GLP-1, Seed Oils & Alcohol: Top Nutrition Professor Destroys Common Diet Myths — Dr. Dariush Mozaffarian

Everything you think you know about weight loss may be wrong — and one of the world’s  leading Nutrition professors has the science to prove it.

Dariush Mozaffarian, MD, PhD — Dean Emeritus at the Tufts University School of Nutrition and Director of the Food Is Medicine Institute — has spent decades studying why we get sick, why we gain weight, and why so much of what we've been told about food is overcomplicated at best, and actively harmful at worst. In this conversation, he dismantles the myths driving the obesity epidemic and replaces them with what the evidence actually shows.

In this episode, you’ll learn:

• Why counting calories is a bad approach— and what actually drives weight gain
• Why most high-protein advice is backwards, and what you should be eating instead
• The real story on seed oils and ultra-processed foods (it's more nuanced than the headlines suggest)
• What GLP-1 drugs can and can't do — and why they're not the whole answer
• The truth about alcohol and how it relates to your wellness
• How to lose body fat and keep it off
• How to build a sustainable way of eating that supports your metabolism, your heart, and your long-term health

If you've ever felt paralyzed by conflicting nutrition advice, this episode cuts through the noise. Dr. Mozaffarian doesn't deal in trends — he deals in evidence. And the picture he paints is both surprising and deeply clarifying.

Dariush Mozaffarian, MD DrPH:
Director, Food is Medicine Institute
Distinguished Professor, Jean Mayer Professor of Nutrition, Professor of Medicine, Dean Emeritus https://tuftsfoodismedicine.org/ 

Pre-order Dr. Mozaffarian’s book at: https://us.macmillan.com/books/9781250394286/foodismedicine/

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Transcript

SPEAKER_01 0:00

Our food system is driving death and disability around the world. So obesity is the greatest and most rapid change in human health ever recorded in history. So all of this has happened because of the changes that we talked about, ultra processing and the rise of industrial agriculture. Since 2000, we're exercising more, we're eating about the same or less, and we're gaining body fat. A big mistake we've made in science and in public health is to talk about obesity in terms of conscious choice, in terms of willpower. What we've learned is that obesity is about unconscious biology mostly. Our physiology is actually exquisitely attuned to maintain our body weight. Vast majority of scientific expert groups, independent groups that have looked at this have concluded that alcohol at any dose is harmful. If you have a piece of bread and then 10 minutes later have a piece of chicken, or if you have a piece of chicken and then 10 minutes later have a piece of bread, there's dramatically different blood glucose responses to the bread if you have the chicken first. You can go on any diet, right? You can go on a paleo, keto, gummy bear diet, but ultimately the body's biology will fight back. Don't track your calories, track the quality of what you eat.

SPEAKER_03 1:05

Welcome back to the Living Room podcast. My guest today is a cardiologist and nutrition scientist, the author of over 550 scientific publications, and one of the most cited researchers in medicine globally, named by Thomas Reuters as one of the world's most influential scientific minds, and the founder and director of the Food is Medicine Institute at Tufts University. Now, in this episode, we get into what the science actually tells us about diet, heart health, how what we eat drives almost every chronic disease we face, and what we should be eating right now to improve the way we look, feel, and perform. It's one of those conversations that will completely change how you think about nutrition and all of the misinformation surrounding the topic. I hope you enjoy this one as much as I did. Let's dive in. Dari, firstly, welcome. And I actually want to start by saying thank you. I think when we first came up with this crazy concept, you were one of the very first members of our scientific council that sort of uh shared this true north vision of creating a space where we could democratize some of the science to living healthier for longer. And I think that was maybe three years ago now, right? And so um it is a pleasure and a privilege for me to be able to have you on the on the pod as one of our early episodes and to share some of that wisdom. I think we have we both align on the idea that um there is no single longevity expert across all of these domains that impact length and quality of life. But I think it's safe to say that when it comes to nutrition and nutrition policy, you're as close as it gets, um, I believe. So I want to start on that note by asking you a very easy question. How did we end up here? Because not you and I, I mean with nutrition um in regards to the domain in general, because it feels like there is so much misinformation and grandiose claims and confusion. And I think I probably speak for everyone listening. So if you can just answer that really quickly, then of course.

SPEAKER_01 3:12

So, so Chris, that's a pleasure to be here. And it's been really great to work with you. I think the vision that health is really central to happiness. Um, if you don't have health, as successful as you are in every other aspect of your life, um, you know, quickly other things become much less important. And so, and so uh, and and for too many people today, health is is uh elusive and and you know slipping out of their fingertips um at all levels of society and in all countries. And the primary driver, although there's many, is actually our food system. Our food system is driving death and disability around the world, and particularly in our country, but around the world. And so I'm often asked, like, how did we get here? Why are we in this mess? And um I I cover this in in a book that I have that's coming out, uh uh uh Food is Medicine. Uh, it many people start with the 1980s, um, with ultra-processed foods and and you know, companies trying to make foods addictive, and and there are some truths to all of that, but you just have to step back maybe about 50 years before that. Um, really, the the roots of the mess we're in um are from three big themes of the 20th century. We have a 20th century food system uh that was crafted to address 20th century priorities and actually did so very, very well. And so, what were those priorities? The first was vitamins, the second was calories, and the third was ultra processing, which we can talk about. And so let's just take each of those very briefly. The first vitamin that was discovered and isolated and synthesized was 1932, vitamin C. That's modern history, less than 100 years ago. Uh, in the 1920s, vitamins were unknown, right? So we didn't know that there was something in food that could be a good idea.

SPEAKER_03 4:56

The whole concept of vitamins was on there.

SPEAKER_01 4:58

It wasn't even, it wasn't even, I mean, there were some theories that the word vitamin was sort of proposed in 1912 as a concept, but had never been discovered, had never been proven. So, you know, healers have known for thousands of years that there's things in food that are good for you, but this idea that there's a specific molecule that can cure or or prevent scurvy or cure or prevent uh pellagra or cure or prevent rickets or night blindness, these devastating, very common diseases, Berry Berry, was theorized, but not proven. Uh, and so really it was the 1930s where vitamins were discovered, and that coincided with the Great Depression in World War II. And President Franklin Delano Roosevelt, knowing we were going to war, heard about this vitamin stuff. And he brought together the nation scientists in a conference, and I love this title, a national nutrition conference on defense, to say, what do we need to go to war? And that led to this uh uh concept, which we now call the recommended daily allowances, the RDAs. What's in food? What are the molecules in food that we need to eat? What are the levels? How do we break it down? And how do we create, with technology, with supplements, with fortification, the right food to prevent vitamin deficiency diseases? And that was very successful. Vitamin deficiency diseases largely disappear. Doctors haven't seen or heard of Pellagar or Scurvy or Berry Berry or Ricketts or these other conditions. So that was the first big thing was the discovery of vitamins. The second big theme was calories. Uh, 30 million people died of famine in World War II. And if you adjust for the world population, that's about 100 million people today. And so we've seen a little bit hints of shocks of food inflation and the Ukraine war and wheat prices. We don't have 100 million people dying around the world, right? Imagine 100 million people dying. It was a massive shock to the world psyche. And then scientists saw the world's population exploding. More people were born in the 20th century than in all of prior human history combined. Billions of people were born in the 20th century. Uh, and so scientists did the math and said, we don't have enough food. Even if we plant every available acre, we're not going to be able to produce enough food. And there were books like The Population Bomb that predicted that uh hundreds of millions of people were going to starve. And so the next big thing that happened after vitamins was the green revolution. And that's basically the industrialization of agriculture. Highly bred intensive wheat and corn and rice species, chemical pesticides, chemical fertilizers, and massive irrigation and water use. And it was successful. We we increased crop yield by 10 or 15 or 20 fold per acre. And countries that were on the brink of starvation, like Mexico and Pakistan and India, became wheat exporting nations or rice exporting nations in 10 years in the 1960s and 1970s. But that led to lots of downstream problems from really dramatically reducing the biodiversity of crops and how we grow foods. And then the third big theme, the last one, was ultra-processing, which I mentioned at the beginning, which really started in the 80s. And that started with the mistake of the low-fat diet, which we can talk about in 1980. For the first time, the dietary guidelines said Americans should avoid fat to prevent heart disease, which was a mistake. But now companies had to make all these products that they've been making for hundreds of years with natural fats and make them without fat. And so it led to emulsifiers and stabilizers and colorants and all these things. And then tobacco companies bought all the food brands in the 1980s and 90s. RJR, uh uh RJ Reynolds and Philip Morris, the two big tobacco companies of the world, bought most of the food brands. And they used the same addiction scientists and marketing scientists they had assigned to tobacco to try to make food as appealing and as addictive as possible. And so, fast forward to today, the reason we have the food system we have today was initially, you know, science and government policy and business innovation came together to address vitamin deficiencies and calories and low-fat diets. And then added to that was this, you know, intense business interest of tobacco companies to make as much money as possible. And most of the food brands, by the way, now are no longer owned by the food tobacco companies. They realized they couldn't make a lot of money like they can tobacco and they sold them. But the reason we have the food system today is because we were trying to address different goals, getting enough vitamins and getting enough calories. And we we we won. All right. Let's declare victory. Um, you go to the cereal aisle today and you'll see, you know, boxes and boxes of starchy, cheap wheat, rice, uh, and corn flour fortified with vitamins, right?

SPEAKER_02 9:44

Yeah.

SPEAKER_01 9:45

Um, but what we missed and what we didn't understand is that complex chronic diseases, obesity, diabetes, brain health, gut health, immune health, you can't break it down to a single vitamin, right? You you have to really understand food and and we lost kind of the beauty and complexity and a lot of wisdom uh of of ancient ancient diets. And so, and so the reason I I think it's important to understand that is that we did all of this consciously, intentionally. And uh if we just put those that same formula together, science, policy, private sector innovation, we can fix it again. I think that's the that's the positive message. We can fix this in 10 or 20 years, this messarin.

SPEAKER_03 10:28

How did you get to where you are now?

SPEAKER_01 10:30

So I think the the I'm asked frequently, you know, how did a cardiologist become so interested in in food and nutrition? And and my answer, you know, only partly tongue in cheek is why isn't every cardiologist infatuated with food and nutrition? Um, you know, this is the top cause of death and disability in the country, is poor poor poor diet. And, you know, I did 11 years of training after college. So four years of medical school, three years of internal medicine, four years of cardiology. In those 11 years, I barely learned anything about nutrition. And yet, when I was seeing patients, and I still see patients now in downtown Boston and Chinatown, well, when I was seeing patients, it was sort of obvious to me that nutrition was a big part of their challenge. And yet I wasn't learning anything about it. So is that still the case? So it is still the case, but it's rapidly changing. And we can talk about that, I think, when we we talk about solutions. Um but that was a big realization for me that that uh the biggest issue facing my patients wasn't being taught to me. And so this was in the late 90s uh uh and early 2000s. I said, let me actually train myself. And so I read all the papers I could. And what the second big shock, which really led me to my career, was that even then, even 25 years ago, the science didn't support a low-fat, low saturated fat, low cholesterol diet. It supported a high healthy fat, minimally processed, Mediterranean-style diet that we kind of understand now, low in ultra-processed foods, high in phenolics and bioactives and fibers and all the stuff we can talk about. Even then, the science supported that. And yet, you know, and intimate snack well fat-free cookies were that became the top-selling cookie, and everybody was getting fat-free frozen yogurt and fat-free salad dressing and baked potato chips and fat-free cheese, and you know, fat, fat free, all these things that just you know, highly processed fat-free foods. But the science didn't support that even 30 years ago, but the science wasn't being translated into policy. And so those two kind of uh realizations are what's driven my career is if we're gonna make people healthier, millions of people at a time, or hundreds of millions of people at a time, we have to address food. Healthcare has to address food, uh policy has to address food, and we have to make sure that what we're doing is is actually uh consistent with the the current science.

