Controlled clinical trials demonstrate that plant-based diets can significantly improve cardiometabolic health outcomes. In a landmark study involving 22 pairs of identical twins, researchers found that participants on a healthy vegan diet showed statistically significant improvements in LDL cholesterol, fasting insulin levels, and weight compared to those on a healthy omnivorous diet. The study, which was featured on Netflix as a documentary series, highlights that while plant-based diets offer clear health benefits, the quality of plant-based foods matters—healthy plant-based options like legumes, vegetables, and whole grains are more beneficial than processed plant-based alternatives. This research supports the broader goal of transitioning toward more plant-forward eating patterns for improved cardiovascular health.
Plant-Based or Bust? - Finding Common Ground in Nutrition Science - Chris Gardner, PhD本站添加:
[music] [music] >> Aloha and welcome to this presentation of the Vegan Society of Hawaii. We are so delighted to welcome Christopher Gardner, PhD.
The topic of Professor Christopher Gardner's presentation today is plant-based or bust finding common ground in nutrition science. Aloha, Christopher. Aloha, Mahalo. Thanks for having me, everybody.
I'm going to give you a little my background and then go through some fun things. And I started my career a long time ago as a philosophy major. And you know what you can do with a philosophy major? You can wait tables and be a restaurant person. And so I did that for about 6 years, at which time I met a girl.
She lived in California. I had been on the East Coast. I quit my job, moved back to California for her, with her, and then she dumped me.
And she was a vegetarian and I was not.
And I thought, maybe if I become a vegetarian, she'll take me back. So, I became a vegetarian in 1983, which is what, 42 years ago.
She did not take me back, but I stayed vegetarian.
And I worked in so many restaurants that about 6 years later I thought, well, [laughter] it's time to grow up. I have to do something for a job. Maybe I will have a vegetarian restaurant. I am sick and tired of people asking me, "Where do you get your protein?"
So, I thought maybe if I open my restaurant and I had a master's degree in nutrition, I'd have this articulate response.
But when I went to apply to the master's program at Berkeley, in California, they said, "You can't even apply. The only science class you took in college was Psych 101." And I said, "Yeah, that's how I got out of my general education requirement. I took Psych 101."
You got to take Gen Chem, Organic Chem, Biochem, Biology, Physics. Oh, you got to take a lot of classes. You can't even apply. So, I did.
And as an older student, I actually got all A's and A+'s.
When I had been in both high school and college, I was very much a B+ student.
But as an older student with focus, at this point I'm like 26 to 30, oh, I did really well.
So, then they said, "Hey, you know, you're smarter than we thought. Maybe you should get a PhD." And I thought, "Why would I need a PhD to open a restaurant?"
But I actually really liked being in school now that I had a purpose. So, I said, "Okay, I will do that." And I actually wasn't all that proud of the doctoral work that I did. I don't think I really got very good mentoring.
But I turned out I was really good teaching assistant. So, I thought, "Oh, that's the other thing you can do with a PhD. You could be a teacher.
Okay, maybe I'll be a teacher." But no one gave me a job. And I got married in the meantime to a different girl. And had a baby and I needed money. And I looked far and wide. I just begged, groveled, whatever for a job. And the first job I got was a post-doctoral research fellowship at Stanford. And I said, "Hey, oh god, I really needed a job. Thanks. Um now that you've given me the job, how much teaching and how much research is there?
Cuz turns out I'm not really all that good at research." And they said, "Well, a post-doc in academia is basically all research. It's not teaching at all." I thought, "Oh, wow, now I'm really screwed. But maybe if I have Berkeley and Stanford on my resume, somebody will give me a job someday." It turned out the faculty that I was with at Stanford that were in the medical school, so Stanford actually doesn't have a school of public health. But in the medical school, the division I was in, which is called the Stanford Prevention Research, tries to prevent heart disease, cancer, diabetes, overweight.
It's very behavioral economics motivated and it's culturally oriented and it's all lifestyle.
And so I started learning that I could be an observational epidemiologist. They had these huge data sets.
And I got to work with the American Heart Association, the National Institutes of Health. And I started cranking out research papers that were pretty good.
Every time I did it, it always said, "Here is this kind of study where we looked at a big data set and eating this is associated with that."
And usually the last line is was, "And somebody should run a clinical trial to see if there's a cause and effect, cuz association isn't really all that strong."
And at one point somebody gave me a little money and then a little more money and then a little more money.
And it turned out for like 15 or 20 years of my career, I became a feeder and a bleeder. I became a human nutrition interventionist.
I gave people soy, garlic, antioxidants, fish oil, the Atkins diet, the Mediterranean diet, the ketogenic diet, a vegan diet.
And then I would wait to see if I lowered their blood pressure or their insulin or their glucose or their cholesterol.
And I actually did a number of pretty good studies. I'm pretty proud of them.
But I noticed that in some of our studies we would finish up and say, "Hey, this is great. We got you to eat that and this health factor improved. Go forth and eat well." And and most of it was plant-based. It was all about fiber and garlic and things like that. And they said, "Well, you know, we don't really cook all that much. We buy a lot of food and junk food. And thanks for having us in our study, but we're not really going to do it."
So, this is a little humiliating. I got all All I wanted was a restaurant and I got a faculty position at Stanford. And I got millions of dollars of your taxpayer dollars from the National Institutes of Health to run randomized clinical trials.
And I wasn't really being all that effective. So, suddenly I turned my sights a little bit. And I decided to work for the CIA.
I know that might sound odd, but the CIA I'm really talking about is the Culinary Institute of America, not the one in the Pentagon, okay?
So, I turned down the FBI, the Food and Beverage Institute, and I turned down the NRA, the National Restaurant Association, so that I could hang out with chefs.
And I realized what people really like is food that tastes great. How come health professionals don't think enough about taste? Greg Drescher is my hero.
He's the vice president of all these things at the CIA.
And he coined the term unapologetic deliciousness. And I realized for decades I had been apologizing. I said, "Oh, I found this cardboard that you could eat.
This cardboard's really low in saturated fat and high in fiber. And it'll lower your cholesterol." But as I said it, my face would scrunch up apologetically saying, "I know you think you want the cookie or the steak. I'm so sorry about this, but I want you to have this thing that biochemically will lower your cholesterol, but doesn't taste good."
And he said, "Why are you apologizing?
Why don't you take this from a chef's perspective and say that you are going to blow their taste buds away with a global fusion of flavors from the Middle East, from Asia, Africa, the Mediterranean, Latin America. There are tons of plant-based, plant-forward, plant-rich foods and menus that are great."
So, now I consider this the relentless pursuit of deliciousness at the intersection not just of health, but sustainability, culture, and innovation. I hang out with chefs a lot now.
And I was part of a group that was a scientific board that looked at what kind of nutritious, healthy recommendations are there that will never go away. They're not fad diets. They're going to stay.
And there was a business board that was trying to make it economically viable.
The chefs were trying to make it delicious.
And we wanted to be environmentally sustainable and socially responsible at the same time.
And we came up with these 24 principles of the Menus of Change. And the Culinary Institute of America has this great graphic artist. So, this is an infographic of all the 24 principles. The 12 on the right are all nutrition principles. And the 12 on the left are more operational.
Buy fresh, leverage globally inspired plant-based, lead with menu flavoring and messaging.
Okay, so one of the main things that they came up with across those 24 principles of the Menus of Change was something called the protein flip.
So, they said, "Wow, Americans eat way too much red meat.
Maybe they could eat less red meat and better quality and have it less often.
And they should put plant-forward stuff forward and represent that more on the menu." And they came up with this idea called the protein flip, which they originally got from trying to help the food industry with a dessert flip. The The food industry was getting hammered over all the calories in their desserts.
And so they said, "Well, I'll tell you what. Instead of a huge piece of cheesecake with a raspberry on top, how about a bowl of raspberries with a little bit of cheesecake on top? We'll flip it."
And they said, "What if we did that with meat?" So, the standard American diet has always had big slab of meat in the middle, maybe with some potato on the side with sour cream and butter and bacon, some overcooked veggies.
