Cardiologist Kim Williams, M.D. Wants To Eradicate Heart Disease

Heart health is serious business. Serious as a heart attack, as the saying goes, given that currently 1 out of every 3 people in America die from cardiovascular disease (CVD) – our #1 killer. According to the American College of Cardiology, CVD currently accounts for approximately 800,000 deaths in US. Among Americans, an average of one person dies from CVD every 40 seconds. Right now more than 90 million Americans carry a diagnosis of CVD. And over 45% of non-Hispanic blacks in the United States live with heart disease. But this isn't just an American problem. On a global level, CVD is the single largest cause of death in developed countries and accounts for 31% of all mortalities. If you take a moment to ponder these staggering statistics, you quickly realize just how vast the epidemic of heart disease has become. And yet there is hope. Because this disease that's debilitating and killing millions annually is entirely avoidable. It's completely preventable. And it's even reversible. The solution begins with personal responsibility. It's about what you put in your mouth. It encapsulates your lifestyle choices. And it extends to erecting systemic changes in our health care model to prioritize prevention over symptomatic treatment. To walk us through these important issues I sat down with former American College of Cardiology president Kim Williams, M. D. — one of the most inspiring, intelligent and pioneering leaders in the growing movement to modernize how we think about, treat, avoid, and prevent our most onerous threat to human health. A graduate of the University of Chicago and the Pritzker School of Medicine, Dr. Williams currently serves as Chief of the Division of Cardiology at Rush University Medical Center, and is board certified in Internal Medicine, Cardiovascular Diseases, Nuclear Medicine, Nuclear Cardiology and Cardiovascular Computed Tomography. In addition to his tenure as President of the American College of Cardiology (2015-16), Dr. Williams has also served as the President of the American Society of Nuclear Cardiology and Chairman of the Board of the Association of Black Cardiologists. Tangential fun fact? Dr. Williams was also a teen chess champion before becoming Illinois' No. 3 singles tennis player at 15 years old with no previous background in the sport. Faced with a choice between pursuing professional tennis or medicine, he chose medicine. Back in 2003, Dr. Williams became concerned that his LDL cholesterol — the kind associated with an increased risk of heart disease — was too high. After some research into the positive benefits of adopting a plant-based diet, he decided to give it a shot. It worked, bringing his LDL down to normal levels. He then began prescribing his nutritional protocol to his patients. That worked too. Then an interesting thing happened. Dr. Williams became president of the American College of Cardiology, a 49,000-member medical society that is the professional home base for the entire cardiology profession. This gave him a broad platform of authority to advance awareness and the legitimacy of a plant-based diet as both a treatment and preventive protocol for heart disease. Today we unpack his story and probe the science, economics and politics behind nutrition and cardiovascular health on the road to avoiding, combating and ultimately overcoming America's #1 killer. Peace + Plants, Rich Learn more about your ad choices. Visit podcastchoices.com/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Rich Roll?

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• 0:44Rich Roll?

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• 1:05Speaker 01

  Everyone's going to get older and they're going to pass away at some point. Wouldn't it be nice if we were as healthy as possible until that happened and not have these chronic diseases that are completely avoidable? Almost everyone has had a family member who suffers from heart disease, or has had heart disease, or has sudden cardiac death. And so, just trying to get them to understand that there is a relationship between your lifestyle and your outcome. Just make that connection. If we can do that, we would all be so much better off.

• 1:34Rich Roll?

  That's Dr. Kim Williams, this week, on the Rich Roll Podcast.

• 1:49Rich Roll?

  The Rich Roll Podcast.

• 1:52Rich Roll?

  Greetings, everybody. How you guys doing? What is the latest? How are you feeling? Happy belated Halloween. Hope you got through it. Hope you had fun. Not too much fun, though. Hopefully, not too much candy, not too much high fructose corn syrup. In any event, my name is Rich Roll. Welcome or welcome back to my podcast, the show where I go deep, I go long with the most interesting people I can find to bring you compelling conversations, compelling conversations about things that I think matter. Personal health, interpersonal health, planetary health, emotional health, spiritual health, and in the case of today's guest, cardiovascular health, heart health. And this is serious business, people. I mean, really serious.

• 2:34Rich Roll?

  Serious as a heart attack, as the saying goes, not just figuratively, but I think quite literally, in fact, given that one out of every three people in America die from heart disease, our number one killer. And what's really interesting is that at the beginning of the 20th century, heart disease was a really uncommon cause of death in the United States. It wasn't until mid-century that it had become the most common cause. Currently, according to the American College of Cardiology, cardiovascular disease, CVD, accounts for approximately 800,000 deaths in the United States. And among Americans, an average of one person dies from CVD every 40 seconds.

• 3:15Rich Roll?

  More than 90 million, 90 million Americans carry a diagnosis of cardiovascular disease. And over 45% of non-Hispanic Blacks live with CVD in the US. And this is not just an American thing. Outside the United States, on a global level, CVD is the single largest cause of death in developed countries and accounts for 31% of all deaths globally. So let's just stop there for a minute. Let's pause and actually ponder these statistics. I mean, when you do that, it's quite staggering. I mean, it is an absolutely insane epidemic. And yet...

• 3:56Rich Roll?

  Here's the thing, it's entirely preventable, it's avoidable, and it's even reversible with some basic diet and lifestyle changes. And this solution starts with what you put in your mouth. It's about how you move your body, it's about your lifestyle choices, and it extends to erecting systemic changes in our healthcare model to prioritize prevention over symptomatic treatment. This has to change, and we have to change. Unless you want to be that one out of every three, it's really imperative to take personal responsibility for our diet and our lifestyle choices. And these are decisions that they just can't wait. They have to be made now.

• 4:41Rich Roll?

  One of the most inspiring, intelligent, and pioneering leaders in this growing movement to change how we think about, how we treat, how we avoid, and how we prevent heart disease is none other than the outgoing president of the aforementioned American College of Cardiology, Dr. Kim Williams. Dr. Williams is a graduate of the University of Chicago and the Pritzker School of Medicine. He currently serves as chief of the Division of Cardiology at Rush University Medical Center, and he's board certified in internal medicine, cardiovascular diseases, nuclear medicine, nuclear cardiology, and cardiovascular computed tomography. Don't ask me what that means, but it sounds impressive. In addition to his tenure as president of the American College of Cardiology,

• 5:26Rich Roll?

  where he served between 2015 and 2016, Dr. Williams has also served as the president of the American Society of Nuclear Cardiology and chairman of the board of the Association of Black Cardiologists. This is an extraordinary conversation with an amazing human being, and I got a bunch more I want to say about Dr. Williams and the extraordinary conversation to come, but real quick.

• 5:58Rich Roll?

  Okay, Dr. Williams. This is somebody I've wanted to have on the show for a long time, a number of years, and I was finally able to make it happen during the recent International Plant-Based Nutrition Healthcare Conference in Anaheim, where we were both keynote speakers, tracked him down, held him hostage, and we got it done. And what is really cool about Dr. Williams, perhaps unique and compelling, at least compelling to me, is that Dr. Williams himself became a vegan in 2003 because he was concerned that his LDL cholesterol, the kind that's associated with an increased risk of heart disease, was too high, a cardiologist with high LDL. So he adopts a plant-based diet. It works. He starts putting patients on a plant-based protocol.

• 6:43Rich Roll?

  That works. He begins writing about it, including a piece on MedPage Today. That's something that doctors read, and that kind of went viral, at least for that subculture, that community. Then he becomes president of the American College of Cardiology, which is a 49,000-member medical society that is basically the professional home base for the entire cardiology profession. So here we have a plant-based guy, a vegan, as president of the ACC. I mean, that's kind of a big thing, and that really helped to raise awareness around plant-based nutrition as a legitimate preventative protocol for cardiovascular disease in the eyes of at least the traditional medical establishment.

• 7:26Rich Roll?

  In any of that, this is a great conversation. It's a conversation that goes deep into the science, the economics, and the politics behind nutrition and cardiovascular health. We cover all manner of topics, including the politics of industry influence on available information and clinical studies. In other words, who's behind what's being said and who's trying to hide the truth. We dig into the contributing factors behind cardiovascular disease, including heme iron, and we address a few popular myths around cholesterol and the various forms of saturated fats. We talk about sugar, high fructose corn syrup, and their damaging effects on heart health. And we talk about how we can do better, Dr. Williams' efforts with the ACC along with

• 8:09Rich Roll?

  others to help the public make healthier choices, how to avoid an unhealthy plant-based diet, the benefits of a whole food plant-based diet on heart health, and the hows and whys behind Dr. Williams' personal choice to adopt a plant-based lifestyle about 15 years ago. And it's just a great conversation. It's super powerful, and I truly believe it's potentially life-saving. So with that, I give you Dr. Kim Williams.

• 8:42Rich Roll?

  All right, you ready to go?

• 8:43Speaker 01

  Absolutely.

