Dr. Matthew Nagra Makes The Ultimate Case For A Plant-Based Diet: Busting Nutrition Myths Around Seed Oils, Soy, Protein, & More

24:48They're just, it's not worse. And that's really what we could conclude there. So articulate the best argument for those that are advancing the seed oils are the root of all evil, you know, argument. The best argument I think that anyone can make around oils period is that they're calorie dense. So in about a tablespoon, you're getting 120 calories right there. Compare that to like a whole banana, you know, you're getting even a bit less than 120 calories. So if you were to use tons of oils, just pouring it on your foods or, you know, frying with a whole bunch or deep frying perhaps where there's a lot of calories being added.

25:24That could be problematic for sure. I would agree with that. Now, we don't see that in trials, in clinical trials, probably because of the way that they're used. If you're using oils to stir fry some veggies, the calorie density of that meal is still very low. But if you're just throwing oils on everything, you're having six, seven, eight tablespoons a day. I mean, that's a ton of calories and that could be a problem, especially if it's leading to fat gain. In the health hierarchy of seed oils, my understanding is that olive oil, you know, stands above. Is that true? Is there a qualitative difference?

25:57Does it have to do with polyphenols? Like, how do you think about this in terms of like parsing all the various seed oils from, you know, canola to, you know, sesame and everything else? So it's interesting when we look at outcomes. So again, like actual heart attacks or strokes, we see that olive oil and canola oil are pretty comparable. Actually, even for total mortality, now that I'm jogging my memory. I'm old enough to remember when everything was canola oil, and then canola oil was the root of all evil. You need to stop putting canola oil in food. Yeah, and that's largely because of concerns over the fact that they're—how they're extracted or processed or concerns over the omega-6 content.

26:36It, again, comes back to those mechanistic concerns. But when we step back and look at actual heart attacks, actual strokes, mortality risks, the actual deaths that occur during a study, there doesn't seem to be a meaningful difference between olive and canola. And there's a couple possible reasons for that. So olive oil is richer in certain polyphenols, especially if it's extra virgin. However, canola actually lowers LDL cholesterol a bit more. So maybe you're getting a bit of an advantage with the canola oil with LDL cholesterol, but then the polyphenols and the olive oil exert other benefits on, say, arterial function.

27:06So the net result is about the same. And this is why I always advocate for people stepping back and looking at the final outcomes, not just a certain marker, but does it lead to less heart attacks? Does it lead to less strokes, less cancer diagnoses? etc. That's ultimately what matters because you could have a million different mechanisms working in different ways. We want to see the net result. Is there something special about the health promoting aspects of extra virgin olive oil that does separate it? It seems like very much a health benefiting oil. Yeah, one of the things that I've seen with olive oil, but I haven't seen many comparisons to others, so I can't say it's necessarily better, but I would say there's more evidence for is actually blood pressure lowering.

27:47There does seem to be something there, and that could be, again, due to the polyphenols in there. When it comes to neurodegenerative disorders, we see that while not statistically significantly different, there was a study, I believe it was also the Nurses' Health and Health Professionals follow-up study, where olive oil did tend to be a bit better in that regard, but then canola actually tended to be a little bit better, or vegetable rather, oil tended to be a bit better for cardiovascular events, but they weren't statistically significant, the differences there. So it's hard to say, is that a chance finding or is that true?

28:19Like there might be some unique properties either direction, but they don't seem to be very large or super meaningful. You mentioned omega-6 fats and the sort of deleterious health impact that those can have. My understanding has always been that we're eating way too much of the omega-6 fats and not enough of the omega-3. So while we need to reduce our omega-6 intake, we also need to buttress our omega-3 intake and that there's something about enhancing the omega-3s that buffers the negative impact of those sixes. Is that true or how do you describe that? So I used to be very much in that camp.

29:01Yeah, I mean, that was the idea, right? And I believe that wisdom has now shifted on this. Yeah, so that was because the omega-3 fat ALA, which is found in things like flax and chia and walnuts and soy products, that competes for the same enzyme that this omega-6 fat linoleic acid does for conversion into, you know, the case of the omega-3, it's EPA and DHA, which we typically get from like fish or algae-based supplements. And then linoleic acid can get converted into that arachidonic acid, that inflammatory omega-6, theoretically. It doesn't end up happening, but that could be the case. Now, the theory was that if you're having more omega-6 and less omega-3s, that the omega-6s are going to take that over and you're not going to convert the omega-3s into the EPA and DHA.

29:47The issue with that is, now as we have more research and actually monitoring how much gets converted, the differences are not very big. It seems to be the absolute amounts that matter. So if you're consuming enough ALA or the omega-3 to meet your needs, it doesn't really matter too much how much omega-6s you're having. It doesn't seem to impact the conversion to any sort of meaningful degree. And something else that's come out very recently, this was last year, there was a really good study on this that looked at the actual health outcomes, again, going back to things like cardiovascular risk.

30:16And they found that both are beneficial. So the omega-3 are beneficial and the omega-6 are beneficial. However, the omega-3 are more beneficial. So if you look at the ratio, a better ratio of omega-3 to 6 is going to look better because the omega-3s are more beneficial than the omega-6s. That doesn't mean that the omega-6s are harmful. they can still be beneficial and we need a certain amount of them. But more people would benefit from placing emphasis on the omega-3s simply because people don't get as much of them in their diet and they might exert additional benefits. Well, and the omega-6s that we're getting are all in these ultra-processed foods.

30:48That's the problem. Yeah, so it's the package that they're coming in, of course. So if you're using them, again, in cooking, stir-frying, et cetera, that's fine. But I wouldn't be getting the majority of my calories from these ultra-processed foods. Well, with respect to cooking with them, whether it's stir fry or something else, talk a little bit about oxidation points because when you heat these things, they become something different, right? There's a difference between putting olive oil on your salad right out of the bottle versus the stir fry version. And these oils vary in their oxidation points, yes.

31:22So in the process of heating them, like is there something that we need to be aware of or a preference that we need to make in order to make the best, healthiest choice? Yeah, so it's actually funny. The olive oil, because it's rich in monounsaturated fats, but lower in polyunsaturated fats, it's often sort of separated from the vegetable oils because they're richer in the polyunsaturated fats. And it's thought that those polyunsaturated fats are the ones that can oxidize at high temperatures and cause problems. And that might be true to a degree, but it doesn't seem to be meaningful. It doesn't seem to actually lead to a meaningful increase in these reactive species.

32:02However, if you were to put them through several repeated cycles of heating and cooling, which might be practiced in certain fast food restaurants or where they're frying with them all day, that could potentially lead to an increase in these compounds. And there is a study showing that it can increase inflammatory markers when consumed. We do not see that with more typical cooking patterns of stir frying for 30 minutes or something. So I don't actually put a lot of weight into those concerns at this point. And I would say that they're fine to use for cooking. And in fact, there was the NIH AARP study where they looked at different cooking fats, and they had over 400 ,000 Americans in that study.

32:35And they found that, again, these vegetable oils, they had canola, corn, and then they also looked at olive oil. They all led to benefits for a number of different outcomes, cardiometabolic outcomes. Is there any oil out there that's commonly used that you would say, yeah, stay away from that one, opt for this one? I would say not necessarily of those groups of the vegetable oils and the olive oil, but the saturated fat-rich oils. So things like coconut oil or butter on the animal fat side. Yeah, coconut oil does have considerable saturated fat in it, which does distinguish it. It does have a higher heat point, though, which I had always thought that makes for a healthier option in terms of cooking.

33:17and there's something about the saturated fat, like the composition of the saturated fat that makes it more readily available as an energy source and less likely to kind of do the negative things that saturated fat tends to do. Like, is that a myth that has been debunked now or is that true? So there's some truth to that. So the fatty acid composition, even the saturated fat composition is different than something like butter. And we have trials showing that coconut oil can actually lower LDL cholesterol compared to butter. So it does appear to be a better choice there. That's strange because it's like the intake of saturated fat in a reductive sense should elevate your LDL.

33:58Yeah, so there's three main types of saturated fat that raise LDL, but there's others that are neutral. So for example, stearic acid, which is the main saturated fat in cocoa, in chocolate, that actually doesn't have an impact. It's neutral for LDL cholesterol. But then things like palmitic acid being one of the primary fats in butter, that can raise LDL cholesterol. So that composition actually does really matter. Now, I wouldn't take that and say that we have to look at the composition of every different food. Most of the ones that are rich in saturated fat are rich in those ones that can raise LDL.

34:28There are very few exceptions. The chocolate being one, and to a lesser degree, cheese might have less of an impact on LDL cholesterol than other high-fat sources. So when you understand the differences between the different types of saturated fats, it's not that surprising, really, to see differences in results. Yeah, butter is sort of back, right? And there's a lot of people celebrating this. Finally, we're putting seed oils in their rightful place. And we're going back to what our grandmother always cooked with, which is butter. And we're all better because of it. Yeah, so that came from the Butter is Back headline from Time magazine.

35:05I think it was in 2014 or somewhere in that ballpark. And that was based on a meta-analysis of observational studies that did not identify an association between butter and cardiovascular disease. And this is actually something really important to understand about a lot of the research on nutrition and cardiovascular disease is they did something called over-adjustment. So when we're conducting research, we'll adjust for confounding variables, as I mentioned earlier, right? We want to level the playing field, make sure that exercise habits aren't impacting the results, make sure that smoking habits aren't alcohol intake and so on.

35:39but they adjusted for LDL cholesterol levels or other markers that are similar to LDL cholesterol level. The reason that that's problematic is that you and I, if we ate the exact same diet, we might have different LDL cholesterol levels just based on genetics, right? And so let's say my baseline, my genetic baseline is lower than yours. I could eat a bunch of butter and end up with the same levels as you. And by adjusting for LDL, that's essentially what that study would be comparing. It would be comparing people with the same LDL, but different levels of butter intake. And if butter increases cardiovascular risk by increasing LDL cholesterol levels, you're removing that variable, right?

36:18If A leads to B and B leads to C, but you make sure B is identical for everybody, you won't link A to C. And so we can't over-adjust for variables that are literally on that pathway. And that was unfortunately what was done in that study. Now, when we don't do that and we do proper adjustment models here, we see very consistently that saturated fat or butter intake increases risk.

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38:45there's something anthropologically interesting about the way in which we as tribal you know beings like tend to you know kind of champion the arguments or the ideas that reinforce our like tribal view and this is across the board like i said at the outset but there is something weirdly like when people are like, yes, it's like our team is winning kind of thing. You know what I mean? When it should just be like, what's true, what's not, like this should be a dispassionate, you know, sort of pursuit to understand what's in our best interest. But the culture has really shifted quite a bit. I mean, you know, I don't know, six or eight years ago, there was this, you know, real rise in interest in plant-based nutrition.

39:31And we were seeing, you know, all these new food products come on the market and plant-based restaurants. And, you know, even today, now, of course, most restaurants have plant-based options, et cetera. But there has been a precipitous sort of decline in enthusiasm in recent years. The culture has shifted. And it is very much about butter is back right now. This seems to be kind of the predominant paradigm. And within that, we've seen this very strange, you know, kind of celebration of beef tallow, right? Like we all saw RFK, I can't remember what fast food chain restaurant. Yeah, like they've now, they're now gonna make their fries with beef tallow.

40:12Like let's put matters to rights on what beef tallow is and what happens when you eat it. Like, is this a move in the right direction, Matt? What are we doing? It is a saturated fat rich animal fat. It's very similar in composition to butter with small differences. Now, we don't have a lot of long-term trials or long-term observational studies on beef tallow and outcomes. So someone could throw their hands up and say, hey, we don't know. We don't know if it's necessarily harmful. But we can draw conclusions based on our prior knowledge. We know that saturated animal fats raise LDL cholesterol levels.