What if we thought about all the cultures around the world where we could have salads and tacos and stir-fries and pastas that could be vegan or vegetarian. But if you're having a hard time shifting someone, don't tell them it's vegan or vegetarian. Just say it's got a condiment or a side dish or maybe just 2 oz of meat on it, not six or 10 or 12. So, they fully embraced this for the last decade, this whole chef group working on the protein flip.
And in the last few years, Stanford got a billion-dollar donation from somebody who wanted Stanford to build a school of sustainability, not one professor, not one class, a new school of sustainability that has just launched.
And my colleagues and I, including Greg Drescher, there's his picture again from the Culinary Institute of America, are actually thinking not in terms of randomized clinical trials, which is what I did, but thinking about institutional food settings where chefs design the menus.
I'm really interested in changing agriculture. I would love Americans to grow less meat and more beans and more vegetables and more fruits than they do right now, but I don't think the farmers, the ranchers, and the fishers will change what they're doing unless they can make a living.
So, we're thinking, ah, well, what if we could change demand? What if there was a lot of demand for this in institutional food settings?
What if schools and hospitals and prisons and things like that ordered a lot more plants?
So, we came up with this name, the Sustainable Healthy Institutional Food Transformation or SHIFT. Isn't that a good acronym?
The School of Sustainability wanted us to link that to greenhouse gas emissions. So, let's try to lower greenhouse gas emissions by serving more plant-rich meals. And we had to give a pitch that the impact was huge cuz the food sector is responsible for about a third of greenhouse gases, and we had chefs to work with, which we thought was very innovative. Don't just penalize people or be punitive, oh, don't eat this and don't eat that and don't eat the other thing. This is, oh, enjoy this and enjoy that.
And the feasibility would be that if we looked at things like universities, hospitals, and schools, and beyond that, which might be military and prisons, etc., that if we took some of the amazing people at Stanford, we could scale that up. And that's kind of where I am today. I have my nutrition science in my back pocket, but I've been working on that. So, I've gone from my idealistic bohemian youth to this old guy with a beard, and I'm trying to work on food systems and culinary aspects of food, okay?
Let me now tell you about some of the science that I do. So, I have long been aware of how challenging it is to try to communicate to the public. And one of the things that we try to do in our studies from the past is make them easy to remember. So, here's an old weight-loss study I did in the Atkins, traditional diet, Ornish, and Zone. This is a really big-time medical science journal, JAMA.
I did another weight-loss one called DIETFITS, which was low-fat and low-carb.
More recently, we did one which called one called SWAP-MEAT, which if we do have time, I'll get to it at the end of today's presentation. Look at what a brilliantly clever acronym that one is.
Don't you like that?
We're very picky about using the first letter of each word, not the second or the fifth letter of the 12th word.
Or a ketogenic versus Mediterranean diet study. Or up here, this is our latest microbiome Fecal Immunomodulatory Food and Fiber Rich Foods for Fecal Immunomodulatory Food. Do you like those? Those all got published in important medical journals as well.
But the most interesting one yet has been this study that turned into a Netflix docu-series.
I'm going to focus on that for a number of reasons. One, because part of the intervention is a vegan diet. Now, I got to tell you, this was never my idea from the beginning.
This guy, Louie Psihoyos, approached us.
He had won an Academy Award more than a decade ago for The Cove. This was a documentary about dolphin slaughter in Japan, and they were feeding Japanese schoolchildren mercury-laden dolphin meat and and getting away with it. So, this was a documentary exposé, The Cove. It got an Academy Award. I don't know how many of you are athletes or have ever heard of this, but four or five years ago, he had another documentary called The Game Changers. And this was all vegan athletes. This is all elite vegan athletes at the top of their game, not eating any animal products whatsoever. That was pretty popular.
He came to me and a colleague who works on the microbiome, which is a hot topic in my field of health right now, your gut microbiome and the microbes in there.
I said, I would really like to do a new movie, and I would like it have to do with the It It should involve diet, and it should involve the microbiome, and it has become such an important part of my life that I now differentiate my life into these three segments right here, before Louie, before Netflix, and after Netflix. So, let me give you my quick little story of how this all happened.
He approached us in the fall of 2021, at which point my career was already doing pretty well. I had grown up in New Hampshire, the Live Free or Die state, went to college in the East Coast, got my job at Stanford. I do a lot with the American Heart Association, the American Diabetes Association. I worked with the chefs to create a group called the Menus of Change University Research Collaborative.
On the Stanford campus, I started a plant-based diet initiative, and I get to work with some of the world's authorities on the microbiome, Justin and Erica Sonnenburg, both PhDs. They both work in the same lab together, husband and wife, and they are just phenomenal.
Louie approached us, and he said, okay, I got this idea.
I have money for you to do a study, and I have a potential contract with Netflix if you will run a study and let me film the study participants and go off on my own while you're doing other things and film other people and put it together. And the only guidelines I have for you is I want the diet to be vegan, and I want the participants to be identical twins. I thought, I identical twins? Man, it's really hard to recruit for a study. Won't it be really, really hard to recruit identical twins for a study? So, we had a whole bunch of Zoom calls, and he said, you know, I do have money. And he said, all right, all right, all right, all right, all right. You got money, you're going to help us recruit the twins.
This sounds fascinating. We've never done anything like this before, working with a film producer. We are willing to give it a try. We designed a study that would have 22 pairs of twins where we would deliver food. I'm going to go into this in more detail in a little bit. For 4 weeks, and then they'd be on their own for 4 weeks, and we'd get their blood and their poop and other stuff, and we'd have a study. And we'd send everything out to the lab.
And he said, yeah, you can do that, and I'll be filming your participants, and I'll be filming other things at the same time.
And we got pretty much wrapped up in the study more than the movie cuz they did all this, and we finished the study quicker than we've ever finished a study before. We finished like from January to August of 2022, we did the whole study. At which point, when we're done with the study, we have to take blood and poop and other samples and send them out to laboratories and wait to get the results back, and then we have to type it up, and then we have to submit it to a journal, and by now it's 2023, and we've submitted to the journal, and we're waiting to get it published.
If you don't know how how this works, it's horribly slow. You submit it, they reject it, you submit it somewhere else, they say, maybe, only if you fix it, if you do this other thing, and time goes on and on and on. And we actually kind of completely forgot about the whole movie thing cuz we were trying so hard to do the science and get it published.
And in the end of 2023, we got this published in one of the JAMA Network's of publication, JAMA Network Open, which is a really It's not the top medical journal, but it's pretty good.
It's a sister journal of the main journal, American Medical Association.
So, super happy that we got this in a good scientific paper. It looks good on my resume. And then there's a thing called an Altmetric score that I'm going to tell you about later about how much the social media and traditional media have covered it, and they covered the heck out of it.
So, in November and December of '23, our lives were super busy talking science with everybody about our new paper. And to be honest, we had pretty much completely forgotten about the whole movie thing. And then, the movie had always, according to Louie, been planned to be released on January 1st, 2024, when people make their New Year's resolutions. That was his original contract with Netflix.
He started this in the fall of 2021 and knew he wanted to release it in January of 2024. And he did. And oh my gosh, we got so much love at first. 50 million people watched the docu-series in January. And then, came the criticism. So, people It got so many people watched it that some people watched it and gave us a hard time. And all of a sudden, a huge amount of my time was saying, yes, thank you for the praise. And oh my god, why are you slandering me? And why is social media ripping us apart? This is Ah, this isn't fun.
Okay, so that was kind of what was behind what was going on. And And in retrospect, I can already say, given how many people have told me they changed their diet because of the docu-series and are eating more plants or going vegetarian, that was not the best study I've ever run. I've run more than 25 studies. That was like my 10th best study. But nothing I've done in my entire career has been as impactful as this thing that ended up on Netflix.
It's just been amazing.
So, I want to just quickly tell you the scientific part of the study. I don't know how many of you will like these details, but just so you know, it had a hypothesis. If we I If we randomize identical twins to a healthy vegan or a healthy omnivore diet, and I'm going to describe later why I said healthy, for just 8 weeks, which is really not that long, those randomized to the healthy vegan group would lower their LDL cholesterol, which would be the primary outcome of the study, which wasn't really rocket science. If you go vegan, you're going to have less saturated fat and more fiber.
