it's worth it being the best version possible if you want to try momentous signature spec creatine head to livemomentous.com and use the code the proof for up to 35 off your entire first order that's livemomentous.com promo code The Proof for up to 35 % off.

45:05Livemomentous.com, promo code The Proof. This episode is proudly brought to you by Ironmate. Over the past decade, I've seen what's possible when you stay consistent. I stopped binge drinking, I started eating a plant-based diet, I prioritized sleep, and I changed how I trained. At 40 today, I am the healthiest I've ever been, stronger, leaner, faster with my best ever blood work and VO2 max. And while wellness would have you believe that takes a pile of expensive gadgets, it came from doing a bunch of things well enough for long enough. I'm certainly not claiming that Iron Mate got me here. That would be a stretch, but it's part of the routine and there's decent peer-reviewed trial evidence that daily supplementation with a multi-nutrient supports cognition, mostly in people that are older than me so I do hold this loosely but covering my micronutrient bases with little downside seems like a sensible insurance policy to me.

46:02I'm on Iron Maid's scientific advisory board so I've been able to see first hand how Daily Ultimate Essentials is built. 90 ingredients in a single sachet, NSF certified for sport with every single batch, third party tested for over 290 plus banned substances. Simply mix into cold water and enjoy. They offer a 90-day money-back guarantee on the quarterly plan. Go to im8health.com and use the code Simon at checkout for 10 % off your first order plus a free welcome kit. That's code Simon at im8health.com. Your kind of line of thinking there are, well, people have eaten fermented foods for thousands of years.

46:46I imagine that someone may apply, and I think I've seen this kind of argument for people that recommend cut the carnivore diet. They say, you know, our ancestors ate loads of, bucket loads of meat for thousands and thousands of years, so it must be good for us. Can you see how that same thinking could be applied, I guess, to a dietary pattern that you don't recommend? Yes, yeah, and I would be open to that. But I've heard time and time again that most of the time us humans were unsuccessful at hunting and killing something that had a lot of meat. We were often left grubbing for roots because we couldn't find enough.

47:28So I don't think, and people have done new, they've found intact teeth in caves from long ago. and said it looks like they're eating more grains or something i think even lauren cordain um who was one of like the fathers i guess of the paleo diet yes he was he i remember reading one of his papers and i think this could shock some people in the paleo low-carb community if they haven't read this paper i'll put in the notes but he he kind of goes in and and describes to the best of his understanding that even the type of meat that was being consumed. And compared to the kind of hamburgers and sausages and all the things that are being consumed by Americans and Australians today, the meats were far leaner.

48:16The game meat was very low in saturated fat. So it was even a different type of food that would have been consumed, as you say, when they were kind of fortunate enough to get it. And so let me circle back to fermented food, because Justin and I have written some papers about, or given more talks than writing papers on the idea of the commercial industry getting ahead of the science and saying, wow, the microbiome is super hot. Here's a gut shot. Here's these three strains of bacteria. Here's these two types of fiber. And one of the issues is, oh my God, it's really complicated. There are hundreds of species of bugs in our gut, and there are dozens of different kinds of fiber that would feed them.

48:58And so as you're consuming food, oh my God, the pH is killing off, the low acidic pH in the stomach is killing off a lot of the live bacteria you ate, but there's billions of them. So some of them get through and then you have to feed them with fiber. And eventually there's a goal that you'll say, ah, we know all the good from the bad microbes and we know the ways to feed them and we know the way to implant them. And so we have recognized you have a microbial deficiency in Akkermansia. and so we're not going to put a turkey baster up your butt anymore for a fecal transfer. Actually, I'm working with Sean Spencer, who you should also interview, who's working on poop pills.

49:41Personalized poop pills. You'll take a poop pill and it'll go down. Based on your composition of your microbiome? I don't think it's personalized yet. It's just the idea of will it survive the... To what extent will it survive the intestinal tract? and is it so someone else's someone else's poop yeah and who's gonna donate the poop well you hope it's coming from a healthy person and then maybe it's a mixture of healthy people so it's a mixture of all the healthy poop okay so they have done that in mice yes and then they've taken it from like an obese phenotype oh that was one of the classic breakthroughs yeah maybe you can explain that oh I don't know if I can explain this but and it's I think it was Rob Knight's lab but the first author was, ah, not Turnwell, oh God, I'm Peter.

50:30Sorry, Peter, I'm blanking on your last name. Peter Turnbell? Yes, yeah, that sounds right. I'm confusing him with someone else who did our dish study. I think David Lawrence and Peter Turnbell. I don't know if they're on this paper, but they've done a few papers in this space. Anyway, this idea of taking these notobiotic mice where they have just clean GI tracts and you introduce bacteria to them and you feed them the same kind of food and one group gains more weight than the other. So it's fascinating what can happen. But then, so here's the silliest example that I've seen right away is Costco is now selling big bottles of kombucha.

51:09And there are people who are concerned with fermented foods. Doesn't that sound dangerous that there's bacteria? So they make the kombucha, they pasteurize it so they kill off all the bacteria and then they add live bacteria back to it afterwards so that they can say on the label, it contains this many billion microbes. It's like, wait a sec, shouldn't you just be drinking the kombucha that had the microbes in it? Why are you killing the microbes and then replacing them with other microbes? Does that work? That's a separate question. Then here's the kombucha and it was brewed making these microbes.

51:46Also, that is also still an interesting question. I had Professor Maria Marco on the show. I'm not sure if you know her, but she studies fermented foods too. Actually could be a good collaborator with you and Justin. And she was telling me that they're starting to learn that the kind of skeleton of the bacteria, even when it's dead, may be having an action and interacting with live microbes in your colon. And so there's all sorts of kind of interesting ways in which these fermented foods seem to be affecting physiology. And so, you know, the deeper you go into the science, the farther away you get from joy and pleasure and just food.

52:29like isn't it cool that these chefs in residence from Spain just fermented the crap out of everything knowing that some would be a disaster thinking that if we found something new that was that tasted really good and proved to be good for you wouldn't that be awesome but if we become reductionist and say it's just this one molecule in this one thing then then to me the science isn't any fun anymore. And it's back to philosophy of why did I go into this? I wanted people to not just be healthier, but to enjoy their food and align their personal values and live in a healthy planet. And okay, so there's no sure way to know that.

53:10Is that where you are most interested like going forward with studies, looking at highly generalizable studies that look at an overall dietary pattern, find a way to make it delicious so adherence is high, and in the study measure things that we would accept as good outcomes, so have been clearly established as a good outcome. That's kind of connecting all of these dots. So there's still a scientific approach because just delicious food on its own, that's not really enough. I mean, I could make the most unhealthiest ice cream sandwich. That's very delicious. But how can you create food, a menu that's delicious, but is shifting risk factors and these things that we care about?

