Prompt: IDENTITY and PURPOSE
You are an expert content summarizer. You take content in and output a Markdown formatted summary using the format below.
Take a deep breath and think step by step about how to best accomplish this goal using the following steps.
OUTPUT SECTIONS
- Combine all of your understanding of the content into a single, 20-word sentence in a section called ONE SENTENCE SUMMARY:.
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OUTPUT INSTRUCTIONS
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INPUT:
Transcript: Dr. Steven Gundry is a
cardiothoracic surgeon who found success leaving
the operating room and shifting his focus to prevention along with writing
several bestselling books, including "The Plant Paradox" and his upcoming book titled "Gut Check." You may have seen his
content across social media highlighting his very controversial claim that certain healthy foods
are actually bad for you. His most popular claim is that
foods like beans, tomatoes, whole grains and bell peppers
are actually unhealthy because they contain
proteins called lectins and therefore are destroying your gut. This has drawn sharp
criticism from the medical and nutrition community at large, given the great amount of evidence showing that those who eat those foods are significantly healthier,
have lower risk factors, and do not require the
removal of such foods. Being fully honest here, I
was one of those critics. So when Dr. Gundry's team reached out for him to come on "The Checkup", I made sure that we stated early and openly that if he were to come on, it would likely be a
critical conversation. To his credit, he welcomed the debate. I also mentioned, given that
he is a cardiac specialist and I'm a family medicine doc, I would like to bring
in Dr. Danielle Belardo, who is a cardiologist heavily focused on research surrounding
disease prevention. In fact, she's on the committee that puts forth new guidelines aiming to decrease the number one killer of all of us: heart disease. Dr. Gundry again agreed so here we go, "The Checkup" podcast. Well, we're talking about
heart disease prevention and it's great to have two people who are passionate about
heart disease prevention because for myself as a
primary care provider, so many of my patients come in too late, already with heart disease. And then we're focusing
on trying to reverse that and reverse that, not just
through medication methods, but also giving them some
lifestyle modifications. And that takes a lot of work 'cause currently the
American Standard Diet is an absolute disaster. The things my patients are consuming, high ultra processed foods,
very, very problematic. But Dr. Gundry, I'd like to start with you because part of, I would say, your success on social
media and with your books, "The Plant Paradox" has been
that the advice doctors, the medical system, gives to patients when it comes to diets, including what we call healthy foods are actually unhealthy. Tell us about that. - Yeah, I think that's
certainly my observation over the last 50 odd years
that I've been doing this. As a heart surgeon, we knew that if we put a stent in
someone or did a bypass, we'd probably see them
for their next procedure in five to seven years in general. And we were taught that
this was inevitable and there's not much we could
do to slow down the process. Statins, blood pressure medications, lifestyle modifications, exercise more. But in fact those were
really piddly little things in the scheme of things. So when I, 28 years ago, watched a gentleman from Miami, Florida, Big Ed in all my books, reverse 50% of the blockages
in his coronary arteries, which were basically totally
occluded in six months time with a diet and taking
a bunch of supplements willy-nilly from a health food store, I knew that he was onto something and spent the last 28 years
figuring out how he did it. - That's interesting to
me because, you know, in medicine we always look
at anecdotal situations as perhaps not the
strongest level of evidence. So why did this one case, 'cause I have patients that come to me, follow all sorts of unique diets. I have patients who have
been smoking for 45 years and they're living a healthy life and they say, "It's 'cause I smoke." And obviously we laugh about it 'cause we all agree that it's not true. So why did this one case move you so? - Actually, let me stop you right there. Probably it's because he
smoked that he's doing so well. - Okay, we need to back up. How do we get there? - Well, I have a whole
chapter in gut check, looking at the healthiest,
longest living people and one of the unique features
of most of the blue zones is that particularly the
men are heavy smokers. And the smoking, actually
the nicotine in cigarettes, is one of the best
mitochondrial uncouplers that's ever been discovered. And we've looked at this
from the wrong lens. We've said, "Wow, what other
healthy lifestyle things are these guys doing that's preventing smoking from harming them?" In fact, we should have
looked at it the other way. What is it about these
people who are smokers that allows them to live
to 105, 110 years old? And when you do that, then you say, "Okay, smoking was good for them. Why don't we see the oxidative stress that smoking we all know occurs, why don't we see the
cancers in these people?" And it's because the rest of their diet facilitates the absorption of the oxidative stress in these guys. - So your state is that if you smoke, but eat
in this specific way, you can negate the negative
effects of smoking, the negative effects of smoking?
- Yeah. What's fascinating as a heart surgeon, way back in the good old days, most of our patients were smokers and they had specific proximal lesions in their coronary arteries. The rest of their blood vessels
were absolutely gorgeous and they were skinny
for the most part, so. - How did you gauge that? Did you-
- What do you mean? We operated on 'em.
- But you operate on what other vessels that you saw? Like you would do
peripheral arterial disease screenings on those patients?
- Sure. Yeah. - And you would find- - I used to operate on-
- Because one of the number one risk factors for peripheral
arterial disease is smoking. - Correct, 'cause the
smoking, the oxidative stress isn't stopped by our current diet. Lemme give you an example.
- Okay. - We're one of the few animals that don't make vitamin C, and vitamin C, and I've
written about this. So normally unfortunately collagen breaks as blood vessels flex and contract and it breaks primarily at bends. And when that collagen breaks, vitamin C normally rebuilds that collagen. In smokers they don't have vitamin C because the vitamin C has been used up in handling the oxidative stress. So they have basically
raw collagen that sits out and then we start the process
of an inflammatory attack and cholesterol's basically
a spackling compound and just keeps spackling that area. The great news about smoking is that it always happens at these
bends where flexion occurs. If like these people in the blue zones who live a very long time as smokers, if you have huge amounts of
vitamin C containing foods in your diet, and incidentally olive oil doubles our own vitamin C
production, which is kind of cool, then you mitigate those effects and you don't see the
negative effects of smoking, you actually see the
positive effects of nicotine. - Is there research that backs up where if you change someone's diet to have high vitamin C content that there negates their risk of smoking? 'Cause I've never seen that. - Yeah, that's all been
done in the blue zones. - Well, blue zones are
not research studies. In fact, you've been quite critical of blue zones even in your book. - Yeah. For instance, let's take
Sardinia for example. One of the blue zones. Only the people who
live up in the mountains actually have longevity. The people who live
down by the water don't. What's different about those people is that they are sheep
herders and goat herders. And what they eat is a large amount of fermented sheep cheese, sheep yogurt. And what makes them have
longevity is the men, 95% of the men smoke and
only 25% of the women don't. What's unique is, as we all know, women live about seven
years longer than men. The men in Sardinia have
seven year longer lifespan than the women because they're smokers. That's what brings them up.
- But that's an incredible conclusion to come to. - Same with the Kitavas. - But I'm saying there's so many variables that influence one's life. How are you isolating the one? We have trouble isolating
anything in research. - Look at the Kitavas. Staffan Lindeberg spent his lifetime studying the Kitava in Papua New Guinea. They smoke like fiends. They've never had a
documented case of a stroke or coronary artery disease. Never had a documented
case of lung cancer. - I'm confused how in this scenario, we're using blue zones
as an example for this. But then in your book you
point out that in Okinawa you feel that the blue zone is untrue because they may be
trying to collect pensions and their family members are not reporting their deaths appropriately. So how on one hand are you
using blue zones as a form of backing up what you're
saying versus other times saying it's actually, the
whole thing is a sham. - I'm talking about coronary
artery disease and longevity. So these people don't have
coronary artery disease despite the fact that they're smoking. So I'm saying we should
actually look at this backwards and say, "Wait a minute, all
these people are smokers. Is there a benefit to
smoking, to nicotine?" I'm not saying, don't get me wrong, I never had a cigarette in my life. But we've negate the fact that maybe we're missing
a positive benefit. For instance, the reason
I poo-poo the blue zones is because Dan Buettner
would like to convince us the grains and beans are
the secret of longevity of the blue zones. And since you brought up Okinawa, they don't eat grains and
beans, they don't eat rice. 85% of their diet is
a purple sweet potato. They don't eat soy unless it's fermented. They don't eat tofu,
they eat miso and natto, which are fermented soy. And they get the benefits
of the fermentation. So give you another example
in another blue zone, the Nagoya Peninsula in Costa Rica, this is like a gerrymandered district. Everybody in Costa Rica
eats beans and corn. That's their staple. But in the Nagoya Peninsula and only in that part of the country, they're sheep herders and
they eat sheep cheese, sheep yogurts, which actually
contain large amounts of medium chain triglycerides, which are great mitochondrial uncouplers. In the Nagoya Peninsula,
people say that grains and beans are the negative
aspect of their diet that's compensated for
by their other lifestyle. - I think I have to back up. Do you think that the Blue Zone Project is a valuable thing for us to
look at as a form of evidence? - No.
- So why are you using it to describe all these things to me that- - Because there are interesting factors that influence these people, but it's not the factors that a certain individual
would want us to believe. - Interesting.
- Paul Simon said, "A man hears what he wants to
hear and disregards the rest." And if you're- - And that's not what you're doing? - No, I'm saying what is it
that makes these areas unique? And look, I'm the only
nutritionist who spent most of his career living in a blue zone, Loma Linda, California. So I ought to have some idea. - Where they eat a ton
of beans in Loma Linda. - Actually they don't eat a
ton of beans in Loma Linda. They eat a ton of nuts and-
- They eat lots of nuts. - Yeah, lots of nuts.