40:46We know that they ultimately lead to cardiovascular events, especially with that rise in LDL cholesterol levels. and if we were to replace something that has been shown to do the opposite with those foods, chances are it's going to be worse for us. Now, am I going to say that having ultra-processed foods with beef tallow, especially hyper-calorie or hyper-palatable ultra-processed foods with beef tallow is going to be significantly worse than having hyper-palatable ultra-processed foods with vegetable oils? Probably not because there's a lot of other factors that are going to be the same between them.

41:19I mean, if you're going to a steak and shake or a McDonald's or whatever, whether it's beef tallow or seed oils, I don't think is gonna make the biggest impact. But if anything, I think we can expect it to be even worse for you, which is sort of the irony there. The message really should be like, stop eating at these fast food chains, not like, oh, now it's great. You can go get fries with beef tallow. Like this doesn't seem to be moving the ball in any positive direction forward. Exactly. That was the biggest issue, I think, with that whole sort of campaign was, I mean, you have RFK Jr. going in there and like advertising this fast food joint and eating their meals.

41:56And I think that's going to send the message that like, hey, you should go here. It's good stuff where, you know, it's still going to be problematic if you're having that regularly. So the reason we're talking about seed oils or maybe before we kind of pivot here, talk a little bit about the controversy within the plant-based community. Why is it that there is that cohort I referenced earlier that is so adamantly against seed oils in any regard? It seems to me that the emergent evidence since, you know, that became kind of the paradigm has changed. And perhaps there's a resistance to really objectively looking at that library of evidence.

42:35What's going on there? Yeah, I mean, that's been kind of the status quo in the community for many years since I first got into it, which was over a decade now. And it comes from a couple things. So one of the studies that they often reference was by Vogel and colleagues. And this looked at a rather large dose of oil. And it was actually olive oil, so it wasn't even your traditional seed oils. But they looked at about a quarter cup of olive oil along with bread, and there were some other foods served with it. And then they measured artery function, so the ability of the arteries to dilate after consumption.

43:08And they found that temporarily there was an impairment in the artery's ability to dilate fully. And from that, they drew the conclusion that, hey, you aren't able to get what's called, or as good of what's called flow-mediated dilation, therefore it's going to be worse for your cardiovascular risk. The problem is this is a temporary reduction in that dilation through a very high intake of fat in that meal. And that has never been shown to translate to actual cardiovascular events. We know that in a fasted state, so if you measure first thing in the morning without food and you're not able to dilate correctly or to that same degree, that can increase your risk of cardiovascular disease.

43:45But the short-term changes after a meal have not been shown to do so. And then again, we can step back further and look at, well, what does the broader evidence say about actual heart attacks and strokes? And we see a reduction in risk, right? So that goes back to the outcome versus mechanism argument. So that was one of the things that they sort of based their argument on. The second thing that they come to is they look at, say, the work of Dr. Dean Ornish or Dr. Caldwell Esselstyn and displaying these positive results in people adopting a low-fat plant-based or plant-predominant diet. and I would say yeah you see reductions in risk of cardiovascular events in the case of Ornish's trial it was diet plus you know some exercise and other lifestyle factors and that's great but we also see similar reductions in trials on say the Mediterranean diet where there is a lot more olive oil and other things so we can't say that those results are better than necessarily including oils because they weren't directly compared to each other right Ornish didn't compare a low-fat plant-based to one that's richer in olive oil or other oils.

44:43It was standard care versus the lifestyle. Right. And I mean, Ornish got amazing results, but there's co-founding variables there that involve lifestyle shifts. Exactly. Yeah. But when we look at the evidence we have on oil specifically, including substituting oils for healthier or whole foods like, say, avocado, we see that they're comparable, as I mentioned earlier. So, I don't think there's any good evidence to point towards this oil-free approach being better than the oil-inclusive approach. In fairness, one thing is true though, which is that polyphenols aside, oils are very calorically dense and not necessarily nutritionally dense.

45:22And a lot of the people who are at highest risk for a cardiovascular event are also obese. Like obesity is driving so many of these poor health outcomes. And the first thing you need to do is, you know, get these people down to a reasonable weight. And removing oil from the diet is an effective way to do that. So I think there is a decent rationale for eliminating or at least reducing oil in acute cases. But I know personally, when I try to go oil-free, it becomes very difficult and hard to sustain over time. Yeah, and that's one of the things that I think we see with oils is that they make like vegetable consumption more appealing.

46:03If you're cooking them up with some oils and you're adding spices and stuff and the oil will help soak up some of those spices, like that makes it a lot more fun to consume those healthy foods. Whereas, you know, without the oils, maybe not so much. But I agree with you that, yes, they are calorie dense and that could possibly be a reason to limit intake if needed, you know, if it is a case of potentially needing to lose some excess body fat. But outside of those cases, I think it's fine to include and it can be an absolutely promoting. Well, the reason we're talking about oils and butter and beef tallow is because, you know, the number one killer is cardiovascular disease.

46:37This is what is, you know, the reason behind why, you know, most people die. And to the extent that we can make lifestyle changes to circumvent falling into that trap, we should all do so. And in order to do that, we need to understand our blood markers. Like you mentioned LDL. So let's talk about LDL. Like what is LDL? Because I think this is another misconception out there. There's a lot of LDL denialism in terms of its relationship to cardiovascular disease, particularly from the more carnivorous food tribes out there who would have you to believe that this is something you needn't worry about.

47:19And just because your LDL is elevated, it's not necessarily related to that cardiovascular risk. So here we go. So once again, like set matters to rights here. Like what does the science say? What is your perspective? And how should we understand this? Yeah, so LDL stands for low density lipoprotein. And when we have cholesterol in the bloodstream, it needs to be carried by something. You know, I have a glass of water here. If I poured oil in it, the oil wouldn't dissolve. It would separate from the water, right? And so fats in our bloodstream are kind of the same. So they need some sort of carrier to transport them through.

47:51And LDL is one of the transporters for cholesterol and other fats. And now what's unique about LDL and a few other lipoproteins is that they contain a protein called ApoB. And I know this has been brought up when you've spoken with Simon Hill. Yeah, Simon and I have talked about it, but it's been a minute. And not everybody listens to everything. And I always think, well, we already talked about this, but like, you know, we need to keep talking about it. So continue, please. Yeah, so ApoB, it's sort of like a protein tag. And it has a charge on it, like, you know, how a magnet will have a positive and negative charge.

48:25Well, it has a charge that interacts with the opposite charge on proteins inside the artery wall. So when that LDL particle slides in, because it can slide in and out of that outer lining of the artery, it can sort of bind due to that charge, and it gets held in that what's called subendothelial space. And when it's there, it triggers an immune response. Our white blood cells come in. They eat it up, and that sort of initiates the progression to a plaque. and over several decades, obviously, that plaque grows and can eventually rupture and cause a heart attack. So that's the very quick version of ultimately what that does.

48:59Now, the more of these LDL and other ApoB-containing lipoproteins that we have in our blood, the more are going to end up in there and cause problems down the road. So that's sort of the mechanistic understanding. But how do we know that it actually leads to cardiovascular disease? Well, we have multiple lines of evidence here. We have observational studies where you measure people's levels, follow them for many years, and you see that those with higher levels have higher risk of cardiovascular events. We also have drug trials and different types of drugs. We have statins that might lower LDL cholesterol from like 30 % to 45%.

49:31You have PCSK9 inhibitors, which just abolish your levels down to very low levels. And then you have other medications that lower them less. And you have diet as well. So we've shown that lowering LDL cholesterol through pretty much any of these means leads to a reduction in cardiovascular events. and the reduction that we see in events is dependent on how much we lower LDL. So the more you lower LDL, the lower your risk gets. And then finally, we have genetic studies. So Mendelian randomization studies where they'll look at people with genetic variants that lead to higher or lower levels throughout their entire lives.

50:04And in those with lower levels, we see significantly lower risks of cardiovascular disease because that's carried out through the entire life and isn't influenced by a change in medications down the road or diet and so on. The evidence is incredibly clear and consistent there, and that's independent of other variables because we're talking randomized trials and genetic studies where it's not going to be influenced by so much of differences between people's exercise habits or whatever. So what is the best version of the argument that LDL is a red herring? Like how are people advancing this argument and getting mindshare around this?

50:43So a couple of the things that are brought up is people often compare, say, the risk of having elevated LDL cholesterol to the risk of having insulin resistance or the risk of other markers being either elevated or too low. And the problem with that is that these are often compounding issues. So if you look at elevated LDL cholesterol alone, and you can take, again, yourself or myself, relatively healthy individual, but let's say genetically you have just a higher LDL. You can take that by itself and it's going to increase your risk to a certain degree, but you exercise, you eat well, you do all these other things that are going to lower your risk.

51:18So that elevation might not be sky high, but it's still there. But then you take, say, a group of people with insulin resistance. They're insulin resistant and they often have high LDL and other lipoproteins with that and they have high blood pressure and they have all these other things going on. And so the risk of that individual is going to be higher. That is one argument that's often used. It's like, oh, LDL, small impact, don't worry about it, compared to all of these other bad things. Well, why not care about all of them? That's how I would look at it. It's like, let's control the LDL. Let's manage blood glucose.

51:48Let's drop that blood pressure. Let's take care of all this stuff. And so that is what I see is most often the argument, but I just don't think it's a very good one. Right, so from a mechanistic point of view, though, Is there an argument that LDL and CVD is an overstated correlation that is more red herring than alarm? So one of the arguments there is that it's either inflammation or oxidation of the LDL particle that is the problem and not LDL itself. There's an issue with that, though, is once that LDL ends in the subendothelial space and it's held there, it triggers inflammation and will be oxidized.

52:29It's going to happen. Now, the reason it's happening is because you had too much LDL and it ended up in that space in the first place. So it's still the too much LDL that was initially the problem. And how we actually know that it's the concentration that matters more so than whether or not it was oxidized or whatever, is because you can do studies where you adjust for oxidized LDL. And in that case, ApoB concentration, so having elevated ApoB, again, that protein on LDL, that still is associated with risk even after you adjust for oxidation. Whereas if you do the opposite, if you adjust for ApoB, but you look at oxidation, it's not associated with risk.

53:06So that tells us that what matters is the amount of ApoB containing lipoproteins of which LDL is the main one matters most. So in other words, this is given voice by saying something like when you measure LDL, that's just measuring basically like serum levels of it, right? and serum levels don't necessarily correlate to cardiovascular disease. What we need to look at is cholesterol that becomes oxidized and therefore adheres to the arterial wall and creates these blockages or hardened. Yes, sort of. Is that like, you know, by armchair, you know, attempt to like parse this. But it doesn't make sense because it's the LDL concentration that does correlate very strongly with risk.

53:53And we can see that manipulating the amount in your bloodstream has a significant impact, right? That's what leads to it being in the artery wall and ultimately oxidizing and, you know, progressing onto a plaque. So yeah, you're kind of getting the right idea there, but it still comes back to like, we have very strong evidence for the actual concentration of LDL being a problem. So we should get our blood tested. We want to know what our LDL is, But more importantly, we want to know what our ApoB is. That is a more definitive marker of our situation. It seems like you used to have to kind of ask for ApoB.