SPEAKER_03 12:40

How did we get to that point though? Like how did that become the trend or or the norm that fat was the the bad thing and that we should avoid that in all the foods we eat if the science didn't support that ever? Was it to do with you know the cost of goods? What how did that happen?

SPEAKER_01 12:58

So it's really uh it goes back to what we talked about before about you know the the history was just so important to understand. Scientists unpacked food to address vitamin deficiency diseases. Uh, vitamin deficiency diseases, by definition, a single vitamin, a single nutrient causes or cures a disease. And it was very successful, right? Vitamin D, if it's absent, you get bone problems and bone disease. And if you give the vitamin D back, you heal the bones. Uh and so that approach of finding the nutrient was mistakenly extended to chronic disease. Scientists defeated vitamin deficiency diseases and said, now we're let's let's turn our eyes to a new horizon. The horizon was heart attacks. Heart attacks were the had become the top cause of death. Uh vitamin deficiency diseases had receded. And so scientists used the best available science they had in the 1960s and 1970s, which wasn't great science, early science, and said, We think fat and saturated fat cause heart disease because saturated fat raises LDL cholesterol, the bad cholesterol, and and studies comparing the US and Italy and Greece and Japan and the United States saw correlations between fat intake uh and heart disease. There were exceptions, like France. France had very high fat intake and low heart disease. People said that's the French paradox and said it was wine, it wasn't wine. Um there were exceptions, but that was the best science they had. And so in 1980, for the first time, the official guidelines of our country said to have low-fat diets based on this kind of vitamin approach, in a way, nutrient approach to chronic disease. And what we've learned since is that, you know, chronic diseases are complicated and no single nutrient can really account for them. And it's about food processing, about food quality, about the thousands and thousands of interesting molecules that are in our food and interact with our gut microbiome. And so we're now kind of really unlocking this dark matter of food that you know has been mostly unknown. Um, and so I think we're at a really exciting time where we can really start to unlock the power of food for nourishment.

SPEAKER_03 15:04

Nutrition in general, I think, has been one of those um obviously fundamental pillars that we focus on um with real depth here, much of which is thanks to you. But still seems like there's a lot of discord, even in science, even amongst the scientists. And so I think as a consumer, it's very difficult to know who to trust or to know what is to sort of fact from fiction, signal from noise. How do we go about setting a standard by which we as consumers know who the beacon of truth is or who we should be listening to? Because it feels like there's some fundamental principles that we have really robust evidence for, but yet we you know go on social media each day and there's some new fad diet or removing an entire food group or macronutrient. Yeah. How do we how do we reconcile for that?

SPEAKER_01 15:56

So, you know, if you go to South America, there's a place where a famous place where two rivers can converge, the Solamos River and the Rio Negro. And it's like dark, uh dark, muddy, turbulent waters and deep, dark, clear waters. And these rivers converge, and there's like this crazy streams, and and then eventually you get to calm river and they kind of blend together. That's where we are right now with nutrition science. We have this kind of old science of reduction, what we call reductionism. Let's break down foods, figure out the nutrients, and craft a perfect diet, like the the soilant science, right? Or the energy bar science or the protein supplement science of it's all about the nutrients. Uh, and then we have the new science, which is saying, hey guys, hold on. Like maybe we don't know as much as nature knows, and maybe we should eat whole foods. And maybe we should not just measure 50 or 100 nutrients in food. There's actually 7 million nutrients in food that have now been documented by some new companies. 7 million supplements. 6,900,000 of them, 999,000 of them, not even ever measured before. And we don't even know what most of them do. Uh, and so maybe we should eat whole foods, eat minimally processed foods, think about diet patterns, avoid all of these additives. And so this kind of two realms are are converging. And that's one big reason for this confusion and controversy. The other big reason, which which I've I've found to be true, is that um, you know, nutrition is a science, obviously, but food is more than science. Food is joy and dignity and culture and flavor, and everybody eats. And so everybody feels like, well, I I I kind of understand food. And so, you know, if I were a rocket scientist and I went to dinner with a group of smart people, um, they wouldn't tell me like what rocket fuel I should use to get to Mars, right? Yeah. But if I go to a dinner party and people find out what I do, most people will tell me what the problem is in the food systems, it's all the sugar, it's all the hormones, it's it's the additives, it's X, Y, or Z. Like everybody kind of has their own ideas, which is natural because we eat. And so I think this combination of truly advancing science and changing science with the personal nature of nutrition. And then lastly, the rise of social media influencers and and sort of expert non-experts, um, who in some cases are truly trying to communicate and help, and in other cases are trying to make money with clicks and likes, um, leads to a lot of misinformation. And so in my book, you know, food is medicine, I try to really lay this out and you know, hopefully we can start to talk about now what what what did we get wrong and and what should people really really focus on now?

SPEAKER_03 18:44

So just double clicking on this uh, you know, social media expert piece, I think that is a big part of the problem is that you know, some people will create content that is actually kind of compelling and and sometimes pull on a thread of science. You know, we we've spoken in previous episodes that much of their perspectives are based in some thread of science, right? And it's not usually a bad actor that is creating some uh you know completely new made-up thing that it's usually just an overreach. What is it that you are seeing before we talk about the right approach or what we believe to be the right approach? What are some of the things that you're seeing which we just know are not true?

SPEAKER_01 19:26

There's so many. Yeah, right. Um, and again, I don't mean to to um you know denigrate people that are trying to communicate to the public, right? Like this. We need to communicate to the public, and they're not always getting good information from the government. And so, and so, you know, it's not always purposeful, uh, but there is misinformation out there. I I think some of the biggest threads that are of misinformation now, I would say uh maybe three, um, just that come to the top of my head that that it's all about calories, that obesity is all about calories. That's completely wrong. Uh, we should not be focusing on counting calories when it comes to long-term success in body weight, and we can talk about that. I think a second recent piece of misinformation is that seed oils are bad for you. You know, seeds are one of nature's most power-packed bounties of nourishment, and their fats are unbelievably healthy. Uh, and even industrial seed oils, they might not be as good as you know, other virgin oils, but they're still good for you. They're maybe not as good for you. And so that's a big piece of misinformation that seed oils are bad for you. And then I think a third one, and the more recent one, is that we all need more protein. Uh, and and that's also not accurate. And and we we we can talk again about about that. I think people would be interested in in protein. So those are three things that I hear all the time. Um, and then uh, you know, and then there's on top of that, the diet tribe wars like keto is better than paleo, is better than this and better than that. And and I guess I can we we can talk a little bit about, you know, what the priorities are for a healthy diet, and I think it'll clarify why those diet tribe wars aren't um aren't as complicated as it seems.

SPEAKER_03 21:04

Yeah. Let's let's unpack the first one of them because I think this is something that we've all been confused by, and that is energy intake or or output even, or the combination of both. This whole concept of calories in, calories out. Can you give a sort of high-level perspective on that? Because, you know, there is there is good science behind creating a calorie deficit. Well, I mean, is the only way to lose weight, fat, but how we do that, or is it? I mean, you tell me. I'm I don't want to stay in my lane here.

SPEAKER_01 21:36

So, so uh a couple points. First, so obesity is the greatest and most rapid change in human health ever recorded in in history, right? This massive global issue. Um, uh every country in the world has at least some increase in obesity and some even much more than the United States. The Middle East, Mexico, other countries where you have even have more obesity than the United States.

SPEAKER_03 21:56

Is is that trend still going in the same direction?

SPEAKER_01 21:58

Yes, still going in the same direction. In in all the countries in the world at different paces, but everywhere. And it's all new. It's all in the last in the 1980s, there was no obesity epidemic. So all of this has happened because of the changes that we talked about, ultra processing and uh the rise of industrial agriculture. So the first thing to point out is this is a big problem. The second thing I just want to point out is that obesity is not the only problem. And so I see this with physicians or with patients. If they're thin, doctors say, oh, you must be having a good diet. You know, go ahead, you're on your way. If they're obese or overweight, people say, Oh, you've got to work on your diet. And I'm sure you see this at Wonder Health. People can be any body weight and their diet can be off and they can dramatically improve their health without any change in weight. So I don't want to minimize obesity. It's a public health crisis, but I also don't want to, you know, put it on a pedestal is the only thing we should think about. Um, but let's let's talk about obesity as an issue. At the cellular level, of course, ultimately the laws of thermodynamics hold and and energy in, energy out, you have to conserve energy. And if you don't, you're gonna have extra energy. But the mistake is thinking that translates into the calories you read on the back of a package and that you consume. Um, why is that a mistake? So, so from the 1970s to 2000, while the OPCD epidemic was was ramping up, calorie intake in the United States slowly went up by about 20 calories per year on average per person. Uh and so over 20 years, an extra, you know, 300 calories or so were consumed over those periods. And that kind of tracked the onset of the obesity epidemic. And so far, kind of makes sense. You know, we were eating more, we gained weight, like calories in, calories out. But a funny thing happened at two in 2000. In 2000, right around the time people started paying attention to the to the to the obesity epidemic, started trying to eat fewer calories, calorie intake flattened in the United States and has actually gone down a little bit since 2000. Uh, and obesity has continued to rise without any change. Now, the you know, sensible person might say, well, physical activity went down. Uh, but actually, by every measure, including objectively measured energy expenditure using doubly labeled water, physical physical activity went up after 2000. So, since 2000, we're exercising more, we're eating about the same or less, and we're gaining body fat. So, how is that possible? How is that happening? One of the most interesting things about this is that five years ago, I knew all these trends were true, and I didn't understand why. And just in the last five years, more and more research is starting to come out to really answer this question. And so the first thing I want to say is I'm not sure why this is happening. I don't know. But here's what the science suggests. So the first thing that's interesting is several recent studies have suggested that what's changed mostly is our resting energy expenditure. The amount of energy we burn while we're sitting and doing nothing has gone down by about 220 calories per day. And so, and uh for a person who's sedentary, about 80% of their energy expenditure is just resting energy expenditure. Yeah. And so if that's gone down 220 calories per day on average in the population, imagine what's happening to obesity. You only need to be off by 10 or 20 calories a day to gain weight.

SPEAKER_03 25:22

Yeah.

SPEAKER_01 25:23

220 calories, that explains the obesity epidemic just by itself. And we can talk about that. The second thing that's happened, totally separately from that, is that when we consume calories, our bodies digest those calories, but our gut microbiome and our large intestine also digest those calories. That's exactly why they've uh co-evolved with us, is to digest calories that we didn't digest, to harvest everything because we evolved to need calories. And so the microbiome actually shares our calories. Uh and in a health, uh not just the fiber, because if you give them fiber, that's not calories for us, but they actually share our calories, the starch, the fat, the protein. So if you give somebody a very traditional, minimally processed diet, the microbiome might digest 20% of those calories. If you give somebody a super highly processed kind of modern diet, it might digest 4% of those calories, 5% of those calories, and our body's getting all the rest because it's all digested early in the stomach and small intestine, doesn't get to the large gut.

SPEAKER_03 26:21

So 16% the additional Right.

SPEAKER_01 26:24

And so the average American consumes about 2,400 calories. Let's call it 2,000. Yeah. Let's call it for easy math. So the difference is the microbiome digesting 400 of those calories and our bodies only absorbing 1600 versus the microbiome digesting 50 of those calories and our bodies digesting 1,950. That's a 350 calorie delta. That's separate from resting energy expenditure. You put that together, that's a 500 calorie delta up to a 500 calorie delta that has changed in the last 20 or 30 years. It's like a obesity epidemic, right? And why is it happening? Because of highly processed foods, ultra-processed foods, loss of natural intact structure, loss of fibers that nurture our microbiome, loss of polyphenols and bioactives that nurture our microbiome. It's our food. Our physical activity has gone up. More people are running marathons, more people are going to the gym, more people are doing yoga, more people are doing pelotons. Granted, we're not where we should be for exercise. But the 1960s and 70s weren't this golden age of lifestyle in the United States, right? We were exercising more than we were in the 70s. Uh, we're we're exercising more, we're actually eating the same amount of calories as 2000, but we're gaining weight because of the quality of the food. And so what I emphasize to people, you know, if you want to lose weight in three months to go to a wedding or to go to the beach, sure, you could go on any diet you want and cut your calories and you'll lose weight, right? That's why diet books sell. You can go on any diet, right? You can go on a paleo, keto, gummy bear diet. Yes, you will lose weight.