• 8:44Rich Roll?

  All right, let's do it.

• 8:44Speaker 01

  Okay.

• 8:45Rich Roll?

  Dr. Williams, it's a pleasure to finally meet you. Thank you for carving out the time to talk to me today.

• 8:50Speaker 01

  Certainly my pleasure.

• 8:51Rich Roll?

  Is this your first time at this conference, or have you presented here before?

• 8:55Speaker 01

  I actually have presented, you know, a couple of years ago, and then I think once before that.

• 9:00Rich Roll?

  Uh huh.

• 9:00Speaker 01

  This is wonderful.

• 9:02Rich Roll?

  I only got in last night, so I missed your talk yesterday. Sorry about that.

• 9:06Speaker 01

  No problem.

• 9:07Rich Roll?

  What was the, what was the specific subject matter that you spoke about?

• 9:10Speaker 01

  So what I normally talk about is heart disease and dying. And in the past, I've always talked about sort of vegan diet versus vegetarian versus pesco vegetarian versus eating real like, you know, beef and pork and the like. And what does the data show? How is processed red meat worse than red meat, which is worse than chicken, which is worse than fish, which, and it's sort of the hierarchy of cardiovascular

• 9:38Rich Roll?

  Right.

• 9:39Speaker 01

  effects. And this one is actually, was going to be a fair amount of that from other people. And so what I proposed to the plantarian folks got stalled would be that I actually talked about sugar, because there's just so, we're accumulating so much more data on sugar.

• 9:56Rich Roll?

  Mm hmm.

• 9:57Speaker 01

  Probably the linchpin, even though there's data out there before, the linchpin was an article in the Journal of American Medical Association last year that showed that the Sugar Research Foundation had actually paid some researchers, the influential people, to Turn attention away from sugar for cardiac disease and towards saturated fat. Of course, that was a good target, but it left lots of us, people doing plant-based nutrition, eating a high amount of sugar, thinking it grows in the ground, it's okay, doesn't have a mother, doesn't have a face, and fits our criteria, when it turns out that the data was actually pretty damaging.

• 10:40Speaker 01

  Well, now, there's actually been a fair amount of sugar research and correlation with everything, all the things that you would want. There's a good mechanism, that is, the sugar increases your insulin levels, insulin increases plaque, insulin resistance makes it heap up on itself, and the next thing you know, you've got sugar addiction, and you've got a lot of sugar marketing. And I then spoke about the sort of the politics, economics, the fact that our country actually does have congressional support for farm subsidies for production of high-fructose corn syrup.

• 11:20Speaker 01

  And so, we pay them with tax money to produce things that make them inexpensive so that we eat them more, which increases the amount of disease, which we then pay for with our Medicare system.

• 11:33Rich Roll?

  Right.

• 11:34Speaker 01

  And it's really a circle that needs to be broken. That was actually pointed out to me by one of the Oregon congressmen. I had no idea until a couple of years ago that this was going on.

• 11:41Rich Roll?

  Oh, it's a huge problem. It's a huge problem, and the repressed pricing of these types of products, including all the processed snacks, et cetera, tend to disproportionately impact the lower socioeconomic strata of our culture, further, you know, further, further creating, you know, exaggerating the divide between the haves and the have-nots, and, you know, these people end up getting more and more sick and more and more dependent.

• 12:14Speaker 01

  You did that well, you could have given my talk. So, I did talk about that. I talked about the SNAP program, healthy foods in hospitals. How we need to change a lot of things, but the SNAP program has really been sort of the safety net for people. And there was an article published just a couple hours before my talk that I was able to fit in there, talking about the important, how having a SNAP program, that is, having access where you could actually go to a grocery store and buy some decent food, actually decreases healthcare costs by $1,400 per person per year. That's incredible numbers.

• 12:47Rich Roll?

  And what is the current scope of how you can spend those SNAP dollars? Because I know traditionally, it didn't apply to healthy produce, et cetera. Although I was doing a podcast with, I think it was Dan Buettner, the other day, and he was saying that you can now use SNAP dollars at your farmer's market. Is that true?

• 13:02Speaker 01

  We, well, as far as I know, but, but the other side of it is what we've been after. That is, we, meaning the American College of Cardiology and the American Medical Association, actually passed a resolution pushing Congress and regulators to change the SNAP program so that you cannot buy unhealthy foods and to try to make preferences. And so we, we, I think people are starting to understand the impact of diet on our society. And the more data we accumulate, talking about healthcare costs and the food choices that we make, the better off we're all gonna be.

• 13:36Rich Roll?

  Yeah, I think it's, I think it's happening. I mean, certainly, there's a tremendous amount of work to be done that remains, of course. But let's go back to the sugar thing for a minute. You know, I think we as human beings are reductionist by our very nature, and the scientific method is reductionist as well, by necessity, I suppose. But we always want to look for, you know, that one evil culprit. Like, it's the sugar, it's the saturated fat, it's the this, it's the that. And that's what we should be sort of marshalling all our attention and resources towards. But obviously, you know that this is a incredibly complex matrix of many factors that come into play that contribute to things like heart disease.

• 14:17Rich Roll?

  So when you're thinking about sugar and when you're thinking about saturated fat, like, how do you explain these ideas to the patients that come to see you?

• 14:28Speaker 01

  Well, there's, first of all, there's certainly a lot of data that's impugning and supporting saturated fat, and this is a big fight that people are having.

• 14:37Rich Roll?

  Right, I want to get into this, too, so.

• 14:39Speaker 01

  It would be great, but the interesting thing about it is that when you're talking about saturated fat, or you're talking about cholesterol, or the new bad kid on the block, heme iron, that is iron that should be good for you, except it came in a form of a red blood cell, and it's very toxic to your blood vessels and making heart attacks, stroke, and death.

• 14:59Rich Roll?

  And this is the iron that is contained in animal products?

• 15:01Speaker 01

  In blood, exactly, exactly right. And so it turns out that you've got all these candidate genes, if you want to call them that, for what is actually causing so much of the differences between plant-based nutrition and the standard American diet, for example. But none of those things I just mentioned are actually taken in isolation. Sugar, absolutely. I mean, you're putting it in tea, you're putting it in coffee. The data on tea is good, the data on coffee is even better, but you're putting in, once you put sugar in it, and you're doing it in high amounts, which some people do, you're actually increasing everything from blood vessel inflammation to atherosclerotic plaque. And so that's the one distinction, and that is, it's really difficult to cull out saturated

• 15:46Speaker 01

  versus polyunsaturated versus monounsaturated. And if you're overweight, maybe you really shouldn't, and if you are running and healthy and athletic, then you probably can tolerate more, because you're going to burn it as fuel. But sugar is probably not good for us under any circumstances.

• 16:05Rich Roll?

  There's an idea out there that there's no distinction between refined sugar and the sugars that you find in fruit, for example. So can you speak to that? Is there a difference in how we metabolize these things and the health impact? When you're talking about sugar, what are you talking about specifically?

• 16:22Speaker 01

  Well, if I can borrow a term from you, reductionism. You know, we have to think of these things in the absence of like prospective trials. We think of them in terms of mechanisms. And so what I, in preparation for this talk, said the bad guy here is insulin. We know that people would get, when they get central obesity, they get insulin resistant. Their insulin levels are very high and it's promoting more and more plaque. And therefore, that's the thing that I would like to control is the insulin level. And so that's, I took the fruit sugar, fructose, the usual blood sugar that we have, glucose. Sucrose, of course, is the table sugar. That's the combination of glucose and fructose.

• 17:04Speaker 01

  And let's see, what happens when you have a dose of this and increasing doses of it? What happens to your insulin level? And I was able to find a manuscript that detailed all of this. Over time, you take, you know, 50 or 25, 50, 100 grams, see what happens. And, but they did an interesting thing. They actually had a fourth thing in there and it was actually white bread. And the insulin levels with all four were about the same. And so the idea that refined carbohydrates, refined grains are pretty much as bad as sugar is pretty much true as far as your pancreas is concerned and production of insulin.

• 17:44Rich Roll?

  Right. And, and with respect to, when you were talking about that, it made me think of a conversation that I had with Dr. Neil Barnard. He was very adamant that we should be looking more at the fat intake in our diet and the impact of that when it comes in the form of animal products in our diet and how that relates to the onset of type 2 diabetes rather than all of this focus on sugar. So how do you think about that? Or do you have a different point of view on that than Dr. Barnard?

• 18:18Speaker 01

  Well, so Neil's a very smart guy. He reads a lot and I try to read as much to catch up with him. But the fact is that I think that they're both bad. We actually, that article that I mentioned, if people look it up, the Sugar Research Foundation, Sugar Industry, in the Journal of American Medical Association. There was actually an accompanying editorial that had this one graph that everybody should see. It's country by country. Cardiovascular disease mortality on the one axis and a dot for sugar and a consumption per capita and a dot for saturated fat and the two of them for every country.