54:30This is a new marker. But is that now being mainstreamed where if you go in for a typical blood panel, they're just going to do it as a matter of course? It's not standard. I've seen it a lot. Like patients of mine who are also being managed by a cardiologist, I'll see that the cardiologist does do it quite often if I hadn't already. But from like a standard kind of GP practice, I don't think most will measure ApoB. It's not really a part of clinical guidelines yet. I do suspect it will be. But what is a part of that normal lipid panel is your total cholesterol, your LDL cholesterol, which is a pretty good marker, and your non-HDL cholesterol.

55:07So it's your total cholesterol minus HDL, which is very closely approximated to ApoB. It's a pretty good alternative if you can't get the ApoB. And in most cases, just to be honest here, the LDL is good. It's a pretty good approximation in most cases. But in people with metabolic syndrome and people with elevated triglycerides, it's not necessarily going to be accurate. It can be underestimated because if your triglycerides go up, they start taking up some of the—or they start being taken up by the LDL. And so you kind of get a skewed measure there. But by and large, LDL is pretty good. Non-HDL is better.

55:45ApoB is the best. What about... having an elevated LDL, but also having a very healthy, high HDL, the so-called good cholesterol. Does that buffer that? How should we think about that? Like you get the test, you get your LDL, you get your HDL, and you get your total cholesterol. So you have these three things. You want APOB in there, of course, but in case you didn't get it, like how do we make sense of how those numbers interact with each other to decode, you know, how to move forward? Yeah, so we used to think HDL was important. At least the concentration was important. And that's because high HDL does associate with good outcomes in the long-term in most observational studies.

56:25However, things like exercise raise HDL, not smoking leads to higher than if you were smoking, and other healthy behaviors increase that HDL. Also, genetics impact HDL. So with LDL, like I said, we have the genetic studies, we have the randomized trials, we have a lot of evidence pointing towards modifying LDL and how that can impact risk. But they've tried drug trials to raise HDL. They didn't seem to lower risk of cardiovascular disease. People with genetically higher HDL cholesterol don't appear to be protected from cardiovascular disease. So the HDL concentration isn't actually a great marker.

56:59It generally associates with good outcomes because it's associated with healthier behaviors, but if you were to modify that number, it's not necessarily going to translate into better outcomes, if that makes sense. LDL is important. APOB is the marker to pay most close attention to. but in terms of assessing your overall CVD risk, you wanna look at family history, of course, and in the context of that, like where does getting a calcium scan fall? Like, what are other things that we should be doing to really know exactly where we're at? Yeah, so to first off estimate risk based on those measures that you can get through a blood test or family history or blood pressure, there's some great calculators online.

57:44I know the American College of Cardiology has one. I actually really like the European Atherosclerosis Society Calculator, and these are free to use online if you wanted to kind of plug and check your own numbers and see where it comes out. So that's one thing. But when it comes to, say, coronary artery calcium scans, one problem with those, and I think it can be a useful tool, especially in elderly individuals who are higher risk, is that if you measure at a younger age, say in your 30s or 40s, as we see a lot of people in the carnivore community, they'll measure it and be like, hey, it's zero.

58:12Well, it's probably going to be zero because that's the late stage plaque. That's the calcified plaque that's been there for decades before it finally did calcify. Just because you have a calcium score of zero does not mean you don't have plaque. In fact, the non-calcified plaque is the most dangerous plaque. That's the one that's going to break off and cause a clot and ultimately leading to a heart attack or stroke. The calcified plaque is actually more stable. In fact, medications like statins, while they lower LDL cholesterol, they actually can lead to an increase in calcified plaque, which stabilizes them.

58:41And that's one reason that you might not have as high of a risk of a cardiovascular disease or a cardiovascular event after that. So it can be useful in certain high-risk individuals, especially those like over 60, 65. But at a younger age, it's not super useful unless you are a very high-risk individual. And if you pick up on some calcified plaque there, that's really problematic because that means you probably have a whole lot of uncalcified plaque. Are there any other scanning techniques that are coming or would be good to explore? It seems like there should be some imaging that would be helpful here.

59:15I mean, there's some studies looking at like certain ultrasound techniques. There's a recent keto study maybe we wanna get into that used CT angiograms, but these aren't very easy to get. These aren't things that are gonna be widespread, whereas something like a calcium score is actually pretty easy to get. There's a lot of private labs that do them. So unfortunately, I'm not aware of what would be a really easy, simple test like that to do for most people. But you can make good decisions around treatment based on risk factors as well. And if you were a high-risk individual, then you can maybe get a referral to one of these more advanced tests.

59:52All right. So cliff notes on seed oils, like not so bad, but not too much. Like better than butter and beef tallow. So nothing to get too crazy about, but certainly not something to overindulge in. LDL, once again, important, ApoB, et cetera. What's next in the hierarchy of misinformation or topics that you feel it's important for people to kind of understand truth versus fiction? I think a big one is the whole plant-animal protein debate. I think it's one of the most powerful changes you can make in your diet to actually improve your long-term health. But then there's so much misinformation around like, well, plant protein doesn't work as well as animal protein or basically name your fallacy when it comes to those.

1:00:39Amino acid deficient, lower absorption rates. You're going to have to eat so much food just to meet your daily requirements, et cetera, et cetera. Animal protein is superior is basically the bottom line here. Yeah, I think maybe before the health stuff, yeah, let's talk about the whole muscle and strength aspect. I think there's three sort of questions that we have to ask there. One is, can you get the same amount of protein from plant foods as you could from animal foods? That's maybe the main concern for most people. And I would say it depends on what you're replacing. So if you just go to a buffet and you decide that you're going to eat plant-based now, and you just load up on whatever is labeled as vegan, you're probably going to end up with less protein if you're having a lot of rice and veggies and things like that.

1:01:23but if you swap out meat let's say your standard 80 % lean beef for tofu and you eat the same amount of calories which would be a bit of a larger serving for the tofu but the same amount of calories you get about the same amount of protein now if you replaced even extra lean beef with say seitan which is a wheat-based protein for those who aren't familiar and really nicely mimics sort of a meaty texture you can match lean beef so actually have more than your standard beef if you use textured vegetable protein, which is like soy without or with much of the fat removed. That also has a meaty texture and matches roughly the lean beef for protein content.

1:01:58So that's easy enough. Now we can also look at dairy. If you replace your, say, 2 % or 1 % milk with soy milk or pea milk, you get about the same amount of protein. Skim milk has slightly more, but it's not too far off. Now if you were to choose oat or almond milk, yeah, you're getting less protein there. So that's where that sort of decision-making comes in. If you look at eggs and replace that with a tofu scramble, you get more protein. So I just like to emphasize a bit of focus on those higher protein plant foods. It doesn't have to make up your whole diet, but where you would normally have some beef or some chicken or some fish, make sure you're replacing that with some of those higher protein plant foods and you can get around the same amount of protein.

1:02:35Yeah, but Matt, leucine, this is the thing, right? Leucine, most plant foods are insufficient sources of leucine. And without leucine, you can't form complete proteins. So leucine, one of the amino acids that's important for triggering muscle protein synthesis, it is found in quite significant amounts in certain plant foods like seitan is actually very high. Yeah, but nobody eats seitan. Sure. I'm just mentioning one example. But soy is also quite a good source. Yeah, but that's estrogenic. We'll get to that. Okay, keep going. But yeah, Yeah, so that can be a good source. I believe azuki beans are pretty good.

1:03:13But I want to also highlight that we don't need to necessarily hyper-focus on leucine because there's a threshold to how much is actually beneficial at a meal. So it's about 2 to 3 grams. And that's the amount you can get through a pretty simple meal with some grains, some tofu, and veg. The tofu alone can often provide about that amount depending on the proportions that you're having. So you can meet that leucine threshold relatively easily. and I don't want to jump too far ahead to the outcomes part but we actually have a trial where they monitor leucine intake as well and I will definitely touch on that in a second but the point being here is that on the amounts of protein you can get roughly the same amount then it comes to a question of amino acid content do plants contain all of the essential amino acids so there are nine essential amino acids meaning these are the nine building blocks of protein that we cannot make ourselves we need to get from food and all plants contain all of the essential amino acids full stop.

1:04:09So that's one of the biggest myths out there is that plants don't contain all of them. Now, the pushback there would be, well, they don't all contain a lot of all of them and that's fair. But if you're eating a varied diet throughout your day, and not even at every meal, but if you're having certain things for breakfast, let's say you're having some oats with whatever nuts and seeds you're throwing in there and then for lunch you have some beans or lentils with rice or whatever, those will all combine and complement each other. You don't necessarily have to have this variety at every single meal.

1:04:41And we don't see that that's a problem at all with getting enough of the essential amino acids throughout the day as long as you're eating some variety and not focusing on a single food. And then the third thing that gets brought up, so the last thing before we get to the actual outcomes, is digestibility. So do we absorb much plant protein relative to animal protein? and the concerns over that are stemming primarily from two measuring systems or scoring systems for protein digestibility. I'll try not to get too in the weeds on this but just briefly describe them. So one of them is called the protein digestibility corrected amino acid score or the PD-CAS and the other one is called the digestible indispensable amino acid score or the DIAS.

1:05:23You don't have to remember them. Don't worry about it. I'm just throwing it out there. Now, you will find that based on these measuring systems, a lot of plant foods will score lower 60-70 % maybe in that ballpark, except soy scores in the 90s. It scores quite high and maybe one or two other plant proteins. Whereas animal proteins score very consistently in the 80s to 90s or sometimes even higher. Now, the problem with those scoring systems is that I'll start with the PD-CAS. For one, it's typically measured in rodents, in animal models. We aren't rodents. We have different digestive tracts. We have different growth rates.

1:06:00We have different protein needs. And so we can't necessarily translate that to humans. And in fact, this goes across the board. So when people are making nutrition claims online, I would always look at, are they talking about humans or are they talking about animals? Because a recent review found that only about 5 % of results from animal trials translate to humans. So most of the time they either don't work, there's unwanted adverse effects, or they just don't work as good as other things that are already out there. So animal trials, it's a starting point. It's not necessarily translatable to humans.

1:06:29The second issue is that they don't just measure digestibility. They measure the digestibility of the lowest available amino acid. And this is critical. So let's say you had a report card. And let's say there were nine subjects. We'll call them the nine amino acids. And let's say you score straight A's on eight of them, but you got a C on one of them. Your score on the PDCAS for the aggregate would be a C. It wouldn't be like a B plus or whatever the actual average would be. They would score you based on the lowest number. So if you take a plant food like beans that have low amounts of methionine but are higher in the other amino acids, you'll get scored based on how much methionine is there, right?

1:07:08So that's a huge disadvantage to plant foods when it's not even a problem if you're eating multiple foods, right? They'll complement anyway. So that's a big problem. Because you'll be eating something else that is high in methionine. Exactly. Whereas an animal source of protein may be more complete in the sense that all of those things are in equal proportion. Exactly. Yeah. And that's a point that I've never seen somebody mention when citing the PD-CAS or the DIAS to support their view on the animal proteins. The third issue with the PD-CAS, it's not maybe as big of an issue, but they measure digestibility from mouth all the way through the other end.

1:07:45So basically they feed foods, they measure how much protein goes in and how much comes out, and the difference is presumably what's absorbed. But near the end of the small intestine, or sorry, the large intestine, there's some bacteria that will chew up some of the protein so it can skew results a little bit as well. So there's issues around that. Now moving on to the diast, and I'll go through it quickly because it's largely the same, but it's typically measured in pigs. It has that same issue with the limiting amino acids, so it docks points based on amino acid profiles. They do overcome the whole issue with the bacteria and the digestive tract because they insert a tube through the abdomen to the end of the small intestine and they suck out the protein from there versus going all the way through.