SPEAKER_03 27:51

You're just eating less.

SPEAKER_01 27:52

Yeah. But ultimately, the body's biology will fight back, your resting energy expenditure will go down, your microbiome will get will get uh uh uh uh dysphiotic, um, and you'll start to gain weight, even if you keep your calories the same because of all these issues we talked about. So, what I tell people is don't count calories, don't look at the calories in the back of a package, um, don't track your calories. Um, track the quality of what you eat. Eat minimally processed, healthy foods that are gonna nurture your body and nurture your microbiome. And long term, long term, you're gonna be successful, like long term, like a year. And aim for a pound a month weight loss, you know, not 10 pounds. If you lose 10 pounds in a year, 10 pounds the next year, 10, yeah, that's that's great. And that will happen if you just naturally eat a healthier diet. And I've I've had many patients and friends and family members who've just switched just a few things in their diet, and they're shocked by how their body weight slowly starts to come off when they actually eat foods that work with our physiology rather than fighting our physiology.

SPEAKER_03 28:54

I have so many questions. Firstly, the the resting metabolic rate, the amount of calories that we're burning at rest, what what's the hypothesis as to why that would have gone down?

SPEAKER_01 29:05

Lean tissue or so the the most interesting lines of evidence point to uh what's called thermogenesis, the generation of heat. And so thermogenesis was really understood well from hibernating bears. And so bears, they hibernate for months. How do they not freeze? They have brown fat, not white fat, which is the normal fat that stores energy, but brown fat, which is a brownish tinge, and that generates heat. So instead of just sitting there and storing energy, it uses the calories and it generates heat by uncoupling of the electron transport chain in the mitochondria. So it's actually mitochondrial uncoupling of, remember back to your high school biology of the ATP cycle, and the electrons go through, and instead of, you know, creating molecules in ATP, they generate heat, they're wasted. Uh, and so infants have brown fat because when they're born, they shiver and they're cold and they need that brown fat. And for a long time, uh, scientists thought that, you know, after infancy, brown fat disappears and adults don't have brown fat. But then with modern techniques, it's been seen that all humans at all ages have brown fat, and that the amount of brown fat activity is low in people who get overweight and obese, uh, and that you're burning less energy, and that even muscle fat, muscles, not just fat, can also generate heat. Uh, and that white fat, which is the energy storage type of fat, can be coaxed and stimulated to be more like brown fat, called and they're it's called beige fat. And so through browning of adipocytes into base fat or from having brown fat uh or from even this process occurring in your muscles, you can actually give off heat uh and and burn calories. And so, what are some of the signals that have been seen in experiments that affect all these processes? It's all nutritional factors. And so certain molecules that are micro, a healthy microbiome produces activates brown fat and beige fat and activates thermogenesis. Polyphenols that are in berries and and uh um uh uh nuts and you know other seeds activate um uh thermogenesis, curcumin uh in in turmeric activates thermogenesis, um, EGCG and green tea activates thermogenesis. And so while, you know, again, the answers aren't 100% clear, I think thermogenesis is probably one major, major pathway uh by which we're kind of all a little bit colder.

SPEAKER_03 31:30

Yeah, yeah, yeah.

SPEAKER_01 31:31

And our resting energy expenditure is just kind of low and we don't even notice it because it's sort of become the new norm.

SPEAKER_03 31:37

And it's only very marginally, like 200 calories, but that compounds very quickly.

SPEAKER_01 31:41

And 200 calories over 20 years, yeah. So the difference has been 10 calories a year. Sure. So we're all fighting and trying to, you know, keep our weight stable, and we're getting colder and losing energy expenditure because of the quality of the food we eat. Or the lack of quality of the food we eat. And do you think there is some uh over time that the And there may be other mechanisms, but thermogenesis, I think, is at you know at the top of one of the most interesting ones. Yeah. Sorry.

SPEAKER_03 32:07

The the macro nutrient breakdown of what we're eating, you know, there is a thermic effect of different macros, right? Like eating more protein, for example. I think one misconception or one of the sales pitches for for eating more protein is that you burn more calories when you consume it. And and you mentioned earlier about the the this protein craze being a thing now yesterday I was in a store and I saw protein popcorn, which is the first time. But everything here, there seems to be a protein version of it. Yeah, could can can you speak to maybe the um without going too off-piste here, the the impact of the macronutrient intake and and how we've gone so far off the rails there.

SPEAKER_01 32:49

So that that's that's excellent, Chris. You're you're turning into a true nutrition expert. Um, yeah, so thermogenesis, beyond what you know, muscles and Bayesian brown fat can do, there is also thermogenesis in digestion of food. And so that's part of thermogenesis. And it's called the thermic effect of eating. You need to burn a little energy to digest the food. The the thermic uh needs for digesting protein are a little bit higher than for fat and for carbohydrate, you know, slightly higher. And that is pitched in marketing and by protein gurus as being important. In randomized control studies in people, um, the effects, if they're there, they're quite small. Uh, and they're especially small. They seem to be the smallest in people who have diabetes or obesity. Uh, and so they're they if for people who might need it the most. And so while it's probably true that there is a slight thermic difference in protein versus fat versus carb, um, in practice it's probably not very meaningful. So that's one reason why you know high protein diets generally don't outperform higher low carb diets or higher low fat diets. It's really about the quality of the food. And again, we can talk about um uh maybe once we get through protein, what are the priorities of what to eat to be healthy? Um and it's the the macronutrient composition doesn't seem to have have much to do with it. Really. So so why, why are why are these high protein was that so what are the benefits of protein? And maybe we can start there and then and then talk a little bit about the the new protein craze. So it's it's very clearly established that if you're regularly strength training, as you would if you're a member of Wonder Health, or if you're, you know, several times a week, you know, 30, 40 minutes of strength training, not running, not swimming, strength training, uh eating more protein will build muscle. It will build more muscle mass, it will build more muscle strength. Uh well known. And so, yeah, if you're if you're strength training, you should get enough protein. Um, most Americans are already getting enough protein, even if they're strength training, so you don't need more, but but that's clearly been shown. But if you're not strength training, and 80% of Americans, 80, 90% of Americans maybe aren't regularly strength training, what happens to the extra protein? Has anyone that's just an obvious question. Where does it go? Do you build muscle? Right? Has anybody built muscle from anywhere? It's not that easy, right? And so the amino acids are in the bloodstream, they're circulating, you've digested them. The muscles are like, eh, I don't need them. You didn't work me out in the last couple of days. I'm okay. They get sent to the liver and they get turned into body fat, just like sugar. So high protein, putting that extra protein in your shake, having high protein Pop Tarts, there's high protein cheese puffs, high protein Dunkin' Donuts drinks, all these people are building up on the protein and they're not strength training, it's going to all get turned to body fat. Uh, and so it's a it's a mass marketing craze. And so my message is you know, if you see something that advertises high protein, it's probably not good for you. It's kind of like low fat, right? Like low fat was the was the health halo of the 1980s. High protein is the health halo of the 2020s. And so don't try to eat more protein unless you're really, really strength training and you actually need more. Um, because again, most Americans with normal amounts of regular healthy eating, you're getting enough protein.

SPEAKER_03 35:59

What is enough protein?

SPEAKER_01 36:00

So a little bit controversial, um, but I think most experts would say that around 10 to 15% of calories if you're not strength training, and around 15 to 20% of calories if you are strength training, um, is adequate protein. And the average American adult has 16 to 17% of calories right now. Uh, and so sure, if you're on a vegetarian, you know, vegan diet and you want a strength train, you probably have to really actively think about your protein sources. But if you're an omnivore and you're having, you know, poultry and chicken and eggs once in a while, and you're having red meat once in a while, and you're you're you're gonna get that 15 to 20 percent protein without trying.

SPEAKER_03 36:39

How does how does that equate to to grams per pound or grams per kilo?

SPEAKER_01 36:43

Yeah, so so uh I, you know, the it the official recommendation is grams per kilogram of body weight. Um, and again, sort of controversy, but roughly 1.2 um you know grams of protein per kilogram of of lean, healthy body weight, not not if you're you know overweight or obese. But that's hard for people to do the math. And so let's again go back to a 2,000 calorie diet. Uh 20% calories on a 2,000 calorie diet would be 400 calories, that's 100 grams, right? So, so roughly you know, 100 grams of of protein is is more than enough for for most people.

SPEAKER_03 37:17

So I don't need that protein popcorn tonight then.

SPEAKER_01 37:20

Yeah, you don't need the protein popcorn.

SPEAKER_03 37:21

I'll take that back. Yeah, so let's switch gears a little and talk about what good looks like. What does good and what does great look like? Because I think there's a lot of people obviously need to make some pretty drastic changes, but some of those changes are actually in in practice quite simple. So what what does what does good look like to you?

SPEAKER_01 37:42

So I love that you asked that question. And this is why um, you know, I I use the phrase food is medicine. Uh food is not only medicine, you know, food is other things, but it's joy and dignity and culture and and and other things. But food is truly truly medicine. It's it's the positive power of food. Um for for since the 1980s, since the low-fat guidelines, we've sort of framed food uh as something negative, a battle against deprivation. Diet almost means like you know, struggling against food. It's this thing we have to fight against. And we have done careful research in others showing that most disease in the United States and around the world is from insufficient intake of the good stuff, not excess of the bad. And so when I start with patients and when I think about policy, policy change, which is a lot of what we work on as well, my major focus is how do we increase the availability and intake of protective foods? And so for the individual person trying to eat better, um, of course, if there's some stuff you're doing that's really bad, like if you're drinking six Coca-Cola a day and having like six candy bars, yes, cut that out. But for the average person that's already figured that stuff out, I don't focus on cutting this or avoiding that. I focus on adding the good stuff to your diet. And so, and so the way I think about food is kind of in three categories. There's the protective food, and that's the most important food that we're almost all eating too little of. Uh, fruits, nuts, seeds, vegetables, beans, uh, fish, seed oils, fruit oils, nut oils, uh, and yogurt. What do those foods have in common? So the plant foods are all minimally processed plant foods that mostly give rise to life. If you plant them in the ground, they'll give rise to a new plant life, a bean, a whole grain, a seed, a nut. Most vegetables are actually fruits that that are also give rise to life. Anything with a seed, a pumpkin, a pepper, an avocado, and all of their fruits, actually. So all of those foods are are really good for you. Why? They have the fibers, which feed our microbiome, and a healthy microbiome is central, but also they have thousands and thousands of phenolics and bioactive compounds, the kinds we've we've started to talk about, um, that that feed our tissues and feed feed our microbiome. And then fish also have omega-3s, uh, and yogurt is a fermented food, has live probiotics, also helps the microbiome. And so that's what we need to be eating more of. And and it's uh uh and it's not just plant foods, right? There's seafood and yogurt in that category. Then the second category of foods is what I say, you know, kind of the middle category is foods to eat in moderation. Um, these are mostly minimally processed animal foods. And so cheese, milk, poultry, eggs, butter, unprocessed red meats like fresh or frozen beef or pork or lamb. Those foods are okay. You could not eat them at all and be healthy. You can add them to your diet in moderation and be healthy. They're perfectly fine to eat. They're not as healthy for you as the protective foods, but they're not as bad for you as the worst foods, which we'll talk about. And and uh in that list of minimally processed animal foods, cheese and milk are actually at the top. Um, cheese is a fermented food. It's the top fermented food eaten in the United States. It actually lowers risk of diabetes. Milk lowers blood pressure, lowers risk of stroke. Modest effects, they're not dramatic effects, but they're a little bit beneficial. Uh, and eggs and poultry and butter are kind of neutral. They're not really good or really bad for you. And then unprocessed red meats are um okay, one or two servings per week. If you have more than that, they're actually pro-inflammatory. Red meats are pro-inflammatory and also carcinogenic. And then the worst foods, the third category, um, is all of the highly processed packaged, ready to eat, ready to uh eat foods, frozen foods. And they're bad for several reasons. Um, they have high starch, you know, all the white rice, white uh uh, white ripe bread, corn flour, cornstarch, the the green revolution's fruits, right?