• 18:58Rich Roll?

  They're in lockstep.

• 18:59Speaker 01

  They're in lockstep. It was Japan at the lowest, United States at the highest and all these countries in between. So I'm not sure that we need to make a distinction. I think we just need to find out all that we can about each element that's not good for us, whether it's heme, iron, or sugar, and then try to avoid them.

• 19:15Rich Roll?

  Right. I mean, looking at that from a correlative point of view, it's hard to parse the distinctions between them, right?

• 19:22Speaker 01

  That's right.

• 19:23Rich Roll?

  From a scientific perspective. Well, I think, you know, the average consumer right now, you know, we're in an interesting time. There's so much information available to everybody, you know, with all of our devices, et cetera. But I think it's also never been more important that we become more discerning about the sources of the information that we consume. And there are a lot of vested interests out there that are heavily invested in making sure that you remain confused. And it is confusing unless you're someone like yourself who's really mining the data and, you know, rolling up your sleeves and really trying to understand what's going on out here. You can go online and you'll

• 20:05Rich Roll?

  see, oh, it's sugar. Oh, it's fat. Oh, it's this. Saturated fat is back. You know, all this discussion about saturated fat and heart disease is nonsense. And now we know that saturated fat has no impact on arterial cholesterol, you know, levels increasing, all of this. So can you just help me make sense of this for the listener who's just trying to like make better choices?

• 20:30Speaker 01

  Well, it's not easy. You know, I recall several years ago, 14 years ago, when the portfolio diet came out.

• 20:41Speaker 01

  Which is David Jenkins, it's a marvelous work and again, Journal of American Medical Association, so not vegan propaganda rag, I mean, this was a peer reviewed, high quality manuscript, and it talked just about inflammation and cholesterol, your LDL cholesterol and your C-reactive protein. What is the response to a statin versus a plant-based diet? Wonderful article. And I figured that after you saw that the LDL cholesterol, the bad guy, goes down dramatically within two weeks with both the statin and the diet, the plant-based diet, and it had

• 21:22Speaker 01

  almonds, it had plant sterols and soluble fiber, et cetera. And then you looked at the inflammation, and they both went down, but the plant-based diet lowered it faster than the statin did, okay? I figured that that would capture everyone's imagination, sure, it's biochemical, it's not outcomes, heart attacks, stroke and death, but it's pretty important. Well, the response was actually not as much as we would like, and one of the reasons was that at the bottom, you could see that it was supported by the California almond industry, and part of the diet was to do three handfuls of almonds every day. Doesn't mean it wasn't right, I'm sure it was right, I think that Jenkins is a wonderful

• 22:07Speaker 01

  guy, but it was a good lesson to me, early on, to try to stay away from industry influence as much as possible. Right. And so we have had, just what you're saying, confusion. If I were going to pick one, I'd be concerned about the Egg Board and saying that cholesterol is not a nutrient of concern, which actually came out in the Dietary Guidelines for Americans early in 2015. We were able to show them, that is, Health and Human Services and the USDA, who sort of partnered together to put that document together and run the dietary advisory group.

• 22:48Speaker 01

  We did get them to change it. We showed them all the literature. Neil Barnard was very helpful there. But you're realizing that you've got to have science that's pure, that's independent, so that no one's vested interest. It's interesting. Everybody asks me, well, when is your book coming out? And that's one of the reasons I don't want to. I mean, there's plenty of books out there, A, great books, and the other is I never want somebody to say that I have a vested interest other than my own.

• 23:13Rich Roll?

  Right. You're just trying to show books.

• 23:14Speaker 01

  Exactly. Never that. It's always going to be about my patients, about my family, about my country. And that's what it's about.

• 23:22Rich Roll?

  Yeah. Well, I think, you know, first two things. First of all, that was quite a victory for the ACC when you were president, right? Getting the, you know, getting those nutritional guidelines shifted with respect to cholesterol. So, you know, thank you for that.

• 23:35Speaker 01

  I left out the punchline. The bottom line of, in the document, it actually says, which is a quote from the Institute of Medicine, not ACC, it said that people should eat as little cholesterol as zero. Oh, I'm sorry, a little class of cholesterol as possible, which of course I interpreted in my brain, as I just did, as zero, which means you pretty much have to be a vegan, because there's only, you know, how many animal products don't have cholesterol? I think egg whites, jello, and honey. That's about it.

• 24:03Rich Roll?

  Right. Well, let's talk a little bit about, I mean, the second point I was going to make was that, you know, we're in a capitalist society, and, you know, it costs money to perform this research, and somebody's got to pay for it, right? So, aside from grant money, or however else, you know, these studies get funded, industry is sitting there, you know, willing and ready to fund these things. And that comes with its whole, you know, bag of compromises, obviously. But to see our way forward, I mean, do we need new ways of funding these studies? Like, how can objective studies get performed?

• 24:43Rich Roll?

  In a way such that they're not compromised by industry interests.

• 24:50Speaker 01

  A lot has occurred over the last few years. The development of data safety monitoring boards, for example, where people who are completely independent of the study, they are paid by industry, which is a funny thing because they're paid to block them if things are going badly in the study. And yet, that's considered a relationship with industry. It was something we ought to think through, I think. But we also have clinicaltrials.gov, where if they're going to do a big clinical trial, they should submit it, everyone can review it. And so there's more of a truth than there was before. If I could point to one issue with the industry-sponsored trials in the past, and it's really not just industry, it's all of us,

• 25:35Speaker 01

  is the positive publication bias. We see, for example, hem iron. Suppose there were five investigators out there, and four of them found that there was no relationship between hem iron and heart attack, stroke, and death, and one of them did. The four, if they submit it as a negative study, it may not get published because it's not scintillating. But also, us as investigators, when we do a negative trial, we say, "Oh, well, that didn't work," and we move on to the next thing. They might not even submit it. Whereas the one that found the relationship, they're going to publish it. So it brings up the whole question of this positive publication bias really brings up the question of all of the things that we're doing

• 26:19Speaker 01

  and why we would like to have large, prospective, registered, randomized trials. So since that's been happening, we actually are getting data in pretty much every area. Everyone knows the acronym for the trial, and you will wait for the results. You have a presentation on what the methodology is, and then two or five years later, you get a big result, and it's positive or negative, and everybody knows about it now. So that, I think, has been an improvement, and it mitigates the industry influence because they can't cherry pick what's going to get published and what's not.

• 26:56Rich Roll?

  Much ado has been made in, over the past year about this idea that saturated fat is back. Lots of articles being written about everything you thought about saturated fat is wrong. We don't need to worry about this anymore. It's your new best friend. Knock yourself out with bacon and eggs. So when you read that, when you see that, what, what happens with you?

• 27:19Speaker 01

  So, there's so many responses, but I'll try not to recap too much of what I said already, but just like a couple of highlights. One is, we just don't take the Crisco. Put it in a pan, heat it up, and then drink it. Okay. So whenever we're getting saturated fat, it's with something else that probably isn't good for you. And it might be hem iron, it might be cholesterol, it might be just animal protein itself, and it's, you know, the fact that that promotes cancer growth. So, we have to take everything. I started to say with a grain of salt, but that might not be the best thing to do either. But we have to try to look at the research that, you know, that what they're really doing typically is, is doing food frequency questionnaires, and then analyzing the components of what

• 28:04Speaker 01

  people said they ate, and then trying to correlate that with outcomes. And that is just very difficult. You're making several assumptions along the way, and you're not really capturing the, the whole team of things that are potentially damaging. And so to pick out each one and then get reliable results every time may be difficult. So the best example, I think, is the PURE trial. And that's the one that everyone's talking about. Slim Youssef is a good friend of mine, and, you know, we happened to be at a dinner at the European Society of Cardiology, and the day that his article came out, I sat and talked to him for a while about this. And my concern is that you really weren't capturing the vegetarian population, which meant that you were actually comparing

• 28:46Speaker 01

  Things that were not healthy necessarily from one population to the next and then nineteen different countries and that is not, not the same kind of fat that we're getting in the United States. Okay, so, you know, he had, he defended it well. He said there were some small vegetarian populations in the nineteen countries, but they don't overwhelm the data. So my, my biggest concern about the peer trial is that, and I probably should have, I might run it by him the next time I see him, is they actually did a pretty darn good job of categorizing the fat, saturated, polyunsaturated, monounsaturated, but the carbohydrates were not characterized that I could find it anyway. I bet he has an appendix

• 29:29Speaker 01

  somewhere where he can explain that because, just as you know from my interest in sugar, carbohydrates are not all carbohydrates. And so when you're talking about complex carbohydrates that are not going to drive up your insulin levels, you're probably doing something that you, you can burn as fuel. It's not going to be, you know, anti, it's not going to be inflammatory. It's not promoting a rise in your cholesterol and increasing plaque formation. That is completely different than having a sugary, refined flour type of body response. And so it wouldn't surprise me that saturated fat falls second to carbohydrates if they're refined carbohydrates in terms of the damages that they can do. Right.