1:08:23But then the other problem is they typically use raw foods. So they use raw beans, raw lentils, raw grains. And by cooking those foods, you make the protein more digestible. So they're also skewing results, particularly for plant protein sources that do become more digestible with cooking. And when we look at the limited research we have in humans, where they're looking at the digestibility of the whole protein, so not the individual amino acids, we see that high-quality plant protein sources like soy, pea, or wheat-based proteins, they have about a 90 % or even above a 90 % digestibility that's only a few percent off even the highest digestible animal proteins.

1:08:59So the difference is we're talking a few percent here. It's hardly anything. With that, we can speculate that, well, maybe the results will be the same. maybe plant protein will be slightly worse, but not too far off. But that's why we ultimately test these in the clinical trials where you pit a vegan or plant-predominant diet against an omnivorous diet and measure actual strength and muscle gains. And we now have two trials that have done that. And in both cases, the plant protein, as long as they're eating the same amount of protein, led to the same muscle and strength gains as the animal protein with no significant differences in any outcome.

1:09:32So if at the end of the day, let's just for sake of argument say, yes, plant protein's somewhat less digestible, let's say that it doesn't have as balanced of an amino acid profile, if at the end of the day you get this same result, same muscle gain, same strength gains, who cares? Who cares about these individual mechanisms? Maybe there's mechanisms working in the opposite direction for plants. Maybe the carbohydrates that are packaged with plant foods a lot of the time help spare some of that protein so it can be used and integrated into your muscle. There's a possible mechanism there. Ultimately, I don't want to speculate too much about what these mechanisms could be because I don't think we know for certain, but who cares?

1:10:06The results are the same.

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1:14:45do those findings extend to when you isolate the proteins in powder form so if you do a pea you know soy blend of of protein powder versus like a whey is there an argument or any substantiation to the idea that like whey is better by definition than these plant-based protein powders it's funny because i feel like these trials these more recent ones were sort of responses to those initial criticisms around the powders. So when we look at trials on pea, rice, or soy protein, in comparison to whey protein, we see no significant differences there. But one of the criticisms was always that, well, maybe when you isolate the protein, it's more digestible, so it's going to function better than a whole food.

1:15:28It's sort of the opposite of what you're suggesting there. And so when they conducted this, we'll say the first of these two new trials in Brazil, was published, I believe, in 2021. Yes, they supplemented the vegan group with some soy protein and they supplemented the animal group or the omnivorous group with some whey protein. Most of the food or most of the protein in both groups came from food. And that's critical. So if there is a difference between plant food consumption and the, say, protein quality there and animal foods, we should see a difference in that trial since the majority of their protein came from those sources and we did not in any outcome.

1:16:04So I think that's pretty compelling evidence that no, you can get the job done with plant protein as long as you're eating sufficient protein, which in this case was 1.6 grams of protein per kilogram of body weight, which is typically recommended for those looking to pack on muscle. The argument that generally follows this is, okay, yeah, but if you're going to be making sure that you're eating enough protein on a plant-based diet, then this is gonna be difficult and you're gonna have to eat like tons of food and be hypervigilant about what those foods are. I would say you do have to probably spend or pay a little more attention, especially if you're coming from an omnivorous diet.

1:16:41As I mentioned earlier, there are certain plant foods that are higher in protein and certain ones that are lower. But to be hypervigilant, I think that's an exaggeration. If you monitor pretty much anyone's protein intake on a plant-based diet where they're centering their meals around protein, and this is what I advocate to patients as well, is when you're designing a meal, focus it on the protein component. So if you're having lentils and rice or some veggies, make sure that centerpiece is the lentil dish. Or if you're using tofu, make sure that's the center. And then build around that. Add the fruits and veggies and other things around that.

1:17:16And if you're doing that, it's pretty easy to hit those targets. If you're aiming for that high, high end of 1.6 grams per kilogram, you could probably do well by adding a protein supplement. It doesn't mean that you need to, but it can help you get there without thinking about it much. And I do that and I never think about my protein intake anymore because it's so easy. And look, every gym bro who's going to the gym is using whey protein anyway. So it's not like it's really different than what the omnivores are doing. It's just a different type of protein. Sure. If their omnivorous diet was so exceptional, there would be no need to be drinking these protein smoothies all the time.

1:17:50Yeah. And even if they were already meeting their needs, there's not really harm in taking an extra shake or something either. And I would say the same about people on a plant-based diet. Well, in terms of meeting your needs, like even in a performance context, what does the science say is required in order to produce the muscle synthesis that you want? And what does excess protein intake do for that or not do for that? Because look, if our friend Garth Davis will say that we're obsessed with protein and it's not helpful to us, the recommended daily allowance is what, 0.8 grams per kilogram, which really isn't very much.

1:18:35But right now there's a lot of promotion of really doubling down on your protein. And perhaps there's a reason for that as we age, like at my age, it becomes more important than it was 10 or 15 years ago. But what do you make of that argument and how we think about the amount of protein that we're intaking? Yeah. I mean, I know the RDA, I would say, is a little bit low. And there's been an argument for that now based on newer data that's come out the last five, six, seven years around especially bone health parameters and risk of frailty in older age. And so I do actually advocate for a little bit of a higher intake, around 1.2 grams per kilogram is a pretty safe number for most people.

1:19:15And for most athletic endeavors, that's going to be enough as well. It's for those who are looking to squeeze out every ounce of muscle and strength gains that going up to 1.5 or 1.6 grams per kilogram is a reasonable thing to do. And there was a really good trial, or sorry, meta-analysis of trials that was published just a couple of years ago by Tagawa and colleagues. And they looked at protein intake with and without resistance training. So in trials where they didn't add resistance training, but they just upped their protein, pretty much nothing happened, very little. And so you're not just gonna sit on your butt, slam protein shakes and hope to gain much muscle.

1:19:49It's just not gonna happen. But in those who were resistance training, Even in those with very low protein intakes, like 0.8 grams per kilogram or less, they still gain muscle. So that's the biggest lever to pull is actually lifting some heavy things, right? But in those who up their protein to about 1.5 grams per kilogram, they experienced the largest benefits and then there was no further benefit after that. So again, it kind of depends on your goal. I think resistance training is really important, but especially for bone health and so on, I would advocate for a little bit of a higher protein than that RDA of, we'll say about 1.2, maybe 1.1 grams per kilogram.

1:20:23Well, this brings us to the point in the podcast conversation where we have to talk about Nagra versus Norton. You've had some, you know, colossal beefs with our friendly Norton. Norton claims, negged by Nagra. Talk about like the, can we talk about this a little bit? Yeah, yeah, fine. You know, where do you guys disagree on this stuff? You know, what led to, you know, some loggerheads here? I would imagine that has something to do with protein. Actually, more with red meat. I mean, protein to a degree as well, but it was red meat. I'll give some background on that. So there's a study that he and other people, I don't want to just single him out, often cite to suggest that red meat, unprocessed red meat is not problematic in the diet.

1:21:06And this is a study out of Canada where they looked at unprocessed red meat consumption and the risk of cancer. But they did something interesting where they separated people into those who eat little fruits and veggies, moderate fruits and veggies, and then high fruits and veggies. and they found that in those with a lower intake of fruits and veggies, unprocessed red meat was associated with cancer risk, but in those with the highest intake, it was not significantly associated with higher risk. So Lane takes that to say that, well, at even a regular intake of unprocessed red meat, if you're eating fruits and veggies and have a good diet quality, it's not problematic.

1:21:39But my criticisms of that study, or rather that conclusion from that study, is that if we look at the amount of red meat that they were consuming, the high consumers were having, we'll say a little above 500 grams a week. That's less than a serving a day. So 100 grams is a typical serving. That's about, you know, a deck of cards size per day. And so these people were consuming less than that. And that's sort of the threshold for where we typically see risk. So I would argue that the men in that study weren't even consuming enough. And the women in that study were consuming even half as much, so even less.

1:22:11So that's problem one. The second problem is they lumped all the cancers together, or they did another analysis where they lumped 15 cancers together. The issue with that is if, let's say, unprocessed red meat increases colorectal cancer risk but doesn't impact these other cancers or most of these other cancers, well then if you're looking at overall cancer risk, you're not going to see much. Even if you get an uptick in one cancer, it's going to be sort of washed out by the other ones. So I don't think it's fair to consume that there's no risk there. And then the third problem is it's just cancer.

1:22:39What about cardiovascular disease or other outcomes? We can't conclude that it's safe for all of these other issues. So that is sort of what I made a post on, and this is back a few years ago now. It's funny, I'm surprised he even commented. I didn't have much of a following or anything at the time, but somebody tagged him and was like, hey, Lane talks about this. What do you think? Or they were maybe a bit concerned about the conclusions they'd heard from him. And he just commented saying that I'm biased and cherry picking and there's other data that supports his position. And so I just replied, well, can you share that data?

1:23:11Because I haven't and other data like that. And in fact, he often talks about that study because of its uniqueness in the way that they did the analysis. So it doesn't make sense that there would be other data that supports it. Lane is somebody who's also gonna say, you're gonna wanna be intaking more protein than this RDA. Yeah, and I think we agree. And that's the other thing I really wanna be clear of. I think a lot of the information he puts out is good, right? I'm not to be super critical of him in general. I just think around the animal protein versus plant protein debate and the red meat stuff, I think there's maybe a bit of bias there or something.

1:23:41But yeah, I would very much agree with him on going a bit higher than the RDA. Most people believe that red meat is perfectly fine and appropriate as a part of a healthy diet. This could be a semester course here, but perhaps that's true. I'm interested in your perspective, but my sense is that we're just eating altogether way too much of it. And when you consider the fact that, cardiovascular disease is the number one reason why most people are going to die. And the relationship between CVD and saturated fat and cholesterol and LDL, red meat intake is only going to drive you in the direction of that rather than in the reverse.

1:24:29Yeah. And I think a really important variable here is dose, right? You mentioned eating too much of it. Like, do I think that someone, and I'll say this as a vegan, even when it comes to health, do I think you can include red meat, especially lean red meats once, twice a week, something like that? Yeah, I don't think it'll have a meaningful impact. The problem is where you're averaging a serving a day. Like that's where really the problems start to creep up. And even with lean meats, we see, and there was a trial by Bergeron in 2019, where they actually compared red meat, lean red meat, white meat, and plant protein, and they matched saturated fat, they matched fiber intake, and still the plant protein lowered ApoB relative to the animal proteins.

1:25:07And so there's still a benefit. What do you make of that? Like what would drive that differential? I think a part of it is going to be the dietary cholesterol. So that's one thing that wasn't matched because it's inherent to the meat. And I know there's a lot of debate around dietary cholesterol and the impact that it has. And there's some nuance there. So if you take somebody who eats no dietary cholesterol, you take a vegan and you start feeding them cholesterol through eggs or other foods, their LDL is going to shoot up more. whereas if you take somebody who's already eating about 400 milligrams of cholesterol a day and you add more, it doesn't do anything.

1:25:39There's a plateau effect. There's also genetic differences person to person but that wouldn't show up in a trial like that because everyone was doing every diet. So it could be that little bit of a bump in ApoB could be due to the dietary cholesterol or potentially due to some of the phytochemicals and the plant foods maybe having a little bit of an impact or something as well. The exact mechanisms, I mean, I don't know that will tease out exactly what proportion each one contributes to, but those can all be factors. Let's talk about plant meats, so-called fake meats, the plant analogs to our favorite meat and dairy products.