I'd actually be stunned if that did not lower your LDL cholesterol. So, this is not really a very risky hypothesis. This is pretty darn straightforward. But we did measure everything else under the sun that we could with the money that we had. We thought many other things might improve also.
They were filming us while we were doing this. We had 44 individuals, 22 pairs.
You're going to see in a minute who is featured in the documentary. It looked like we had a very diverse group of people featured, but to be honest, it was like 3/4 women and very much a non-Hispanic white population. It's in the Palo Alto area, so they were quite educated.
The nice thing was, of all the people in the study, only one person quit in the middle, which is very good for something like a nutrition intervention trial. And because they were twins, that meant their twin couldn't be in the final study either cuz you had to We were matching them to themselves.
So, the other twin was mad.
But other than that, we only had one person drop out in the whole study. Just out of a term that we would call internal validity.
This is really good for internal validity that so many people finished.
They all got food delivered for the first 4 weeks, whether they were vegan or staying omnivore. They were all omnivores to begin with.
And then they had to make food on their own for the next 4 weeks.
And the blood was for cholesterol and glucose and things like that. And the poop was for the microbiome, and we did lots of questionnaires.
We found a company that would deliver food to them, so they delivered delicious vegan and delicious omnivorous diets.
And the two the words that I use in my In my world are efficacy and effectiveness.
Efficacy sort of is if if you've made this as rigorous as possible and controlled everything you can, like delivering them the food.
That's a different question than if people are cooking for themselves. We call that effectiveness. It's more generalizable.
So, really this This particular study had two domains. In the first one, it was more rigorous when we delivered the food, and it was more generalizable when they were cooking for themselves, if that makes sense. So, we're trying to hit both of those.
In my world of nutrition, there's something called the healthy eating index. And if you add up all the different foods you're eating, people have come up with an algorithm that says how healthy the overall set of meals you're eating are. And the scale goes from zero to 100. And these are some data points with three Here's a some graphs, some lines with three data points. Baseline, when they when they were finished getting their meals delivered, and when they finished making them their on their own here.
For reference, I want to tell you that the average American on a score of 0 to 100 scores a 60. I'm a professor. When I grade people's papers, if they got a 60, they fail. That is a D. So, America fails. America's diet is not good.
Okay, so we made a really great healthy vegan diet for people. But I got a little side story to tell you here. We also didn't want to set the omnivore group up to be a straw man to knock over. And we actually made their diet better than it was at baseline.
Does that make sense? We were actually serving them healthier omnivorous food than they normally ate.
Now, both of them dropped off when we stopped feeding them, but we're super proud that both groups, at the end of the study, even the omnivores, were eating what would objectively be called a healthier diet than they were at the beginning. Now, keep in mind, that probably undermines our opportunity to show a difference.
If the omnivores had stayed at their crappy usual diet, and that there were health benefits of changing your diet, this actually undermined our ability to show the difference if we made their diet better. Does that make sense? But I'm a firm believer in my new favorite word, equipoise, which basically means try to make it fair. Try to give both diets a fair shot. Don't rig it for the purpose of headlines that you won because you made the other diet crappy on purpose.
And it's not really fair. So, we're super proud that we did that. Here's the results. Drum roll, please.
The main outcome had been LDL cholesterol.
And son of a gun, the vegans lowered their LDL cholesterol and the omnivores didn't. That's pretty much to be expected. They had less saturated fat and more fiber, which is pretty normal for a vegan diet. That was statistically significant. This is called a probability score. It's like a percentage. 0.02 is like there's a 2% chance this difference was by chance alone, and there's a 98% chance this is real.
So, we did that with lots of other things. HDL cholesterol, triglyceride, glucose, insulin, other things. And it turned out two other things were statistically significant. The fasting insulin levels had a low probability of being by chance alone.
And their weight dropped on the vegan diet compared to the omnivores. Some of these others were in the right direction, but as a scientist, I have to focus on the things that were statistically significant. So, it was LDL, insulin, and weight were all better.
Okay, tada! What are the strengths of this? Oh, it was a randomized clinical trial. In my world, that's a big deal.
Identical twins? Oh my god, that was such a cool aspect of this. Like there's always genetic differences between people. And because they were identical twins, we negated that.
And boy, we had really high retention.
We kept people in the study, except for that one person.
And they did a good job of adhering to the diet even when they were on their own. They were eating better than before the study, according to the data.
Now, honestly, it was a small sample size, and it was only 8 weeks.
And it really wasn't very generalizable.
It was mostly white, well-educated women. But it's pretty good for what it was. No studies are perfect. So, we concluded that the vegan diet led to improved cardiometabolic outcomes according to all the standard processes of science that we went through.
Clinicians can consider this dietary approach as a healthy alternative for their patients.
>> [gasps] >> And other than that, that's the science of it.
Well, what was interesting after that was some of our colleagues said, "Oh, that's so great that you have blood. Can we borrow some of it?"
And can we look at some biological clock things that we found? I don't have time to go into this in detail, so I'm just going to use this word epigenetic.
So, epigenetics is different than genetics. You can't change your genetics, but there's a way to modify what kind of proteins get made from your genes.
And so, this is called the field of epigenetics. So, you can actually modify what happens with your DNA.
And the people in this field have come up with what they call biological clocks.
And they say the biological clock is different than your chronological clock.
You might be 60 years old, but it might be that if we look at your epigenetics, there's a biological clock that says you're 40 years old or or older.
You could be younger or older because of your metabolism.
And there's another thing called telomere length.
Telomeres are the caps on the end of your chromosomes. And as we age, the caps get shorter and shorter.
It looks like people with the longest caps, they're like protective caps on the end of our chromosomes. As those get longer, people tend to be live longer lives, have more longevity.
So, a group said, "Hey, we want to look at this in your data set." I said, "Are you crazy? It was only 8 weeks. What What is going to happen to longevity in 8 weeks?" Well, they actually found that the biological clocks and the telomeres looked better for the vegans than their omnivore identical twins in just 8 weeks. And they published their own paper, and oh my god, the headlines were all over the place for their paper, which was a secondary analysis. This is like after the fact, let's look at this. So, remember I mentioned before this thing called an altmetric score? This is the thing about news outlets and Twitter users and Facebook and Wikipedia and other things. And so, a good upmetric score, like social and traditional media, if you get a score of 20, it's pretty good. People noticed your publication.
So, here's our main paper. We got a score of 2,000.
Okay, so people really noticed our research paper.
Okay, but this is a little humiliating.
The genetics people who just did a little thing on the side had more press than we did in social and traditional media.
I think that's pretty funny. And we actually have some positive microbiome results that were better for the vegans than the omnivores, but those are pending and haven't been published yet.
So, I can't talk about it yet. That was our study.
Okay, so hopefully you got at least a rough idea of what the study was. Okay, so here's what was bizarre again. So, let me go back to this old map of Oh, we were going through this thing. Louie came to this with the idea in the fall and wow, we didn't finish the study till the end of 2022 and then it took us a year to get published and we forgot about all the other stuff that was going to happen until Oh my god, it's a Netflix movie. Here I am actually in Kailua on January 1st, 2024 and my wife says, "Quick, come. Come and look."
I said, "What?" And she said, "Holy crap, you're third on Netflix with your study."
I said, "Oh my god." Like I I actually didn't know all the other stuff he was filming and I thought, "Wow, maybe we'll be on the cutting room floor. I know he was filming a lot of other stuff. I wonder how much will be included."
Holy crap. And here's where I finally realized Louie's genius. I thought he picked genetic identical twins as sort of a scientific leg up. Oh, and I do think this is why a good scientific journal took our research paper and published it cuz wow, what a novel thing to do a diet intervention in identical twins where genetics is controlled for, how scientific. But Louie was much smarter than that. Aren't they adorable?
Look at that. Identical twins are so fun. Oh my god, they were hilarious and they hand-picked four pairs that were particularly adorable and that were very racially, ethnically diverse, too. I'm sure they did that on purpose.