• 30:13Speaker 01

  And so we really need to have good comparisons of healthy foods. So none of that was talking about whole food, plant-based diet. And the last comment is, I borrowed, I think from Juliana Hever, you probably know who said it. Sure, I know, yeah, yeah. Tell me who said this originally, but the fat you eat is the fat you wear. That is such an important concept that, and I know the American Heart Association did a wonderful job, by the way, a few months, I think last May, of doing a presidential advisory where they reviewed all of the available literature on saturated fat and came to the conclusion that you really shouldn't eat it, based on the literature. They also actually made a slightly controversial statement, which was that you

• 30:54Speaker 01

  probably shouldn't eat coconut fat either because that has so much saturated fat in it compared to other vegetables. And I know they got a lot of pushback from it. I know they're, and it's interesting that the presidential advisory was one guy, Dr. Stephen Hauser, who's a wonderful guy, and then John Warner, who took over as president, sort of got the blame just because of the timing that they switched in. So, but you know, what can you do about that? They have the right to review all of the literature and make an expert opinion and say that that's what it is. It's an expert opinion. Nothing definitive. And all that does is invite us to do studies. And if there are people, I know David Katz thinks at Yale thinks that coconut oil is really good. I don't have enough data to

• 31:37Speaker 01

  make a conclusion myself. Let's do some trials and come up with whether or not it's damaging or not.

• 31:44Rich Roll?

  Yeah, I think a lot of people would like to know the answer to that. I mean, what I, my understanding, and correct me if this is incorrect, is that the saturated fat in coconut oil is comprised in large part by lauric acid, which is a more easily metabolized version of saturated fat, a more readily available source of energy burning fuel versus the sat. So there's different kinds. There's not just one saturated, there's different kinds of this, right? Like, this is not clickbaity stuff. Like, you got to really, you know, dig into it and understand that this is highly nuanced. And you devoted your whole life to this.

• 32:26Speaker 01

  Well, this part is, I'm much more of a nuclear guy. So I thought I was going to spend my life doing cardiology and nuclear physics at the same time, and now I'm in nutrition. But I am a fan of all of that. And yes, the AHA report actually goes into that and talks about something that I didn't know, that the fat you eat is the fat you wear, but more so if it's animal fat. That is the vegetable saturated fat for the reasons you said, that shorter chains, there's less calories in it. So it actually is better for you. But is it good for you? That's the question. And that we don't know.

• 32:56Rich Roll?

  Yeah, interesting.

• 33:04Rich Roll?

  So you are the outgoing president of the ACC. There was a one-year tenure?

• 33:10Speaker 01

  Yep, 2015 to 2016, so.

• 33:13Rich Roll?

  So let's talk a little bit about that organization and what the kind of mission statement and purpose of it is and what your goals were during that period of time. And other than what we already mentioned, what was accomplished?

• 33:28Speaker 01

  Well, it certainly is a growing organization. It is dedicated to making sure that people do better in terms of their heart health. So the mission actually is to improve heart health and transform cardiovascular care. And the two go hand in hand. What we really are meaning is to try and add more members, add more member varieties. And so we have 53,000 members or so right now. It used to be cardiologists. Now it's, then it became cardiologists and nurse practitioners. And then it became pharmacists. Then we started doing international. And so anyone who's interested in improving heart health and is part of the team. And we work right now on a lot of issues

• 34:13Speaker 01

  that are facing the cardiovascular field. Prevention is one of them. And so I would say that during my year, we focused a little more than we had in the past on population health. It was interesting to have meetings on population health, have experts come from all over to Washington DC, to the heart house, and discuss how we can make things better. And it's, you know, everyone's sort of looking kind of, you know, out of the corner of their eye saying, "Why are cardiologists trying to decrease their income?" Just because we feel like this is our job.

• 34:45Rich Roll?

  Isn't that the core goal here? I think you said, I saw a quote from you, like, "My job is to put cardiologists out of business."

• 34:52Speaker 01

  That's exactly right. And, you know, it would take a while. And I have to say that it's timely. It would be great if other organizations were focused on these things as much as we do because, and, you know, inside and outside of medicine. Because last year was the first time in 40 years that cardiovascular disease deaths in the country went up. And that is just something that we just can't abide by. And you know, they've we're always bragging about this decreasing curve, about 50% over 40 years in cardiovascular mortality. And it's bypass surgery and statins and beta blockers and all these medications for heart failure and decreasing sudden death because we put in defibrillators that shock

• 35:33Speaker 01

  people when they when they have a fatal arrhythmia and they come back to life. And we were so proud of all this stuff. And then the American population somehow has overcome.

• 35:44Rich Roll?

  An end run around this, no matter what you do.

• 35:47Speaker 01

  Exactly. And when the CDC put those numbers out there, they said it was obesity and diabetes that's driving it. And that's a nutrition. And so at all, the fundamental issue that we've been dealing with for the last so many years is really at the core of all we do. And it will uproot and undo any success that we can do with devices and medications.

• 36:11Rich Roll?

  Yeah, it's got to be a shift in priorities and focus because it is amazing to reduce by 50% the mortality rate of people who are suffering from heart disease as a result of all this amazing science and technology. But if that comes at the cost of really addressing the fact that the incidence of people who are, you know, becoming patients in the first place, then you're waging a losing war.

• 36:39Speaker 01

  Yep. Ultimately, yeah, everyone's going to get older and they're going to pass away at some point. Wouldn't it be nice if we were as healthy as possible until that happened and not have these chronic diseases that are completely avoidable by lifestyle?

• 36:56Rich Roll?

  Yeah, I mean, we need to be talking about prevention and we need to be creating systems that promote prevention. I mean, we're seeing it with the rise of functional medicine clinics and doctors who really are up to speed and paying attention to these things. And but, you know, it's tough when we have a structure that's set up that allows well intentioned doctors only 15 minutes with a patient and they're incentivized to just diagnose and prescribe and move on to the next thing. Like, we're never gonna, you know, crack the code.

• 37:24Speaker 01

  That's right.

• 37:25Rich Roll?

  Until we really get to the core of how the whole, you know, system functions.

• 37:30Speaker 01

  That's right. Getting back to what the college does, the population health is just one small aspect. We actually are a global organization. We have forty chapters, international chapters, where a chapter can be formed whenever there's members who have attained a high level of proficiency. They're called fellows of the American College of Cardiology. If you have twenty fellows in any area, you can have a chapter. And then that has a governor, which then participates in the governance of the college. No taxation without representation, right? And so it turns out that we have collectively learned a lot. You know, we have, our members

• 38:12Speaker 01

  in Lebanon, for example, are dealing with smoking in very young people, heart failure in Brazil, and it's not just the Chagas disease infection that people can Google and say, oh, my gosh, this people get an infection, their heart, you know, disappears. They also have hypertension at a high rate, the diabetes in Mexico, and then the obesity in the United States. And we can all learn from each other about how to improve outcomes. So the international mission, I think, is key to success for us. We also do a lot of hospital accreditation in terms of making sure that if you're going to go in for an angiogram, you're going to a places that knows what they're doing, and they've demonstrated it. And probably our

• 38:55Speaker 01

  biggest product nowadays is the registries, the National Cardiovascular Data Registry, NCDR. It collects information on all the important diseases. You have a defibrillator, are your people putting in defibrillators when they need it? If you have atrial fibrillation, are you getting the right medication for it? And so a lot of disease management. So with that, you would think that we cover the globe, literally and figuratively, literally and geographically, and as well as figuratively. But we do feel that all of these things should be reduced. And we're managing things that can be prevented. And so let's continue to

• 39:38Speaker 01

  focus on that, and we'll try to continue putting that influence out there.

• 39:42Rich Roll?

  Right, very good. And was the, was your presidency, is that like an appointed thing or an elected thing? Like, how does that, how did that work?

• 39:49Speaker 01

  It actually is an election.

• 39:50Rich Roll?

  Election.

• 39:51Speaker 01

  But it's, it's an election by a nomination committee that reviews all the people who are applicants, who have been leaders, who, and it's, in my case, it was other people asking me to run.

• 40:02Rich Roll?

  Uh huh.

• 40:02Speaker 01

  And I'm saying, I don't know if I can do this. Just, just physical.

• 40:06Rich Roll?

  Politician.

• 40:07Speaker 01

  Well, the politics was fine, actually. You know, there was a time when I was very much interested in the political side. I've been an advocacy person for a while. Always going to Congress, talking about how to improve outcomes for everything and, you know, like hospital food, that's one of our, that's the thing we're on right now. Let's legislate that hospital food has to be healthy. And we actually got that through the American Medical Association. So I know I'm tangenting here.

• 40:35Rich Roll?

  Thank God.

• 40:35Speaker 01

  But to give you an example.

• 40:36Rich Roll?

