33. Ultra Processed Foods, is there a simple solution?

 In today's episode, we explore the controversy regarding ultra-processed foods, starting with an attempt to define just what those are. That's actually not been carefully approached yet. Then we look at the more serious attempts to construct ways to measure and precisely discuss the hazards of ultra-processed foods and ways we might rectify those. We range far afield from our esoteric medical school lectures all the way back to our own childhood eating experiences. We talk about the role of wise choices with any foods, including fast foods. And yes, you can eat those wisely or less wisely. We circle back several times to the importance of some basic home cooking skills and habits. We invite you to listen to this episode and enjoy.

Dawn Lemanne, MD
Oregon Integrative Oncology
Leave no stone unturned.

Deborah Gordon, MD
Northwest Wellness and Memory Center
Building Healthy Brains

Transcript

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[00:00:00.000] - Dr. Dawn Lemanne

I don't care if you're poor or rich. If you don't know how to cook, you will not have control over your food and your health as much as you would if you learned even the simplest things, how to boil water, how to steam something, how to chop things gently and simply, those kinds of things.

[00:00:17.690] - Dr. Deborah Gordon
I think that is brilliant.

 [00:00:20.860] - Dr. Dawn Lemanne
You have found your way to the Lemanne Gordon podcast where Docs Talk Shop. Happy This is dropping. I'm Dr. Dawn LeMans. I treat cancer patients.

 [00:00:39.960] - Dr. Deborah Gordon
I'm Dr. Deborah Gordon. I work with aging patients.

 [00:00:43.800] - Dr. Dawn Lemanne
We've been in practice A long time.

 [00:00:45.460] - Dr. Deborah Gordon
A very long time.

 [00:00:47.780] - Dr. Dawn Lemanne
We learn so much talking to each other.

 [00:00:49.880] - Dr. Deborah Gordon
We do. What if we let people listen in?

 [00:00:54.940] - Dr. Dawn Lemanne
In today's episode, Dr. Gordon and explore the controversy regarding ultra-processed foods, starting with an attempt to define just what those are. That's actually not been carefully approached yet. Then we look at the more serious attempts to construct ways to measure and precisely discuss the hazards of ultra-processed foods and ways we might rectify those. We range far afield from our esoteric medical school lectures All the way back to our own childhood eating experiences. We talk about the role of wise choices with any foods, including fast foods. And yes, you can eat those wisely or less wisely. We circle back several times to the importance of some basic home cooking skills and habits. I have some pretty strong opinions about those, which I hope you'll agree with me or not. But either way, we invite you to listen to this episode and enjoy.

 [00:02:07.720] - Dr. Deborah Gordon
This morning, Dawn, I wanted to start out with a little bit of a story, if you'll indulge me. I love stories. Okay, this is a pretty short story. About almost exactly, oh my God, 50 years ago, I was in my first year of medical school, and I think you started a couple of years after I did for our listeners. We went to the same-I think it was more than a couple, but okay. We went to the same fantastic medical school.

 [00:02:38.660] - Dr. Dawn Lemanne
It was fantastic due to us.

 [00:02:40.390] - Dr. Deborah Gordon
Due to us, yes. Uc San Francisco. And in our first week, they assembled us all in a giant auditorium for a talk that I think of now as a shock and awe talk. Did you have any such presentation in your first week of medical school?

 [00:03:01.280] - Dr. Dawn Lemanne
Well, maybe, but maybe I wasn't as shocked and odd because I don't know what you're going to say.

 [00:03:06.000] - Dr. Deborah Gordon
Our talk that first week, and we all were taking furious notes until we realized what was on hereditary fructose in tolerance.

 [00:03:16.140] - Dr. Dawn Lemanne
No, I do not recall that lecture.

[00:03:19.940] - Dr. Deborah Gordon
And I must say, I have not thought about that in eons, but I did think about it.

 [00:03:25.420] - Dr. Dawn Lemanne
And as an aside for our audience, you really don't want to go to medical school unless you are shocked and awed by topics like hereditary fructus tolerance.

 [00:03:36.320] - Dr. Deborah Gordon
To be fair, I wasn't shocked by its import so much as, Excuse me, why are you talking to us about this? When it is so rare, it's a genetic condition where you get a bad gene from mom and a bad gene from dad in one or more of several particular genes, and you really get sick when you eat fruit or fructose. It's usually identified in young children. And 50 years of practice, have I even heard of a patient who had that? No. So my shock and awe was, why are you talking to us about this? And that's what has stayed with me. But I must say today's talk made me think about that.

 [00:04:18.690] - Dr. Dawn Lemanne
Really? Okay. I know what we're going to talk about, but tell our listeners what we're talking about today.

 [00:04:24.840] - Dr. Deborah Gordon
If you've been reading either the regular press or current medical journals, it's been all over since September, October, November, that, oh, my goodness, ultra-processed foods are bringing us down. So I want to talk about ultra-processed foods from several different points of view, their claim to be associated with. Note that we talked about this a little in the previous episode, that you can see trends, and if they go together, then they're associated and correlated, but they're not necessarily causative. And they've done a few studies to try and say it's causative, but it's definitely correlative where over the last 40 years, they attribute the onset of our widespread adoption of ultra-processed foods, which we will define, to the mid '80s. And in that time, gee, has anything else changed in that time? But anyway, maybe it's the ultra-processed foods that are causing increased mortality, obesity, diabetes, vascular disease, cardiovascular, cerebrovascular disease, inflammatory bowel disease, and I bet there's some cancer increase over the last 40 years.

 [00:05:54.080] - Dr. Dawn Lemanne
Yeah, that's really true, especially in younger people. We're seeing diseases in the oncology field that we used to see only in older adults, over 50. And now we're seeing in young people under 50 cancers like colorectal cancer, pancreatic cancer. Colorectal cancer is the biggest cancer killer of men under 50. I don't think most people know that. But if you're a man, if you're destined to die of cancer, the most common type that you would die of, unfortunately, would be colorectal cancer these That wonderful actor, that man, Broderick, I'm going to remember his name for the notes, but who very famously died of colon cancer not long after appearing and starring.

 [00:06:43.620] - Dr. Deborah Gordon
Do you know who I'm talking about?

 [00:06:45.500] - Dr. Dawn Lemanne
There are several. So no, but many young people have had to contend with something that used to be limited mainly to older people in the larger numbers. So that's Yeah, that's really quite concerning. And pancreatic cancer in young women and breast cancer in young women. We're talking women in their 30s, even their 20s. And the youngest case I know of that I've heard of, I believe, is a seven-year-old with colorectal adenocarcinoma.

