April 6, 2020
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Nick Andre: Engineering Nutrition: Chronic Disease and the Appropriate Human Diet

this talk is called engineering
nutrition I think probably a lot of us here are software engineers and Googlers
so it makes sense to kind of — one of the higher-level things is that I think the
the ways in which software engineers tend to solve problems tend to lend
themselves well to scenarios where you don’t necessarily understand all the
details or you you kind of have to know what you don’t know because that’s kind
of the lives we live in as software engineers. So I kind of apply that
approach to nutrition and I’m just hoping that y’all will find interesting.
I kind of have to address this question first like why I came here, stopped
doing software. Maybe I was frustrated with working with other teams or
whatever but: why am I here right now to discuss nutrition? This was me in the
year 2000: like nice little little skinny Nick but starting about like the fourth
grade I started to gain weight rather quickly and it was above the expected
like normal rate of growth for development and you know it didn’t feel
all that great like I had pants buttons flying off during elementary school
which is like a kind of a traumatizing experience. My mom called the doctor
and I was able to glean this gem off my medical records: it says “Mom doesn’t know
how much he weighs. Says he is really big 2/6/07” That was really fun
and I got to go to my doctor and talk about all this stuff. By the time I was
21 I actually had a hypertension diagnosis from my pediatrician which is
usually… You’re not supposed to have hypertension as a child. This was as high
as 158 over 83 and my right arm, systolic I ate the correct way in that I avoided fatty foods like chips. I would eat
crackers instead of chips because they’re leaner. I selected leaner meats
like Turkey, I used whole grain bread as much as I could. My mom always got the 1%
low-fat milk. I had been shown this in elementary school and I
knew what I was supposed to do. I knew that grains were the base of the food
pyramid I knew that that’s what I had to eat. My mom would always (if she
cooked beef) she would literally paper towel the grease off of it after even
buying the leanest beef that was available in in Whole Foods. The one habit I did have was snacking you know it was usually on things like crackers I
did so kind of because I was hungry in between meals and there was assuredly
some aspects of addiction there kind of roaming to the closet whatnot. But
I remember I didn’t really feel full all that much you know I could eat a lot of
like pizza and crackers and still be hungry and I had a sweet tooth or a
sugar addiction. Basically my doctor told me what you always get told which
is that I had to eat less and move more so I did. Statistically though the rate
of success for such interventions where you exercise and restrict your eating
are very low especially in terms of the ability to maintain clinically
significant weight loss which is defined as like 5% of body weight or more over a
24 month period. When I tried it it basically produced malaise, fatigue, and a
constant background of hunger that was worse than I was used to experiencing.
And eventually my resolve to kind of be in that constant state of hunger faded
and and my weight kind of return to previous levels. The whole ordeal of like
having your mom called the doctor and having to go in it kind of produced…and
this is like me at like age 12… I have this about a decade of mental
state which I would kind of classify as an eating disorder. You kind of associate
eating and guilt there like 1 and 1. You have this kind of obsession with
overeating and eating too much and and the key problem is that science confirms
that this intervention is just not effective. And given only this tool which
is eat less move more: what can we conclude when it fails to achieve our
goals? The only possible conclusion if that is your framework is that we or I
am simply too weak despite my best efforts to achieve lasting weight loss.
I’m reasonably certain that the majority of Americans are overweight
kind of feel similarly. Having come to a point where I’ve moved beyond this
phase, I can now understand exactly how unhealthy it was to be constantly afraid
of eating. You have to eat every day and to feel it if I was full I would need to
pay for that indulgence with like subsequent meals or exercise — it has a
lot of overlap with the medical diagnosis for bulimia. But this is the
mindset that that calorie counting produces yet it really was only
effective in making me miserable. The summer before my senior year of college
in 2014 my uncle was a doctor in Massachusetts inform me that humans were
not designed to eat grains. I was particularly devastated because like a
baguette was like my lunch at that point in time. But I guess my uncle had decided
that (he was a primary care doctor) and I guess he decided the money wasn’t good
enough so he went over into weight loss where all the money is
now in medicine. And he used something in his practice called the ketogenic
diet and basically I figured I’d go on Reddit and try it out. In about 134
days I went from 200 pounds which was basically borderline obesity to 160 pounds which
is like an ideal weight for someone like a male of 6 foot. Oh sorry
my bad — you can tell I put this together with great forethought XD Oh my lord. Oh Iulia is there. Hello! So the interesting thing is that I’d
been a tri-sport varsity athlete in high school which oftentimes entailed very
high intensity exercise for two hours six to seven days a week and never
before had I been able to attain that hold on how do I…oh it’s got one over there so
we can all see Iulia and say hi to her. never before had I been able to attain
like that low level in fact at that point in time 160 pounds I was 10 pounds
less than than when I graduated from high school. But that wasn’t all that
happened — I started feeling almost like my body was working again
like I had remembered as a child I would have energy and I would bound
around and jump and then it kind of started to to fade and exercise became
less fun. And now, at this point in time I presumed skipping down the
halls and I’m sure I look like a complete goon when I do it. But there
were other things too like sinus headaches I used to get them pretty
regularly they call them like “holiday headaches” when you eat too much sugar
like I used to get those all the time and they went away. I don’t really get
food comas so much anymore and there was just a lot of changes that were
pretty interesting to me. And unfortunately with these
experiments you kind of go up and down and this was what I look like the day I
joined Google about 18 months ago. Hopefully now I look a little bit better
you know I look a little bit different so one person she told me I need to
change my badge photo because my face has changed shape a
little bit. But to be scientific about it during 2018 when I did this again I
actually didn’t do any exercise at all while I tried the diet, maintaining my strictness. It’s kind of a learning process you have to go through
understanding what works for you and what doesn’t work for you and and trying