Okay, so here they are in the study for 8 weeks. They filmed They just featured those four. You couldn't follow 44 people around, but they followed eight people around and filmed all kinds of things that they did. One of the things they filmed them doing was working out.
They actually had an exercise instructor.
And this is a small point of contention that I'm going to bring up just to defend myself.
We really measured a lot of stuff and paid a lot of money and there's a way to get a really detailed analysis of how much body fat, body muscle, and bone you have. And my budget was out. I didn't have any more money and I told the producer I could not do that. He said, "Well, I'm just going to do it in the eight people then. I'm going to do it on my own without you, Christopher."
I said, "That's fine, but I'm not going to put it in the research paper cuz eight isn't enough. I have to have it for everybody." And there were people who watched the documentary and some of the vegans lost muscle in this small group and they read our research paper and they said, "Ah, Professor Gardner, you are so unethical. You only published the things that worked. You didn't publish the things that didn't work. Oh, you're corrupt." And I I had to defend myself and I said, "No, I never saw these data.
The guy just did this on his own." I'm thinking, "Louie, why did you publish that that part where it's like they actually did lose more liver fat and visceral fat, but they also lost muscle." It wasn't a very easy message. It was like, "God, of all the great stuff you filmed, I I kind of don't even know why you included in the document documentary, but then it was quite obvious. This was the trainer for the movie. This is Nimai Delgado.
He's been vegan since he was born.
This is like the opportunity to say, "Here's the super uber ripped buff vegan dude.
You can all be like him if you go vegan."
Right? So, this part wasn't actually very scientific, but it cracked me up.
And Nimai is a really interesting guy and he is vegan and he's enormous. And he wins medals and he was in the previous movie, Game Changers.
But then Louie found a three-star Michelin restaurant in New York where the owner had gone vegan.
Uh yeah, actually stayed vegan for many years. Just recently, he started adding a few animal source things to stay afloat. But this is a big deal. He filmed why Chef Daniel Humm went vegan at a Michelin star restaurant in After going vegan, he retained his three stars.
And he knew that Cory Booker was vegetarian.
And so he interviewed him in the movie.
And he knew that Eric Adams, the mayor of New York City, was vegetarian and had helped the hospitals in New York go plant-forward first. So, New York City hospitals now take their hospital patients. Ruth, I don't know if they did this for you, but they said the first option is plant-based. Oh, if you want something else, you have to ask for it.
So, he even wrote a book about this.
He interviewed a chicken farmer who had quit being a concentrated animal feeding operation chicken farmer and transitioned to mushrooms.
And in the movie, he talked about all the different things that were going on in the world of food, how many animals were raised in industrial feedlots as opposed to being grass-fed.
He talked to a regenerative cattle rancher who went to eat at the vegan restaurant owner's restaurant. I thought that was pretty clever.
He brought up all the masses of the wild animals across the planet compared to how many cows raised for meat, which is just horrifying, like a 20-fold difference in cows raised for meat versus all the other wild animals on the earth. He talked about how much the how much of the animals come from concentrated animal feeding operations in the US. I don't know what it is on the islands, but it is almost all CAFO on the states. Talked about the lagoons of manure that get generated as they wash the poop and pee out of these huge facilities. And even what do they do with that? They spray it on the fields and one of the interviewees for the documentary was this woman who lives next to a concentrated animal feeding operation. Her home, her laundry, and her kids were being sprayed with the feces coming from these lagoons of manure.
Talked to a trial lawyer, activist that did a weird little series about the contamination of chicken under a black light. That was actually pretty funny.
These are one pair of twins react Look at their teeth showing up bright white in the light. Marion Nestle, who's a famous public health nutritionist and somebody from the NRDC.
Brilliant. So, we didn't end up on the cutting room floor. We were featured throughout the whole documentary. We were the theme that tied four different 90-minute segments together. So, it's like 6 hours of video.
But he also brought in all these different voices around a plant-based vegan diet.
And it was brilliant. It was really well done. So, that was the movie that resulted from our study. It is hard to tell you how many people stopped me and said, "Hey, hey, you're that guy. I changed my diet."
Or "Oh my god, my daughter went vegan on me and now I have to deal with it. Oh my god, we're having a vegan Thanksgiving.
Oh my god."
It was so fun.
But it wasn't all fun.
So, after the docu-series came out, an Australian actor went on social media and tore apart our study as being horrible. That Why is an Australian actor criticizing our study?
And then a whole bunch of Well, by the way, not many people saw that. I think it says 8,000 views. Okay, but there's a whole bunch of social influencers. Some of these have millions of followers.
And they all trashed us. It said, "That was a terrible movie. They really didn't do the science right. That was all for entertainment. They didn't cover science. Don't be fooled."
And then I found out about a guy who makes videos and he is very funny and very thorough.
And he took all the arguments against us and defended us. I didn't even ask him.
He just he just showed up and he had 80,000 views. Way more than that Australian actor guy. That was really fun finding this guy, Chris McGaskill.
So, if you guys want some great scientific information, go to Viva Longevity that Chris McGaskill does.
They are super well done, very intelligent, etc. We tried to go on Instagram. I'm not very good at Instagram, but we tried to defend ourselves.
There's a guy named Peter Attia who's a super duper influencer right now and a super duper meat lover. And I've actually worked with Peter before and before even calling me and asking me what I thought, he trashed me on social media. He said we failed science 101.
He just wrote a New York Times bestseller called Outlive. He also has funding into like a venison company in Australia right now. So, he's making not concentrated animal feeding operation meat, but he's making sort of regenerative ranching meat. Anyway, he said, "How harsh, my feelings are hurt.
Categorical failure to isolate and test a specific independent variable. Oh my god, Gardner doesn't know what he's doing."
Okay, so this is a pretty weird comment.
Isolate and test a specific independent variable. Peter, please, if you go on a vegan diet, you can't isolate a variable. The vegan diet had more nuts, seeds, legumes, and meat alternatives.
It had less meat, poultry, fish, eggs, and dairy.
If you wanted to go to a nutrient perspective, it was more fiber, more fiber per thousand calories. It had more grams of plant protein. It had more folate. It actually had more iron, isn't that interesting? I don't have time to get into that now.
And it had much less saturated fat, total protein, percent of protein, and B12. Is that bad?
Probably not too much less.
Okay, I had just finished, so I was the recent chair of the American Heart Association. Interestingly, before Peter trashed me on social media, I was asked, "Hey, there's all these popular diets out there, Christopher. We actually have some new 2021 American Heart Dietary Guidance. Why don't you see how all those diets measure up to our guidance? Here's 10 different domains of types of diets, and here are the 10 domains where the American Heart says it's important to be aligned."
Okay, so it was a really fun exercise.
So, first of all, we had to think how many diet categories are in that, and we came up with 10 diet categories.
And some of the categories had more than one name. For example, a really low-fat vegan diet is often called Ornish or Esselstyn or Pritikin or McDougall or Physicians Committee for Responsible Medicine, but we only had one category for them, not five.
And instead of isolating one thing, what we made it clear in this paper was each one of these diet patterns that people have been interested in, including paleo and keto, are that it's a set of recommendations and guidance. Some things get emphasized, some get included, some you're asked to limit, and some you're asked to avoid.
It It's a one thing, Peter.
Nutrition has moved on. It's not just an isolated nutrient. It's the foods that hold those nutrients and the different patterns people eat when they choose those foods.
So, that was one way we tried to address Peter's critique. And then he also said, "Ah, how meaningless animal and plant-based foods are. That's ridiculous. That's not a way to talk about foods."
Sorry, I beg to differ, but there's a whole bunch of scientists who write papers like that. The Harvard group of public health has written all kinds of things like that. In fact, they've kind of taken this to the next level. So, they have a plant-based diet index.
And they also talk about animal versus plant foods. And the most clever thing they've done recently is come up with a healthy plant-based diet index and an unhealthy plant-based diet index. So, think about that. I I know there's some vegetarians who are vegetarian because of animal rights and welfare or the environment.
And to be honest, soda, Oreos, and french fries are vegetarian, but that's not healthy.
