The Truth About Seed Oils, Food As Medicine, and RFK Jr. | Kevin Klatt PhD RD

Summary

Highlights

• Kevin Clatt emphasizes that while food affects health, using food as literal medicine is flawed. 🍏
• Seed oils aren't the big bad villains; rather, the science doesn't support their demonization. 🔬
• Nutrition is nuanced! Quick fixes and trendy diets often oversimplify complex science. Let's appreciate the intricacies! 📚
• Kevin shares why rigorous scientific evidence is crucial before accepting nutrition claims. No shortcuts here! 🧪
• There's a call to action for more serious investment in nutrition research—it's much needed! 💸

Key Takeaways

• Kevin Clatt highlights the misinformation in popular nutrition trends. Stay skeptical, folks! 🤔
• The 'food as medicine' mantra isn't as straightforward or magical as it sounds. Get ready for some debunking! ✨
• Seed oils have been wrongly maligned—don’t fall for the hype! 🛢️
• Precision nutrition is a work in progress; it's not time to jump on every dietary trend. Chill and be informed. 🧠
• Guardrails over prescriptions: Nutrition guidance should steer, not control your diet. 🚦

Overview

Chapters

• 00:00 - 01:30: Introduction and Expert Credentials The introduction sets the stage for a discussion that challenges the common perspective on viewing food as medicine. The narrator expresses a controversial opinion, suggesting that the notion of food as medicine is flawed. The episode features a conversation with Kevin Clatt, who holds a PhD and is a registered dietitian. Kevin is a research scientist and instructor in the Department of Nutrition Sciences and Toxicology at UC Berkeley. He has earned his PhD in molecular nutrition from Cornell University and completed his dietetic internship at the National Institutes of Health. This chapter serves as an introduction to Kevin's credentials and the upcoming conversation about nutrition science.
• 01:30 - 04:00: Field of Nutrition and Public Perception The chapter discusses the complexity and challenges in the field of nutrition, highlighting how it is perceived by the public and the controversies surrounding it. It centers around a conversation with Kevin, a noted figure in nutrition studies, who emphasizes the importance of evidence-based guidance amid the overwhelming amount of information. Key topics include the debated claims about eggs, seed oils, and the concept of food as medicine. Kevin provides clarity by outlining reliable guidelines in the midst of widespread misconceptions.
• 04:00 - 09:00: Complexity of Nutritional Research The chapter "Complexity of Nutritional Research" delves into the intricacies of nutrition science. The speaker highlights the importance of nuanced, in-depth answers to complex questions in the field, rather than simple soundbites. This approach contrasts with more superficial explanations common in some outlets. The chapter emphasizes the significance of providing accurate and unbiased information, which is essential in expert discourse. Dr. Kevin Clatt, a guest on the Checkup podcast, embodies this detailed approach, aiming to educate the audience deeply on nutritional topics. The discussion aims to offer listeners a better understanding of nutritional research's complexity, encouraging learning beyond oversimplified media representations.
• 09:00 - 15:00: Eggs and Nutrition Science The chapter titled 'Eggs and Nutrition Science' delves into the complexities and controversies surrounding nutrition science. It begins with an acknowledgment that while nutrition is widely regarded as important, the reasons for its importance differ significantly among various groups. The discussion recognizes the shifting opinions and trends within the field—from left to right and vice versa—emphasizing how the topic of nutrition has become increasingly confusing over time. The chapter also hints at the skepticism people have towards experts in nutrition, highlighting the challenges faced by professionals in the field.
• 15:00 - 20:00: Nutrition, Media, and Public Perception The chapter discusses the misuse of the term 'expert' in media and the importance of thorough research in the field of nutrition. The speaker emphasizes the necessity of understanding scientific studies in depth, recognizing their limitations, and not just taking them at face value. It underscores the disparity between genuine experts and the self-proclaimed ones, commonly found in media and podcasts. The chapter aims to shed light on how media influences public perception of nutrition and the responsibility that comes with being considered an authority in the field.
• 20:00 - 29:00: Progress and Challenges in Nutritional Research In the chapter titled 'Progress and Challenges in Nutritional Research,' the discussion focuses on the evolving landscape of nutrition science. It draws attention to the NIH nutrition roadmap which emphasizes precision nutrition, the study of individual differences in nutritional needs and responses. The chapter highlights the importance of understanding food composition and its impact on both long-term health and chronic disease management. Additionally, it stresses on improving nutritional strategies in healthcare settings to enhance patient outcomes.
• 29:00 - 35:00: Food as Medicine: Misconceptions The chapter titled 'Food as Medicine: Misconceptions' discusses common misunderstandings and misconceptions about the role of nutrition in chronic disease. It highlights a prevalent notion that nutrition lacks evidence or understanding, countering this by explaining that we do possess knowledge about essential nutrients and have effective, evidence-based supplementation and feeding programs around the world. However, it acknowledges that the methods used in nutritional science can sometimes seem insufficient, implying room for further research and development.
• 35:00 - 38:00: Practical Nutritional Advice This chapter discusses the complexities and uncertainties involved in understanding the long-term impact of diet on chronic diseases. It highlights the challenges faced due to the long latency periods associated with these diseases and the difficulties in translating nutritional knowledge into practical advice. The author shares their personal journey into becoming a dietitian and doing a PhD in nutrition, driven by a desire to move beyond prescription-focused healthcare.
• 38:00 - 45:00: Challenges in Communicating Nutrition The chapter 'Challenges in Communicating Nutrition' explores the complexity and confusion in nutrition communication. It highlights the public's demand for clear-cut answers to dietary questions, like the health implications of eating eggs. Such binary questions lead to contrasting information and a perpetual media cycle, complicating official dietary guidance. The chapter suggests that certain nutrition questions might be inadequate and contribute to ongoing public confusion.
• 45:00 - 51:00: Supplements and Evidence-Based Recommendations In this chapter, the focus is on the complexity of making evidence-based recommendations regarding supplements and nutrition. A key point raised is the issue with the oversimplification found in media discussions about whether certain foods, like eggs, are 'good' or 'bad'. The chapter underscores the importance of study design in nutritional science, emphasizing that any question about the healthiness of a food must consider what the food is being compared to in diets. This relativistic approach is crucial, as the health effect of a food item can vary significantly based on what it's being compared to or replaced with in a diet.
• 51:00 - 57:00: Nutrition Policy and Structural Challenges The chapter titled 'Nutrition Policy and Structural Challenges' discusses the complexities of conducting nutritional research. In particular, it emphasizes the absence of a placebo in nutritional trials and how this leads to an infinite number of pair-wise food comparisons. Unlike pharmaceutical studies, where dose optimization is key to minimizing side effects and maximizing therapeutic outcomes, nutritional studies focus on understanding the dose-response relationship across different quantities of food, ranging from high to low amounts. This complexity presents unique challenges in forming effective nutrition policies.
• 57:00 - 62:00: Healthy Diets and Political Influence The chapter discusses the complexity of conducting dietary studies, particularly in understanding the effects of certain foods, like eggs, on human health. It highlights the challenges of designing studies with numerous variables, such as different population risk levels and individual responses to dietary cholesterol. The conversation critiques the feasibility of large-scale trials with many variables, emphasizing the presence of numerous effect modifiers that influence study outcomes. This indicates the difficulty in obtaining definitive conclusions regarding diet and health on a large scale.
• 62:00 - 69:00: Future Directions in Nutrition Research The chapter discusses the complexity of questions being asked in nutrition research and highlights the inadequacy of generalized queries such as 'are eggs good or bad?' It emphasizes the need for more specific questions, focusing on individual impacts rather than broad statements. The discussion points out that while eggs are nutrient-dense, their impact on health, such as their effect on LDL cholesterol, can vary based on individual factors.
• 69:00 - 81:00: Seed Oils and Public Misunderstandings This chapter discusses the public misunderstandings surrounding seed oils and their nutritional value. It highlights that for most people, seed oils do not pose a significant health risk and are important sources of nutrients, such as choline, which is crucial during pregnancy. The conversation emphasizes that the general population should not overly prioritize seed oils as a nutritional concern, and it criticizes the loss of nuance in discussions about nutrient needs.
• 81:00 - 83:00: Conclusion and Call for Further Research The concluding chapter discusses optimal food patterns across different life stages and reproductive states. It highlights the complexity and depth experts bring to dietary discussions, contrasting it with the often simplistic views of carnivore diet proponents. A call for further research is made, emphasizing the nuanced and varied nature of dietary needs.

The Truth About Seed Oils, Food As Medicine, and RFK Jr. | Kevin Klatt PhD RD Transcription

• 00:00 - 00:30 Oh man, I'm going to piss off some people. I think seeing food as medicine is wrong on several fronts. There's not a great way to look at food on several fronts. In this episode, I sit down with Kevin Clatt, PhD and RD, who is a research scientist and instructor at UC Berkeley's Department of Nutrition Sciences and Toxicology. He's earned his PhD in molecular nutrition from Cornell University and completed his dietetic internship at the National Institutes of
• 00:30 - 01:00 Health Clinical Center. Basically, he's the guy who actually reads, teaches, and performs the nutrition studies everyone loves to quote. We dive into great detail throughout our conversation, unpacking why nutrition seems messier than ever, focusing specifically on the viral claims around eggs, seed oils, and the food as medicine mantra. Kevin does a great job in laying out the guard rails you can trust amidst all the noise. What I'd like for you to pay special attention to is how he answers
• 01:00 - 01:30 my complex questions. He rarely gives a simple soundbite answer like your typical podcast bro. Instead, he focuses on the nuance to make sure you're getting the most accurate and unbiased information. That's what experts are supposed to be doing. Anyway, I hope you learn as much as I did throughout this conversation. Please welcome Dr. Kevin Clatt to the Checkup podcast. Nutrition. Yeah, it's a it's become a bit of a
• 01:30 - 02:00 buzzword. Least controversial topic. Yep. Right. Like most people agree nutrition is important. Yeah, but they agree for vastly different reasons. Yeah. Participate in vastly different food camps. It used to be left, now it's right, then it's left, then it's right. I think the field of nutrition is the most confusing it's ever been. You're an expert in the field ostensibly. Yeah. Although people don't
• 02:00 - 02:30 like the word expert. I was say, don't call me that. But unlike most podcasters these days or health gurus or health podcast guests, you truly are an expert because you've actually put in the time to do the research to understand what is being said to understand when someone quotes a research article what was studied, what was missed, where the limitations are. What's your gut take on the field of nutrition right now if you were to
• 02:30 - 03:00 give a banner for it? Oh my goodness. I mean, the field of nutrition I feel like is often very separate from like the popular understanding of nutrition. Like we have an NIH nutrition roadmap that was released a couple years ago that heavily embraces like precision nutrition, understanding interindividual variability, understanding more about food composition, how it affects health both in the long term and chronic disease and then in the short term like how in the hospital do we feed patients better to improve outcomes? I think the
• 03:00 - 03:30 popular conception of nutrition is very much what we would think of as like nutrition and chronic disease. So I always, you know, people are like nutrition doesn't know anything as like a very common perception. I'm like, well, we know all the essential nutrients and like we do have like great very evidence-based like program like supplementation feeding programs and things and global health and a lot of implementation science there. There's a lot we do know in nutrition, but there is just this I think the methods in nutrition always leave a little bit of
• 03:30 - 04:00 uncertainty more than you'd get with like uh you know drug trials and these sorts of things. Um in how does diet how what I'm eating now affect something that's happening 20 years down the road? You know there's long latency periods to chronic diseases before they manifest for the most part. Um and so yeah, nutrition it's I think there's a lot that gets lost in translation. Um there's a lot of people I became a dietitian and did my PhD in nutrition not because I didn't want to write prescriptions but then I think the
• 04:00 - 04:30 public is always looking for a prescription of like how many milligrams of this and how many servings of this um are eggs good or bad and it's all like a yes no thing and I think anytime your question doesn't have a definitive answer like it's it's going to forever fuel a media cycle and people putting out information about it um that seems contrasting to whatever official dietary guidance is and it's a never- ending loop and so sometimes the questions aren't um I think adequate uh things like are eggs good or bad you know
• 04:30 - 05:00 that's always in the media and that like there's so many first principles in nutrition science that I think are violated by that question on its own like in nutrition if you're I always take these questions and turn them into a study design and you have to ask like you know if you're going to do a trial of like are eggs good or bad you immediately have to ask like well what are people eating instead of the eggs and so like are eggs good or bad are going to be immediately be a relativistic answer of like are eggs good or bad relative to lentils or to
• 05:00 - 05:30 red meat and like there's an infinite number of these trials that you could do that I think gets at like a major issue in nutrition we don't have a placebo in our trials and so you have essentially infinite pair-wise comparisons across foods and nutrition is inherently interested in the dose response relationship you know like in pharma studies you're trying to do all of your uh pharmacocinetics early on to optimize for the dose that's going to like lower your target and then not have side effects. In nutrition, we care about high, medium, and low and everything in between there. Um, and so you have, you
• 05:30 - 06:00 can imagine, you know, this egg question, you've got now infinite comparators across many different doses and you can quickly come to a 65 arm trial that's never going to happen. And so like, and even then like that would only be certain for the population that you studied it within. Are they high risk at baseline? um are they going to be somebody who's like a hyperresponder to dietary cholesterol and their blood cholesterol levels? Um there's all these like effect modifiers and uh but that that I think illustrates like the
• 06:00 - 06:30 questions that we're asking sometimes are not the right ones um both in the literature and then also kind of in the the public sphere. So will we never know are eggs good or bad? I think the question is like it's like are eggs good or bad for like for who? Um I mean there eggs are like nutrientdense foods that I think um you know I'm not here to endorse any food in particular but like um the impact of them on of dietary cholesterol like on LDL cholesterol is
• 06:30 - 07:00 like quite small and I think you know if you're somebody who's at elevated risk you might be counseledled to consume less. Um, and if you're somebody who's not, like the general population data largely doesn't implicate them as like at least anywhere near the top of like nutritional priorities anybody should be coming up with. And they're important sources of nutrients that are like I did my PhD in choline, which eggs are uniquely a rich source of, and that's quite important during pregnancy. And so I think we lose some of the nuance of like like nutri nutrient needs and um
• 07:00 - 07:30 optimal food patterns and things vary a bit across the lifespan and with different reproductive states, for example. See, I find you as an expert being at a tremendous disadvantage here because if I ask that question to a carnivore diet expert, I use that term loosely there, someone who's a proponent of the carnivore diet, someone who's a podcast host, they'll give you a very short and simple answer that doesn't have any of the nuance that you introduced. And to
• 07:30 - 08:00 the general public, that feels like they're telling the truth, but almost like as if you as the expert won't tell them the truth. Yeah. Why is that not the reality? I mean, I I I want to I think we might be at a point where the public is getting tired. Like, you can go find anybody to say anything is good or bad in a sort of a deterministic way. Um, you know, we're at the point now where you turn on social media and everything from vegan to carnivore is the optimal way. And it's just like,
• 08:00 - 08:30 well, that just can't be true. And I think at some point you have to start to bring science to at least provide not a prescription, but some like guidance and guard rails around like what we think of as being relatively healthy in the diet. But I think I would like like the public to just be a bit less prescriptive and also look at diet as sort of we can't know things like we don't have the precision in our research tools to know things as like deeply and specified as people would want to. Um, and I think uh like the general guardrails essentially
• 08:30 - 09:00 is what nutrition science is going to provide you. And like eating more fruits and vegetables, eating more legumes and nuts and seeds and then if you have a specific problem then like tailoring the diet around that with the help of like a dietitian or physician can like allow for the more specifics. But a lot of the hyper specification of things I think is just to sell you a brand or a product or whatever. And so it's there's a huge financial incentive to be seen as like offering the way, the truth, and the light around diet. And it for it to be
• 09:00 - 09:30 what looks like anti-establishment quite often. Um, and that's not to say that there's nothing wrong. Like there's a lot of nutrition official nutrition advice has a lot of flubs along the way. Um, I understand the lack of like trust in nutrition science and there's polling to show that there's lack of trust in it. I think a lot of that starts with like some humility from the field about like how deeply we can know things. I think there's some people who think that we just need to like shout it louder and say that the data is stronger than it is and that'll get the public to um kind of adhere to what official dietary guidance is and I'm not I don't fully appreciate
• 09:30 - 10:00 or I don't fully agree with that approach. Yeah. I don't either. I think the more transparent you can be even though it's flawed the more buyin longterm you'll get. Yeah. So what you said that we have made significant strides in nutrition research. What do we know with a higher level of evidence about nutrition that would be valuable for someone to know? Yeah. Um, I mean, so we know the general like essential nutrients, which is great. Um, you know, I'm going to I think we should stick like I always like to couch this as a
• 10:00 - 10:30 like most people care about nutrition and chronic disease and they're not like interested in like acute inpatient nutrition care. We have like RCTs and things, but nutrition knows different things in different sectors. But in nutrition and disease kind of health outcomes, um there's things like women of reproductive age should take folic acid to reduce the likelihood of having a neural tube defect. Like the evidence is pretty solid on that front. Not perfect, but solid. Um there is a lot you know early in around the 1950s 1960s
• 10:30 - 11:00 you start to get the emergence of the basic cardioabolic disease risk factors of elevated body weight uh elevated blood cholesterol elevated blood pressure and then sort of insulin resistance and blood glucose diabetes sort of emerge beyond that. Um, and so there are a lot of controlled feeding trials where we can in a short-term setting manipulate the diet under very controlled like everything weighed on a gram scale to the 0.1 gram precision. Um, for anywhere from like 2 weeks to sometimes you get longer than you
• 11:00 - 11:30 definitely get longer than that for sure like out past 6 weeks. Um, some controlling the diet up for like up to 12 weeks. Um, where we know that changing the diet composition particularly the fat composition can influence blood cholesterol levels. changing sodium can influence blood pressure levels. Same with potassium. Um, and then we have so we we know a lot about dietary fat composition and blood lipids basically because they're like a major risk factor that change independent of weight. So just changing the composition of the diet has a pretty substantial effect on lowering total and
• 11:30 - 12:00 LDL cholesterol. Um, we we know things like the DASH diet which sort of takes our knowledge of not only sodium but other elements of the diet. um it's the dietary approaches that stop hypertension but there's big New England Journal of Medicine and landmark trials um on the DASH diet basically showing you can get close to firstline pharmacological blood pressure lowering with diet by combining a number of elements so it's like reduced sodium elevated potassium like seven plus servings of fruits and vegetables a day
• 12:00 - 12:30 a few servings of non-fat dairy um and that all these things combined have sort of like an additive effect um on the DASH diet I think it's one of my points I bring up with patients is it's like it's like seven or eight things in the diet that all cumulatively add up, but no, one of them is like make or break it. Yeah. And it's sort of a good example of like diets effects tend to be really small, but like adding up a bunch of dietary changes and then doing that for a really long period of time cumulatively is like a net win. And I think that helps orient people to like
• 12:30 - 13:00 expectations around effect sizes because you got everything. You turn on social media and like this supplement or this nutrient that we're all missing is the cure all. Yeah. And it's like that I those things are great. As a researcher who has to do a power calculation for doing the clinical trial like I wish the effect size was so large I needed to enroll six participants because I'd see this magical effect of a magnesium or whatever. But the effect sizes are always quite subtle. Yeah. So we should elaborate on that. you in order to see
• 13:00 - 13:30 the impact of changing this one ingredient in someone's diet and then to see the impact you need to have a significantly higher number of participants in that research. Yeah. Or like it needs to be a big intake differential that's occurring. So like some of the work I did in my PhD is on pregnancy which we think of as like a uniquely stressed state for choline availability. and the choline intakes are relatively modest or low and that you can intervene and significantly sort
• 13:30 - 14:00 of alleviate that choline stress. So like obviously a vitamin supplementation is going to do a whole bunch more if somebody is like deficient at baseline and you need a lot fewer participants because you just expect a bigger effect, right? But in like a well-nourished population like the US like I don't think a vitamin A supplementation is going to be like a magical necessarily. So you need a huge number of participants. Yeah, you need a lot more participants to see that much smaller effect and to handle all the variation that exists. And so same with chronic diseases like it depends on are you recruiting people with high blood
• 14:00 - 14:30 pressure at baseline, how high the more modest and closer to like a relatively um you know or homeostasis is maintained a relatively like healthy state like to see diet effects you tend they tend to be much smaller and you need a bigger sample size to see them confidently. Um and so that's a a problem for like our nutrition research infrastructure. the ability to like recruit hundreds of patients like you would do for a pharmaceutical trial is like extremely difficult. You basically can't do it's very very hard to do that in any meaningful time frame with the current way that we fund nutrition science now
• 14:30 - 15:00 and the research infrastructure that we have. Why do you think there's so much disagreement when it comes to the consumption of let's say animal products or saturated high saturated fat content foods and its impact on cholesterol and thereby impact on cardiovascular disease? Yeah, I mean I think there's few people debate that like saturated fat raises LDL cholesterol. There's a bit of an effect modification by the food matrix there. So we talk about