53:57And you could, yeah. So I'm definitely, what if you had this food that you absolutely enjoyed and you were overweight and lost weight and you were hyperlipidemic and your cholesterol cleared up and you were hypertensive and your blood pressure went down and you were pre-diabetic and your glucose went down and you loved it. yeah, that's the North Star. And I really think that is possible. If you take advantage of the Asian diet, Mediterranean diet, Latin American diet, Middle Eastern diet, Indian diet, just not the US standard American diet. Is that subjective experience of the subjects, how they enjoyed the meals?

54:34Is that something when you read studies in this space from other labs, other universities. Is that something that you think is missed, is underappreciated? Oh, absolutely, which is why Kevin Hall was brilliant when he did, in a couple of his papers right now, he said these hedonic values. Were you full? Were you satisfied? Did you enjoy it? And the numbers aren't, and he usually does these things on a scale of zero to five, and they're not five, but his point is I'm comparing diet A to diet B, and they were just as satisfied and they liked the taste just as much and they were just as full. So they might not have been super full, super satisfied, best thing I ever ate.

55:19But he's comparing two diets that are similar in those hedonic properties, which I think is hugely important just in terms of, okay, so you're going to follow this long-term. We showed it work. One of the first studies I did was two low-fat diets. And they were matched on total fat, saturated fat, and cholesterol. But one was very plant-rich and one was very convenience-based. And so my hypothesis was that, and they were both low-fat by American Heart Guidelines and low cholesterol. And they were people with elevated LDL cholesterol. And sure enough, both groups lowered LDL cholesterols just one month.

56:02and we fed them all the food. But the one on the plant-rich doubled the LDL cholesterol lowering. More fiber. Yeah, more fiber, more antioxidants. That's actually why we did the garlic study because there was more garlic in it, more soy, several different components that probably in a composite way or collectively - Kind of sounds like the portfolio diet, but lower fat. Yeah, yeah. Same idea as David Jenkins' portfolio diet. But at the end of the day, I said, isn't this great? we found this go do this and the participants looked at me and said are you going to keep cooking for us I said dude that was a month that cost so much money no not for the rest of your life and they said well we're probably not going to eat that way And I said, well, we don't shop that much.

56:53We don't cook that much. We go out to eat a lot. And there's these other things that we like. And so understanding all those really practical hedonic values. That's why in the book, what I really like to do is for me, a big part of adherence to a behavior change is more about environmental sustainability, animal rights and welfare, human labor abuses and slaughterhouses or fast food workers or drought. So somehow aligning some of those food choices with personal values. Beyond someone's health. Yeah. And when you do it, they tend to align. Like if you find the things that are good for the planet, they're often good for health and so on and so on.

57:39So if you take the time to figure out how aligned they are, it can be more of a motivation. But the more interesting thing for me as I've been studying this is not everybody agrees on the same personal values. Somebody's more the eco-warrior. Someone's more the animal rights and welfare lover. Some are more the social justice, labor force lovers. but they all kind of align together. I also think we've created a society where convenience is king. Yes. And even where someone may have values, if they're not strong enough and don't have enough conviction in the value, it's very easy to kind of have your arm twisted by an environment that makes it super easy to kind of go against your values.

58:27and I think to extend that, I think we can't underestimate as well the kind of loss of the skill of cooking. And in your book, I think you mentioned a recipe that your father-in-law taught you and then you taught, was it Jackson? Is that your son? Yeah, passed from generation to generation. Yeah, it seems like that's happening less and less and less. But if that skill of cooking was there and love for it and the passing of the recipes from grandfather to son and then grandson, I feel like all of us would be cooking much more regularly. There would be more reason to cook. And it's fair that you'd have to put more emphasis on convenience.

59:17So there are faster and slower recipes. And there are culinarians who don't mind spending hours and hours. hummus is my favorite thing to make hummus is so fast oh my gosh it's just chickpeas and tahini garlic and garlic yes a lot of garlic and olive oil and paprika and lemon that's it hang on garlic garlic didn't lower cholesterol but it tastes so good right and so that's it's it's funny that although we have that null published trial i eat so much garlic did larry how did Larry take the results of that study? Oh, he was disappointed. Yeah. Oh, we worked so hard to prove what almost seemed irrevocable in it.

1:00:02Oh, we already know this is true. We'll just, we'll have to do the best study to prove that it's true. But he was, you know, enough of a scientist that he said, okay, at that dose for those people and that outcome, we were wrong. Did he go on to show any other interesting things about garlic that you can remember? No, he didn't do that many. One of the interesting things was he was such a chemist that he was not accustomed to recruiting humans and having them cancel and reschedule. He had an artificial human digestive tract in his lab. And he was the one who pointed out to me that he would take some of these enterically coated garlic tablets and put them at the start of this thing, which as it went down would hit the acidic environment of the stomach and then the neutral small intestine and then the environment of the colon before being excreted and finding you could still see the company's name on the pill.

1:00:58Like the enteric coating had never caused the pill to dissolve. And so his point was, you need someone like me in the lab looking at all the pH differences and the times in the GI tract. And he was really great at using science to answer that kind of specific question. Will the allicin ever be made available from this pill? And so I'm not aware that he found any other human nutrition scientist to work with. Because to be honest, there's not many of us who like doing this. It's a pain in the butt. Humans are a pain in the butt. It costs a lot of money. It's really hard to do. The adherence goes up or down.

1:01:40people slander you in social media what would you say are the the positions that you have on on food or food groups coming back to that certainty that you hold but you would say i hold them loosely they're the ones i'm kind of i'm least certain about these i don't know that level so i actually kind of set that up in my book so i have a chapter of my book that's devoted to the solid four and, uh, wait, something called, now I've even forgot what I call it, but there's a solid six and a set of four. Big, big four, solid six. Big four, solid six. So yeah, if you don't mind, let me, let me start there and I'll kind of address your question.

1:02:24So a really fun exercise for me was to be part of American Heart Association. And after they, um, updated their 2021 dietary guidance, the public said, oh, which of the popular diets align with the domains of the newly updated American Heart. And so they said, Christopher, do you and nine others want to look at popular diets and how well they align? And I said, oh, what a fun project. Yes, absolutely. This is diet patterns, not individual components. So at the high end of the ones that were the most aligned, it was DASH, Dietary Approaches to Stop Hypertension, and Mediterranean, and Pescatarian, and Ovolacto-Vegetarian.