So, this is actually a hazard risk. So, this is sort of risk for having coronary heart disease goes up if you're eating more and more of an unhealthy plant-based diet index with things like this, but your risk for heart disease goes down if it's chickpeas and kale and whole oats and things that are healthy plant-based options, right? So, it's not just plant-based. So, I agree, Peter, it's not just plant-based, but if you do separate things out to the healthier animal and the unhealthy animal and the healthier plant and the unhealthier plant, the animal plant thing really does work for a lot of things. I went on a podcast and defended myself for two hours. Oh my god, who's going to listen to this?
Apparently, thousands of people listened to this two-hour thing of me defending myself. On social media, I got a criticism from someone reading our research paper, and it was actually a quite reasonable criticism up front.
So, let me show you one of the tables from our study where we were talking about how many calories people got from protein, carbohydrate, or fat when they were on the vegan versus omnivore diet.
And at baseline, when we randomly assigned them, as you might expect, their diets looked very similar.
And then when we were feeding them and when they were on their own, their diets got a little different. The vegan group definitely had less protein than the omnivores. But one thing this reader noticed was it looked like we were delivering in the food delivery phase delivering less food than the other group, and that that might have caused them to lose weight, and so it might not have been the diet, it might have been weight loss, and it might have been that we manipulated the weight loss by not delivering the same amount of food, which I thought was a very reasonable criticism, and I'm actually I don't do Twitter anymore cuz Elon Musk ruined it, but at the time, I was really good at tweetorials.
So, instead of just one simple message, a tweetorial means you string a whole bunch of them together.
And so, I did a tweetorial, and I said, "Great catch, you know, you went into the supplemental materials, and you found out this. This is That's pretty cool. So, it's really a little more nuanced than that." And as I got into the whole explanation, I said, "You know what? We delivered the same number of calories on both diets, but they didn't come with a gavage. They didn't shove a thing down your throat and cram the food down you.
We delivered the same number of calories, and they ate until they were full.
I think they didn't eat as many calories cuz plant-based foods tend to be more filling cuz they're full of water and fiber. It could actually have been cuz they didn't like the vegan food as much.
That's another possibility, and I can't tease it apart, but we didn't intentionally feed them a different number of calories. So, the criticism the way you lodged against us isn't fair, but I really respect that you saw that, and you called us out on it. And I've had a head I've had a chance now to respond to that. So, what's really funny is not this guy, but another guy in social media who often criticizes me, who's a super duper low-carb fanatic, apparently had given me the same criticism, and I hadn't noticed because he actually read this tweetorial.
And then on social media, he posted a video apology.
Look at this.
I appreciate his explanation. I apologize for my quick judgment on on this specific matter. I was wrong.
I can't even tell you how satisfying that was. That's like more satisfying than the docu-series to have someone on the toxic social media apologize.
But I felt pretty good about it. I actually had agreed with this guy who criticizes me before saying, "Hey, see, we agree on stuff."
And on this one, instead of just saying, "Hey, you're wrong, and you're mean, and you're nasty," I said, "Wow, good catch. It's very reasonable that you made that criticism, but let me give you some more background, and then you'll see that the criticism isn't quite valid, but thank you for calling our attention to it, right?"
The other tweet I got on this was, "Hey, this is probably one of the best pieces of sci-com, science communication, I've ever seen. What's so great about it is people don't even know they're watching science communication. It's very entertaining."
So, this got a hundred thousand views from Kizzy PhD. Who's that? Who's Kizzy PhD? So, if you look, she had done sort of a tweetorial, too. So, these are all the different tweets that got strung together for hers. And what I learned was Dr. Kizzy was one of the ones who got the COVID vaccine out as fast as it came out during the pandemic.
And so, what I'm reading into this is she saw this, and she's like, "Damn, we made that vaccine so fast for people, and people wouldn't take it.
They like didn't believe the science.
They thought we were injecting them with bizarre things.
God, I'm just trying to help save people from the pandemic.
And ah, I think we need to make science communication more entertaining so that we can engage more people."
So, this is the kind of back and forth that I got from this, and it turned out there was a firefighter in San Francisco who had developed cancer.
He had turned vegan to fight it, and I can't tell you if it was the veganism that did it or that and more things, but he did beat his cancer, and he went on to start a San Francisco Cancer Prevention Foundation.
He saw the docu-series, and he said, "Hey, have you ever thought of working with firefighters? Firefighters have higher rates of most cancers than the general population." He said, "We do in our foundation, we do a lot to help the the families of firefighters who have died or who are disabled. We never really thought about preventing cancer with diet. If we gave you money, would you do a study in firefighters?" So, listeners, be ready. We have 120 firefighters.
They haven't exactly gone vegan, but they've got they've gone plant-rich, and they get allowed a little bit of eggs and yogurt and fish.
But for the most part, they've gone vegan. And so, we have another study that someone is filming right now for firefighters going vegan. And all of a sudden, I'm now getting asked to do a different kind of presentation. The American Heart had me come talk about partnering with the media to enhance the impact of prevention science. Like, how do you communicate this in a way that's more accessible to people?
So, that's been really fascinating.
Okay, so now let me show you having shown all that, let me show a really specific study that we did about plant-based meats cuz I'll bet even you guys listening right now have some questions about this. So, hands down the plant-based meats are better for the environment, they're better for animal rights and welfare.
Are they healthy?
Huh, wait a sec. They're like aren't they processed foods? So, could they be unhealthy? I don't know how many of you saw these.
They were about I don't know if you can see the tiny writing here. Paid advertisement, paid advertisement, paid advertisement. These were all full-page New York Times ads and other places put together by the Clean Food Facts Committee.
And there's some little tiny writing under there paid for by the Center for Consumer Freedom. Who are they? Well, if you look, it's basically Big Food.
It's basically the Cattlemen's Association and some of the folks who used to work for tobacco when they tried to make tobacco seem okay. So, they've been slandering the plant-based meat folks. Okay, well, if their question is, "Oh, they're not healthy cuz they have coconut fat in them which is saturated fat and that'll raise your cholesterol and they're high in sodium so it'll raise your blood pressure and they're ultra processed so you'll get heavy."
Well, I saw those ads and I thought, "Wait, wait, wait, wait a sec. This is like This is my superpower.
I design studies and run them objectively and publish them in medical journal paper. I could do this."
As long as you make sure we're clear on healthier than what.
So, it's not are they healthy or not, it's are they healthier than what they're intended to be substituted for, which is red meat.
Okay, so we got this published and I already told you how proud I am of our acronym for the SWAP Meat study.
So, American Journal Clinical Nutrition is top nutrition journal.
And our hypothesis was if we got healthy adults, not sick adults, to get two servings a day of either animal meat or plant-based meat for 8 weeks and in this case they would cross over so they'd be in it for 16 weeks, they'd do both diets then we would see that selected health outcomes would be better for the plant-based phase.
If it was really animal versus plant. So, I'm going to get into that a little more later. So, we found 36 adults to do this. They're in each phase for 8 weeks, at least two servings a day of Beyond Meat or animal meat and they swapped over and we had them bleed and poop and fill out questionnaires just like last time. That part's kind of similar and it wasn't just burgers. So, Beyond Meat compared to animal products makes a burger and crumbles and sausages and chicken strips and things like that.
So, we went and found the company who also had burgers and beef and pork and sausage, etc. And if you were to just look at this from a nutrient perspective, this would be another one of those no-brainers.
The plant meats were higher in fiber and lower in saturated fat compared to the animal products.
That should be good for a lots of health things. Interestingly they were not only matched in calories and had the same amount of protein but protein but they had similar amounts of sodium. So, let me just take one side minute to explain this. There were a bunch of Beyond Meat products that when you got them and opened them up at home, they had less sodium than the plant ones. But just as two specific examples, the burgers and beef crumbles had more than the raw meat burgers and the raw ground beef. But guess what the participants did when they were grilling their burgers and their ground beef, they salted them.
And in the end, it was the same amount of sodium. So, that slanderous wasn't really fair. It should be tested in a scientific study, which is what we did. And we got the 36 participants to eat more than two servings a day, so like two and a half.