SPEAKER_03 41:40

Yeah.

SPEAKER_01 41:40

Um uh in ultra-processed foods, the sugars, the salts, the additives, the lack of natural cell structure. They've been broken down and molecularly disassembled. So that's the worst food in the world.

SPEAKER_03 41:51

Preservatives, like shelf.

SPEAKER_01 41:52

Preservatives, shelf life. You know, Pop Tarts are literally made to last a year beyond their Best Buy date. Like, like, like the maker Pop-Tart said, this is essential for the identity of Pop Tarts that they should last a year on your shelf after the Best Buy date. So, what does that mean? Is that right? Yes, that's right. That's uh that's officially a goal of theirs for Pop Tarts to last a year past their Best Buy date on your shelf.

SPEAKER_03 42:14

So just I when I first moved here, we bought a loaf of bread from a market nearby. And I think I maybe had one slice of this sliced loaf of bread, and then a year later we were moving some furniture around in the kitchen and some appliances, and we found it down that it slipped down the back of like a dishwasher, and it was exactly identical to the day we bought it.

SPEAKER_01 42:41

Yes.

SPEAKER_03 42:42

That is criminal.

SPEAKER_01 42:44

This is a very good rule of thumb. If if you buy something that doesn't spoil, right, it's probably not good for you, right? Uh, and and that's I I I don't want to make people feel guilty. Obviously, you have to buy packaged foods. There's realities of practical life, but which we can talk about, but ultimately we should be buying, you know, foods as close to nature as possible. And so those three buckets of foods, the protective foods, the foods to eat in moderation, and the ultra-processed foods to avoid, that gives kind of a framework for understanding the diet wars and what to eat and what not to eat. If you go to a paleo or a keto diet and you start eating lots of beef and cheese and milk and eggs, and you cut out ultra-processed foods, you're moving up the scale away from the ultra-processed foods to kind of the foods that are okay in moderation. That's a that's a plus for most Americans, right? But it's not as good for you as if you were eating instead nuts and seeds and fish and yogurt and fruits and vegetables. And so it's a spectrum. And so when people say, you know, should I have eggs for breakfast? Is it good for me compared to a super refined breakfast cereal? Absolutely. Compared to hash browns and toast, eggs are great. Is it as good for you as yogurt with almonds and blueberries? No. But if you want to have eggs, why don't you instead of matching it with, you know, ultra processed? Foods like bacon and and and toast and white toast. Why don't you match it with spinach and olive oil and avocados and make it healthier, right? People say, you know, should I put cream cheese on my bagel? I say, have the cream cheese skip the bagel, right? Yeah. The cream cheese is better for you than the bagel, like which is just a big, big puff of starch, right? So I think this spectrum of foods kind of helps people, you know, understand what to eat. And again, what I focus on is say, okay, look, among these protective foods, which of these do you want to try to add to your diet this week?

SPEAKER_02 44:32

Yeah.

SPEAKER_01 44:32

This month, which of these can you increase a little bit? Uh and and move forward with that. Uh, and that helps people kind of start to move towards a healthier diet.

SPEAKER_03 44:41

Sorry, that all makes perfect sense, but uh this might be a naive question. But why does that not reflect this new food pyramid? You know, the the the new version of the food pyramid, correct me if I'm wrong, there's very it's very much protein heavy at the top.

SPEAKER_01 45:01

Yeah, so you know, the dietary guidelines uh for Americans come out every five years and they're updated based on kind of the science and the government. And this new update that has come out of the Trump administration, um uh, there are some problems with it. But but actually, it's actually the best dietary guidelines I've seen in my career. Uh, and so there's some real strengths to it. And so, so you know, it's worth talking about what they show because the media, I think, has sort of pitched the guidelines for the things that are controversial rather than the things that are really big and really different. So the new dietary guidelines actually, one of the most important things they say for the first time is that Americans should avoid processed foods, packaged foods, ready-to-eat foods, foods with artificial sweeteners, colors, preservatives, dyes. No dietary guidelines has emphasized that before. And so if you put all that together, that's maybe 60% of the food supply. So that's big. Um, and then the guidelines also say to embrace healthy fats, which is great. We need a lot more healthy fats in our diet. Um, they say to minimize refined carbohydrates. So that's your white rice, your white bread, you know, your crackers, your bakery goods that most Americans don't think are that big of a problem. Uh, they also continue to recommend, you know, fruits and vegetables and avoiding salt. And so all of those things are non-controversial. Really, the only thing they changed that that the media has highlighted is they they recommended more protein uh from about you know 11, 12% of calories, which was where it was before, to 15 to 20% of calories because of this idea that they want people to work out and and have you know better muscle mass. The guidelines actually don't say to eat red meat as your only source of protein. The guidelines literally say have your protein from a range of sources, from red meat, poultry, eggs, dairy, nuts, seeds, beans, soy, legumes, beans. And every dietary guidelines going back to 50 years has said that to have your you know protein from a range of sources. So they're not really a meat-focused guideline, but the media has kind of made them out to be. And if you look at the actual new triangle, the inverted pyramid, um, I view it as a triangle with three pillars. And so one pillar is uh protein and dairy and healthy fats. One pillar, another corner is fruits and vegetables, and another one is whole grains. And there's actually, if you look at the image, 60% of it is fruits and vegetables and whole grains, 40% of it is animal products, and of that animal products, there's fish, there's poultry, there's eggs, there's red meat. So there's not more red meat on these guidelines than there ever have been before. But but, you know, the government was trying to be cute. And so, you know, they flipped the pyramid and they put red meat as the very first thing you see in the top left. So it's not taking up more space in the pyramid than it ever did before. It's just the first thing you see. Uh, and so they were trying to kind of, you know, send a message. But if you really look at it as here's the range of foods that my shopping cart should look like, it's actually very sensible and I think, you know, pretty pretty good dietary guidelines.

SPEAKER_03 48:04

Would you make any changes to it? And the reason I the only reason I say that is I feel like fiber is underplayed slightly in it.

SPEAKER_01 48:15

Yeah. Well, so I'm really happy that the guidelines say first and foremost to eat real food and to avoid highly processed foods. Again, that's never been a message that USDA has been willing to make because they they they have competing goals of helping Americans be healthier and supporting the US food sector.

SPEAKER_03 48:33

Yeah. Yeah.

SPEAKER_01 48:33

And they've never really wanted to say, don't eat food, right? Uh uh, and and so, and so that's a big deal. So I'm very happy with that. I think if I could edit them, you know, the things I would have done is to um not I wouldn't have increased the protein target. I think Americans are eating enough protein and I I wouldn't have changed that. And I would have made clear that that there's a hierarchy of healthfulness of fat sources and protein sources. They basically said have your fats from a range of foods, have your protein from a range of foods. Um they're not all created equal. But they're not all created equal. And so, and so, you know, plant-based sources and seafood sources are at the top. Then I would put fermented dairy like cheese and yogurt. Then I would put, you know, other animal foods like eggs and poultry, and then maybe unprocessed, you know, meats. And then at the bottom I'd put processed meats, meats that are preserved and last for weeks, whether it's low-fat deli meats, which every health conference I go to gives me this like low-fat, you know, roast beef sandwich, right? Which is terrible for for us, but they think it's good for you because it's low fat, right?

SPEAKER_02 49:35

Yeah.

SPEAKER_01 49:35

So processed meats are are I think I think the worst. So it would have been nice if they'd had a hierarchy um of fat and protein sources. But other than those two changes, I think really the dietary guidelines are a big step in the right direction.

SPEAKER_03 49:47

Yeah. I guess it's tough to fit all of that into a very simple shape, right? Like that's is a bit more nuanced than that. Um, can we just assume that for a second that we live in the world where people are following this? Yet we go back to the comment that we or the the discussion we had earlier about this law of thermodynamics and like you consume too many calories, you will always put on weight, whether it is you know intentional and through training and lean tissue or it is fat, right? If you eat a you need a surplus of calories to do that, and you need a deficit to do the opposite, to lose weight. Assuming that everyone is following the guidelines, is there a risk that people think that they're you know um eating the right volume of food but are overeating?

SPEAKER_01 50:43

So a big mistake we've made in science and in public health and in clinical medicine is to uh talk about the causes and solutions for obesity uh in terms of conscious choice, in terms of willpower, in terms of understanding really the biology underlying, underlying our choices. I think we what we've learned is that obesity is about unconscious biology mostly. There are exceptions. There are people who eat for stress or you know, people who have eating disorders, and you know, that's not an insignificant part of the population. So maybe up to one in 10 Americans might really really have have significant kind of issues. But but that aside, our physiology is actually exquisitely tuned to maintain our body weight.

SPEAKER_03 51:28

Yeah, yeah.

SPEAKER_01 51:29

We're not exquisitely tuned to become obese, we're exquisitely tuned to maintain our body weight. Uh, the average weight gain in this country, uh, in in the average American is a pound per year.

SPEAKER_03 51:40

Is that right?

SPEAKER_01 51:41

That's it. And and yet that's the obesity epidemic, right? You go to your high school reunion, you graduate, you come back 20 years later, everybody's gained 20 pounds, you come back for your 40th, people have gained another 20 pounds. That's the obesity epidemic. But it's but but with all the toxic food environment and the food being, you know, even with inflation being cheaper than it's ever been in human history, and parties and and pretzel sticks and buffalo wings and alcohol, and we still manage to almost maintain our weight within a pound. Yeah, yeah, yeah. So it's really unconscious physiology trying to maintain our body weight. And so, you know, if we all ate a truly minimally processed healthy diet, um, we'll still have obesity because we've always had sort of a bell-shaped curve of of human variation. You know, all go back a thousand years, there were some humans that had excess body weight. But we'll return to what we were like 50 years ago, where being normal weight was normal. You know, when three in four Americans have overweight or obesity, yeah, and of the other quarter, there are people who have visceral adiposity, you know, fat around their organs and are thinned. Being normal weight is no longer the normal, right? And so we would definitely return to that without counting calories, without trying, without overeating. And uh, and and fat is definitely your friend. And this has been proven in randomized trials. And so uh, you know, the Atkins diet um was was this kind of high-fat diet. When people eat high-fat diets, um, they they actually lose weight, um, even though those calories are are all you can eat. And and to go back to thermogenesis, there's some great science, uh, which I also you know cut cover in my book, that there have been randomized trials in people um comparing people who've lost weight and then get put on low-fat diets or high, high fat, low carb diets, and just measuring energy expenditure. And the the on the low carb diets, their energy expenditure, uh, excuse me, on the low fat diets, the traditional low-fat diets, their resting energy expenditure goes down by about 300 calories per day. They start to regain weight, they feel cold. If you go on a very high-fat diet, their resting energy expenditure doesn't go down, it stays up. So there's something about carbs, you know, that that worsen resting energy expenditure. And there's something about fat that protects it. And so fat's your friend. So I I probably I don't measure it, but I probably have a 45%, you know, of my calories come from fat. The the recommendation from 1980 was less than 30, right? I embrace fat, you know, extra virgin olive oil, avocado oil, pour it on everything, cook it with everything, nuts and seeds and avocados and seafood. Um, you know, you should embrace fat. And and really carbs and fast carbs, highly refined starches, sugars, that's that's the bigger problem in the food supply. Yeah.