1:03:02And at the bottom was Keto and Paleo for violating the domains. And everything else is in the middle. Low-fat vegan, high-fat vegan, regular low-carb, regular low-fat. I feel like there was one other. Anyway, that should be close to 10 categories there. And so we made like a heat map of agreement versus disagreement. So the American Heart domains, 10 domains were on the vertical axis and then the horizontal was all the different diet patterns. And the cool thing was there were four things that everybody agreed on, even keto and low-fat vegan. And it was whole foods and more vegetables and less added sugar and less processed food and refined grain.

1:03:48They all agreed, which would not be interesting if Americans already did those like, oh, we know that that's boring. We already do that. But Americans don't do any of those. They eat a crap ton of added sugar and processed food and refined grain and a crap ton of, and they hardly eat any vegetables or whole foods. So that's where you would start if someone was listening to this, had never made a change, was eating the standard American diet. Because they could follow any popular diet pattern out there and it would follow that. Like you wouldn't be violating any of the rules. Which explains why you see such very passionate anecdotes online for all of the different diet camps.

1:04:30because there's something to all of them. Okay. But then there's another category where not everybody agreed like somebody disagreed, and one was beans. So Gundry's come out with this plant paradox thing that lectins are anti-nutrients, and they'll grab nutrients, and you'll lose them when you poop out. Okay, but beans have so many great things in them. So almost no one is against beans, which we really should call legumes. Can I ask you how often you use the term legumes? Do you use that ever in Australia? I'd use legumes a lot because it also encompasses chickpeas and lentils. Ah, okay, good for you.

1:05:14How about pulses? Do you use that word? I don't tend to use pulses, but I know that it's sometimes in literature. Okay, so botanically, can I just help? What's the difference between a pulse and a legume? We need more Americans to be food literate. But botanically, legumes is the overarching term. And it means fresh peas, fresh beans, soy, all soy products, and all peanut products. And pulses. And then pulses is dried beans, dried peas, lentils, and chickpeas. So that whole family, they're all leguminous. They are all nitrogen fixers if a farmer's growing those. Less synthetic fertilizer. All of those are cover crops that generate high protein, high fiber, low saturated fat.

1:06:00So what's the term you want people to use? Legumes. That's the best one. But when we were working on the Dietary Guidelines Advisory Committee, we kept seeing legumes or beans or chickpeas. And we were playing around with all the words. And it was a big mouthful. And we said, we should use legumes because botanically, legumes is at the top of this list. And the communications department said, no, you're going to have to say beans, peas, and lentils. And we said, but we looked at the evidence and the evidence isn't legumes. It's these other things. And they said, Americans are going to go to the grocery store.

1:06:29It's a translation thing, right? I think I agree with them. And I do too, because I know that Americans will go and they say, damn it. I found the peanuts and the soybeans and the chickpeas and the lettuce. I couldn't find the damn legumes anywhere. Exactly. It's like, that's. You don't buy canna legumes. That is the word. I think part of the answer here is to really promote the leguminati. so if everybody wanted to be part of the leguminati and hats and t-shirts merch is coming for the leguminati okay you make it i'll buy it you make it i'll buy that would be super cool okay so anyway beans got short shrift but they're really fine almost everyone agrees and fruit is another one so fruit is sugar so i know there's lots of low carb people that say not only added sugar but fruit sugar fruit sugar is bad for you no it's not there's really a matrix around the sugar in the fruit, unless you're having fruit juice.

1:07:25So almost everybody agrees on fruit. I think as well, I think more and more people in the low-carb community have come around to that. Okay. Thankfully. I think that many of the kind of prominent players, not all of them over the last kind of four or five years have developed an appreciation for the quality of the carbohydrate. Good. Yeah. The ones that are operating in good faith. And the next one is the nuts and seeds that have fat. So there's the low-fat vegan group that really vilifies anything that has fat in it, even unsaturated fat, but boy. Seed oils. Yeah, oh, we could do seed oils in a minute.

1:08:02That's part of it, is the seed oils. Yeah, okay. So the unsaturated fat in nuts and seeds is pretty good for you. The cholesterol in eggs, really, most people handle that metabolically without too much trouble. There's a really nice paper coming out soon showing that the cholesterol in an egg for somebody who's sick and also eats a lot of animal products anyway, probably not good for you. But if you're healthy and you don't have very many eggs, it's probably not going to make any difference at all. And what do Americans eat for breakfast usually? Sugary cereals. Compared to what? So instead of what?

1:08:40The eggs would be way better than that. And then fish. So the vegetarians won't eat fish because they have a face on it. You've probably heard that, right? How do you describe your diet? I don't eat anything with a face on it. I'm a vegetarian. Fish have a face. Fish are pretty healthy. And again, instead of what? So instead of some of the other entrees, fish should be over. And that'd be five. Beans, fruits, nuts, eggs, fish. And the last one I would add is yogurt. I'm not a big dairy fan. Most of the world's lactose intolerant. But because of fermentation and the cool interest in yogurt, of all the dairy, I would support dairy more than the others.

1:09:20Do you think there's some independent effects of yogurt that, or distinct effects, I should say, that go over and beyond other fermented foods? No, but I would like to try that, right? And so that's the next step. But here's the problem. So when we did FeeFeeFoe, part of the way we got people to six servings a day, and you call them serves, but I call them servings. This is the fiber fermented food study. Yeah. So in that, we assumed when we started that we didn't know which microbes would do it. And we knew that people had food preferences and maybe some wouldn't eat sauerkraut or they wouldn't drink kefir.

1:10:01So we just said, look, there's about five different kinds of fermented foods that Americans will at least be familiar with. Any combination you want, try to get six servings a day. And when we calculated this all out, turns out one of those big bottles of kombucha is only 50 calories, and a serving of kimchi or sauerkraut is like 50 calories. And it turned out like six servings a day is 300 calories. And when we said six servings, people said, oh my God, that's all they ate all day, was fermented food. But they really didn't. It wasn't that many calories. Now picture trying to separate kimchi from sauerkraut from yogurt.

1:10:42How many servings a day of each would you give for how long for what? Again, it's all these inflammatory markers that we look at. Of the fermented foods, yogurt would be the most commonly consumed fermented food in America. Yeah. Right. And so is that a better option to go for because it's relatively well accepted already? study what's interesting to me is if you were to compare them in a study what you would measure that would help you kind of declare one a winner over the other because there are so many things that you could measure yes again that's the challenge of science so just the idea of and to be honest one of the more exciting things was in that fee-fi-fo study where we had fermented versus fiber-rich foods.