things and having things and there’s a lot of experimentation that goes into it
but um I resumed lifting and exercising as of about March of this year. But I kind of resumed exercising once I felt that I wanted to and once I
felt that it was enjoyable. And interestingly there’s
a truck that comes here called body spec and they do DEXA scan so I was able to
go in and get like DEXA scans and you can see this is in March of last year
and this is I think about a month ago and you can see that the red here means fat
and you can see that there’s some less here. I kind of came to the conclusion
that something was amiss because what I have been doing to achieve these results
was entirely opposite to what my doctor he told. And it worked for me twice now
and so it kind of led me down a bit of a rabbit hole and a lot of reading to
understand — to be able to reconcile that anomalous observation with what I
had learned and known about. Every nutrition presentation has to
start by explaining that there is an obesity crisis going on in America. You
can’t really discuss nutrition at all without discussing the obesity crisis
and discussing that we’re at the point where the military is actually
struggling to find and keep fit individuals. We all pretty much know
this and we’ve been hearing about it for so long that it kind of seems like old
news. Even within the last few years though that the problem is getting
monotonically worse like this is just from 2011 to 2017 and if you look at the
beginning here there’s a lot of green and as time goes on they had to add this
additional category here greater than 35% obesity in 2013. And I think it we’re
kind of numb to it at this point in time to be honest I actually talked to a guy
who was from a small Eastern European community where they didn’t have obesity
and I asked him like what his reaction was like when he immigrated the US and I
asked him what it was like when he landed in Dallas Texas and saw the
obesity rate and he literally said they started crying. I think it’s a it’s just
a very emotionally powerful thing to understand we have problems that we have
to work through and I think we have to talk about this and have dialogue and put
different options on the table to understand like what we can do to manage
this. The problem gets much worse though it doesn’t stop at obesity: we’re
having an epidemic of chronic disease in this country and by chronic disease I
mean any disease that isn’t obviously caused by an external pathogen it kind
of comes from within you. These are kind of a set of them there are more but
heart disease is probably the one that you hear the most about. Stroke, which is
kind of basically heart disease. Diabetes. Cancer, dementia. And even
problems with mental health — I don’t know if you know this but we’re having a
crisis of mental health even in the university system and whatnot they’re
all talking a lot about this because the rate of mental health issues is
increasing kinda dramatically. And the interesting thing is that these aren’t
independent they seem to all come together like some big kind of sad
family. The term used to discuss this it was coined in the 90s it’s
called “metabolic syndrome” it’s just the idea that there’s a problem with your
metabolism. And they’re all intercorrelated: if you have diabetes you’re twice
as likely to have many common cancers like liver or pancreatic and endometrial
cancer. Diabetics are more likely to get heart disease. Alzheimer’s appears to be
a symptom of diabetes. And even diseases that you wouldn’t really even assume or
associated kind of show up with a strong positive correlation with with diabetes,
like migraines, arthritis, and hypertension. And like the cost of these
diseases on our healthcare system is immense. At present we spend the
bulk of healthcare money managing — and not curing — chronic disease and there’s a
simple reason: we really don’t have any any manner of curing it. You just kind of
have pills that you take indefinitely: these are things like cholesterol
medications, blood pressure medications, and diabetes medications. They do not
cure the disease which makes them very profitable because patients kind of take
them indefinitely. I didn’t even realize this but I think a quarter of Americans
have arthritis at this point in time — that’s what they stated 140 billion
dollars of medical costs on arthritis alone. And this was from the CDC’s website: 90% of the nation’s 3.3 trillion dollars in annual
healthcare expenditures are for people with chronic health conditions. And I
think beyond just the dollar cost by cause of death and certainly by decline
in your health and vitality chronic disease is taking an indescribable toll
on our civilization. Obviously therefore we want to know what causes it: and it’s
McDonald’s! Obviously. I’m just kidding it’s not McDonald’s. The first thing
that people will usually say when you say the chronic disease is increasing is
they’ll say oh it’s it’s simply because of lifespan and life expectancy
improvements. That’s wrong actually chronic disease are not a natural part
of Aging. Many believe that we observe them today because we eliminated
infectious agents which would normally have killed us at
like 37 years of age or something like that before the diseases took hold. So I
kind of have to describe a little bit about what life expectancy is: we’re kind
of misinterpreting a little bit. So it’s the average number of years that
you would live from birth so the vertical axis here is percent of people
in a population alive that were born and this is number of years from birth and
at a certain point everyone’s dead and the more people die off as time goes on.
So a lifespan of 40 can actually mean that 50% of the people died
in infant mortality right at birth and 50% of the people died at 80. I don’t know if
you guys know: where has the greatest increase in life expectancy come from?
Like which side of this graph? and it actually ends up being infant mortality.
That’s the place at which we saw the most gains in life expectancy and there
haven’t been as many gains in older people actually living longer. We like to think so because medical care is improving and everything. It
turns out that if you look at the data the maximum life span which is this kind
of longest lived 10% of the population hasn’t changed that much over the past
several centuries at least and there have pretty much always been people who
live to what we would consider senior age. So chronic disease is more describing like for these people how healthy are
they? The other thing about this is that chronic disease is actually moving
younger and younger in age brackets so between 2000 and 2010 stroke rates and
young adults increased by 43.8% and these are people
that like are normally in the prime of their life. And it’s not a
survivorship bias trend! People are not suddenly living longer than 25 years of
age. Likewise type 2 diabetes used to be called adult onset diabetes but they
can’t call it that anymore because kids are getting it now. When you have a
disease that appears kind of from nowhere and it isn’t infectious a good
hypothesis to test is that nutritional problems drive the disease. For one it’s
a very large variable and we know that deficiencies or dietary-metabolic incompatibilities can drive disease so it’s a good thing to rule out.