1:26:16This is low-hanging fruit for the more omnivorously or carnivorously inclined to point a finger and say, plant-based diets are terrible. They're rife with processed foods. They want you eating bugs and all of these processed foods, and this is what's destroying our health. Yeah, I actually, I don't know if you're aware, published a paper on this last summer in the Canadian Journal of Cardiology where we actually reviewed the research on plant-based meats and cardiovascular risk in particular. and we looked at both the nutritional profiles of the plant-based meats across the literature and the at the time available randomized controlled trials of which now there are a couple additional ones and with nutritional profile what we found was that compared to the meats they're designed to replace they were lower in saturated fat on average obviously lower in cholesterol because that comes from animal products a bit higher in fiber and ultimately aligned with better cardiovascular profile.

1:27:23Then when we looked at the six randomized controlled trials on the topic, we saw that they consistently lowered LDL cholesterol compared to meat, total cholesterol as well, no negative impacts on blood pressure, which was maybe a bit surprising because of the salt content of a lot of these products. And then there was also a little bit of weight loss in a couple of the trials. So from a simple swap of just replacing the meat with the plant-based meats, we actually saw improvements in a number of markers. Now I'd love to see long-term data on outcomes as well down the road, and hopefully we get that.

1:27:53But the data currently does point towards them being at least a more heart-healthy choice, yet there's still this very strong opposition to these products around their process nature or name, again, your appeal to nature fallacy. Yeah, I mean, it's a frankenfood. It's filled with all of these fillers and additives and preservatives. I'm looking at the nutrition label. I don't know what these things are. I can't pronounce these words, the studies show that in comparison to its meat variant, that it actually is healthier. So it really is about what it's replacing. Like if you're just gorging on these plant-based meats all the time and forsaking your more nutritious vegetables and fruit and whole grains, et cetera, like this is not a good choice.

1:28:44But if it truly is replacing what you were eating prior, where the evidence seems to suggest that it actually is a healthy alternative, although it is processed by comparison. Although the meat you might be eating might be filled with hormones and all kinds of other stuff. And of course it comes in a package that's higher in saturated fat. And we've already talked about what that drives. I think a lot of, especially competing interests, have really jumped on the consumer fear around things like processing or ingredients you can't list. For example, there's this organization called the Center for Consumer Freedom, and they are backed by meat industry and other industries, as well as many individual donors of whom are anonymous.

1:29:29But they have taken out plenty of ad campaigns. They took out ads in the Wall Street Journal bashing plant-based meats. They took out a Super Bowl ad, of which I'm assuming they paid$5 to$8 million to create fear around. in the ad, it was children at a spelling bee who couldn't spell certain words that were in the ingredients. And so there have been like these campaigns, I think to a degree have been quite effective at sort of inducing fear around these products or at least capitalizing on the already existing fears. Yeah, I mean, certainly these products could be healthier and hopefully they will become healthier than their current versions.

1:30:06Like for example, I know Beyond Meat is working on, a new version that will address the concerns that people have about the less than healthy aspects of that product. And I think that's great, but there is no doubt. And I know this for a fact, like with inside sources, that there was indeed an incredibly well-funded and well-coordinated attack against the sort of plant-based meat, fledgling industrial complex, for lack of a better word, to really create this idea that these were really unhealthy foods and that people should avoid them at all costs. Like, that didn't happen by accident. That was very purposeful to, you know, get us from where we were when there was a lot of enthusiasm about these products to kind of where we are today.

1:30:56And I think what is really fascinating within that is really sort of a social experiment. Like, it is the more conspiracy-minded folks who are most vehemently against these products. And these are people who have been, you know, manipulated by an actual conspiracy to believe what they believe. Yeah, I've actually never heard it put that way, but that's perfect. And yeah, I think you also hit the nail on the head with, like, say, Beyond Meat trying to reformulate their products. One of the underappreciated aspects of these plant-based meats and just processed foods in general is that we can reformulate them, right?

1:31:37You can't just do that with a cow overnight. That's many generations of selective breeding and everything. So when you see companies like Beyond Meat or even Impossible Foods, now they have light versions of their products that are like lower in saturated fat. They're modifying these foods to actually be healthier. Now we have data on the older products showing that they're already healthier than the alternative. And with the swap meat trial, they compared Beyond Meat to even organic and grass-fed meat products and the Beyond Meat fared better. So - But Matt, you're a paid shill of Beyond Meat, right?

1:32:06I didn't receive it. I have not received a penny. I did. Wasn't that, didn't Christopher Gardner get accused of that with the Netflix series? Well, I think he got accused of it because they had funded or at least partly funded one of the trials that he did. I don't think he received anything. I don't wanna speak too much on that because I'm not sure of the specifics, but that was my understanding. I have received zero, to be clear. I mean, people are gonna say that regardless. I think we just have to stand by the science and make sure the methodology is good. And if that's the case, who cares where the funding's even coming from, as long as that stuff is all in line.

1:32:40But I know that there's obviously gonna be concerns around that regardless. Right, it's really hard to shift people's minds around this. And I'm not saying like, listen, you should just knock yourself out with these products. you should be sourcing your nutrition from whole foods close to their natural state as often and as much as possible. But I just wanted to, you know, shift people's perceptions of, you know, how they might be perceiving these products and to think about it a little bit more clearly and critically in terms of like maybe what they're reading and hearing when it comes to these things.

1:33:15Yeah, and I think you can ask the CEOs of these companies if they think people should center their diets around those products or beans. And I think they would, you know, side with the beans. These are supplemental things that can be, you know, included to enjoy once and all. If you sit down with Ethan Brown, who is the CEO and founder of Beyond Meat, incredibly smart guy, really has his heart in the right place, is trying to do good in the world, and, you know, has a very big mission. he could fill your brain with just a million facts about why this is a healthier option and how they crafted it in the way that they did, et cetera.

1:33:51But I think the problem, one of the big problems here is that whether it's Beyond Meat or any of these other companies, they've never been able to be in control of the narrative. And they've allowed that narrative to be created for them. And they're always responding to it rather than basically being in front of it. And I mean, that's like a PR thing, I guess, or like a branding thing. But the story that Ethan wants to tell isn't really penetrating culture in the way that all the stories about, that are sort of anti-Beyond Meat are, find their way across the internet, I guess. Yeah, I mean, I've seen like the latest little short documentary they made, Planting Change, and a few other things.

1:34:37They're trying to get that message out there, but I think it is a question of, is it permeating those circles outside our own, right? Like we are seeing this stuff, but is it getting to those people that really need to hear it? And I don't know. I mean, time will tell. I mean, there isn't a lot of cultural receptivity right now, at least, you know, I don't know what's going on up in Canada. Yeah, you know, it is what it is. But it does raise another kind of ripple here, which is the difference between processed foods and ultra processed foods. So when we hear the word processed food, processed bad, and certainly we wanna avoid processed foods and most definitely ultra processed foods in our diet, but there is a little bit of confusion when it comes to that word, which is very loaded because pretty much everything's short of fruits, vegetables, and I don't know, like meat, meat also.

1:35:30Like so many foods are processed and there's a whole spectrum here of health and harm. Yeah, the most used sort of classification is called the NOVA system for classifying foods as like unprocessed, processed, ultra processed. And this came out of Brazil. And basically they have four different levels or four different groups. So group one foods are the unprocessed or minimally processed foods. Fruits, veggies, meats would be included in there, certain dairy products. And then group two foods are the ingredients. So like the culinary ingredients like sugar, salt, oil. So group three are foods where you add those culinary ingredients to the unprocessed or minimally processed foods.

1:36:08So even canned vegetables because of the salt and the liquid, that is considered now a processed food. And then you have breads, certain types of breads and things that would factor into there as well. And then ultra-processed foods are foods that are essentially made in a processing facility or factory, used primarily of industrial ingredients. And these can range widely from these plant-based meat alternatives to sodas to sausages and bacon to pastries and on and on and on. And something to understand is that even within that group of ultra-processed foods, there are wild differences in the types of foods.

1:36:49It's like a can of soda is not the same as a Beyond Meat, which is not the same as an animal-based sausage, which is not the same as a donut. You know, like they're all very different. And what we've seen out of the last few years, and this is really interesting research, is that when they separate out the different types of ultra-processed foods, it's mostly the processed animal foods, so the like processed meats and the sodas that are the worst. Those are the ones driving most of the risk. What about all the refined grain processed foods? So then when you get to the grains, refined grains are sort of in the middle of that spectrum, but then the whole grain products, so even whole grain cereals or whole grain breads are associated with lower risks.

1:37:26So we have some foods in this ultra-process category that can actually improve risk, and then we have some foods that worsen risk and some that are kind of in the middle. Now, refined grains in general, I tend to put them sort of at the middle of the spectrum because you always have to compare it to something, right? And because refined grains make up such a wide or a large part of the American diet, it's good to have that as sort of the centerpiece that you compare everything to, at least in my view. And that's not to say that it's nearly as good as like whole grains or other foods. And they tend to only really increase risk at least significantly if they're leading to weight gain.

1:38:01So if you're adjusting for things like weight change over time, they're just pretty neutral. They don't seem to increase risk. But they're always going to, because we're talking about like Oreos and saltine crackers, like the hyper palatability aspect of it is going to, you know, cause you to overindulge on them. Yeah. And so that's a possible criticism, right, for making the claim that, you know, in a calorically balanced state, these refined grains are refined. Yeah, like who are those people? Yeah, the guy who eats one Oreo and walks away and says, I'm good. Not necessarily even Oreos and things, but even like white rice or white bread, like those would fall in that category too.

1:38:34So even within that, there's a bit of a range. But yeah, I agree with you that generally speaking, refined grains are probably going to promote more of an overconsumption pattern than otherwise. So generally going to be worse off with those. Right. Did we say everything we need to say about that? I think so. I mean, there's this fear around the fact that things are processed. But even just because something's processed, I mean, there's such a wide range of those types of products and there can be differing effects, right? So just because something's processed doesn't mean bad, on average, we can say, yes, they're less healthy.

1:39:04Extra virgin olive oil is a processed food. Yeah, exactly. Tofu is a processed food, which I think we still haven't gotten to. Well, that's a loaded. Maybe that's coming up. I don't know. So you just exposed yourself as a target by saying that. Yeah, there you go. But even like whole wheat pasta or whole wheat breads, I know there's some people that are concerned about the - Well, that's also like, that gets a lot of people in a lot of trouble, those foods. It does, at least in the social media space. But generally speaking, those are associated with good outcomes. It's just a matter of, again, like we talked about earlier, stepping back and looking at the final outcomes.

1:39:39What are the results that we see with these foods? And we see generally those foods are associated with better outcomes. Right. All right, soy boy. Defend your estrogenetic food, favorite food. Yeah, so soy does contain isoflavones. These are a type of flavonoid, and they're commonly referred to as phytoestrogens. phytoestrogens, phyto mean plant, estrogen, obviously estrogen. And the reason they are termed that is because they have some similar structural characteristics to the estrogens that we create, but they are not identical. But because they have some similarities, they can interact with estrogen receptors in our bodies, and so they can have some sort of a hormone modulating effect.

1:40:17The question is, what is that effect? Is it something that we're worried about? And when we look at randomized controlled trials, in fact, a meta-analysis by Reed et al., I want want to say in 2020, maybe 2019, when we look at that meta-analysis of it was like 41 randomized controlled trials, we see no clinically significant effects on testosterone, estrogen, or other sex hormones. We see a similar data. There was recently a study on or a meta-analysis on trials on women, pretty much the same results, no clinically significant effect on hormone levels or measures of estrogenicity, things like uterine lining thickness, for example.