  Yeah.

• 40:36Speaker 01

  And the, it was such an impressive outpouring. We were a little nervous as the college. It was actually Neil Barnard who was, who started it when the, in the Washington DC chapter of the AMA. And, you know, we had, there were people at the college who were nervous that, you know, we're going to step on everyone's toes. But ultimately, we went on ahead and supported it and pushed it and.

• 40:58Rich Roll?

  What's the resistance to that?

• 40:59Speaker 01

  So the issue is that you're going to make an enemy somewhere. And so you're always looking for unintended consequences. It's politics in a way.

• 41:07Rich Roll?

  Right.

• 41:07Speaker 01

  Okay. And suppose, for example, and I don't think this would happen, but suppose, for example, the American Hospital Association said that, you know, the, this, you know, this program you're doing is disenfranchising our hospitals. Therefore, we're not going to use any more ACC products, which is then going to hurt our patients. Okay. So, I mean, so you.

• 41:28Rich Roll?

  Right.

• 41:28Speaker 01

  You're trying to balance everything. And so, but at the end of the day, you realize that it's just the right thing to do, you know? And damn the torpedoes, we're going to go ahead. And so, so I, you know, along with Neil and I thought we were going to be alone at the microphone. And sure enough, AMA delegates were lined up outside the door, trying to talk about the, the ravages of the hospital food. Now, there, most of them were actually plant-based. All of them were concerned. Cardiologist coming up to the mic saying, "I just put a stent, I just put three stents in this person, I'm bringing them back to the CCU, I come around on them and you've given them bacon and eggs."

• 42:07Rich Roll?

  Yeah.

• 42:08Speaker 01

  And what are you doing?

• 42:09Rich Roll?

  Unbelievable. And the McDonald's in the lobby, right?

• 42:12Speaker 01

  Absolutely. And so this is something that we really are taking on and we'd like to improve, I know it's going to decrease our income, but it's going to improve the outcomes of our patients and that's what we're really about.

• 42:24Rich Roll?

  Yeah, that's great. Have you done similar, have you had similar initiatives with school lunch?

• 42:28Speaker 01

  So, we actually...

• 42:29Rich Roll?

  Or is that outside your...

• 42:30Speaker 01

  You know, there's two things that happened with, one about five years ago, there was a pilot in our Northern California chapter of the ACC, a pilot that they were supporting, that they were very proud of, where they had gone to the schools and removed the junk food and put carrots and celery. And it said that it had an amazing impact. And the kids actually started to like the more healthy foods, they were making more healthy food choices and that it's, by their assessment, they were making more healthy choices at home. So that actually, I think, may have influenced FLODUS, the first lady of the United States.

• 43:12Speaker 01

  And they were actually, she sent a representative to our population health meeting at the American College of Cardiology to talk specifically about the FNB program. I did see the Jimmy Kimmel sort of, they had a good joking relationship and Kimmel would say, "Well, you tried less move and nobody did. So let's go with the FNB, except you gotta change the name because it doesn't sound right." And so they go back and forth, but I think they got the point across, that fruits and vegetables were the way that people were supposed to go. And so it would have been nice to have that program, that kind of program, I think they were starting in Norfolk, Virginia, I haven't seen an outcome from it.

• 43:55Speaker 01

  Deb Eschmeyer was her food czar, who was very helpful in getting that and very helpful to us when we were fighting this dietary guideline thing.

• 44:04Speaker 01

  I don't know where that's going to go. I know a lot of the things that in the Obama administration are being reversed and it would be good to see what what actually happens in terms of school foods.

• 44:14Rich Roll?

  So you famously adopt a plant-based diet in 2003. It's been about 15 years, right? So, so let's talk about that. Like, what prompted that? You know, how did you make that decision?

• 44:29Speaker 01

  So it's interesting that this, in retrospect, I mean, you make a decision and then you can look back on it later and try to figure out what led to that. And I was able to identify a few key things. One that I don't talk about very much was my affiliation with the Association of Black Cardiologists. And there was one cardiologist in that organization. His name was Tazwell Banks. And Tazwell was always talking about diet, and he was always talking about Dean Ornish. And he had seen the life trials and read them, paid attention to them, changed his diet. And he was director of the coronary care unit at DC General Hospital,

• 45:08Speaker 01

  part of Howard University. And he was, he claimed, he made this outlandish claim, that every person came in there with a heart attack, he changed their diet that moment to vegetarian diet. He made sure that they understood it before they left, and then they'd stick to it. And he had followed everyone for at least one year, and no one had a recurrent heart attack. This was back in the days when recurrent heart attacks was actually quite frequent.

• 45:34Rich Roll?

  So how many years ago was this?

• 45:35Speaker 01

  So that would have been probably the mid 1980s. It was not too long after some of Dean Ornish's first studies were out there. So that was in the back of my mind, because I had actually heard that. And then, being a nuclear cardiologist, I'd actually seen the land schooled Dean Ornish PET scans with rubidium 82. Rubidium 82 is an isotope that you do PET scanning with. It turns out that that actually was my research when I was a cardiology fellow, was in rubidium 82. So everything with rubidium, I'd always take a look at it. And so I'd seen those images, where in three months, the blood flow dramatically improves, and, you know, is, can that really happen? So I put it in the back of my mind.

• 46:19Speaker 01

  And then, right before I went to that American College of Cardiology meeting where I had the cholesterol test. In the context of getting a little older and having my son, who was a nationally-ranked tennis player and I was his coach, and he had aged out and he was going to, you know, play baseball at Valparaiso University and I wasn't on the tennis court twice a day, every day. That change in lifestyle and continuing that diet of chicken and fish, which we thought were healthy back then, but if I had just done the literature search, I would have seen that that actually was high in cholesterol.

• 46:57Rich Roll?

  Right, that's a common misunderstanding.

• 47:00Speaker 01

  Exactly. And, you know, there are some relative benefits. If you compare it to processed red meat, it's way better, it's a little better than red meat, but it's still not vegetables in terms of mortality.

• 47:11Rich Roll?

  Right, so you're eating this diet. Look, I'm eating good. I'm not eating processed meats. I'm eating red meat. I'm eating my chicken and my fish and I'm keeping it clean and, you know, I'm doing what I'm supposed to do.

• 47:21Speaker 01

  That's right. And so, in that context, I'm on my way to this meeting and where this is about to happen to me, where I get the blood test done, and there was a lady who came to my lab, my nuclear lab, and I was the reader that day, who actually had a scan that looked pretty good, but as usual, I look through the chart and I see that there's an old scan, so I pull it up and I'm comparing it, and it's dramatically improved. This was a study, the first one, which had been about six months earlier, had a tremendous amount of blood flow problems. She must have had, I figured, three vessel disease and that those vessels were pretty tight.

• 48:03Speaker 01

  Okay, so, I'm looking on our little worksheet because we, you know, my nuclear lab that I created at University of Chicago was, you know, we just collected data on every little thing was in the report that you would ever want to know. And there was something missing. It was the bypass surgery. What happened to the bypass surgery? What happened to the stenting? You would have had to stent probably five vessels. I figured no one would do that. She probably went to bypass surgery. How did it get so much better? And so in the absence of any data that they could, that they collected, I actually called the patient. I said, sorry to bother you, but I think my lab left out something. Okay. Did you get by, when was the bypass surgery or the stent? And she says, no, they told me about it. They told me I needed it, but I refused. I looked on the line and I

• 48:47Speaker 01

  found Dean Ornish's program and I went on this diet and started exercising. And it took about six weeks for my chest pain to go away. I would never do that, by the way. I would do the Dean Ornish and the stenting. Six weeks of chest pain is probably not what we're recommending. But she lost a lot of weight and she was exercising so well that she was training for like a 5K or a 10K. She was just doing so well. And she tripped on a curb and broke her ankle. And so that's why she was back in the lab because there's, she's refusing an angiogram, had not gotten the standard treatment, and now she's got to go to the operating room for an elective surgery. And everyone's afraid.

• 49:29Rich Roll?

  Yeah, it's problem patients.

• 49:31Speaker 01

  Oh, Mike, well, because anesthesia does not want to put you to sleep with untreated heart disease. And so it really was a fantastic story. And the idea that the Ornish diet could be just as good as the scans that I was saying routinely after bypass surgery, after stenting was very impressive. And then fortunately, I had my cholesterol done in the next couple of days after that. And

• 49:54Rich Roll?

  Right. So your LDL was like 170.

• 49:56Speaker 01

  It was 170. I didn't actually believe it. I thought, you know, this was back in the day where we had the exhibitors on the floor in the meeting. Okay. And you go into the exhibit hall and you stand in line, you get your cholesterol tested for free. Great. I thought it was a plot to sell cardiologists statins. So I went to their competitor and it was 169. So then I fasted all night.

• 50:23Speaker 01

  Came in the next morning. It's so funny that now.

• 50:26Rich Roll?