We can start to look at that by looking at populations that have escaped chronic
disease in the past. There are a number of really fascinating works that aren’t honestly referenced all that often these days. Weston Price is probably the one that you have to read if you’re interested in this space
because he was a dentist in the early 20th century and they had
observed at that time that the rate of tooth decay was dramatically increasing
in western populations. And he basically traveled the world with a camera in search of groups of people that did not have tooth decay. And of note he was able to find groups of people that lived pretty close together — within like a one-hour walking distance — so they’re similar genetic population similar common ancestry but they had different diets and different rates of disease in terms of tooth decay — so he could literally go through and count the
number of teeth that were decayed and these are some of the pictures he took
and you can see the comparison between like a population that had access to
certain foods and a population that didn’t and one of the things he noticed
was that when the foods of Western civilization became available that’s
when disease started to appear. Diabetes was actually diagnosed as early as ancient Egypt this is the Ebers papyrus it is the first document that they believed described diabetes and it dates to about 1550 BC. The epidemic was
first noticed by two scientists or doctors named Elliot Joslin and Reginald
Fitz and they presented basically they’d gone through medical records in the late
1800s and determined that the number of people reporting to Mass
General Hospital had increased basically exponentially over the past seventy four
years. At the time they didn’t necessarily identify that this was an
epidemic they just thought people were kind of coming in more readily when they
developed the horrifying symptoms, but as time has kind of told they were actually
witnessing the beginning of an epidemic in the 1800s whereas like the early
1800s it was unusual for them to see one diabetic a year but by the end they were
getting a couple of month. And by 2017 — the 2017 CDC statistics say that 73.5% of seniors in the US have diabetes or prediabetes. This number doesn’t get talked about a lot and I think that that’s a problem. Though doctors in ancient Egypt recorded heart disease they were actually very few if any case reports of the characteristic symptoms
of heart disease in the 1800’s in the U.S. This is kind of notable because the symptoms of heart disease are very distinctive — someone has pain in their
chest and then an otherwise healthy male drops dead. That’s something that doctors
tend to observe. There were a few discussions of these in Nina Teicholz’ book which i will also recommend on the follow up sources. But basically
they were unable to find a lot of case reports on heart abnormalities in the
medical records in the mid-1800s and an authoritative textbook in 1915 had
actually no mention of coronary thrombosis which is a heart attack. Likewise cancer like everyone agrees
that cancer has environmental roots the only question is kind of which part of the environment: carcinogens or lifestyle? There were two researchers who published kind of a seminal work in the early 1980s and they concluded basically
that 75-80% of cancers were probably environmentally
driven. Unfortunately they concluded at the time that it was probably dietary
abnormalities or changes in diet that were probably responsible for a majority,
whereas the assumption at the time was actually that everything when it comes
to cancer behaves like the idea of a carcinogen. Like we all know the idea of
a carcinogen it’s some component that kind of mutates your DNA and causes
cancer but the assumptions were made that food acted upon cancer in the same
way and that is why we kind of believe today like you don’t actually hear all
that much about nutrition even though it’s been observed that there were you
know substantial differences in westernized versus non-westernized
populations and along certain dietary lines for cancer rates. Likewise hypertension is another one of those examples as soon as they developed the sphygmomanometer which is my favorite word, they went basically through all different countries trying to find
people who had hypertension and it turned out that in non-westernized
countries the blood pressure declined with age they actually went down or
stayed the same whereas in almost every Western country
like the United States in affluent countries the blood pressure went up as
people aged almost universally. Synthesizing this all we kind of have
some good news and some bad news on the plus side it looks like by
lifestyle modification there are ways that we can avoid and ameliorate chronic
disease. That’s definitely a positive but on the on the negative side it seems
like our lifestyle is driving a massive epidemic of chronic disease You kind of have to start digging in — if they all come together we have to talk
about like what’s common about chronic disease and and in what way can we try
and relate it and and work out from there.
As I mentioned seventy three point five percent of US seniors have diabetes or
prediabetes That’s an interesting place to start
because this is an affliction that like it’s in the right place at the right
time if that makes sense; it’s afflicting those that are near their life
expectancy. And if you expand the definition to include all kind of
related metabolic dysfunction the number grows to eighty eight percent so
about approximately one out of eight people in the US general population are
healthy by various metabolic tests. I have to kind of describe a little bit
about what diabetes is: it’s a disorder of carbohydrate metabolism. So
you probably all know people in your life that are diabetic who have to prick
their finger and measure their blood glucose — diabetics struggle to
properly handle and digest carbohydrates so they end up with a lot of blood sugar
piling up in their bloodstream. there’s There’s kind of a key hormone that’s responsible
for orchestrating the digestion of carbohydrate and it’s called insulin and
basically there’s a kind of a deterioration that happens in someone’s
insulin response over time. Basically what this graph is — it’s a lot of
lines superimposed — but what happens is you feed someone a meal and then you
watch essentially how much hormone it takes to digest it and what you can do
this you can compare that over time. This is from a seminal paper by
Joseph Kraft in 1975 but he basically grouped people and showed the
association between worsening insulin increasing insulin action and diabetes
development later in life. you can use this insulin metric to
understand — it’s called insulin resistance, is the term for it — and you can
use this metric to understand someone’s metabolic health. So the interesting
things happen when you start to try and apply that framework if you apply like
“insulin resistance is the problem” that is is underlying diabetes and you try to
use that and measure that and see what disease rates
look like. This particular study is a
prospective cohort study and what they do is they they measure this blood
metric — this insulin resistance — by just doing that integral over that time and
then they essentially segregate people into terratiles based upon like low
medium high by approximately a third a third a third and then they count over
the next ten years how many bad things happen to people in each group and the
crazy thing about this is they use this test (this isn’t exactly what I described
it’s a little more involved test but it’s along the same principle) that
people who had optimal insulin sensitivity had absolutely nothing bad
happen to them in terms of clinical events. They use clinical events like a
heart attack diagnosis a diabetes diagnosis hypertension diagnosis sort of
things like that or stroke or things like that. And what you see here is: the better your insulin — the better your metabolic health — the fewer problems happen to you. These are all chronic disease diagnosis right? The interesting thing is cholesterol didn’t predict these events at all which was kind of interesting. The other really interesting thing to consider is survivorship bias: so one of the key
studies that people do a lot to understand aging and health are to look
at centenarians because they represent us a selection bias on the
characteristics that keep us healthy over time and they they did basically a
similar test — this insulin area in over here on the far left you have adults
which are people who are like ages I think 50 to 75, in the middle you have
people who are 75 to 100 and on the right you have centenarians which are
100 or more years old and the interesting part about this is that the
the centenarians are as healthy as the adults but in the middle here there’s a
bit of a sojourn that goes down and basically the the the authors of this
paper correctly called this out: This could be easily explained by a
survival effect consisting of natural selection of subjects having a preserved