1:11:36We got them to six servings a day. At baseline, they were eating like half a day. That was the average. And some people zero. When the study was over, we went back later and they were eating on average three servings a day on their own outside the study. They felt better or they enjoyed the taste. And what if those are different factors? Like I felt better, but I didn't like the taste or I liked the taste, but I didn't feel any better. Again, that's sort of another level of, that's like too much detail. We should just, that's a pretty reasonable thing to add into your diet. So we have a chapter on the microbiome in the book for those kinds of things.

1:12:18It's cool. It's really fun. It's new. It's gross. There's lots of poop jokes when you're working with a microbiome. But it's a hot new topic and it brings in the opportunity to work with a microbiologist and an immunologist. Do you get worried sometimes with a hot new topic that the kind of commercialization of things occurs rapidly ahead of the science? And that it will doom the science, yeah. So if the claims are made, like if we say, oh, it's plausible that this will happen, and then the commercial product says this will happen, and you try it and it doesn't, you might dismiss that whole new line of products before it was really given a fair chance.

1:13:04You ran a study looking at the ketogenic diet versus Mediterranean. Oh, that was one of my favorites. I don't think we've discussed that on this show. Okay, we could do that. Cause that was again, this balance of rigor and generalizability and what the point is. Cause I think, okay, so this is, ooh, ooh, you asked me before, Like, what do you loosely think? Yeah, what are you holding with a kind of low amount, a degree of conviction? Yeah. And so that study was designed to do that. So I'm fascinated with the popularity of the ketogenic diet. It doesn't make any sense to me. It seems wackadoodle.

1:13:44How could you be, to be ketogenic, you really can't have any beans and any vegetables other than some leafy greens. Okay. Okay, above ground vegetables you can have. Fruits are out. Okay, so, and it really was supposed to be fat, fat, fat, really super high fat. And most people that I run into can't adhere to that. But what we always saw was when we assigned somebody to Atkins in our old A to Z study where A was for Atkins or low carb or Mediterranean keto, they were always the best ones at getting rid of added sugar and refined grain. because those are the biggest offenders. Like if they were gonna cheat and not adhere, that is not where they were gonna cheat.

1:14:28So in low carb, low fat, we said both of you should choose healthy low fat and healthy low carb. And I know added sugar and refined grain is low fat, but it's not healthy. Switching gears for a second here, folks, to talk about Shopify. Shopify is the e-commerce platform that we use at 38 Terra to sell our science-backed gut health products into the US, the UK, Australia, New Zealand, and soon to be Canada. If you've ever thought about turning an idea into something people can actually buy and experience, this is one of the main hurdles that stops people building the site, taking payments, routing orders to your warehouse.

1:15:10Shopify makes these things an absolute breeze. It's honestly never been easier. The design and launch tools, templates plus AI, get a professional looking storefront up fast. No coding required. Then there's checkout, where a lot of stores quietly lose people. Some recent tweaks we made to our Shopify checkout have meaningfully lifted the number of customers who subscribe on their very first purchase. And returning customers can check out in a single click. And if you get stuck, their built-in AI assistant sidekick helps you build, troubleshoot, and keep moving. Like having someone in the room who's set up a thousand of these things before.

1:15:46All you need is the idea. Shopify handles the rest. Start your free trial at shopify.com forward slash proof. That's shopify.com forward slash proof. Sign up today at shopify.com forward slash proof.

1:16:07Most people don't think about brain health until something feels off. Personally, I'd rather look at the data while everything's functioning fine. That's part of why I use function. It gives you access to a set of tests you'd otherwise chase across several appointments. Two markers I pay a lot of attention to, omega-3 index, which reflects your EPA and DHA status, DHA of course heavily concentrated in brain cell membranes, and homocysteine, which is consistently associated with cognitive decline risk. Both of these are modifiable, which is the point, measure and then intervene members can also add on tests like APOE the genetic test for inherited Alzheimer's predisposition if that's something that you want to know none of this of course replaces your doctor its information a more comprehensive view of what's going on inside you so the conversation starts from data rather than guesswork check your health the way that I do function provides more than 160 lab tests for one dollar a day and member pricing on advanced imaging.

1:17:09Join at functionhealth.com forward slash Simon Hill and use the code Simon25 for a$25 credit. So just to be clear, in those studies, typically the low carb group would get their consumption of added sugars, refined sugars down lower than the low fat group. And we said it with the same conviction to both groups. That's just what happens when you put people back out into the real world and they make decisions eating within those two different kind of frameworks. Because for the low-carbers, that is the worst offender. And for the low-fatters, it's like, well, I'm kind of cheating here, but it is low-fat.

1:17:47Particularly back when you ran A to Z because it was probably, presumably less ketogenic convenience foods. So, if you're going to go low-carb, it kind of wipes out most of the ultra-processed food, middle-of-the-aisle foods. Yeah. So my feeling was, wow, I really think this new trend is particularly effective at that. Okay, so what if we took a Mediterranean diet and gave much more emphasis to that and made it really high in fat? So our Mediterranean diet was 50 or 60 % fat, and we're having lots of avocados and olive oil and everything and fatty fish. Is that higher than a typical Mediterranean diet?

1:18:33Yeah, we intentionally made it higher so that it would be lower in carb. That was the whole point. Like this is still consistent with a Mediterranean diet, but it's a slant on it. So we actually, in the paper that we wrote up, we called one the well-formulated ketogenic diet because we tried to follow Steve Vinny and Jeff Folek's advice, which was not high meat. It was high fat. and for mediterranean we called it mediterranean plus there's a bunch of mediterranean scores out there and the scores are usually the main food groups and don't specifically mention sugar and refined grain so he said we want you to be a mediterranean and get rid of the refined grain and the added sugar and we want you to be a little higher in fat than usual seems like a very healthy diet to me right at mediterranean plus and so that i thought that that would the answer we were trying to answer the question of after you get rid of the added sugar in their fine grain and raise your unsaturated fat is there an additional benefit to getting rid of the legumes and the root vegetables and the fruits because those aren't allowed on keto and most health organizations around the world recommend legumes and whole grains and fruits.

1:19:52There isn't, I don't know of any national dietary recommendations that don't recommend those three. But keto suggests avoiding them, virtually all of them. So that's why we designed that study thinking it's complicated, like we changed the Mediterranean diet and we're approaching the keto a very specific way. And we took people with prediabetes or type 2 diabetes. And what were you interested in measuring? The whole battery of outcomes. So we had to sign up clinicaltrials.gov for glycosylated hemoglobin as a primary outcome, because these are people with prediabetes and diabetes. But we measured weight and the lipid profile and glucose and insulin and all those.

