Joe Rogan Experience #1175 — Chris Kresser & Dr. Joel Kahn Transcript

Transcript

0:00 Five, four, three, two, one. I feel like the head broccoli in the United States today. Came back to Michigan, very active cath lab heart attack. in Detroit, one in Austin, Texas. What better purpose in life? Five books and a bunch of medical papers and a whole lot of blogs. And, you know, conventional medicine didn't have much to offer for me. it's vegan, but it's, you know, it's heavily influenced by Japanese tradition and cuisine,

3:52 that point too. that I had about vegetarianism and veganism. when it comes to diet. without thinking about the entire patient. It's pretty unusual. And we're going to represent a I mean, this is pretty rare segment. The biggest problem with nutritional research epidemiology is that it of the diet. They're not considering the quality of the diet. Are we talking about avocados and healthy whole foods?

8:51 not the whole solution a lot of scientists i'll give a shout out to los angeles brightest nutrition You see something in a cell. That is something you honor, but it's a long jump from there to human. Do we have the data to ask the question, does protein correlate with survival? Do they lift weights? I mean, there's never been a randomized clinical trial of smoking because that would be unethical.

11:13 And there's even more than that. to make reasonable conclusions. And we separate them into, you know, low consumption, medium consumption, high consumption. you three of the, I think, the worst problems with nutritional epidemiology. The first is data It's a little bit like the Kavanaugh thing going on right now. people reporting on what they ate at some time in the past. So, you know, how much of a problem

14:45 an elderly, bedridden, frail woman. So it's just inaccurate. It's completely inaccurate. And the It's just Americans are overweight and obese. And so what we know is that in those observational studies, the people who eat more red meat are also smoking more, they have higher body mass index, they're eating less fewer fruits and that's 600 percent increase. Okay. The IARC, the WHO report that suggested that processed red meat was a carcinogen, that was 18% increase.

18:09 So, you know, there are quotes, like, if you look even 20 years ago, like, there's an article in Science, the journal Science, came from observational studies were portrayed in the media as being causal, which any epidemiologist We'll just go to Loma Linda. Loma Linda is an hour east of here. why the heck are they living 12 years, 8 years, I mean, why is there a 104-year-old cardiac surgeon, Elliot Worsham, walking around

21:34 But you do it once. It's all clickbait headlines. get sick and you make changes and then they're counting if you're dead or alive. Well, it might He's healthy. So the healthy user bias is not an issue for paleo people. You know, we can talk about that. 1985, 2002. Lauren Cordain published her book in 2002. The I'm a heart doc, not a statistician. Actually, let me go to 2014, Morgan Levine.

24:41 If you ate plant-based proteins, the risk of cancer goes down. You eat beans and you eat – there are three studies that were Seventh-day Adventist studies. with the general population, which is just garbage because of the healthy user bias. So the first one was called the Health Food Shopper Study. So they looked at people who and then they asked the vegetarians to ask their friends who also ate meat. So the idea was the

28:22 I think they recruited people who read vegetarian magazines, exercise, physical activity, fruit and vegetable consumption, cigarette smoking, alcohol, That's all observational data. I just want to go back for a minute to meat and cancer. World Health Organization is not a vegan group. Yeah. That's still 50,000 to 60,000 people a year that get colon cancer if that data's right.

31:11 They didn't say related. It's everything, And I honor that. Hopefully you guys are enjoying a little Cabernet now and then. It's not that it doesn't bring up an interesting point, and vegetable intake and alcohol intake and family history? say limit your saturated fat in your diet and none that are in international society Because they couldn't identify the exact milligram to recommend.

33:25 USDA. from any cause okay so if because that's what we care about most right if you if i die of uh study that compared relatively equivalent groups of people that shows that vegetarians or vegans heterocyclic amines or HCAs, which damage the gut. have been shown to reduce the formation of heterocyclic amines or HCAs. So same thing. If you're, you know, if you're marinating meat or

36:57 They didn't find an association in the Netherlands, Canada, France, Italy, Japan, and Sweden, I think we have a gong moment because I really want your listeners to come away with a few He said processed meat. Well, it's all meat. This is science. There's this classic, and now I'm shifting to cardiology, that they took healthy volunteers They had them eat the same burger with a big salad.