 [00:07:15.580] - Dr. Deborah Gordon
Okay, well, I don't think that one is ultra-processed because I haven't been eating them long enough. But do you think-It could be.

 [00:07:21.490] - Dr. Dawn Lemanne
Children are more sensitive to some carcinogens than our adults. Children are much more sensitive to radiation, for instance. I don't think this has to do with radiation, but no, I don't jump to that conclusion. And I've had a patient who's 19 years old. I've had a patient who's 22 with these kinds of adenocarcinomas of the digestive tract that you see typically in very much the older population. So, yeah, it's something that we're starting to see and notice. And is it connected only to ultra-processed foods? We don't know, but it's certainly ultra-processed Just Foods is in the police station being interrogated.

 [00:08:05.240] - Dr. Deborah Gordon
And has been gaining attention for some time. And what I find interesting is that a fair amount of this research or publication about the research, at any rate, is Coming from Brazil. And in a listing, I believe it was in the Guardian article or the New York Times article, and we'll put all these links in, especially the ones that you can easily get yourself access to. At the The different countries that have the least and the most ultra-processed food. And Brazil is one of the ones with the least processed foods. And I'm going to have to remember what the other countries were that were in that ballpark. But Brazil is, here it is, leading the investigation into ultra-processed foods. And specifically, they created a designation system like, how can you determine whether something's an ultra-processed food, which I went down that rabbit hole for a while, which let's all go down it a little bit. Just to think about foods and to think about whether this category of different foods is helpful or not. The gist of all these articles this week, by the way, step back, broad picture. In Lancet and The Guardian and coming from our own Department of Health and Human Services in this country, gee, there should be some public policy in response to the heinous behavior in our bodies of ultra-processed foods.

 [00:09:48.140] - Dr. Deborah Gordon
The response to that is a little bit what I want to challenge as we get a little farther into this. But there's clearly food that we know is whole or minimally processed. If I a cucumber in my garden, I can peel it, and it's still category one. It's a whole food. Category two is traditional culinary ingredients. Category threeWhat would that be? Before we go on, may I ask you a quick favor? Hit the subscribe button. You're hitting that subscribe button really, really matters. You're making sure cutting-edge ideas that matter to you move to the center of medical discourse, where they belong. Thank you.

 [00:10:31.780] - Dr. Dawn Lemanne
What would be a traditional culinary ingredient?

 [00:10:34.790] - Dr. Deborah Gordon
Flour. Instead of just cooking up your wheat berries, somebody grinds them and makes them into flour.

 [00:10:41.400] - Dr. Dawn Lemanne
Okay, so grinds them up very finely.

 [00:10:43.110] - Dr. Deborah Gordon
Yeah, so you can do things like that. And it's traditional. So it's stuff that's been done, the advice of the Weston Price Foundation, foods that we ate before we got too civilized to just take care of them ourselves. And foods that you could raise and minimally process at home and make them into something a little more refined.

 [00:11:04.850] - Dr. Dawn Lemanne
So we're talking about grinding, cutting. Are we talking about cooking?

 [00:11:08.420] - Dr. Deborah Gordon
Yes, rendering fats.

 [00:11:10.320] - Dr. Dawn Lemanne
Rendering fat. So cooking an oil or a fatty food until it becomes clear and you remove all of the stuff floating on top.

 [00:11:17.810] - Dr. Deborah Gordon
Or just salvaging the fat. That's a terrible way to say it. Salvaging the fat where I'm going to cook a duck, one of our former living, now no longer living, ducks for Thanksgiving. And I am warned, if I roast it, that I'm going to have multiple pints of duck fat to be rendered from this duck that we're going to cook and eat.

 [00:11:41.010] - Dr. Dawn Lemanne
By rendered, you mean it's going to leak out of the roasting duck while it's in its pan and you're going to then pour it into jars? Yes.

 [00:11:49.730] - Dr. Deborah Gordon
Someone said, you have to cook your duck in a deep dish pan or your oven will forever blame you for its nasty smells. So Yeah. So you can get these fats, you can grow some spices and add them. These are all still traditional culinary ingredients. Processed foods begin to get into the category of processed as opposed to just traditional when you combine categories one and two, which hardly seems like this should be a category on its own. But if you simmer and cook things and then put them together with muffins that you've made from your ground flour, they call that processed foods. But in, I think, most common thought, that is mostly food. That seems like whole or minimally processed food.

 [00:12:43.220] - Dr. Dawn Lemanne
Let me get this straight in my mind. So Group One is picking it off the tree, and Group Two is maybe chopping it up, warming it up so the fat melts and leaks out and separates, and you can then separate the the meat and the fat. And then group three is combining something from group one and group two?

 [00:13:08.140] - Dr. Deborah Gordon
Yes.

 [00:13:08.780] - Dr. Dawn Lemanne
Okay. Yeah. Okay.

 [00:13:10.740] - Dr. Deborah Gordon
And so refined flour goes in that group, too. Remember what we said about grinding grains.

 [00:13:17.710] - Dr. Dawn Lemanne
So we're talking about grinding it even more so that the flour is much finer and powderier?

[00:13:22.000] - Dr. Deborah Gordon
Not necessarily. And that's where we get into category 4, because category 4 is like all of above, plus at least one ingredient or one process that wouldn't be in your kitchen. So for instance, in flour, highly refined pastry flour would count as an ultra-processed food because it can't just be done in your wheat grain, wheat pellet. What are they called? Wheat groke, grinder. It has to go through an industrial process to yield designated pastry flour.

 [00:14:09.130] - Dr. Dawn Lemanne
So pastry flour is not something that could be made at home? What about fine bakeries in, say, I don't know, Paris in the 1800s, they weren't using pastry flour?

 [00:14:18.920] - Dr. Deborah Gordon
I think they had more sophisticated grinding mechanisms than you would have in your kitchen.

 [00:14:26.620] - Dr. Dawn Lemanne
So this sounds really complicated.