  This is wrong.

• 50:26Speaker 01

  Exactly.

• 50:27Rich Roll?

  We're gonna figure this out.

• 50:28Speaker 01

  Exactly. So after fasting all night, it was still 169. And so I stopped eating animals right at that day and never went back.

• 50:38Rich Roll?

  Wow, that's amazing. And you, you wrote about this, you wrote this, it was on like, what's that site called? Like Med, MedPage Today or something like that? I actually couldn't read it because I'm not a member or I can't log in to read it. But you kind of talk about why you made this decision.

• 50:53Speaker 01

  Right.

• 50:53Rich Roll?

  The reasons that supported it, you know, the history leading up to it. And it caused quite a stir. You had as many fans as detractors, right? And there's been a lot of think pieces written about this. And given your, you know, your position as, you know, president of the American College of Cardiology, kind of foisted you into the spotlight in a big way. So there was a, there was a very bright light being shined upon you and this decision. What is he actually saying? He's a member of this vegan propaganda unit. He's advancing some industry, you know, interest. I don't know what's going on here.

• 51:28Speaker 01

  All right.

• 51:29Rich Roll?

  But there was a lot of, you know, there was a lot of discussion about this.

• 51:33Speaker 01

  Right.

• 51:33Rich Roll?

  So, you know, how did you, you know, weather that, navigate that? And how do you kind of perceive that now in retrospect?

• 51:40Speaker 01

  Well, you know, it's an interesting story in that it was actually a staffer in the American College of Cardiology PR department, the media department, who noticed that I was eating different and always asking for different food at the meetings and said, well, why don't, why are you doing this? I said, heart attack, stroke and death. And she said, well, why don't we put that in our blog, you know, and do a little nutrition prevention page? So I said, okay, that's fine. And then that got picked up by MedPage Today.

• 52:09Rich Roll?

  I see.

• 52:10Speaker 01

  Then that got picked up by the New York Times. And then the next thing you know, it's all over the place. And Dean Ornish came to my rescue at MedPage Today and wrote, asked them if they, he couldn't write a, because there's like a 400 word limit. He says, you know, can I write a substantial piece to talk about the data that made him do this? And so that became a wonderful companion piece. And a lot of people looked at it. And you're quite correct, I was accused of. You know, it's industry influence and pushing some agenda. It's really just about my LDL cholesterol. Then I found out all the other stuff that that happens because a lot of the publications weren't out there in 2003, but the data's out there now. Animal protein is bad for you. Heme iron is bad for you.

• 52:55Speaker 01

  The cholesterol, the IGF-1 in the animal protein. This is, this is all science. And so the difference is now I read it. Now, the other major controversy, which I probably shouldn't repeat one more time, but I guess I'm gonna do it, was making that comment, which was completely half joking, but I was making a statement about cardiovascular research. And the fact that nutrition research is typically in the American Journal of Clinical Nutrition, it's not in the Journal of American College of Cardiology so much. And so it's not in front of the cardiologists. And so I made that statement, again, more than half joking.

• 53:37Rich Roll?

  The statement that, that.

• 53:38Speaker 01

  Two kinds of cardiologists.

• 53:40Rich Roll?

  Yeah, why don't you, you say it.

• 53:41Speaker 01

  Right. Two kinds of cardiologists, vegans and those who haven't read the data.

• 53:45Rich Roll?

  Uh huh.

• 53:45Speaker 01

  Now.

• 53:46Rich Roll?

  I got you into a little trouble.

• 53:47Speaker 01

  It did. Well, the interesting part is that, you know, it's like, like, like they say, if you take the text out of the context, then all you're left with is the con. And so people were misunderstanding. They thought I'm throwing all my colleagues under the bus when I'm really claiming or asking for more research, more review articles, more, more data to go into cardiology journals so that people are actually seeing it and they can influence their, their lives and their patients. But then, two things started to happen. One is, you know, the pushback from that was actually, I think most people understood that I was saying that if they know me at all, if they don't know me, they, they wouldn't say anything to me. If they did know me, they knew that I was, you know, saying that in a joke, in a jocular

• 54:32Speaker 01

  manner. But there were some people who took it seriously, particularly at Rush, where, you know, I'm the chief of cardiology. And we now have, you know, nine vegan cardiologists. Because people looked at the data and they saw that, you know, this is probably something I shouldn't be eating and they've they've changed their own lifestyle, which is wonderful because it gives us a good cadre of people who work on prevention. The other thing that happened, though, I have to say is that I'd spent six years on the American Board of Internal Medicine doing the cardiology exam and then the ACC leadership position. So I'm seeing a lot of cardiologists.

• 55:11Speaker 01

  Then my time at the American Society of Nuclear Cardiology, I was president 12 years ago. Each one of those organizations has had some luminary person who died of heart disease. And I'm kind of saying, that's where we really need to start. That is, in order to fix the population, through all the powers of our ACC, AHA guidelines, the the people who are actually getting that data out there and putting it in the hands of patients and the prescriptions and telling people what how they should live is cardiology. So at this point, I've had enough of the sudden cardiac deaths.

• 55:52Speaker 01

  I'm actually, my my new goal is to not retire until the leading cause of death in cardiologists is no longer heart disease.

• 55:59Rich Roll?

  Yeah, it's amazing that it it precipitates at that level amongst, you know, amongst your peers. You know, on some level, it's like you can't transmit something you haven't got. Like if you're if you're not living this life in a certain way where you're, you know, where you're an embodiment of the message that you're promoting, that's inherently problematic.

• 56:18Speaker 01

  Right. So I it really has affected me in terms of the guilt when one of my friends would pass away. You know, they knew that I was eating different. I ate with them. They knew that I was eating different. And did I say anything? And did I say it loud enough? And so now, any quip that I can come up with that gets on my page today or Twitter, I'm I'm fine with. I'll take the backlash if it's going to save some of my colleagues' lives. Ultimately, that will help our country. That will help reduce this this terrible epidemic of of heart disease, even if it makes me unpopular.

• 56:51Rich Roll?

  We should point out that your LDL went down from 170 to 90, right?

• 56:56Speaker 01

  It did.

• 56:57Rich Roll?

  Yeah. How long did that take?

• 56:58Speaker 01

  Well, you know, according to David Jenkins, it probably took two weeks, but I measured it at six weeks. Ah. But, you know. It's like nothing. Yeah, yeah, it's interesting. And, and I, you know, statins do work that fast, diet works that fast, they both can precipitously drop the cholesterol in a matter of days, really. And so it's interesting that there's, there's a lot of confusion about the amount of research on diet and cholesterol that people really need to understand. And so why was I so, people will say, oh, you're that, one of those 25% who are hyper responders. Well, that may be true, but more than likely, it's just the fact that I was eating a certain

• 57:39Speaker 01

  amount of high cholesterol food, and then I decreased it dramatically, and you could see that fall. The thing that has confused most of the diet research on this is the idea of saturation of the receptors, meaning you can only absorb so much cholesterol, you're making some in your liver, and then you eat some, and you can only absorb so much. And so when someone tests a regular American diet, which has a lot of cholesterol in it, and then they say, I'm gonna give you zero or one egg, and then, for, and then we're gonna do a crossover in, you know, three weeks or something, and you're gonna do two eggs every day. The cholesterol difference of those two diets is tremendously different, okay?

• 58:24Speaker 01

  But the amount of absorption of that extra cholesterol is small because you already got all this baseline cholesterol. So what I think everyone would see is that we're all pretty much human, and, and that that saturation of the receptor phenomenon, that is, you can only take up so much. If you're, if you're eating a lot of cholesterol, you eat more, it makes very little difference. If you're not eating a lot of cholesterol, and you eat, and, and you stop, your cholesterol goes down. Right.

• 58:56Rich Roll?

  Yeah, so it's not a one-to-one ratio of dietary cholesterol to blood cholesterol.

• 59:01Speaker 01

  It's a much...

• 59:02Rich Roll?

  Right, right, right. Yeah, that's interesting. I think what you said about, you know, the responsibility that you feel to kind of, you know, speak to these issues in light of, you know, having colleagues that have passed away is an interesting one. It's like, how do you, like, what is the best strategy to be as helpful as possible to people who are in need? You know, are you the person who's gonna like browbeat somebody? Are you just gonna be a lighthouse and stand in the light and wait for people to come to you? Is it some, you know, somewhere in between those two things? But I think being mindful or having an understanding of how you best communicate is really important, right? Like, you know, yourself being somebody who, you know, is somebody of high stature within,

• 59:46Rich Roll?

  you know, within this field that is directly relevant to this problem, I would assume that that makes you feel compelled to, you know, speak a little bit louder than perhaps somebody else.