• 15:00 - 15:30 these nutrients, but like you can get saturated fat from meats or dairy and different types of dairy and the the relative effect of saturates on LDL varies a bit with those foods. But I think most people you find very few people arguing that like replacing saturate sources with mono and polyunsaturated sources isn't going to reduce LDL. I think a lot of people question the second part of that equation. Yeah. Does that change in LDL meaningfully reduce cardiovascular events which can be influenced by its effect size? you know, it can be small in some individuals. It's quite quite
• 15:30 - 16:00 variable um the degree to which somebody when they change their diet that the effect size that they're going to see. Um and I think, you know, there's there's old trials in this literature that are suggestive of that replacement lowering cardiovascular events, but they're like pre-statin era. People have el total cholesterols like in the 200s and 300s. Um so people question like is this added LDL lowering really all that beneficial for reducing cardiovascular events? like calculating a number needed to treat is really tough in this space
• 16:00 - 16:30 because you don't have a really rigorous data to do it all that often. Um, and then there's always concerns that just because LDL is lowering, I think medicine, there's a lot of hard learned lessons that you can see the biioarker go down in the direction that you want it to, but there's like an offtarget effect. And so there's always concerns that like particularly in the we're in the era of everyone thinks seed oils are toxic. And so current recommendations are to replace saturates with more omega6 rich polyunsaturated vegetable oils, particularly high in linoleic
• 16:30 - 17:00 acid, but we recommend a mix of omega-3s and omega sixes. Um, and those, you know, there's a concern that, you know, you might see LDL lowering, but those might have an independent bad effect. Um and so that's always you see that for the past 40 years in guidelines. People don't really recommend more than 10% of total calories coming from PUFA because of um theoretical concerns of harm. Um and there's just not populations that are eating much higher than that that you can go and observe that they're totally fine. Um so the recommendations are slightly more cautious. But um yeah,
• 17:00 - 17:30 you don't you don't have huge blockbuster trials that say like we swapped saturates for PUFAs across a dose response range across these diverse populations and it lower cardiovascular events in all of them. Like that's really really high bar for the field to reach. So we know I think relatively confident that sadrits being replaced by PUFAS lowers LDL. We don't see a strong evidence of harm in any marker that you look at. There's a little bit of added improvement in blood glucose and insulin for that and liver fat. And you can see this in these small trials that the
• 17:30 - 18:00 field has strung together. Um, and then you have ep epidemiological data. So like the observational evidence where you give out people either food frequency questionnaires or in some of it there's 24-hour dietary recalls, but it's mostly food frequency questionnaires. And those you can estimate how many how much energy you're getting from saturated fat versus polyunsaturated fat and do kind of replacement modeling algorithms um that sort of mirror what's happening in the RCTs. And you can see a similar often um like it's a very analogous that you see
• 18:00 - 18:30 reduction in LDL in the control trials. You see often a reduction in cardiovascular events in most of the epidemiology and that's sort of the two strongest types of evidence nutrition is going to put forth. There's a little bit of primate data that's going to show that um replacement of saturates with PUFA is also lowers cholesterol and reduces atherosclerosis size. Um, but yeah, you you have all these individual lines of evidence that have like they're impactful, but they're miss they're not like a smoking gun sort of thing. So
• 18:30 - 19:00 finding trial data where people have reduced saturated fats, replaced them with PUFAs and actually followed people to have cardiovascular events. There are older trials that did this. They typically relied upon more captive populations where you had control of the diet already and so mental hospitals were big ones. Um you had um like LA the LA veteran study is one example where veterans used to be housed and the diet was controlled. So anywhere where somebody was institutionalized um and the diet was being controlled you could
• 19:00 - 19:30 do some interventions and people um did that back mostly in like the 60s and uh they just by modern trial standards weren't always the best. Um, a lot of times they intervene on they change the intervention diet but didn't really do anything to the control and so they're like slightly imbalanced. A lot of them are done during the era of trans fats being in the food supply. And so they lower the intervention group either there's endless debates in the field about this where the intervention group sometimes the intervention reduced
• 19:30 - 20:00 saturates at the same time it reduced trans fats. And so people when they like replace it with PUFA um and so people are like a you've overinflated the benefits of replacing saturated fats because you also lowered trans at the same at the same time. And then you have other intervention studies that intervened with high PUFFA diets, but they used a margarine that probably had some trans fats. And so they're like, "Ah, maybe you didn't see the mortality benefit because you just did a trans fat intervention at the same time you did a poof intervention." So there are these endless debates from that really limited literature base. Um you'll see like the
• 20:00 - 20:30 American Heart Association has a um a position statement on this where they use like four core trials that they rely upon. And three of them are adequately randomized. And you know, they point to like what we would expect that mostly soybean oil replacing saturated fat sources in the diet, lower cardiovascular events. Um it's like a composite of all cardiovascular events, which a lot of the evidence-based medicine people don't don't like composite endpoints. They want to break it out by individual event type. Um and
• 20:30 - 21:00 again, there's these limitations that I mentioned around and the timeline of it all, right? Over what period of time is this? Well, they're like usually like four to four they're over two years long was the inclusion criteria the American Heart Association relied upon. But those trials are just I look at them as being like they don't point to like a strong signal for harm. Um but they are not gold standard necessarily. So it would be amazing if we as a society had like you know people who could basically just be like living paid research participants five years living in some
• 21:00 - 21:30 capacity long term where we can control their diet. But that's so hard to do. Can we take the data that we've gotten from statins, their effect on impacting LDL cholesterol and in general the cholesterol profile, seeing the reduction in the ASCVD risk score and events and then say, well, if we're seeing these substitutions in certain fats lower the LDL cholesterol and the
• 21:30 - 22:00 cholesterol profile, shouldn't we expect to see the same or is not not as simple as that. I think that's one supporting line of evidence, but it's not a direct one to one. So all drugs um lower LDL like there's many drugs out there. They lower it through different mechanisms. Uh we don't even 100% know the mechanisms by which dietary fat composition changes lower LDL. Um they do a similar thing of like obviously there's enhanced clearance of LDL from the plasma compartment by the liver.
• 22:00 - 22:30 There's also some debates about whether there's reduced cholesterol synthesis for the mechanism of how they actually lower blood cholesterol. But um we would expect that LDL lowering to produce beneficial effects. I think the big question becomes like what are potential offtarget effects of the diet. So if you go like super high in polyunsaturated fatty acids, you might at some point create a new problem. Yeah, there might be a toxic effect at some point. And finding the dose response data there is pretty limited. You're often relying on epidemiology. I know the cardiology
• 22:30 - 23:00 world is kind of like right now at the point where it's like the lower the better on LDL and diet is like recommended as a major way to as a lifestyle way to help control LDL but um that effect size is going to vary quite a bit and I don't think you can do anything with diet to get down to like less than 30 or 40. There's these old um sort of like Simeon diet like sort of mi mirroring this like super high plant-based diets, lots of soy protein, lots of high pufa oils. Um and people can get like pretty substantial like 15
• 23:00 - 23:30 plus% lowering in LDL cholesterol from these diets. Um but like that's not getting you down to like below 40 necessarily. Well, it's also the same when I screen people for cholesterol and I find their LDL to be above 200. I'm almost telling to them like this is probably not because of your diet. This is a genetic issue because to get it that high is it's yeah it's tough. I mean there are like we've seen it in the era of carnivore keto diets where people are getting like if you're getting 80% of your calories from fat and you're skewing PUFAs then the natural fat
• 23:30 - 24:00 composition of the foods you're eating is getting you like 40 plus% of calories from saturates. And so we've seen people get like super really high. Um, and like it comes down with, you know, dietary switches. But apart from those like obscure scenarios, um, I try and orient people like, let's see if we can get down like 10 to 20 points with a lot of dietary changes. And people vary like the nature of the genetic uh, issue that they have that's leading to their cholesterol being high. Like sometimes it's responsive to diet, sometimes it's
• 24:00 - 24:30 not. There's not like a great way to predict that necessarily. Um, you know, there's random things in in diet that can like I had a patient one time who um Turkish co like boiled coffee contains um these plant turpenoid compounds that raise LDL and there's like good data on this and makes coffee epidem coffee epidemiology really messy because you know study to study done across different countries were showing different relationships to cardiovascular mortality. Um, and it turns out like if you're drinking like
• 24:30 - 25:00 six cups a day of a boiled coffee, like a Turkish coffee, um, you can like it raises LDL quite a bit. And so I've had patients drinking boiled coffee, not putting it over a filter that are just ingesting tons of turppines and they stop that and their cholesterol goes down 20 points. Wow. But they're like high consumers of this like obscure thing. So every like diet through many different mechanisms. It's mostly fat composition, type of fiber, a little effect of dietary cholesterol, obscure things like like turpenoids that can uh really impact LDL. Probably the polyphenols impact LDL a tiny bit. Um,
• 25:00 - 25:30 but they all work through potentially slightly different mechanisms and your patients all have LDL being raised for slightly different reasons. So, a lot of like when I talk with patients, it's very much setting the scene for like you might see magic, you might see nothing. We just like I I want to be clear that we know the like general average effect, but there's quite a bit of variability which underlies a lot of the academic enthusiasm for precision nutrition of like trying to predict why is there so much inter-individual variability in the response to diet. Yeah. Um I'm going to
• 25:30 - 26:00 ask this next question not with your thinking cap on surrounding acute hospitalized medical interventions. Sure. thinking more chronic disease, average person who wants to lower their risk or perhaps lose weight or something along those lines. Is the notion of food is the notion of using food as medicine overrated and really not very valuable?
• 26:00 - 26:30 Oh man, I'm going to piss off some people. I asked it in this very specific manner specifically. I think seeing food as medicine is wrong on several fronts. There's not a great way to look at food on several fronts. Like the totality of diet can have medicinal effects for sure and nobody's denying that. But like we're not studying food is medicine for the most part. Like if you want food a lot of people say food is medicine and then you
• 26:30 - 27:00 ask them okay well where are the randomized control trials with heart disease endpoints for foods and it's I mean you have like the pimemed study as like one single example but most people don't want to study we don't have the level of evidence to back up the statement that food is medicine that we have for actual medicines um in almost all cases and so I think that's bit of overstating the efficacy of food based interventions. I think a lot of the food is medicine stuff comes from the idea of like we should do healthy food prescriptions and this sort of stuff.
• 27:00 - 27:30 Um, which there's active trials ongoing around that. I'm curious to see what the evidence is. I have no idea how it's going to turn out necessarily. Um, but food as medicine also like tends I see a lot of hyperbole around it that makes me quite cautious like oh olive oil polyphenols are going to like cure you of breast cancer. And I'm like it comes with this like weight of having this like massive treatment effect. And there is again evidence like the DASH diet having like close to firstline
• 27:30 - 28:00 pharmacological therapy for blood pressure lowering and like I don't want to underell that at all. And I want people to appreciate that like what they're eating on their plate every day like does impact their health. Um but it's definitely like overstating it and I think makes it very prescriptive when there is a lot of flexibility. like we nutrition has not always done a good job of tailoring the diet to an individual's culture preferences. Um and there's a lot of ways that you can take dietary interventions and adapt them to whatever your socioeconomic status is, whatever
• 28:00 - 28:30 your religious beliefs are. Um food is medicine sort of takes the very small subset of foods that we have studied which are mostly like there's a lot of like love for the Mediterranean diet and there's nothing like that we know of that's like so uniquely amazing about the Mediterranean diet. It's just that like nutrition is like science happens to study it. Yeah. Science is founded in like western traditions and so they got interested in the Mediterranean but like you could probably have a Japanese traditional Japanese diet, traditional African diet, all that if we put the money and resources into understanding
• 28:30 - 29:00 those foods, the food composition to design trials around it. Um that you would find similar benefits to the Mediterranean diet. When you look compositionally at the foods, there's no reason to believe that like it's all that magical. So, it puts a bit too much mysticism around food for me. Um, it's like it's not about the food. It's about the totality of a number of interventions across their nutrients. It's like a food lifestyle. Yeah. Yeah. It's I I want something like that conveys a similar message but like more timid. Um because I food almost is
• 29:00 - 29:30 medicine cuz I you clinically you see the dark side of this and so I did my clinical training at the NIH clinical center which you don't get there until you've gone through many specialists particularly to like there's a lot of oncology patients and they are there on like a cartisel therapy is like a last stitch treatment after several others have failed and you see patients family members spending their last dollar on food and supplements that they think magical dietary regimens, green juice,
• 29:30 - 30:00 fasting, and they have really bought into this like food is medicine and it's I can't tell a patient like that. There's no randomized control trial data to support really any of this. Um, and I think that's a I can't tell you the number needed to treat, number needed to harm. I've seen harms of it like anecdotally as a clinician where patients who definitely did not need to lose weight were already wasting away got put on a green juice fast and they are now emaciated even more 3 months later than they probably would have been if they had drank an enure. Um and so
• 30:00 - 30:30 yeah I think that is where I know you said don't go into the impatient setting and I just went to the inatient setting but I think that's a very concrete clear example. Yeah, I just meant don't go into the impatient setting because I know it's very easy to start saying, well, someone congestive heart failure, you want to put strict limitations on their sodium or you have someone who has calcium oxalate stones, you want to tell them to avoid spinach, you know, like there are sometimes where like cuz we just did a video with a famous chef
• 30:30 - 31:00 where I presented a case to him and he had to guess, I guess, cuz he's not a doctor or anything, what the ca what the pre presentation was and what the treatment would be with his cooking. So we used food as medicine there. Oh, nice. Okay. But it was I presented him a pirate story who had scurvy and he created a citrusy meal or a celiac patient where he took out uh use specific noodles that didn't have wheat in them, right? Like a patient with PKU that's on a restricted foline diet. That's like real where really food is
• 31:00 - 31:30 the medicine. Um I think there's like food has beneficial effects for health, but this is where I I worry about calling it medicine. I think if you go ask dietitians who work in different areas like inpatient dietitians love to say food is medicine but they mean the ensure that is preventing the malnutrition in the patient is the medicine which if you go out to the you know the regular general population they think ensure is poison because it's seed oils and corn syrup solids or what or multidextrin um and so I think the vibes
• 31:30 - 32:00 of food as medicine are good if you got people in a room and ask them to define okay well which foods are medicine at which doses is and for which populations you'd come up with 85,000 different answers unlike if you ask what is a stat and it is pretty obvious what it's standardized. Yeah. Yeah. I think that those two schools of thought really need to be hammered into the minds of people when they watch content surrounding nutrition because food as medicine for someone working on the inpatient side which is why I wanted to avoid that not avoid it but like initially in that
• 32:00 - 32:30 answer was because it's different than food as medicine as it's talked about colloially like amongst friends. Yeah. So I think that that is an important takeaway because what what does it mean that food is medicine? Can you really eat an anti-cancer diet? Like what what the hell does that mean? I would love for the US to fund research to know if there is a diet we should be feeding when patients have specific types of cancer um and does it have any effect and even that it's very hard to do is
• 32:30 - 33:00 hard to do and that's in a specific population. Right? Now extrapolate that even further for a person that is healthy almost uh not having cancer in a screening way, right? So you're taking a healthy population, you're saying prevent them from getting cancer. Talk about making it 10 times more complicated than already the complex picture you tried to do. And I mean that's where I think like general guard rails are fine without getting hyper prescriptive like high fruit and vegetable diets, maintaining healthy
• 33:00 - 33:30 body weight. There's like general guidance from the World Cancer Research Fund and the ICR that put together these like monographs of diet for cancer and it's it's overwhelmingly perspective cohort data. We don't have like for cancer if it's a bad one because we don't have like biomarkers really that we can readily control the diet and assess people come up with ones but they have kind of questionable prognostic capacity. Um so for certain outcomes we have like I think just naturally more robust evidence where you can measure blood pressure you know blood lipids take only a couple weeks to reach a new
• 33:30 - 34:00 sort of homeostasis. Um and so like you can do a dietary intervention study in just a few weeks and see okay blood cholesterol dropped like 15% or whatever. Great. Um and that persists over time with those changes. And so there's different biomarkers, different diseases that we can say a bit more confidently that like the totality of dietary changes has a effect that is potentially relevant for prevention. Uh and in other disease states we don't have as much data or we only have one type of data. Um, so it's it's yeah, I don't want to underell like people get
• 34:00 - 34:30 really in the weeds on a lot of this stuff and it's like we've had the diabetes prevention program like landmark trial that used, you know, the supposedly poisonous low-fat diet if you go on the internet, but there's a low-fat diet to counsel on weight loss get like an average of around 7% weight loss and you see huge improvements in people who were pre-diabetic at baseline kind of not progressing to type two diabetes diagnosis. So like we which is something you spoke about with my recent interview with Dr. Jason Fun where he said that it wasn't part of diabetes sort of
• 34:30 - 35:00 management. Yes. That was an interesting history that was told. Well because I wasn't around then it was hard for me to understand that. But what is the actual reality when it came to the early 2000s of management of type two diabetes? Yeah. you get the the diabetes prevention program in the like trial in the '9s and you know a few publications that come out from it that start to show that like you know the degree of adherence to the low-fat diet and the weight loss is like highly predictive of not progressing on to type two diabetes
• 35:00 - 35:30 like late 90s early 2000s you see these publications pop out and so by like 2002 2004 ADA is putting out their position statements and you can track it across the 90s they always kind of said beyond the evidence at least with the way that we look at it now like lifestyle is important weight is probably a risk factor like council on weight loss. But it gets more I think the impetus for it and its focus and the guidance like really starts to get hammered in in around 2002 where they're like we've got the DPP trial now which is still a super landmark trial you look back on like we
• 35:30 - 36:00 know that you it randomized either to lifestyle or to metformin or just to control um and that lifestyle and metformin do quite similarly and quite well in preventing a number of individ a large majority of individuals from um progressing from pre-diabetes to diabetes. And like that's prevention 101 if you want to call that food as medicine. But all these people are eating different foods. They were all had sort of their lifestyle counseling individualized to what their current state was. Um and just again it focused a lot on weight loss. Um and there were
• 36:00 - 36:30 like other dietary goals but it this was like even pre the era where like there was a big focus on like reducing sugar sweeten beverages like that was not like a major component of the DPP per se. Um, so yeah, like the people I think want this like fine-tuned, hyper prescriptive, super granular, and that's fine if you've done all the big think things leading up to it. And I think people have to realize there's like diminishing returns for the most part. Um, and you know, maybe like you individually will like benefit a ton
• 36:30 - 37:00 from this supplement. That's great. And I'm not here trying to like gaslight you if you think something does something amazing. But for the population at large, the tools of nutrition research can at best for the most part give you some of the broader guard rails that you should be following. And then it's, you know, takes more and more triing and of type stuff if you want to like fine-tune the details later on. And then you should be seeing a medical professional if you have like very specific issues or concerns. Yeah. Yeah. This is where doctors take a lot
• 37:00 - 37:30 of smack talk where they say doctors don't know anything about nutrition or my doctor has never talked to me about nutrition and I'll talk to a patient and I'll give the general guardrails about like increasing fruit and vegetable intake, lean cuts of meat if they do consume meat, you know, like just some very basic things, trying to get some fish into the diet to get omega-3s. Um, and then people say, "Well, it sounds like you're just telling me to eat in moderation." And I'm like, "I kind of am
• 37:30 - 38:00 very sexy." Yeah. Yeah. And it's I know that's like what grandma used to say. And you know, a patient will come in and say like, "Is it terrible that I have ice cream once a month or I have a hot dog?" Cuz I saw this study from some classification that said processed meats increase rates of colon cancer by x%. And I'm like, look, like it kind of is in moderation, but like what moderation means to you might not be what moderation means to someone else. So we have to be careful about how we say it. But in
• 38:00 - 38:30 reality, when I'm talking to patients who are living in real life, and when I say real life, I mean not the concierge medical population that are millionaires and billionaires that have a chef traveling with them. Yeah. Exactly. So that is kind of a unique population because it's not real life. Like I'm talking to people who have jobs, who have children, who have multiple jobs, multiple children, and are stressed out and what is right for them. Yeah. And for me, it's more about trying to remove
• 38:30 - 39:00 some of the bad habits or limit some of the bad habits rather than think about boosting immune system or boosting health or health hacking. And people view that negatively on social media because they say, "Oh, it's because you're not as advanced as the experts on the Huberman podcast. You don't understand the research that they're looking at and you're just being simplistic." What is the counter to that? So I can use it in the future. Yeah.