 [00:14:28.740] - Dr. Deborah Gordon
You Good point. I would say complicated and there's been a couple of people speaking to this this week. They came out in response to the articles in The Guardian, The New York Times said, wait a second, put a break on this ultra-processed food is the devil issue because there's plenty of good foods, reasonable foods that are considered ultra-processed and hazardous that are probably better, if not just as good as the real food itself. So for instance, you could, and this is the example I thought of this morning, for category three, which is you take some of your ingredients that you've made yourself. You could make yourself a gigantic stack of pancakes, take a bunch of bacon and a bunch of maple syrup and pour it all over your breakfast, which they They still advertise when they're advertising breakfast restaurants, which is a little distressing to me. And that would be not a processed food. But if you bought a breakfast bar that was high in protein and low in sugar, such as the one that I like and I have no sponsorship or affiliation with, but after I give blood today, I'm going to eat a David bar, which is highly processed.

 [00:15:57.620] - Dr. Deborah Gordon
It's got a lot of protein in it. It has no carbs in it. It would be so much healthier than for me to eat a gigantic stack of pancakes, bacon, and maple syrup, even though I love maple syrup.

 [00:16:09.920] - Dr. Dawn Lemanne
There's two thoughts that I have while you're talking about that. Well, three, actually.

 [00:16:15.140] - Dr. Deborah Gordon
I bet you have 10, but limit us to two or three.

 [00:16:17.880] - Dr. Lemanne
The number three that's going out is, Thank you very much for donating blood. It's really important. And yeah, have whatever you want, even the stack of pancakes, of course. But the David bar sounds wiser. But the question that comes up when I think about that is, number one, the amount, so a giant stack of pretty much anything is probably unhealthy. Exactly. And is it the amount that people are eating that is problematic as much as what they're eating? One of the most interesting studies I've ever come across was one that involved a diet of white sugar, white rice, and beating patients. So any doctors out there, don't do this at home or in your practice. And this was way before the kerfuffle with vaccines and autism. I think it was back in the 1930s. And I think the gentleman, the professor in this story, was at Duke, and he wanted to treat hypertensive patients, patients with super high blood pressure. And a lot of these patients were obese. And so what he did was he He limited their calories. It worked, okay? So he limited their calories, their daily calories. To keep them from eating, he actually, I think, was accused of beating some of the patients to keep them away from their food.

 [00:17:49.400] - Dr. Gordon
Sounds like a bad TV show.

 [00:17:51.500] - Dr. Lemanne
But anyway, so it worked. And they improved their hypertension. Their blood pressure went down to normal with this low-calorie diet. I think it was something we're in the triple digits in terms of calories per day, and all the patients lost weight. The diet, however, was cooked rice with white sugar.

 [00:18:05.320] - Dr. Gordon
Oh, jeez. I wouldn't eat. I wouldn't even get up to 900 calories.

 [00:18:09.900] - Dr. Dawn Lemanne
It was the calories that actually the calorie restriction that was active here rather than the content of the diet, which I think does play into, and I know you're going to talk about this. I hope you'll tell us a little bit about this. The idea that people who have access to super good tasting food, and that means good tasting in terms of our caveman sensibilities. We want something with high calories that doesn't take up a lot of room in our stomach. One of the problems with ultra-processed food or however we want to define it, these things that taste really good and are quick and easy to digest is that we eat too much of them. It drives us almost uncontrollably to over eat in terms of calories.

 [00:19:03.140] - Dr. Deborah Gordon
Because it's not satiating.

 [00:19:05.540] - Dr. Dawn Lemanne
For whatever reason, or it just tastes really good and it doesn't take up much room in the stomach because it's so high in calories per bite.

 [00:19:12.710] - Dr. Deborah Gordon
The problem with it, yeah, those are called the Hyperpalatable Foods. And a little bit the problem with if we made a law against those instead of ultra-processed foods, is like, what's hyper palatable for me is the chicken liver I gave you today. And that may It will not end up being hyper palatable for you.

 [00:19:32.500] - Dr. Dawn Lemanne
I'm going to give it my very best.

 [00:19:34.970] - Dr. Deborah Gordon
I know you will. I think this is, again, blaming the processing for... There are many other factors that are associated with the people who eats the most ultra-processed food. So you made a reference to if you have access to the best food of the best quality, and that access This is usually socioeconomic, right? And background, your background and what you have access to?

 [00:20:06.940] - Dr. Dawn Lemanne
I think absolutely. And I have a real strong feeling about where we need to go with that, and we can talk about that in a minute.

 [00:20:20.440] - Dr. Deborah Gordon
So the other associations of people eating the most ultra-processed food, they have less education. People with higher eat more ultra-processed food, adding fuel to the fire. They engage in less physical activity. They smoke more and they consume more alcohol. Although, have you seen the statistics about alcohol consumption going so much down? They are ripping out vineyards in California because wine sales are so much down. And people our age, and I'm looking around our recording studio here, we're slightly different ages, but we're all in that category. We're still drinking as as much alcohol as we did before.

 [00:21:01.420] - Dr. Dawn Lemanne
Oh, speak for yourself.

 [00:21:02.700] - Dr. Deborah Gordon
Oh, right. Okay, I'm drinking more than my teetotalling 20s. Yes. But our kids, our kids' generation is generally drinking less alcohol.

 [00:21:14.600] - Dr. Dawn Lemanne
I worry about the rogue valley, actually. I think if we ever had a big catastrophe or something, we have all this agricultural land, but mainly what we're growing is wine and cannabis. That's what we'll have when I5 closes down.

 [00:21:37.100] - Dr. Deborah Gordon
Those of you interested, there is a good local cattle grower, and I'll put a link to his website that you So let's keep supporting the people that are growing some protein sources and eggs. Absolutely. Good idea. I've got two people to cite for that. Let's keep them going. There's so many factors in why somebody would And not all fast food is bad. I was going to say to go to a fast food restaurant, and I've never done this, but I definitely have some people whose dietary journeys I've followed a little bit who will think nothing of stopping at McDonald's for lunch, and they get two cheese burgers, hold the bun and hold the French fries. I just want the lettuce. Some of them, of course, don't eat the lettuce, the burger and the cheese. And I think, well, that's a really good food selection at a fast food restaurant. Yeah.

 [00:22:35.040] - Dr. Dawn Lemanne
Who is the low carb diet professor at Duke, who's very famous, and I'm blanking on his name. Anyway, he has been talking about that for a long time about just if you have to eat fast food, and this is for his demographic, he has a clinic in which he takes overweight and diabetic and insulin resistant patients and puts them on a very low carb diet. And a lot of them don't cook and have to eat out. They don't have a lot of money. And he says, okay, if you go to McDonald's, just eat the meat and the cheese and throw the bread out or hold it if you want. I have done that myself many, many times. Absolutely. And I'll tell you, it's much faster to just get the whole sandwich and throw out the bread than to wait for them to cook it without the bread.