39:13 up your veggies, going to talk fast. Just talk normal it was felt plenty of time it was felt study. You're from Newton. Framingham's a city outside of Boston, and they basically invaded one killer of men and women. Because the biggest enemy out there is smoking and crap diet. Other people went out and did studies. Those are the highest sources. Whether it's the World Health Organization, the American Heart Association, American College of Cardiology,

42:47 They might pick a different cutoff point, I've got cholesterol in my blood. trials. Everybody just go read Clark 1997, 395, it's called metabolic studies, change the diet, So that's a problem in the studies when you average everything together. They eat almost no dietary fat in Okinawa, Japan, and they have the greatest longevity in the world in 1970.

44:28 cut back on animal products a hundred years of cholesterol research. has more saturated fat So there never really was good evidence to suggest that dietary cholesterol and saturated fat are connected participants recently that found no relationship between saturated fat intake and cardiovascular history of most scientists being wrong about most things

48:07 And then the federal agency goes back on that recommendation after so many years of telling people to do that. He's a professor of medicine at Stanford. We have to look at the science and what the science is saying. This discussion is do you have a stroke, heart attack, erectile dysfunction, lose a leg, or do you not? fat. So let's stay with saturated fat because there is differences there. They're both, you

51:05 high in protein, foods high in sugar, foods high in fatty sources. Ultimately, they got sophisticated You have 10 times the heart attack risk that you had when you lived in Japan. attack. But when you parse it out, multivariate analysis, there's a stronger relationship between the number one food in studies like this is usually butter. I scooped cholesterol out of blocked arteries.

53:18 So that doesn't mean that the cholesterol is there because people were eating it, Joel. and in that group dietary cholesterol or does saturated fat levels in the blood. And of all of abdominal circumference, plasma insulin, C-reactive protein, as well as an increase in HDL cholesterol. So we're now talking about randomized controlled trials, Well, they're just the beginning.

56:52 Something killing Americans left and right in the 1940s and 1950s. strongly suggested that dietary saturated fat and heart disease, that's not what's called the ultimate randomized clinical study, but it's one high quality. in 1979. You change their diet. This is the ultimate careful experiment. It might be for researchers, influence academicians, influence speakers. This is in Mexico, though. Well,

59:04 They find a guy I actually verify it what's amazing it's of Clinical Nutrition, that same journal is a editorial that destroys the study. This is 15 reasons this is horrible this is nonsense since those two times and that's just the bottom line we have had confusion in the fat, your cholesterol goes up. Do you think it is? Absolutely. last for so long, and you'd have to isolate people in a ward so they weren't exposed to air pollution and other factors that could affect the result.

1:02:47 That's how science is supposed to work. But then when they started doing trials where they were giving people beta-carotene supplements, not only did it not improve their lifespan, they got more cancer. So, you know, science marches on. Let's talk low-carb diet. Low-carb diets are high in saturated fat. Yeah. I mean, it's right here. There's 395 metabolic ward studies that were randomized controlled trials.

1:05:59 Well, you missed that one. But Chris, what is your issue with this? of the effect of the food on the body, all that has changed radically. That saturated fat in the diet, chicken, eggs, cheese, beef, is related to raising your cholesterol, I gave you the background to it, the Siri-Torino study, the Chowdhury study. They actually estimated if we could lower the saturated fat content of the British population by 60%,

1:08:25 21 international societies say you will further the populace health if you lower saturated fat in the diet. Like whatever they've studied today. I published a study in 2012 that's been quoted 100,000 times from a major medical journal. in this major study quarter all over the world, the first author is Brian Ferentz, but I'm there Dr. Lauren Cordain, who had the first popular book, a PhD in Colorado, has written an article

1:10:46 This is in a medical journal. Even if you read my first book, but these new studies that he's showing, and we can go over them again, These aren't new studies. Here we go. Again, we've already outlined there's a big difference between epidemiology studies and randomized trials. And, you know, if you look at Dr. Harcombe's paper, of replacing saturated fat with polyunsaturated fat. And then the last two were Cochrane reviews,