glucose tolerance and insulin action that means is that the people below this
line who are in this group they all died before they got to being centenarians. So
taking these two things together you can generate a hypothesis and the hypothesis
is: something associated with diabetes or this core dysfunction
in metabolism causes much of chronic disease and if we can fix this problem
if we can understand how to treat this problem we can ameliorate a lot of
chronic disease without having to give everyone a separate pill for each thing
which is kind of how are our medicine system works today Obviously we now have to look out into how diet and chronic disease overlap. there are lot of
different ways to get at this problem. But I think the coy answer to the
changes in our food consumption patterns are that humans evolved eating food
(which would be kind of like these plants and animals and things) and today we’ve
kind of switched to incorporate a lot of food-like substances which are anything
that didn’t kind of obviously come from an animal or a plant and you’re not
quite sure how it got to look like it is In particular I think there are a lot of
ways you can talk about this one of the things I think isn’t talked about enough
is is the addiction aspect of these things over here there’s a there’s a
difference between like feeling hungry and a craving that literally drags you
out of your apartment at like 2:00 a.m. for like Ben & Jerry’s tonight dough
there’s there’s a there’s a distinction between those two things and there that
that idea that we could be addicted to food to have an addiction loop within
our brain isn’t really discussed enough but one may observe that the foods don’t
tend to associate with that addictive behavior as much as as as processed
things like this do like I don’t know of anyone that’s addicted to steak I mean I
eat a lot of steak but I’m not like addicted to it Toby might disagree maybe
I’m addicted to steak so we can deduce that in principle there’s probably some
aspect of the quality of food that’s important to the human diet trying to we
kind of have to go through and develop a framework for placing things that we
think are good versus things that are bad we can refine it as we go along but
we kind of have to have some method of figuring this out the easiest place to
look at that is paleontology today we all pretty much eat very similar things
I mean even if you go to poorer countries a lot of the things that you
are food aid and other things that are shipped in from
places like the u.s. so like white flour is pretty much universally there are not
very many humans today that do not eat white flour and sugar whereas it points
in the past there have definitely been you know what sugar didn’t always used
to be a thing nor did the material necessary to mill grain and things like
that so we want to kind of go through the evidence to understand what changes
happened with changes in food consumption see if we can correlate them
for instance it’s commonly known that the average height of European males
dropped considerably after the last ice age melted with the change in climate
patterns the the theory from most of the scientists was that the reduction was
influenced by global climate change and the adoption of Agriculture but what you
kind of see is that that hunter-gatherers in the thirty thousand
year ago time span we’re actually taller on average than we
were today height being kind of a proxy for quality of nutrition there are other
studies that look into the kind of association with different diets and the
general conclusion of a lot of this evidence is that agriculture provided an
increase in raw caloric production that enabled civilisation and I think that
was very important because we wouldn’t have had civilization without that but
the quality of the nutrition that we gleaned from it was somewhat inferior
and chronic disease was produced was higher um this is probably because
humans haven’t had enough time to adapt to it if you look evolutionarily like we
spent a very long time being hunter-gatherers there were about two
million years give or take that we spent kind of eating a hunter-gatherer
scavenger diet and we switched our diet when we became agrarian to include a lot
of these newer foods and then in particular in the past century we’ve
accelerated a lot of these changes processing and adulteration of the food
and what we get is an epidemic of chronic disease the most interesting
data point to talk about current nutrition policy in my opinion are
studies of Egyptian mummies and I’ll tell you why
Egyptians actually had rampant obesity and heart disease despite a lack of
videogames their medical texts describe heart attacks in pretty reasonable
detail the the death and the chest pain being called out in particular the most
interesting thing about this is that using a stable isotope analysis we
actually determine the protein source for Egyptian mummies and determine what
portion of it came from agrarian sources like proteins in grain or whatnot and
what proportions came from animal proteins it’s they use a technique
called stable isotope analysis which looks at the relative concentration of
nitrogen and it has to do with the the adulteration of the the ratio that
happens during metabolism but what we what we find is that the Egyptian as
they call that in this paper which went through in great detail was that ancient
Egyptians most likely consumed less protein of animal origin than do modern
humans and they didn’t have sugar they didn’t have much of any refined oil like
we do today but they did have stone ground wheat flour the interesting thing
is that that is exactly what the modern dietary recommendations would have us do
they would have us cut sugar and use whole grains to eat I don’t know whether
they didn’t read this paper or what not but we kind of that have to get into the
modern changes obviously the beginning of our obesity crisis
today as we think about it dates to about 1980 prior to that obesity rates
had held somewhat constant for a number of decades by total coincidence the
Dietary Guidelines for Americans which was the first point in time that the
government had taken a position on particular matters of nutrition came out
in 1980 which also coincides with the beginning of the obesity epidemic this
was kind of kick-started by the the seminal work in this field called the
dietary goals for the United States this was by a senator named George McGovern
and this basically ignited this hypothesis that you want grains over fat
meat is bad grains are better and the interesting thing was actually pulled a
2nd edition copy of this and it had an additional four word added and it’s said
this is from the ranking minority member on the committee it says I have serious
reservations about certain aspects of the report I have become increasingly
aware of a lack of consensus among nutrition scientists and other health
professionals which I thought was kind of interesting but they basically this
report was kind of enshrined by the USDA with the Dietary Guidelines for
Americans in 1980 which was kind of the first point that
the US government had actually taken a stance on nutrition besides just
encouraging people to eat enough of the right things and kind of establishing
RDAs basically they the recommendations at the time called for a decrease in
saturated fat consumption and they wanted you to replace it with grains
fruits vegetables and industrially refined seed oils you know these as
vegetable oils despite the fact that they’re not from vegetables the problem
was that the the strength of the evidence behind that recommendation was
not that strong this is a Philip Philip handler the president of the National
Academy of Sciences at the time he testified in Congress what right has the
federal government to propose that the American people conduct a vast
nutritional experiment with themselves as subjects on the strength of so very
little evidence that it will do them any good yeah I could probably have my talk
there but the so you kind of have to unpack this a little bit and talk about
what the core idea was that motivated these guidelines um I actually have the
two respective time magazines over there for talking about this whole fat heart
disease thing for you to peruse at the end if you’d like but the core tenet was
called the diet heart hypothesis and it argued that fat in the diet particularly
saturated fat elevated cholesterol particularly LDL or what they call bad
cholesterol which led to heart disease or if you talk to some people about it
it’s the acceleration of heart disease and therefore the guidelines recommended
that you replace it with either polyunsaturated fat or carbohydrates um
if you look critically at this you’ll start to see a problem which is that you
can actually probably generate seven different hypotheses from these
depending upon which at the top of the bottom thing you choose in each and then
beyond that when you say you know I want fat and I don’t want that anymore you
have to replace that with something else so they kind of decomposed into two