1:20:40And they Actually, both groups lost a ton of weight. It was a crossover study. So it's 12 weeks on each diet. Well, for HbA1c, you have to go to 12 weeks because it's the lifespan of the red blood cell, which is what's affected there. So it's 24 weeks. And again, we had really great retention in both of those. Although it happened in COVID. We lost a couple extra people because it was going on during COVID. You don't do washouts between diets, right? I haven't. Yeah, that's a whole separate issue. I figure if they're on the diet long enough for the thing to have washed out, then, because you don't know how long to make a washout.

1:21:18Is it one week, two weeks, four weeks? Nobody ever really perfectly returns to where they were in the beginning. Okay, that's too complicated. Anyway, we were - We've done that before. We did it in a previous episode. Yeah, I designed that study to say, okay, here's keto, and I really do think this added sugar refined grain thing is a big deal, but you could do that with Mediterranean. and still have the legumes and the whole grains and the fruits. And so overall in the whole study, they both dropped their glycosylated hemoglobin. And they both got better in a number of factors. And of all the battery of factors, keto did better for lowering triglycerides.

1:22:00Mediterranean did, but keto did more. And keto raised LDL and Mediterranean lowered it. So the only two things that were statistically significant were LDL worse for keto, triglyceride better for keto. Do you remember how much weight they lost? Was it like a significant amount? Oh yeah. It was like six, uh, I think it was six kilos. So that's like somewhere between five and 10 % of body weight probably. Yeah. Yeah. And it wasn't a weight loss study. It was never designed to be a weight loss study. So this brings us to, I think a really interesting point. So Sam Klein's study. Aha, yes. Very similar.

1:22:39And now that I'm hearing you explain this study, there are some similarities in that population in his study, and I'll get you to explain high level what this study was. But my understanding is that it was a population of people with prediabetes and obesity. So similar group of people. And they were interested in looking at three different diets, the ketogenic diet, a Mediterranean diet and a plant forward low fat diet i think they called it and high plant protein did they call it that i don't think there was a high plant protein group okay maybe matching the protein no in fact the ketogenic diet had the highest protein yeah yeah absolutely okay i remember that but so in this trial what the reason i'm finding this interesting now listening to your results is that in sam klein's study which i think was like six months long so it's a little bit longer and it wasn't a crossover.

1:23:36They just got randomized to one diet. In every group, they lost the same amount of weight. It was about 10 % of body weight, which again, it's similar to what you found, but it's just like a longer trial. They had more time to lose weight. There were a few interesting findings and I haven't done a forensic analysis of this study, so I'm going off high level findings at the moment. But the ketogenic group, despite all these subjects were given their food throughout that period. So that's an expensive study. and the ketogenic diet had a high percentage of calories from saturated fat, but their LDL cholesterol A-B didn't go up.

1:24:15Right. And so I'm thinking, what's going on here? Is it that they lost more weight? Is that a confounding variable, or is it the subjects that they recruited? Why is that biomarker behaving differently to that diet? Okay, so I have to go back and see this. So losing 10 % of your body weight is a significant amount. So I want to bring David Ludwig back into the equation too. He did an elegant study years ago where everybody had to lose 10 % body weight and then they got randomized. I remember that. He's really looking at after you've lost weight and restabilized, what impact does diet have? So this has sort of the essence of that.

1:25:00But I think the point was during the six months, they all lost 10 % body weight on average. So one of the issues there is the catabolic state. And so part of the catabolic state is your LDL and APOB are probably doing great during catabolism. And the challenge is if you restabilize at that, what happens if you then mess with the diet or if you're maintaining the diet? So when you're not going to keep losing weight forever, you're eventually going to reach a maintenance. Yeah. And you're saying maybe if you reach that maintenance and still have that high saturated fat intake, LDL cholesterol swing back up.

1:25:41Yeah, and I'd have to read it closer. So the senior author, Sam Klein, is great. He's at WashU. I might invite him on the show. Yeah, he's a really good speaker and he's very balanced and objective, really like him. So I'm looking forward to digging into this paper more. Myself, it was really high fat and more protein and LDL didn't go up and liver fat went down. It went down much more on the ketogenic diet. It actually went down in everybody. So the paper does a nice job of saying weight loss was the prevailing factor here. Weight loss helped everyone. But on top of that, on the keto diet, after weight loss, the liver fat was better.

1:26:22And also was kind of remission of prediabetes. Yeah. They had a high percentage of subjects, which makes sense with less liver fat. And so what I haven't found, because I looked through the paper quickly, I've seen the nutrient profile. I haven't seen the foods. So I think nutrition scientists are often remiss in not doing that. If I can go back to Kevin Hall, some of his best studies, he like took a picture of every dinner and every lunch and included it in the paper. It made for such a huge file, I couldn't download it. I couldn't figure out what the hell was going on. And I realized, oh my God, he's got a high resolution picture of every diet, every dinner and every lunch.

1:27:04And his paper is even more impressive when you see those pictures because you can take nutrients and mess with them. You can like add protein powder and add cholesterol powder or you can make them with food. And making them with food is much harder to try to get. If you're trying to balance multiple things at the same time. It's hard unless you tweak it with a couple little things and make it less real food. And so again, you're stuck on the dilemma of rigor versus generalizability. So I'd love to see Sam's foods and maybe there are pictures of them. I just didn't see it. I didn't see the pictures and I didn't see it described either.

1:27:49I'd love to get him on the show and ask him as well. I believe in the discussion they were attributing the lower amount of liver fat to the carb restriction. But there were some other differences in the diet. The keto diet also had significantly more protein as well. And that could be another variable that's at play. And we should do those longer term. And doesn't mean it holds for everybody. But for that group that was overweight, they are overweight and metabolically unhealthy. One of Sam's, I think, greatest contributions is he's done some very cool studies showing that there is a group of people who are overweight but metabolically healthy.

1:28:28He has some really interesting examples where, oh my God, that person probably is hyperlipidemic, hypertensive, probably has blood glucose issues. Oh my God, no. At that time point, or does he track them over time? I feel like he's done studies with these just to show how they react differently to the same intervention, even though they might have, I'm not sure I'm saying this correctly, might have the same percent body weight, body fat, central adiposity, and yet, but it might be central adiposity is the differentiator, and yet their clinical markers suggest that they're metabolically healthy.