1:14:03 cause. That early studies showed some relationship, So when they did longer-term studies, there's no increase in cholesterol on average. And those are observational studies, and we have all these randomized controlled trials that are showing no increase in cholesterol, no increase in insulin levels, and actually a decrease in all of those markers. Cochrane, C-O-C-H-R-A-N-E, is a group of scientists that try and be very objective,

1:16:16 How so? Don't jack with me on arterial walls. 1985 Nobel Prize in Medicine. May I please read the conclusion? we pick up people at age 50, 60, and we start jacking with their diet and Please, what is wrong with what he said? has been the meta-analyses, Siri Torino, Chowdhury 2010, 2014, D'Souza 2015. Ajala or Hala. I'm not sure how to pronounce the name. These are all on my website. If you go to

1:19:54 diet more effective for diabetes than the low-fat diet, the greater the carbohydrate restriction, So, I mean, this is the gold standard of evidence that we have is randomized controlled trials. What a meta-analysis does is it looks at all of the evidence and it looks at the quality of evidence and then it comes up with a result from looking at all of these trials.

1:21:42 Just three quick bullet points. But he's talking about high-saturated fat. That's a whole different topic. biomarkers. Absolutely. Then you can decide what you want. It does not say that it does. show any relationship. Here's the conclusion. No meta-analysis of randomized controlled trials and 40 observational studies with 650,000 participants that concluded current evidence doesn't clearly support

1:26:06 there is a potentially important reduction in heart disease risk by reducing saturated fat I don't care, honestly, what he said. I've got to go with the best science in the world because I deal with patients who have serious disease. And that's, again, why looking at meta-analyses of randomized controlled trials, looking at very large reviews of observational studies with

1:28:07 findings may often be simply accurate measures of the prevailing bias. And that what that means is that, let's say, you know, you have a paper that, you know, 30, 40, 50 years ago, that says saturated That's what most people don't realize. Again, he's making comments that have no reference. It might be one, but these are very general statements. increase your risk of dying of heart attack and stroke

1:29:58 1970, the highest heart attack rate in the world was Finland. Five years later, heart attack dropped 80%. What's wrong with what he said, though? It's as low as 3% of the diet in Okinawa. There's no way to control for all of those factors in a study. and 650 in another showing no relationship. vegan pro-advocate who's not at all all vegan he's written a book about the mediterranean diet

1:34:11 But that's my point. So you can't look at cultures that have a completely different lifestyle than the standard American lifestyle and draw any inferences about animal products. So a really and each of the studies that have been done on Mormons found that their mortality, single variables in observational research. And again, I'm not saying we shouldn't use

1:36:40 We add stress management skills. It's not all smoking, diet, exercise, and the size of your body. They confirmed Finland and Crete. Actually, Chris, I just think there's a good concept to let your listeners know. stroke, and diabetes are talking about better quality of life. Is this correct? You get the whole picture, biochemistry, epidemiology, randomness, clinical trials,

1:39:20 You know, I'm not telling people quit eating meat today or you'll die. mechanistic data or mechanistic arguments are not persuasive if they don't You need to throw them out there and let us know the reference. societies have it wrong they could but it's a controversy theory to say that Hooper-Cochran created a whole fervor out there that we can go back to eating all these great foods that Atkins wants us to eat.

1:42:07 It's so technical. We used to think ulcers were caused by stress. all these people that tell you 10% or less saturated fat, some say as little as you can possibly get in your diet, They republish, republish, republish. Not that fast. Not that fast. There's nothing new since 2016 that rocks the idea that 21 international societies got it wrong. There's

1:44:35 these three reviews that I mentioned, one was in 2013, one was in 2017, and one was in 2018. you'll see a change in the saturated fat guidelines. And it's not a big conspiracy. it's hilarious, isn't it? It's just hilarious if it wasn't. Yeah. I mean, it's, it's actually So, Joel, what is wrong with what he just said? Well, you said they eliminated it.

1:47:27 Had to have six papers retracted and had to resign. Since 1990, it's 92%. Forget about that. What about what he said about Well, he's predicting that there'll be a change in the recommendation. Forget about that. Forget about that. What about what he said that are out there to try and improve Now, they haven't published anything new since 2016. They didn't change saturated fat.