SPEAKER_03 54:30

Why is it that so many people rebound so aggressively when they've lost, you know, and they've intentionally lost fat? Yeah. Because I I think that the the point that really resonates with me is that we always seem to now I I fluctuate a few pounds either side. And sometimes I feel like even if I'm being really careful with the volume of food I'm eating, I'm not losing huge amounts of weight and I'm not putting on lose of uh uh uh huge amounts of weight if I'm eating too much. Is there some science to that that there is this sort of just balance point? And then why is it that people who get into a really bad position then lose a lot of weight end up rebounding so aggressively?

SPEAKER_01 55:09

So, so let's turn back. Uh uh, I want to answer that, but let's and talk about that, but let's turn back uh after that to the pleasure of eating and the satiation of eating. I I think that's really important to talk about uh as well in ultra-processed foods. Uh, but but there's very clear science that that on average, all of the mechanisms in our body try to maintain our weight. And so you can actually, there's been studies done where you intentionally overfeed people, they eat extra calories and then you let them kind of go back to normal and they'll lose weight. They will eat less and lose the weight to just kind of get back to where they were. So the problem is that you know our body's set to our current state. And so once we've slowly gained weight over time, you know, you try to lose that, the body starts to fight back, right? Resting energy expenditure can go down, your microbiome can change, your metabolism can change. And so rapid weight loss, especially, the body will fight back rapidly. The second problem uh uh is that if you do it just by counting calories and not by modifying the quality of the diet to eat everything we talked about, you're starving your gut microbiome, your thermogenesis might go down. If you do it uh not by counting calories, but by eating foods that are gonna work with your gut, gonna activate your thermogenesis, then you might see, like I said, that you lose, you know, a pound a month without trying. And then you're not fighting this thermostat so much, this weight that you're slowly resetting your thermostat. And so I think the the this is my best guess, right? Because nowhere have we successfully beat the obesity epidemic at scale in communities. It's not happened.

SPEAKER_02 56:42

Yeah.

SPEAKER_01 56:42

So maybe this is all wrong. But based on clinical experience, based on the science, I think that if we all really ate minimally processed, high-fat, high protective food diets, nurtured our gut microbiomes, um, uh also had reasonable activity, but but you know, I think again, that that's not the as big as biggest part of the equation right now. Um, I think we would slowly normalize. And most importantly, younger people wouldn't gain the weight that then predisposes them to this battle, right? I mean, I mean, it's possible that the the challenge for the existing generation is gonna be large. And we can talk about GLP1 drugs and and why those, the pros and cons, those may be necessary once you've really hit, you know, uh one in 11 Americans weighs more than 300 pounds. So, you know, it's gonna be hard to have those Americans get back to a totally normal body weight. But really, the the the fight should be for our children, right? And how do we ensure and younger people and and middle-aged people who don't have have that weight yet, how do we keep them from gaining the weight? So so I think it's it's gotta come back to diet quality uh and to the the the uh the the minimal processing of food and the types of foods we're eating as the first and foremost consideration.

SPEAKER_03 58:02

Feels kind of a look, I love I love the um idea of not having to count calories and track macros. It's kind of annoying, right? And also I would wager that most of the tools that you're doing that with don't work terribly well. And if I'm right in saying that, you know, if you eat a hundred calories too many each day, over the course of a year you'll put on a bunch of weight. And if you eat a hundred calories too few, then you'll lose a bunch of weight. And if those calorie trackers are not within that frame of accuracy, then they're not all that helpful.

SPEAKER_01 58:35

And remember, too, that you could eat exactly the same amount of calories and track it accurately, but not know is my gut microbiome digesting them or am I digesting them? Or what are the calories doing to my thermogenesis and my resting metabolic expenditure? They might be doing different things that you can't even measure with just tracking calories in.

SPEAKER_03 58:52

Yeah. Yeah. Huh. Let's get a bit strategic here. As so I'm assuming that, you know, we're we're taking this on board that we, you know, eat along those three pillars, the protective foods and then eat in moderation, then the avoids, and that we can manage to sustain that over time. What are the additional um considerations that we should weave into that approach? What are the things that we should absolutely avoid if we want to, you know, maximize our health and our body composition? Then what are the things that we should be eating more of that don't fit within that frame? So, like I'm I'm thinking alcohol, sweeteners, supplementation, those things. I think we're bombarded with so many different perspectives there. Nice, easy question.

SPEAKER_01 59:39

Yeah, yeah. Well, so so let's first just go back to the macros as part of that. Yeah, uh, because you mentioned that uh, I think uh well, that you can have a healthy or unhealthy diet with almost any level of carb or protein or fat. And it's that that's not the primary consideration. In today's modern world, carbs are the biggest thing that have been highly refined, and now protein's starting to be added to that. So I'm worried protein's gonna go the way of carb, but still carb is so generally on average, if you have a lower carb diet, you're gonna be healthier because carbs are tend to be horrible in the modern US diet. But that's not because carbohydrate per se is bad for us, it's just because of the way it's been processed. Right. So, really practically the macros don't matter. I mean, I do think there's evidence that that high higher healthy fat diets are good, but again, it could just be because of processing of protein and carb, right?

SPEAKER_03 1:00:26

Yeah. So so You mean the the the fact that you're not eating as many processed foods.

SPEAKER_01 1:00:31

Exactly. Exactly. If you if you have more olive oil and you have more whole father, whole fat dairy, yeah, you're gonna have less white bread and white rice and goldfish crackers, right? Um and Pop Tarts and the bread that fell behind your your pantry and was okay. Yeah. So I think macros aren't the priority. Um, but if you have to follow anything, embrace healthy fats, right? Big big picture role. Yeah. Uh I think if you're eating that overall healthy diet, um, you know, I guess a few, a few um uh tricks of the trade to help kind of with that. And so, you know, I I I love, you know, a good sourdough bread or white or bread. Um, I think it's incredibly tasty. You know, I like I like good Persian rice. I'm from, you know, Iranian American and nice great rice. And I like a nice pasta dish once in a while. You know, all of that's starch. And and so starch is just glucose. And so people don't realize that white bread is literally glucose with salt in it. Yeah, yeah, yeah. Right. Uh, and and so, and so you know, cutting that out completely is difficult. And so just some tricks of the trade. I tell people if you're gonna be having rice or pasta or bread or crackers or, you know, any of the any of these starchy foods, think of them as the side, not the center of the plate. So your plate's not centered around the rice or the two thick slices of sandwich bread or, you know, a big bowl of pasta or whatever. Think of it as a side. Never have it on an empty stomach because the glycemic response and the body's response changes based on what you've eaten before. And so the worst thing that that that we do in the United States in terms of that is restaurants bringing the dinner rolls first thing, right? That should be after the food, not to start, right? So don't eat the dinner rolls first thing. Or if you eat them, drown them in olive oil, right? Before before you eat them.

SPEAKER_03 1:02:13

Uh wait, wait, wait. Before you move on from there, yeah, yeah. Can we unpack that a bit? Because that seems counterintuitive to most people to drown it in olive oil. How does that work mechanistically?

SPEAKER_01 1:02:25

Yeah, so so uh um, so corn flour, wheat flour, rice flour, potato starch, right? That's refined grain, refined starch, refined grains. It's glucose, it's 100% glucose. And whereas sugar is actually half glucose and half fructose. And if those starches are refined, in other words, they're don't have natural intact structure anymore, like think of a steel cut oat has natural structure versus a whole grain processed breakfast cereal does not, it's digested very, very quickly and leads to spikes in blood sugar and all the negative downstream consequences. So that's why I'd say, you know, eat it as a side to have less of it. But in addition to less of it, the order in which you eat it matters and what you eat it with matters. And so if you have, there have been very nice studies done that if you have a piece of bread and then 10 minutes later have a have a piece of chicken, or if you have a piece of chicken and then 10 minutes later have a piece of bread, there's dramatically different blood glucose responses to the bread if you have the chicken first. Uh and so having a stomach with other things in it slows the digestion of the starch. And then secondly, if you actually physically mix it, it's even magnified. And so if you're gonna have bread and you dip it in olive oil and enjoy the olive oil, we my in my family we go through at least a liter of olive oil a week, right? Uh dip it in olive oil, enjoy it, you're gonna slow the digestion and the negative impacts uh of that starch. And so, and so that's kind of a rule of thumb about starch is enjoy it with with you know uh uh uh uh uh other foods and mix it with other foods. So if you're gonna have pasta, tons of vegetables, tons of olive oil. Um, if you're gonna have rice, you know, put curries on top of it, put stews on top of it, mix it with food. Um, you're gonna have bread, pick the thinnest, you know, a sandwich, pick the thinnest bread you can, or have it open face and one slice, right? There's ways to kind of minimize starch because that's one of the biggest things.

SPEAKER_03 1:04:14

Without removing that from your diet, you still enjoy it.

SPEAKER_01 1:04:17

Food has to be flavorful and enjoyable. Uh and and you know, to get back to your point about flavor, uh the GLP1 drugs, I think, are teaching us that uh natural, normal human physiology does not like ultra-processed foods. I uh public health experts for about 30 years have been saying that the food industry has hooked us by concocting foods in a certain way that ultra-processed foods hook us to eat more. Um I actually think they taste terrible.

SPEAKER_02 1:04:45

Yeah.

SPEAKER_01 1:04:46

So I actually think they don't taste good. And and I I believe uh I can't put myself in other people's minds, but I believe that people are like they superficially start to make us think they taste good, but they really don't. And that's why you keep eating them because you're waiting for that satisfaction of eating something that actually really tastes good and it never comes. Where if you truly have a healthy meal, you're like, that was great, and and you're done. So I think that's true. But even that being said, what's interesting about the GLP1 drugs is is many people, not all, many people go on them, not only they eat less, they're their their tastes change. And they no longer crave twinkies and hojos and candy and and soda. And they they try to eat those things and they feel disgusting. And they say, they say, Oh my gosh, the the hojos taste like plastic now. Or wait, what's a ho? What's a ho ho? Ho ho from their your your uh Brit British background. Hojos and Twinkies are these like highly processed like um cakes that you find in like 7 Eleven or you know, yeah, yeah. Now I think I know what you mean. Oh, yeah, yeah. So so you know, schools used to sell them. They used to be an old school, maybe they still are. So, and they crave people on GLP1s, they start craving cherries and fruits and and salads. And so And so I think we actually have a nation of GLP1, which is this hormone made by the gut that goes to the brain. We have a nation of GLP1 deficiency or resistance. Much like diabetes is a disease of insulin deficiency or resistance. I think we have abnormal GLP1 function when we have obesity and diabetes and metabolic dysfunction. And so I think what the GLP1 drugs are showing us is that if we normalize human biology, we're actually evolved to crave fruits and vegetables and fish and dairy and healthy foods. And so I think that's a great message that we're not like biologically destined to eat junk food. We're actually biologically destined to eat real food, but we've been our biology's been been uh uh you know taken over and GLP ones are starting to to normalize that. And so I and that's why the food industry is terrified of GLP ones, because it's not just people eating less, it's people changing what they eat.

SPEAKER_03 1:06:55

Can can we uh double click on the GLP one, Agonist, for for a minute? I think there is because there are so many seemingly positives for them, but we're not but one concern I think you know, if we think about all of the recommendations you've made and then think about drastically reducing the amount of food people are eating very quickly and losing a lot of weight very quickly, they're they they don't align, right? And so is there a concern that of course in the short term people are changing their body composition very quickly? And for people who are dramatically overweight, that is the benefits are going to outweigh any negative, I suspect. But how does that impact us long term? Because if you're losing lots of lean tissue or bone density, perhaps, by virtue of losing that very quickly, and we suspect that when you lose that weight quickly, you will get a rebound. How do we how do we solve for that?