• 39:00 - 39:30 Oh, what I mean there's not like a quick counter which I think is gets back to this problem. Um but I mean to like unpack that I think you know people are I guess the other experts that are providing hyper prescriptive advice. I would just always encourage people like in a real in real like clinical nutrition where I mean you're getting five minutes to talk about diet maybe max like even where nutrition you have an hour like to real like a dietitian has an hour with a consult for a patient like you're doing like a whole diet history a whole assessment of all of
• 39:30 - 40:00 their whatever they've had clinically done to them their biochemical labs their body what we call anthropometrics of body weight circum weight circumference anything that might inform upon their nutritional status before we then talk about like what are your values and preferences and pref and kind of what foods do you even have available to you and like then thinking about like what changes can we make and so I'm always and even with all that data it's how drastic are the changes that you're making well so they're just they're just super tailored like what you're paying for essentially with a dietitian is to
• 40:00 - 40:30 like be like let's think about let's triage of all the like the thousand there's thousands of products out there right and thousands of influencers who if you went out and did every single thing that they confidently told you to do you'd be broke even the like rich millionaires would probably be close spending 10,000 bucks a month on supplements because there's always I mean there are I have I've had patients taking more than 45 supplements and like that is not an upper limit by any means and so if you actually want to like figure out what is the most likely to benefit me. It takes a pretty detailed
• 40:30 - 41:00 assessment and then really tailored to you as the individual and that's what I think you should want out of it. somebody who at baseline is cookie cutter saying take 250 milligrams of magnesium take 200 milligrams of turmeric 95% cumoids or whatever that they're going to say like over and over to every single person that's not it might seem hyper specific but it's the least individualized thing as possible it's just as generic to me as the general guidelines I agree but this is how people get tricked and I see this in the real world play out a lot they go
• 41:00 - 41:30 see a doctor or specialist someone they do some kind of tests Yes, because you're doing tests that are validated, that have some logic behind them. They'll do some tests and they'll say, "I tested you. I'm the expert. Here's what you need." Almost I'm probably going to get in trouble for saying this. People will watch a lot of chiropractor videos. You've seen them online. Yeah. The thing to me that's most interesting
• 41:30 - 42:00 is the people who very much support, let's say, chiropractic medicine for relief of pain, for relief of symptoms, are usually people who are interested in natural remedies, natural cures, don't want to be on medications. Totally reasonable. I think that's a good general standpoint to start on. But then those people also want individualized care. Yeah. Because they want to be treated like an individual. They understand human bodies are different and pharma oftentimes misses that and in the day and age where it's
• 42:00 - 42:30 run like an assembly line, all those negative things that they say about modern medicine. Agree. Now we're on the same page. But then if you watch any chiropractor video on Tik Tok, whatever, they're always doing the same three things. Yeah. Doesn't matter if you have knee pain, it doesn't matter if you have toe pain. It doesn't matter if you have neck pain. Doesn't matter if you've been in an accident, not been in an accident, play sports, don't play sports, they're doing the same three things. And that's what it comes down to some of these influencers where it's like, yeah, they evaluated you, but was that evaluation
• 42:30 - 43:00 actually valuable enough to for them to specify what treatment they're selling you? How do we decide that? How like how does how is a reasonable person person supposed to know? Yeah, I think that's a million dollar. If I knew the answer to that, we would I would be much wealthier than I am. Um, yeah. I I mean, the nutrition world has 8 million versions of that where it's like everybody's got a gut reset program and they've got in nutrition like laboratory testing, it's so hyper
• 43:00 - 43:30 context and specific that like sometimes a plasma nutrient level does or doesn't inform and it depends upon your state and all these sorts of things that like I as a PhD trained dietitian need. So like I'm like I know what the DRI said and I know the validation data but you can go out I've had patients come to me with IGG food sensitivity testing a spectra cell micronutrient lab from white blood cells like all these things that are are being used by other practitioners to like guide their diet.
• 43:30 - 44:00 And I think it just kind of hooks people in for longer because you do the baseline test, then you do a follow-up test, and then you make tweaks, and then um when things don't move in the right direction, you do another change. And like it's it hooks people in for a much longer consultation with that practitioner, which helps them build up rapport. And I get a lot of patients who are five years into having tried various of these practitioners and are just frustrated and tired of people selling them like a quick and easy solution. Um because they I think they start rightly skeptical. modern medicine's like hiding something from them about like a quick
• 44:00 - 44:30 and easy solution and then eventually kind of have to come to be frustrated with the alternatives that are all very confidently providing them with I know the way the truth and the light about diet and supplements and natural medicines. Um all I try and do is arm people with like what should make you skeptical. I am encourage folks to be skeptical of pan practitioners as in they practice in everything like pan as in all. Yeah. Um, and I get people coming to me as a dietitian who are like, "Okay, well, what's my exercise
• 44:30 - 45:00 plan?" And I'm like, "That isn't that's do it. That's the exercise." But they're going to people who are giving them entire like lifestyle overhauls on this is your supplement routine, this is your diet routine, this is your um, you know, exercise routine. And it's just at some point I think folks need to realize that like very few people are experts in all those things. I am very big on scope of practice. Even within nutrition, there are domains I try not to touch on at all because it's just outside my field. I'm not up to date with the most the the most relevant data. Um, and so, but
• 45:00 - 45:30 we're seeing that everywhere on social media where people are pretending that they can walk in five lanes and be an expert in everything. That's just not possible. Um, I would always encourage people to look at the totality of what's out there. Like it's fine to want to get somebody's opinion on a single supplement, but just also realizing that there are many many other practitioners you could go see that are going to tell you with the same level of impetence and confidence that impetus and confidence that this other supplement is going to
• 45:30 - 46:00 do the same thing and that there's dozens and dozens and dozens of supplements out there on the marketplace. Um, and just so going in being skeptical and having trying to think about like, okay, I'm going to if I'm going to try something, I need to know how am I going to decide what I'm going to try. Work with a practitioner who's willing to kind of do that with you and not is just like confidently selling you one thing that they're also doing for every other patient that walks in through the door. Um, and having like some sort of test set up to like, okay, what do I need to know a priority needs
• 46:00 - 46:30 to improve? like I need to how am I going to objectively know that I feel better, sleep better, whatever it is, whether it's like through a log or something that you're doing and give it three months and see if anything meaningfully changes. And be real with yourself cuz that's if you're not walking in skeptical of the practitioner and the products that they're selling you, you're going to end up on spending tons of money, seeing a bunch of different people on 45 different things and having no idea at the end. You're going to be in this soup of like, well, maybe I feel better, but I don't know which of these 45 products was doing it. Um, but we are sort of in this like
• 46:30 - 47:00 wellness capitalist capitalist healthcape out there where you can just sell anything. You know, if we allowed pharma to make the claims that supplement makers are doing and supplement makers aren't even making it themselves. It's not illegal um to have your influencers who have an affiliate code doing all the illegal marketing for you nowadays. So, um I don't know that there's a way to combat the one-on-one like good feeling you get when a practitioner is listening to you. you start to trust them and then they have the like the answer for you other than
• 47:00 - 47:30 to convince people that like that's not real. Yeah. It's it's it's a good feeling in the moment and I wish modern medicine could combat this by not having six minutes spent with your doctor trying to address everything. Um I wish there was referrals for dietitians. You can't most insuranceances will not cover dietitians or maybe just a couple visits at best. U a lot of times you have to have type two diabetes or chronic kidney disease but like we as practitioners I think are you know we get the 30 minutes to an hour to sit and develop a rapport
• 47:30 - 48:00 and trust and individualize with patients but a lot of people are looking to their doctors who have six minutes to cover their entire everything clinically they need to cover to somehow cover nutrition that it's just it's an impossible task that um until things change and you can actually go see a nutrition practitioner and it's accessible and affordable to people it's I think it's a big losing battle Folks, I have a specific question and a very interesting question that I don't understand the nuance of. Specific
• 48:00 - 48:30 question is your patients that were jumping around from those providers that were encouraging them to take 45 supplements or follow their protocol, what have you. If you can and you've seen them harmed by it, right? Yes. Okay. So, you can go back. It's usually why they're at my doorstep is they're like, I have all these non-specific symptoms that we can't figure out which of the 45 supplements is the problem. So, if you can go back to before that person went to see those
• 48:30 - 49:00 providers and say something to them in order to prevent them from falling into this trap, what would you tell them? I don't think I would tell them anything specific. I would just listen to them hear what their problems are and talk about like be like I will talk about any data diet you want to talk about that you want to try support you in it that's what I like you know nutrition guidance for the public is like almost a losing battle because everybody has different reasons they eat whereas like with a patient it's just a matter of I think a
• 49:00 - 49:30 lot of people go to alternative practitioners because they just don't feel heard by their doctor and sitting down and saying what are you feeling what have you heard what have you read let's talk about it and I've yeah I have a very select patient population but this is from my experience of folks coming and they're like frustrated and just I think feel relief from somebody listening to them explaining the nuances, the logic behind and the data, you know, because everybody's now has a PubMed ID in their Instagram bios or in their Instagram uh post saying like there's science to back this up. Taking
• 49:30 - 50:00 a little bit of time to walk through, well, this is what the science said. This is where there's uncertainty in it, where there's not uncertainty in it, um and what it might suggest. and doing that for all the things that they're hearing about just to make them feel empowered and know going in whether something is likely to work or likely to not and they can call it quits in 3 months if they don't like it I think is most of the solution here is just uh listening to patience listening to patients and and helping them feel empowered in a situation where when you turn on Instagram it's like the least
• 50:00 - 50:30 empowering thing in the world you have dozens of people who are telling you that you can take control of your life and they all have different solutions for it again vegan to carnivore for and that puts this pressure on to patients and I think people feel it more and more that just pressure on the general population that like they have to put in the work to try out everything and then when they fail when it doesn't address their symptoms like they feel like they've failed somehow and the next person in line is going to tell them well it's cuz you did this diet and you should have been doing this diet and then it's on them to again undertake a
• 50:30 - 51:00 new diet and so it's this perfect cycle where you keep spending money and it's always your fault when things don't work out and I think kind kind of flipping the script on that and just being like I will I will tell you the uncertainties in the data which there are a lot and we can come to like a you and me together and hopefully led by the you as the patient like what what you want to do what you want to try out how we're going to think about um setting up a some sort of a protocol essentially um for whether this is going to help your symptoms or
• 51:00 - 51:30 not but going in clear-headed where I'm never going to lie to a patient and be like yeah every single person needs 300 milligrams magnesium you're people will be like massively improved. I'm like cuz the data just isn't there for that despite it being repeated across all of social media a lot. Um and I think you need to have people who are also ready to hear that. There are people who are like very much in the true believers of specific things and that's totally fine. Um everybody's diet has always you go back for thousands of years and every culture every culture has beliefs about
• 51:30 - 52:00 diets. There's a ritualistic element of it that almost fulfills like a religious thing. And I think that's for the most part good until you start getting people with like zanthomas from their carnivore diet. We're like, okay, it's gone a little bit too far. But I think autonomy and choice around food is something that we should promote and use the science as a guard rail to nudge people in directions that we think are helpful and then just be honest about when there's not data for stuff. But that is something that does not make you a lot of money as a practitioner. I can tell you. Yes. and tying to not making a lot
• 52:00 - 52:30 of money. It's hard to get that information out because the algorithm is sharing things people instinctively lizard brain want to click on and share and they're not instinctively clicking and sharing content from you saying uh food let food be thy medicine is not as cool outside of the hospital as you think it is. They're thinking more I want the person who says there is a cure for what ails me and they share that that gets all the love. Therefore, the good evidence kind of gets put into the
• 52:30 - 53:00 background. Yeah. And I I think it wouldn't be really like one all those sites are e-commerce sites at the end of the day. If you think social media is just for interaction with your friends, everything is e-commerce nowadays. They're all trying to sell you something. But like I I have like weird autoimmune stuff that doesn't fit into any textbook diagnosis. And so like I have been there being like I will buy anything that might be helpful. But I think that is like the most the vulnerable populations that need to be the most skeptical. And I'm saying that from my own experience of like having
• 53:00 - 53:30 spent money on random stuff that I hope would be helpful. And like sometimes you have to learn through experience of like I tried this and tried this and tried this and then 5 years later I still have the same autoimmune symptoms. Maybe slightly better. But helping people set that like realistic expectations about what you're getting. We have so much skepticism around like how has big pharma and big food influenced food nutrition guidance. And I think realizing that that doesn't make the little guy on Instagram like somehow free of conflicts of interest. If anything, they often have more. They're like directly um benefiting and their
• 53:30 - 54:00 whole livelihood is dependent upon selling stuff. So, it's 2025. People lie on the internet, I think, is kind of like a a theme that we all need to just embrace and then navigate that wellness landscape. And even if you do have something like a serious condition that doesn't have a clear medical treatment for it, I've had those patients. I'm like, I will talk you through the theory if you want to try something, the safety associated with it, noting that there's no randomized control trials that show that this is helpful. I think you need more practitioners who are just like
• 54:00 - 54:30 open to listening to patients with where they're at, which modern medicine is in no way um helping patients in that sense. You said people lie on the internet. Um, in especially in this healthcare space, are you comfortable naming any of your worst offenders or perhaps if you don't want to name names uh the the theories that they've put forward? I I that have tricked the most patients of yours or perhaps you've seen the biggest impact on. Yeah. I mean, you might have
• 54:30 - 55:00 interviewed some of them on the podcast. Uh, I don't know that like there I I see themes. I like truly try not to track I I what I'm most concerned with is healthcare practitioners on the internet that are like just repeating things that they've heard uncritically. Like there's a lot of both dieticians, physicians, nurse practitioners, you know, dancing to cute Tik Tok videos of like these are the five foods to avoid or whatever. That's what I get sent a lot and what I like am most likely to criticize. The big sort of people who have a brand and
• 55:00 - 55:30 are obviously selling something. I think the public just needs to be skeptical and there's not I don't spend too much time like critiquing those things all that much. Um I think there is general what I focus on are like themes to be skeptical of over people because all these top influencers have a PCOS nutrition guideline and now they all have menopause supplement lines and then they all have a gut health thing. And so I think the public being aware that like these are sort of like hot gimmicky things that sure there's a
• 55:30 - 56:00 bunch of microbiome data and nobody's doubting that the microbiome is like related in some way to health but that doesn't mean that there's like testing it is going to give you any valuable testing is not going to give it a therapy that someone claims works through the microbiome works on the microbiome isn't doesn't mean it's clinically efficacious for anything. Um and at the end of day for nutrition it always comes back to like eat a high fiber diet. That's what I find hilarious about those sendin microbiome tests. Patients will ask me if they should do them and I'm like I can just give you the advice for free right now and it's
• 56:00 - 56:30 the same advice and it'll be the same advice no matter what bacteria is in your microbiome. Yep. And if you tested it tomorrow, it would be very different. Exactly. And all those things are like 16RNA based for the most part. And it's like what does that mean? It's above my So it's a it's how they sequence who is there essentially in your gut microbes. But it tells you like the relative abundance of specific bacterial species essentially like it doesn't capture fungi and viruses even. So it's not even getting all the microbiota there. It doesn't tell you what genes they have. So you need whole genome sequencing to
• 56:30 - 57:00 do that. And then it doesn't tell you about their function which you can start to get at from looking at their transcriptto or at their metabolum. And so there are like many different metrics you can lay out for the microbiome. Knowing the relative abundance of which bacterial species are there versus not is like minimally informative. Like it was hot early on as an early microbiome method, but like a lot of like top researchers in the field who all are saying we don't know the best probiotics, we don't know the best diet for to individualize around your
• 57:00 - 57:30 microbiome. Don't buy these tests. Um they're like not even using these things in research because it's not as advanced as it needs to be uh nearly as much as they were because they were relying on it early. But these there's a lot of gimmicks out there, things that are like I think people want the feeling of being on the cutting edge. Um but the cutting edge often means we know very limited about it like our and I and that's it's fine if you want to do a diet or a supplement or something. Yeah. But being real with yourself about like cutting edge means high uncertainty like and I
• 57:30 - 58:00 think that that gets left out a lot of times in the marketing and the hype of things and that cutting edge doesn't mean that everything that happened before it is necessarily wrong. Like there are there are blockbuster trials and nutrition that changed nutrition recommendations that are like like with um peanut allergy prevention in young kids. It used to be said like delay and then that then block like actually no earlier is much better and we when there is definitive evidence like that out
• 58:00 - 58:30 there there's like a huge fullcourt press for changing info out there. Yeah. Like no one's secretly hiding this like this top information from you. Um again like in chronic disease kind of stuff where it gets uncertain. I think often you'll see people overstating the relative confidence we have in the data and I understand why that degrades trust, but there is not like secret blockbuster studies out there that people are hiding from you. We don't fund nutrition research seriously enough to to know those answers to have those blockbusters like things. Um, so yeah,
• 58:30 - 59:00 it's I don't I don't remember where we're going with that, but No, no, that that makes a lot of sense. If I was your patient and like we're sitting side by side like this and I say, "Doctor, like this this microbiome test came or this blood test came and they told me like if I do this, they'll be able to tailor my nutrition around that. Should I do this?" I would say no. Well, I'm curious what that conversation would look like. Why
• 59:00 - 59:30 Why would you say no? Well, I I would just say like, you know, currently no medical guidance recommends this. these tests are like have limited evidence sort of backing them up. Is there something general to that effect of like there's not really data for it? Uh and I usually ask patient, do you want to go into like what the theory is and why people are pushing it? Um and some patients want like the deep dive and some people just want to hear no and there's various what's the deep dive of of why those things in general fail. So one of the failure sniff test I mean yeah one of the ones that you see the
• 59:30 - 60:00 most common is the food sensitivity tests which you can buy now like target from Everly well or whatever. Um and so they are like IGG based food sensitivity tests that get sold as like the more IGG you have and reactivity to a specific food the more like you are to be like sensitive to it. And they're not really defining sensitive. It's just like this nebulous concept of I feel bad after eating something maybe. Um, but those are like the science of IGG is just your immune system is constantly in you have a immune cells