The probability of that being different is like n- n- nothing. Like there's an 80% chance that those are similar.
That's what that P value means. So, here's our two phases, plant-based, meat-based. The Beyond Meat had this mission to serve great great food that's that tasted, smelled, and looked like meat.
Now, think about for a minute what could the other meat phase have been? We probably could have got McDonald's or Burger King or something like that. But remember that word I used before, equipoise?
I didn't want anybody to criticize us for getting a low-quality meat versus what we were testing was the Beyond Meat. So, we went to Good Eggs a provider in the Bay Area that does absurdly fresh groceries. So, these are organic and regeneratively farmed and pasture-raised and all the foofy important words that the, you know, the good meat eaters want. So, that again we would have this equipoise, it would be fair. We were giving the meat folks a fair shot versus the plant.
So, once again bam.
Well, what are the results here and boom.
So, the main outcome of this study, which I'm not going to spend a lot of time unless somebody wants to ask me later, is sort of this new emerging heart disease risk factor called trimethylamine oxide.
And we thought that would be lower in the plant meat and there is a biochemical reason to expect that and it did work. It was lower in the plant phase than the animal phase.
Interestingly, people thought because they were processed foods that people would gain weight. Technically, they were a little le- they had lower weight on the plant phase than they did on the animal phase. It wasn't really very much. Technically, it was statistically significant. This is this probability value again.
For scientists, the most important P value is a really low one. The lower you get, the smaller the number the more important it is. This actually isn't a very clinically significant difference but the reason it's so statistically significant is pretty much everybody was a pound or two lower on the plant phase plant-based phase.
So, you can get good statistical significance even if it doesn't look clinically significant if everybody does the same thing and the results aren't noisy.
And then the LDL cholesterol was also a statistically significant finding, 10 mg per deciliter lower, that's very clinically relevant. And it's obvious, they had more fiber, less saturated fat, and they lost a little weight. So, that's a no-brainer and actually, I forgot I had circled those. This is one of the more interesting ones, the blood pressure was not different between the two groups.
So, three things are better and one of the things that people were worried about wasn't any different. So, we said this study found several beneficial effects and no adverse effects from the consumption of the plant-based meats relative to animal meats.
And we did this and we published this and I can't tell you how many people called me up and said, "Oh my god, Professor Gardner, I can't believe that you're concluding that the these are healthy plant-based processed meats.
Don't you want people to eat legumes and peas?" And I said, "I sure do want people to eat legumes and peas. I've been trying for 30 years to get them to eat more beans, peas, and lentils and they're not. A ton of them are not giving up their red meat."
And that wasn't the question. I wasn't asking if they were healthy outright.
I wasn't asking if they were healthier than legumes or peas.
We were asking if they were healthier than red meat cuz that's what those products were designed to replace.
Now, I'm I'm definitely a fan of beans, peas, and lentils, legumes, all the rest of those leguminous plants.
I'm kind of hoping maybe the plant-based meats are a gateway drug to more beans, peas, and lentils.
Maybe if they s- Oh, making that switch wasn't that bad. Oh, I'm going to actually try some legumes and peas now.
So, really to interpret how to think about those plant-based meats, it's instead of what. It isn't just are they healthy?
It's are they healthier than eating meat? And in my study, they are. Is that the only study we need?
No, in science, people should replicate what we've done and they should do different doses and different sources but prior to this, with those New York Times ads slandering them, there weren't any studies to respond to that comment.
And now there's a pretty good one.
I also think what happened with them, I don't think they're still there but Burger King and McDonald's took them on and offered an Impossible Whopper and a Beyond Meat burger.
That meant they were on a white bun with cheese maybe with a crappy sauce. So, maybe if there was even something good about them, you might have displaced the benefit of having the plant-based patty over the meat-based patty if you slathered it with all kinds of other things.
So, I'm always interested in instead of what and with what.
That always helps me appreciate how to talk to somebody who's who thinks strongly one way and you might disagree but if you both talked about instead of what or with what you probably could come to more of a consensus.
Okay, so here's my recap. I tried to give my background tell you how we got that docu-series made after publishing it in a good strong medical journal how I dealt with the critiques and the responses in social media. Oh my god, what a time suck. This is a whole new thing for a scientist to have to address not just peers but the public and the social media influencers slandering you or slandering companies making food. And so I wanted to end on that strong note of doing another scientific study that took another angle on this for which I did get grief also from people who didn't understand it, right? I do want to tell you that in October of this year we won an Emmy for the docu-series. Woo! Woo!
Woo!
I'm now an Emmy-winning I don't know.
That's an exaggeration. That's Louie.
That's not me. We just did a good study and he filmed this and everybody I'm going to have a book coming out in October called Food Sense.
These are the competing covers for today. Who knows what the real competing cover will be. I just turned the whole thing in. The copy editors are working on it. They're proposing different covers for me.
But my book will talk about stuff like these same issues as I try to find better ways to communicate with people cuz everyone eats.
And it just seems like such nonsense sometimes. So hopefully I'm going to help people make some food sense out of this. So not only am I the old guy who went through all these different careers and dropped one and changed another, but now I'm a Netflix and Emmy winner and about to be an author. I can't tell you how many people I have to thank who helped me do all this. There's teams and villages and colleagues that have helped me for years put all this stuff together.
And that's what I did. I am happy to take some questions.
What that was. So we did So we didn't give them any specific instructions about added salt and added oil. If that's what you're referring to, first we delivered the food and we said, you know, it should be fine this way.
But you should enjoy your food.
When certainly when they were cooking on their own, Denise, uh I with all the work I do at the American Heart Association, we are not low-fat people. We are low saturated fat people. So when you substitute saturated fat for something else, if you were sautéing in butter and you're now sautéing in olive oil or avocado oil or another sunflower safflower oil, our data say you do better than if you had the butter. Now, you might do better yet if you if you steamed it, but I work with a lot of chefs who think, "Wow, sautéing that really seared in the flavor and steaming it just kind of made it mushy."
For sodium we're definitely everybody in the health community is up for less sodium.
I also published this study with some colleagues that show that really for the most part 15% of our sodium intake is added at home and 75 to 85% is from the junk food that we eat.
And so if it's up to you and what you add at the table, adding a small amount is probably okay. And again, if if you're not going to continue to eat it because it's not joyful and pleasurable enough, you won't stick with it.
So I'm up for some balance, Denise, of unapologetic deliciousness, keeping sodium down, and not overdoing fat, but anybody who's substituting saturated fat for some oils, avocado, nuts and seed fat, I'm I'm all in.
I'm a Mediterranean in that regard. Alice, is there used to be a food upper limit for cholesterol.
Don't get any more than 300 mg per day.
And both the Dietary Guidelines for Americans and American Heart Association has kind of abandoned that number because people tried super hard to count it and it's really hard to count.
And instead they say eat a heart-healthy diet or follow dietary guidelines and you'll end up not getting much dietary cholesterol in your food. So that's the dietary side and I'll push that aside when it comes to total cholesterol versus LDL and HDL cholesterol, I don't even report total cholesterol in the blood in my studies anymore and I haven't for a decade. I only report LDL cholesterol and HDL cholesterol. Because there are some folks, especially women, more likely than men, to have a higher proportion of that be HDL.
So I don't look at any of the total cholesterol guidelines anymore.
Only LDL cholesterol. There's also another fancier way if you wanted to do it this way, but I don't want to confuse anybody. There's also something called non-HDL cholesterol.
Most of non-HDL cholesterol is LDL cholesterol. It's mostly just the two, but there's actually, sorry if your head's will spin, there's an intermediate density lipoprotein cholesterol and a triglyceride-rich cholesterol.
And those are relatively small components. So as long as you just say LDL or non-HDL, which a couple of physicians I've seen are moving toward that, that's mostly the bad side and the bad number to focus on.
The other really scary thing in that regard, given that we actually have really effective drugs to lower the bad cholesterol, uh it used to be in my day when I got my PhD sort of 130 mg per deciliter LDL was the cutoff. And if you were above that, they were concerned. And if you were below 130, it was okay. And then the drugs are so good they said, "Let's get everybody below 100."