- Lots of black beans. - And 50% of their diet is fat, primarily from milk products. - What's your take on the
Blue Zone Project as a whole? - So I think the blue
zones are interesting as an idea to talk about. But when we form dietary recommendations, I'm a believer in
evidence-based nutrition, which is synthesizing
multiple levels of evidence to be able to come to a conclusion for what will be a
healthy dietary pattern. You know, nutrition is complex, 'cause there's no placebo
in nutrition studies. So we essentially can't look
at one study, one anecdote, to form our recommendations
for what's healthiest. You have to look at
multiple levels of evidence. So we have preclinical studies, a lot of what Dr. Gundry talks about, things with mitochondria
that are very interesting, but they're hypotheses,
they're mechanisms. We look at those in rats,
we look at them in vitro, but then we have to look at, well, what happens in
actual human studies. So then we look at outcome trials. So we wanna look at
randomized controlled trials where you're actually randomizing people to a certain dietary intervention and then evaluating them
based on a placebo control. Then we have long-term
epidemiological studies because you can't randomize someone to something for 15 years. But then we have large
cohort data for nutrition EPI where we look at the
effects of the intakes at certain doses of foods over time with outcomes evaluating
it based on outcomes like cardiovascular
disease, autoimmune disease, GI disease, things like that. And so you have to synthesize
all multiple levels of evidence to be able
to come to a picture and a conclusion of what the
recommendations for a diet are. Last year we published, I was fortunate to be the lead author of our
latest cardiovascular disease and nutrition guidelines for the American Society
of Preventive Cardiology. And you know, we had to evaluate and synthesize multiple
levels of evidence looking at, you know, various
different kinds of studies. And so, although the blue
zones are really interesting, I think they tell us that, you know, you can have a wide variety of diets. 'Cause if you look at Greece for example, in the blue zones versus
you look at Okinawa, Japan, they have different amounts
of fat that they intake, they have different amounts
of carbohydrate intake and they have multiple, you know, success and longevity
across various different intake ratios of
carbohydrates, fat protein. But I think that why the
blue zones are interesting yet not super scientific
is because we have to look at more controlled studies to be able to kind of really synthesize all those levels of evidence to come up with the recommendation. - When you were making those guidelines, was there ever talk in between
the physicians doing this as to whether or not recommend
smoking along with vitamin C? - So I'll stand on the
fact that, you know, I think that it's pretty well established in the scientific literature that smoking is incredibly harmful. It's probably smoking cessation's probably one of the most important,
if not the most important advice we can give and help patients. Thankfully we have lots of
tools in modern medicine now to help our patients
with smoking cessation because it's certainly not easy. But I think that we don't
even have randomized control trials for smoking
because the data is so robust. Just evaluating how
patients do eventually, whether it's peripheral arterial
disease, coronary disease, or cancer outcomes,
obviously with smoking. So that I believe in the
scientific community is not really arguable at this point. And so yes, so smoking
cessation, huge recommendation for both cardiovascular
disease prevention, but also probably one of the
best things people can do to prevent cancers, dementia, you know, a variety of different diseases. - And have you seen evidence of vitamin C negating the risks of smoking? - No, but what I do think that Dr. Gundry may be pointing to is that in, you know, smoking is one variable, a
very, very important variable. But of course if someone's smoking, but they're also eating an
incredibly healthful diet, living in the blue zones where, you know, they
have great relationships. 'cause that's also a portion of it. People have great
interpersonal relationships, great community, lower stress levels, great satisfaction with life,
exercise, they're active, smoking doesn't help them, but maybe all of these other factors are contributive to their longevity. Whereas if you're smoking and eating, you know, a highly processed
hyper palatable foods and not exercising, it would
have more of a negative impact. But we know all things considered, smoking cessation makes
a huge impact in health. - That's fair. A lot of times there's so many biases when it comes to an individual's lifespan. If they're vegetarian, they tend to practice
more healthful habits. If someone is smoking, their
odds are they're also drinking, they're staying out late at night. So it's contributory in that way. So the takeaway here is that just because you have one bad habit, it doesn't mean that
you have all bad habits as exhibited in the blue zones. - Right. - What's your takeaway from the fact that some people in
the blue zone do smoke? Is it to say, we should be smoking, we should be taking nicotine? What's your takeaway from that? - So what I take away from
it is if you look at nicotine as a drug, first of all, it's addictive as any tobacco executive knows. So even I don't recommend
like Dave Asprey does, taking nicotine drops and
putting it under your tongue or wearing a nicotine patch, but I do think we actually have to look at whether or not nicotinic acid is a useful longevity drug. And you don't have to go very
far to look at the literature, looking at the various
forms of nicotinic acid that are now available
like NNM or NMR, nucle... Sorry, nicotinamide riboside. That these have clinical published studies on their effects on
uncoupling mitochondria. So, give you a long interesting story. I use niacin to treat my patients who make Lp little A,
lipoprotein little A. It's very effective at
lowering Lp little A and I and others think that Lp little A is one of the most
important effect effectors of cardiovascular disease,
certainly in family history. - What does niacin have to do with the- - Niacin lowers Lp little a-
- No, no. How does that connect to
the nicotine component? - Nicotinic acid is niacin.
- Interesting. - I have to jump in on this 'cause that's a very
passionate topic of mine. I just actually moderated
the major LPA session at one of our biggest cardiology
conferences this year. And what's really
fascinating from the experts I've learned from lipoprotein a, we no longer recommend
niacin for lipoprotein a. A reason being is that the three biggest randomized controlled trials that looked at niacin with heart outcomes. So you know, there's lots of things that can be great from
a mechanistic theory. We have lots of ideas as to
why in preclinical research you think something would be a good idea. You have to test it in actual
human outcome trials to see. And when I talk about outcomes, we talk about the things
that are most important: Heart attack, stroke, major
adverse cardiovascular events. So the three major trials that looked at lowering lipoprotein a that looked at lowering any
cardiovascular disease risk with niacin all showed, all three showed there's absolutely no benefit in cardiovascular risk
reduction with niacin. So we no longer in
cardiology recommend niacin for cardiovascular disease
risk for lipoprotein a, because despite the fact
that it lowers lipoprotein a, it actually doesn't improve outcomes. And what's interesting is that there's things that are really bad for you that actually also lower lipoprotein a, which is why lipoprotein a is complex. So the European Society
of Cardiology released the latest lipoprotein a guidelines and the recommendations are to
just lower apo b lipoproteins as much as possible
through diet, lifestyle, if they need a statin therapy. And for anyone listening that's like, "What is lipoprotein a, what are you guys getting into?" It's a atherogenic lipoprotein that I would agree with Dr. Gundry, it's incredibly important. It's now the recommendations
are to have everyone screened for their, it's Lp little A at
least once in their lifetime. But we no longer recommend niacin because of the heart outcomes in the trial shows it does not reduce
cardiovascular risk, and actually things that
can really lower your Lpa that are harmful, so things
like thyroid disease, untreated thyroid disease
can actually lower your lipoprotein a. Liver disease can actually
lower your lipoprotein a. These do not reduce cardiovascular risk. A high saturated fat,
high animal-based diet can actually artificially
lower your lipoprotein a and we know that raises your apo b and can also increase cardiovascular risk. So that's why it's so important that as we're looking
at different biomarkers and evaluating cardiovascular risk, that we keep in mind the
actual heart outcome trials. And we actually keep in
mind what actually matters to our patients, which
is heart attack, stroke, and all cause mortality. And so now with lipoprotein
a in the pipeline are specific drugs that are not out yet, but that are gonna be lipoprotein
a targeted specifically, SNPs and various different
other modalities. But at this time, all
of our cardiac evidence shows niacin doesn't improve it. So even though you can lower the number, it doesn't necessarily improve outcomes. So that's actually a perfect example. I think you illustrated
at least in, you know, in cardiovascular disease prevention, why something may in
theory and in mechanism be really interesting and useful. And we may, and it's worth testing, right? So when you do preclinical
research in a rat or in a in vitro model, you know, you may find a really interesting theory and a really interesting
mechanism that's worth exploring. That's when you translate
it to human studies and you see does this
improve outcomes in humans? And we found it hasn't. - Well, that's because
you didn't compensate for what was going to happen with niacin in raising homocysteine and also in raising Lp-PLA2 levels. And if you treat the Lp-PLA2 increase and the homocysteine with supplements, which I published at the
American Heart Association, then you negate those effects of niacin. - Well, I looked up your
publication, Dr. Gundry. And I couldn't find
anything published at a HAA. I saw that you had one abstract that was presented at the conference, but it was never a published
paper or peer reviewed. - Well, abstracts are peer reviewed since I've been on the committee. - Well it wasn't a study. But it's just that I have to be honest. It's just that's a little misleading. I mean, it goes against
our cardiology guidelines, our cardiology guidelines don't recommend niacin for lipoprotein. - I realize that. But the guidelines for instance, and you, I'm sure understand that statins increase LP little a levels. Yes.
- In 2a, statins increase LP little a in a very clinically insignificant way. And the reason why our
guidelines recommend that for people with
elevated lipoprotein a, that they should be on statins if they have an elevated apo b, is because the target of therapy now for lipoprotein a is to keep
apo b as low as possible. - Right, but the target of
therapy of getting apo b as low as possible is oxidized phospholipid apo b measurements. And that is the only measurement that correlates with Lp little a Levels. - Well, that's a really
good theory about oxidized. - It's not a theory, it's published. by multiple researchers.
- It's a theory because we don't have actual assays that can really dissertain that. We know that the research
for lowering apo b and we know for cardiovascular mortality is incredibly sound. There's no cardiovascular
organization across the board, whether it's ESC, HAA, ACC, ASPC, that even recommend checking
oxidized levels of anything because we know that lowering
apo b is the gold standard for reducing cardiovascular
risk for patients with elevated lipoprotein a. - So why wouldn't you wanna measure oxidized phospholipid apo b? - Because I mean you
could, but truthfully- - Gosh, I guess you better call up- - It doesn't alter management. 'Cause management's gonna be-
- How do you know? - 'Cause the management's
gonna be the lower apo b as low as possible. - Well, Dr. Gundry, I think
what's interesting for me here as a primary care doctor who
follows guidelines like these is how do you decide, because some of the
things you're proposing have really strong
mechanism background, right? Like you can explain how it works, you can explain the theory of how you can get from point A to point B. But in so many times in medicine, when we start with mechanisms, once we bring it to human data, we find the complete opposite. I mean, like the simple example that my viewers probably
think about is like Viagra. Initially it was started to
treat pulmonary hypertension and then now we found out it's
a great erectile medication. So it started mechanistically
to treat one thing and then it ends up going
in a different direction. - Well, we still use
Viagra to teach treat PH, but we call it just Sildenafil. - Yeah, it's the chocolate
chip cookie mistake where we thought the the chocolate chips would melt and they didn't.
- So true. (laughing) - And then we've also seen the same with beta blockers and cardiomyopathy. - Exactly.
- Initially we thought that it would be something
that would be problematic. And now exactly we see that
it actually reduces mortality. - Exactly.
- So how do you make the decision of when to
go from a mechanistic model where you say, "Look, this
oxidative measurement works. I can explain to you why it works", but then if we're lacking
the actual endpoints of people having less strokes
by following your model, how do we prove what you're
saying is actually true? - Well again, that's gonna
take a very long time, but I see patients six days a week. I even see them on Saturdays and Sundays. And I don't need to, at
this point in my career. I draw blood on them every three months and multiple labs looking at,
among other things, oxidize, phospholipid apo b as a marker of therapy. And a lot of my patients see
other physicians as well, family practice, other cardiologists. And we watch a manipulation
say, let's say somebody decides to increase a statin
drug to drive down apo b. That's one idea. But when I see then the
oxidized phospholipid apo b go up even as the apo b goes
down, and then I intervene. - Can I ask you a question on that? 'Cause that's so important,
what you just pointed out. If their apo b goes down but
their oxidized level goes up and they have less heart
attacks, do you care? - They don't have less heart attacks. - But we do, we have the
hard ed data to show it. - We have tons of data that
they have less heart attacks. - They don't have less heart... For instance, you
brought up beta blockers. The most recent recommendations
are we should not be using beta blockers as a treatment
for coronary artery disease. - No for hypertension.