• 60:00 - 60:30 all along your gut and they're interacting with food derived proteins and it's more of IG is like a marker of a tolerance like you make antibiotics antibodies to foods that you've eaten recently. And so I've had patients who like and I use this story a lot like where they eat something and it scored high on their IGG um test and then they cut it out of their diet and then they come back and then now they get totally new foods that they're supposedly sensitive to. Like there's not really a time at which you're not going to have
• 60:30 - 61:00 high IGG to something because that's just a normal. Why are these companies Why is every every well Everly well yeah Everly well why are they selling this if it's clearly disproven and doesn't work I think there's like is it hope that it might work or like there was early in like attempts at using it it's like a for just anybody who knows about diagnostics it's like the worst thing in the world has very poor sensitivity and specificity um for uncovering anything and nobody wants a diagnostic test that
• 61:00 - 61:30 never gives you an answer of no like if you're always diagnosed with like you're sensitive to something that is like a grifter's dream and not a great sensitivity test. Um, so yeah, I I I got like people are making money out of it. There is anecdotal like evidence that people are saying like I told me I was high on this and I cut it out. Um, and like those the action taken from it may well be real. Like if you score high on wheat and then you have like IBS and you cut out wheat which is like a major source of FODMAPs like you might feel better. Like there's
• 61:30 - 62:00 biological plausibility for how these things could work in a way for somebody that didn't ever really require the test, but they also didn't get maybe they didn't have access to a dietitian or a physician who who knew something. So you can stumble into I think something that works, but but it's like the clock being right twice a day when clock right twice a day. Yes. Um but like I don't want to gaslight people who have done it and say that they've had a benefit from it, but it doesn't mean that it's indicated for the entire population. And there are ways to find out about foods not working well with
• 62:00 - 62:30 your body that are not that unscientific. Well, yeah. I mean, the gold standard in GI like clinical diabetic practice is just like food logging and then like symptom logging and then trying to like review that after some time and then triing elimination diets. Um, so it's not it's like not high tech. I think it's just very sexy. But like there there are other diagnostic tests out there like everyone wants to optimize around like micronutrients and so people will measure micronutrient like there's like
• 62:30 - 63:00 I think it's spectracel but you can and there's probably others now at this point but I've had patients come to me with like I got my micronutrient panel and all the amino acids and it's all from their white blood cells which white blood cells are not like a validated matrix to measure any of these things and say like when you measure something in the blood you don't really care about the blood usually you care about like how much is in a tissue. Sure. And whether that nutrient is performing the function that it's supposed to perform for your phys your health and maintaining your physiology. Um and so measuring the amino acid levels of white
• 63:00 - 63:30 blood cell isn't really telling you about whether you have enough amino acids in your liver, but your muscle tissue or your muscle. Yeah. Like it's but it's implied that that it's somehow useful. And I think this is something for like laboratory testing in America. Like there's more regulations around making sure that you get the same answer twice than there is about whether the answer is meaningful. And so we have a lot of laboratory tests that like I've had patients come to me with full cardiovascular risk panels with all these like cytoines and things I've
• 63:30 - 64:00 never even like heard of. And I go look up the reference from the laboratory test and it's like one study shows that it slightly improved specificity and sensitivity in predicting who would have a 30-day re readmission in patient. So patients who were like at risk of who had just had a heart attack impatient whether they'd be readmitted 30 days later is now being measured on somebody who's like just a normal generally healthy population. And like even in those impatient people like your blood cholesterol and your BMI and more
• 64:00 - 64:30 predictive the majority of the bulk of it and so there's no added value even in the setting it was tested but you have to go to PubMed and understand diagnostic testing. So you're just getting it sold to you as a product. Yeah. And I think a lot of practitioners are not nearly as like a lot of alternative practitioners sell this stuff and they're either not being skeptical or know that it sort of is a buyin to hook people in for longer. It gives them something to do. I think patients leave always wanting to feel like they this is the classic parting gift, right? Yeah. The antibiotics for viruses. Yeah. Um and in nutrition I
• 64:30 - 65:00 think it's something similar and often it's a huge problem for the scope of practice of dietitians of like a lot of it is education like I mean in patient stuff you're like you have specific prescriptions for formulas and whatnot but like if you're just educating people on based off of like what they told you and you're telling them what you think the diet should look like and I think it's always it should for good dietitians we really need to be trying to like deliver something like I try and have spreadsheets available for patients where they can see the math that I have
• 65:00 - 65:30 and like just to feel like they're getting something and do like a little meal plan. I teach people how to meal plan with like a coded Excel spreadsheet if they want that. Um, but don't feel like you're delivering something because that's often a lot with the alternative practitioners have and they get a ton of money out of like you, you know, you have to pay for those tests and then they're coming back again and again to review it and um, and but none of them are really indicative of like they're not doing what they say they're doing of like they're measuring the status of a nutrient in your body. Um, and then
• 65:30 - 66:00 there's no trials showing that like randomizing people to getting this test versus not are actually improving any clinical outcome. For the field of nutrition outside of doctors, there exists a field of nutritionists and dietetics. What is the difference? Why do I get so much hate in the comments when I say it wrong? What is what do I need to know about this? Uh in America there are there's not like
• 66:00 - 66:30 really as many like federal regulations as you might think. Um so there are it's like very statebystate. Um dietitionians it's like a typically it's a protected title in a state and so you have to have gone through a specific series of like now it's a graduate curriculum that we call the dactic program in dietetics. So your dactic courses and then like a thousand hours of supervised practice and then pass an exam and then you can be a dietitian. Nutritionist is not. And that's like a master's. Now it's a
• 66:30 - 67:00 masters. It used to be bachelor's entry level. So you'll see a mix out there, but it's increasingly all masters. Um so I teach in one of the mast's programs at UC Berkeley. Um so your yeah your goal is to train people who are meeting specific educational thresholds and clinical thresholds and get exposure to the general population. everything through like, you know, people doing nutrition support where they're either tube feeding or IV nutrition like TPN on patients. Um, and so that's like a protected title and that you you should
• 67:00 - 67:30 not be using the saying you're an RD if you're not actually an RD. Yeah. Uh, nutritionist is not a protected title. And so I want to be clear, this is specific to America. Other countries have more protected terminology around like like the UK has like a registered nutritionist and they have a registered dietitian credential. We don't have anything on nutrition. Um, so when someone says they're a nutritionist, what does that mean? You can't gives you zero information about the person's training background. So Sam could be a nutritionist. You're a nutritionist. Congratulations. No, but literally like you don't eat anything. I see people
• 67:30 - 68:00 like like they did a two-day workshop on like on the weekend and then they're like, I'm a nutritionist, a career changer. And like some of the people who are like the most influential nutritionists online have no like formal training in any of this. A lot of it's like people coming up like got into bodybuilding and they have like the physique that somebody wants and then they sell nutrition plans and will call themselves a nutritionist over time but don't have any like formal training. Um we are actually bad at understanding this as doctors. Yes. Because we have like in my program we have nutrition
• 68:00 - 68:30 students. I have no idea what that means. I don't know where they're a student from. I know that they help me talk with my patients when I don't have enough time in order to give them education about what a carbohydrate is. Yeah. But I have no idea. Are they studying to be an RD or are they taking some course? I mean, I'm sure they're not, but I mean, I have met like deans and heads of endocrinology programs who go, Kevin, what's the RD after your PhD mean? And I'm like, you probably shouldn't tell me about an endocrinologist. You don't know what the
• 68:30 - 69:00 dietitian is. But this is a problem, I think, for dietitians, too, is like and nutrition becomes its own little insular world. I mean, it's like a, you know, we have the Essron soup that um is not really accessible unless you've trained in it. That doesn't help us. But and even just like what is an RD? It's a it's a full acronym soup. Um but we I think RDS need to get out there and interface more like a lot of what you know inatient RDS even like you might how many times do you interact with an RD in your medical
• 69:00 - 69:30 training? So there was someone from nutrition that actually came with us on rounds. Yeah. Yeah. So that was a thing, but I just didn't know that they were an RD. Yes. I would have probably accidentally called them a nutritionist by accident. And you might have gotten a tongue lashing about that. I'm like less cagey about it. I'm like, call me whatever. The fact you know I exist. Great for me. I mean, I always had the problem because dietetics is like 90% female. And so I always got it mistaken. They were like, oh, the medical resident. I'm like, no, I'm the dietetic intern. Like, okay, got it. Um but yeah,
• 69:30 - 70:00 dietitians I think you know are humble, quiet um you know they fought to be recognized as like a clinical profession. You know there's a lot of historical sexism and the field field is 90% female for a reason. And it was come it comes out of the field of home economics and then um it really gets launched by like the wartime like World War II in particular where there was like high rates of malnutrition lots of concerns about the readiness of soldiers making sure the food supply was adequate for both feeding people adequately at home and soldiers and so dietetics got like a big launch there um but it's I
• 70:00 - 70:30 think struggled you back in biochemistry just was nutrition in like the 1940s and so there was a very gendered like if you are interested in nutrition and you're a man you go become a nutritional biochemist and then if you're a woman you go into dietetics and a lot of like really badass women like fought that and you see like PhD RDS at various institutions who have done great work but I think in general the field still struggles to like be recognized taken as like a serious STEM um major a lot of
• 70:30 - 71:00 people like when you're in undergrad you don't think at least in America you don't think like I might be premed or I might be pre- N nursing or I might be like pre-dietics like that's just not it's not thing. Um, so you have to have heard about dietetics in some way. I'm glad we're giving it a commercial right now. Yeah. Yeah. Exactly. So, should people if they are listening to someone for nutrition advice and they find out they're a nutritionist, should they stop listening? No. No. I don't I mean, so dietitians are like probably it'd be
• 71:00 - 71:30 great to go to dietitian. Dietitians are also like overkill. like we're like medically trained professionals who like can go and feed a baby with like short gut um in the NICU who just survived neck and needs TPN. Like I mean there's like a really advanced skill set of dietitians and like not everybody needs that. I think you should go to people that you trust that you have a rapport with that are not selling you a bunch of stuff at every angle. You feel like you're getting good coaching motivation experience out of I want to hammer home because I know that message is so important and I know people will it
• 71:30 - 72:00 won't land correctly. the idea of not paying for something. You're not saying that because you're anti them making money or that you're anti- capitalistic or something of that. You're saying it because there's nothing really to sell. Well, you should pay for you should pay to talk to the person. Of course. Yeah. But I'm saying like productwise. Yeah. There's nothing that exists that's proven that people can sell to make money but also help you. Is that a fair like general statement to make? I think
• 72:00 - 72:30 for the general population, yes. Like you might run into something where it's like your diet is really low in something. You're you have a restricted diet, you're vegan or whatever. Like they might tell you take a B12 supplement. That's like totally fine general. You might not have much dairy and I might recommend like a calcium supplement. I think when it's like this person seems to be pushing their affiliate code link on every single person that they're interacting with that you should become a bit skeptical. But like I've had patients like I I with meal planning takes a lot of time. I'm not going to do that for free. So if somebody wants to pay for like a full
• 72:30 - 73:00 meal plan, that's paying for the service of the thing, but when they're selling you the products, I think or the testing. Yeah. That's when like red flag should pop up. Not because again, we're anti them selling those things. It's just because there isn't even one that I can think of. You found like some very specific examples with vegans and B12 or folic acid. Yeah. In those who are trying to conceive or of reproductive age, but in general, there isn't much to sell. And that's why people judge the doctors are not selling something. I'm like, "No, no, those are the people
• 73:00 - 73:30 telling you the truth in the least sexy way possible, but it's the truth." So, I think that that was just an important thing to call out. Yeah. No, I don't think there's anything that I would like think of every patient that I'm like, "Oh, yeah, they needed that." Like, every single one of them needed that. Like, it has to be individualized and it should be like even in patients unless it's like you eat zero B12 and you need B12. Like, I'm medically saying do this. Also, like how rare is that? Like, no. No. meaning rare is a specific incident of that being valuable. Yeah. Oh, it's
• 73:30 - 74:00 it's the definitely the minor case, but like I I think if somebody is trying to like it recommends a product to you once, like I'm definitely one people walk away like it's not a crazy thing to recommend a product once. It's when somebody's like giving you a cookie cutter thing that they're not being honest. Like these are the red flags I usually encourage people to look for because you telling someone with folic acid or B12 that's like such a specific thing. You're not pushing a line of B12 formulas. Like that's where it starts
• 74:00 - 74:30 getting weird for sure. I mean I even I have to be careful about this. I've done work in like control trials in choline and um it's like one of the nutrients that I'm like have the most perceived expertise in and but we've had industry funding for it. But I get all these patients referred to me to talk about choline and like I have to be careful to be like let me not like I'm they want me to come tell them take choline and I'm like I want you to go see someone else to be honest. So like somebody you should work with somebody that again you trust is clearly minimizing conflicts of
• 74:30 - 75:00 interest is not trying to like push something on you. Um it depend like pregnant women like your practice probably should be saying to take a prenatal and an omega-3 because that's what standard of care. Um so the the product diff like a single product being recommended. This I think maybe this is where like nutrition and drugs are really different. So like often patients are coming to me asking for a product. They want my take on like this specific brand of yogurt. Do I buy it or not? And so a lot of what nutrition ends up being
• 75:00 - 75:30 you have to interface with the marketplace in a way that like is not behind a prescription pad. And so people are going to tell you about products all the time if you're talking to a dietitian or anybody in nutrition. And that alone isn't a red flag. It's somebody's like dying on the hill of like fier is better than chobani. Like those are the red flags I want people looking for a bit more of like this feels off. They're married to this one thing. there's no flexibility for me because outside of the PKU patient where
• 75:30 - 76:00 you need to restrict phenol alanine nutrition isn't very hyper prescriptive um and even on things where you might think it's prescriptive of like calorie counts and everything there's so much error in our estimates there's so much error in the amount that's in food like all of it is is again guardrails over prescriptions um and so yeah I that should be the title of a book for you guardrails over prescription I like academics so much I'm like, I want to write my the book I want to write is an entire history of like nutrition like like you know
• 76:00 - 76:30 something overly wonky that 12 people will buy. What do you mean that that would be in hype demand right now? I just wrote a 20page review article on all nutritional guidance in America dietary guidelines, nutrient reference, all the things that shaped their evolution over time. And so, um, that'll be out eventually, but I like I was like spending hours on internet archive like reading 1890s like dietary plans from the USDA and like that's the nerdy stuff that I like more so, which again makes no money. So, in due time, yes. Um, so if I'm a person
• 76:30 - 77:00 that's interested in learning what I can do with my diet, should I see I'm trying to lose weight or I'm trying to accomplish some goal, who should I see? I mean a lot of times with a dietitian it's going to depend on whether you know somebody or can find somebody locally oftentimes like ideally you would be referred by a physician. And so your primary care that you trust and have a rapport with I think is a good place to lead you in the right direction of like if it's just weight loss do we have you
• 77:00 - 77:30 they'll know about what you've done lifestylewise um and I think there's more and more of realization lifestyles is going to be a small impact in starting you know something like the GP1s so they might be able to start you on that and then you might go see nutrition counseling on the side as needed. Um but it depends I think a little bit on what your specific concerns are. I would love to say like go see a dietitian, but I'm also aware that there are like 100,000 dietitians in the country. They're not there's not that many of us. We don't get referral. We don't get Well, that's because it seems like everyone sends someone to a
• 77:30 - 78:00 nutritionist because there's so many more of them because you doctors don't get taught in medical school. This is why I want there's a lot of talk about nutrition being taught in medical school and those ACGME hours are like fought after. And like the five hours you guys end up getting of nutrition, I think are going to be great because you're not going to become nutrition experts in that time. Somebody will tell you at some point like this is the difference between an RD and a nutrition. So some of the I did my posttock at Baylor College of Medicine and they have like they already had a nutrition education for a while and the RD is like teach it and I know that they explain
• 78:00 - 78:30 those basic differences of like when you do run into a nutrition problem inpatient, outpatient, whatever it is, whatever your specialty is, like this is who to refer to. And often times it would be a dietitian if you want somebody who needs like a full nutrition assessment basically. Um, and that's not a bad place like to if you're going to spend 200 bucks on the supplement for a couple months, like you might as well just talk to somebody who's going to like actually take a deep look into your diet, talk about what are some like highlevel goals that you want to set, maybe some swaps that would be high
• 78:30 - 79:00 impact for whatever your concerns are. Um, and just orient you to like this kind of landscape that we're focused in. But why are you skeptical when doctors say that they talk nutrition with their patients? Well, because you have like three minutes to do it and so it's always a bit of a sound bite. I mean, I as a patient have had doctors like I usually hide that what I do. Um uh because otherwise I get like half of the appointment I'm paying for is talked about the nutrition element of things. But I had patient like doctors like my
• 79:00 - 79:30 rheatologist was like, "Yeah, you should go gluten-free." And then I was like, "You know, that's like a lot of work. Like are you going to provide me any like resources on that?" And she's like, "Oh, no. I just tell patients to do that." And I'm like, maybe don't like like there's no trial evidence for that being helpful for your like I get there's anecdotal evidence of it, but I'm like actually avoiding all gluten in the diet is like you have to know highly educated on all the different ingredients and whether they might be gluten containing or not. It's not just like a throwaway advice, but I think that's what happens with doctors is
• 79:30 - 80:00 throwaway advice. um you guys get training like you'll touch on vitamins and stuff in your biochemistry classes and your sort of like early meds MS1 MS2 like didactic training you touch on nutrition in different ways but you never get education in food which is the basis of nutrition like you talk to doctors about like what food compositions are how much B12 is in different foods like what's the fatty acid compositions of different oils like this is all coursework in becoming a dietitian where you have to know the food science you do food preparation
• 80:00 - 80:30 like you're taking it's a hodgepodge career path of like it's like you're taking anatomy and physiology and organic chemistry and then you're taking a food science chemistry type class and then you're preparing food and you're taking a community nutrition class. It's just you get like a broad um array of like everything and that's like a full fouryear degree. The idea that doctors can do that can do that and then like there is data randomizing people to like counseling from a dietitian versus other practitioners, dietitian versus nothing. how much frequency of dietetic visits do
• 80:30 - 81:00 you need? And it's like typically like six visits a year, hour long, like so every couple months basically coming back up and that improves like blood lipids and blood pressure and weight like meaningfully but marginally. So the idea to me that like in those hourlong counseling sessions that are hyperindividualized with like an assessment and followup that like dietitians are producing solid but like not massive effects that a doctor is like giving out a pamphlet and it's