 [00:23:26.300] - Dr. Deborah Gordon
For them just to process your request.

 [00:23:28.960] - Dr. Dawn Lemanne
Yeah. So If you're going for fast food, you're going for speed. That's in the name. So yeah, toss the bread. So, yes, there are ways to do that. You're talking about how we define healthy food. And what you're saying, I think, is that these kinds of public health designations, so everybody's trying to talk about the same thing, which is very important in science. If we say something like, you shouldn't eat ultra ultra-processed food. Well, what is ultra-processed food? We have to define it then. And you're saying that the current definition, I think this is the NoVA definition, is not terribly helpful to the ordinary person on the street. I agree. I think I had trouble. In preparation for this, you asked me to take a look at this, and I did, and I found it really obtuse and difficult to follow. Group three is a combination of what's in group one and two, and what's in group one and two is, well, this or that, but maybe not. Yeah, I didn't find it very street friendly.

 [00:24:36.760] - Dr. Deborah Gordon
Or very logical. If you add food coloring to a food that is not from the beets you cooked last night, it makes it category Group Four. Group Four. And it's not very helpful.

 [00:24:49.880] - Dr. Dawn Lemanne
Yeah, I agree. I don't think this is a really helpful way of thinking about it. I applaud people trying to talk about these things and to try to come to an agreement. But it's not unusual in science, especially in biology, for there to be disagreements on how to categorize things. In my field, I was in a meeting a couple of weeks ago, and one of the talks was about what is the definition of Cancer. Oh, wait. These things are not- Wait, I thought that was settled. It's something that's really depressing. I'm interested in physics, and something that's really depressing about physics, if you think about it, is that all of our physical laws and everything, they're all made, described after making thousands of measurements, and then we have to assume that those measurements are going to continue in the same fashion and with the same results. And that has been true so far for things like gravity and the speed of light. But I always in the back of my mind think about the Thanksgiving turkey story. The Thanksgiving turkey says, Life is good. Every day, this very nice farmer comes and gives me a big bunch of food and a nice place to sleep.

 [00:26:01.260] - Dr. Dawn Lemanne
It's warm and the foxes can't get in. And so I have nothing to worry about. Anyway, but science is based on observation at some level. And you can argue about that. There are people who make careers arguing about the philosophy of science. I am not one of them. But as far as all of these categorizations, if they're not useful, then we don't have to use them. And I think, and one of the things that I What I wanted to say is that if we talk about food and cooking, we look at each particular person, and I think our audience knows that a hostess twinkie is not as healthy as a Probably a stock of broccoli or steak or something like that from a good source. But a lot of people, I think one of the problems is they don't know how to cook. And so you tell them, here's what you should eat and everything, and that's all fine and good, but they can't translate that. And I think that's where our cultural efforts ought to be. And I have been looking at... So I think it's Spain and Greece have reversed their rise into obesity, and now they are losing weight as a population.

 [00:27:19.480] - Dr. Dawn Lemanne
And the way they've done it is by incorporating cooking and nutrition classes into primary schools. Japan has done that for a long time. They, of course, They have 10 times less obesity than the United States. They are the healthiest nation in the world with the longest. By that, that's very, very objective. We can measure it. They live the longest. So that's how I'm defining that. And they teach nutrition and cooking in school.

 [00:27:49.240] - Dr. Deborah Gordon
You know one other thing they do in Japan, which is interesting? They get up and down off the floor multiple times a day.

 [00:27:55.660] - Dr. Dawn Lemanne
Oh, with the furniture and everything?

 [00:27:57.060] - Dr. Deborah Gordon
Yeah. Anyway, that's probably not related to the food or their blood sugar. But I think it's all the factors that make Japan the longest living population are so interesting. The respect for elders, the getting up and down off the floor. Anyway.

 [00:28:14.050] - Dr. Dawn Lemanne
So the nutrition education, though.

 [00:28:16.000] - Dr. Deborah Gordon
Did you have nutrition education in school? Yes, I did.

 [00:28:18.890] - Dr. Dawn Lemanne
And cooking? I did. So here's my story about... You want to hear my story?

 [00:28:22.340] - Dr. Deborah Gordon
I do want to hear your story.

 [00:28:23.740] - Dr. Dawn Lemanne
So I was raised by a lovely single mother, and she worked very hard to get me and my brother through our childhood and off into the world. And she worked long hours and didn't know how to cook. So we ate fast food three times a day, most of the time. But she sent me to a Seventh Day Adventist primary school. We were not Seventh Day Adventists, but she liked their educational rigor, and she sent me there. The Seventh Day Adventist culture, and this does have to do with their religious belief, that's how they tie it in, but the Seventh Day Adventist culture is really beautiful in its attention to health and nutrition. I was sent home with little notes like, Dawn should not be having white bread. Please make her sandwiches with whole wheat bread and do not put baloney in them.

 [00:29:25.300] - Dr. Deborah Gordon
Right. Aren't they vegetarians?

 [00:29:27.840] - Dr. Dawn Lemanne
Vegetarianism is encouraged, although not mandated. And then we did have classes on nutrition from an early, early age. And I do remember that. And I remember with that encouragement, even though my mother didn't cook and we had one sauce pan and a coffee pot, I did learn how to cook. I taught myself with some help from other people around and things like that. But I didn't learn anything fancy, like how to... A lot of when I got to high school, we had home economics. I didn't take those classes. But from my friend's report, they included things like how to make a cake with a Betty Crocker box of cake mix, those kinds of things. But in any case, yes, I did teach myself to cook. I don't mean fancy. We're not talking French traditional chefery or anything like that, but I can make a good healthy meal from simple ingredients. I think everyone should be able to do that. I don't care if you're poor or rich. If you don't know how to cook, you will not have control over your food and your health as much as you would if you learned even the simplest things, how to boil water, how to steam something, how to chop things gently and simply, those kinds of things.