1:29:08So I think he's been one of the best proponents of, don't just look at somebody and say, oh, I guess I better put you on drugs here. No, no, no, look and see how metabolically healthy or unhealthy there are, because there are lean people who are metabolically unhealthy and overweight people who are metabolically healthy. I had Professor Roy Taylor on. I'm not sure if you've come across his work. But he is kind of involved in similar research. And in fact, he's looked at diabetes remission in people with a normal BMI. So the folks that on the outside look slim but develop type 2 diabetes, because they have a predisposition to storing that fat viscerally at a lower body weight, which then screws up metabolism.

1:29:58And I think that's an important point. This Sam Klein study, though, I guess if we zoom back out, philosophy, think about your thesis, think about my thesis of nutrition. This is an example of a study that on face value seems like a pretty good study. you're saying good good research group and in many ways it for this particular context it is it challenges the eat food not too much mostly plants framework how do you suggest and or how do you go about this yourself or suggest you know other people involved in science engage with challenging data in a way that allows us to stay open-minded and grounded.

1:30:52So it is digging deeper into some, you really have to look at some of the finer details, who the people were, what the duration was, what the actual foods were, and can it be replicated? So you have to wait till another study does this because you got to compare it to a bunch of studies that came before that. and I remain I try to remain open minded that I'm wrong sometimes I'm just going to leave it at that all my ideas don't always pan out but a lot of them seem to be pretty consistent I've been doing it for 30 years and I often see this eat food not too much mostly plants replicated again and again so if we were to find all the papers that supported that versus this one, would we do a meta-analysis?

1:31:41I'd like to see, I mean, dig into this study, but if there was, if Sam or someone else was to do a follow-up, there's a similar study done in a more generalizable way, back to our generalizable conversation, because all the food was provided for six months. My experience, whether it's on the low-fat vegan side of the diet wars - Which is also super hard to do. Or the ketogenic, is that the moment you stop providing food, yes, there are people online that you'll find who are kind of champions of these studies, but for every one person that adheres to it for a decade, how many people after a few months give up?

1:32:19Again, it's answering a different question. It's not does that diet work when done perfectly, it's how does that diet hold up in the real world? There's just a paper that got published where one of these groups that does diet tracking found 430 ,000 new users of a food tracking. And then they excluded a whole bunch of people until they got down to 5 ,000 people of this whole thing, 1%, that tracked at least once a month for a year or something like this. And some of them tracked every single day and some of them tracked two to three times and some of them only tracked once a month. And they lost more weight if they tracked every day.

1:33:02and I looked at it and I said, it's only 1 % of the population. They excluded 99 % of the population who can't track even once a month for a year. So 430 ,000 new people. So I've seen again and again, people who track their diet religiously actually do lose more weight than others. But very few people can do it. So if it was easiest saying, oh, this works, and then you said, oh, well, then I'm actually going to do it now. I hated doing it before, but now I'm going to do it that you tell me it works. That's actually back to the calcium thing. The calcium pill works if you take it. And the point of taking that calcium pill was to prevent osteoporotic fractures.

1:33:48And yet, they stopped taking the pills. And they didn't keep tracking the diet. And in our studies, they have a hard time staying on keto because it's so restrictive and a hard time staying on really low fat vegan because it's so restrictive. And then we have to get back to the joy and pleasure of food. It should taste good and be social. I knew we were going to get to protein, but I have to weave protein in here for a moment because this idea of of control in a study providing food seeing something and then kind of reducing control and seeing something different is something that was observed by luke van loon who he's been on this show and i sent you one of his papers last night or the night before but long story short they ran a very short a 10-day crossover study this is with elderly subjects this study's been explained on this show, but they were interested in looking, basically trying to compare plant protein to a mix of animal and plant, an omnivorous diet.

1:34:58And the short-term study, not long enough to look at strength and muscle size and whatnot. So they just looked at daily muscle protein synthesis, which is kind of a surrogate biomarker. And when they gave the subjects the meals, these elderly subjects, and protein intake was about 1.2 to 1.3 grams per kilogram. So, I'd say moderately high for that population, higher than probably the average. And they observed no difference in muscle protein synthesis, whether you were eating, getting all your protein from plants or a mix. So, then Luke and his team thought, well, let's extend this study and run it for 12 weeks and randomized people to the omnivorous diet or the vegan diet.

1:35:47And this time it's too expensive to give them the food. So how about they go out and procure the food themselves? And they had a dietician work with them to kind of help explain to some extent what high-protein plant foods look like and how to make these meals. And they went and conducted that study over the 12-week period. And also, I should add that they added a third arm, sorry, who did the vegan diet plus resistance training. Yeah. Which I thought was pretty neat. Yes, I love that part. And which reminded me of our conversation with Stuart Phillips, where we all agreed resistance training is the most important lever.

1:36:28If we're talking about protecting muscle, we spend a lot of time on protein, but most people don't resistance train. So let's just get that out of the way. Got it. So in this study, they had the three groups, vegan diet, omnivorous diet, or vegan plus resistance training twice a week. And this time, because they've gone for 12 weeks, they have long enough to not just measure muscle protein synthesis, but now we can look at the volume of the thigh muscle. And we can look at strength, which is arguably the most important outcome that they measured as it pertains to quality of life. and a couple of things that I thought were interesting in this study.

1:37:07Firstly, in both of the vegan groups, the daily protein intake dropped by about 20 to 30 grams per day. So the omnivorous group was at like 100 grams a day and those two groups were around 70, something like that. So despite that, whatever education they got, translated to lower protein intake. Then they looked at what happens to muscle protein synthesis. So in the vegan group that didn't do resistance training, it was lower. But when you added resistance training, muscle protein synthesis was essentially the same. Yes. Okay. So the training sort of rescued the muscle protein synthesis despite lower protein intake.

1:37:50And strength actually increased in that vegan group with resistance training as you'd expect but and I think I don't know if concerning is the right word it's a 12-week study the vegan group with resistance training lost muscle size and the omnivorous group who wasn't doing resistance training was able to maintain it and so when I look at that study and I think about an elderly population over just a 12-week period a couple of Protein intake dropped as soon as they changed their dietary pattern. So education or something, there might be something that was missing to help these people understand what foods contain protein.

1:38:36And secondly, even with resistance training, they were losing more muscle volume than a group of omnivores that were not. and so it it challenges uh a kind of position that i hold or a bias that i hold towards plant protein and now you're going to leave it for me well i'm i'm i'm throwing that out onto the table i guess to to have to have you share your thoughts you can challenge the way that i'm thinking about that or presenting it or maybe you see it differently or you know i i guess i'm just interested at a high level what you make of that trial and how it shapes the way you think about protein in the context of elderly so people that are 70 plus yeah and that's a different population with bigger concerns so what i am surprised they didn't have a fourth arm the omnivore with resistance training right for balance so that's a little bit odd i love the resistance training saved the diminishing of the muscle, go to the gym.