different high level hypotheses which are that if you replace saturated fat
like your steak with vegetable oil you’ll reduce death via reducing heart
disease death I guess that kind of makes sense and the other hypothesis would be
if you take saturated fat in the replace it with grain you will reduce death Oh
overall via reducing heart disease death those are kind of the two hypotheses at
a high level that you would get out of this this kind of theory interestingly
it’s not entirely clear which one at which time each is advocating so if
these are the Dietary Guidelines for Americans from 1980 and they are clearly
saying they’re basically advocating that you want to eat more complex
carbohydrates and limit saturated fat which is a trade-off one to one for
carbohydrates and saturated fat if you go on the Harvard School of Public
Health’s website today they say the other and they say that eating
polyunsaturated fats in place of saturated fats are high or highly
refined carbohydrates reduces the problem you have to be very very careful
to make sure that if you’re considering hypothesis you actually consider one
hypothesis at a time and go through it and and work through it directly rather
than kind of jumping to whichever one people like to jump in this field a
little bit I apologize I’ll have to do a little bit
of a quick chemistry aside for you I hope this doesn’t bring back any like
nightmares of AP chemistry tests or things like that but this is a saturated
fatty acid a saturated fatty acid is straight in that every single one of its
carbon atoms is saturated with hydrogen when you have an unsaturated you fatty
acid you basically remove one of those hydrogen atoms and it results in a
double bond here but and it results in a kink so there are many different types
of these they are grouped roughly by how many bonds are unsaturated so this is a
saturated this is a monounsaturated four one double bond and if you had to it
would be a polyunsaturated which means like one or more the top one is 1600 or
palmitic acid which is a common in saturated fat in steak but every fat
that we have is made up of kind of a combination of these so you have
different fatty acids with different chemical properties in general like the
more saturated fat the the it will tend to be solid at room temperature and its
melting point will be higher so butter is mostly solid at room temperature
because it has a higher proportion of saturated fat than olive oil
importantly though butter is actually only 61 percent saturated fatty acids
the key word to Google here is fatty acid decomposition or composition and
it’ll tell you what’s in here so you’ll recall that one half of this
diet heart hypothesis as heart disease hypothesis was that saturated fat raises
cholesterol and if you look at this it’s gonna start to get a little bit complex
because there are actually seven different types of saturated fats in
butter do each of those saturated fats have a different effect on cholesterol
and the answer is yes fatty acid with chain lengths 18 which
is stearic acid and 10 or shorter are conclusively established have no effect
on cholesterol whatsoever 16 palmitic acid has minimal effect the two ones
that Hammond effects are 12 and 14 those are the two primary ones which are
actually is just in the next slide a minority of steak and lard so bacon and
n steak both have minority of the saturated fats that alter your
cholesterol whereas coconut oil actually has majority of the saturated fats alter
your cholesterol the other thing it just becomes a mess very quickly because pee
everyone says that olive oil is wonderful because it has tons of this
oleic acid which is a heart-healthy monounsaturated fat whereas lard also
has tons of metalic as so what’s the difference so and the idea that
cholesterol drives heart diseases I think it’s a drastic oversimplification
I don’t really have the time to cover this in sufficient depth um I’ll try to
do a separate talk on it if there’s enough interest but you can pretty
safely conclude at this point that that hypothesis was wrong because heart
disease begins before cholesterol accumulates um this is just addressed
they’re actually six different discrete types of a throw squatting lesions this
is from a book called the natural history of coronary atherosclerosis by
Christine belacan who was a renowned pathologist and he groups these by kind
of rough cause so abnormal proliferation abnormal coagulation and abnormal
permeation and one of the quotes he has here which I thought was particularly
interesting this is very like science speak so I’ll try to translate you if
you have a thesaurus medical texts actually become very comprehensible but
basically what this says is that the accumulation of cholesterol and heart
disease does not associate with the beginning or the progression of
heart disease and moreover when the cholesterol does accumulate at the end
other macromolecules other large macromolecules and the blood accumulate
at the same time historically we developed the test to measure
cholesterol first so that was the first thing we noticed and thus that became
the hypothesis but and the interesting thing is we actually experimenting data
on one of the hypotheses about above the simian diet Heart Study in essence it’s
it’s kind of a simple design they Swiss done in the late 60s early 70s in
Australia and you hand half the people in in a group randomly tons of safflower
oil and special Margery and designed have low saturated fat so to the best
that they could they tried to get a one to one substitution of whatever you read
and currently which was presumed to be a higher saturated fat meat with a low
saturated fat and high in polyunsaturated fat oil and then you
basically count how many people died right it’s pretty simple little bit
gruesome there was a problem though the people who got the substitution died 75
percent more often and this was sufficient to reach the threshold of
statistical significance proposes a bit of a problem for a hypothesis if we
expect a benefit and the mortality goes in the other direction
the other interesting thing was they forgot to publish the actual count of
mortality for about forty years after the study was concluded I don’t know
exactly how that I there’s probably some historian that can go in and understand
in fact no no experiment has ever been able to show directly under him that
they can get a mortality benefit from a substitution like this and in general
the way that this works is that if you have a hypothesis and you throw a
billion dollars at testing it and you can’t prove it correct it’s wrong that’s
kind of how this works in science like if a billion dollars is insufficient to
it’s kind of a good principle but to be fair there are people who still will
tell you that all these trials that I say didn’t work were success and I have
to explain to you a bit of the shenanigans that go on in nutrition for
you to understand why I might argue this while they argue that so it comes down
to like what your hypothesis is so when I set my hypothesis I made it very clear
that we actually need to prevent people from dying in order to consider our
trial of success and to ative Li you believe the same thing
right you believe that if we fix heart disease that we are going to result in
fewer deaths overall assuming that because a great way to explain this is
if you look at just the ratio of deaths if I give everyone in this room arsenic
I will substantially lessen the probability that you die of a heart
attack but that’s not a victory for like some great new pill that cures heart
disease right that’s a poison so you have to be very careful in constructing
your hypotheses so the major ways that they do this are surrogate and composite
endpoints so a surrogate endpoint is described as anything that you wouldn’t
know as a problem unless your doctor told you it was it’s not something that
outwardly like death is a very hard endpoint you know if you were alive or
not whereas like the amount of little molecules floating around in your blood
is not a hard endpoint and so the example of the surrogate endpoint is
when they did that original Sydney died heart study when people died more often
and at the end they published they said good news this diet reduced everyone’s
cholesterol in their blood so we’re super sure everything’s fine carry on
with your lives you can probably see why it can be a little bit dangerous to
start relying on intermediary endpoints like blood markers without clear
established associations and a composite endpoint is kind of a neat statistical
trick I probably don’t to use this in your working life but the example I have
is this you’re on a team picture this nobody got promoted 10% daughter raise
and you the clever statisticians say 100% of the team got promoted gotta
raise or breathe oxygen today and what you have done is listing less impressive
but more likely things after the impressive sounding Knoll and and doing
the union of those things and this is I’d love to tell you that this doesn’t
happen all the time in science this is a from a trial of a medication designed to