 [00:30:48.470] - Dr. Deborah Gordon
I think that is brilliant. And perhaps... So one of the responses I'm going to make to this whole ultra-processed food is that we can't... The cat's out of bag. We can't undo processed foods, although David Ludwig has one suggestion for doing it. But the idea of re-instituting cooking for boys and girls from a young age, and maybe even doing it some way for adults is a brilliant idea. Instead, what if everybody had... I mean, that's horrifying a little bit that your mother, praise be to her for what she did. Oh, my God, it's heroic. I could never have done anything like that. But, gee, I wish she had the basic cooking equipment for you to delve into when you got the interest. Maybe she helped you acquire that.

 [00:31:41.980] - Dr. Dawn Lemanne
I still have some of her pots, pans, and dishes, and I use them. That is fantastic. They're very simple tools. There was a connection to socioeconomic issues in that she had to work long hours and all of that. But had she not worked long hours, I mean, cooking wasn't in her radar. It something that she was particularly tuned into. I have friends and patients these days who are extremely wealthy who cannot cook, and they eat out all the time. I find that that, bless their hearts, They're doing the best they can. I think that a simple, and I, again, I'm not talking fancy, how to set up a simple kitchen, how many pans do you need? You need like two. Okay. Do you need a blender or a food processor? No. Do you need a sharp knife? Yes. Do you need some dishes to serve the food in? Yes. Do you need to know how to cook a vegetable? If somebody puts an egg plant or a broccoli stock in front of you, do you know what to do to get that on your plate? I think, yeah, that would be where I would put my efforts.

 [00:32:59.720] - Dr. Dawn Lemanne
And if the elementary schools could do that, that would be great and maybe open up those classes so that the parents who want to could come and learn with their kids. And it wouldn't take long. It's probably about a 10-hour course to get up and running in a kitchen.

 [00:33:15.540] - Dr. Deborah Gordon
I will say, who's picked up this mantle a little bit and publicizing it? I am not very familiar, but I do encounter at times TikTok videos. And I'm going to I'm going to try and find this one gentleman who says, Do you know that if you take a banana and mash it up and a sweet potato and an egg and put it in a pan like this, then in 10 minutes you can have blah, blah, blah? And that is not one of his recipes. They are more successfully oriented than that. But his videos are 10 seconds and maybe 30. I would try that. Yeah. And they're simple recipes that take a minimal amount of tools. I'm going to try and find him so we That sounds lovely. Linked to that. But I have a patient who I try to encourage to eat, and he says, well, everything I eat has to be able to come from the deli at Safeway, wasn't even at our local organic food store. He's got all the money in the world. I am-Yeah, that leaves you out of control of your health.

 [00:34:23.300] - Dr. Dawn Lemanne
I don't think that's where most people would choose to be if they could, out of control. Having little control over that. And deli foods, the issue with deli foods, there can be... One of the issues for me is hygiene. You never know who's handling and how they're handling your food. Having worked in places like that, I have an idea. And it's not pretty, but I know places try very hard. But also deli food, like potato salad, will have mayonnaise made with with seed oils, which I might choose not to eat. If you go to a restaurant, say a nice Mexican restaurant or Chinese or something like that or American, they will grill or fry the food in seed oils. And again, you don't think about that. You think, oh, I just have a hamburger, but you have a hamburger plus a bunch of cotton seed.

 [00:35:23.920] - Dr. Deborah Gordon
So I can answer this question, but since you brought it up, I'm going to let you answer it. What's this big deal about seed oils? They've been forever. They work really well in the frying pan. My olive oil smokes at too low a temperature. Why can't I fry my fill in the blank with canola oil? Sure. Aka. Rape seed oil. Canola stands for Canadian oil because it was used to- Because they grow it there.

 [00:35:51.500] - Dr. Dawn Lemanne
It grows well in cold climates.

 [00:35:53.270] - Dr. Deborah Gordon

You know what its first use was for and why it became a big industry after World War II?

 [00:35:57.180] - Dr. Dawn Lemanne
I think for lubricating industrial machines. Submarines. Submarines.

[00:36:01.820] - Dr. Deborah Gordon
Submarine lubricating. But why can't I cook with canola and cotton seed oil?

 [00:36:05.700] - Dr. Dawn Lemanne
You certainly can. But when you cook those oils, you create a lot of toxic byproducts that gum up the human and animal metabolic works. So really, you're giving yourself a little dose of toxin along with the food that you're trying to get in. And it's so simple to just switch out to an oil or fat that It doesn't do that. So I use ghee. If I want to, I will use tallow or beef fat if I've stored some. I'll use coconut oil sometimes. Those are my three big go-tos. I'll also use butter if I'm a little bit more careful with butter because butter burns at a lower temperature.

 [00:36:51.460] - Dr. Deborah Gordon
And I think the important thing about these seed oils is that they are polyunsaturated fats, which are vulnerable to high heat and throwing off free radicals that cause oxidative damage to what's around them.

 [00:37:04.040] - Dr. Dawn Lemanne
Well, what you said was the scientific version of what I said. They're not good for you.

 [00:37:09.400] - Dr. Deborah Gordon
But I just want to have to throw in my favorite oils because they're different. And I think My favorite oils are cooking. Well, I do cook with butter. Duck fat is fantastic for cooking eggs. It's my favorite for that. And then the readily available commercial oils made from monounsaturated, not polyunsaturated the fats, which would be avocado and olive oil. And olive oil does have a lower smoke point than avocado oil. But if you're getting it so hot that it's smoking, it's because you've ignored your food while you've been cooking it. So attention, olive oil, avocado oil. Those are the ones I use.

 00:37:53.620] - Dr. Dawn Lemanne
Very interesting. Well, you were talking to me off Off of the podcast about deli meats and processed meat. They keep coming up as bad guys.

 [00:38:08.690] - Dr. Deborah Gordon
Bad guys.

 [00:38:09.450] - Dr. Dawn Lemanne
Yeah. Well, one of the interesting things about processed meat is As bad as sodas in some comparisons. Yeah, I would want to be sure. Maybe this has been done, but I would want to be sure that we're weeding out your patient's activities, for instance, the one who says, Well, I have plenty of money, but all of my food has to come from the Safeway Deli, which is delis are where you get processed meat, mainly. So perhaps it's a sign. It goes along with the sunrise or summer ice cream connection and drowning connection. Maybe it's a sign that someone's taking an easy way to get food has some limitation in their ability to feed themselves in a healthy way and are getting other people to feed them. And if you get other people to feed you, if they want to give it to you cheap, processed meats are going to come into the picture pretty quickly.

 [00:39:10.520] - Dr. Deborah Gordon
And processed differently. Like at our local stores, you can buy processed meat, really, that's a brick off of a ham that's been packaged so that you can put it in a sandwich if you want to or package turkey loaf.