1:49:23 So what is wrong with these studies that he's citing? Have they been resoundingly criticized? There's nothing like that that has happened with those papers. and got them to add that sentence as keep cholesterol as low as possible. Chris? It says So what was his mistake? And then Joel mentioned that he and his cardiologist friends got them to add something

1:52:35 saturated, a convincing review of meta-analyses, a meta-analysis of randomized controlled trials, I really think we should clarify that. I'm not making it up. It on it. It's right here. I'm reading it. I'm not making it up. Yeah, eat your vegetables. There's a very famous food doc in Santa Rosa named John McDougall. Another man's faith allows him to eat only vegetables.

1:55:10 People be really quality over quantity. Yeah. Because I'm not saying, you know, we started by saying there's no one-size-fits-all approach, right? that mean that for that person, if they eat a diet that's very high in saturated fat, increase the risk of heart disease? And is it going to increase the risk of death study that's that reference said, despite a lack of evidence supporting low fat diets, only in 2010

1:59:00 So the sources of saturated fat in the American diet, 33% comes from pizza, desserts, candy, potato chips, pasta, tortillas, burritos, and tacos. that that would be true for someone who's eating what I would call like a nutrivor diet, which is, So it actually causes the liver to make more saturated fatty acids in the serum. It does exist in plants like some in avocado, some in olives and olive oil.

2:02:30 Well, we know the biochemistry right here in Los Angeles, University of Southern California, There's no studies that show that eating meat in the context of a healthy diet shortens your lifespan. But, you know, protein is really amino acids. very technical stuff, leucine. And there are some This is high-level cell metabolism. October 1, 2016, Song at Harvard.

2:05:36 which, again, is, like, indistinguishable from chance using that low of a relative risk. matter to people in terms of the quality of This is science. and cancer and fresh red meat and heart disease so look at reviews that include But is it epidemiology where they don't take into account all the other risk factors, including the rest of their diet, smoking, sedentary lifestyle, obesity, all the various factors?

2:08:17 The available epidemiologic data are not sufficient to support an independent And again, we come back to the relative risks. That's just, you know, common sense will tell you that. I want to live a long, healthy life. One, which will take your prostate and your breast tissue, So, you know, there is a relationship between animal products and breast cancer.

2:10:52 randomized controlled study of animal versus vegetable, it won't be done. Should a breast I'm not persuaded by mechanisms unless they're tied to real outcomes that we care about. I think mechanisms are Joel? cell has a receptor called the LDL receptor. Nobody knew it. It completely controls the You want your LDL cholesterol like Loren Cordain, the founder of the Modern Paleo Movement, said, 50 to 70.

2:14:00 Does saturated fat raise your cholesterol? in their blood cholesterol from eating two to four eggs a day. I don't know how more clear it can be than not. equation google it look it up on wikipedia it's called the keys equation the change in the class Yeah. In our typical reductionist paradigm, absolutely. There are many factors that contribute to heart

2:16:57 No, no, no. A friend of mine says heart disease is not theoretical. Since 2010, the question has come up, does an increased saturated fat cause coronary heart disease? is going to depend on your genetics and your microbiome and where you're starting. it's going to be pretty hard to show much of a difference. We're talking 150 grams. Okay. So this is Dius from 2009, Dietary Cholesterol and Coronary Artery Disease, a Systemic Review.

2:20:31 see this and we'll have jamie pull it up on the big screen yeah anybody that googles it's called We have a meta-analysis of observational studies, including 350,000 participants that found no relationship between saturated fat intake and cardiovascular disease. led to the restrictions on cholesterol and saturated fat in the first place. The plot's very clear. It's changing cholesterol to dietary saturated fat. It's well accepted in the

2:23:19 again. We have to look at the research, the weight of the evidence. We have to look at What is your take on that, Joel? your plaques, you live, has not changed. Right, but what is wrong with these studies? And what's the centenarian studies? and observational data, large amounts of observational data that have been reviewed He says eggs also typically increase HDL.