• 81:00 - 81:30 throwaway and you know people who like obviously like we both know Danielle Bolardo and her patients I think do wonderfully and she's got like tons of information for them and she's got really people really like hyped up that are hyper motivated about lifestyle but for the most part for the average doctor that's out there like just a throwaway comment like it's unlikely to do a lot of good and I've also seen it do harm where like people misinterpret the advice in some way or they say oh this person told me I'm like I I mean I get a scary amount of people physicians
• 81:30 - 82:00 calculating what it would take to be a normal BMI and what their current BMI is and they tell them like how many calories to eat a day being like some super low number and it's like some 1200 calorie restrictive thing, super low calories, and saying, "Well, your BMI is 32 right now, and you need to lose this number of pounds to be a BMI less than 25." And it's like defeating for the patient where they're like, "I got no support or evidence. All he did was tell me that I need to lose a ton of weight that I have no idea how to lose." Um,
• 82:00 - 82:30 and so that sort of stuff is has like off, you know, side effects that I think we don't want. So I want doctors to be advocates for nutrition like in the impatient setting like it's and to be aware of the field. Yeah. Yeah. You should know we should be able to have a conversation and it should be not me teaching you the acronyms and you being like what is an RD sort of who are you is sort of like kind of what the state of nutrition physician interaction is. And so I've talked with a lot of nutrition physicians who they themselves are like outlier people because you guys
• 82:30 - 83:00 don't have formal fellowship training in nutrition. often pedes GI or endocrinology that do like some nutrition fellowship training like a a one year of like nutrition focus afterwards but there are just a handful and so we need more dietitionian physician kind of interaction you know position statements should be written together I think there needs to be more advocacy from the AMA for coverage of dietetic services there's a little bit more that's happened with having like a big push for diagnosing malnutrition in like
• 83:00 - 83:30 the inpatient setting that requires more physician dietitian interaction and so I have hope for the future for sure but like we have this entire career path that is like like you we want nutritionists in society we have a like legislated you know standardized way of doing that as RD and for some reason we just like don't use it as a society like you don't well because I feel like they found a short code with nutritionist getting a two-day course you don't even need the two-day course then like I mean and so this gets into like there's a huge political battle here cuz like you
• 83:30 - 84:00 both from a right and a left perspective, you don't have support for like having some sort of credential around nutrition because um like even if dietitians have a title act, they don't always have a practice act per state that like so that there's not legislation around you as an RD. Like I in California, I don't have to have a license as an RD. We don't even have lensure. Uh because the left wants or tends historically has been more friendly to like alternative medicine type stuff and the sort of alternative
• 84:00 - 84:30 practitioners are huge opponents of um dietetic lure and then on the right there's sort of like typically like a freedom to practice freedom of choice of who your provider is. There's kind of some overlap on the extremes. Yeah. Uh but I think it's just in general there hasn't been like support for state or federal like broad um saying like just like physicians are like we are the physicians and then there are all these alternative practitioners and it took things like the DOS a while to kind of get recognized at the same level as MDs. Um there's not a lot of like strong political capital fighting for like we
• 84:30 - 85:00 need to have like this as the credential nutrition practitioner that people should see and should be referred to and should be covered in insurance. So it's a huge mess. there was an attempt to get um dietetic coverage um for the it was called a medical nutrition therapy act and it was submitted in 2020 but it was never really obviously 2020 it was a busy year uh so I know that there's effort now to um get a new uh something submitted before Congress so that it can be pushed through because right now Medicaid only covers dietetic it only
• 85:00 - 85:30 reimbures for dietetic services once you already have type two diabetes or chronic kidney disease it's like the least prevention focused thing you can imagine you have to have the disease so you have pre-diabetes, it's not going to get reimbured necessarily, different insuranceances cover different amounts of dietetic visits. But like if you have like cancer and you losing excessive amounts of weight and struggling to get, you know, if you're a family member of somebody with cancer and you're like, I have no idea how to feed them, you can't just like go see a dietitian who have lots of knowledge and strategies about that. So like as a society, we need to like take nutrition so much more
• 85:30 - 86:00 seriously and actually like fund it. Yeah. You're talking about nutrition from I think the side that social media doesn't talk about it. Yeah. They talk about it like Dana White goes to see a dude and I say a dude because there's no real license there. And he says I'm never seeing a regular doctor again because they're only talking about diseases that they can diagnose now but not about preventing those diseases. And I'm like, well, that sounds like great in theory, but what proven way are you going to change these people's lives
• 86:00 - 86:30 outside of helping them maintain a healthy weight? You know, the the basics that are put people to sleep these days? What is that person telling you? Because I don't know. I don't know what miracle potions they're discussing, but I'm unaware that they exist. Yeah. I mean I what I when I talk about dietetic like reimbursement and coverage it's like the landmark trials like the diabetes prevention program that were just like diet study dieticians were involved in individualizing the um lifestyle
• 86:30 - 87:00 intervention arm of the DPP like we need to nationalize that trial basically and it's not there was no turmeric there was no magnesium supp like there was there was no gut microbiome testing it was just like dietitians you know a little bit more intensively and then sort of phased out in the DPP and then the look ahead trial was sort of the follow-up at the DPP um that was a bit more intensive but we need those style interventions rolled out at like national levels that have coverage and you should be able to get in get involved in this and America's just never funded prevention
• 87:00 - 87:30 seriously and so it's left open to people who have the resources to go see alternative practitioners who are kind of getting sold magic in a pill that may or may not feel like magic to them at the end of the day but like is not clearly not producing broadscale societal level um improvements in rates of obesity and things like that. We just got the newest numbers in August for 2021 to 2023 and the levels of obesity are still like 40%. And so um yeah, there's a lot I mean and I don't think I'm not selling this as like dietetic reimbursement to
• 87:30 - 88:00 like fix all ALS like we need policy at every single level. But uh I think in the societal inaction around nutrition and prevention both from we barely fund it research wise we barely reimburse it on the care side of things. We don't really take policy around legislating what the food industry can do and formulation everything from formulation to advertising like just nutrition is not taken seriously at every single level and that totally allow and couple that with physicians not getting much
• 88:00 - 88:30 time with patients and people feeling not heard or like they haven't spent time with them. Alternative practitioners are going to like have a field day totally thrive in that space. And it's obviously like a unique subset that can actually afford that. But I increasingly um see patients who come to me and they're like, "Oh yeah, I used to I I used to see this practitioner and they told me all these things and they're they're also telling me about how financially stressed they are." And I'm like, "Oh my gosh, how are you paying for like 200 bucks a pop to see a chiropractor and all these supplements and things?" And so, um, I think it used
• 88:30 - 89:00 to be I think that there's been a thought like from more at a national level and from like thought leaders in the field like, "Oh, supplements are just we don't need to like regulate them beyond the dash act from the '9s like it's just a rich people thing. They're not really harming themselves." But like now we are in a totally different world where everybody from every walk of life is dealing with these e-commerce based um social media platforms where they're being sold tons and tons of products. And I think it's it's concerning for the general population that's being
• 89:00 - 89:30 basically lied to about the efficacy of products and often times isn't even buying what they we think they're buying. But I often think about the lens too of like you know you might think saying oh whatever is anti-inflammatory and is harmless for the general population. But you have a highly motivated subset of the population that has chronic inflammatory diseases that we actually want to know like do those supposed anti-inflammatory things work but they're buy they're the first ones buying them. Yeah. Um, and I am always worried about like protecting
• 89:30 - 90:00 the vulnerable subpopuls that are going to be hit that are going to be prayed upon essentially by um, people making ridiculous claims without evidence behind them, which becomes like this chicken and egg issue of like you have to fund the research infrastructure and the studies to get data to say whether things work or don't work. And I think at the federal level, we've just never we've funded some nutrition. And you'll see like numbers quoted about how much of the like NIH budget is nutrition, but like that includes like if you knock out
• 90:00 - 90:30 a neuronal population in a mouse model and study how it affects food intake. So those are like massively overinflated. If if you actually like look at the number of clinical trials intervening with food or supplements across a range of things that people care about um it's minimal data if any. Uh we've sunk a lot into like vitamin D and omega-3s for like and antioxidants for cardiovascular disease. But I think a lot of people nowadays and this is a good thing and I think interfacing more with what the general population wants is important to
• 90:30 - 91:00 drive research agendas. People just want to feel good. They want to feel energized. They want to feel like their quality of life has been improved. And when you go look in the literature for like does this supplement actually like improve people's quality of life? Does it improve their sleep? Do they feel less groggy? Do they feel le is their mental health better? We are just scratching the surface on that and don't have the research investments to even the research money to even seriously investigate the things that the public cares about and is asking of nutrition.
• 91:00 - 91:30 And yet the claims are being made. Yes. and and the claims are out there in abundance and it's up to you as an individual even like you and I like I mean I have a lot of knowledge. I still don't have I can't just know things that we don't have trial data for and so um it is up to me to decide if yeah the internet my algorithm thinks I am both a pregnant woman because I do pregnancy research so I get a lot of interesting things but also knows I have like chronic autoimmune issues and so I get everything like there are 50 supplements a week that are pushed to me that are a cure all and I'm like I could not afford
• 91:30 - 92:00 to try all of those and it would take years to try all of them and so it's just any I A lot of people are like, "No, I love the supplement. This guy is saying that there's no evidence for it." Like, yada yada. I'm not I don't want it to be supplement by supplement at a time when you look at it. But like when you look at the totality of what is marketed to people, there is not the data to back up any of these things or the majority of the claims that they're making. Um, and I think we as a society like taxpayer dollars are funding research. We should be seriously thinking, you
• 92:00 - 92:30 know, for the current administration like about we should fund things that people care about. Um, and it not just be like, you know, antioxidants for cardiovascular disease, but like things mental health is a big one. Like how does diet impact mental health? If I wanted to do a study on that right now, I don't even know who would fund it. Like I'd have to write a really compelling grant to the NIH to maybe fund it. It would be hard to find the infrastructure to do it as well as I'd want to do it. Um the food industry may or may not chip in some dollars for it
• 92:30 - 93:00 but the funding model in research is very much like NIH does a lot of the basic stuff a little tiny bit of clinical trials very little in nutrition and then you have pharma is outsourced to do all the clinical research and a lot of the non-farmaceutical intervention space is just starved I mean we saw this during co like we couldn't like I would love it if we lived in a research environment where you could just do a mask RCT in sort of a pragmatic way but we don't have a nationalized healthare care system. It's there's not like clinical research
• 93:00 - 93:30 infrastructures set up within our medical system. Um so there's huge limitations for understanding any non-farmaceutical intervention including nutrition, including supplements. Um that are always going to hold us back from ever having like the evidence base to say what works and what doesn't. Yeah. The two groups that I feel like are prayed upon most often with social media kind of overlap to some degree because of genetic distribution for demographics. Women and those with autoimmune conditions. Yeah, because often times uh their presentations that
• 93:30 - 94:00 occur with certain conditions are non-specific in nature meaning they don't fall neatly into a category of a diagnosis which leads doctors to misdiagnose often uh doctors to be short with them because it requires significantly more time input multiple visits which they can't get and as a result they're harmed by the system therefore they're seeking the alternative. alternative sounds very promising because there's a lot of certainty in in their promises which then kind of can help at times because some of these non-specific symptoms can
• 94:00 - 94:30 be treated by placebo. Yeah. So they get some improvement. They then become spokespeople for the product inadvertently in many cases and the cycle just keeps going. Um, which is why I actually view a problem that was a huge problem 20 years ago as less of a problem today. In the United States, we're I think everyone always says we're one of two countries, New Zealand, United States, to allow direct to consumer advertising. I don't even know if that's true. It's just repeated so often that I still say it. Um, and it is
• 94:30 - 95:00 true that the United States does allow it and we see the commercials on TV. But I think that impact is now gone. Yeah. And the reason why I think it's gone is because the most effective advertisement for a pharmaceutical is no longer a commercial that is played on television, but some person saying they took substance X and it did affect Y and that going viral on social media. And there is no rule preventing that. And how do you limit free speech in general to prevent a person from doing that? The FTC does not have the budget to enforce.
• 95:00 - 95:30 And how do you enforce like a person saying, "I did this and it helped me." They're not even telling people to take it. advertising. Yeah. So, that sort of messaging is very influential. And I'm not necessarily saying pharma's pushing people to do that because they don't need to. People will naturally do it. And it's only risk for them to encourage people to do it. So, I think that's an interesting shift in our media model. I don't know if you've seen that play out. Yeah. Yeah, I mean I think that's like the way that supplements kind of taken over and work. But I definitely agree
• 95:30 - 96:00 that it's um in like women, anything that affects women in general, menopause and pregnancy are two big areas, but also like endometriosis. I've seen more and more content around that. Any just also like diet optimized for what phase of the menstrual cycle you're in has been like a really big thing that I'm like I wish there was. I mean there's like there's I think one randomized control trial looking at this that finds null results but you find people out there like you're doing seed cycling that you need to eat different types of
• 96:00 - 96:30 seeds during the ludal phase and I'm like yeah nobody has funded that study like it feels you know when once you this is one thing I it takes some investment but that's why these long form podcasts are good but like once you start and think like did we fund a wellpowered randomized controlled trial to ask whether but see I think these statements that you're saying these words you're I don't think most people knows what that means. Just an intervention like like asking yourself whether a claim
• 96:30 - 97:00 someone's making has been actually tested. It's likely that someone has tested this to the degree needs to be tested which is usually a tons of people beyond beyond an anecdote like did researchers get together even if you don't fully understand like the research process because it can be quite nebulous like a very black box but like like think basic question like who would have funded this study like I encourage patients who are interfacing with all this to just just ask questions like what study showed that can you send me the link and obviously it's like for
• 97:00 - 97:30 very motivated patient populations that are and even then it's hard to decipher what the heck. A lot of times people can't tell you like I I'm happy to tell you the like like I can name the study, the citation, the year like for the things I'm telling folks. I feel very uncomfortable like giving a recommendation based off of data that I don't like know primarily at least the guideline that summarized that data. Um but all these practitioners are out there just like making up wild claims like they're they're genuinely just making stuff up or repeating things that they heard. Yeah. Or they'll give you a study but that's not what the study has
• 97:30 - 98:00 said. Yes. Like that happened on my podcast with Dr. Fun where he was talking about how the treatment of diabetes with insulin and lowering he hemoglobin A1C didn't help people but really like the study was looking at to what endpoint were they treating it. So like treating it was never in question. Yeah. It's to the degree which we need to treat. That was like insulin intensive. Yeah. Like lowering below 6.5 versus to like seven or 7.5. Yeah. With like old school drug like with just insulin not with like modern drugs.
• 98:00 - 98:30 Yeah. So the takeaway from those studies was not like let's not treat people's hemoglobin A1C's. It was like let's be a little bit more lax but still treat. Yeah. No, I just on Twitter there was uh the most rigorous diet trial ever done was being talked about as a Minnesota coronary experiment which is like in reality the most failed diet trial that was ever done. Like it was in mental hospitals when they were deinstitutionalized. People only got the intervention for like a year. It was like 80% dropout rate. Like every violation of a rigorous randomized control trial but it was being presented to people was like this is the most rigorous trial. So yeah, like somebody
• 98:30 - 99:00 can certainly send you a PubMed ID and that that alone is not enough to say whether something works or not or whether they're an expert or not, but I mean some of this it's like so like go to say nowadays I guess, but like like you need to have some expertise and like some training in it like if somebody didn't hasn't done clinical trials themselves or hasn't done extensive training that they should understand what a clinical trial is and they're like giving you specific recommendations and health advice, that's like a red flag on its own but I understand why
• 99:00 - 99:30 there is sort of like anti-expertise sentiment that and distrust of medicine so it is at some point people in medicine are going to have to like address this the fact that we have turned medicine into a business and limited people's times to get to know we're like so far beyond the like I know my local primary care physician and see them at like the grocery store or whatever like it's so divorced and kind of inhumane feeling and I think what people are seeking is just like someone who makes them feel human. Yeah. The
• 99:30 - 100:00 human connection of it all. The the idea that we need to work backwards in this situation of from the human standpoint then how do we help someone is the right mindset that we need to have. You know, we talked about supplements and I wanted to ask you as an evidence-based uh RD, what supplements do you think do have good evidence that you routinely recommend to people? So I think of supplements as doing what the name implies. So like there are there are supplements the phrase dietary
• 100:00 - 100:30 supplement is regulated in a way that includes many many things everything from like protein powders and meal replacements um nutrient supplementation and then you've got like bioactives where people are playing naturopath where they're like treating chronic diseases with like bioactive extracts and you've got probiotics and so it is when people say supplements like it is kind of like what supplement um there are things that dietitians are using all the time. Like in the hospital, we're like regular. We have a whole category
• 100:30 - 101:00 of things like oral nutrition supplements that we use to help people to get their calories and protein up. And that is common in outpatient nutrition for somebody who's like at risk of malnutrition. It's not uncommon to like recommend a protein powder for folks that have some sort of goal and are struggling to meet that for healthy population or general population. Even for the general population, like a protein powder, I think is like a very common supplement that is not it's not not evidence-based. Like again, like for what purpose, I guess, is the question. Yeah. And this is where food is not a prescription. So there's like a lot of
• 101:00 - 101:30 cho like the level of evidence impetus you need for a drug to prescribe something is a lot higher than like yeah you're not reaching like we estimate your protein goals between 1.2 gram per kilo 1.6 g per kilo for the type of exercise that you're doing. ACSM recommends that you're not getting that easily or struggling to get that or bored from eating too much Greek yogurt and chicken breast or whatever. And you know we could incorporate a protein powder in there. I don't see anything wrong with that. I think it's within the evidence, but is there like a definitive
• 101:30 - 102:00 randomized control trial showing that this is amazing? Like, no. It's a general guardrail in that regard. Yeah, I think almost everything in these guardrails. Um, there are like again the B12 for vegans, but also for older adults that you have a much higher incidence of B12 deficiency above the age of 50, it's recommended to get crystallin B12 either through fortified foods or supplements beyond that age because the gastric absorption decreases. Um, calcium and vitamin D is one that you'll see quite commonly, particularly in post-menopausal women
• 102:00 - 102:30 who are not eating that many calories to begin with. It's kind of hard to reach recommended levels. So, like when you're below sort of a benchmark kind of a target nutrient that we go for, it's very common for a dietitian to recommend a supplement to truly supplement the diet. Um, I think when you get into like bioactives, um, it's a it's a whole it's a wild athletic greens. What about it? I'm asking you. You want to get sued with this podcast?