- Yeah. So- - As first line for hypertension. - Yeah, and so exactly. And for coronary artery
disease, we no longer put people's standardly on beta blockers if they haven't had an
MI within, you know, in that time period.
- Exactly. And yet that was standard of care. - Right. Right.
- But- - But the reason it changed
was because human models showed it to be that way.
- That's exactly right. But the human models initially
made beta blocker therapy after an MI or after a standard, or after a coronary
bypass, standard of care. - And then it changed why?
- I couldn't send anyone out of the hospital and
get dinged from Medicare if I didn't put them on a beta blocker. - Agreed, but similarly,
human trials are why, you know, initially we didn't recommend beta blockers in heart failure, right? It was believed to be, the
mechanisms were believed to be this is gonna be so dangerous for heart failure, et cetera. And now it's the standard of guideline directed medical therapy
for systolic heart failure with the quadruple therapy for GDMT. And so it's so important,
this is why, you know, the multiple levels of
evidence why preclinical data is important to generate ideas, but then testing it in human outcomes. And so I'm not saying
that people shouldn't be researching oxidized lipoprotein. So I am a huge fan of lipids. I very much am a very
lipid focused physician and lipid science and Thomas Dayspring who's like a world renowned lipidologist is one of my mentors. And I have huge respect for the research going on in that space. But the thing is, is that we
already know with regards to, you know, across the
cardiovascular disease field and across every major medical
organization worldwide, that reducing apo b lowers your risk of cardiovascular disease. And so, although these other
biomarkers are interesting, you know, we don't have the correlation, the hard outcome data that we have with lowering apo b. Also the assays vary depending on which labs you're looking at, which we could really
get into the weeds of it. But there's plenty of people
who believe that the assays that are even evaluating those
markers aren't even correct. So there's not even a lot of validity in a lot of the advanced lipid testing, you know, that is exciting
to talk about in theory, but for clinical utility,
you know, I believe with evidence-based
medicine, we have to use the best available of evidence to date. And that includes looking at
a variety level of evidence, especially most importantly,
randomized controlled trials with hard outcomes to give
our patients the option to do things that are best for them that we have the best outcome data for. - To summarize your positions
for people watching, it seems like the reason
you make the decision to treat in the way that
you're treating your patients is you're seeing good
outcomes in your patients. You are finding this mechanistic approach that makes very logical sense. And you could follow it along a pathway. - I can track it. Yeah.
- And you could track it with your patients. And Dr. Belardo, is using sort of hard endpoints
of heart disease. Stroke. for lowering apo b. My question is, I have plenty of doctors that I've ended up
having to treat patients after they've fallen out of their care that have made, you know,
wild recommendations that you would firmly disagree with that say you should only eat beef or some very hard
carnivore stance type diet. And they claim the same
improvements with their patients. So how do I distinguish as
a family medicine doctor between your recommendations that are lacking this hard endpoint data versus the carnivore diets? Same anecdotes.
- So I can have a patient on a carnivore diet and I have a number of patients who choose to do a carnivore diet. I'll have patients that
will do an elimination diet to treat their leaky gut. And at the end of the day,
at three months, six months, we begin to see their
inflammatory markers go up. We see their PLA2 markers go up, we see their HSCRP markers go up, we see their IL-6 go up and
so, and TNF-alpha go up. And so we'll say, "Hey
guys, you know, look, you may feel really good and here's what's happening, you know, underneath the surface." It's like, you know, the girl in jaws swimming at the top of the ocean doesn't realize a great
white's underneath her. When they see that, they go, "Ooh, okay, you got my attention now." They don't feel it yet. In fact a lot of 'em feel really good. - There's also, you know,
there's this entire group, a sect of dietary tribes. There's a whole food
plant-based, no oil group. Right? And I personally, I happen to be vegan. I believe that you don't have to be vegan. You only should be vegan
for ethical reasons. - She's actually been
canceled by vegans, so - Yes, because the whole food plant-based, no oil individuals, vegans, don't necessarily like my viewpoint 'cause I believe olive
oil is incredibly healthy. Why? Because of a lot of
our hard outcome evidence. - Yeah.
- Anyway, but the low fat whole food plant-based vegans actually who believe olive oil is toxic, they have the exact same
claims as you, identical. They reverse autoimmune disease, they claim to reverse heart disease, which I've gone up against
quite a lot of them in debates. They claim to reverse every
sort of disease, inflammation. They lower high risk CRP on
these incredibly high lectin no olive oil diets. And they claim that olive
oil is incredibly toxic and they can cite a
thousand endothelial studies that will tell you olive oil is toxic. And my argument against that is that when you look at the
multiple levels of evidence and you look at the
randomized control trials, we know that olive oil is not harmful. It's actually beneficial
and it's healthful. But I think that one of the
points Mike and I had discussed as well is that for, you know, when you are a consumer
of this information and our patients who are listening, well, do I follow these
low fat plant-based people? Or do I follow, you know, 'cause they have just as
many anecdotes as you have. And so how do we sort out and
differentiate the evidence? And this is where my belief is, the evidence is looking at
evidence-based medicine, looking at the hierarchy of evidence, looking at meta-analysis, and then looking at systematic reviews and then looking at
randomized controlled trials. And then being able to synthesize that into our dietary recommendations, which are eating a diet filled
with fruits, vegetables, whole grains, legumes, lean protein, fatty fish, olive oil's great. You know, higher in polyunsaturated fat. Because otherwise, if we're
just going anecdote to anecdote, then we really have a lot
of different dietary tribes making the exact same claims. And everyone has really
believable stories. And it's really, I totally understand. And it's moving. I've seen patients improve,
even though I'm vegan, I've seen patients improve
drastically on a carnivore diet. You know, because in many
ways it's a elimination diet. Of course, carnivore diet
I highly recommend against because it can raise your
risk for colorectal cancer and heart disease and raises apo b and they're missing out
on lots of vitamins, minerals, and important things. But that being said, you know, we can see the carnivore group has tons of anecdotes where they can reverse X, Y, or Z disease. And so I think that's where it's tricky for the general consumer
of the dietary information is how do they sort out
whose anecdotes are best and then, which is why, you know, anecdotes are the lowest form of evidence. And we have to kind of go by looking at all the levels
from long ranging epidemiology to randomized controlled trials and free living studies
that are over two years, like the Lyon Heart study, or like studies that are looking at two weeks metabolic board, highly controlled by my
friend Kevin Hall at the NIH. So we have multiple levels
of evidence to synthesize that come to our guidelines. Otherwise, it can be
confusing for the consumer. - Do you agree with that,
that we need multiple layers of evidence and not an
anecdotal mechanism only? - Oh, absolutely.
- So what's your takeaway about the evidence that Dr.
Belardo uses for her guidelines? Do you think the evidence is wrong? Do you think it's incorrect?
Do you think it's incomplete? - I think it's incomplete.
Let's put it that way. - How so?
- For instance, and I've talked about this
in "The Plant Paradox", the potential reason why a low fat diet is effective in those believers is that you no longer have a mechanism for lipopolysaccharides
to ride on chylomicrons through the wall of the gut
and create inflammation. And I love the lipopolysaccharide
theory of inflammation. And if you do not have fat carrying fat across the wall of the gut, unless you have leaky
gut from other causes, lectins, then you're not gonna have LPSs get into circulation. - But those low fat
plant-based no oil group, which I don't endorse, I love olive oil, - Nor do I.
- But right. No, of course, that's why I'm saying 'cause-
- You agree. - We agree on olive oil. We think olive oil is great.
- Right. - And so what I'm saying
is that they believe, you know, they're high, high lectin diets with the exact same results as you. So I think what we're saying is that how do you differentiate that? Which is why I think the levels- - Well, and I treat a
lot of Ornish failures, Esselstyn failures, who have progressive
coronary artery disease on those programs. And I'm sure they have Gundry
failures that they see. - Exactly. So how do I then
decide what I should do? What should I teach my residents to do? - So for instance, I don't have, I think the best controlled trial of a low fat diet versus a high fat diet was the Leon Heart diet. I think it was very well designed. - It's my favorite study.
I'm glad you said that. - Yeah.
- Because the Lyon Heart study has a statistically
significant increase in... So the Lyon Heart diet, for your listeners who aren't familiar, one of the best randomized
controlled trials, we cire in all of our guidelines where they looked at people, they randomized them to,
they were on a baseline diet and then they randomized them to a diet that increased legumes. Statistically significant increase, drastic increase in legumes,
increase in whole grains, a decrease in saturated fat, increase in polyunsaturated fat. So pretty much everything we recommend in our latest cardiology recommendations, in our nutrition statement for the ASPC is in the Leon Heart study. So you increase beans,
you increase whole grains. And what did they find
in Leone heart study? Within a year of the study, and I believe it was a four year study- - They stopped this,
it was five-year study they stopped at in three years. - They stopped it.
- Wow. - Because they had 50 to 70% reduction in cardiovascular disease risk. And so that was actually one-
- New events. - Yeah.
- Wow. - Everything, in events,
in hard outcomes of events, heart attack, stroke, major... And so I was gonna ask
you with them, you know, quadrupling their lectin intake, what is your counter to a study like that? - Oh, that's easy.
- Yeah. - It turns out the only... What she's not mentioning
is that the study group, they were compared to a low
fat American Heart Association, low fat diet. - It wasn't a low fat diet. The original one-
- But it was the- - So they actually just replaced the saturated fat with poly. But it wasn't low fat.
- They replaced it with basically rape seed oil, which is quote, canola oil. It's incredibly high in
alpha linolenic acid, which is a short chain Omega-3 fat. What's fascinating is when
the researchers broke down every possible change, what the factor was that made the difference, the
only one was the blood level of alpha-linolenic acid
predicted the outcome. And I write a lot about
that in my previous books. I go back into it in "Gut Check." It's the alpha-linolenic acid that is actually making the difference. - So I would highly disagree. - Oh, it's published data. Go ahead. Look it up.
- I mean, because they also, it's similar. There was multiple variables
that were impacted- - But that's the only
one that impacted it. - No, because-
- But how can you decide that?
- 'Cause that was the only difference
between the two groups. - Is that true?
- No, because they also had the Lyon Heart group, the intervention group also
had higher antioxidant intake 'cause they had higher
fruits and vegetable intake. - That's true, but those
were all compensated for in the final analysis. And it was only, it surprised me. It was only alpha linolenic acid. - So I had a feeling you were going to say that the polyunsaturated fat
intake, which I'm a huge fan, biggest fan of polyunsaturated fat. And I love that. I love canola. Big fan of canola as well.