• 59:58Speaker 01

  I think you're right, you know, being compelled now. But what compels me really is the bad outcomes, and that's for patients, that's for family, it's for colleagues. Well, and I really am a believer that every person, and that's whether I'm in the clinic, dealing with patients, or talking to colleagues, everyone's different. You have to kind of deal with people where they are. And there are some people who are interested, some people who are not interested. Our job is to try to increase their interest and their investment in changing their health outcome. And so I think it takes a wide variety of strategies. And some people, you just hand them an article, Journal of American Medical Association,

• 1:00:42Speaker 01

  August 1st, 2016, "Animal Protein Kills You." Doesn't matter which kind, in terms of increasing death, but each one kills you in a different rate. Processed red meat, much worse, et cetera, et cetera. That article is so easy to hand out to people, and it can change their behavior.

• 1:01:00Rich Roll?

  Right. One person will just be like, "That's all I need. I'm done, I'm making the changes." The other person's like, "Well, I might just prefer to go to my grave eating unhealthy food."

• 1:01:08Speaker 01

  And I've heard that multiple times.

• 1:01:09Rich Roll?

  What are you gonna do with that guy?

• 1:01:10Speaker 01

  Well, you know, actually, I sat next to him, you know, three nights ago at the Inter-American Congress of Cardiology in Panama City. And he's a wonderful cardiologist, I won't say his name, of course, and he won't listen to this... But he was saying that, you know, he saw my, my talk in Panama City on diet and mortality and eating animals. And he says, no, I will never change that. I just won't do it. And it's, and that's, I've had patients say that to me. The mortality rate of people saying that to me is pretty high, but that, that's talking about, you know, people who are, who have disease in a clinic. So I, I would say that everyone is going to require something different and you're not going to get a hundred percent. But I could say two things. One is

• 1:01:51Speaker 01

  the ground swell of, of everyone coming together from different points of view. So I know you've been in Australia, right? What I noticed about our, our plant-based nutrition colleagues in Australia is that there's a little less cardiology, a little more animal rights. Okay. A little more environment. And we have that in the United States as well. And I think everyone coming from different angles to try to solve this, we're going to help each other. The other observation is the power of media, like what you're doing right now. The number of people who have walked up to me and I saw your 20 seconds in, in What the Health, and I saw, I saw your 90 seconds in, in Eating You Alive. And I really

• 1:02:33Speaker 01

  appreciate what, what you did. And I haven't eaten an animal since I saw that movie. And that really, it's really encouraging. I think it's, it's going to make a difference. So, so I should be interviewing you and congratulating you on getting out there and, and getting the message to people.

• 1:02:47Rich Roll?

  Well, I appreciate that. But, you know, you're, you're, you're doing the hard work. You know, you're doing the important work and, and, you know, and you're the man behind the science that supports all of this. And I, but I think you're right. We need all voices. You know, you need the hardcore protester who's, you know, storming in the streets and you need the quiet person in the corner. Like, all of these voices are important. The environmental, the animal rights, like they all, there's an interplay here. And I think the more variation we have, then the more opportunity you have for somebody to connect with one of those voices, right? Because everybody is different, like you said. So when you have these patients come into your, into your office,

• 1:03:30Rich Roll?

  and you do an intake or whatever, and you're trying to figure out like, okay, what's going to motivate this person? You know, I've spoken to doctors like Robert Osfeld, or, you know, Dr. McMackin, and they'll actually, even Joel Kahn, like they'll, they'll actually, you know, write out a prescription pad, like eat vegetables, and they'll hand them a DVD of what the health or forks over knives, or something like that. Like, how do you, you know, what is your protocol?

• 1:03:53Speaker 01

  So this is interesting that I, we have the benefit, which I know a lot of physicians my age do not like this benefit, of electronic, electronic health record. Everything has to go in this electronic system. So I'm sitting in front of the patient. I'm sitting at 45 degrees, but they can see the screen too. And so I actually pull up the same, I sometimes will actually, if it's someone particularly highly educated, actually stick in my jump drive with the slides on it, and I start giving them my talk. I know it's, you know, it's the luxury of being chief of cardiology.

• 1:04:24Rich Roll?

  Let me, let me give you my keynote.

• 1:04:26Speaker 01

  Exactly. And, and it really resonates with people to see the data, because most of my talk is just this article, and then that article, and the other. And so it's all data, and they can choose to not respond to it. But while I'm giving them this data, and after I've assessed, you know, where they are educationally, which is important, to try to make sure that you're speaking at where they can understand. One of the things that we have to do is we take a food intake questionnaire, and find out where they are right now, and how much change do they really need to make? And then, you know, I have to admit, I do a lot of transition diet stuff, because I've seen just, you know, I don't have randomized trials on it,

• 1:05:11Speaker 01

  but it started off with the fact that the transition diet, by that I mean like, Veggie burgers, veggie hot dogs, veggie stuff, the kind of stuff you get at Tiger Stadium.

• 1:05:18Rich Roll?

  Right, right, right. Yeah, the bridge is to just get them used to a different way.

• 1:05:22Speaker 01

  Well, it actually, what it really does is just, it stops the animals. And so, these, you know, I know I get a lot of friends and even family saying, you know, you really shouldn't be eating veggie bacon. It's like, it's processed. Well, we have a lot of data on processed meat. I'm still looking for the data on processed vegetables. Every time I hear something processed, it seems to get absorbed a little better. But you might be missing nutrients and stuff like that, that you could be. I would hope that somebody does that research. In the meantime, what's happening is their cholesterol is going down, their weight is going down, their blood pressure is going down, because all of these, you know, veggie products are full

• 1:06:02Speaker 01

  of veggie protein, which lowers blood pressure. So I'm reaching my goals, okay, in terms of their healthcare and specifically for cardiology. That seems to be the easiest switch to pull, that is, to find, whatever it is, you tell me an animal product, and I will find a vegetarian substitute. And it could be, you know, the veggie cheese made out of chickpeas, which is fairly common. And, you know, and, you know, well, obviously, down the road, these products will be out there, because they're increasing so rapidly, which means the uptake must be good, because it's a capitalistic society. They wouldn't, if they weren't successful products, they wouldn't do well. So I'm saying that we should

• 1:06:44Speaker 01

  be researching them, and finding out if there's benefits or not, or to all this processed stuff. It doesn't sound like the best thing to do, but I can tell you, it's better than animals.

• 1:06:54Rich Roll?

  Yeah, yeah, yeah. Well, it's never been easier to find these products.

• 1:06:57Speaker 01

  That's right.

• 1:06:58Rich Roll?

  And it's getting better every day.

• 1:06:59Speaker 01

  Every store, every store has them.

• 1:07:00Rich Roll?

  Yeah. Which also means it's never been easier to be an unhealthy vegan, you know?

• 1:07:06Speaker 01

  Right. Well, we're very particular about that. I'm glad you mentioned that. There's been loads of literature coming out. We had a recent high-profile article in the Journal of American Cardiology.

• 1:07:17Speaker 01

  Talking specifically about unhealthful plant-based diet. And they actually made an index of how many of these refined carbs and sugar and the like. And there was a correlation with death. And so, let's try and have more fruits and vegetables and less of this stuff. I don't know how you would characterize a veggie hot dog, you know, I mean, or a veggie burger.

• 1:07:44Rich Roll?

  Like, what food group does this fall under?

• 1:07:45Speaker 01

  Well, you know, but is it healthy or is it not healthy? We don't actually have data. We have data that says, you know, you can get a vegan doughnut. That is not healthy. It doesn't matter if it's vegan or not. It's not healthy. But we don't have good data on, you know, sure, you can say potato chips, it's fried. And so, you know, there's a certain amount of data that we have and then data that we don't.

• 1:08:10Rich Roll?

  Right.

• 1:08:17Rich Roll?

  How are we going to better address serving the people that need this information the most? You know, we touched on earlier this socioeconomic divide. And we're in a culture in which wellness or being vegan, quote unquote vegan, seems to be the purview of the well-heeled who can do all their shopping at Whole Foods. And meanwhile, we have millions of people living in food deserts. And these are the people who are suffering the most from these chronic ailments. And we need to figure out strategies and ways for penetrating these communities and serving them better. And I know this is something that you care a lot about and have put a lot of thought into.

• 1:08:56Speaker 01

  Well, it's not an easy issue. These are the areas that I grew up in, in the south side of Chicago. And the west side of Chicago is where I work now at Rush University. Have to mention, you know, have to shout out to Rush. Even before I got there, there was an interest in the community that is not financially motivated. They're actually spending hard-earned dollars to go and set up programs to try to take care of people, do primary care in places that you probably wouldn't want to walk, you know, at night.

• 1:09:27Speaker 01

  In the neighborhoods on the west side, particularly as a south sider. But as it turns out, all of this hard work is going to be improved even further if we can have programs where people will get education. And so I've actually gone to the west side community centers and given talks and been in the churches, giving informational talks about diet that have improved some of their outcomes, on the one hand. Then we have a couple other major programs, one of them in cardiology called the Heart Program, Heart standing for Helping Everyone Assess Risk Today.