• 102:30 - 103:00 I have never purchased athletic greens personally or ever recommended it. Green powders in general are like, you know, they have this is a classic labeling thing that people do or it will be a blend and they have to legally like list it by weight, but you don't know what their proprietary blend is like. And they'll be like, "Oh, it has chlorella and spirulina and all these like magical sounding algae." But then the first ingredient is like spinach. Like it's like freeze-dried spinach. And then they they put it in milligrams instead of grams. So it sounds like there's a ton of it. Like there's 5,000 milligrams of
• 103:00 - 103:30 this in there. And like I'm like like if you got out a scale and try and weigh freeze-dried spinach powder at 5 grams, you're like, "Wait, that's all that's in this per serving." Um, so there there is a lot of these products that are just like hodge podgees where they throw it's a multi it's a very expensive multivitamin with like a bit of a soluble fiber, maybe a probiotic, a bunch of bioactives. It's never been tested in the formulation that it's in. Are there 14 person randomized control
• 103:30 - 104:00 trials from some university study that showed that it changed some marker for an individual ingredient? That's common. Yeah. But like it's not really what we would think of as like rigorous evidence that says the whole general population. What about for someone who has a really terrible diet? They eat American standard diet. They eat burgers, hot dogs, and like I just need something to make sure I'm getting some nutrients. A multi I recommend a multivitamin as an I I or people like this is an insurance policy. you're probably low on a lot of things, but like I'm not going to go order a bunch of somewhat non-specific
• 104:00 - 104:30 labs to try and assess that. A lot of diet and nutrition counseling is like using the DRI as sort of like the dietary reference intakes. There are like estimated average requirements essentially for the nutrients. And so we use those as like a benchmark to like again as guard rails. It's not hyper specific, but um if people are super low in it, they might be recommending a nutrient supplement. Um, iron of course is very common. Um, but doctors are more involved in the iron than just the RDS are. Um, yeah. And I I don't really come
• 104:30 - 105:00 in hitting it hard with supplements. Um, I get again I get a lot of the pregnant patients that come to me and they want me to tell them to take a choline supplement. like like um which is like a genuine it's I think that's a great example of like I was involved in the the research of it but it had like um industry funding and the I want professional medical organizations to take a much bigger role than they are taking in some of the hot topic things
• 105:00 - 105:30 that are out there like I can't point to guidance from the American College of Obsetrics and Gynecology on choline supplementation because they haven't the the evidence is at a point where it's like you could make a statement Yeah, practitioners are talking about I know a lot of OBG1s who are already recommending it. Um, and I've like I'm like I I want an authoritative guideline like that's why you guys exist. Um, right now they just sort of talk about it as like eat enough from the diet and this is what the adequate intake value from the nationalmies is. Um, but that
• 105:30 - 106:00 doesn't tell you anything about supplements. That's just like food based thing. And so with um Danielle Bardo led the American Society of Preventive Cardiology um practice paper on like you know it's a consensus for lifestyle and and diet and we taught a long talk and ended up including like a bit in there about supplements because it's amazing how much every major guideline committee because there's not much evidence for it. They just sort of like ignore it and say like oh we don't even talk about this in our guidelines. I'm like but that's a problem. You should be talking about it in your guidelines and you should be saying you know and and there
• 106:00 - 106:30 are some supplements with like a much more data. I guess one I one of I should have mentioned was like like a psyllium husk fiber has some good data in IBS. Um and so like potential relief of symptoms there. It's otherwise relatively harmless. Um that's one I like will commonly recommend for both constipation and for IBS symptoms and so and for potential cholesterol effects. Well, so it lowers LDL but the cardiology societies like don't say much about that because there's no cardiovascular endpoint trial with psyllium husk fibbrin. I don't that's like the situation where it's like you're getting
• 106:30 - 107:00 other benefits and like this could be an added one with limited risk. So yeah, I mean it's one though where like I you have to have a very tempered I think guideline committees are holding back from providing any guidance on it. Individual practitioners then are left without the guideline committee to like kind of refer to and it sort of just ends up being whatever that practitioner but they're happy to put a heart on a Cheerios box. They are supplements are a weird because it's like there's no st like there's minimal standards around um like they have to be
• 107:00 - 107:30 safe what's supposed to be in there what's on the label is supposed to be what's in there but like we know that these things get violated all the time. Um there's also concerns about like the human facilium like the heavy metal content of them depending on where it's grown and soil it's grown in. There's not as much regulation as you think that there should be or enforcement of the regulation that exists. And so like I would I would love it if we had more regulation of supplements around. So I could say like oh yeah you'll get like it's good for your constipation. You might lower LDL a little bit with psyllium and know in the back of my mind
• 107:30 - 108:00 that if I tell you to do this every day for the next six years and you actually do it that you're not like slowly accumulating Yeah. some heavy metal poisoning. Yes. Yes. Fair. Which is a hot topic that consumers ask about all the time. Yeah. This is a perfect segue actually for the next topic. We're trying to make America healthy. We are. I don't think again cuz I don't know when America was healthy. Like if you really think about our progression is like we could always be healthier. So right now with RFK Junior at the helm
• 108:00 - 108:30 of HHS, Dr. Oz coming in for CMS. There's a whole new team coming in. With this new team, there's a lot of focus on the field of nutrition. Should be really exciting for you, right? Like you have someone who's on your side. Are you as excited or am I mistaken here? There is excitement in the field for sure. Putting on my politician hat right now. Um there are there's a it's a mixed
• 108:30 - 109:00 bag. I know some people who are aligned with the administration and around it who are operating in good faith and want to change things and I understand that there is a national conversation around diet that I would argue has never been this loud. Michelle Obama tried like I just want to give it up to her. Many people have tried over the years. It hasn't always taken off and has it gotten partisan. Like Michelle Obama's attempts to like lower sodium in the school lunch program alone was just like totally pillaried. Um uh but yeah, so like now I I
• 109:00 - 109:30 understand the enthusiasm. I do have a lot of concerns about our bedfellows in this situation. And so like there is a lot of false dichotoies around like infectious disease versus metabolic health as though you can't do both. Like there's nothing that says you can't take a vaccine and also improve diet. And like it's like we don't need to say like you know there's like a recent enthusiasm about vitamin A for measles and I was like just endorse the MMR and then like there's no trials in the
• 109:30 - 110:00 developed world for vitamin A. Like there's some of these things that are frustrating um from enthusiasm for things that don't have evidence and then skepticism about things that do like vaccines. And then there's I think a a lot of like a vibe around the chemicals in food are bad which at a high level we could have conversations about food additives and things but there has been a lot of um overstatement of the risk of like food dy is like tartrezine I think there was a video about saying that it's
• 110:00 - 110:30 linked to all these issues and I think the effect size of like we remove tartisine and wait 20 years to what happens to population metrics all else staying the same like I don't think we will detect any differences in really anything. Um and so that is a concern that like the things that there's so much enthusiasm and action around are not um the most high impact interventions and they sort of are like the easy things like yeah you just remove the approval for the util the ability for the food industry to add
• 110:30 - 111:00 this well because it scores political points. So like I think which might have some utility on its own, but yeah. So wait, scoring the political points. Yeah, like maybe you do a low hanging fruit thing. I'm waiting to see whether they go for the high impact stuff that's actually hard. Like the moment you have to start thinking about, well, how do we get less of whether you know the ultrarocessed foods, sodas, sodium, and things like things where industry is going to have to substantially reformulate and change their products. The level of advertising that's done to people, especially kids, is going to have to be reduced. These are the big
• 111:00 - 111:30 hills that are labeling on the front. So front of package labeling is being um explored right now. From the last administration, there was a lot advanced forward, but everywhere else in the world is front of package labeling that calls out like high levels of things, but quote unquote warning labels on foods are have always been some close to a no-go. And so maybe now there's political will for that kind of stuff, but there is going to be a bloodbath behind the scenes of course industry fighting against this. I don't know that the will is really there at the end of
• 111:30 - 112:00 the day. Like time will tell. Um I'm skeptical a bit because I know it's easy to score political points by finding a villain like high fructose corn syrup that people already in their head have classified as a villain and say I'm replacing that in all our sodas and putting cane sugar in there. And it sounds like you're addressing what people want, but in reality you're not changing anything. this steak and shake just like announced they're replacing seed oils with or with a tallow and it's
• 112:00 - 112:30 I'm like this is not a health win. Yeah. Like none of these things are actually changing anything and people are like well in totality you're lowering your chemical burden. I'm like that's great but if you really want to have an impact in people's lives like when I talk about with my patients about why ultrarocessed foods are unhealthy I'm not pointing to some chemical inside them that's unhealthy. It's not a nutrient issue. it's strictly because that they're hyper palatable. You eat a lot of them. You're hungry quicker after. And it's kind of a big macro view of why I try to get them
• 112:30 - 113:00 to eat less of them. But then you'll have people are like, "No, it's because of ingredient X." Because if you look at the petri dish or the rodent model, when we feed 100x the amount that's in your food to this rodent, they get cancer. It's like, but that's not useful for us. And I view it as a lot of posturing without a lot of actual succeeding of doing anything. So I get very skeptical that any real change will happen because you know I I look at the RFK Jr. situation. I have conversations for such
• 113:00 - 113:30 a wide variety of people cuz I'm exposed where I work at a community health center where you have people who are barely making ends meet um full below the poverty line. But at the same time, I live in the celebrity world to some degree with social media. And I'm at these events with very wealthy people, ultraconnected people. And yet, their ideas are not so different. Yeah. In their beliefs where they both believe that RFK is doing the right thing and why don't we try something new? Why don't we just break it? Why are you
• 113:30 - 114:00 against using food as medicine? And my answer to that is, and I'm curious where your answer is in comparison to mine, when we think of food as medicine, there's very few interventions that have been tested to the degree where they could actually act as medicine. The ones that we do have good evidence for, no one really wants to hear or no one actually wants to do because they require real work and they're annoying. And they are. I totally agree because I failed to do most of them as a healthcare hypocrite myself. And what most people are actually selling you or are achieving on the
• 114:00 - 114:30 political front are just points being scored but not actually changing any real outcomes for people. Do you feel that way or do you feel slightly differently? I think I feel pretty much the same like like there's enthusiasm from many political angles. The vibes are right. I mean I worry about the vibes of like you we're trading in infect vaccines for removing food additives. Um, that's where it's like I I'm curious whether we will see any serious big action that actually like makes it across the finish line. Um, I
• 114:30 - 115:00 feel totally the same about like taking on a food additive that is fed a thousand times to rat a thousandfold the concentration of rats and seeing cancer. Um, is not all that relevant to human exposures. And if you are getting enough of that food additive from those foods, it's probably coming with a whole bunch of other things that we don't want. So, it's the package that's coming in. Like, we're all I think everybody wants more spinach and less Pop-Tarts. Like, that's But no one actually wants to do that except the carnivor,
• 115:00 - 115:30 but um but yeah, but like the serious thinking about how do we as a society shift our current food environment? Like you go out and things are getting maybe slightly better, although there's questions about that, but like it's what 80% of things that we probably shouldn't make up the majority of our diet. Like it's just the readily accessible easy things are the things that are like extremely unlikely to be eaten in a way that maintains your body weight, extremely high in sodium, not the greatest fat composition, not very much
• 115:30 - 116:00 fiber, processed to hell, which might influence a whole bunch of other things or at least strip away some other protective components. So you can like list out all the things that might be the the problem. Um, but thinking about how do we as society totally transformationally change the food system requires thinking about like what we grow, the economics of what we grow, how it's produced, stored, processed, makes it into formulated into what things that people are actually going to buy and where you like break the chain of the current system that we have that
• 116:00 - 116:30 is somewhat self-reinforcing is a it's going to take serious regulation and there's going to be winners and losers in that. I don't trust that. I don't think that this administration has thought about that and knows the point at which it's going to go and take action. Like even if you have this big think idea of like let's just ban all the ultrarocessed foods, where are you going to get a database of all the foods in society? How are you going to make sure that every company adheres that it's not a UPF? How are you going to make sure that they don't just reformulate things which industry is amazing at doing? I've been watching the
• 116:30 - 117:00 yogurt industry, the yogurt aisle change so much over time as people think whole fat dairy is good again. the sugar hasn't dropped at all in most of these foods. And they take out some additives so it looks more natural. I'm like, that's still a 250 calorie dessert posing as a breakfast food. Like, and so we could see a ton of reformulation that is not the direction that we want things to go in. Um, I don't think the administration has picked who the winners and losers are going to be if they do anything dramatic with the policy. I don't even think they have the
• 117:00 - 117:30 policy in mind of how things are going to change. Um, yeah, there are so many layers. I was on part of a Texas A&M like big panel as far as like reinvisioning the food system and it just at every layer every you know all the societal actors involved from what is grown to the growing of the food the packaging processing formulation and selling it there are all like interventions you consider across that entire life cycle there um I haven't seen a plan maybe there will be one from
• 117:30 - 118:00 the administration of all the policies they're thinking about because I don't think there's going to be one thing that solves it it's going to be a confluence of many shifts, you know, some carrots, some sticks that have to start to shift the food supply. Um, and ultimately incentivize producers to make food that is concordant with healthy body weight, healthy disease risk factors, um, access to RDS. Yeah. I mean, that that and that's a very small piece of it, but like I don't I don't I mean, it's like education is a starting point for all this stuff for sure. And I don't I think we have to also as much as we've talked
• 118:00 - 118:30 about evidence here, I think we need to get very exploratory because you're going to run into the fact that we don't have like where's the randomized like cluster trials that have tested out different policies in different states? They don't exist. Like we're going to have to take a leap of faith, I think, in some ways and test things out. I mean, I think there's one of the politicians said lately that they want to see like states be legal testing grounds for policies and seeing whether they work or not. I think it was in the context like building more housing or whatever. But I think nutrition could take something similar that like it's
• 118:30 - 119:00 not just about I I would love more research funding to understand nutrient requirements in pregnancy and the composition of processed foods and how they drive intake and what I think we need all that. We need to invest in it. We also need to be thinking about at like the community level and the state level what policies, what programs, what incentive programs there are for like buying more fruits and vegetables. There's things that have been lightly played around with with like farmers market two for one bucks or whatever if you buy fruits and vegetables with your SNAP dollars. Um, and so all these
• 119:00 - 119:30 things we need to get like super creative and and actually testing and and measuring like did this make an impact or not? Yes, no, move on from it if not. And doing it in a way that it doesn't take the current pace of research. We are so underinvested in nutrition research. It is too slow. We will know in 45 years how the composition of ultrarocessed foods drives food intake behavior at the rate that we are able to produce data now and by that point we will be economically sunk from the cost of health care related to obesity and associated
• 119:30 - 120:00 chronic disease and the solutions to get more funding for the research. Absolutely. Yes. I mean we have never taken nutrition research seriously. We currently have six USDA human nutrition research centers that have a applauded for all that they are able to do. But we need to like massively invest in that. It's always nutrition has been kind of weird. Like started in the under the USDI umbrella and then it's like sort of gotten NIH funding. Um but we need like a cohesive federal mission and tons of funding for everything from
• 120:00 - 120:30 understanding what about our food drives food intake behavior and how we can, you know, allow that to be more aligned with our biology and weight regulation to what's the optimal diet for pregnant women. Um, you know, we talked about this off the pod, but other things the administration is interested in. I've written some Substack articles on this, like uh the fluoride and IQ issue, you know, the the splashy meta analysis that came out most recently and Gemma Pediatrics had zero studies from America. It did not apply. Yeah. like
• 120:30 - 121:00 totally and and it got painted in the media as though like you need to be worried about fluoridated products when in reality it was like the naturally high levels of fluoride in China largely compared to lower levels and weak ecological study designs and so like there was an effort to have a national children's study in the US in about 2000 and it never got off the ground unfortunately but it was recognized in the year 2000 that we needed better data on environmental exposures and kids development what how when people are
• 121:00 - 121:30 exposed during pregnancy. How does that influence kid childhood development, which there's a ton of interest in that now from like the Maha Commission executive order is all about protecting people from chemicals and contaminants. If you go look for large cohort data that has like that has either stored urine or store blood and has assessed developmental outcomes and IQ and all these things, it doesn't exist. or it's these tiny little thrown together cohorts like what we did for lead and and legislated lead around which there's still big questions about because we don't have good nationally
• 121:30 - 122:00 representative data. So, we need to like we have pharma doing tons of awesome clinical trials that like I don't want to pit the food versus pharma or anything like I it's great that we have GLP1s and things but we need to have unless I don't know how you get a private version of that level of investment in food which means you need government and right now we have government research being cut not amplified so if the MA commission and that those vibes are really going to do anything they need to be get really serious about funding the research they get really serious about laying out like
• 122:00 - 122:30 what are all the issues of preventing what finally ends up on our fork being things that are more aligned with our biology and reducing disease risk. Yeah, there's so much potential and excitement that could happen from this, but I could see it as equally going in the complete wild direction of like spending money to research whether or not removing high fructose corn syrup and replacing it with cane sugar makes an impact. Like I don't want to know the answer to that study. That study's already been done unfortunately. So, okay, good. There you go. Um, but I'm just saying in principle the idea of that and I I I just hope
• 122:30 - 123:00 that they pair people who are interested in getting to the bottom of some of these questions because they deserve answers and it has been tragically underfunded. I actually did a a debate with individuals who are on the vaccine skeptical side and the the thing that I related to a lot with the people that were almost taking the opposite stance that I was was that their system is broken. Yeah. And I agree with all the problems that they talk about. Like I
• 123:00 - 123:30 completely agree. But then where they then land from the problems and where they want to go with the problematic system that we have is not reasonable. It's not based on accuracy or science which how can you expect an average person to think critically as if they're researcher. So, I hope there are people put in charge that actually put forth the budgeting, the theorizing of what the money should be spent on and make it valuable because I think there is an
• 123:30 - 124:00 opportunity to make a big change when it comes to nutrition and environmental research, but I'm I'm very skeptical. And this is where I think government failed us during the questioning of RFK Jr. like they hammered him on the measel stuff and like I'm glad they did obviously because I think it's an important question and we're seeing the imp implications of that right now but not one person asked like you want like celebrate him for a second and say okay you're very interested in fixing environmental exposures and nutrition how do you have an outline of a plan so
• 124:00 - 124:30 that has been that has been my approach is to like people are probably going to think I'm naive like but I'm like I would rather say this is how to do it I'm not hearing the how this is what I would like to nudge you in the how direction. Whether that will be actualize actualized behind the scenes, I highly doubt especially like we're doing the entire research infrastructure like um and I have a lot of friends in nutrition who now don't have jobs because global health has been totally decimated. Um and I think we should like absolutely condemn that kind of stuff.