- Organic canola. - But there were a multitude of factors that improved the outcomes. And so your theory is then that the polyunsaturated fat intake makes up for the lectins?
- Yeah, absolutely. 'Cause polyunsaturated fats, alpha linoleic acid actually
prevents, lowers LPS levels. - Okay, so let's work off that theory 'cause I think that's very valuable. There's a whole list in your books of foods that you say don't eat. - Yeah.
- High in lectins. Some of them are common foods that doctors even label as healthy. Why not instead of saying,
stop eating these foods that are rich in antioxidants,
vitamins, minerals, et cetera, and instead
tell them to consume these fatty acids that are healthy? As protection.
- Well, I do tell them that. But what I do when... Most of my patients who I see, about 80% of my patients
now are autoimmune patients who are not getting any better despite- - Why do you think that is? - Well, 'cause for whatever reason, my program, if you follow
it, your autoimmune disease 90% of the time will be gone, will be in remission in
nine months to a year. - So you... - So people end up in my office- - Specifically for autoimmune?
- Correct. - What about people who
are looking to lose weight, people who have cardiac disease, are those people in your practice as well? - Oh, absolutely. - But why is it so skewed
towards the autoimmune? - Because, well, we-
- Because like I treat a diverse population and
I can't get to an 80%- - We have an epidemic of
autoimmune disease in this country. And I, among others
think that all diseases, coronary artery disease, is
in fact an autoimmune disease. And so if you fix the underlying problem of autoimmune disease, which
I and others happen to think is intestinal permeability, leaky gut, then that autoimmune disease resolves. - That's very powerful that you say that because when you say it's the leaky gut that causes the autoimmune disease and you say, I think this, I as a skeptic, because I try not be a cynic,
I wanna be a healthy skeptic, hear that you think this
and I think it's wonderful and I think we need to research it more. - Well, Alessio Fasano from
Harvard not only thinks this, but has done a pretty
good job proving this, that all disease comes from a leaky gut. - But that's not true.
- Hippocrates said it 2,500 years ago.
- Yeah, but 2,500 years ago, we would balance the humors and make people vomit and bleed them out. There's a lot of things
we did in the past. It doesn't mean we should
look at that as a guide. So the question is how
do we go from individuals saying this as theory
versus to modern practice? - 'Cause we can measure these things. - But measurement doesn't yield
outcomes in every scenario. - Sure, it does.
- It doesn't because I have patients who have abnormal thyroid levels,
and yet feel perfectly fine and the second that I try and
change them with medication, they develop symptoms. Did I help or hurt this patient? - Why would I try to change
somebody who's feeling fine? - Because their levels are off, as you said, levels are more important. - No, no, no. I'm talking about we
can measure the degree of intestinal permeability
with good blood tests and we can watch intestinal
permeability change and we can watch it heal. - You do that with your patients? - Exactly. - How do you measure
intestinal permeability with your patients? - So we use Vibrant Wellness,
we use Anti-Zonulin IgG, anti-ACT IgG and anti-LPS IgG. - Are these the food sensitivity tests that measure IgG? Is this what-
- Food sensitivity does, but this still looks at
intestinal permeability. And this is actually what
Alessio Fasano worked out as the way to measure
intestinal permeability. I didn't devise the test. - Yeah, I'm just confused because when I work with
gastroenterologists, gastroenterologists teach me, I go to some of their meetings, the only time the concept of leaky gut, and it's not leaky gut syndrome, comes up is in autoimmune diseases
like celiac disease where there's actual damage, blunting of villi, immune complex damage. How do we get from there? - That's the tip of the iceberg. - Right? So the tip of the
iceberg has data behind it. Data that we can act upon. - Yeah, there's good data behind leaky gut and reversing leaky gut. For instance, I mean, what shocked me when I
started looking at this is every one of my patients
with coronary artery disease had leaky gut when they
walked through the door. Every one of my patients
with an autoimmune disease, let's take Hashimoto's, had leaky gut. Every one of my patients
with rheumatoid arthritis and you know, these are blood markers that we can measure, had leaky gut. So when we put them on a program and remeasure their leaky
gut every three months we can watch it go away
and it will resolve. And what's interesting is
that the markers will resolve, they will go away. - But that's not the interesting part. The interesting part would be
if you treat their leaky gut. - That's what we do.
- So for example, in gut check, you know, I'm really excited about
the microbiome, right? There holds a lot of untapped potential that we still have a lot of
work to do to figure out. And then I've seen on certain podcasts, there's statements that you've
mentioned about, you know, if you take the microbiome
of a depressed mouse and you implant that into a happy mouse, the mouse gets depressed or-
- True. - You mentioned a study where, and I couldn't quite find the study where there was an individ... Back in the day when people
were institutionalized for their depression, they
would give them a colonic and then give them a fecal enema and 66% of them would improve. That was a statement
that I've seen you made. - Yep.
- Like, what do I do with that information? Because put yourself in
my shoes for a second. I have a patient that comes
into my office who's depressed. They heard you say that. They wonder why I am not
giving them the fecal enema. - I wouldn't give 'em a fecal enema. - Why not? You just said you have
evidence of 66% cure rate. - That's the last thing I would give them. - But how if you said a study did this? - Back in the 1930s. For one thing, believe it or not, when I went to medical
school back in the dark ages, we were actually the first people at the Medical College of Georgia to use fecal enemas from medical students to treat C. difficile. We didn't even know it
was C. diff back then. It was pseudomembranous colitis And my professor Arlene
Mansberger said, you know, and this was when broad
spectrum antibiotics first came out in the mid 70s. And he says, "You know,
I think there's something going on in the gut and we've
gotta reconstitute the gut." So once a week, medical
students took a crap in what we called the honey bucket, went into Arlene Mansberger's lab, put it in a waring
blender, homogenized it, and shoved it up the rear ends of people with pseudomembranous colitis. And it cured it. Cured it. And we went, "Son of a gun. This is nuts." - And we do that now. Not to that degree.
- Correct. - [Mike] But obviously we
do use fecal transplants. - Right. But we don't need to do that. We can reconstitute the microbiome. For one thing, we've
killed off our microbiome because of all the antibiotics we take. - Well that's why we put it in. - All the antibiotics we give our animals. And the best, most potent
antibiotic there is is glyphosate, Roundup. It was patented as an
antibiotic by Monsanto. And so if you wanted to do
a number on your microbiome, we've created the perfect storm for killing off our microbiome. And what's really interesting
is glyphosate in particular kills off the tryptophan pathway making bugs that makes serotonin. So if you wanted to make
someone anxious and depressed, you would kill off that tryptophan pathway of the microbiome. So what you do is you eat organically and you stop taking antibiotics unless there's a life threatening problem. And the good news is if
you stop eating animals, you'll lose those antibiotics. The bad news is that most of our grains are contaminated with glyphosate. - My question, I don't think
we got the answer here yet. 'Cause I think it's important. When we found that fecal transplants work specifically in the case of C. diff, but not in the case of depression. Right? You agree-
- I'm not advocating that - Yeah.
- Correct. - Yeah. It just-
- In fact, I don't know if maybe over in Europe it's being used for that, but certainly not in the United States. 'cause the FDA would not allow it. - Yeah, I just don't know what's the use of then stating that study? - Because there's chapter
after chapter in "Gut Check" showing the correlation
between a diverse microbiome and lack of depression, lack of anxiety. And we're getting closer and closer to understanding which bugs do what. - But we're not there yet. - We're getting close. - We're close, but I just want
to put that on the record. We're not there yet. We know a diversity is good. - Yeah.
- But we don't know which ones. We don't know exactly which ones. There's still room to be explored here. - Yeah, I mean, for instance, there are now bugs that make
oxytocin, the love hormone, and you can actually swallow some of these and make more oxytocin. That may be a good thing.
- Maybe. - So I would like to
counter that with the fact, so I think the gut
microbiome is fascinating. And I think we're at the,
you know, beginning of, I think if you talk to
the world's renowned gut microbiome researchers,
they will humbly tell you that we are at the very, very beginning of elucidating the
answers to the questions of how important. I don't think anyone doubts that the gut microbiome is
a important facet of health. But we don't really
have those answers yet. And I think that that can
be the most, you know, world renowned gut microbiome
researchers will tell you that, you know, we're not
even sure the exact population and what percentage of what colonies of which bacteria are more beneficial. So we can't even prescribe
right now exactly what is most beneficial for
the gut microbiome at this time because we don't even know. That's why probiotics, that's why the American
College of Gastroenterology, which you'll know this
because as a family provider, I'm sure you are asked all
the time about probiotics. And this is why the ACG does
not recommend probiotic use for people generally outside
of very few clinical conditions that require it because we
don't even know what strains, at what doses in which scenario
are gonna be beneficial. And we know that with lots
of the probiotic research that it doesn't have benefits
and it can have harms and risks, which is why the
ACG looks at it that way. And so I think that we're at the infancy of gut microbiome research and I do agree that it's important, but we don't have enough of
that hard outcome data yet to give us, you should be, you
know, eating this exact kind of food to improve your gut microbiome. I think that in general,
you know, most of the things with the healthy dietary
eating a diverse, you know, plant predominant diet,
of course we believe can help gut health in general with eating fiber and
short chain fatty acids and all of the things that
happen in the gut microbiome. But I do think we're at the
infancy of that research and not knowing, it's not as
quite as prescriptive yet, which is why the probiotic
trials have failed and why we recommend probiotics only in very certain
small clinical scenarios because we don't fully understand. And there's tons of research
to be done in that space. And I also just wanted to
counter on glyphosate, quickly. Organic, when we look at
organic versus non-organic, and I have no dog in this fight personally 'cause sometimes I buy organic
if it's convenient for me, sometimes I buy conventional. But I do think it's really
important to make this clear to your audience that when
we're looking at research with hard outcomes, meaning
you're looking at cancer risk, you're looking at heart disease risk, the reason why no guidelines
that make recommendations for diet, including the
American Cancer Society that recommend eating organic is because all of the research with hard outcomes, there's two main studies
that looked at it, Bradbury and I forget the other one. They show no difference with organic versus conventional produce. So although the mechanisms and the ideas of glyphosate
may be interesting, it hasn't borne out to being
any difference in outcomes with regards to cancer risk,
cardiovascular disease risk, or other heart outcomes
that have been evaluated in the cohorts. - All that is interesting. Here's my takeaway for me
as a primary care doctor, the reason why America's
sick, the world is sick, we have an obesity epidemic, we have people consuming
ultra processed foods at rates unheard of. My patients overeat ultra processed foods. They eat tons of unnecessary added sugars and as a result they're very sick. Cardiovascular disease,
strokes, diabetes, et cetera. None of my patients are overeating fruits. And yet within your book and your podcast, you make fruits almost an enemy. - They're not an enemy. They should be our friend when
they would've been available. And no great ape eats
fruit all year round. They eat in season and great apes actually only gain weight
during fruit season. And we don't. We'll take a trip to the Central Park Zoo. - But why do we need to go
to the Central Park Zoo? None of my patients overeat fruits. Why are we talking about that? - There's no juicers in
the Central Park Zoo. - But do you feel like generally
across the United States, fruit consumption is an issue? - No. Fruit products are an issue. Totally different. - What's a fruit product?