1:40:52And so we have really good data consistently pointing towards there's no real impact on hormone-related outcomes. Now, where does the concern come from then? Well, for one, it's just an extrapolation of the word estrogen, phytoestrogen, and thinking that that is then estrogenic. And two, there were a couple pretty extreme case studies that were published a number of years back where there was like an individual who consumed 14 or plus servings of soy milk a day and like pretty much a soy diet. and he may have experienced some breast growth, breast tissue growth. So he's patient zero for the soy boy phenomenon.

1:41:32Pretty much, yeah. Yeah, pretty much. But here's the thing. We can't even, based on that, conclude that it was the soy necessarily. We weren't adjusting for any other factors. He's eating a very monotonous diet. Maybe there's other things that are lacking or in excess. We don't really know. But even if we granted that it was the soy, I mean, that's a ridiculous amount. Nobody's recommending that amount. The randomized trials we have go up to five servings a day or something, which is still quite a lot, and we don't see any meaningful impact there. So on that basis, the soy foods are quite safe.

1:42:02And then we can look at the long-term data on breast cancer risk, for example, and we see that those with the highest soy consumption consistently have lower risk of breast cancer. In men, we see lower risk of prostate cancer as well, and then we see lower risk of cardiovascular diseases on top of that. So it's quite beneficial sort of across the board. and we see improvements in bone health parameters so lower risk of osteoporosis in older age largely because the specific receptors that the phytoestrogens will bind to they're concentrated in bone tissue amongst other tissues and they have pro-estrogenic effects in bone tissue which is good that actually helps maintain bone mineral density whereas in breast tissue they have anti-estrogenic effects which is potentially one reason why we see a lower risk of breast cancer People are very resistant to the idea that soy might be a healthy food product.

1:42:53And in thinking about like why that might be the case, there's a number of options. Either everything you said is incorrect and you're just wrong, right? Or people just don't like soy and they wanna keep eating what they wanna eat. And so they're just not gonna hear it. Like there's just a, people tune out around this. But I think that latter explanation gets to notions of identity like that we form or that have something to do with what we eat and the association between being a meat eater and how you think about your role of manhood in our culture, which is a whole kind of other podcast, which is not your expertise.

1:43:38but I spend a lot of time thinking about, you know, time and time again, I have people like yourself on who say some version of what you just shared and have been sharing over the course of this podcast. And then I kind of cast my gaze, you know, out onto the world and wonder like, why is this message so difficult to hear? Or why is it so challenged in kind of penetrating the mindshare of people when you're trying to help people be healthier? Like, do you have a working theory of that? Or do you spend time thinking about that at all? I do, but I don't know that I have a good answer. I feel like a part of it is really what you said as the second sort of example, and that I think people are really attached to the status quo of the meat consumption.

1:44:25And to a degree, the soy sort of counters that. And on top of that, there is this sense of needing to be manly and masculine. And when you hear the estrogen word, Maybe there's some fears that are created there. Like there's a number of possible explanations, at least on an individual level. And then I also wonder about an industry level, like we talked about the plant-based meats. I wouldn't be surprised if there's some, there are some maybe campaigns or have been in the past to really counter that more pro plant-based. Follow the money. Yeah. Follow the money. Let's talk about deficiencies. There is this idea that a plant-based diet is inherently deficient in nutrients.

1:45:09It's nutrient poor. It also contains plant toxins that these plants are out to kill you. You're not getting any B12 and you're not, like we mentioned, leucine already. It's leucine deficient. might not be the best way to get your omega-3s. So if you need to supplement, then doesn't that have something to say about the overall viability of this way of eating? So I'm met with this all the time. And I actually had a debate with a prominent carnivore proponent, Anthony Chafee. It was quite, it got heated at points near the end. And I should say, sorry to interject, but like the carnivore will say, the carnivore diet is optimal because it is the most nutritionally complete and dense of all diets.

1:46:00That's part of that narrative, isn't it? Sure. On that note, I mean, there was a recent study that looked at four different iterations of the carnivore diet, and they consistently fell short in thymine, vitamin C, a couple other nutrients. I think iron was in some cases short, potassium was short. How could it be short in iron? Yeah, so animal foods, while they aren't super rich in iron, so like per serving, like something like lentils is actually higher in iron. It's just the bioavailability of the iron is somewhat different. So as far as hitting the dose of iron, it is potentially a little bit harder, at least for the standard REX.

1:46:33But it has the, what are the two types of iron? It has the mix of the heme and the non-heme. You're going to get your heme iron and the lentils are the non-heme iron. There's a whole other thing about that. Yeah, but just as far as hitting the recommended intake, the absolute intake, forgetting the different types and everything, it did in some cases fall short. And then, like I said, there were, I believe, eight nutrients that they listed as falling short. And this was a very recent paper that came out. So that's to tackle the whole carnivore is the most nutrient dense. I mean, I haven't seen a single iteration of a carnivore diet that meets all nutritional needs yet.

1:47:05And I've analyzed a few people's, like, what I eat in a day and haven't seen anything. But that aside, I really want to tackle this idea of, well, if you need to supplement, clearly it's an insufficient diet or there's a problem with that diet. So in this debate I had with Anthony Chafee, I actually, I did this thought experiment. I'm going to do it with you in a moment where I sort of challenged that notion. And he did not want to answer my question. He dodged it eight times. We counted it. And that's because it really, I think, pokes a hole in this ideology. So let's say that there's two diets.

1:47:38There's diet A and diet B. Now, let's say diet A provides most of the nutrients you need, but you might need to supplement one or two things, but it leads to a long and healthy life, lower risk of cardiovascular disease, cancer, lower risk of frailty and older age. And then there's diet B. Diet B provides all of the essential nutrients you need. You don't need to supplement anything, but it leads to a higher risk of cardiovascular disease, cancer, higher risk of frailty and older age. Which one would you choose? Of course, A. Yeah, so he didn't want to answer that. And the The reason is because it tells me that what you care about are the health outcomes.

1:48:10To you, the deciding factor between following a diet or not following a diet is not whether or not you need to supplement. It's whether or not you get good results at the end of the day. So if a vegan diet with appropriate supplementation like B12, obviously, if it leads to good long-term health outcomes, then who cares if you need to take one supplement or whatever a day, or maybe you take a multivitamin to cover your bases? It doesn't matter. What we care about are those health outcomes. So that sort of gets rid of that argument around supplementation, as long as you're honest enough to answer that question.

1:48:41Well, it's also a red herring because omnivores and carnivores are supplementing anyway. Oh yeah, carnivores are all on electrolytes. And they tend to be more obsessed with optimizing their nutrition through strategic supplementation. It's a thing. So it's not really relevant in my mind. And sure, take a B12 supplement, But maybe take a vitamin D supplement and a multivitamin and all these, you know, like we all have certain deficiencies that occur depending upon our environment and the circumstances of our daily life. I think even the most well-intentioned and rigorous people with their nutrition, if you get a blood panel, there's gonna be, even if you're within the healthy range, you're gonna be on one side of it more or less.

1:49:30And so that suggests that, you know, we're not always like hitting the bullseye every single day with everything that we're doing, regardless of how optimized your diet is. Yeah, it's like - It's a distraction. Yeah, and it's like when we talked about protein earlier, it's like every guy going to the gym almost is taking away protein. But when you're on a plant-based diet, all of a sudden it's an issue that you need to take a protein supplement or maybe you are taking it to maximize your intake. Like, it just seems to be a really easy thing to bring up when sort of faced with that idea of a plant-based diet.

1:50:02Right. Well, it's that thing that happens when, you know, when the argument, you know, suits you, you'll serve it up, you know. But when it's directed in your direction, then you don't want to talk about it. And, you know, I suppose on some level, everybody's guilty of this and we all have our blind spots. but this comes up a lot in terms of, you know, the research cited or the research dismissed within the hierarchy of, you know, kind of, I mean, there's a lot of cherry picking going on, but you can cherry pick anything because there's so much research out there and you're gonna be able to find something that substantiates whatever claim you're trying to make.

1:50:36And this is something that, you know, you're always kind of banging on about in your videos. Like, because somebody will make a video and say, well, you know, so-and-so said this, but like that research is nonsense, you know, it's worthless and you shouldn't pay attention to it. And then that same person will make a video and say, this new study came out and it says exactly what I've been saying all along. I'm like, suddenly, you know, the library of research is now valid and worthy of your attention. Yeah, I do that a lot and actually try to point out these sort of double standards in a lot of my videos because I think, and maybe I'm wrong, but I think it's much easier to understand when someone's being perhaps dishonest are a bit shady in how they're presenting evidence than to actually go into all the methodological issues all the time.

1:51:20I try to do that too. I'll try to explain why one study is better than the other, but I really want to hammer home. Like, hey, this person is citing this type of, say, observational research when just last week they were saying that all of this research is trash. So why are they citing it now? Because it supports their view. And you can go on and on and on, whether they're cherry picking anecdotes or whatever. And I think that's really easy for people to understand just the double standard versus necessarily getting all of the little intricacies of the research itself. Was there anything else that came up in your debate with Chaffee?

1:51:51Oh man, there was a lot there. Oh, there was a couple of times. This was, this was kind of brutal. I, um, there were times where he'd cite research and I'd ask him very basic details about his own research that he's citing and he wouldn't know. Like I'd say, how did they track meat intake or, um, what were the results for this or whatever? And he wouldn't really know any of it. And that was really an example of somebody who's sort of maybe reading an abstract or cherry picking a result and wanting to showcase it, but not really looking at the research in depth. And I've seen that a lot with his content.

1:52:22I'm trying to think, he came up with the appeal to nature a lot, you know, so appealing to, well, historically humans ate meat, so that should be good for us. Or, I mean, there's a lot of things that are natural that aren't good for us. a lot of, whether it's natural plants or certain animals, there's exposure to a lot of heavy metals that are naturally derived. I mean, just because something's natural doesn't mean it's good. Well, also we, you know, we developed to be incredibly resilient and able to eat many, many different things. So what we used to eat isn't necessarily determinative of what we should eat when we have the option to choose.

1:53:02Yeah, I absolutely agree. And we have so much research now around like what makes up a healthy dietary pattern that we can make really good informed decisions regarding those outcomes versus relying on, well, you know, historically we've done this, so it should be good. I mean, you're kind of guessing in that case. It seems like the carnivore diet has been around long enough. I mean, we need obviously more long-term studies on what's actually happening. So we can actually point to like, here's a, you know, a canon of understanding that tells us what happens when you do this for 20 years or 10 years or whatnot.

1:53:34But it's been around long enough where we're now seeing even some of the OG influencers making adaptations to their diet. I mean, most famously, Paul Saladino now eats fruit and honey and I guess a couple other things or whatever. So, it's like he went from exclusively, his whole thing was like nose to tail. And now he's adapted and we'll see where that goes. I don't know who's still hanging on tooth and nail, but you probably know better than I. There's a couple, like Sean Baker, Anthony Chafee. They're a couple that I can think of who are apparently strict. But then, yeah, there's Paul Saladino.

1:54:07But Sean's got like a really high hemoglobin A1C. He did, yeah. You would think like, oh, that would come from eating processed food and sugar. But like when you're eating, you're seeing like the consequence of a very high saturated fat diet on his type 2 diabetes risk. Yeah, and I believe he had low testosterone on that earlier test as well. Which is really weird, right? Yeah. You would think like, well, testosterone is one thing that's going to take care of itself if you're going to eat this way. Well, funny enough, when Paul Saladino was on Carnivore, he posted his blood test results. And if you pause the screen, you see that his estrogen was actually elevated above the range.