 [00:39:25.860] - Dr. Dawn Lemanne
So it's that word processed again that comes into here. And the definition of processed changes. It's a little too flexible to be useful in describing whether a food is healthy or not.

 [00:39:41.480] - Dr. Deborah Gordon
Exactly. So my favorite staying within this framework that maybe we want to be critical of processed foods. David Ludwig, who works at, I think, Boston Children's, and he's on the faculty Harvard School of Public Health, which has heretofore been championed. Walter Willet is our famous Carbs are Wonderful, Fat and protein are Bad, researcher from Harvard School of Public Health. Well, David Ludwig is also there. And he wrote an article that I think is on his blog in some way, but he's also published an article recently, one of the articles you got from me, thank you, from the New England Journal of Medicine. And he looks at processing that isn't so bad. And his best example of this, from my point of view, is a food that counts as an ultra-processed food that I think is good for you and you can't over eat is dark chocolate.

 [00:40:48.340] - Dr. Dawn Lemanne
Oh, you can definitely over eat that.

 [00:40:51.000] - Dr. Deborah Gordon
Well, then you're not eating it dark enough.

 [00:40:54.300] - Dr. Dawn Lemanne
Yeah, I don't really like dark chocolate, so you're right. I wouldn't over eat it. I wouldn't eat it at all because I don't like it. But if you like it, it's apparently good for you.

 [00:41:03.980] - Dr. Deborah Gordon
It is good for you. And peanuts to peanut butter, olive to olive oil, those are not hazardous processing procedures. But he said, Almost Most uniformly, the hyper-processing of carbohydrates poses a greater concern because if you turn an apple with its chewing requirements and fiber content into apple juice, it's easier to consume more sugar. To be less satisfied, you were talking about satiation qualities of white rice and sugar. That sounds terrible. But anyway, the digestion rate of carbohydrates, processing them makes them digest faster. Our blood sugar goes up, our blood sugar goes down, and we're hungrier sooner. Whereas if we're eating a fat or a protein, our metabolism stays much more stable. So that's his suggestion, I think, that we look particularly to the ultra-processing of carbohydrates.

 [00:42:13.960] - Dr. Dawn Lemanne
Well, And you can measure that in any particular person. People respond differently to different types and amounts of carbohydrate. And we can measure that with a continuous glucose monitor. And we can see after a particular meal how The body responds to that particular food. And I think that's really where we're heading.

 [00:42:38.540] - Dr. Deborah Gordon
Don't you know? I mean, there's a move afoot in the modern medical community to say we're all crackpots and quacks who are suggesting people without diabetes use continuous glucose monitors.

 [00:42:49.300] - Dr. Dawn Lemanne
Oh, it doesn't worry me. So that's always the process when things are changing. People who are committed to the older ways get a little hot under the collar about it, and then they calm down when the data comes out or they die off. And the data comes out showing whatever it shows. And if it's the newer ways are better, then that becomes the new thing until it's not. And the David Ludwig-Walter-Willet situation makes me smile whenever I run into that because I have seen that they disagree on things.

 [00:43:27.440] - Dr. Deborah Gordon
And they're both at the same institution.

 [00:43:29.020] - Dr. Dawn Lemanne
And they're both at the same, and they're both part of the School of Public Health there. But that'll all get worked out. And I think that they're both right. And the reason that they're both right is because certain people have... There are people who will respond better to a low fat, high start It's usually not high fructose, at least not unrelated to-Hold that thought.

 [00:43:51.070] - Dr. Deborah Gordon
I want to get back to you on that. Hold that thought.

 [00:43:53.910] - Dr. Dawn Lemanne
And people who will respond better to high fat type type diets. And there are a lot of people who actually fluctuate in their needs. So seasonally or with a particular illness or if they're sleep-deprived or training for some event, or if they're pregnant or if they're a child or if they're a nursing infant, people have different nutritional needs and those needs fluctuate, and we don't know very much about that. We are just learning about that. And the only way we'll learn about that is to put continuous glucose monitors on people and actually see how their different dietary choices affect them in that moment. And if the same dietary choice affects them differently in a different moment.

 [00:44:36.600] - Dr. Deborah Gordon
Then I'm going to circle back to my fructose intolerance story because people get really sick who have two variant genes at one or more of the locations of the genes that regulate fructose digestion and metabolism. But if you have one gene, you don't get that sick, it's not noticed, but you do have a reduced tolerance for fruit, and it shows up in the elevation of a blood test that is one of the blood tests that I think everybody should get every year or few years, but that nobody does, is uric acid. If you have one variant in an Alderace gene or two eating what looks like a normal amount of fruit, will raise your uric acid, maybe not to the point of giving you gout. And that's what people typically... Physicians typically don't order uric acid unless they're worried that you do have a swollen toe joint and somebody in your family has gout. Do you have gout? Yes, your uric acid is sky high. But if your uric acid is moderately high, you can have ramifications in multiple vascular systems from having eaten a doctor's recommended amount of fruit in your daily consumption.

 [00:46:11.360] - Dr. Dawn Lemanne
And that's because the recommendations are based on things like the NOVA and other scales, similar scales, where people, scientists, are trying to organize a field that's poorly understood in ways that they can communicate with each other about it and make data.

 [00:46:28.090] - Dr. Deborah Gordon
But we could get not just a continuous glucose monitor is great. I am not criticizing that. I'm eager to get dive into my two weeks. But people get chemistry panels and doctors don't draw them fasting, so they don't know what your fasting glucose is. I have a couple of friends who's doctors, and they are in their 70s, who've never ordered a hemoglobin A1c. And I bet most of our listeners already know what that is, but that's a representation of how much of your hemoglobin has sugar in it, and therefore a reference range for your average blood sugar over the last, is it three months? Three months. Three months about how long red blood cells live and uric acid. I mean, those are four simple tests. You could do fasting insulin with that chemistry panel, hemoglobin You'll have an A1c and uric acid, and you'd know a whole lot more about your carbohydrate and specifically fructose tolerance than you would from following standard guidelines.