2:27:24 It's eggs. It's eggs. Well, we were talking about does saturated fat raise blood cholesterol? Until 20 years ago, That's a wonderful thing. heard the word of four letters, TMAO, 2011. Cardiologists sitting at the Cleveland Clinic What does TMAO do? It stuns your HDL so it doesn't reverse cholesterol transport. It causes LDL to their fish flesh, along with that mercury in their PCBs and their DDT. What is the association of

2:31:05 What would most doctors and researchers say about fish consumption and cardiovascular disease and mortality? Fruits and vegetables. There's a picture. I would see it. mortality. And this single fact about TMAO just kind of blows the thing apart. you know, lots of plant foods that support healthy gut, then you may not see the same association. And part of what supports that

2:34:48 Joel? It's okay. Dietary precursors of trimethylamine and man, a pilot study. No, no. You asked the question, is there any new human physiology that's relevant? We can talk about whether fish in 2018 is uniformly a healthy food product. Why? So that does not denigrate the topic. No, no, no, that's not what he's doing. yolk and meat i'd agree with that that's not what it says because the fish consumption vastly

2:38:36 What we know is that eating red meat in the context of a standard American diet may slightly raise your TMAOo but not nearly as much as eating fish will Correlated by epidemiology studies? Nobody's looked at the correlation of fish flesh preformed TMAO and a 4,000 patient study in the cath lab table. people who are eating the most fish having the most heart attacks, and that's the opposite

2:40:37 That's not kidney function. Is it good to have high levels of TMAO in the blood, whether they're from fish, egg yolk, or red meat? what's the calorie content in the United States that's from cod, halibut, red meat, and egg yolk? But you're talking about TMAO as a mechanism. That is scientifically true. We're not talking about higher. We're talking about

2:42:42 I might have even mentioned that Lead author, I cannot say the name, Yazdikashki. Well, it hasn't been done in humans yet. Fish is associated with increased risk of diabetes? Risk of diabetes, that's epidemiology. Wait a minute, fish is associated with increased risk of diabetes? what do you eat on a regular basis? But diabetes and fish? Because there's many papers.

2:45:16 Yeah, different story. intake of fish was correlated positively The concept is plausible. Sure. Is it resolved? Jamie, dude, read the sentence. But wait a minute. It says findings But you were saying TMAO from animal protein is what causes this problem. We all recognize it. We need to go over this. are very high in methionine, making sure you're getting enough of the glycine-rich foods, the bone broth, et cetera. And then you're also eating plenty of a mixed diet that contains

2:49:08 I've never argued for an all-meat diet. So it says there's no relationship there that they can analyze. Yeah, they're eating fish and chips, watching TV. You know, that's how science works. And you believe that this is probably, well, I shouldn't say you believe, So in your opinion, this sort of highlights that there's a lot of complex, different moving parts

2:52:12 temporality, biological gradient, like a dose response, TMAO, I think, is a great example of that. Is it fair to say that we really just are That's not what we said. It's an endless flow of new knowledge. Meat allergy. You see the one that says NIH? The average person should eat meat, though. Go to the second one. You end up on my cath lab table because you're in the emergency room for whatever reason.

2:55:19 24% of Virginians show the antibody. Now, I don't wish that on people. People don't walk around with this without knowing that they have it. This is something that's only been discovered over the last couple of decades. I doubt, you know, the basic biochemistry of meat and the carbohydrates in meat have changed. Is there a cross-reaction between glyphosate and being bit by a tick and our intestinal

2:57:24 Dangerous shit. It's Bayer. It's Bayer now. It's all Bayer. Correlation is not causation. had a 15% higher risk of being hospitalized for gastrointestinal hemorrhage. It needs to be over 100% at least to really rise out of the noise and say, okay, we're really seeing a signal. I mean, you might as well say that Sagittarians have a higher risk of arm fracture.

2:59:59 Moreover, given the complicated associations of eating behaviors and patterns. we now know is really important for our overall health. Are any studies comparing for people, Poland, eat food, not too much, mostly plants. Everybody loves it because it's consistent with Are we going to evolve that to something more brilliant? And we'll figure out TMAO with a block or with fish or with eggs or with choline or whether this tick allergy ends up spreading into Michigan or California.