1:54:39He didn't talk about it. He skipped right past that when he was reviewing his blood works, but it's in there. What does that tell you? I don't know if it says much about the diet or something else that they're doing, but it's just interesting that you're seeing these people who are always fear-mongering over soy and estrogen and whatnot. You're seeing that their hormones are a bit off, and they aren't providing any explanations around that or attempting to. and they're just kind of glazing over. I just thought it was really interesting that that was still in the video and maybe he didn't catch that it was there, but it was on his blood work.

1:55:08But yeah, I mean, a lot of people have fallen off. There's Paul, there's Frank Tafano, there's a YouTube channel, 50 Plus Beauty, recently had a stroke while on the carnivore diet, as of a number of other people. There's the carnivore kid he went by, Michael something, I can't recall his name. He had, I believe it was 95 % occlusion or something like that of his LAD, so like the widowmaker artery, and he was freaking out. And I'm not going to say that, you know, their time on the carnivore diet, because it may have been a matter of a couple years is what led to that, but it's still a problem that occurred while on the carnivore diet.

1:55:46And you'll often see these same people cite anecdotes of something, even subjectively improving while on a carnivore diet and claiming that it was definitely the carnivore diet. Whereas, well, why don't you ever highlight these negative issues that come up? and there's a lot of them. So yeah, that's interesting. Yeah, what is, there's an Instagram account. Carnivore Cringe. Yeah, Carnivore Cringe. And it basically posts like people's comments on like forums and Reddit, subreddits and stuff like that. Like, hey, I haven't had a bowel movement in like 14 days. Like, is this normal? Yeah, no, there's tons.

1:56:16It's actually wild some of the stuff that comes up on there, whether it's around blood work or hair falling out or insert whatever issue you can imagine and they're on there somewhere. All right, so here's your second opportunity to look to camera and address the carnivore enthusiast out there. What's your PSA? My PSA is that there is not good evidence to support the carnivore diet. The recent keto CTA trial showed that those following a ketogenic high animal-based diet with high LDL had rapid progression of atherosclerosis. There's plenty of anecdotes for those who cite anecdotes suggesting potential harm.

1:56:55And until we have better data to support this dietary pattern, the existing data that we have on red meat consumption or the plant foods that are eliminated suggests that it is not a smart idea. Conclusion of PSA. When you mentioned the diet A, diet B a few moments ago, there's also the diet C, whatever composition that might take, which is the diet that drives short-term results with long-term detriments, right? So in the context of anecdotal evidence, like I feel so much better, my autoimmune symptoms have disappeared. Like this is something that happens in the plant-based community too. I'm guilty of it.

1:57:37Like I have plenty of anecdotal evidence of how I felt better and it changed my life, et cetera. The weight of that is dubious, obviously, but when it's you, it's very personal and it's emotional and it has valence, right? But I think what's lost in that is that, you know, this positive experience that you're having in the context of carnivore diet is at the cost of the long-term consequences that, you know, humans aren't so good about, you know, kind of like gazing into the future and evaluating that when in the current moment, they're like, this is working, you know, why shouldn't I keep doing this?

1:58:18Yeah, and I mean, like you, initially when I made the change was largely because I was experiencing these anecdotal benefits. And so I understand how powerful that can be both for myself and my dad, as I talked about. But we always have to consider that these are generally going to be short term things. You aren't going to notice that you're developing cardiovascular disease until you have it. And if we look at messaging from the carnivore community or the animal based community, it's often about really quick fixes. It's often about your gut health, weight loss, joint pains. It's things like that.

1:58:49It's rarely going to be a lower risk of heart attack or whatever. That's something that they'll throw in once in a while, but it's not super common. And now they don't have good evidence to support those claims either. I want to be clear, there isn't good evidence that it's going to improve all of these things, at least in the majority of people. But even if it did, we're not considering the long-term risk and they're promising people immediate results, which is really enticing. On the gut health piece, how do they substantiate that knowing what we know about the importance of fiber intake and plant diversity in terms of developing and cultivating a healthy microbiome?

1:59:26Like how does, you know, eliminating fiber and eliminating diversity in your diet contribute to gut health? Like the argument that, how do they make that argument? Again, I want to be clear that when it comes to these anecdotal experiences, which is largely what they cite to promote the improvements in gut health, it's not clear, and we can't conclude based on anecdotes, if that diet specifically is what's leading to benefit, if other similar or other elimination diets would also lead to those benefits, or if it was just chance and they were going to get better anyway. All of these are possible explanations.

1:59:59But let's just say, for sake of argument, that it was the carnivore diet or the elimination of fiber. We know that in certain conditions, especially certain inflammatory bowel diseases, that when there's a flare, actually reducing fiber intake or certain types of fibers can improve symptoms. That's not necessarily something you want to carry on through a lifetime, but during a flare, that could be a really good idea. Certain types of strict elimination diets that are low in fiber, like elemental diet, for example, usually around meal replacement shakes or the certain types of shakes that adhere to that protocol, that can improve symptoms in certain cases too.

2:00:34but that's not necessarily a preventative diet and it's not something that you necessarily wanna keep up all the time, but you may need to shift towards intermittently when there is maybe a flare or acting up of these symptoms. Yeah, from an elimination diet perspective. there is certainly the chance that you were eating something that was contributing or inflaming whatever underlying gut condition you were having. and by removing it, it settles down. But over time, to deprive the body of fiber is going to lead to some kind of poor outcome. Yeah, exactly. And we have actually studies looking at eliminations in people, say again, with inflammatory bowel disease, and we see that different people respond to different foods.

2:01:19So there's, you know, let's say you ate a pretty balanced diet and you removed everything, you're just eating animal foods. If for whatever reason, I don't know, wheat was bothering you. Well, yeah, you're going to see improvements, but you didn't need to eliminate all the fruits and veggies and everything else that came along with it, right? You could have isolated that food. And that's why it's really nice to, or a really good idea to work with, say, a dietician where you can do a proper elimination, trial those foods one at a time, and there can be a strict protocol that could be catered to the individual and really tease out what is the problem here or can we even figure out the problem?

2:01:50And then you don't have to do something that's so extreme and that might come to your long-term detriment. Yeah. The next thing I wanna turn to is bone health. There was this epic Oxford study that came out that seemed to suggest that plant-based enthusiasts and vegans fared less well or fared poorly in comparison to omnivores in terms of bone health and like avoiding bone breaks. So help me make sense of this. Yeah, so that one really spurred headlines. That was in 2019, I think it was. And the main headlines I saw were 43 % higher risk of fracture. And that's actually true based on the findings, but there is some really important nuance here.

2:02:35So they looked at, in the Epic Oxford study, so these are people in the UK following different diets, they looked at vegans, vegetarians, meat eaters, there might have been a pescatarian group, I can't recall. And they found that the vegans had a higher risk of fracture, but the vegans also tended to weigh less. They had less vitamin D and calcium intake. and they did a bunch of analyses to sort of rule in and rule out different potential explanations or components that were maybe missing. And it didn't look like vitamin D or calcium explained the totality of the results. Maybe a little bit, but not sure.

2:03:09Why were they lower in those? You have to remember that with Epic Oxford, they were enrolled back in like the 90s. This might be before widespread fortification of like plant-based milks and things like that. So their calcium intake might be much lower. Because that is going to be the main source for a lot of plant-based eaters. And then also with vitamin D, maybe it's a supplementation thing. I mean, they're living in the UK. It's not super sunny. Hard to say. They didn't actually track vitamin D levels in that study or vitamin D intake in that study. But past studies from that same cohort found that vegans did have lower vitamin D levels.

2:03:43So that's a possible contributor. But what I believe ultimately explains it is the difference in weight. So being a heavier weight reduces your risk of osteoporosis because you have more weight on the bones and your bones are going to be stronger. And when they separated the analysis to those with a BMI below 22.5, which is sort of middle of what's considered the healthy range or the normal range, and then those above 22.5, those in the higher range did not have a higher risk of fracture compared to meat eaters. So the vegans in that group seemed to be protected. But in those with a lower BMI, there was a higher risk.

2:04:17and because of the way that the weight skewed between groups it looks like it's quite possible that there were a number of actually clinically underweight vegans and especially once you get below that bottom cutoff for BMI your risk of osteoporosis goes up a lot or your risk of fracture goes up quite substantially and so it looks like in the study they were probably comparing a number of quite significantly underweight vegans to some that might some omnivores who might just be skirting that kind of border of what's considered underweight. And that would skew the results largely. But to further support the conclusion that it wasn't something inherent to the diet and it might be that was the Adventist Health Study 2, which came out just a few months later.

2:04:58And this looks specifically at hip fracture risk. They found that there was a higher risk of hip fracture in women. This was not the case for men. And I want to highlight that with Epic Oxford, we didn't see that in men either. It was specific to women. But they did another analysis where they looked at supplementation practices. So in those who didn't supplement any vitamin D or calcium, there was a higher risk of fracture in the vegans. For those who just supplemented calcium but no vitamin D, there may have been. It was not statistically significant, but we'll say for sake of argument, there may still be a risk there.

2:05:31But then in those who supplemented both vitamin D and calcium, there was not a significant increase in risk over the meat eaters. And in fact, there might even be a bit of a lower risk. And in this group, there isn't a clear signal that there was a lot lot of people who are maybe in that underweight category. So this would suggest that if you're maintaining a healthy weight, if you're making sure you're getting adequate calcium and vitamin D, and that doesn't need to be through supplementation, it can be fortified foods. If you're taking care of those things, you can do just fine. Of course, exercise is also very important, weight-bearing exercise, we want to take care of those things as well.

2:06:00And I'd say that that's probably the most important factor, but nutritionally speaking, I think we can take care of it. What do you say when people come at you and just say, well, you're just a biased vegan activist. You know, your whole worldview is skewed by, you know, whatever vegan, you know, propaganda you have consumed over the course of your life. So I, for one, I wasn't always vegan. And in fact, a lot of the myths that we've sort of debunked today around seed oils and things, these are things that I did once upon a time believe. But I think ultimately the most, maybe the most convincing argument I can make for me being able to set my bias aside when it comes to at least looking at the nutrition literature is I can look you in the eye and say that fish is a health promoting food, that certain dairy products, especially fermented and low fat products can be a part of a regular part of a healthy diet, that having meat once in a while isn't going to be to your detriment.

2:06:53I think there are other reasons to avoid consuming those foods, but I'm not going to lie or exaggerate on what the research says about their health value. So now at the same time, I think there are a lot of people in the online nutrition space who will claim that they aren't biased because they are omnivorous and they eat a little bit of everything. But I just want to point out that your bias could be for that. So when someone like myself maybe challenges the healthfulness of red meat or the superiority of animal protein or their inclusion, like say with Lane, for example, it might be the person in the middle ground who has a bias for that and they want to counter this more exclusionary argument that I might present.

2:07:29So I think I'm pretty good at setting aside the bias when it comes to the nutrition literature, but I do have a bias in that, yes, I am vegan. And ideally, I would like see the world shift that way. Right. Because you're, you're, and you're relying on your, the anecdotal evidence of your own experience to inform why this is the best way to go. No, I, I, I'm not just saying, okay. I'm just, you know, I, I know like, I'm just, I'm thinking about my, like what the, the kind of things that I have to field, uh, and just, uh, you know how you internalize that and respond to it yeah i mean like ultimately i don't think there's anything i can say or do that would be uh better you know at convincing someone that maybe i'm able to set that aside as you know other than what i said about like fish and dairy and and and meat to a degree like um i i can't see how someone who's who has that strong of a bias would be able to say those things very openly, you know, so.