 [00:47:28.480] - Dr. Dawn Lemanne
I think that's That's really true. I don't know the answer to this, but maybe you do. I wonder if uric acid fluctuates throughout the day. It certainly fluctuates if you're on a long fast. For instance, I did my uric acid levels before, during, and after a seven-day fast that I did and on patients that have carried out seven-day fasts. And the uric acid goes way up about day 5, 6, 7, way, way up above the normal level. Not hugely, but above the normal high end of the standard normal level. So uric acid is dynamic as well. It has to do with the breakdown of cells. It's a good thing in fasting, you want your cells to break down in the old damaged ones so that you can make new ones when you begin eating again. So I think that these things will be, I think, will become clearer as we do take more measurements on our patients and are able to do measurements on each patient. And I hear your pain when I think about these standard ways of looking at and trying to classify good and bad foods and good and bad diets. I do agree that the NoVA classification is really clumsy.

 [00:48:49.700] - Dr. Dawn Lemanne
And fortunately, I don't think most of our listeners will have heard of the NoVA classification. They certainly don't ponder it and worry about it all day long. Or rely on it, yeah. But if If doctors come across it and do, I think because it's a bit disorganized and still being built, I guess, maybe is a kind way of putting it, it's at this moment really not really useful on the ground in practice. I completely agree.

 [00:49:20.550] - Dr. Deborah Gordon
And it would be... What I thought you were going to say, what you felt my pain about was, I am so frustrated with people who call themselves family doctors, internists or cardiologists, and don't order what I think are the most basic of all tests, like a hemoglobin A1c or C-reactive proteins specific to cardiovascular inflammation. If you're a cardiologist, they don't order that.

 [00:49:47.740] - Dr. Dawn Lemanne
Really? That's not being ordered?

 [00:49:49.090] - Dr. Deborah Gordon

That's not part of the routine cardiology panel. But speaking of cardiology, so this is a little either It's a total distraction. We can cut it out or you'll find it interesting. So in the cardiovascular world, you know, probably know that the most commonly prescribed drug these days is probably not hypertensive drugs anymore, although I think they're certainly out there, but is, of course, a statin.

 [00:50:18.980] - Dr. Dawn Lemanne
Oh, yes.

 [00:50:19.980] - Dr. Deborah Gordon
Now, statins have something in common with ultra-processed foods.

 [00:50:26.120] - Dr. Dawn Lemanne
Oh, what's that?

 [00:50:27.500] - Dr. Deborah Gordon
They both lower your own intrinsic GLP-1. So the modern obesity drugs Ozempic and Monjarro are replenishing depleted GLP-1 stores. You need GLP-1 for metabolic health, for appetite control, for even other addiction issues, and processed food consumption by way The way of promoting a particular gut bacteria, desulfovibrio. Desulfovibrio lowers your GLP-1, and so do statins, particularly if you take them every day, which is another thing I get angry about. You should give them every other day.

 [00:51:18.880] - Dr. Dawn Lemanne
Statins increase blood glucose. Yes. They push you toward diabetes.

 [00:51:22.990] - Dr. Deborah Gordon
That's how they do it. They lower your GLP-1.

 [00:51:25.740] - Dr. Dawn Lemanne
Yeah, interesting.

 [00:51:26.900] - Dr. Deborah Gordon
But this is the funny thing. That's just fun. There's a easily available over-the-counter. It can be used as a supplement or as a digestive aid that can increase, Can decrease, sorry. Can decrease your desulfovibrio, should you have that, and raise your GLP-1. And it's advertised on television as a way you can eat your grandmother's overly rich cooking at Thanksgiving, which is an interesting comment.

 [00:52:04.280] - Dr. Dawn Lemanne
I think you can paint your... I have a relative who likes that color, and she paints her rooms that color.

 [00:52:12.760] - Dr. Deborah Gordon
What color?

 [00:52:14.520] - Dr. Dawn Lemanne
Hot pink? 

[00:52:15.500] - Dr. Deborah Gordon
Oh, yes. Well, you can buy it as a tablet as well. But yes, we're talking about bismuth. So Pepto-bismol can diminish your disulfovibrio.

 [00:52:28.330] - Dr. Dawn Lemanne
That color cuts my appetite.

 [00:52:30.000] - Dr. Deborah Gordon
Yes, exactly.

 [00:52:32.900] - Dr. Dawn Lemanne
But some people like it. If you're in the mood, I get it.

 [00:52:38.020] - Dr. Deborah Gordon
So if you're going to eat ultra-processed foods, you don't want to get VAT, you should coat your gut. You should bring out the pink before you eat.

 [00:52:48.040] - Dr. Dawn Lemanne
Are you recommending that, Dr. Gordon? Should we all go buy a bottle of Pepta-Bismol before our Thanksgiving dinner next week?

 [00:52:56.600] - Dr. Deborah Gordon
No, I think you should. I have several tests that I started doing learning and studying with Dr. Bredesen, particularly for the complexity of cognitive patients, but now I like to do them in everybody. I like to do a stool test, and somebody who has a high amount, and it's not very common, I see it, of disulfovibrio in their gut, which frankly they can get from either having had a parasitic or traveler's diarrhea of some sort or ultra-processed foods, I might suggest they use Peptovizumab for a while.

 [00:53:32.830] - Dr. Dawn Lemanne
What's your favorite stool test for that?

 [00:53:35.220] - Dr. Deborah Gordon
I like GIEffects by Genova Diagnostics. All right. I have a microbiology-Do you have to have a prescription to get that? You do have to have a prescription to get that. I don't think there are any that are DIY, that are approved by the microbiologist who do split samples and compare them. There's two that they recommend, and I've just gotten in the habit of using this one. But doctors can order them. Medicare covers it. Med Advantage doesn't cover it as well.

[00:54:08.600] - Dr. Dawn Lemanne
To recap what we've talked about here, it sounds like highly processed foods, what the actual definition of that is up for grabs or a little bit not satisfactory in in your opinion, based on at least the NoVA categorizations, that we want people to know how to cook, even simply, not fancy. You don't have to go to a chef's school. I love that. Because countries that have instituted cooking and nutrition classes in schools have better health outcomes, longer lives, better health, lower weight, those kinds of things, specifically Japan, Spain, Greece. And that there are tests that might be useful, uric acid, hemoglobin A1c, high sensitivity or cardiac-directed C-reactive protein. And did I say uric acid? So this is the starting up again. And if I repeat myself, we can cut things out. So yes, C-reactive protein, high sensitivity or Cardiac directed, and cooking classes for elementary school students and their parents, if they don't know how to set up a basic working functional kitchen so that they can cook simple, whole foods.