SPEAKER_01 1:07:55

Great, great questions, Chris. So so there are people that can lose 100 pounds in two years on a healthy diet. I mean, I've seen it, you know, there are people that just change their diet and say, I'm gonna do it, and they can do it. And so And keep it off. And keep it off. So far, I mean, you know, I haven't been following them for 20 years, but I've I've seen it happen. So it's not impossible, but but for the average person, whether it's biology or society or a culture of food, for the average person, it's very hard. And so, you know, I'm a physician, you know, first and foremost. And so if somebody is sick and needs a GLP1 drug and is indicated for a GLP1 drug, it's okay to try it. I'm not somebody who's like, oh, these are the worst thing, you know, these are the most remarkable drugs that have ever been invented for obesity. And what's amazing is they were developed as diabetes drugs and discovered by accident to, and that just shows how little we understood obesity, right? That the best drugs we've ever invented were accidentally developed. We just didn't understand, still don't understand obesity. Uh so I think they should be used, but we're not using them wisely. Uh and and so, you know, you you you you let alone their cost. Um, we we have a cost analysis that that that we've done that even accounting for all the downstream health benefits of the weight loss, less cardiovascular disease, less hospitalizations, back pain, gallstones, depression, everything, they still don't save money. Um, even if you take them and stay on them, they still cost money. And so if all the L if if half of eligible Americans took them over the next 10 years, we'd spend another $50 billion in addition on top of their savings in GLP one drugs. So, you know, that's a lot of money and it's gonna kind of so these are gonna bankrupt, and this is at the at the new most favored nation price of $245 per month, which is much cheaper than the than the sticker price. So they're too expensive. So that even if they worked, but I think the the problem you raised is the is the bigger problem that you lose weight quickly on doing anything. If you lose weight quickly, you'll lose not just fat, but also muscle and bone, a substantial amount of muscle and bone loss. And then most people don't stay on GLP1s long term. Um, 25 to 40 percent of people are still on the drug at a year. 25 to 40 percent. Most people are off the drug at one year. And then if they haven't changed their lifestyle, if they've used GLP1s as kind of a band-aid, they regain the weight. And probably, this hasn't been well studied, they only regain the fat. They're not gonna regain the muscle and bone that they spent their whole lives gaining, right? And so they're gonna be worse off. It's called sarcopenic obesity, right? Low muscle mass obesity. And so right now with GLP1s, we're basically renting weight loss, right? For for thousands of dollars a year instead of buying true long-term health, we're renting weight loss. And all of the society guidelines that that recommend GLP1 use say these should be done on a foundation of good nutrition lifestyle. The FDA actually, if you read the approval for GLP1 use, it says obesity uh GLP1s are approved for obesity treatment as an adjunct to nutritional lifestyle. That's not how we're using them, right? We're using them as the first line. Yeah. So I think GLP1s should should only be used with wraparound nutrition and lifestyle counseling for everybody. And for if you're low income, with a prescription for healthy food to help you pay for it too, right? Sure. Um, uh and otherwise, I think it's it's clinically inappropriate. I think it's you know ethically indefensible, and it's economic suicide for our country to be just passing out GLP1s like like they're the solution. They're they're a tool that has to be used on top of lifestyle, not as a replacement for lifestyle.

SPEAKER_03 1:11:29

Yeah, that lifestyle piece has to be the foundation. Yeah. And I think one thing I sort of struggle to reconcile with is the advice that is being given alongside them is you don't need to worry about lean tissue loss, providing you're still doing resistance training and doing all the right things. So I think even when we are doing being given the correct advice, actually doing the thing is is easier said than done. Yeah. And if you weren't doing the thing before, it's going to become even more difficult to do it.

SPEAKER_01 1:11:55

That's right.

SPEAKER_03 1:11:56

Because if your appetite is suppressed and you're it doesn't matter what target of protein we give people, then if they're not going to eat it, then they're not going to be able to build it's like trying to build a house without any bricks.

SPEAKER_01 1:12:05

Right. Or or or they're eating the protein but not going to the gym.

SPEAKER_03 1:12:08

But not doing the weight training. Yeah. Yeah. Yeah. There's a lot to unpack there. We won't go too too far off piece. Can we just go back very quickly to this idea of um the the pairing the bread? And I don't want to over overdo it on this, but what why do we even get given bread in the first place? Like it strikes me as a poor choice for even like a the restaurants because you're gonna feel fuller quicker. Yeah. Where's that come from?

SPEAKER_01 1:12:35

It's uh you know, it's interesting. I in my book I cover a lot of the history of kind of all the stuff. I didn't look into that, and so that's actually quite interesting. And and that I should look into that and under understand why. Um, you know, I have three three teenagers right now, um, two in high school and one in middle school. Uh and and uh when my kids were little, you know, we knew the science, and and we knew my wife also studies uh nutrition. She's at at Harvard School of Public Health, and and we knew that their they their lifetime risk of diabetes and their lifetime risk of overweight and obesity, like the odds are stacked against them to be healthy. They're stacked against them. They have they have a much higher chance of being sick than being healthy. So we wanted to do everything we could to teach them about healthy food. And so when we'd go to dinner and they're hungry, little kids hungry, we'd like put a napkin over the bread rolls, yeah, just they wouldn't see them until the food came, you know. And so it's it's a really crazy, you know, crazy system we have. And and um, again, it's just sort of a simple rule. And so what I tell people is just skip the bread, yeah, and instead of ice cream afterward. And and and they're like, ice cream, like you're a cardiologist who studies food as medicine. Why are you recommending ice cream? And I explained to them that ice cream is actually healthier than bread. And and that, I use that example because first it blows people's minds a little bit. But also a key message there is that healthy eating is not about deprivation, it's not about you know taste, it's about really understanding nutrition. And so, why is ice cream healthier than bread? Ice uh bread is, as I said, glucose with salt and maybe other additives and preservatives if it's not, you know, not well made. Ice cream has protein, it has dairy fat, and dairy fat's not bad for us. It has vitamin D, it has other vitamins, it has something called milk fat globule membrane, which are sphingolipids and phospholipids that actually interact with our genes and affect our gene function. Bind cholesterol in the gut can actually lower the bad cholesterol to some extent. And so don't eat that dinner hole before dinner, whether you're at home or in a restaurant. And then after dinner, have a scoop of ice cream. And even better, add some almonds or slivered almonds or walnuts and some throw some blueberries on top and raspberries on top, and then you're even making it more healthy. And so, you know, food, food should really be about pleasure. Um, and if you start with kind of healthy principles, you can actually have an even tastier diet than than I think kind of the average American's diet.

SPEAKER_03 1:14:55

There's nutrient, there's nutritional density in the in the ice cream, but not in the bread effectively.

SPEAKER_01 1:14:59

That's right, yeah.

SPEAKER_03 1:15:01

Can I ask you some personal questions about your nutritional practices? Yeah. Because and we've had some discussion about this in the past, and I think we're both aligned in that you know, it shouldn't just be about eating a nutrient-dense diet, and so much of our happiness is born out of these shared moments with family and friends and the joy that we get from eating. How often are you eating foods that you know you shouldn't?

SPEAKER_01 1:15:29

Well, so as I said, I think the my biggest weakness is starches, you know. So as a as a as a Persian, I love like good tadig, which is the crunchy rice at the bottom of the of the rice that comes, you know, from from brown browned rice. I love some good sourdough bread with, you know, dinner or with the soup or things like that. And so for me, that's the thing I have to sort of just just be sure I'm having, you know, as again, it's as a side, I'm eating with other things. I'm not eating it by itself. Other than that, I just go for flavor. And the way I've grown up or the way my GLP1 system is wired, or the way my microbiome is wired, because I've eaten healthy food, I crave healthy food. Like it, yeah, I actually crave salmon and asparagus, you know, I crave almonds and and um carrots and hummus and and you know, foods that are really, really delicious. So I don't beyond just kind of being a little bit careful about the starch I eat, um, I couldn't, you know, I see a bag of flavored, crazy flavored potato chips uh or or you know, other highly processed foods, and I actually don't want to eat that. You ever eat them?

SPEAKER_03 1:16:33

Yeah.

SPEAKER_01 1:16:34

I mean, I I would I would I wouldn't like it. Like I would take a bite and it actually doesn't taste good. And it's it's it's like exercise, right?

SPEAKER_03 1:16:41

Yeah, yeah.

SPEAKER_01 1:16:41

Once you start to exercise and you really are doing it regularly, you can't go back to a center electrode and you feel terrible. It's really the same with with healthy eating.

SPEAKER_03 1:16:49

You told me a story once. I might butcher this, but I think you were away somewhere, you'd gone on holiday, and there was no salt. Is this right? Is that right? Yeah. That's right, yeah. Can you tell that story? Because I I thought that was kind of a fascinating insight. How to you can kind of rewire your perspective on this.

SPEAKER_01 1:17:05

Yeah, that's right. So when I was a uh a junior faculty member at Harvard, I was working with this group in Italy on fish oil, and we were studying fish oil and and the health benefits of fish oil, which is truly, you know, miraculous. At grams per day, fish oil can prevent heart attacks. It's kind of amazing, right? Grams per day, uh milligrams per day, even, you know, in some cases. Um, and and so we were in we're living in southern Italy, uh outside Pescara, which is on the Adriatic coast, and uh the most kind of authentic Italian food, stunning. And we rented a little house, you know, for for two months, and uh we went, you know, to the local market and and came back and walked, and it was long and had our bags. And we came back and there's no salt in the house, and we hadn't bought salt and and we didn't want to walk all the way back. And so we said, okay, we'll make do for a few days. And so, you know, that first pasta we made that night, boy, it tasted bland, right? No salt and boiling. And then we had tomatoes and and you know, uh mozzarella cheese and the tomatoes were like not great. And then by the next day, like the food started tasting a little bit different, and we started noticing flavors that we hadn't noticed before. And by the second day, it didn't taste so bland anymore. And that that lack of, and by the fourth or fifth day, the food tasted brilliant. It was incredible. It had all these new flavors that that we hadn't noticed before. And I learned thereafter reading about it that the salt receptors in the tongue are actually highly plastic and highly changeable within days, within weeks. Uh, and it kind of makes sense. Like people in northern China that have the highest intakes in of salt in the world, their kids aren't saying, Mom, my my food's too salty.

SPEAKER_03 1:18:42

Yeah, yeah. And then some you ate it, you know.

SPEAKER_01 1:18:44

Some countries in Africa that have salt half the level of the US don't say, Oh, give me a salt shaker, right? So, so the the human taste for salt is highly malleable. And so try it yourself. Just cut out salt from your cooking. And and instead, we never use salt in any of our cooking. And we use cheese that has plenty of salt. We use lots of cheese. We sometimes add a little bit of salt at the table, but not very much. Um, and you will find within a week or two, you will be noticing flavors and noticing tastes that you've never actually noticed before in food. Now, the downside and the risk is you can almost not eat in restaurants anymore. Because restaurants add so much salt to their food to hide and mask other flavors that almost everything is gonna taste like the chef like poured a salt shaker on it. Do you think the same applies to the sensation of sweet? Unfortunately, no. Oh, really? So then well studied, and and the tongue receptor is not malleable to sweet. And so salt, but but not sugar. So so you can't, if you cut out sugar, low, low sugar things aren't gonna taste sweeter, unfortunately.

SPEAKER_03 1:19:46

What's what's the science on salt intake? Like, do you have a perspective there? I've heard so many conflicting opinions.