1:39:41And I assume they weren't like running ultramarathons. They were just going to the gym twice a week. They were doing very basic resistance training, twice a week, age-appropriate resistance training. It is interesting that they did vegan and not vegetarian. Vegan is hard for most people to do. So a part that I didn't realize about the trial was first they were in a short-term study where all the food was provided. How long was that? 10 days. Oh, okay. So in some of the studies we've been doing recently, two of them, we have provided food for four weeks and then had them cook on their own for four weeks.

1:40:15Well, it was a 10-day crossover, the first one. So really 20 days they had the food provided. Wait, wait, what's the crossover part? The first study, the 10-day. Yeah? The omnivore versus vegan. With no resistance training. No resistance training. Just looking at daily muscle protein synthesis was a crossover design. Okay. No, but how many days are they getting vegan food? 10. 10 and then they had 10 days of the omnivorous diet yeah so my point is most people are unfamiliar with a vegan diet and they think oh all I can have is tofu and lettuce and so when you start showing them the chickpeas and the black beans and the Latin American and the Asian and the Indian and the African all of a sudden they start seeing a lot more options are there they eat more food that's why I want to see the food not the nutrients I want to see like what they were eating So part of that is, I think, oh, I have to eat vegan and I'm full.

1:41:09I'm not going to eat anymore because I don't like the options that are available. Because they were self-selecting. That was the word that stuck out to me. Self-selecting food. Self-selecting food. They were randomized, so they didn't select their group. Right. Once they're in the group, they procured and made their own food. Yeah. And so I'd love to see those Kevin Hall tables. Were they feeling just as full? did they like the palatability of the diet they were trying did there are some of those pleasure type things fullness satiety i know there wasn't a significant difference in weight loss so it wasn't as though they i don't believe they were in a much greater calorie deficit okay but i'd still want to know like the quality of the food because i feel like it's pretty easy to follow a crappy vegan diet yeah so you mentioned there that Vegans harder than vegetarian.

1:42:02So do you think for, let's just stick with this elderly population, people that are 70 plus, let's say they don't necessarily have the high level of education that you have on nutrition. Is a Mediterranean or vegetarian diet you think is kind of quote unquote more dummy proof in that you're going to get all of the good things that you want people to get more of, high fiber, phytochemicals, less saturated fat, et cetera, but you're not going to fall short on things like protein? Because it's less restrictive. Part of it is a familiarity thing. Vegan is really hard for most people. And I think there's a lot of misconceptions of what it is.

1:42:48So I don't want to make too much out of this because I didn't read the whole thing. Now, the Mediterranean one, that was the Sam Klein one. This one is just the Omnivore Vegan, Vegan Plus. Straight up Omnivore, yeah. Yeah. So again, I want to see the foods in some of these papers. So let's go back to the reason for our whole conversation. So I'm writing this book because I got 30 years of playing with these different trials and sort of going in and out of rigor and generalizability and then trying to help people say, oh, well, I don't want to spend my whole life thinking about this and I want to be healthy.

1:43:22So how do I go about this when it seems like there's a new paper that challenges what was out there before? And the way I approach it is, well, I want to see the actual foods that they were eating because of all the issues that go around with familiarity and taste and culture. And if you just narrow it down to a name of a pattern, vegan, I can show you five different vegan patterns or probably five different keto patterns. and that part's harder to communicate to the public but I wish instead of saying ah, all the other studies were wrong there's this new study does that one have to be right? it's just, oh, I wonder if there are some important subtle differences and I'd like to try it maybe I want to try keto or I want to try vegan but I don't want to lose muscle so I'm going to look a little more into legumes I heard on the Simon Hill podcast which is my favorite podcast, that legumes and joining the leguminati is one way out of this, right?

1:44:24So I think just having fun with it and playing with it and being skeptical of the science and thinking of the bigger picture is how you have to approach all these. Does the dietary guidelines need more of that? Photos of like real photos of food, whether it's like the ketogenic diet or the Mediterranean or vegan, showing what a week kind of worth of food looks like in recipes. Clearly, you're not going to get the right calories and size for everyone, but it seems like that's a little bit of a missing piece. Oh, yeah, but there are. So like American Heart has this, American Diabetes has this, the Dietary Guidelines of Americans has had it in the past.

1:45:07So if you look, if you dig deep enough, lots of people have come up with here are some examples. These look good. These taste good. But it's a level of detail that when we talked about not many people cooking these days, they don't want to run out and say, wow, I want to find that recipe and cook that tonight. But I do wish it would come back to the food and the culture. So what's the answer then? If you can put in the dietary guidelines and people ignore it or it's too hard basket and we go back to our convenient food. And I wrote a book like you. So I believe books can make a difference. I do believe they can.

1:45:45And your book launched in Australia as like the number one health diet book when it came out. I saw that. But if ultimately people fall victim or vulnerable to a food environment, I want to believe that books, I do believe books are powerful and can make a big difference at an individual level. But ultimately, as you think about, and I know you wrote about the system and the food environment. When you think about big picture, have you given thought to what the top couple of levers are that you think need to be pulled to make a big difference such that everyone doesn't have to become a nutrition scientist and sit here and listen to Sam Klein's study dissected?

1:46:30So one is there's opportunity for the government to step in, but they haven't really over decades, so I'm not expecting to them. We grow too much corn, soy, and wheat. We have too many concentrated animal feeding operations. There would be a way, a legislative way, to make a dent there. I'm sad that our culinary intelligence has dropped off and people don't want to cook so much, which is why now my favorite idea is institutional food. So I have a new grant at Stanford to work with. University food, hospital food, prison food, military food, worksite food. The new president of the Culinary Institute of America is Michael Bakker, who you should interview.

1:47:16He was the head of Google, where for 12 years, he remodeled the free food at Google to be healthy and delicious. And it was very much from a culinarian aspect. And so now that he's taken over as president of the CIA, those chefs that they're graduating, if they can change the curriculum, which is his larger vision, to match something like Google, where it's delicious and healthy and good for the environment, that means that when Americans eat 50 % of their food outside of the home, they'll get exposed more to convenient food that's delicious and healthy and environmentally sustainable. And I think as they see more of those options, some of them they'll cook.