3:03:06 foods diet we both agree on that 100 the question is whether animal foods uh should be a part of the What is the benefit of putting that one quarter of your plate, Whereas plant foods tend to be higher in carotenoids, polyphenols, flavonoids, diolosulfides, which are in cruciferous vegetables, and fiber. just a question of what's theoretically possible, it's a question of looking at the studies that

3:06:24 Of depletion, which is the first stage. So these were people who were educated vegetarians and vegans. And is the problem that B12 is nonexistent in plant-based foods or that it's not as bioavailable? Like what's it coming from? Cows store it in their stomach. vegan to be aware of given those big differences in depletion between the populations so joel if

3:09:46 It's an interesting statistic. I want to come back to humans. 90% of all B12 right now is being in B12. medicine, but I have friends that adamantly show me their blood work. I don't take pills and look I'm going to demonstrate my B12. some people believe is the preferred uh choice which i think chris would agree with so contrary that can't meet our essential nutrient needs

3:12:29 high doses and it won't be a problem. But as I mentioned, a lot of vegetarians and vegans who So methylmalonic acid and homocysteine are much more important markers. but also dementia and Alzheimer's. It's vitamin D. It's DHA. it's like you can essentially hack your way to a better, healthier life by just adding a few things like B12, Yeah, they do.

3:15:30 And I honor the paleo diet. Yeah, and for me, the bigger question— That's interesting. So the three top sources of iodine would be, well, iodized salt is the main one. that is a risk for iodine deficiency. I have written about that. But let's look at things like calcium. Let's look at iron. an increase in kidney stones. Associated by epidemiology studies?

3:18:54 Yes. I agree with you. water fasting. That's that guy that So this is just a theory. benefiting from it. The question is, what is the long-term implication? We're going to have an honest discussion as much as you can to say, why is Michaela and I honor that. It could have. But Sean's adopted it. I don't mind it intravenous. when you're consuming vitamin C with all these other things,

3:23:07 that there's some kind of competition in us between glucose and C. A little alpha gal in there maybe I mean as a practitioner myself Jordan Peterson, and he's eating his big giant steaks and he looks great. things to the world but unless he's tracking So that's another thing to consider. We don't know. He's a very nice guy. Yeah, yeah. Someone tried to get me.

3:25:47 I eat vegetables with essentially every that Michaela Peterson brought up when she was on the podcast, that That's what she should have kept on doing, gotten her gut analyzed, gotten her gut healed. Yeah. Maybe not. enjoy the rest, you know, those years of my life, I won't be in pain and discomfort the entire time, kinds of chronic diseases. He wrote a book

3:29:00 Is it? Yeah, well, that Because they're very important for the microbiome. They had a very high meat diet, but still. they had a very low intake of plant foods, but they would still trade for them. And then during And they measured every single thing they can measure in the microbiome, in their stool, metabolites, TMAO, and all the rest. Your body remarkable resiliency, and that's part of the issue. You can feed a human a whole lot of diets and make it

3:32:23 I don't think that's been published um it should be an interesting project you know it takes about three to six So then how can you say you cannot do it? This is a new word, Nutrivor. What is the mechanism? What do they eat? There's been recent data that suggests that grain consumption and legume consumption went back further than it was originally thought it was.

3:34:47 Joel, how does it reverse heart disease? Dr. Lester Morrison, internist, it's real answer, saw that in the country of Norway in World War II, were randomized clinical studies using cath lab techniques, using ultrasound techniques, They don't pay for Mediterranean diet. That's like, wow, number one in the world. Oh, yes. We don't have that study. Amen, brother.

3:38:22 Whole food, plant-based is really the proper medical term. Junk food vegetarian or junk food vegan diet. So all the vitamins and minerals And that's not really a controversial statement. Yeah, that's right. You can do it on any dietary approach. I'll love you wherever you're at. Don't do it with these calorie-empty foods. at one point and a vegetarian. And I have friends that are vegans and vegetarians. Again, I'm not

3:42:36 So this is what I said before. I know. They've fallen back. It's cool. Obviously not. I mean, he's this big, stocky German, but he lifts 1,200 pounds, Recovery, which roll on your class. Okay. Sean O'Malley was for a while, but he found himself to have much more energy when he started eating meat, And Griff Whalen used to be with the Miami Dolphins.

3:45:12 I mean, pretty cool. And any deviation from it that's a whole food-based diet, especially with proper nutrients that are supplemented, And I think that's... not unimportant, but he's a prime thank you both very much for being here well thanks for the opportunity joe i mean this Educate yourself. K-R-E-S-S-E-R. Thank you.