Now the drugs are so good they're saying get everybody below 70 for an LDL.
And I know there was just a debate in the last American Heart Association meeting where they found another drug to get your LDL down to 30.
And it's getting a little ridiculous that they got you on multiple pills in higher doses to get your LDL lower and lower and lower and lower. So just as I am not a medical doctor, I'm a nutrition scientist, if you go in and your blood is 100 to 130 for the LDL number, you're probably fine. If you're under 100, that's amazing.
If you're really focused on being under 70 and under 30, that might be taking things a bit too far.
Unless unless unless unless you're super high risk for heart disease. If you have super advanced heart disease, I know there's going to be a doc who's going to be really aggressive and try to get your blood LDL cholesterol even lower than that and there are drugs that'll do it.
I hope that answers your question. Yeah, no, it's a great question. So we're So we did one paper that's been cited more than almost any other paper I've ever done. We were Jan, we did a high-fiber versus a high-fermented food diet and we only picked one dose. For the fermented food dose we picked six servings a day. And as many times as I've said that, people I Look at that reaction. I totally saw your reaction. Okay, but so here's my quick qualifier for the six servings a day. And this is just a random number that we picked so it would be different than before.
A bottle of kombucha is two servings.
Uh kimchi and sauerkraut, a half a cup is a serving and it's like 25 calories.
Okay. And so we had a dietitian who actually took all the data that people had been filling out and they actually did in our study get to six servings a day and maintained it for six weeks in a number of different ways. Nobody was required to do just sauerkraut or just yogurt. And they Oh, if you don't like kimchi, you don't have to have it at all. Most of the combinations of six servings added up to 300 calories.
Okay.
So if you're eating 2,000 calories a day or something near there, you can imagine that 300 calories is a small proportion of that. What we found, Jan, in our study is once the study is over and people are on their own, they eat more like three servings a day, which is more like 150 calories a day.
So we don't have a titrating number where we said, "Let's try one, three, five, seven."
That That would be insane. Plus it's really hard to figure out what you're measuring. One of the things we look at these days is inflammation and I don't want to go down there. It's a huge rabbit hole. There's no clinical marker of inflammation that a that a physician will measure for you right now.
It's certainly a hot topic and we're we certainly think that the trifecta is change your diet, improve your microbiome, lower inflammation, and improve immune function.
Part of this is can you change the microbes in your gut?
Can you have more of the healthy microbes and fewer of the pathogenic microbes? And so the answer is starting to be yes, but everybody is so different. And what we found in that study, Jan, is that some people started with a very depleted microbiome and they responded differently than someone with a very rich microbiome.
As you might imagine, somebody with a rich microbiome had less room for improvement. A depleted microbiome had more room for improvement. And really my caution right now is that the commercial industry is getting way ahead of the science.
Uh a fun point and I'm going to have to leave you with this just for the sake of time.
Uh we After we finished that study, which got a lot of publicity, we got funded to study 130 pregnant women. And we got them to eat more fiber, more fermented food, or both for their second and third trimester. And we are now tracking their infants over time to see what the maternal transfer was and what did it do for the kids?
Um we haven't finished so I can't tell you what the results are, but I have to tell you a really amusing anecdote on the side is when we did the first study and we said, "Please eat fermented food, whichever kind you like." Not many people like natto so I don't want to get into the natto. Although I bet more people in Hawaii like natto than people in the mainland. But we just said kimchi, uh uh kefir, kombucha, yogurt, sauerkraut, and we counted it up, and with these 130 moms that I found this in the store, I found this gut shot, I found this pickled, I found this other thing. I Does this count? So, they've been asking about all these things if they count or not. Some of them they killed the bacteria off and they added live bacteria later and sometimes they had the products of the microbes and so, our group actually just wrote and published a whole paper in Advances in Nutrition and I will if if you can't find it, just write me an email [email protected].
It was a very practical paper like if your head is spinning because the commercial industry is going gonzo with new fermented products, read this paper and we will try to explain what some of the differences are. It does not Jan say the differences lead to these different health outcomes. It is really more of a clarifying thing to say we are going batshit crazy because our study participants are reporting things we've never heard of before and we now have to go look into how valid these things are along the old lines of simply eat more fermented food. But, let me tell you something exciting.
And so, the exciting thing is uh the Culinary Institute of America holds a number of really interesting conferences. They must hold one month and they are so delicious when you go.
One that's very well known is called Healthy Kitchens, Healthy Lives and 500 physicians go and they get to do hands-on cooking with chefs. But, they're proposing a new one and I'm the co-director of it. It's a Stanford Culinary Institute of America conference and it's called Food for Life, Food for Health.
And they're inviting chefs to be attendees and physicians.
And they want the chefs and attendees to work side by side. Not only that, the Culinary Institute of America is now offering a new master's program in culinary therapeutics.
And the idea is to train chefs who would like to work in the health care system.
It's been so exciting working with chefs who are interested in this. Here's my other anecdote is we have a very vegan, vegetarian, plant-based chef at Stanford who's in charge of catering events.
And my division a little while ago had an event where they basically had steak and cookies.
And I I said, "Oh my god, I showed up at this event from my division. What the How can you have steak and cookies at my at an event in my group?"
And the administrator said, "You know, the last time we had all salads and everybody complained." And I said, "Everybody?" And they said, "Well, Garrett complained." I said, "One guy complained? And so, you switched from salad to steak and cookies?"
And she said, "You know, I hate this part of my job.
I'm in the administrator. I'm asked to pick the menus for the events and somebody's always unhappy.
You pick."
And so, I said, "Ah, that's a great idea. Okay, uh can I pick for the next event?"
And for the next event, I really didn't do anything. I went to our chef Andrew and I said, "Andrew Maine, Chef Andrew, we're going to have an event.
You're a chef. Make stuff. How much money do you want per head? Like 25 bucks per head? Okay, let me get that approved. 25 bucks per head."
And my division said, "Oh my god, Christopher, that was amazing." And so, for the last 4 years, every time we have an event, they ask me to pick and they give me credit. And I say, "I don't deserve any credit. I only know Andrew.
Let me make this clear. I'm not picking any of the menus. I just say Chef Andrew, make stuff that's fresh, seasonal, local. Make it heavily plant-based cuz he's the vegan chef.
And if you want to have a soup that have bacon bits that you could add or if you wanted to have something where you could put feta cheese on top, put it on the side so that maybe it's not everybody wants to be vegan or vegetarian today, but make it plant-based and so far, everybody in our group says, "Wow, Christopher is so good at the catered events." And it is so funny cuz I get no credit. I just I know his email address and I know his phone number and he's really into it. And so, celebrating those chefs and acknowledging it and giving them shout-outs, I think is the way to move this forward.
And what I'm very interestingly, I've been working with Google for the last decade and Google has done a lot to improve their food and there was a guy who's the head of hospitality, Michael Batter. And Michael Batter just stepped down from the hospitality position at Google to become the president of the CIA.
He's the first non-chef president of the CIA. And they hired him. The CIA has graduated 55,000 chefs to date. Most of them are not in Michelin star restaurants. Most of them are in a hospital or a school or a Marriott hotel or something like that. Actually much more reasonable hours and less stress to be in that kind of chef situation.
Anyway, Michael Batter is part of the reason that they have a new master's program in culinary therapeutics.
And so, they're thinking of retraining chefs or shifting the way that they train chefs to be more aligned with what we've been talking about today. And so, I I've never been this excited to think at the level of the president of the Culinary Institute of America, there is a fundamental paradigm shift going on and getting away from baking and French cooking and more towards cooking for health and the environment.
So, it is a very exciting time.
So, definitely fermented food. So, Anna, I have coconut oil and coconut milk in my kitchen.
Uh and I actually make a really great coconut curried veggie dish with coconut milk. My wife really wants me to buy the light coconut milk, which is an option cuz they have light coconut milk.