1:48:04Oh, I didn't realize how easy hummus was to make. oh, I didn't realize there were so many different kinds of hummus. Oh my God, I don't have to eat them on chips. I could have red bell peppers with hummus. So I really think bringing the culinarians into this with the deliciousness and having them take on more responsibility. So my key to a lot of this is why would a farmer or rancher or fisher who all struggle in life to make a living as far as I know, the ones who are actually doing the production and the raising, None of them that I know of are multi-bazillionaires. I think it's just the big food ones are.

1:48:40What if you said, I want you to grow less corn, soy, and wheat and not have a concentrated animal feeding operation, do biodynamic, buy pasture-raised. Sorry, do pasture-raised. I think their first reaction would be, I'm too afraid nobody would buy it, and so I'm not in a position where I can do that. And then you learn that your local hospital or a network of hospitals or a network of universities or the military was changing their menu and they would buy everything that you produced. I've been using WHOOP for over six years and I can confidently say it keeps me on track when it comes to my sleep and exercise routines.

1:49:19The next generation of WHOOP isn't just tracking your workouts. It's monitoring your sleep quality, your recovery state, and even giving you insights into your biological age. No screen, no distractions, just continuous data on what your body actually needs. And here's what matters. Daily WHOOP wear is linked to increased physical activity, to better sleep, and improved heart rate variability. I have no doubt that my WHOOP is helping me train smarter, recover faster, and make decisions that support my long-term health. Head to join.whoop.com forward slash Simon. That's join.whoop.com forward slash Simon to get one month off your first subscription.

1:50:08Who's connecting all that up? So who's connecting with the education with the chefs and then the changes to the food system to kind of help supply those foods? There's some interesting examples popping up all over the country and the world. There are people in Europe who are ahead of us already. And so I am personally pivoting to that. I'll keep one foot in the door of doing randomized control trials with humans. But on the other side, I personally want to shift my efforts into institutional food settings and human behavior. Well, I think you could almost blend them in that. Why not take prisoners if it's ethical and you can do it?

1:50:53And if you're changing the food that they're being fed and run a scientific study as well. So they did that. Now that's illegal. You can't do it so much with prisoners. Maybe not prisoners. About the military. Right. So we are doing it with students. So actually, between Michael Bakker, who was at Google and is now at the CIA, and 70 universities, we have something called the Menus of Change University Research Collaborative. And 70 universities have said they will pledge using their dining halls as living laboratories to do food architecture, like placing foods in different places, or messaging, or procurement, or we've actually done a thing just in the last six years where 35 universities of the 70 pledged to lower their greenhouse gases by 25%, not all at once over a 10-year period, by eliminating some of the meat and dairy and replacing it with legumes.

1:51:52And their 10-year pledge was met ahead of time at year four. And they now increased the pledge to a 40 % reduction in greenhouse gases by tracking the procurement of what they're buying by changing the menus. and so yes you can still do the it's just a different kind of research like we're not randomizing universities but we're doing research on the students who eat in the dining halls what values of yours is it that leads you to care so much about the environment and animal welfare and these other things outside of your own body's health ah it's just i mean that that is part of my book too. I mean, part of the challenges I've seen over the years, even when we get a study that works and I say, and then I see people don't want to make the change because the focus of the change had been their health.

1:52:48So picture that you know this thing will work and you're actually really interested in it. And today you attended something that had a steak and a chocolate chip cookie. And you said, you know, I can start that tomorrow. I'm going to have the steak and the chocolate chip cookie right now because tomorrow I'll be better. And it's only me that I'm impacting. And then what I see kind of in Stanford students that we teach is, oh, if you bring up the societal issues or the animal rights and welfare issues, you start recognizing, oh, if I make that choice, it's not just my health that I'm impacting.

1:53:27So you know what? I don't actually need that today. I can have the other choice today. So part of it is aligning. Do you think that's representative? Like Stanford is representative of the way students from other institutions would also think? Is there like a political alignment there? That's why we have seven universities in the collaborative and 35 of them participated in this menu change. They're from East, West, North, South, and middle of the country. So it's not being primarily driven from human health. It's being primarily driven because of these external issues? Well, to me, it's been driven by getting the chefs interested in contributing to the science.

1:54:10So this is actually the big aha moment for me. When this was first proposed like 10 or 15 years ago, I thought, aren't the chefs busy enough? Don't they want to like, I got enough to do in my day without worrying about trying to do research? And what was really amazing was how many of them said, you know, it kind of sucks that we're on this research university and people write about all the great findings they have. They're saving lives and creating new things. And we just serve the food to the people who are doing this. We could be part of the research. Oh, that would be cool. So I think being part of the change making is not to all of them, but it's attractive to enough of them.

1:54:50And sort of elevating maybe the stature of the chefs and the Culinary Institute of America has a new master's program that's very business and sustainability oriented. So they have chefs who are not only going to get their culinary degree, but to implement the sustainability aspects and the business aspects. Again, it goes back to this menus of change is something that the CIA created that had a scientific advisor board, a business board, and a chef board so that chefs could do things that made money, but they were scientifically valid. And because they're chefs, it's delicious. It needs to be delicious.

1:55:33But why do you personally care about the environment? So what is it about Dr. Christopher Gardner that, what value is it that sees you say, you know what, I'm going to make this choice today, not just for my health, but for the environment when it could be pretty easy for you to kind of turn a blind eye to that. Ah, it's a great full circle way to wrap up the talk today, Simon. It's my philosophy major. It really is just thinking about the bigger picture, the truth and the good and beauty. And like, wow, could all those things be aligned? Ah, it's super satisfying to see that they can all be aligned.

1:56:13You don't actually have to choose one or the other. You can put them all together, which is why, and it makes my science more fun. I don't know, lately I've heard a lot of people comment that I always seem to be smiling when I'm talking about science and I'm not upset or angry or proselytizing. It's really fun. It's like a fun, it's a super satisfying, enjoyable experience when I do it that way. And it feels like a better way to connect with people that are like-minded. Well, I certainly always have fun with you and we love hanging out with you. So you're welcome back anytime. time. Food sense out.

1:56:51October 13th, but you can pre-order now depending on when you release this. There you go. Eight food. Not too much. Mostly plants. Okay. Food sense, what to eat and why. Food sense, what to eat and why. Seven words. Seven words. Seven words again. Oh, I didn't even realize it was seven words. All right. Thanks for having me, Simon. I'll let you get back to San Francisco. We'll do it again soon. Okay. Thank you. Thanks.

1:57:20There you have it, friends. I hope you enjoyed this episode. If you did and want to stay up to date with future episodes, be sure to hit that subscribe button on YouTube and follow on Apple or Spotify. Finally, thank you for showing up and the effort that you're making to take control of your health. I look forward to hanging out with you again in the next episode.