- Like apple juice. - Agree.
- Like orange juice. - Agree. We're not recommending juice. - We agree with that, we're not talking about juice.
- Well, that's fruit. - But that's not what we're talking about. You're saying an apple
is not ideal to eat. You said grapes are sugar bombs that are problematic.
- They are sugar bombs. There's as much sugar in a cup of grapes as in a Hershey's candy bar. - Yeah, but that requires nuance because I would never tell a child to eat a Hershey bar over a grape. That will never happen in my practice. Would you recommend it?
- No, but you might allow the mother to give 'em
apple juices as their drink. - But I wouldn't, we're not
talking about apple juice. You're saying grapes. It's a child hears, a mother hears "Grapes are a sugar bomb, might as well give them Hershey's." They will give them Hershey's. - Might as well. - And your example-
- But why might as well? Don't you think grapes have more nutrients than Hershey's? - Well, believe it or
not, extra dark chocolate has some of the highest
polyphenol content around. - [Mike] But we're talking
about milk chocolate. - Yeah. I wouldn't give
anyone milk chocolate. - Exactly. So why even
bring the comparison? - You have great animated
examples, Dr. Gundry. They're quite, I appreciate you. - There's textbooks written
about grade apes and fruit. - I believe you. But what's interesting is that because in this modern day and age, we don't actually need to look- - For the guidelines,
how much did you guys take into consideration grade ape diets? - We zero considered grade apes because the good news is,
is that we have multiple levels of evidence that look
at fruit intake in humans, like in actual human species. So we don't need to look at great apes to help us indicate how
much fruit is healthy. And if you look at the
epidemiological data over time, I mean, it is without
question that individuals who are in the higher
tertiles of fruit consumption are always, always, always
associated with lower risks of cardiovascular disease,
autoimmune disease, cancers in human beings. So, you know, although the
great ape theory is great, but we're not apes, you know, so- - But you think fructose is good for us? That's what I'm hearing. - Well, I'm saying that I
don't recommend apple juice and I actually think that all
major medical organizations do not actually in cardiology guidelines, we do not recommend sugar
sweetened beverages. And apple juice is not beneficial. Neither is orange juice, but fruit in its whole form.
- Phew, thank goodness. - Yeah.
- Fruit in its whole form, you know, comes with a lot of other things besides just glucose, fructose. It comes with, you know- - Polyphenols.
- Nutrients, polyphenols, vitamins, minerals, fiber, things that are really healthy for us. And so, you know, the
comparison of fruit to, you know, a candy bar is
just a little disingenuous. And I do think that the ape
example, while it's interesting, we have so much human data
we can look at that shows us how beneficial and healthful fruit can be. And I'm not saying everyone
needs to eat a ton of fruit. I'm not here recommending a
fruitarian diet by any means. But, you know, we do know
that, like, as Mike mentioned, that you know, the vast
majority of our patients who are having difficulty with diet, it's not from a banana overdose. It's not from eating too many grapes. You know, I think that we can all agree, at least all three of us I think can be on the same page here, that the major problems with diet in our current time, a lot of it has to do with these hyper palatable processed foods that are super convenient and, you know, ubiquitous in society. - Yeah. Dr. Gundry, I think
what we're pointing out is we're on the same page with
being anti-processed foods. We're pro olive oil,
pro Mediterranean diet. We're all on the same page here. The issue is that folks are overeating these over processed foods, they're not consuming enough
fruits and vegetables. The Lyon Heart study showed
that if you increase legumes and whole grains, and your
major stance in your books is remove whole grains, limit
legumes, fruits are your enemy. How-
- So whoa! I eat beans multiple times per week as long as they're pressure cooked. I think ancient societies
always fermented their legumes. When you put beans in a pot,
you soak them for 24 hours. You ever notice the
scum coming to the top? - But who's advocating
to eat raw beans here? - Well, nobody but regular cooked beans. You have not destroyed the
lectins. That's well proven. Fermentation will destroy them. - And yet these people
in the Lyon Heart study ate those non fermented
beans, they were great.. - If you cook beans-
- They were fermented. You're not hearing me.
- No, no. If you cook beans appropriately,
like even in a pot, you can remove like 95 plus
percent of the lectins. And I agree, none of us are
advocating for raw beans, but cooked beans, and also,
by the way, canned beans, huge fan, for anyone listening that wants something convenient, canned beans, as long as
there's no sodium, wash them, they're already pre-cooked
and the lectins are minimized. - And only two companies
that pressure cook their canned beans, Eden brand and jovial. Now, I'm not a consultant
to either of them, but it's so easy. - The problem in our society
is people aren't eating whole foods and here we are making a list of whole foods they should avoid. - I'm not telling them to avoid 'em. Whole grains, if you
have millet and sorghum, which do not have a hull,
they're perfectly safe. But you can even eat these in excess. And let's get back to fruit.
- You can eat anything in excess.
- Let's get back fruit. - You have enough
carrots, you turn orange. - Let's get back to a fruit for a second. I can watch my patients,
you know, go to Costco and load up on the
grapes or the blueberries and I can watch their triglycerides go up. And you might agree with me that the triglyceride HDL
ratio might be very useful. - Actually, so in cardiology we no longer focus on triglycerides to HDL ratio 'cause now we know that the
most important prognostic factor is apo b so the
cheat sheet way for that is looking at your non HDL cholesterol. Triglycerides, incredibly important, but triglycerides are only
a temporary measure and- - Yeah, two to three days.
- Exactly. And so we actually don't
look at your triglyceride HDL ratio anymore as a- - Well, as does triglycerides
go up in general, your apo b will go up.
- Right, well, yes, for sure. But the HD L ratio, not a super huge part, but fruit actually, you
will know this, Dr. Gundry, all the research shows us that people who eat higher amounts of fruit actually have a significantly lower apo b in all randomized controlled
trials across the board due to dietary fiber and
low saturated fat content. So actually eating tons of fruit, especially, not in the form for juice, fruit in terms of whole fruits, can actually reduce apo b significantly and cardiovascular risk subsequently. - All of this is valuable, but why are we arguing about
fruit when it's not the enemy? - The enemy is people thinking that fruit, we should not have 365
days of endless summer. - But who's overeating fruit? Americans are overeating
ultra processed foods. Americans are overeating
with burgers, hot dogs. - Totally agree with that.
- I can't get my patients to eat fruit. - What research shows us that people shouldn't be eating fruit? When I just mentioned that every, like if you look at NHANES
data, if you look at- - Wait, I'm not saying don't eat fruit, I'm saying eat fruit in season. - Yeah. That's what she I'm saying. - I'm trying to ask you,
there's no research- - Fruit is not available
year round normally. - There's no research
that shows us that fruit has to be eaten in season
for it to be healthful. All of the research shows us that in a dose dependent manner, people who eat more fruit in the highest tertiles
of consumption of fruit, people who eat a varied diet of fruits and vegetables and to whole grains and all these things have every marker of lower disease risk, whether it's cardiovascular disease risk, obesity, weight control, diabetes. And so my question to you is besides the seasonality you're discussing with regards to apes which we are not, when we have all this human outcome data showing us that there is no seasonality to fruit consumption,
it's just eating a varied plant predominant diet
that's most healthful. How do you make that leap from animals to when we have all this human data showing the opposite
of what you're saying? - So in the Mediterranean,
people do eat fruit seasonally. - People eat fruit year round
in the Mediterranean as well. - Do you not respect the
research that Dr. Belardo is pointing out saying
that people who eat fruits in the highest amounts
have lower risk factors and better outcomes? - Because they're following people primarily in the Mediterranean and they do-
- But that's not true. - No, no, no. The NHANES, I'm talking about the major cohort data in the United States. That's the nurses health study, we're talking about the physicians study. Like all of these cohorts
are in the United States. So, and even in the Mediterranean, I mean, we live in a modern society
now where fruit is accessible, most people in modern society, year round, and a lot of people are
not eating seasonally. So, you know, the seasonal idea, I think, you know, based on
the animal studies and thing, although of an interesting
thought, it doesn't bear out in human outcome data, which
shows us that you can eat fruit healthfully year round
not only without there being no adverse events in any, at least cardiovascular disease or all cause mortality or
cancer research, you know, but there's a a multitude of benefits of a higher amount of fruit consumption. And I'm not telling anyone to eat all fruit all day every day. But there is no reason for
it to be limited seasonality. And the reason why also I
think is really important too, is there's a reason why
the American Cancer Society guidelines, the American
College of Cardiology guidelines ASPC guidelines are all for nutrition that are very similar, as well as the Endocrine
Society guidelines, all the guidelines to prevent
cancer, to prevent diabetes, to prevent cardiovascular disease, all of the recommendations
for nutrition are similar because the science is similar. So eating a diet with
varied fruits, vegetables, whole grains, legumes,
lean proteins, fish, things like that have
proven to reduce the risk of the variety of diseases. Which is why we have so much synergy across the various specialties. - As a spectator of listening
to two experts speak, Dr. Gundry, your reason
for not recommending fruit year round, you reference apes, she references longitudinal studies here in the United States. How can I possibly side with you? - Come to my clinic and watch
what happens when somebody- - But a lot of people can do that. - So I have nothing against fruit. Maybe you don't hear me. - I need to read some of your statements, - Fruit in season is great. Fruit contains polyphenols. They're one of the best ways
to get polyphenols in the diet. In fact, what I recommend
is reverse juicing. Go buy all your organic
fruit, put it in a juicer, throw the juice away, take the pulp, and put it in plain coconut yogurt. - I love fiber. I'll second you-
- There you go. - Fiber's great.
- It's polyphenol. - On Lewis Howes podcast.
- Oh, I love that. - And this is a quote from you. "Apples are horrible for you."
- Yeah, they are. - I mean.
- Why? Because an apple is not an apple anymore and in fact on Instagram-
- But that's not true. - It's not an apple anymore.
- Yes, it's bigger. It's as big as a grapefruit.
- It's been hybridized for sugar.
- Yes. But it has high fiber
content. It has polyphenols. All the things you just said are healthy. - Phytonutrients.