Um I will couple times a year cut up yams or sweet potatoes and spread coconut oil all over them and then just bake them instead of having French fries. It is true that coconut oil raises your bad cholesterol more than any of the other kinds of vegetable oils and as much as butter cuz it is saturated. So, the reason that coconut oil is liquid at room temperature is cuz it's full of saturated fat that has a really low melting point. So, in moderation, I think it's fine. Uh one of my sons actually makes a great uh roasted baked cauliflower dish with coconut milk on it. So, for me, one of my answers, Anna, what were you cooking it with? Remember my instead of what with what?
So, if you were cooking a bunch of fiber-rich grains, beans, legumes, veggies with your coconut oil and you really would eat more of them with a coconut oil than you would with an avocado or an olive or safflower oil, I think it would be fine cuz you're not drinking it. You've got a couple tablespoons of it.
It would depend on the dose and what you had it with, but it does raise your bad LDL cholesterol. There's tons of studies that show it.
Yeah. Boy, I'm all about trying to learn how to message and not make it too complicated, but it is So, one of the issues is, Christina, as we figure out how much does LDL cholesterol and glucose and blood pressure contribute, they always say, "Well, that explains half of who has a heart attack and who doesn't, but it doesn't explain the other half." And so, the other half is inflammation and inflammation is tied to things like TMAO, trimethylamine oxide, and it's been a hard case to make.
TMAO in particular, so I don't I don't know how far rabbit hole I want to go down with everybody who's listening today, but TMAO actually gets made by the gut microbes by precursors, things that were in your food called choline and carnitine, and those come in meat. And so, it's kind of a no-brainer that if you had meat, you had the molecules that the gut will convert to this thing called trimethylamine oxide.
It actually converts to trimethylamine and then it goes to the liver that oxidizes it and becomes this thing called trimethylamine oxide that physicians have not adopted as a standard risk factor yet. How long does that kind of thing take place? Well, uh if we want to go back to our total cholesterol LDL cholesterol from earlier, it was total cholesterol for decades before they convinced people that the difference between LDL and HDL were important enough that they should measure them separately and report them to people separately. So, I think it will take decades. And then, Christina, really frustrating thing that I get all the time, so I don't know if you've heard this part, but fish naturally have TMAO.
When you eat fish, your TMAO in your blood spikes.
And fish are good for you overall. Fish are are healthy. I know most vegans and vegetarians don't eat fish, but among all the bad foods for you, fish is not among the most bad. So, for people who are trying to get off of meat and off of cheese and they're going to have a little fish, I'm in favor. Christina, when we do our studies and we are measuring TMAO, we have to make sure people don't have any fish for 3 days before the blood draw.
And occasionally we catch them and say, "Oh my god, your TMAO is off the out the roof. What's happening? Did you happen to have fish? I said, "Oh, yeah." Didn't you hear what we told you not to you're like messing up the study cuz you had fish.
But then somebody who doesn't believe in TMAO as a risk factor says, "Okay, Professor Gardner, why are you upset?
You know, if fish is good for you and they have TMAO cuz the fish, how can it be so bad?"
And then my tongue is tied and I'm trying to explain, well maybe the fish from the TMAO is different than that the TMAO that came from the meat and the microbiome. So, Christina, I'm I'm a little tongue-tied myself on that one and I can't explain it very well today. So, I'm really not surprised that it hasn't moved forward. It's a cool interesting idea. I see it related more directly in the conferences I go I go to to inflammation.
And then I go back to my same pat answer for inflammation. There's hundreds of inflammatory markers and no clinician or group has come up with a simple metric of inflammation that a clinician will measure and give you.
So, until I think until we can figure out the immune function and the inflammation score uh we're going to have to wait on that one would be my take.
Yes. Okay, this is a good one for me to end on. I don't think it's going to be super satisfying, but I I got really into TMAO. I measured it in that swap meet study. It was a really hot topic at every American Heart Association conference I went to. I said the precursors are carnitine and colity and choline.
And then the next conference next to me said, "Here's why choline is so important and why we're deficient in it."
I said, "Wait a sec. In this room, I was just saying choline is a precursor for TMAO and it's bad and in that room, you're saying choline is a hot new topic, not the carnitine.
But the choline part. So, my only answer for today, Diana, is that when the American dietary guidelines get put together, they talk about nutrients of concern, nutrients that are important for metabolism that many Americans don't get enough of. And that list is currently calcium, potassium, fiber, and vitamin D and choline is not on that list.
Choline is considered a vitamin and a nutrient, but it's never been sort of a a top interest nutrient until the last couple years. So, I've seen more and more on choline lately.
And people say, "Oh, we're not getting enough." And here's the food sources and some of them are meat and some and some things that are not vegetarian.
So, I don't have an answer yet. I I will say there is some kind of resurgence or or new interest in choline, not the carnitine part, but very specifically the choline that some people are saying we need to get more of. So, my follow-up was if you don't get enough, what happens?
If you don't get enough vitamin C, you get scurvy, but no one gets scurvy anymore. If you don't get niacin, you get pellagra. No one gets pellagra anymore.
If you don't get vitamin D and calcium, you get osteoporosis. Nobody Oh, yeah.
Lots of people get osteoporosis. Ah.
That is still a concern.
So, if you don't get choline, what what is it what's happening to people that is adversely affecting their health?
So, pretty much of a non-answer for you, but at least I've heard of choline. I appreciate that there's new interest in it. I appreciate that it complicates the topic of TMAO, but the topic of TMAO was already complicated by the fish thing.
And so, I I never had a perfect answer for the TMAO.
Anyway, can I give you my selfish answer? Like if I keep saying cholesterol, cholesterol, cholesterol, at some point they're really bored of funding me. And so, if I say, "Oh, cholesterol and TMAO and the microbiome and my chances of getting funded are better cuz I'm looking at something new and novel even if it goes away. I will tell you 15 years ago I got really interested in something called homocysteine that had this level of interest for 5 or 10 years and it was at every medical conference and it's completely gone now.
Every once in a while I see some doc who still measures homocysteine in the blood and I say, "Really? That is so last century, homocysteine, but okay, if you're still measuring it, I think that fell off the radar a long time ago and TMAO may fall off the radar or maybe we'll find a specific type of TMAO or the source of TMAO that is additionally important.
So, I have a really fun evidence-based answer to give you, Lorraine. So, we did a weight loss study for low fat and low carb a long time ago called DIETFITS. We published it in 2018. There were 600 people, 300 people in low fat and 300 people in low carb.
Overall, there wasn't a big difference between the two, but there's a lot of variability within each group to see how each one did. And I had one postdoc who said, "I would be really interested in the most adherent 10% of the low fat and the low carb people, the ones who are the most successful at getting really low in fat or really low in carb cuz a lot of people had a hard time adhering to very extreme diets.
Very low fat and very low carb is hard to do. So, we did that. We took uh it was a year-long study and we took the folks who at the 3-month mark were the lowest in fat and the lowest in carb and we followed them out to 12 months to see what was happening.
In both low fat and low carb, they lost more weight than everybody else.
Probably cuz as an extreme diet, there was less that they were willing to eat.
I think that was actually a strategy for eating less. If it's super extreme that means there's a lot of things that other people eat that you're not willing to eat and so, you just don't get as many calories.
But a stunning thing in the low fat group was this.
They were eating a certain number of calories from added sugars and refined grains at the beginning of the study and we wanted both people to have a healthy low fat and a healthy low carb.
So, we said nobody should be eating added sugars or refined grains.
You should pick healthier sources of fat and healthier sources of carb, whichever group you're in.
And the group that had been the most successful eating low fat and who were still the most successful at 12 months had doubled their intake of added sugars and refined grains.
That was shocking to me to be perfectly honest. I thought, "Wow, you've fully embraced this and you got in low in fat as you could. I wonder how you did it."
Oh, no. Oh my god, you did it by doing the thing we asked you not to do. You're having all kinds of added sugar and refined grain, which is in fact low fat.
So, that those data, my own data, Lorraine surprised me and shocked me and I thought, "Well, that that's really not a good way to do low fat. I would rather you have some avocados, nuts, and seeds, and fatty fish and have some avocado olive oil and and sauté some things in oil and have some salads with some salad dressing to avoid you having all that added sugar and refined carb.
Mahalo, Professor Christopher Gardner, for this amazing presentation.
Aloha.
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