2:08:26But I don't know, there's some people I'm not gonna convince. What is a point of confusion in nutrition science that you wish we could glean clarity on? And like, if you have in your mind, like the ultimate study, if funding was no, you know, no problem, you know, what would that look like? And what would you be trying to gain clarity on? So it depends on if you're asking more from like a overall health longevity standpoint, which I think we know the foundations quite well, but there are some very nuanced questions or things that I would like to see further research. So is there a specific kind of angle you're looking for?

2:09:13I'm just, I'm thinking in terms of, you know, people are really confused about this. I'm not sure I even really understand this. And if we could just figure this out by testing this against this, then, you know, we would know this and that would allow us, you know, that would like, you know, there's a domino effect to that that I think would be really helpful for people. Yeah, okay. I think one, and if I thought about this longer, I might come up with five other ones that I think are more important. But one that I would really like to see is around the long chain omega-3 fats in vegans in particular.

2:09:44So the long-chain omega-3 fats are the ones that people can often get from fish. They're in other animal foods. And then algae-based supplements for vegans. Now there's debate over - And that goes to the deficiency thing, right? Like, you know, yeah, you can do the algae-based omega-3s, but they're not really as good as the fish oil versions. So they are. They've been studying, they're nutritionally equivalent. But where we don't have research is on if they're even beneficial or necessary in this population. So vegans are unique because we don't consume any of those long-chain omega-3s in their final form.

2:10:17We consume ALA from things like flax, and then we convert them to a modest degree, we'll say. And so a question I would have is, how would, say, a vegan cohort who's supplementing compared to a vegan cohort who is not compared to maybe a pescatarian cohort? I think that would be really interesting to have those three. It's kind of amazing that study hasn't been run, right? Because this is a common question we have. Yeah, we actually don't have actual long-term outcomes in that sort of a study at this point. We have studies showing that you can raise omega-3 status in vegans by supplementing algae-based oils.

2:10:53We have research comparing vegans to pescatarians, and they generally fare similarly in, say, the Adventist Health Study 2. You can argue one slightly above the other for certain outcomes, but it's comparable. But we don't have the long-term outcomes comparing vegans without supplements to vegans with supplements. And then I would like a third sort of group there of the pescatarians just for comparison's sake. That's something I would love to see because I think it would really help put to bed the debate or discussion around, do you even need to supplement these things? Paging Dr. Christopher Gardner.

2:11:24He's like the perfect guy to do that. Yeah, I mean, he does a lot of the clinical trials. I don't know if he does a lot of the long-term like perspective cohort stuff. I don't think he does, but I am sure he knows something. Who wants to do that? That sounds like a lot of work. It takes a lot of time. in it for the long haul, right? Well, it depends. So what will often happen is you have cohorts like the nurse's health study, for example, it's been running for like four decades and you have all this data collection over that time. And then you can then analyze that data. So you know what they were eating and to a degree what they were supplementing.

2:11:52I just don't think they've tracked omega-3 intake. And I don't think there were a lot of vegans in that cohort. So that makes it challenging in that case. Maybe you can do that type of analysis with like the Adventist health studies. Maybe they have that data on supplementation. I don't know. So it's not like you necessarily need to wait another 15, 20 years and start a new cohort. You might have that existing data. I just don't know. But it would be a really cool thing to see, I think. What is your sense of how AI is impacting our ability to synthesize these massive data sets and draw interesting conclusions from them.

2:12:28So I was actually just talking with some some colleagues the other day about this who one of them is actually using it for a study they're running and it was it's really impressive on how you can get it to do a lot of the sort of calculations and things like power calculations and that you probably at this point still want to double check a lot of that I've definitely noticed issues with or mistakes with certain things when I'm using some of the AI software but I think it is a it's possible that in the coming years we really use that to advance our knowledge and to conduct research that maybe we couldn't do before.

2:13:00I know they used it for a couple of recent studies looking at plaque measurements on a CT scan and things like that. So I'm looking forward to it, but don't have too much experience with it yet. Is there anyone who comes to mind when you think of people that are doing interesting research out there at the cutting edge of our understanding of nutrition? I mean, Chris Gardner, you mentioned, I think he's doing some really cool stuff. I know Robert Osfeld's working on a really cool trial right now. Oh, he is, though. I didn't know that. Yeah, he's working on a, I don't know. I didn't even know that he was, you know, doing that kind of like research work at all.

2:13:36Yeah, so before COVID, he was starting work on a trial and then it kind of got sidelined because they couldn't enroll people for a while. And then I think they just finished with enrollment. I don't think I can say too much about the trial, but I think it's going to be really, really cool, really interesting. So, and if they are done enrollment now, Hopefully it's sooner than later that we get those final results. So he's doing some really cool, interesting stuff. I would say, and this is sort of a really unfortunate thing now, is Kevin Hall. I don't know if you're familiar with him. I know who he is, yeah.

2:14:06Yeah, NIH researcher. He's recently stepped down, early retirement it seems. I saw that. Which is really, it's such a massive hit to the nutrition community. He was doing so much research around ultra-processed foods. He was helping us understand not just what ultra-processed foods impact our health, but like what components are responsible for that. So like, is it the hyper palatability? Is it the fat content? Does the protein content matter? Like figuring out all those things, because again, if we understand those variables, we can make healthier products. And so that's a massive, massive hit.

2:14:37And I think he was really on the forefront of a lot of that. My understanding is that he resigned because he was put into position where he was gonna be restricted in what he could study and what he could say. It wasn't that they were firing him, but he was being reined in in a way that was making him deeply uncomfortable. Yeah, he said that there was some form of censorship and he ultimately had to report on certain things or report differently than he wanted to on results. And obviously, I mean, he's a very, very honest, world-renowned researcher. Like, you know, I would have loved to see what else he had coming down the pike here, but.

2:15:17I mean, thanks a lot, Doge. It's this interesting thing with the Maha movement, right? Like on paper, Maha is all about like, let's get rid of the ultra processed foods. And here's the guy who's like doing the heavy lifting and helping us understand this. But for political expediency or whatever, perhaps he just didn't fit the bill in every single category to make him palatable. It's not awesome. That was sort of the irony of the whole thing that I saw a lot of people posting about. It's like, this is literally the guy that's helping us figure out what's wrong with all surplus foods. Right, he should be waving the flag of this whole thing.

2:16:00Yeah. Anyway, that's a whole other thing. Last thing I wanna ask you, six days from today, I'm getting a pretty significant back surgery, L5-S1 fusion. Oh, wow, okay. For an advanced spondylolisthesis that is unstable. So I'd be remiss if I didn't take advantage of the opportunity to ask you how I should be thinking about my nutrition leading up to this and my nutrition in the aftermath to be as healing, promoting as possible? I mean, really the foundations are going to be adequate protein intake, obviously for the structural components, hydration. There's no magic bullet there. It's just going to be really the foundations of making sure you're having a nutrient-rich, healthy diet, make sure you're getting adequate protein, hydrate appropriately.

2:16:54You know, there's some - Anti-inflammatory foods, yeah. And there's some research around certain like supplements, glucosamines, things like that, but I wouldn't say any other research is super impressive. so it's definitely not something I necessarily advocate for in these cases but I'm gonna be taking all the supplements trust me yeah I've already got like momentous creating I'm like okay tell me you know and like they they now I'm in communication with their chief research scientist to kind of help me you know make good decisions around like what I can do to I mean not that they're magic bullets or anything like that but you know I don't want to make any mistakes and I wanna put myself in a position, you know, to heal as best I can.

2:17:36As long as you're not doing anything crazy and they're checking for interactions and stuff like that, maybe there's some benefit there at worst, maybe there isn't, you know, so. All right, cool. Well, this was great, man. Thank you so much. I feel smarter than I was two hours ago. Is there anything else you wanna add? Did we miss anything? Or, you know, I guess it would be good to give you, to like allow you to, you know, to sort of end this with a thesis or a call to action for anybody who's listening or watching who maybe has been tiptoeing around eating more plant-based or going all in on it, but for whatever reason hasn't been able to pull the trigger or has been under the influence of other influences and is now having a moment of clarity around this.

2:18:20Yeah, I think there's sort of two take-home messages that I can give. One of them is that I know it's enticing and I know there's a lot of information online that could, it might seem like a silver bullet or a magic bullet, but might overcomplicate things. And really when it comes to nutrition, it's pretty simple. At least the foundations are. Eating a diet that's rich in whole grains, fruits, veggies, legumes, nuts, and seeds. That is the foundation of a healthy dietary pattern. Whether you include certain animal foods, some fish, certain dairy products, small amounts of meats like that, you can take it leave it.

2:18:55But those foundations are incredibly consistent across the literature, across populations. The second thing I want to emphasize, and this is maybe for people who are looking to make small shifts, is that shifting even a little bit of your animal protein towards more plant protein can have profound impacts on your long-term health. So if we look at even a small shift of about 3 % of calories, based on the NIH AARP study as well, shifting 3 % of calories from animal protein, especially red meat protein, to plant protein sources could lower risk of mortality from, it was a ballpark of 10 to 15%. So during the course of that study, 10 to 15 % lower risk of dying over those years.

2:19:33And so this is a really, really powerful change that someone can make for what is ultimately maybe a deck of cards size piece of meat for some plants. So just think about those two things. Keep it simple, focus on those foundations, and if you can shift a little more towards plant protein. Amazing. You can find all of Matt's stuff online at, where's the best place to direct people? Instagram is definitely where I'm most active. So Dr. Matthew Negra, dr.MatthewNegra. And then I'm on all the other socials and everything. I love your videos, man. You're like, you know, you're like, you do the, what is it called?

2:20:07Where you, it's just your head and then there's all this stuff going on in the background. Here's what he said. And like, here's the study that actually kind of, you know, it's like, it's fascinating. I don't even know how you make those things, but I love it. Also, Matthew has been on Simon Hill's The Proof Podcast many, many times. I don't know how many times, like six or seven or something like that. Recurring, you know, popular guests there where they go more in depth on this sort of myth-busting exercise that we've been doing among, you know, many other interesting topics. So, you know, if you wanna go deeper, I would suggest that's a good place to go.

2:20:43And you have your own YouTube channel where you put the videos up and stuff like that as well. Yeah, it's the same. You just search my name on YouTube or TikTok or Facebook or Instagram or whatever. And it's pretty much the same. And we'll put links up to all of that stuff in the show notes. So again, thanks, man. I think you're an important voice in this ecosystem of effective health and science communication online. And not everybody is great with their communication skills. The people that know a lot about what's true and what's false, et cetera. but it takes somebody to figure out how to synthesize that and relate it in a way that the public can digest it and understand it.

2:21:22And I think you're really exceptional at that. And there's a real need for that. So I appreciate you doing it. And thanks for having me on here too. I know it's been a dream for a while. So it's good to finally be here. It's an honor. It's an honor, man. Thanks a lot. You're welcome back anytime. All right. Peace. Peace.

2:21:43that's it for today thank you for listening i truly hope you enjoyed the conversation to learn more about today's guests including links and resources related to everything discussed today visit the episode page at richroll.com where you can find the entire podcast archive my books finding ultra voicing change in the plant power way as well as the Plant Power Meal Planner at mealplanner.richroll.com. If you'd like to support the podcast, the easiest and most impactful thing you can do is to subscribe to the show on Apple Podcasts, on Spotify, and on YouTube and leave a review and or comment. And sharing the show or your favorite episode with friends or on social media is of course awesome and very helpful.

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2:23:32Thank you.