treat cardiovascular disease and you’ll notice right here in their primary
endpoint this is called a composite endpoint what they said is the primary
endpoint was first cardiovascular death and a bunch of other things and they
said we improved it and then you go four lines down and you notice that
cardiovascular death was completely null and you have to be very careful about
these things because there are smart people in pharmaceuticals that are going
to try to convince you that their drug works really well and I will add out a
fair is that because as I mentioned there
were seven hypotheses for every hypothesis it’s not really possible to
disprove every hypothesis basically at one point they said cholesterol causes
it at one point they say it’s LDL cholesterol and then they say no it’s
LDL PE or a poby or whatever so there are kind of infinite number of these
hypotheses and it’s not really possible to just you know some of them are
actually mutually exclusive like you can’t actually have two of them be
correct at the same time but they all kind of fall into the same axiom so if
you’ve worked in software or engineering you’re probably familiar with this law
of unintended consequences you know we released these guidelines
and immediately everyone starts getting fatter which was of course a coincidence
and then kind of more coincidence happened we released these guidelines
around the world and slowly other populations everywhere as these
guidelines were released are getting fatter as well a few years behind us to
fight despite you know diverse cultural environmental and socioeconomic
backgrounds why did this happen well the UM the same people who who originally
released these guidelines have a great hypothesis ready to explain to you why
it wasn’t their fault drum roll please the bible their idea is that exactly the
point in time that the guidelines were released the moral character of america
in terms of its willpower laziness and gluttony took a nosedive and the
commensurate lack of self-control and lazing around in the couch and starving
down too much food because our plates were too vague or too blue you know kind
of just did us in and ISAT us a bit but the hypothesis is that conscious
decisions around how much we eat and how much we exercise are the primary drivers
of weight regulation and some people actually take that to the literal
reductio ad absurdum of that hypothesis and say every other concern besides
willpower in terms of those two vectors when it comes to weight management is
simply irrelevant it’s not very difficult to find observations that kind
of contradict this hypothesis there are plenty of people that are what we call
tophi which are thing in the outside found on the inside these are two people
that did the same weight but the amount of that internal to them varies
substantially and you actually can’t tell by a BMI measurement an observation
that like weight gain is the problem in calories as the problem can’t explain
nuance like that and again you remember the 88% of US
adults are metabolic and healthy that’s more people than are overweight right so
how can we explain this hypothesis or this observation with the hypothesis
that the key dysfunction is a caloric imbalance it implies that something more
nuanced is going on right that there’s a there’s a quality problem with the food
and that the quality of the food is probably important and for what itself
these are actually really interesting this was the thesis of Gary Taubes book
but basically obesity does not track with affluence there are plenty of poor
impoverished and laboring countries eating welfare food that have
demonstrated very high rates of obesity this particular paper is by McCarthy
from 1966 and he observes obese subjects that are eating less than 2,000 calories
a day and actually eating fewer calories than the control subjects that were lean
they had about the same amount of physical exertion every day and these
were these are poor impoverished people they’re not driving around in cars and
playing video games in 1960 and basically they observed that the only
thing that they could have they could the difference that they could observe
was the amount of carbohydrate in the diet and this is from the 1960s before
we made these low-fat recommendations but they said that the the proportion of
carbohydrate was 10 to 15% higher in fact how is 10 to 15 percent lower than
usually found in the 19 in the United States population studies and then they
did resemble another group that also had obesity and then you kind of have the
practical side of this we kind of told everyone a long time ago
and could kind of continue to tell them that laziness is the problem gluttony is
the problem everyone now has a membership to SoulCycle and health clubs
have exploded in high-intensity interval training was invented in people exercise
all the time and in the 1950s when obesity rates were about a third of what
they were today doctors actually advised against exercise because they thought it
was stressful in the body and gyms relatively rare the 2000s food pyramid
didn’t even have food in it it literally just had steps you know that’s the level
that we’re going to try and convey to people we’ve kind of done all we can do
to advocate for this framework you kind of have to ask well what’s the result
after we tell this to people and it’s this right that’s that’s what we get and
a certain point I don’t know there’s a there’s a bullshit ISM that people
invoke which is well if we hadn’t done this it would have been a lot worse or
something like that it’s kind of an ad hoc I
with no basis in fact or justification but you really have to kind of watch
logical fallacies but to their credit kind of the public health community
observes that the compliance with these recommendations are poor they kind of
refused to admit the possibility that the compliance as a result of bad
recommendations that are hard to follow a kind of an example is this if I’m
hungry and I I want to follow the USDA food guide pyramid what do I eat like
which foods are approved so even though kind of the vegan push is in full-swing
they’ve kind of maybe tacitly approved a lean dry chicken breast but you know
really we need to be vegan so it’s tofu right and then fats bad sugars bad and
you know steak I’ll just put you in the grave so eggs have cholesterol what do
you like what’s left what what is actually allowable I guess we get quinoa
and I think they also improved probably like a low fat no sugar added yogurt and
you know and that’s it that’s kind of what they Allah and then for everything
else they use the word moderation and let you kind of figure out how much a
moderate amount of chocolate cake is and for me it’s the whole thing and to be
moderate I cut it in half and I save the other half for the next morning you know
what I mean that’s and then they say like people don’t adhere and it’s like I
wonder why like maybe the diet you recommend is unpalatable and
unsatisfying perhaps if people constantly try to make themselves hungry
it’s going to result in binge eating and snacking on garbage you know perhaps
people who are deprived of meat and fat will inevitably sugar you know I just
know from experience that I ate this way and I tried to eat this way and I ended
up kind of hangry all the time and I ended up indulging in garbage in between
meals it’s how I felt and so that kind of retort of like well if people did
comply they would be healthy is not really relevant if they can’t based upon
any reasonable advocacy so the real question you have to ask is that what
else can we try like what else is available whether any other hypotheses
in it I’m surely eluded that I have one that I think is a little simpler and
simpler hypotheses are are kind of good basically the idea is that it’s more to
do with the food quality than the food quantity and if we focus on food quality
we can understand this problem a bit better I think the easiest way to kind
of explain this is with an animal husbandry analogy I don’t know how many
of you were my grandfather’s from farm country so he talked to me about cows a
lot but this is my cow Jill and I put her in a pasture and she kind of grows
up nice and healthy and strong and she attains
certain weight but the key thing is like for my steaks I really like fatty Reba
is like right I want to turn Jill into this Wagyu beef how do we make Jill fat
and if I go ahead and I truck that much hay into the pasture it turns out that
Jill doesn’t really get that much fat or like she doesn’t appear to gain that
much weight she can’t be tempted into the sin of gluttony but I need my fatty
ribeye and what’s the solution and the interesting thing is that we actually
switched the type of food we’re giving the cow instead of giving them roughage
like the kind of designed to eat we give them corn or grain and Jill flattens
right up this um did Jill suddenly get lazy did Jill’s moral character fail her
no it was purely a function of the type of food that she was eating and if we
want y’all to get less fat and sick we’ve removed the food that is wrong and