• 124:30 - 125:00 We need be principled about like I will tell you what I think needs to happen on nutrition and I will turn around and critique you for your stance on vaccines if you're not coming out guns blazing on it. But there is a sort of like you know I think there's a perception that experts got us into the bad situations that we are in and there's some arguments for that in individual cases but I think like profiting off of people has gotten us into like where health why healthcare is the way that it is and the lack of the ability to profit off of diet and reducing environmental exposures is like a whole reason you
• 125:00 - 125:30 need government investment in research because there's no private interest that's going to fund any of this stuff to the degree that needs to be funded. And it's harder to study than drugs are. Yeah. And so, um, yeah, I think people, the anti-expertise vibe that people have should really be like anti-MBAs. No offense to the MBAs, but like they've looked at how to turn every single thing that we're into into profit and to Uber. It's the Uberization of the healthcare market. And if you really think about it, it solved a lot of problems, but it
• 125:30 - 126:00 created a lot of problems. like malnutrition used to be not enough food, now it's too much food depending on what part of the world you find yourself in. So, it's very interesting how we constantly with capitalism create new problems, but we shouldn't stop looking for the solution. Yeah. Because it's a hamster wheel, but if we stop the hamster wheel, those problems will just become worse. And and you just you need you should hold government to a high standard to be confident. Like we should interrogate past failures like why we did why the national children's study
• 126:00 - 126:30 failed should be used as a model to have the 2.0 version of it so that we get the data that we needed 25 years ago and in 25 years we don't look back and not have it but completely losing all faith in government and expertise and thinking that like you're just going to you're going to rely on the goodwill of massive industries to change the food supply. Good good luck. like and you're over the like we're privatizing everything about research right now and I've had these conversations with other nutrition researchers almost all the
• 126:30 - 127:00 younger folks I know who are like gear like hyped up about nutrition have gone off to jobs in industry because they don't see it as a career path like really promising researchers who have done folks studying how food impacts the microbiome food impacts the childhood IQ like all these things that people care about everyone's looking at the landscape and saying I'm not going to have a job in 5 years if I invest in this like we need to we should be concerned as a population that we don't we don't have people going to nutrition research because they think it's a viable career path because it's something that's going to be funded.
• 127:00 - 127:30 Like I I think about this all the time. I'm like do I want to string together a little bit of USDA money, a little bit of foundation money, maybe some NIH grants and some food industry money to have like a coherent lab. And will that actually advance our understanding of human nutrition in a way that impacts people's health? I seriously doubt until unless this is kind of like my swan song of like if this administration wants to seriously change things that would be amazing but the field has seen retirings that haven't been replaced by people and
• 127:30 - 128:00 we are very much at the risk of just having like minimal nutrition research infrastructure. Um so it's something that it's an easy win I think like I'm like kind of shouting the easy wins out for the the administration now and they're on the right path. They're saying the right things. is you're saying the right politically motivated statements, but now just back them up with some actions, too. Right. Saying it is the easy part. Do you have a plan behind the scenes to make the wheels of government turn to fund the research that needs to be done? I don't know. And and hearing like about we're just going
• 128:00 - 128:30 to privatize everything. Like the federal workforce needs to get out into high productivity private industry jobs. I'm like there there well there is that does not exist. The food industry is not going to seriously fund and regulate itself. like there's no incentive for them to produce products that are like supposedly and if you raise their cost of production by incorporating this mandate into them, what do you think is going to happen to food prices that are already skyrock? Well, we've had a wellness section of the food supermarket for decades like like industry is
• 128:30 - 129:00 meeting the need of the desire that is there. It is just like human biology is driving people to eat things that are not the greatest for our health necessarily. And it's easy to hijack that biology by formulating foods that are, you know, that are readily available all the time and easily over consumed. Um, and there's great work happening like in the intram mural program in Kevin Hall's lab like trying to at a very slow pace, not to his fault, but because of not being resourced adequately to understand what it is about processing that influences food intake, how it's like they're
• 129:00 - 129:30 measuring what's happening with dopamine signaling in the brain through there's amazing PhD Val Darcy who's doing work on that. Um, like we should be having I should be able to name dozens and dozens and dozens of these researchers across the United States that are doing everything they can to understand food, how to formulate it, how to best combat, you know, uh, the poor state of health that we're in basically right now. I can't I can point to like a small handful of people that are really struggling to take what little resources we have to understand how um, food
• 129:30 - 130:00 impacts health. And I get the vibes of like people just need to eat less ultrarocessed foods. But the moment you go to industry and you have zero science and you say you need to change, industry is going to fight you tooth and nail on all of that. Um, and so will people. I mean, we saw it here in New York City where they try to put a tax on the big sodas. People got very upset about it and it didn't happen. And that would have been a thing that people talk about wanting, like less soda consumption. Oh, this would have created it, but they didn't want it. I'd be so curious how that would go now. 10 years ago that was
• 130:00 - 130:30 a nanny state thing, but I think all the political parties have realigned that I'm not sure who would be accusing who of being the nanny state in that situation. It's very messy. Yeah. And you have to affect food access issues. Like I mean I did I'm from the east coast and have academically drifted all by driving all the way out to the west coast. I've seen all of middle America. I've seen huge parts of America where like there are more Devita like dialysis clinics than there are supermarkets in the area. And so, you know, you you have a lot of places I stopped where it's like, oh, this this gas station is the
• 130:30 - 131:00 grocery store. And so, there are huge issues like that that we need to s have a government that seriously thinks about these people in parts of America that feel left behind. I mean, NAFTA ruined a lot of things, but like people feel left behind, rightly so. We need to think about like addressing the health crisis in rural America and making sure that people feel listened to and heard and it's not just a lot of this stuff sounds like crunchy granola like port typically like Portlandesque eating patterns and um I don't see that getting a high
• 131:00 - 131:30 uptake like we don't need to air huan more of the urban areas in America like we need to really seriously be thinking about the types of foods that are available access to those whether they're affordable Um, and we I think we need to get innovative and creative and play around with state policy and things. Um, but we could only do that with good research. Good research and political will in a plan. Yeah, exactly. Very curious to see that plan. So, yeah. Well, I'm hopeful for that. If I was to give you a wand, what are you changing
• 131:30 - 132:00 three things about our current nutrition state? Like about the food itself or your choice. You could change food. You can change policy. You can change. Can I change our brains to not over human? You cannot change free will. Well, I mean just I would change something about food so that it is not I think there will always be some percentage of individuals who are like genetically predisposed to overeat. But I would we need to change the majority
• 132:00 - 132:30 of food composition in a way and what is you know people are eating out more regularly. We need to change the food that is served to people and able to be bought in the food environment specifically. What are you changing about? Oh, specific. I mean, this is something I honestly feel like we don't have the research to know. We have done a really good job in nutrition research understanding like we've done a decent job. I trying to understand like what your total energy expenditure is, how many calories. We have non-nationally representative data for that. So, I don't want to say it's great like please fund doubly labeled water studies in
• 132:30 - 133:00 NHANES. Um, so we understand what people's like the general population's energy expenditure is, but like the why people eat has gotten much less funding and I think it's getting more funding now. You hear people talking about concepts like food addiction and things, but how to formulate foods other than feeding people bland lentils and brown rice and making that the only food option. Like how do you formulate food so that it is still tastes good, still culturally acceptable and is not
• 133:00 - 133:30 hijacking our our um you know reward systems and things to lead to overeating. Whether we can even do that is like still an outstanding question and I think is something that we need to answer like very quickly to understand can we reformulate food. So I I think the reducing the energy density of foods is like the easiest likely thing. Although there's more factors that drive food intake there. Um there's a lot going on now into like how soft versus hard food is um that drive potentially drive intake beyond even like what
• 133:30 - 134:00 palletability does. And so it's going to be reformulating across some mix of these metrics to find the sweet spot that people eat enough but not too much. We're not there yet. So the changes I would make, I mean like getting sodium down is a really people have been trying to do that for decades now. It's gotten held up even voluntary sodium reductions have gotten held up because of political reasons. Um but trying out alternative preservatives and getting sodium much lower I think is one of the highest bang for your bucks.
• 134:00 - 134:30 Um I think you know there's always a big focus on reducing saturates but intakes are not super high right now in the population. like there's still a little bit more room and there's definitely still subsets of the population. So, you might think I'm going to say like eat less saturated fat, but like people just need to eat less calories. I think the saturated fat would tend to fall in line um a little bit more. Sugar- sweetened beverages are still a big one um that I think all these things I should say have modest effects. Like again, diet is a cumulative a lot of small things. So, I
• 134:30 - 135:00 don't want to overstate that like we'll stop there's a lot of old stuff of like we'll stop obesity people just stop drinking sodas and that's massively overstating it. Um, but we've seen I don't know if this is true for you but in the Berkeley area I'm like I don't see people drinking sodas anymore and there was like soda taxes locally and things but I see like prepared drinks that like we traded in sodas for like cream and sugar sweetened Starbucks beverages um bobas lemonades and things. Yeah, there's tons and like I don't know
• 135:00 - 135:30 that we've made as much progress on sugar sweet beverages as we would have liked. I don't think at all. Yeah, it's we've we've done a lot of swaps like vitamin waters, all these sorts of things. Um, so I think a ton of progress on I think there's been a lot of distractions with like alkaline water and all this nonsense that like made people think, oh, I'm being healthy, but like are you? Yeah, the ju I mean fruit juices is always an issue too and like especially non 100% fruit juice, but even the serving sizes of fruit 100% fruit juices they sell or like three servings a day.
• 135:30 - 136:00 Nutrition recommendations are like you can have like four to six ounces for little kids and I'm like where are you finding four to six ounces? That's very hard. Exactly. Um so broad progress on like liquid sources of calories I think in general um would be a major one. Um, I think like people eat what you see in USDA data and the dietary guidelines always point it to health. They say like replace whole grains with refined grains or sorry, replace refined grains with whole grains. But like we just eat a ton
• 136:00 - 136:30 of grains already as it is. And if you replace all the refined with whole, like you'd still clear the recommended amount of grains. You were talking about the food pyramid before we got on and like sort of led people to think that grains should be the base of the diet. And so, um, not that I think people need to like avoid whole grains by any means, but there's so many grainbased pre-prepared essentially desserts, but like I I still know people who think of Dunkin Donuts muffin is like their breakfast in the morning. I'm like, that's just eating cake for breakfast. This is like a
• 136:30 - 137:00 cultural norm that we need to like I think be a bit more critical of. Um, and so a lot of the grain-based beverages or grain-based um, desserts and mixed meal like frozen prepackaged meals are like major things I think we need to make progress on. They're like a major source of calories in the American diet that and they tend to be refined grains, a lot of solid fats and then a lot of added sugars. Um, and whether we can reformulate those, I think is a huge challenge. There are some big food
• 137:00 - 137:30 culture things in America that like we don't have a culture of like tons of spices as like an what we think of as American food. Lots of ethnic groups have um their way of cooking things that includes lots of spices, but like we very much have a society that the pallet is salt, fat, sugar, starch. Mhm. And that is you can do that in 8 million ways to create delicious things. Um many of which were like holiday foods at one point that are now daily foods. And I think there is a reasonable conversation to be had around like what is our food
• 137:30 - 138:00 culture. I don't want to make any individual feel guilty or shameful about what they're eating. But like we as a collective have normalized so many things that are clearly not good for our health and we need to think about that as much as we're thinking about the what of what we're eating. Like sure, are no Pop-Tarts for breakfast? But also, like why when you go out into the food environment? Is it not the norm that you can get like a relatively nutrient-dense, healthy bowl that contains some legumes and whole grains and fruits and vegetables, whatever? Um, but you can easily get like the green
• 138:00 - 138:30 powder bread in a food form. Yeah. Yeah. Just I'm going to sprinkle spirulina on everything is what I meant to say. Um, yeah. I I don't I probably sound like I'm like aimlessly wandering for folks, but there are like lowhanging fruit things, but they're not like people are going to rightfully point out like they're not going to fix everything. They're not. And I don't think we have the data or the evidence to say exactly like what transformational food system changes are going to look like. And those go beyond the science. They go to like culture and values and economics. And like as a
• 138:30 - 139:00 society, if the Maha folks do one thing, I think it's like opening up that Pandora's box and being like, what are we going to do? Who who like some somebody's going to lose money in this process. We need to be seriously thinking. Well, that was always my statement uh on these podcasts, which is like what industry benefits from societal weight loss? And I couldn't find one. Someone said airline industry, but then like Well, that's very specific. Yeah. Um
• 139:00 - 139:30 Yeah. And I I don't actually what does what and actually I think they end up losing money once everyone Well, I guess because they need to be on the medications for life. But yeah, and I don't think like I think you're just going to always run into like there's never been a selective pressure that we know of in humans that have ever said like, "Oh, no, no, stop overeating." I mean, I guess like maybe you could get in prehistoric times like too big that you can't chase after the hunting the game and then you but that's unlikely to have been a significant selector pressure. If anything, it's been we like clearly there's a large portion of
• 139:30 - 140:00 Americans that don't just self-regulate on eating food when it's widely abundantly available. And so like this I'm very pro medication. It's just a matter of like of the number of individuals right now who are indicated to be on a GLP1. Can we change food policy to like decrease that at all is a big question that I think we have high intensity interventions like the diabetes prevention program or the look ahead trial that like if we scaled up we could cut into that but it would need to
• 140:00 - 140:30 be like sustained funding and it's probably only going to be a subset of individuals that are going to like really be thinking about food nutrition and life of like a lifestyle intervention all the time and those will probably taper over time. Um, but if you with those trials, you always see like a bunch of weight loss in the first year and then like people getting it back, but they also are only really intense interventions where you're like regularly meeting with dietitians and exercise physiologists for that first year also. So, I don't think society has ever played around with if we provide
• 140:30 - 141:00 broad access to people that mirror those interventions and really funded them. one, it might not be cheaper than the GB ones, but you know, for the people that want it, what percentage of people can we get like uptake on this? Can we how many medications can we cut back on? Can we sustain this for a 10-year period? Like we are 20 plus years post the DPP and have never seen like a massive national roll out. like there's been sort of statewide DPP programs and I think there's one in the veterans
• 141:00 - 141:30 association and things but like if we as a society now are going to be serious about nutrition thinking about scaling up and intervening with something like that is something that we need to really consider and and at least pilot um more aggressively than we have and um try it out and see though I think there always going to be medication that's needed but the degree to which we can cut into it with lifestyle stuff there's a a lot of what I see on I meant to say this earlier like A lot of what I see on Instagram is like very much a hustle culture. Like if you don't want it, like if you're not going to work hard for it,
• 141:30 - 142:00 like that's it's a very moralized tone to like lifestyle. And I think that's like the opposite of what the data says. Like you are not convincing any meaningful swath of the population by shaming them into diet and exercise. All the data except the population that they need to to people who are already fit like I mean like most of the people I think could buy into that are people who are like just muscle mass. Yeah. It's an aesthetic thing most often. Um, but like the data is all like providing people intense support, counseling, motivation.
• 142:00 - 142:30 Like the DPP wasn't shaming people around food. I hope not at least uh what the dietitians actually did. You never know. But um like they're just it's resourcing people to lower the the bar of like we're already, you know, the everyday person is like working a ton, raising kids, trying to make ends meet financially. the idea of like fitting in multiple hours at the gym is just like and then meal planning and all this kind of stuff is just like an added burden on top of everything when you can't afford your rent like that real public health is addressing people in those situations
• 142:30 - 143:00 and so like I think look ahead like gave like exercise equipment and also gave access to exercise physiologists and nutritionists and like we need to be thinking about supplementing people with relatively healthy foods like in a pretty med style type of intervention where you're just giving people tons of nuts and seeds um we have never as a society done that really seriously and I would like to see like basically playing around with at a policy level and like being like yeah we have enough data to think this is a good idea now let's pilot it and we need the political will
• 143:00 - 143:30 to do that industry is probably going to fight it to some degree but you need to push through and actually get these things at local and state levels and see whether there's something to ramp up to a national level but uh whether that will be funded and happen I don't know yeah those are I Like I agree the idea of RDS working with doctors like everyone's like get doctors more nutrition. I I don't think that's going to be a huge payoff. I think getting access so that I can refer my patients to an RD and making sure there's access to them. So training more of them and
• 143:30 - 144:00 yeah we're going to run into an RD shortage real quick. Exactly. We're already in a primary care shortage. So it's a disaster that up front. Then um paying for the research that needs to be done for us to understand what things we should even be doing when it comes to giving nutrition guidance and changing someone's life, supplementation, chemical exposure, all that. The idea of doing these unique intervention trials where you give people food or gym access, things like that have always been frowned upon because they always require a huge ton of money. Yeah.