SPEAKER_01 1:19:52

It's it's you know, one of those things in nutrition that I think is about as slam dunk as you can get, that that high salt is bad. Um, uh, you know, it uh the average American consumes about uh 3.3 grams of sodium, which is one part of salt. Salt salt is sodium chloride. Um the recommendation, depending on you know which group you look at, is around two grams, and we're at 3.3 grams, or or and so we're more than 50% above what what we should be eating. And it's really, really clear that salt for sure raises blood pressure and raises risk of stroke, uh, raises risk of cancers throughout the gastrointestinal tract, in particular stomach cancer. And also, beyond its acute effects on blood pressure, this has really been clearly seen as well. Salt damages tissues. If you have too much salt, you start to get fibrosis and you start to get fibrosis of your blood vessels, of your kidneys, of your heart. Uh, and so uh one of the things that's really amazing is in the United States, people used to think it was a normal consequence of aging for blood pressure to go up with age. Uh, and so they didn't think, you know, that blood pressure going up with which age was a problem, and you had presidents dying of strokes and heart attacks because the doctors weren't treating them. And then we started studying other cultures that have low salt diets, and we saw there are people living to their 70s and 80s that have no rise in their blood pressure. And so this rise in blood pressure with age, you see across the world, is highly correlated with salt consumption. And so, and that's because of the fibrosis. And so we're actually damaging our blood vessels long term. So, salt is bad news. Um, now, now, the the flip side of that is that the salt you add in cooking or you know, at at the table is about 15% of salt in the diet. 85% of it is in processed and packaged foods as a preservative. And so if you're not eating processed and packaged foods and you're just cooking at home, you don't have to even think about salt. You don't even have to have to have to worry about it.

SPEAKER_03 1:21:48

So you mean you can you could still add it to the food to flavor it?

SPEAKER_01 1:21:50

You can add it to your cooking.

SPEAKER_03 1:21:51

It's gonna be nothing compared to to what only in the absence of ultra-processed foods.

SPEAKER_01 1:21:56

And then the other interesting thing about salt that I that I emphasized to to my patients is that things that taste salty generally have pretty little salt. And it's the things that don't taste salty that that are gonna get you when it comes to packaged foods. And so potato chips and salted nuts have about 65 to 100 milligrams per serving of salt, which isn't actually that much. Um, a slice of one slice of bread might have 150 to 300 milligrams of salt, and two slices of bread, which is what most people eat, might have 600 milligrams of salt compared to, again, potato chips might have 60.

SPEAKER_03 1:22:31

How do you how? That's too confusing for me.

SPEAKER_01 1:22:34

So the major purposes of salt is not for the flavor of saltiness in processed foods. The major purpose is as a preservative uh and to hide the taste of preserved and processed food, particularly meats. But why can you then not taste it? Uh, because it's embedded in the food. It's not on the surface, right? In a nut or in a potato chip, it's just on the surface. There's nothing inside. In bread, it's distributed throughout the whole thing to prevent bacteria and mold from coming. Okay. And so, and so it's really about pro processed foods that don't spoil, yeah, not like what tastes salty, usually.

SPEAKER_03 1:23:09

Yeah, yeah. Okay, before we move on to the sort of bigger picture piece, which I do want to uh to to finish on, there are just so many myths, misinformation. This was one of them, like, and maybe that's not misinformation, but just our perspective on what should and shouldn't be right. Can I ask you a few? Um this has been the hardest podcast I've ever recorded because every time you say something, it's opening up so many new lines of questioning. Um, but I think there's a few that as consumers we are unsure about either way. And so alcohol, let's start there. I don't think there is much um debate about there being many benefits to alcohol, but we've been told for many years now, moderation, there is some benefit to true or true or false.

SPEAKER_01 1:24:00

So, so let's start with the first point you made, because that's really important to emphasize. There's no doubt and no scientific disagreement that, you know, kind of more than probably a drink a day, um, and maybe up to two drinks per day for men and a drink a day for women is bad for you. No doubt. And you can't, you know, save it up and do it all on the weekend. You can't not drink Monday through Friday and have all five of your drinks on Saturday. That doesn't work. It has to really be in moderation. There's no doubt there's liver liver, liver disease, cancers, accidents, homicides, depression, on and on and on. So the only debate has been well, what about you know a drink or two per day uh versus none? And also the type of alcohol has been a little bit of debate. The the type of alcohol is irrelevant. That's very, very clear now. Um, there's really no health difference between wine or beer or spirits. It's because it's the alcohol that that is that that really matters. So, really the question is, is drinking a little bit good? And if it is, it would be good for the heart. That's what has been seen. Um, when I started in this field about 20 years ago, I believed that moderate alcohol drinking was protective because we had lots of observational studies showing that. And then we had some mechanistic studies supporting it. And so it seemed to be true. The problem is in observational studies, you're comparing people who are drinking versus people who aren't drinking at all. And usually people who aren't drinking at all, there's a reason they're not drinking at all. So you're kind of comparing people to unhealthy people sometimes. And more and more science that's come out in the last you know 10 years or so has suggested that that benefit is bias. It's not real. And so, while I wouldn't say it's 100% settled, the vast majority of scientific expert groups, independent groups that have looked at this have concluded that alcohol at any dose is harmful. And there's probably no cardiac benefit. And so, and so this idea that, oh, I'm gonna have a glass a day and it's gonna be good for me, net, uh, is probably not true. Now, that doesn't mean you can't drink at all. Uh, it just means that no, that you're doing so, you want to be sure you're doing everything else well to offset that risk. And the risk isn't enormous if you have two glasses of wine, three glasses of wine per week, you know. Um, uh on the flip side, I'll say that that um folks in our neighborhood, um, I think after COVID it really started, a lot of people stopped drinking. Uh, and I know a lot of middle-aged folks, in particular, you know, women, but also men who've just kind of stopped drinking and started doing mocktails and other things. And what's amazing, anecdotal, they say they sleep better, they're lost a little weight, their skin is better, they feel better. So I think even a alcohol is a depressant. I think even a few drinks per week is maybe not great. And so I'm not telling people to stop drinking, um, but but um I do think that alcohol is probably harmful at at any dose. And if you drink, just be sure you do so in moderation.

SPEAKER_03 1:26:46

Do you drink ever?

SPEAKER_01 1:26:47

I I've never drank in my whole life. I've never ever never even tried it. Um, and I it's I think just been philosophical. I was an athlete, I was a wrestler in in in high school and in college and didn't didn't want to get involved. Uh now I do taekwondo. And and and then, you know, after that, I just I saw all the negatives. I saw the calories when I was younger, the dollars, like people going out in New York and you know, spending $12 on a drink. And yeah, I'm like worried about my subway fare home. And yeah, and then and then now, you know, the the negatives of driving and all these things. I was always a designated driver, yeah, always invited to the parties. Yeah, exactly. So so I was in a fraternity in college, I had to go through that without drinking. That was interesting. What I had to do instead. So, so so you know, I made it through life with without drinking, and and um, and you know, when I was about 40, I found out that my mom had has never touched alcohol too. And I didn't know that. So maybe something, you know, in in you know, our our genes or something that just makes us not not want to do it. But I I think it's again, my wife has has had an occasional glass of wine and she enjoys it, but for me, it's not been something I've ever been drawn to.

SPEAKER_03 1:27:47

Next question Diet soft drinks or diet anything, aspartame, what what's the what's the high level summary there?

SPEAKER_01 1:27:58

So if you ask me 15 years ago. Ago at it, say it's no big deal, whatever, it's a distraction, you know, it's all big picture. You have a peach, don't worry about this stuff, you know. But the science is coming out that these things are not inert. And so uh, whether it's artificial sweeteners like aspartame or others, or the natural ones like stevia or erythritol, which are the kind of the new natural ones on the block, lots of science coming out that these affect the gut microbiome, they might affect the brain, they might affect the behavior, they might, in some cases, actually even worsen glucose tolerance and cause insulin resistance. So, so you know, the way I look at them is if you're drinking enormous amounts of regular soda a day, like some Americans are, if you're having like a 64-ounce, you know, big gulp, um, better to get the diet one because that's a lot of sugar, even if it's natural sugar, right? But if you're not doing that, if you're not like downing, you know, a gallon a day of soda, um, don't think these are inert and these are okay. Don't go ahead and buy products that like like these, all these sparkling beverages that have them and all these energy bars that have them and think it's just fine because they they do have effects on our microbiome and on our brain, and they're not inert. So we need more study. But right now it's basically a uh the food industry is is doing a public health experiment on the whole population by by pouring these into foods. They're pouring them into foods, and they probably have adverse effects. And so, and so I consider them sort of a bridge away from high amounts of liquid sugar. If you're drinking tons of liquid sugar, they're a bridge, but they're not a destination. So, so I would try to avoid them uh as much as possible.

SPEAKER_03 1:29:34

Is there any truth to the fact that if you heat olive oil or oils of any nature, that that's going to remove a lot of the benefit?

SPEAKER_01 1:29:42

So it's it's if you heat, if you burn oils, not heat them, if you burn oils, you create uh heat shock proteins and advanced glycation end products and other um uh sort of you modify the the fats uh uh uh uh and you create new compounds that can be damaging and harmful to the body. So, and that's true, for example, for you know, why grilled and charred steak um can cause have carcinogenic compounds? Um, if you burn oils, you can also cause negative compounds. But heating itself is is not a problem. And so, you know, we cook, unless you're really deep frying, we cook with extra virgin olive oil and you know, just keep keep watch of the temperature and and and don't burn it. So as long as you're not burning the oil, um, you know, a little smoke is okay. You know, you don't need to worry about it. Yeah.

SPEAKER_03 1:30:27

Sorry, how do we stop this constant flood of misinformation? Like, how do we fix this? Because, you know, so much of what you've told me today is just so intuitive, really, and makes so much sense. But then, you know, I think all of us are exposed to lots of very compelling people, like either online or in the media in general. And it sounds like that makes sense a lot of the time as well. How do how do we as consumers discern the difference? Because, you know, I think there's a lot of people in positions of power that are doing that as well. And I and, you know, given how quickly the science changes and how even, you know, you, you know, you as you've changed your perspective over time. And I think that the pendulum swings with science. How do we put ourselves in the best position to know who to trust?

SPEAKER_01 1:31:18

Well, ultimately, that's the trillion, that's the trillion dollar question, literally trillion dollar question, because that's about the economic burden of diet-related disease in this country, it's about a trillion dollars per year. So, so that is the the critical question. Ultimately, we need to get to a place where information doesn't matter. Right. When I'm sitting in this chair in the studio, um, this building has been earthquake-proofed. And this chair even has been probably fireproofed and safety checked, and the electrical wires have been checked. And we don't need to know all that and figure all that out. We we we know that the products that we're using are safe, right? Um, that's not true for food. And so we really need to get to a place where food is treated with the same respect and seriousness as all the other products, cars, phones, you know, computers, chairs, buildings in in our lives. Um, so that, you know, we don't have to know. And and the example I'll use is cars. So um from 1930 to 2000 to now, deaths per mile driven have decreased by over 90%. Uh, huge improvements in car safety. And the driver is probably the same, right? The driver doesn't know more, but the car is different. Safety, all the safety features of the car are different. The drunk driving and the culture of drunk driving has changed. And also the roads are different, speed limits and safety signs and rumble strips and all those things. So, so we didn't have to teach people to improve car safety. We just fixed the fix the system, right? And so ultimately that's my goal for food. And there really are some major policy fixes that we can address the uh uh from that we can, you know, briefly talk about from public health and education and healthcare and schools and all kinds of things that we could do in 10 years pretty pretty quickly. But while we're waiting for that to happen and while we're hoping for this kind of policy transformation, we do need to know what to do today for our families and for ourselves. Um, I think the second thing I'll say is that regardless of the knowledge we have, there's a large number of Americans who who struggle to get healthy food because of dollars, because of time, uh, because of transportation, because of physical disability. So that's a second reason why like I stay up at night and I'm driven passionately to make the food system healthy for everyone, right? Not just healthy for the wealth, wealthy Americans who have knowledge and health literacy and time. Um, but if you are able to make decisions and make some choices around food, where do you get you know good information? It's a mess. It's a mess right now. And um, you know, one of the projects I'm most excited about is we've been working with Google, who approached us about a year and a half ago with this exact question. Yeah. They said that, you know, we about 40% of global searches on on Google, which is by far the top search engine, are about lifestyle, 40% in every country. And most of those are nutrition. And when they tried to use their you know, usual large language models, they were getting, they were bringing in the the words of the world and spitting out the that, and it was junk. And they found that even if they tried to like limit to trusted sites and elevate government sites or university sites, they were still getting misinformation, conflicting information. So we've been working with with Google for about a year and a half to help guide and develop a better AI tool for trusted nutrition information. Uh, and the National Academies of Medicine, which is kind of the country's top scientists, are now independently evaluating that. And um, we don't have the final results, but preliminarily, it looks like we're able to build a better mousetrap that the combination of human intelligence and artificial intelligence can make AI better. So I really do think if we do that right, AI can be the future tool, where on your phone, in the doctor's office, um, when you're you know online shopping and you're you know on an online grocery store, in a restaurant, you know, hopefully AI can help us with trusted information. AI also has, of course, the potential for misuse. But I do think this AI revolution can can extend to to healthy. I agree.