Jill Slim’s right down or we just you know eat the rib eye but as it turns out
if we kind of apply this model outwards we look at just about any animal
anywhere we see that all these animals in the wild are able to maintain a
healthy weight with markedly little variation despite massive changes in
food availability and energy requirements this is a paper talking
about the impacts on the lifestyle patterns of lions as droughts come in
throughout Africa and how much more they were I put GPS collars on them and we’re
tracking how far they walks to get food on a given day but the popular
explanation for this is called the the thrifty gene hypothesis it basically
says that every animal especially humans are hard-wired to get fat anytime there
is more like we need in order to maintain a healthy weight we need barely
enough food at any given point in time um but that hypothesis implies a
constant lack of food and it can’t really explain like the evidence can’t
explain it that the Lions sometimes struggles to get food and sometimes has
bountiful prey like during a drought all the Antelope crowd around the watering
hole like it doesn’t feel right intuitively and kind of what it replies
is that there’s probably more sophisticated system than we give credit
for that’s regulating a lot of these things with homeostasis like you know
that your blood glucose and all these different measurements are homeostatic
we don’t accidentally get up to 110 degrees because you exercised there’s
there’s mechanisms trying to make sure you stay in balance and the accuracy of
these mechanisms is actually crazy to think about because over the course of a
decade or so if you have a typical you know human total daily energy
expenditure 2,600 calories that’s 9 million calories
that you eat and assuming you you are actually able to maintain your weight
without any conscious effort like a lot of these animals are able to do one
pound over over you know a decade is something like one calorie per day or
about 0.04 percent accuracy I’ll shamelessly admit just Jones from
KITT but the thrifty gene idea should really be called the supreme coincidence
hypothesis in that for all time every animal has always been threading the
needle on the amount of energy availability such to maintain a constant
weight and it’s only humans that have ever violated that that principle but as
we know like some animals have problems with like sometimes this system breaks
basically us and everything we feed like animals in the zoo like you’ll never see
a tiger like that in the wild they don’t exist and for people that don’t believe
me like there’s an Australian zoo that actually had to remove fruit from their
from their animals diet because of the drastic increase in obesity and tooth
decay that was identified and I don’t know if you’ve seen like the changes in
a fruit over a period of time it says what a watermelon you used to look like
this is what it looks like now that’s not like more vitamin C right that’s
that’s more sugar that’s what we’re doing to it that’s what you want and so
it leads to this hypothesis that some of the foods that we eat are just
incompatible with our physiology and they cause insulin resistance and
chronic disease and all these related downstream problems and if you can fix
this problem the metabolic syndrome will improve to some extent without any kind
of conscious effort to like obsess over how much you’re eating or be hungry and
and if we eat right the body will take care of most of these things without our
conscious effort which I think sounds really appealing to me right at a high
level we’ve kind of made the following changes to our foods we a lot more of
these which are basically solvent extracted oils prior to the early
nineteen hundred’s we couldn’t eat these because they were actually toxic we had
to learn how to detoxify cottonseed oil it was prior to that it was an
industrial waste or they used it as a lubricant and machines but once they
figured out how to do that and then they found out about hydrogenation lo and
behold Crisco became a thing but we also you – sure – ravine has also increased
relatively substantially and some of that has to do with the decrease in
costs now that we have multiple different sweeteners like high fructose
corn syrup and then the other thing is white flour and particularly very highly
refined white flour and you kind of know these as these
types of foods like walk into a convenience store and like a look and
almost everything that you see is going to be this some of those three basic
building blocks and a common refrain is that it’s the lack of nutritional value
of these foods that causes the problem which is kind of very ambiguous and
doesn’t sit well with me because you know we can add vitamin C into the
Dorito that doesn’t make the Dorito healthy and I think people would
understand that intuitively that doesn’t make any sense but it’s probably more
complex and subtle reasons why this is bad or even a chronic toxin and yes in
case you’re wondering salad dressing is almost entirely like vegetable oil it
may be a little sad then I discovered them and the question is therefore if
you try to undo all these changes like you take the big hammer and you try to
cut out absolutely everything that you can possibly think of and do an extreme
elimination diet what happens and this was actually just published on Wednesday
this is the long-term two year follow-up from Berta health and they basically
over a two-year period they put people in a very strict elimination diet and
they were able to essentially reverse diabetes and reduce the amount of
medication better than any other intervention that’s been tried including
these invasive stomach removal gastric bypass surgeries there are kind of two
routes you can go to this elimination diet I probably explained which one I
fit into at this point but they’re both invoked some extent and really I think
the key unifying theme here is a whole foods idea it’s the idea that you want
to exclude pretty much everything packaged and frank in looking one of the
key problems in a in a vegan diet is that Oreos are vegan so it doesn’t
necessarily that’s why we call it Whole Foods and both of these have that
problem so you just have to be a little careful
but they both remove kind of the refined flour and sugar and all that kind of
process stuff some vegan diets implementations allow wheat flours the
ketogenic diet typically excludes oils a lot of the vegan diets typically do – a
lot of them recommend that you don’t eat eat refined or processed oils the major
difference is kind of this basically this meat of our starch trade-off so the
genic diet oftentimes will be based on meat and animal products whereas the
vegan diet excludes them almost entirely it’s probably not the biggest difference
on the grand scheme of things I know what I
but I think that there are some concerns about nutritional completeness if you go
on a purely plant-based diet because historically we’ve been hunter-gatherers
scavenger not purely purely herbivores so the there are some nutrient
deficiencies that can develop but in general I think the major change here is
cutting out the problem as opposed to which hypothesis you go with and
obviously like these are the kind of questions we want to ask right we want
to want to distill it down and unfortunately I can’t answer this
question and I think anyone who tries to answer this question I can a ketogenic
diet improve your lifespan and all these hard endpoints and we don’t have enough
data to say so at this point I know that I’m like it’s promising like I know that
we have strong data that you know certain diseases can be treated I know
that we have improvements in insulin and we know that we track insulin
Association aliy but you know you got to be careful when you synthesize things I
think at this point in time cautious optimism is appropriate here but it’s
going to require future research to pin it down but in general I think it’s
probably safe to say that people under value good nutrition in terms of health
and probably would be surprised by how much better one might feel by eating
better I’m and excluding the food-like substances I think that would tend to
surprised a lot of people I think we tend to de-emphasize that in favor of
like the moderation idea there are some known benefits to a ketogenic diet it’s
been used to treat epilepsy for about a hundred years in various hospitals
around the United States it’s also I think shown pretty promising results and
weight management mild cognitive impairment diabetes and there’s ongoing
research on some more of these topics and it remains to be seen
the interesting thing is there’s a recent drug class called pi3 kinase
inhibitors and it was actually developed based upon the understanding that a lot
of the mutations that cluster around certain cancers cluster around the
insulin signaling pathway so it’s more evidence suggesting that there’s there’s
a story to be told here but and I do have to touch on the environmental
impact of diets because it’s been really big in Seattle over the past few few