 [00:55:45.980] - Dr. Deborah Gordon
I love that. So these are proactive ideas with going forward, monitoring our own and improving our own individual health. And any wrap up comments about what people can do if they are going to buy a protein bar like I buy and that I think has no bad ingredients in it. What would you consider What's the red flag ingredient in processed foods?

 [00:56:18.540] - Dr. Dawn Lemanne
So added sugar is one that I don't always avoid. So if something's added, for instance, honey, I might consider it. There are some bars that I will use before I go to the gym. That are sweetened with honey, but I limit those. And certainly, finely ground grains. In fact, I limit grains quite a bit. I will have some whole grains. I'll have some occasional rice. I don't eat wheat very much. Occasionally, I'll have a slice of sourdough bread, but I really limit grains. I don't have them daily. And I think I think that that's because I've measured my blood glucose, and if I have a small plate of pasta, my blood sugar will go up to near 200 if I'm not careful and don't balance it with proteins and fats and things like that, especially. So I know that I don't do well with grains. Same with oatmeal, things that people consider healthy. And I wouldn't limit those in other people. I would, as long as we have checked their blood sugar and we make sure that they don't spike their glucose after they have something like that.

 [00:57:30.290] - Dr. Deborah Gordon
Or I would say, there are times when I encourage people to spike their blood glucose. I don't know if you ever do this, but if somebody's fasting insulin is too low, their average blood sugar will totally creep up and they won't have enough insulin to build muscle and bone. So the people whose insulin is less than three, I encourage them to eat a high carbohydrate dinner, including rice or pasta, and get to the point where their blood sugar comes quickly down after that because their body is remembering how to make insulin.

 [00:58:01.840] - Dr. Dawn Lemanne
And that's a really good point. That has to do with the personalization of diet. And that requires a really astute physician like you that will measure these things and actually give you real advice, not just read a textbook to you or read an article that lists the four categories of processed foods, and that leads you to try to figure out what the heck that means for your breakfast tomorrow.

 [00:58:31.870] - Dr. Deborah Gordon
Yeah, I think we're both a little bit in the clear of a lot of the ultra-process concerns because neither one of us each much... I do have a piece of gluten-free bread once a week and rice a couple of times a month.

 [00:58:43.740] - Dr. Dawn Lemanne
Yeah, you will catch me, and you generally do. At my favorite coffee shop, the one day a month, I will order a croissant in you walk. But again, measurement is key.

 [00:59:00.160] - Dr. Deborah Gordon
I would say what I avoid in ultra-processed foods is anything that looks like I should have learned about it in chemistry.

 [00:59:07.980] - Dr. Dawn Lemanne
What does that mean? What does it look like? Is it coming in a package?

 [00:59:11.620] - Dr. Deborah Gordon
Is it-Isosorby-dinitrate Gladiate. It's added to your chocolate bar. I'm not eating that chocolate bar, even though I do think that's an ultra-processed food. That's good for me.

 [00:59:24.140] - Dr. Dawn Lemanne
Okay. So, yeah, if it looks like what it came from, like a stalk of broccoli or a a chicken leg, cook it simply and have at it.

 [00:59:35.230] - Dr. Deborah Gordon
Enjoy it.

 [00:59:35.940] - Dr. Dawn Lemanne
Yeah.

 [00:59:37.700] - Dr. Deborah Gordon
Great. Well, let's go have some non-ultra-processed food. Sounds good. And see if we can put all this together in our brains, hopefully for our audience.

 [00:59:47.720] - Dr. Dawn Lemanne
Well, thank you for the duck. It's a duck liver that I am the proud owner of?

 [00:59:53.010] - Dr. Deborah Gordon
No, you are a proud owner of a chicken liver.

 [00:59:56.270] - Dr. Dawn Lemanne
Chicken liver, okay. Is it highly processed?

 [00:59:58.960] - Dr. Deborah Gordon
Yes, it is It's highly processed, but no, the only thing, it's sauteed. That was a trick question. I know, but it's a Cuisinart. Does Cuisinart count as ultra-processing? I don't think so.

 [01:00:11.280] - Dr. Dawn Lemanne
Well, we'll see what it does to my blood sugar. Yeah.

 [01:00:13.400] - Dr. Deborah Gordon
Okay.

 [01:00:14.680] - Dr. Dawn Lemanne
What did you put in it?

 [01:00:16.700] - Dr. Deborah Gordon
I put in butter and some more butter and some more butter. I put in a little alcohol for flavor, but I cook it off. Onions, more butter. Just sherry, just for a little flavor. Cook it off. Onions, garlic, chicken liver.

 [01:00:34.260] - Dr. Dawn Lemanne
Sounds very healthy.

 [01:00:34.820] - Dr. Deborah Gordon
I hope you enjoy it. 

 [01:00:36.320] - Dr. Dawn Lemanne
I'll let you know. Thank you. I'm going to try.

 [01:00:38.480] - Dr. Deborah Gordon
Okay. Have a good day. Bye, Dawn. Bye, Dawn.

 [01:00:43.520] - Dr. Dawn Lemanne
If you haven't already, please take a moment to subscribe. Your simple click is not abstract. It's not anonymous. To us, it's very, very real. It helps us reach more patients and physicians to challenge the old ways of thinking to talk about health and to keep these evidence-based conversations going. Hitting that subscribe button actually makes a huge, huge difference. And thank you.

 [01:01:13.260] - Dr. Deborah Gordon
You have been listening to the Lemanne Gordon podcast, where Docs Talk Shop.

 [01:01:19.220] - Dr. Dawn Lemanne
For podcast transcripts, episode notes and links, and more, please visit the podcast website at docstalkshop.

 [01:01:28.280] - Dr. Deborah Gordon
Com.

 [01:01:28.810] - Dr. Dawn Lemanne
Happy eavesdropping. Everything presented in this podcast is for educational and informational purposes only and should not be construed as medical advice. No doctor-patient relationship is established or implied. If you have a health or a medical concern, see a qualified professional promptly.

 [01:01:55.500] - Dr. Deborah Gordon
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 [01:02:07.600] - Dr. Dawn Lemanne
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 [01:02:22.040] - Dr. Deborah Gordon
Again, if you have any medical concerns, see your own provider or another qualified health professional promptly.

 [01:02:28.900] - Dr. Dawn Lemanne
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 [01:02:46.330] - Dr. Deborah Gordon
Docs Talk Shop is recorded at Freeman Sound Studio in Ashland, Oregon.