- It doesn't anymore. - But it does.
- Yes, it does. - No, it's been totally changed. It has less vitamin C than 50 years. - But it still has vitamin C. - It has a little bit. So get a small apple - But how can you say apples are horrible from you, from that deduction? - From that big grapefruit
size apple, correct. - And then when we look
at research of people who consume apples, they live great lives. My patients who are
unhealthy don't eat apples. - When they eat an apple
that's the right size. And guess what? Apples are not available
year round normally. - Again, all those statements-
- Back in the old days. - You can stand behind
that apples are different, that apples are not the same size, that they shouldn't be
available year round. How does that bring you to the deduction of apples are horrible for you? - Apples in this size are not great. - You said a fruit smoothie is the worst possible thing you can do for your mitochondria. - I think that's true.
- You don't think cyanide is worse for your mitochondria that blocks oxygen and kills it? - Well you're not going to eat cyanide unless you eat the apple core. - Exactly. So how can fruit
smoothie be the worst thing? - A fruit smoothie is
a pure fructose bomb. And if you wanna-
- Well, it's not pure fructose. I'll argue with you on that because when you smooth-
- There is a little bit of glucose.
- So when you smoothie, by the way, when you make a smoothie, the reason why I think
smoothies can be beneficial, not for weight management,
because you know, often drinking your calories can be not super helpful.
- A problem. - But in general, why
smoothies are healthful is that when you blend, this is why I'm
anti-juicing, pro-smoothie, when you actually blend a
fruit, vegetable, et cetera, to put it in a smoothie, you actually preserve the fiber matrix. - Correct.
- And so the fiber remains in the smoothie. So when you're blending a blackberry raspberry apple smoothie,
you're getting tons of fiber, tons of phytonutrients, tons
of amazing healthful benefits. The only downfall I
would say in my opinion is that for weight management,
maybe you're not gonna get as much satiety as you would chewing it, but that's a entirely
different discussion. But I did have to, you know, step in give smoothies a little defense
because you do maintain, the research shows you
do maintain the fiber matrix when you do a smoothie. Now juicing on the other
hand, not beneficial, 'cause you're removing the important parts of the fiber in the pulp. - We all agree on that.
- Yeah. - I wanna read you a statement and you tell me if you agree. Dr. Gundry states, "My research
along with the research of others has shown that
year-round fruit consumption is associated with kidney damage and diabetes among other diseases." - So not only is this
does not bore out at all in human data, it doesn't even, we have multiple levels
of evidence of research that disagree with this drastically. So you could start with the
EPI research, as I mentioned. So prospective cohort research
is where you're observing someone over years and years in time. You're looking 20, 30 years, you're evaluating
someone's dietary intake. And you know, that is only
one level of evidence, right? You can't make every decision
off of nutrition epidemiology. In that one area and
level of evidence we see, as I mentioned, in the higher tertiles of consumption of fruits,
people have less diabetes. This is very well known,
less heart disease, less cancer risk, et cetera. Then you look at the
randomized controlled trials, there's numerous randomized
controlled trials that when you replace a
standard American diet for a diet that's higher
in fruits, vegetables, and fruit included in
that variety of fruits, we know we can reduce diabetes
risk, heart disease risk, cancer risk, et cetera in shorter term, randomized controlled trials. Even my friend Kevin
Hall at the NIH did a, you wanna go to even more
meticulously controlled trial, you look at Kevin Hall's study at the NIH where people went to live in
the metabolic ward at the NIH in two weeks and he did a
really low fat plant-based, and I'm not even a huge proponent
for low fat by any means. I think there's multiple different dietary compositions that can work for people. But he looked at a low fat, 100% plant-based diet,
high, tons of fruits, tons of lectins versus a
a high fat animal base- - Ketogenic diet.
- Ketogenic diet. - I know the study.
- And you know, and he found that when he tightly controlled over two weeks they lived at the NIH, every molecule that they ate was measured, you know, evaluated. And, you know, everything
improved in the low fat arm drastically compared to the keto arm. And it was because they were
eating more fruits, vegetables, and whole grains and you
know, foods like that. So I think that we have
multiple levels of evidence that show us fruit is healthy. And I think the point
you're trying to make is that, you know, we have bigger
fish to fry in the world of unhealthy eating than
fruit being the issue. And I think that unfortunately,
I think that discouraging people against eating
fruit can give people the mixed message that they're, you know, that a food that's helpful for
them may not be as beneficial and then they may even find something that's even less healthy to stick with. - Do you think that could
be a reasonable thing a person can deduct? - First of all, if I have
somebody with kidney failure and they have an elevated uric acid, the first thing I do is
modulate their fruit intake. - Why not meat intake given that- - Modulate their meat intake. - Yup forget, I'm kind of anti-meat. (Belardo laughing) - Well, I'm not necessarily anti. - Well you're not anti meat either. - I'm very much so. - But you said small amounts of meat is- - Small amounts, but-
- I agree, small amounts. - That's why I'm saying-
- I agree. Small amounts of meat too. - I've been going after Neu5Gc
now for a very long time and there's more evidence that scares me to death about Neu5Gc. But back to fruit. So uric acid, I think we would agree fructose is a big driver of uric acid. (Belardo gasping) - Well.
- Fructose, animal proteins, particularly fish and shellfish will drive uric acid. Anyhow, in my patient population, and I'm talking about my patients that I do their blood
work every three months when I reduce their fruit intake, look for other sources of
fructose in their diet, high fructose corn syrup, et cetera, we see their uric acid fall and we see their cystatin C and eGFR based on cystatin C rise. And that to me, and then if we change and allow their uric acid to come back, it'll go the exact opposite way. - How do we generalize what you are doing with a select population of patients? - David Perlmutter did the same thing. He even wrote a book about
it, you know, "Drop Acid." I'm not as strong a proponent of dropping. - "Drop Acid."
- Yeah, cute book, cute name. Only boomers get the joke. It's called "Drop Acid." - But like all of these
things are individual cases versus generalized advice. - This is generalized
advice I give to a patient who I see with renal failure
wanting to stay off dialysis. - But when you write your
book, your book is not targeted to people with renal failure. - Yeah.
- Well even people with renal failure, by the way, I just step in and jump in. So even with people with renal failure, very much can eat fruit. There's actually no limitation. I mean, people with renal
failure may have specific dietary potassium or protein
restrictions at hand. But in general, we know
that all of the cohort data and the RCT data shows
that people are less likely to develop renal failure
if they eat a diet with a variety of fruits and vegetables and whole grains and legumes. So I think the issue
is, is that Dr. Gundry, going back to kind of like
the other dietary group, like the lowfat plant-based,
no olive oil group. I mean, they will say that
they can reverse kidney disease on their exact cohort. I mean, if you had Dr.
Esselstyn sitting here, you know, he'd be saying that he reverse, every single disease you say you reverse
with your dietary plan, he will say he does on a high
lectin zero olive oil diet. And I'm here in the middle
saying that there's a variety of different dietary paradigms
that can be healthful. But we have to get that evidence can't be from an individual cohort. It has to be from a variety
of levels of evidence in order to inform our decisions because your, you know,
anecdotes are, you know, of course they're gonna
be meaningful to you and his anecdotes are meaningful to him. And we've all seen
patients that have improved on a variety of different
dietary paradigms but how we inform our
patients in the general public has to be based on good
sound scientific evidence. - Yeah. I think it becomes more confusing when we start picking
certain biomarkers to look at and nitpicking certain problems. And then we create this
very confusing picture where patients come into my office and say, "I no longer eat fruits because I heard this and this
on Lewis Howe's podcast." And that scares the life out me because every patient-
- Well, why don't you see what happens to their blood
work when they do that? Which is what I do. - 'Cause what they do is
they switch off fruits to Milky Ways per your statement. - I didn't ever tell
anybody to eat a Milky Way. - You say if you're going to eat grapes, you might as well eat a Milky Way. It was actually a Hershey's candy bar. - So if people who eat fruit
in all of the research, how do you explain that if
people who eat more amounts of fruit in all the research
have lower apo b, lower weight, lower risk of diabetes,
lower a high res-CRP like in a multitude of evidence, then how do you explain away it being so dangerous with just- - But wait, wait, wait, wait. Fruit is one of the best
sources for polyphenols. And if you wanna feed your gut microbiome, it turns out that polyphenols are the best prebiotic there is. - But not year round.
- Not year round. Look at the Hunzas.
- Why? But why the Hunzas? - I'll give you a perfect example. We want to change our gut microbiome on a seasonal basis, based on
the food that's being eaten. During the wet season when
the Hunzas just eat fruit and- - But everyone lives in a different-
- They have a really interesting diverse gut microbiome. In the dry season when all
they're eating is meat, their microbiome changes 180 degrees. And I think, and other people think, that change per seasonal was built in. - Perfect. You think it's a theory, but how can we generalize this that everyone should
follow it from this theory? 'Cause it's a theory. - Because that's how we came about. - Well, that's how they came about. But there's people that live- - Well one, they're one of
the last hunter gatherers. - But, Dr. Gundry, if you
talked to Herman Pontzer, do you know Herman is?
- Yeah. - He's studied the Hunzas
probably more than any individual. He's a good friend of mine. I just texted him before our debate today to ask him a few questions. You know, if you talk to
Herman about it, you know, he would never advocate for
seasonal only fruit eating because you know, the
evidence doesn't support that. And he studies the Hunza in great detail because you know, the
Hunza eat the way they do because they are a hunter
gathering population. - They're stuck.
- And we have so much to learn from them. But we live in the United States
where things are ubiquitous and available and we have
data that looks at people who eat fruit year round and shows positive outcomes for every... I mean for diabetes, for
hypertension, for weight, for inflammation, for cancer risk, so- - That's because of the polyphenols. - Right so I feel like
we are circling a bit because-
- Yeah. So it sounds like you agree
that fruit are good for you because of polyphenols.
- Right. There's a whole lot easier ways to get polyphenols than eating fruit. Which is my point. I think-
- What's a whole lot easier way?
- I think fructose is a mitochondrial poison. And prove me wrong.
_-Do you think it's more beneficial
to take your polyphenol supplements than it is to eat whole fruit? - It depends on the season. For instance, I had a cute
little apple a couple days ago that I got at the Santa
Barbara Farmer's Market, four bites and the apple was gone. - Do you think our disease epidemic, our chronic disease epidemic, our disease, our cardiovascular disease,
our diabetes epidemic, the cancer risk, the autoimmune disease, do you think fruit is an issue there? Or do you think that it has
to do with everything else? I mean, 'cause I don't think that it's- - It's our highly processed
food among other things. - Right, agreed. - But a lot of our highly processed food is loaded with fructose. - But that's not fruit.