months but first thing you have to say about environmental impact of a diet is
that it’s a completely distinct conversation from nutrition and you
cannot you can talk about water you can talk about the other but they’re not the
same right your body doesn’t care about the green house house gas emissions of
and particular food when it decides how
healthy you’re going to be it’s not a consideration that your body has pretty
– if the goals are opposed you have a compromise to make right and there’s a
bit of a logical fallacy that says okay if we can’t produce enough meat for
everyone therefore we should not eat meat which is a perfectly reasonable
solution to that problem would be an improvement in meat production we
wouldn’t suggest you throw out your iPhone if we don’t have one for everyone
in Africa you know to me and when it comes to the environment you need to be
pretty careful to do your homework because there a lot of unhelpful
simplifications and downright falsehoods it turns out that animal husbandry is a
really great agricultural model one of the key concerns is that we need a lot
of calories as our population grows and cows actually convert grass which we
cannot eat into digestible and nutritionally complete source of fat and
protein you actually cannot eliminate ruminants from the agricultural system
because they’re responsible for consuming a lot of the waste products
which are produced during other forms of plant agriculture like soybean leaves
and things so they’re actually a net calorie gain and this is actually a
completely self-contained ecosystem so you actually don’t have to do anything
to this the cows will run in the rain will move the grassland ecosystems
actually involved in a symbiotic fashion with ruminants so you can’t really
remove them this this is what happens on the left here this is what happens when
you actively graze and actively manage a pasture and on the right this is what
happens when the ruminants are removed it’s called the certification and it’s
what happens when ruminants are removed and the amount of ruminant that we have
today they think is at par may be less than what would have been found on the
Great Plains during the 1500s because there were a lot more herds of Buffalo
although the the exact numbers aren’t totally understood but and my friend
noted that there’s kind of a very strong vegan push right now in the nutritional
community and it concerns me a little bit because it sacrifices the
nutritional quality of the diet in the name of various other motivations this
is a Jew this is a nutritious food but some people will actually get angry at
me when I tell you how many vitamins are in the fat and meat right you’ll
actually have a visceral reaction to that the story behind it is a bit
interesting the main force behind vegan diets collectively United States is
called the seventh-day Adventist Church they have a variety of reasons for this
but the members preach vegetarian and vegan diets as a matter of religious
faith they actually do not declare this as a conflict of interest and one of
them is on the twenty20 us a dietary guidelines group and he this
is an excerpt from an article in him but the seventh-day adventists also founded
the American Dietetics Association and a number of the medical schools that
practice under their faith John Harvey Kellogg
the cornflakes man was actually a seventh-day Adventist as well and he
worked on concocting food products that were bland and vegetarian and his actual
stated purpose was to diminish the libido and desire of kids to masturbate
and it is true some vegans actually do find diminished or absent libido which
is kind of a salient indication that your body has decided kids are not
appropriate right now and seventh-day Adventist presence is just very strong
in the Dietetics community as a result of their religious conviction and
unfortunate there’s no like counteracting force I was saying I
should form the Church of the Flying ribeye or something to like counteract
them but the the seventh-day Adventist Church actually owns the largest serial
producer in Australia and it’s actually all their profit is given back to the
church tax-free and they are all interconnected within the health the
nutrition and the grain produced reproduction industry and the origin of
the idea that meat caused cancer was actually a divine vision in the 1860s –
a seventh-day Adventist woman who then has spawned like 150 years of regression
analyses to try and show that meat caused cancer so I’m just closing
personally I felt the kind of improvement eating this way that if
someone told me conclusively that if you eat this way that I’m going to die 10
years younger I would say okay that’s fine I’m gonna be happy and I’m gonna be
healthy and I’m gonna die 10 years younger you know it’s that point for me
in that just the terms of the the changes that I’ve noticed in my own
health and my own happiness and my own energy levels and you know I don’t
exactly remember what I was doing beforehand because it’s been a while but
I did kind of fall off the bus and in 2017 you know I’ve managed to convince
many friends and family to kind of join with me some have found great success
some have struggled the two biggest hurdles and my experience have been
addiction to food and the changing of the palette like it took me a long time
to be able to switch from enjoying the foods I’d previously destroyed the
modern ones the other thing I noticed I look healthier I know if like I think
that one of the great subterfuges of the late 20th century was this idea that we
should should ignore or there should be a
distinction between the outwardly visible health of someone in the the
internal health the idea that you should accept feeling like garbage and impotent
on a low-fat diet because the trustworthy Harvard School of Public
Health professor Walter Willett promises you it will pay off in the long run you
know what I mean and it’s this kind of interesting thing or I could I could see
my mom and back east after a while without seeing me and she said oh my god
you look healthier than you’ve been in years and then she discovers I’ve been
eating bacon and she’s like oh my god you’re gonna die it’s just an
interesting reaction I think this is kind of the product of the the panic
associated with the heart disease epidemic in the mid twentieth century
and not knowing where it was coming from and kind of finding it to be a
mysterious killer I mean at that point they were also smoking probably pack of
cigarettes a day each but you know we’ve pretty much ruled out steak as a cause
of heart disease if I were a betting man I would wager that not smoking and not
having this metabolic dysfunction and eating whole foods would probably put
you in a pretty good spot to not have heart disease and I think we need to pay
a bit more attention to our outward facing health I know this a little bit
challenging me but these are some popular vegan doctors and their age
progression over about six years and I think that like some of these things are
a lot more outwardly visible then you would expect and these are things that I
think we ought to pay more attention to how we look and how we feel and I’m a
suspicious guy you know I understand that there’s recibo effect and
everything I would always advocate that you don’t take me at my word and you do
your own research and you you apply an experimental approach to this to see
what works for you I think that’s what I did that’s how I got here and I think
that that’s kind of the most importat ache so I hope that’s some food for
thought basically the implementation of this
diet is accomplished via a food list you’re doing keto and there are various
like tiers that people will add in the folky oh well starting like the core
foods that are present in carnivore would be meat water and you can have
three different waters it’s hot cold and carbonated you can have salt and you can
have eggs a lot of people honestly the people who tend to eat that way are
people with severe autoimmune problems and they’re actually people who
experience that like they actually cannot deviate from this without causing
horrific autoimmune symptoms and these are things we don’t really understand
and it’s again why it’s very important to understand how you feel in these
things and try different things out and then some people will eat zero carb
which adds dairy spices coffee tea maybe 90% dark chocolate and then like a full
ketogenic diet would add in a lot of things that people normally associate
with a more balanced diet like leafy green vegetables slow starch vegetables
nuts in limited quantities berries sometimes avocados and and people will
try to limit the amount of carbohydrate they eat just because if you’re diabetic
you need to limit that way and the one thing I’ve got to be careful sometimes
because there’s a lot of garbage that tries to get sold and you know people
will try to to pile on to this this idea so don’t eat that stuff anyways any
questions thank you for your time I know that I’ve I say a lot very quickly so
and I think you guys all for like making the time to come out

Randall Smitham