• 144:00 - 144:30 So like I even introduced a program in my hospital system during my residency. We had to do like a pilot project and I had the residents exercise with patients meeting on a day to on a every other week basis I believe it was and after a period of time the patients who were sedentary never exercised before but got some excitement by the doctor of training them like some basic things to do at home. I mean like they weren't teaching them how to bench and squat. Yeah. We were doing like uh squat with a
• 144:30 - 145:00 chair in front of you while holding on to the chair because you have knee arthritis. And we had three variations for each potential uh issue that they can run into. Those patients continued after we did a check-in after a period of time that they were still doing some of the things. And granted, okay, they didn't change their lives where they became Mr. Olympia athletes, but those are not the things that are mandatory for even somewhat good health intervention. So, I I hope more people start paying attention to that basic stuff from the Maha movement. Yeah. I hope the Maha movement serves as a
• 145:00 - 145:30 positive front to this as opposed to a distraction and getting people to look at the other hand and they're getting robbed on the other side. Yeah. Yeah. If people are like thinking, "Oh, I can eat the steak and shake fries now because they've like as much as I want because they Yeah. They've got seed oils out and like a beef tallow in." I'm like, "They're still like 650 calories for a large and 1400 milligram sodium." This is probably not something you want to eat a lot of, but if we can change if the the vibes right now can shift culture and then we can actually get policy that lowers the barrier to
• 145:30 - 146:00 accessing and implementing things that we know are likely to improve markers of health or quality of life. Like that would be amazing. But the that's a big A to Z kind of look at it. That's like A to D. And how you even get from A to B, I haven't seen really cogent plans laid out um of how that's going to happen. And I think time time will tell. Like I I will I don't get enthusiastic about much, but like I'm just I'm not enthusiastic that it's going to happen. Um but I'm like fully on board. I think
• 146:00 - 146:30 a lot of people to like advise on these sorts of things, but also nobody's going to put up with BS. Like if not going to sit here and be like, "Yeah, we're like antivaccine like at the same time." Like um so it needs to be like a concerted multi-prong societywide reorientation around health. Um, and I think they could lead that if they really wanted to and they can align all their coalitions because I know behind the scenes everybody's not aligned in the same way. I mean the the that this administration was good at getting a lot of people with
• 146:30 - 147:00 disperate thoughts on things um all behind sort of one person but then whether that will actually lead to like whether RFK Jr. has the power. Yeah. But also if you get enough political pressure from the general public they'll change their tune. Yeah. Because you know the vaccine, the vaccine, the COVID vaccine, the operation warp speed was a Trump hailed victory. Yeah. Yeah. And now we're introducing members into the um power
• 147:00 - 147:30 positions. The HHS secretary now being someone who's like, "Oh, vaccines are maybe questionable." It's like you can clearly see that there's flexibility in their thought process which a lot of people view as a negatively and I understand why but we could also use the power of the people. Yeah. I mean democracy you're supposed to reflect your constituents not your own personal views. So I think yeah there needs to be
• 147:30 - 148:00 pressure for it. Um, and I think it needs but there needs to be clear guidance on what it is. This I a lot of what I've seen is like people who shop at Awan that are like this get the chemical foods get the chemicals out of our food and like that is I encourage everybody who's a food advocate to drive across the United States and see the current state of things. It's very different in rural versus urban and different rural areas. Um there's huge access issues. There's resourcing issues. There's issues of what we just grow in America. Um how things are
• 148:00 - 148:30 priced. Uh the list goes on and on and on and all of this under the umbrella of like you have freedom of choice and that we respect and that's a important thing. But how do we nudge consumers is going to I think consumers can nudge other consumers. I guess it'll be it'll be interesting to see how all this plays out. Mhm. Is there one claim that sticks out in your mind from the nutrition space that you've recently seen on social media that really irks you?
• 148:30 - 149:00 Just one, three, if you'd like. Interesting. I mean, it's one of those things where there's like a thousand things and there's also like my brain's like just one seed oil is like everywhere right now. Yeah. So, tell tell us about seed oils. What are the what are the claims that you've seen? Oh, oh my gosh. They they drive inflam they're inflammatory. They drive cardiovascular disease. Um they're toxic. They cause cancer. Just
• 149:00 - 149:30 the list kind of goes on and on. Um what does the evidence say? So the evidence says that like you know these are seed oils. It's hard to say anything about a seed oil. I want to be clear on this because the chemical composition of the seed oil of there's there's lots of different types of fats that can exist in seed oils, whether they come with antioxidants, all this kind of stuff. But like when you say seed oil, like everyone just immediately assumes that there are high omega6, specifically linoleic acid, which is an 18 carbon omega-6 fatty acid with two
• 149:30 - 150:00 double bonds. Um, and so people started hating seed oils because of that. Mhm. But now like seed oils have been um through plant breeding techniques had their like 18 the linoic acid like dramatically lowered. Also the omega-3 is dramatically lowered in a lot of them and then the monos and they're like taking over the marketplace. So when you say a seed oil like a lot of the seed oil that you're buying and eating is just like not even high in the omega sixes that were the original reason for the concern. And that marketplace is taking over because
• 150:00 - 150:30 they're more stable at room temperature and under frying conditions when they're more high in the monounsaturates. And it's basically they they've been upscaled to replace um the trans fats that used to be in the food supply and were banned. Um so yeah, you can't even guarantee that they're high omega-6, but but seed oil claims tend to be rooted in the fact that omega6 is um because they have those double bonds, they're more susceptible to oxidation. And oxidation, as we know from the '9s, fanfare around like antioxidants is thought to like
• 150:30 - 151:00 tissue oxidation is thought to contribute to disease in some way. And because these fats get incorporated into all the membranes across all your organs, um you can basically argue that more linoleic acid in any organ is going to cause dysfunction of that at some point. And it's very vibes based. It's not talking about like doses of how much you're eating or anything like that. Um, so yeah, there there's just innumerable claims. Everything from like it causes autoimmune diseases, it's bad for kids IQ, it causes cardioabolic disease and cancer, and the data just
• 151:00 - 151:30 isn't really there for any of that. Um, to be clear, we don't again have blockbuster randomized control trials for the most part. Um we have short-term studies where you replace the food oil. Sometimes it's hyleic which is a monounsaturated fatty acid. Sometimes it's high saturates with these more high um linoleic acid. Typically we focus on oils that are high in omega-3s at the same time. Um but when you replace them you get lower you see lowering in LDL
• 151:30 - 152:00 cholesterol levels. You typically see slight improvements in blood glucose levels. So those are surrogate risk factors for disease. We think they're just risk factors. They're not the end point itself. So we would expect that LDL lowering to lower myioardial inffection or heart attack but it's not like 100% on that evidence where you can go look at the relationship to disease end points is things like um in perspective cohort studies. And so with seed oils that that fatty acid because it's essential your body can't make it itself um the level that's actually
• 152:00 - 152:30 circulating in your cell membrane. So the red blood cell membrane is the biioarker that's used is reasonably correlated with what your diet is. you can actually measure people's blood and because the red blood cell has a longer halflife of like around six months or so um 3 to six months um you can measure that as sort of a marker of what somebody's usual diet and how much of this linoleic acid it contains in it and overwhelmingly across like every perspective cohort study higher levels in your red blood cell membranes which are correlated with higher levels in
• 152:30 - 153:00 your tissues are like associated with good outcomes I think there's like one off study that suggests maybe it's negative for bone, but it's a really tiny cohort. But like the large cohort studies looking at cardio metabolic diseases all show improvements in cardiovascular events and mortality. And so the and the self-reported dietary intake data says the same thing. So the three highest levels of evidence we get in nutrition all don't really point to seed oils being a huge concern for any risk factor that we think has meaningful prognostic capacity. So like causally
• 153:00 - 153:30 related to disease or um in the actual disease end points in the more observational literature and both all that evidence has its own slight flaws. But when you ask for people to come up with well what's this blockbuster evidence that it's like pro-inflammatory and things you get typically mouse models that are fed highfat diets that are obesogenic for the mice. They will get obese regardless of the fatty acid composition, right? and that you use ones that are higher in polyunsaturated fatty acids and they like do slightly worse on metabolic parameters there. Um,
• 153:30 - 154:00 and that is usually the blockbuster take-home evidence that and they completely ignore all the other evidence and they point out the flaws in it. Yes. And because mice are better than humans and like they'll rightly point out, oh, we don't have good biomarkers of like tissue oxidative stress and things which is like true. Um, oh that's the other one. The inflammatory biomarkers which we have and you know this clinically we have very non-specific inflammatory biomarkers like HSCP and ESR but you can
• 154:00 - 154:30 measure like IL6 and TNF alpha and in the few studies that people have looked at this they don't change in a negative way with seed oils. There's even a few trials that suggest that I don't even know clinically I mean what are you checking those things for some rare amuno this is all research clinical trials. I was about to say I've never checked someone's DNF alpha or it doesn't have I mean and now you can like measure 1 beta and things that I think can kind of targets that. So like in research studies you can start to tease this out a little bit more but there's always the concern that circulating
• 154:30 - 155:00 inflammatory markers don't reflect what's happening at like a tissue level. If there is a tissue that's stressed by its high linoleic acid content like it's hard to tell in a human. So even in the research models it's not panning out in that way. No in humans it's just it's really tough. But all the caveats are like we're not feeding like super super duper high levels of this. There was enthusiasm back in like the 1960s um for feeding like up to like 20% of calories from these polyunsaturated fatty acids. Our like cap is typically at about 10% of calories now for this
• 155:00 - 155:30 theoretical risk that like really like we don't have 25 year randomized control trials looking at like cancer in every single way that you can look at cancer as an outcome. Um so like there are like barriers in place on this. The major rationale though is a biochemical rationale. So not even relying on like mouse studies so much. Um but that when you eat high omega sixes you they compete with the omega-3s for elongation and desaturation. So your body needs these essential fatty acids
• 155:30 - 156:00 in the diet to turn them into longer chain forms that are enriched in your tissues and are are beneficial for a whole host of reasons for the tissue. Um, but when you eat a lot of omega sixes, it competes with all the omega-3s and you're not eating an equivalent amount. And even adding a whole bunch more doesn't reduce the competition. So, you don't elongate those omega-3s into the longer chain ones um that we think or those are the fatty acids that are in like fish oil. And we think and there's like primate data, there's rodent data on this that this competition exists. We
• 156:00 - 156:30 think the competition likely exists in humans too. And you basically in animal models to achieve like efficient elongation of omega-3s relative to omega6 you need like a 1:1 ratio which in humans would be like dropping omega6 like linoleic acid intakes down to like 1 to 2% of calories which there's only one research study that's tried to do this at the NIH and it's like extremely hard to feed people diets that don't contain like in the modern food supply um it's it's a you have to use even they
• 156:30 - 157:00 have to limit kind of the amount of oils and you have to avoid things like walnuts because they contain a lot of linoleic acid. So, it's it has this appeal because people think ancestrally we ate this like one to one ratio of omega-3s to omega sixes. Um, most of the modern nutrition community just says like we don't have to worry about the like your body's ability to elongate those omega-3s, just eat fish. And that's why like you get the best of both worlds. You get the linoleic acid that lowers LDL, improves some other biomarkers as well associated with reduced risk of cardiovascular mortality
• 157:00 - 157:30 independent of omega-3s. And then you also get the omega-3s which are associated with improved outcomes as well independent of the omega sixes. Um and you kind of get a best of both worlds. But um despite decades of recommendations around eating fatty fish um there is it doesn't happen like America's omega-3 status indicators where you measure that amount in the red blood cell. when you look at the couple times that we've measured it in more nationally representative samples, the levels are still really low, below what we would want them to be for thinking they're cardioprotective. And so, um,
• 157:30 - 158:00 there are people out there eating a lot of omega sixes that are not making a ton of their own omega-3s and they're not eating it. And so, um, people think that that's like a risk. It's very hard to find cohort data linking that to outcomes, but it's it's based on this notion that you want a healthy amount of omega-3s and mega sixes in the body. Um but yeah, I don't like the data to support really links between these fatty acids and any major disease outcome is just not there and it's one of the
• 158:00 - 158:30 topics in nutrition where we have that biioarker is actually pretty good of exposure. It's not perfect but it's good for a lot quite similar to hemoglobin A1C. Yeah, it's a somewhat similar principle. Instead of the like non-enzyatic modification of the protein by glucose, by the glycation, it's just the um sort of natural incorporation of the fatty acids into the red blood cell membrane. And so it has a similar kind of principle that's the best biomarkers in nutrition um tend to be like essential things that your body's not
• 158:30 - 159:00 making itself and then you can measure in a red blood cell or in a slow turnover tissue like atapose where you can take a biopsy and measure it and it's reflective of like longer term dietary that's like the perfect biioarker of omega6 intake is atapose because it's um stored for relatively long periods of time. Um, this gets back to our like you can measure you can buy all these like diagnostic tests online and micronutrient tests, but they're measuring it in plasma and the half life of nutrients and plasma is so short like on the order of hours from any of them,
• 159:00 - 159:30 but like it often reflects what you ate yesterday, like not what is actually you've been eating long term. And so you could order those tests, but it'll just tell you what you ate yesterday maybe and how fast your tissues sucked it out of the plasma. Exactly. and then your body's ability to like keep a slow steady um you know supply for tissues that need it. And so yeah, nutrition research is hard is kind of what it comes down to. Um I understand people who look at it and they go this is all crap. I'm just like it's like it's there's so many so much uncertainty in
• 159:30 - 160:00 each line of evidence that we should just eat what how we think our grandparents ate or everybody's got their romanticized time in history that they're going to eat at. Um but I think we have enough data that you typically look in like when does the controlled trials measuring you know surrogate risk factors our epidemiology measuring disease endpoints a little bit of animal model data and our understanding of the pathophysiology of the disease when they all align that's like our best case scenario where it's like which you typically you see that in things like sodium um and saturated fat where it's
• 160:00 - 160:30 like that's I a good guardrail can come out of that. Yes, it's a decent guardrail. I'm not going to sit here and say we have like statin level evidence. Um, but it's it's enough that like particularly for somebody who's at high risk of cardiovascular disease, like these are this is reasonable guidance that we want to look at. And for sodium, we actually do have some better randomized control trials back from like the 80s, the trials of hypertension prevention. Um, it's the actually the first nutrient that we have a chronic disease risk reduction, so a CDR DRRi
• 160:30 - 161:00 value for it's a new value. Um the national academyy's finally made a separate category for like a nutrient benchmark um called the CDR in 2019. Wow. So chronic disease nutrition started getting hot and controversial in like 1977 and it took until 2019 for us to get like a solid value um from our our DRI. So it's a slow process and why we need to like massively invest in nutrition research to um increase the speed with which we do these things and
• 161:00 - 161:30 take chronic disease nutrition seriously. Yeah. Well, I'm glad we figured out the healthiest diet today. I think that was very valuable. Yes. I that quick sound bite that I gave you that you can all go follow up on. Um Yes. No, this is this is why I like I like long form stuff because you really have to like dive into the weeds. But if anything, I I hope that people walk away like with the ability to rob rebuff like overhyped, oversold, cure all things that you're going to interface with on every single app and
• 161:30 - 162:00 that you're that you're interacting with on a daily basis. Yeah. I hope they see how much care you put into answering each question and the amount of hedging and nuance you have to present to everything you say because you're trying to actually give an accurate picture as opposed to selling them a potion. And I hope that when they see a commercial of Huberman on TikTok with AG1 that I'm getting flooded with right now of him saying like this is the way to accomplish good like it's just it's not
• 162:00 - 162:30 like those things are being sold to you and they're a distraction from things you could actually invest in in your life that would give better outcomes. And I know some of those things are hard. Exercising, sleeping well, focusing on your mental health. Like I in my eyes as a primary care physician, if everyone in America had $200 to spend a month on some green potion or to see a therapist once a month, like see a therapist once a month all day long is the right medical answer almost
• 162:30 - 163:00 irrespective of your medical or mental health condition, right? Because that will go in the longer run to actually giving you something meaningful. And oh, we got a new randomized control trial. of AG1 versus once a month therapy. Oh yeah, you know that that's that's going to play well with our audience. I know. Oh goodness. Well, say any more about that because you're already at high risk of getting Exactly. Um we'll we'll just have to mute every time we say AG once.
• 163:00 - 163:30 Um no, but seriously, thank you for taking the amount of care that you do and actually spending the time to put in the research. I think your line of work is greatly underappreciated. And I feel like the dream I had when I started, not the podcast, but the YouTube channel, the the engaging content on YouTube, I guess you could say, the purpose of it was not for me to show what I know because I know so little and I have to know of so many fields and trying to help my patients, but it was to give a
• 163:30 - 164:00 platform to people like you who are putting in the effort, who are doing the unsexy work of calculating the CCR ID. What was it? CDR. Yes, CDR. Chronic disease risk reduction. Yeah. Like who are calculating those figures and actually putting pen to paper and figuring out what I need to recommend to my patients to actually make an impact because a lot of the people on these podcasts that get interviewed are not doing that. They're distracting people from that work. And um again, I'm just
• 164:00 - 164:30 grateful that you're doing this. And what I would like to do is I'm going to allow people or I'm going to encourage people to leave comments and questions in this YouTube video or Spotify or however you're getting this and we could do an episode two um where we answer a lot of those questions. Yeah, that'd be great because that'd be fun. Yeah. And I I just want to like it's kind of you to say but I um you know there are so many like unsung heroes of nutrition research and practice that are out there that I
• 164:30 - 165:00 think you don't see many PhDs or RDS and like if you everybody can name a PhD in the health influencer space but like how many nutrition PhDs are doing research that are out out there talking about it. Um, and so they're the folks doing boots on the ground stuff. And I mean, I'm right in the trenches with them, but there is amazing research that's happening out there that I hope people get inspired to like think about nutrition research as a career path. Encourage their congress people to fund it. Like this is a it's a really cool field that not only impacts your health, but just the biology of how your body
• 165:00 - 165:30 handles food. I like I that's actually I didn't say it, but it's what got me into nutrition research. like when I end up doing my PhD in choline because the methyl groups that are on choline ultimately end up tagging the genome the the methods of the coline they're in mom's diet end up tagging the genome in the fetus and regulating its gene expression. And I just thought that was like so profound and cool and what are the implications of that like like how do we study this more? And so I hope that people get not just like what do I need to do for my health today and what
• 165:30 - 166:00 I put on my plate but just getting to know the methods of nutrition research um and understand a little bit more about it I think is can empower people as they go and and interact within the food environment that we have. But we really need that ground swell of social, political capital supporting nutrition research so that we can really actualize all of its benefits. I I understand why a lot of the PhD or RDS are discouraged these days because I know that if you go out and you say the things that you're saying that are very scientifically
• 166:00 - 166:30 accurate, they're going to get a lot of push back and say, "But Dr. Fun told me otherwise, but Dr. Gundry told me otherwise, but this doctor told me otherwise." and they're like, "Why would I bother when I'm just going to get all of these different groups attacking me?" I've actually had maybe not in the nutrition space, but I can say in the women's health space, I've had experts who I want to come on the show to debate someone else or have a conversation with someone else. They don't want to because they don't want the negativity that comes with being online. And I totally
• 166:30 - 167:00 get it because it's a it's a terrible space when uh people are attacking you for no reason. Yeah. Hopefully I didn't say anything too controversial. They'll get me attacked, but we'll see. Time will tell. Yeah. Let me not sign up for episode two quite yet. No, I'm kidding. Well, thank you so much for your time. Hope you had fun. Yep. Did you know that I actually became a master chef and master chef Nick Deiovani became a doctor? Click here to check out that video. And as always, stay happy and healthy.