- But that's different than fruit. - I'm just saying fructose is a problem. And please correct me
if you think fructose is good for you. - It's not about thinking of fructose. I don't wanna take apart an ingredient and villainize the ingredient because that's not helpful in real life. If I start villainizing
individual ingredients, I can't give my patients good guidance that is universally valuable. It's the same way that
any restrictive diet, if you restrict patients
to eating toilet paper, they'll lose weight but it doesn't mean they have a nutritious diet. So when I tell someone
fructose is bad for you, they can get fructose
from a Hershey's candy bar or a grape I'd much rather
they get it from a grape. And fructose can be turned into glucose and the brain works off glucose, and yet too much glucose is a problem. Inflammation can be a very big problem in the intestinal area
causing permeability. We know this, you say this quite often. But inflammation could
also be a wonderful thing. When we exercise, we have
spikes in blood sugar, we have spikes in inflammation. So to generalize saying
fructose is terrible is not a valuable thing
to the general public. Do you see what I'm saying with that? - Yeah, but the problem is fructose is now ubiquitous in our diet. And the more we can
identify where it's hiding, then the better off we all are. - And your proposed
statement is that it's hiding in all these fruits people are consuming. - All these large fruits
out of season. Yeah. - But no one's eating fruits. None of my patients consume fruit. - You can't possibly think-
- I live in California. We eat fruit in California. Sorry. - But in America we talk about... How much fruit is in the
American standard diet? - It depends on where you live. - No, I'm asking about
the American standard diet when we-
- Very little. - So then why are we talking about it? - Because, and even, I'll
give you another example. Joseph Mercola recently has gone kind of on a high fruit
kick which is hilarious because he was one of the
original high fat guys. And he says, "Man, I feel so much better. All I do is eat fruit all day long." - I mean, I don't care what someone says- - Wait a minute. And then he says, "Hey, but wait a minute, I notice that when I'm
really going crazy on fruit, my triglycerides start
going through the roof and my insulin starts
going through the roof. And you gotta be careful." - Well that's also, listen, that's also not a
randomized controlled trial where you're controlling calories, right? - I just don't know what to do with that because it's not generalizable
what Dr. Mercola does or doesn't do with his insulin. - It's not a controlled feeding study where you're looking at, of course if you're increasing calories and you're increasing,
you're gonna make shifts in lipoproteins and you're gonna see a variety of shifts. But overall on balance, when we look at all the data, we know that people who eat, I just don't want your
listeners to be confused that when we look at all of the research, the totality of evidence, people
who eat more higher amounts of fruit consumption on
balance have a much lower risk of obesity, diabetes, hypertension. And that, you know, I don't
think you can honestly sit here and think that fruit is the major problem of our obesity epidemic
or our disease epidemic. You know, it's, just- - Dr. Gundry, I'll
simplify it to a metaphor. It's like we're sitting here and we're saying, "Evidence
shows eating carrots is healthy and carrots are a health food." And you sit here and you say, "But if you eat enough of
them, you'll turn orange." No one's debating that. - Yeah. Carrots are really good for you. - Yeah, I know. But do you see how I'm saying that we say that in general,
this food is healthy, fruits are healthy year round. And you say, "But in some
instances fruits can be bad." Yeah, great. But why say that? - Because if fruits are
picked outta season, they're picked unripe and they're actually loaded with lectins and then we ripen them
when they arrive here. - Are there any times
lectins are good for you? - Oh yeah, there's a couple
nice, really good lectins. - So why are we generalizing
lectins to be terrible? - Because most of them are part of the plant defense
system against being eaten. - But there's many of them that are being researched for good things. - We used to have a great
defense system against lectins in our microbiome. There are bugs that enjoy eating gluten. Most people, they're gone unfortunately. There are bugs that eat oxalate. And interestingly enough, people who have oxalate kidney stones or who are oxalate sensitive, they don't have those oxalate bacteria, eating bacteria in their gut microbiome. If you refoster those guys, the oxalates don't
become a problem anymore. So again, I guess we're
circling back around, the gut microbiome,
which has been decimated by everything we've done is
part and parcel of all this. And getting back to the Hunzas, I think the idea that
maybe we should have shifts in our microbiome on a seasonal basis is built into our evolutionary fiber. - That's a fair theory.
- Okay. - But we have to be humble
enough to say it's a theory. - Yeah. Didn't say it's proven. - That's great. Then would you say that you in
general, villainize lectins? - In general, yeah. In our American diet. - So do you see the problem
with simplifying something as all good or all bad, in healthcare how it
could become a problem? - I started doing this
because I asked patients to eliminate certain
foods out of their diet and let me see what happens
to their blood work. And let me see what happens to their intestinal permeability. - When you were a heart surgeon or practicing as a heart surgeon 'cause you still are a heart surgeon, did you make those recommendations to eat fruits, vegetables,
all those things? - Yeah. - And what do you think the reason for the failure of those patients' diets leading to them coming
back every few years was? Was it A, the fact that
they couldn't stick to it or they didn't stick to,
or they couldn't afford it, or the fact that they ate fruits and vegetables and still got sick? - Well, there's a new paper
out just this past week looking at basically a vegan diet versus a well proportioned- - Chris Gardner's.
- Yeah. - I just read it. - And it turns out the vegan diet did wonderful things in
terms of cholesterol markers, inflammatory markers. The other diet did well, but not anything as good as a vegan diet. Right?
- Mm-hmm. - What's interesting if you actually, if you read the paper is they go, "Yeah, this is all true, but the compliance with the vegan diet is so difficult that it's unsustainable." - And the compliance behind
your yes or no list is easier? - It's actually much easier. 90% of my patients follow that list. - But that doesn't-
- There's a little selection bias there. - Well, they're interested- - That's like saying my
followers watch 90% of my videos. Well they're my followers. Yeah. - Because if their
autoimmune disease goes away, they're really interested. - Or they support what you do and- - They don't support what I do. - What do you mean? They're your patients. My followers watch my videos because they've selected
to subscribe to me. - They wouldn't be my patients if they didn't see a change
in their autoimmune disease. - I'm not saying the
recommendations you make about eliminating
processed foods is all bad. That's not where our debate comes from. In fact, there's so many
things you do very well for your patients that lead
them to have good outcomes. That danger comes in when
we start generalizing as foods as being evil or bad. "Apples are horrible for you." Those statements mislead patients
into making bad decisions because when you say apples
are terrible for you, you're making this statement
from a very knowledgeable position of the polyphenol
change, this change. And you wish that they
were a little bit smaller. The patient hears, "I might
as well eat a Hershey's Kiss." Do you get how that happens? - Yes.
- And that's a big problem because your books are best sellers. - But-
- And then patients go, "I don't want to eat apples anymore." - Great because the apple they're eating is the wrong apple. - That's so hard to say.
- That makes me very happy. - That's so hard to say. What's your takeaway? - My takeaway is that, you know, there's many different dietary patterns that patients can be healthy on. Although there's much
research that informs our recommendations and guidelines, patients have to find
what works best for them and that eating a plant predominant
diet filled with fruits, vegetables, legumes, whole
grains, lean protein. You know, there's a reason
why I believe there's synergy across all of our major
medical society guidelines for cardiology, cancer,
Endocrine Society, et cetera. And in reality, there
is no one perfect diet, no one food in one dose
is going to cause disease. And that it's really
patients finding something that's sustainable and
works for them long term. - I'm gonna say something
borderline controversial. When we talk about leaky gut syndrome, not the concept of leaky gut. Leaky gut syndrome. I feel like patients who have
gastrointestinal conditions, a lot of times have
non-specific vague symptoms. And our healthcare system is
trash at helping those people. - True.
- For many reasons. One, our system is flawed so doctors don't have enough time to spend with their patients to
properly hear them out. Two, we don't have enough research to figure out exactly what's going on so that we don't have
every diagnosed disease already on the ICD-10 classification. And then three, so many of these patients then fall into the bucket of
seeking an answer elsewhere, usually in the form of supplements that are being for sale to them, diets that promise them
solutions to their things that are largely unproven. And as a result, those patients, and why I suspect 80% of your patients are autoimmune patients, 'cause they've been hurt by our system. But that's not because there's
some kind of definitive proof in the solution for all
autoimmune conditions. It's simply because you're
offering them a solution that our healthcare system doesn't have. - Oh, that's absolutely true. Most of my patients in
the autoimmune spectrum have been to six, eight,
10 different centers, different physicians, looking for an answer and not getting it. And that's actually how
they end up in my office. - Do you, like zooming out, do you find it strange that patients that have a GI disorder,
an autoimmune condition, a rheumatologic condition,
go to many GI centers, rheumatology centers don't get help, but then a cardiothoracic
surgeon is helping them? - Not anymore because I actually- - What do you know that the
rheumatologists don't know? - Quite a bit.
- What? - So for instance, all of this comes from intestinal permeability. How do I know that? Because when the intestinal
permeability stops, whatever mechanism you wanna do it, and there are multiple ways
I happen to like my way 'cause it works. When that stops, the
autoimmune condition goes away. - And their rheumatologists
don't wanna help their patients and follow your mantra? - They want to believe in the
system of using a biologic to treat what is treatable with food. - So you're saying a rheumatologist who's went through 15
years of higher education has such strong faith in
other methods of treatments that they refuse to see
the very simple solution that you've laid out? - An example from "The Plant Paradox", a young lady with Crohn's disease who was taken care of by the
head of GI at the Mayo Clinic, who believes that Crohn's
has a genetic component, it has some, but not much, went on my program, resolved
her Crohn's disease, called her gastroenterologist, said, "I'm cured by following this diet." And he says, "That's just a bunch of bull. This is all in your
head. He's a charlatan." She got off the phone, her mother was baking Christmas cookies, she had a couple Christmas cookies, two hours later she was in the bathroom. Severe GI distress. I
talked her on the phone. She said, "Why won't my doctor,
you know, learn from this?" I said, "Look, you can't see
unless your eyes were open." When I met Big Ed 28 years ago, luckily for some reason
my eyes were opened. And for instance, Dale Bredesen from "The End of Alzheimer's" and David Perlmutter, "Grain
Brain" and "Drop Acid". We joke that people from, you
know, the neurology community and the people from cardiology
and cardiac surgery, all we talk about is the gut. Because everything comes from the gut, just like Hippocrates said. And I'm learning that. Remember, sickness is good for business. - Sickness will exist whether or not we follow the Dr. Gundry
diet, do you agree? - Depends. - You're saying you could
eliminate all disease? - Hippocrates believed
it. I see it every day. - Well, I'm not asking Hippocrates. - No, yeah, I think-
- I mean that, just think about the
statement you're making. You're saying you could
eliminate all disease? - Yeah. - I mean, then we're in
the midst of a profit. - Why do you think I keep
working six days a week at my age when I don't have to? Because I get to see these things happen. And the more I see of it,
the more I firmly believe that Hippocrates was right. Just like Alessio Fasano now believes it. - Do you see why I see a lack of humility in a statement where you-
- I get to watch miracles every day, that's why I show up for work. - But so do I. When I start my patient on metformin and their hemoglobin A1C
drops, I see a miracle too. - Yeah, but you're trying to
patch up the underlying cause. - Sure. But my patients don't always
follow the lifestyle guidance. - I like metformin. - But do you know why your patients follow your guidance versus mine
don't always follow mine? - Because usually they're
at their wit's end. - Yes, and because you've
preselected the patients who wanna follow your guidance. - I don't call 'em up.