SPEAKER_03 1:35:10

I'm I'm really bullish and optimistic about the outcome there, certainly for real-time recommendations. I think giving people agency in between now and this the longer-term policy change, you know, if we can get much much more clarity and agency, then we can make better choices. I think just people listening today will have gained some of that, right? Like the idea of the simple, the simplest thing you said, which was skip the skip the bread, eat the ice cream. I think most people don't know that, including me.

SPEAKER_01 1:35:39

I hope so. Yeah. I hope people will, you know, be able to shift. And and you know, we we have to shift with our our pocketbooks and what we're choosing, because then we start to shift the system, but we also have to call out the broken system itself. And so if you're at a workplace and your workplace has junk food and at its events, has bad food. I I just was at a health conference today. Health conferences have the worst food. You know, why is that remote is that they're and it doesn't cost more to have healthier food. It's just just switching the mindset. And so we have to call out our work sites, call out the events we're going to, call out our school districts, uh, tell the government that you know we don't want food for for schools to be to be junk food. Tell the government that we don't want USDA to be spending its money on on you know uh uh uh industrial monocropping, but shift farmers, you know, we can't put farmers out of business, help farmers shift to specialty crops and other things. We have to change the system. So I think you know, we need to shop with our pocketbooks, but we also need to tell our elected officials, our our our places of work, our places of worship, um, that that we want and we demand healthy food. Does it not cost more to eat well? So, right now, and we've done analyses of this, um, if you, you know, at the grocery store, if you kind of generally buy a healthy diet, it does cost more. But it's about, you know, and if you adjust for inflation from when we did the study, it's about $2 more per person per day to eat a healthier diet in the grocery store. So that's not nothing. If you're a family of five and you're low income, $10 a day for the family, you know, over a year, it's you know, $4,000. Like that's that's real money, right? For families. But for most people, it's less than a cup of coffee. You can eat healthy. The the biggest difference is probably cooking and buying ingredients yourself versus buying pre-prepared and packaged and frozen foods and restaurant foods. Whatever anybody says about fast foods being cheap, you know, they're not cheaper than buying ingredients yourself. They're just not.

SPEAKER_03 1:37:26

Yes.

SPEAKER_01 1:37:27

Uh, and and so that's probably the best way to save money is to to buy food in the grocery store and and and cook yourself rather than eating out and DoorDash and all that other stuff. But but then you need time, you need knowledge, you need planning. And again, that's where maybe AI can can help.

SPEAKER_03 1:37:42

Darry, how do you see the evidence evolving over the coming years? Like, you know, it strikes me that so much of what we know or think changes over time. And I think it one thing that excites me the most about more people being interested in the field of science is that we we'll get more answers.

SPEAKER_01 1:38:02

You know, about 20 years ago, when I finished all my training and was sort of starting my faculty career, I estimated we know about half of what we need to know. And in the last 20 years, there's been an enormous amount of science generated. All the things we talked about, you know, have really been discovered in the last 20 years. And so people ask me, now, well, how much is there left to know? And I'd say, maybe we know about 25% of what we need to know. It's gone down. So it's gone down. The more we discover, the more complicated it is. And and so, you know, at the on the one hand, the big contours of a healthy diet, I think we we know and are and are clear, big picture contours, and and that's not going to change too much, but all of the underlying mechanisms and biology, and so a lot of what you know we have talked about and are going to talk about today, I just really want to emphasize is sort of my best guess as a scientist from the knowledge. And there's not a lot of certainty about a lot of this. And so it's exciting, it's humbling, uh, uh, and we really need to invest in the science with sort of a national food shot of science to figure this out.

SPEAKER_03 1:39:03

And I think that's kind of the the overarching principle of the podcast in general and the the concept behind our entire business is we don't know everything about everything. Yeah. And when we when we actually dig into each of these verticals with the world's best experts in each, then we then we get clarity about what we don't know. And I think people who are leading their field are the ones that are most comfortable to say, good question, I don't we don't know truly yet. And that is biology, right?

SPEAKER_01 1:39:30

The the more I I learn, the more ignorant I feel.

SPEAKER_03 1:39:33

Yeah, you and me both.

SPEAKER_01 1:39:34

Yes.

SPEAKER_03 1:39:35

Tari, I'm mindful of your time. This, as I said, has been the hardest podcast I've recorded because I have so many more questions for you. I'm going to finish. I've prepared some quick fire questions for you. So if it's okay with you, I'm gonna ask you then. And these are quick fire, okay? So you can't, you've got 30 seconds tops to answer them.

SPEAKER_01 1:39:56

I'll I'll I'll I'll work on that, yeah.

SPEAKER_03 1:39:58

Okay. Some of these I've already asked you, and you've already answered.

SPEAKER_00 1:40:03

Okay.

SPEAKER_03 1:40:04

Number one. What is the most underrated food of all time? Dark chocolate. Most overrated food of all time.

SPEAKER_01 1:40:12

Oh, that's tough. Um high protein. Yeah.

SPEAKER_03 1:40:17

One single thing you'd remove from the modern modern diet overnight.

SPEAKER_01 1:40:22

Uh Skittles.

SPEAKER_03 1:40:24

Skittles?

SPEAKER_01 1:40:25

No way.

SPEAKER_03 1:40:26

How could you? One thing you'd add to everyone's diet.

SPEAKER_01 1:40:31

Uh dark chocolate. Okay. Dark chocolate covered almonds, even better.

SPEAKER_03 1:40:35

Yes, agreed. Biggest nutrition myth alive today.

SPEAKER_01 1:40:40

Uh that it's all about calories.

SPEAKER_03 1:40:44

What's your go-to breakfast?

SPEAKER_01 1:40:46

Uh one frozen banana, one ripe banana, a quarter cup of milk, a scoop of peanut butter, blend.

SPEAKER_03 1:40:55

What's your go-to snack?

SPEAKER_01 1:40:58

Uh almonds, nuts, any kinds of nuts. Um, uh terrific snack. Um, yeah. What's your favorite nut? Uh I love all of them. Hard, hard to say, yeah.

SPEAKER_03 1:41:08

You have to pick one.

SPEAKER_01 1:41:10

We'll just go with almonds, yeah. Okay.

SPEAKER_03 1:41:13

Um one rule, one rule you follow when eating out, and you can no longer say bread is out and ice cream's in.

SPEAKER_01 1:41:21

What we try to do with my wife is to share the the appetizer, entree, and dessert. Love that. Perfect amount of food.

SPEAKER_03 1:41:30

Yeah, yeah, yeah. And you get to try a bit of everything.

SPEAKER_01 1:41:32

Yeah.

SPEAKER_03 1:41:32

This is off piece.

SPEAKER_01 1:41:33

When you and your wife, no, no, share one share one appetizer, one entree, and then you but then you get to try lots of different tastes.

SPEAKER_03 1:41:39

Yeah. When you and your wife go to uh a dinner party or to a restaurant, do you feel like people are judging what you're picking?

SPEAKER_01 1:41:47

Um mostly if they know what they do, they're worried about what they're picking. Yeah. Which which is kind of silly because you know, we don't we don't judge other people. We know we know all the struggles people have to eat. Well, yeah.

SPEAKER_03 1:41:57

We're all the same in that respect.

SPEAKER_01 1:41:58

Yeah.

SPEAKER_03 1:41:59

What's the most common item in your fridge?

SPEAKER_01 1:42:03

Oh boy, our fridge is our fridge is unbelievable. It's beautiful when I open it. Um, it's incredible. Um, nuts and yogurt and blueberry, probably berries. Probably berries is the most most common stock thing in there. Yeah.

SPEAKER_03 1:42:15

What do you think one nutrition trend is that will last?

SPEAKER_01 1:42:20

Real food.

SPEAKER_03 1:42:21

Yeah, I agree. One that won't be around in five years.

SPEAKER_01 1:42:26

All these high-tech, you know, plant-based alternatives.

SPEAKER_03 1:42:29

Yeah. Something you changed your mind on recently.

SPEAKER_01 1:42:34

Uh yeah, are are are all the additives in foods, right? You know, I used to think uh they're not important, but all these chemical additives, emulsifiers, stabilizers, thickeners, uh, you know, they're they're probably not okay.

SPEAKER_03 1:42:46

One habit you are personally trying to improve right now.

SPEAKER_01 1:42:50

Uh I'm trying to add strength training uh regularly to my taekwondo. Yeah.

SPEAKER_03 1:42:54

Okay, last one. If if money were no object, unlimited resources, what would you study? What unanswered question would you study in nutrition science?

SPEAKER_01 1:43:07

Wow, that's a great question. Um, you know, I think we know what a healthy diet is. And so I I would study how to implement it in practice. How in the real world, what are the policy changes, what are the systems changes, how do you use healthcare, doctors' prescriptions, you know, which is work we're doing now, to complement care for diabetes, for people who are in GLP1s, for other things? How do you really help struggling school districts at $4.60 a meal to create scratch cooked meals from local farms? Uh, how do you, how do you link all this back to regenerative agriculture that saves water and and soil and and doesn't put pesticides into the earth? Um, you know, how do you how do you create systems change and how do you how do we reverse the system, as I mentioned? Yeah, you know, I I have a roadmap, um, but I would love to study that roadmap and and implement it in practice. Yeah.

SPEAKER_03 1:43:57

What makes you what are you most optimistic about when it comes to nutrition policy?

SPEAKER_01 1:44:02

I think that after COVID-19 and and people seeing how sick we were and how people with diet-related disease, you know, really were susceptible to COVID and seeing farms plowed under and restaurants shuttered, and people don't take food for granted anymore. And uh, you know, President Biden held a White House conference on hunger, nutrition, and health. Now there's the Maha movement that's Republican and Democrats. People are getting excited. I feel like we're at a tipping point. Uh, you know, I've been passionate about these issues and working on these issues for for 25 years and seemed like I was like in a lonely crowd.

SPEAKER_03 1:44:36

Yeah.

SPEAKER_01 1:44:37

And and now I feel like we're at a tipping point and we're not turning back. So I really do think that we can fix this and and we can turn around the food system, we can improve our health, we can uh start reducing all the money we're spending on healthcare and be able to spend it on other priorities. We can start preserving our natural resources and we can turn this extractive food system into a restorative food system for our own bodies and for the planet.

SPEAKER_03 1:45:02

Love that.

SPEAKER_01 1:45:03

When is the book out? Uh so the book, Food is Medicine, is coming out in October. Uh, if you you know look up on Amazon or McMillan, which is the publisher, you know, you can pre-order it now. I I try to go through all these issues and make it fun and make it interesting, you know, how we got here, where we are today, where we where we need to go. And um, I'm hoping that people will read it and really, I think, uh come out of it with a sense of optimism for what we need to do and also a sense of purpose uh for for what they need to do in their own lives.

SPEAKER_03 1:45:31

I'm certain they will. Dari, that was tough. I think it's just such a minefield, and I think people will get so many takeaways from that. And I'll add the link to the book in the show notes. It is a pleasure and a privilege. A pleasure, yeah.

SPEAKER_01 1:45:44

Nice to nice chat. Yeah, agreed.