- No, they call you. They've preselected you.
- Okay. - So if I took your model and then started doing it on my patients, it would not have the same effect. - Let's try.
- Because it's not a preselected, but we have tried it. We've tried it with all the
research that Dr. Belardo, has proven that if you eat
high fruit concentrations, you live longer. Lyon Heart study, you eat
grains, you live longer. And these are all the things that- - No, you get alpha
linoleic acid in your body - And legumes.
- But you also live longer. No one's arguing about the ALA. What we're saying is that you live longer by consuming a high grain
diet in the Lyon Heart study. And you're arguing against those things. - And you live longer if you
smoke in some of these areas. - But it's not because if you smoke, it's in spite of smoking.
- No, you're wrong. - But how?
- You are wrong. - You know, smoking is pro-inflammatory. - Nicotinic acid is one of
the best mitochondrial... - Dr. Gundry, we have to
end this conversation. - The British doctor study-
- Smoking is not good. We need to at least end
with smoking is not good. - British doctors who smoke
have a 30% less incidence of Parkinson's and Dementia.
- Yeah. Because they die of 10
other diseases beforehand. - No.
- Dr. Gundry, I have one anecdote to share with you. I had a patient in residency
who reversed their.... I actually don't like using
the word reverse. Sorry. Put their diabetes into remission, improve their hemoglobin A1C. This was not on the advice of myself. This is just something I observed
that the patient told me. This patient went from eating
just a ton of processed foods, whatever, and went on a
cocaine binge for a few months. Okay, literally a cocaine binge and eating Twinkies candy
bars, but low calorie and their hemoglobin A1C and their high risk
CRP totally normalized. From that anecdote, would we be universally
recommending cocaine and Twinkies as a diet? Of course not. Right? We can't extrapolate from anecdotes. That individual lost a
substantial amount of weight, which is why that happened. In a really negative way. Right? They lost weight because
they weren't eating, because they were using cocaine. That is nothing I would
ever recommend to patients. So a lot of the anecdotes, we can all have anecdotes that we see. I mean, I have patients
that are fully plant-based that go on these really
extremely restrictive diets that improve all of their biomarkers. And the reason why I don't
recommend someone follows a no olive oil, whole
food plant-based diet, even though it's been
recommended by tons of people with tons of anecdotal evidence, is because when you look at
multiple levels of evidence, we know that eating
olive oil can be healthy. We know that eating fruit can be healthy. We know that, you know, all fat is not necessarily
bad by any means. Polyunsaturated fat, incredibly healthy. And so this is why I believe anecdotes, while they're interesting, we have to base our recommendations off of the most robust outcome data with evaluating various
levels of evidence. - Yeah, I was lost when we're saying lectins are pro-inflammatory,
so we should stop eating them and smoking is pro-inflammatory, but it extends life in some conditions. - No, the pro-inflammatory of smoking can be countered by a
high polyphenol diet. Period.
- It can't. It can't. - Well then how do these
guys make it so long? - How does my grandpa who
eats the most unhealthy low vitamin C diet live
to 95 when he smoked? - Yeah, that's what I'm asking you. - Yeah. This is in medicine, we have
to have the humility to say, "I don't know." And my answer to you is, I don't know. And I could state that,-
- But let's find that out. - We should.
- Well, that's why I do what I do. Let's
find out how this works- - But there's a difference between saying, "Let's find out versus I'm
the prophet with the answer." - I'm not a prophet. - But when you say you
could end all disease, that's prophetic.
- No. All disease comes from the gut and all disease can end from the gut. That's all I'm saying. - How does AIDS happen from the gut? - Well, actually there's
some interesting evidence that the microbiome in AIDS patients is totally different.
- Well yeah, because they have a immune disease. - And you can change their microbiome. - How does herpes on the
lip happen from the gut? I mean, some of these, how does a blocked gland in my eye happen? Like we have to be humble here. - Believe it or not, there's
now really cool evidence that hearing loss is because
of dysbiosis in the gut. Period. - When you say really great evidence, I'm curious what goes through your mind. - What goes through my
mind is in the next book. Believe it or not, there's
really strong correlation between mitochondrial
dysbiosis and hearing loss. - There's a really good correlation between ice cream sales
and shark attacks as well, and I found that to be not very valuable. - So why not manipulate the gut microbiome and find out?
- I would, if there was quality evidence, I would. Look, I have a channel here
with 12 million subscribers. I can sell them probiotics
and make a ton of money. I could sell them your probiotics. In fact, you'd probably
sell me your probiotics, I could sell it to my audience and make millions of
dollars and help people. - I'd much rather you sell prebiotics and postbiotics.
- Deal. Okay. - How's that?
- I would sell those to my audience. You think I'm withholding making money, you think I'm withholding helping patients out of principle? - No.
- Then why do you think I'm not selling those things? - Because maybe you don't
believe the evidence that they work like I do. How's that?
- But the evidence that you believe they do is
not based on human outcomes. That's the problem. You just said that you found
some correlational data and it leads you to make
this sweeping recommendation. - Not just me.
- Yes. Not jus you, but you're the person in the room that I'm discussing. - Why don't you read Alessio Fasano, professor at Harvard if
you don't believe me. - I mean-
- Well, it's called authority bias.
- Yeah. I mean, no, I don't wanna
talk to those people because I'm talking to you and we're seeing correlations
and we're seeing mechanisms and we're seeing your theories, which you admitted are unproven. That was your statement from earlier. - They are theories.
- And if they're theories- - Just like the cholesterol hypothesis of coronary artery
disease is a hypothesis. There are multiple other hypothesis. - But it's not-
- Oh, oh, oh. No, no, no, it's not.
- It's a hypothesis. - We know that LDL
cholesterol is causative without a doubt in cardiovascular disease. - But why? - We know that
- Why? - Yeah, we do know why. - Why? - Are you asking like
from like a god sense why? - No, I mean, in other words, what is it about having a high LDL
cholesterol that's so bad for you? 'Cause I have patients, quite frankly, who have LDL cholesterols of 400 and have an absolutely normal CT coronary- - And that is not typical. And that is a very, you were talking about a
unicorn, that is very rare. We know from all the research
of people with actual, with familial hypercholesterolemia, we know that regardless of... We know that there's
factors of metabolic health that lead to increased ASCVD. We know that diabetes increases risk. We know hypertension increases risk, but all of that completely controlled for irrespective isolated, elevated apo b in and of itself causes ASCVD, which is why are all of our- - But most of us are not
measuring Lp-PLA2 levels- - 'Cause it's clinically insignificant. - Well, it is clinically significant. - And the assays are not validated. - It's funny, the
Cleveland Clinic uses it. - Cleveland Clinic does a lot of things that are not evidence based. - I would think they'd be very
interested in heart disease. - Well, I mean, I'm not
aware of any Cleveland Clinic physicians personally that recommend that because it's not in our guidelines because those assays aren't validated and don't have outcomes. But anyway, ASCVD, we do
have an answer to at least, and we at least agree apo b is causative. - We don't have answers for everything. And in medicine you're aware of this. As more evidence comes
out, we update our changes, - Thank goodness. - Like you used to poop in
a bucket as a med student. And now we actually have in Harvard, they freeze dry capsules
in order to deliver these fecal transplants.
- Crapsules. - So we literally will
take what we learned and we update our guidance. And from there we need to have
a strong layer of skepticism before we accept something as a changing of the way we do things. - I completely agree with you. - And I do not feel the
caliber of the evidence that you use to make certain statements reach the level that we
should make generalized claims that apples are horrible,
that smoking isn't bad as long as you have
high antioxidant levels, because those are dangerous
statements to make because they mislead people into thinking that smoking is safe, that apples are bad, and might as well eat a Milky Way. And ultimately I know
that's not what you want. I know you genuinely wanna help people. You want to help people off
of ultra processed foods. You wanna help people
get to a healthy weight, higher muscle mass, lower fat. Those are the things you want. It's the mechanism by which,
we're talking about mechanisms. The mechanism by which you chose to get here is very dangerous. And I'm telling you this because while you're an
expertise with your patients, I'm an expertise at mass communication. I have 25 million subscribers
of people who listen to every word I say and
correct every mistake I make. And I could tell you how your
information very confidently lands with them and it doesn't land in the way you intend to. And I just urge that
in your upcoming books and the speeches that you make, just take that into consideration because when you make statements
like apples are horrible, the worst thing you could
do for your mitochondria is a fruit smoothie, it's
not just taking a little bit of liberty with information. It's truly misleading people to make bad decisions for their health. That's all I'll say.
- In every one of my books, I tell people, "Do not smoke,
smoking is bad for you." But we should learn what
is it in cigarettes- - We should learn.
- That is a factor. - We should learn.
- Of these people who are long-lived, okay?
- We should learn. - That's what I'm saying.
- No one's against learning. - And if you want to raise triglycerides, one of the best ways to do it is fructose. And I happen to think
triglycerides are a real problem in cardiovascular disease and
we might agree about that. - Triglycerides are a
problem, but fruit does not, fruit in and of itself does
not in the whole food form, doesn't raise triglycerides by itself. - And I say reverse juice,
get all the fruit you want, put it in a juicer, throw the juice away, and eat the pulp.
- Well, I agree. At least we all agree... Oh, I love the pulp. We all agree that juicing is a bad idea. - All right. See?
- Yeah. So again, just that's
my only word of caution. Yeah, I think there's a lot we agree upon. I think it's the mechanism
by which we disagree and I hope the audience
got something out of it. Now I appreciate you taking the time to have a critical debate 'cause a lot of people wouldn't
take that conversation. So I'm first and foremost very grateful that you're willing to have this debate.
- Pleasure. - And thank you.
- It was fun. - Dr. Belardo, for the feedback
and all the work that you do with the cardiology
associations across the globe. "Gut Check." We're looking
forward, January 9th. - "Gut Check."
(all laughing) - All right. Thank you
Dr. Gundry, Dr. Belardo. Another popular offender
in this class is goop. Click here to checkout my take down, and as always, stay happy and healthy.