• 1:10:06Rich Roll?

  Uh huh, okay, I got it. I wonder what Jimmy Kimmel would think of that one?

• 1:10:09Speaker 01

  I tried hard coming up with that algorithm.

• 1:10:11Rich Roll?

  It's pretty good.

• 1:10:12Speaker 01

  So it actually is playing off of the fact that the American College of Cardiology and American Heart Association put out a risk calculator. It's an app that anybody can get off of the App Store. And you put in all your numbers and it tells you what your 10-year risk of having a cardiac event is. And so we'll go into a church and we will set up booths where we measure a finger stick cholesterol and a finger stick hemoglobin A1C. That's the fancy way of telling you whether or not you have diabetes or prediabetes. And do the blood pressure, fill out the form, you know, age, gender, black or white. And once you have that data in there, it comes up with a number of what your risk is. And then you can have a discussion. You can have a real discussion.

• 1:10:56Speaker 01

  If you change these things in your lifestyle, you can reduce that risk. If you don't reduce that risk, you probably should be on a statin or medication until you can because you're at, you know, if your risk is high. Now, the other program that's very popular at Rush is called the Alive Program. And that is run by our prevention colleagues and they actually go into churches, they've got a, they've been doing it on the, mostly on the west side of Chicago. And they actually do six weeks of study, sort of a Bible-based health, food approach. I'm hoping that we can partner with them. I can see this, you know, Heart Alive, Heart Sandwich, where we go in, see what the risk

• 1:11:40Speaker 01

  is, see what the effect of their educational program is by measuring it after the fact. So anyway, obviously, when I'm describing sort of granular details about Our overall strategy of trying to impact the community is not just sitting there on the west side, you know, hoping that, you know, everybody will come in from the suburbs. We are actually, we do want people to come in from suburbs and they do because Rush is highly ranked and it's a top clinical program. There's, you know, great academic programs in the city of Chicago, but the one with the best rankings in the university health consortium every year for clinical programs, clinical care is actually Rush University.

• 1:12:22Speaker 01

  So we're able to, so far, we've been able to bring in the business that allows us to take care of the community.

• 1:12:29Rich Roll?

  Yeah, that's great. I mean, basically what I'm hearing is you have to, you have to be boots on the ground and engage these, you know, these communities by meeting them where they're at, like they're at their churches, they're at their, wherever the community centers are and like, and it's a one-on-one thing, really.

• 1:12:45Speaker 01

  Absolutely.

• 1:12:46Rich Roll?

  That's how you erect change. That's beautiful.

• 1:12:48Speaker 01

  Yeah.

• 1:12:49Rich Roll?

  Well, your own personal story is, is super interesting as well. I mean, you grew up south side, right? Grew up relatively poor and have, you know, made quite a life for yourself. But what I thought was really, was really interesting is like, you're a tennis superstar, right? You were thinking about going, becoming a professional tennis player?

• 1:13:08Speaker 01

  Well, it was actually my coach that was thinking.

• 1:13:10Rich Roll?

  Yeah. Tell me this story.

• 1:13:12Speaker 01

  Well, you know, it, it is, it's interesting that I was a championship chess player, one of the top in the state of Illinois. And at the end of my junior year, I was the captain of the chess team and, and my guys who, who were on the team at the end of chess season said they were going out for tennis and I just went with them. So it turns out that, yeah, I learned enough in a short amount of time to actually become the number three singles player, even though I'd never picked up a racket.

• 1:13:42Rich Roll?

  Your friends were like, is this guy good at everything?

• 1:13:45Speaker 01

  Well, no, this is, I mean, it would have been nice to have been exposed to tennis at an early age because most people are starting at age four and five and six and here I was 15. And so as it turns out, one of the schools that we played, Chicago Vocational, only had one player and that one player actually told us that there was a program designed for inner-city poor kids at the University of Chicago. Can see what's gonna happen, right? And so I said, "Well, I should just go over there." So I got on a bus and went to this program. And I learned to play tennis on a court with 60 kids. And didn't have, I didn't really have rackets or anything like that.

• 1:14:26Speaker 01

  But I talked to the coach, who turns out he was African-American. And he was actually a sort of part-time minority recruiter for the University of Chicago. And he was the varsity tennis coach. And so he had a tremendous impact on me. He actually got me an interview, which I didn't know was an interview at the time, until I applied to the University of Chicago and I couldn't get an interview. And I called up and they said, "No, you had it back in July." And I was shocked. I'm trying to remember everything I said. Anyway, I ended up getting into the University of Chicago. I learned enough tennis there to go back and play number one in my high school. But I still, this wasn't real tennis.

• 1:15:08Speaker 01

  So I went to the University of Chicago and talked to the coach. He says, "No, you're not gonna make this tennis team. But, you know, you're welcome to come to practices." And I was so determined. It was sort of two things. One was making that leap from Chicago Public Schools with the reading skills to the University of Chicago was a big difficulty. And the one thing that would make me sit and read Playtell for hours is if I had played about six hours of tennis, then I could sit. And so that actually worked for me. And so, and of course, playing six hours of tennis, you actually get pretty good. So, barely made the tennis team, the starting lineup.

• 1:15:47Speaker 01

  But I just barely beat out the number six guy on the day before the matches began. And so I actually did play that year. But I had gone to college a little early, so I was still 17. And that would have been my first year of the 18-and-unders. If I had known that there were tournaments, which I didn't.

• 1:16:09Speaker 01

  But I found out about these tournaments and I started playing them and I lost in the first round of every tournament in the Chicago district. And so after the first couple, rather than just, you know, going back home, I figured out that what I should do is figure out why I'm losing. And I actually would go to the draw after my match. I'd go to the draw, look at the top two seeds, see who they were, see where they were playing, and hang around until I watched them play their matches. And what was the difference? How were they constructing points? How did they hit the tennis ball? Everything. And it turns out that I learned so much by the losses and the observation that I went back to University of Chicago with nobody graduating and I won. I beat everybody, so I played number one.

• 1:16:54Speaker 01

  So then my tennis career started taking off. Once you're the number one singles player, then you can teach lessons on the side, okay? Then you've actually got a stream of income. And so one thing led to another. So my coach really, after I got applied to medical school, and there's this, sort of the last free summer of your life is between freshman and sophomore year. And I'd had a tough year, right between college and med school in terms of not understanding what you understand very well. The intensity of playing pro tennis was not something that I was ready for. And I would cramp up, you know, be up, you know, a break in the third set after my fourth match and I just couldn't, I never got beyond the quarters of any of those pro tournaments.

• 1:17:37Speaker 01

  So then that next year, I focused on the fitness. I really did. And I was training every day. I was, I incorporated into my teaching, I was teaching big junior development groups and, you know, I would try to win that three mile race every single day. Needless to say, I did not lose based on fitness anymore and I had a really good year. And at the end of that year, at the American Tennis Association National Championships, after I had beaten the number one seed. They, my coach was just pressuring me, "Don't go back to medical school, go on the pro Turk, pro circuit." And, you know, I look back at that. So what the, and, and say, would I, you know, because it was a tough decision. The good fortune for me is I got injured

• 1:18:20Speaker 01

  in my semifinal match. And, and so I really couldn't play for about six weeks. And so I would have missed the US Open. This was a qualifier for the US Open, which would have launched me into, I don't know what, you know, no sponsorship. You, we, you eat what you kill, essentially. And without the prize money, you don't do very well. So as it turns out, I did go back to medical school. And, and when I think about it, I really wouldn't give up one year of practice, not one, which for, for pro tennis, I love tennis. It's a wonderful sport. British Journal of Medicine says that it has a 47% decrease in cardiovascular mortality.

• 1:19:03Rich Roll?

  There you go.

• 1:19:03Speaker 01

  To be a tennis player. So I, it's really been a benefit to me. It kept me focused and kept me exercising. But it's, it's, it's not something that would have given up medicine.

• 1:19:15Rich Roll?

  You made the right choice.

• 1:19:16Speaker 01

  I think so.

• 1:19:17Rich Roll?

  And then you got to, it sounds like your, your son became quite the player.

• 1:19:20Speaker 01

  He did, he did. And my, my son is a, is a Marine. And he actually feels very strongly about, you know, coming, coming out of high school, going into college soon after 2009-11. He wanted to actually go and, you know, go into the Marines. And I say that he'd used all that tennis training. The idea of getting up at five o'clock in the morning, it might have been foreign to the rest of the guys in the room, but not for him. That's because he'd been doing that since he was eight, nine years old as a tennis player. You know, being able to think strategically and do hard, physical tasks, that's, I think it's, you know, I don't know if he'll admit that, but I think that's what made him the Marine

• 1:20:03Speaker 01

  that he is. And so he's, he's, he's a great guy.

• 1:20:06Rich Roll?

  Very cool. Well, I know I gotta let you go here soon, but I can't let you go without asking a couple last ones. The first question I wanted to ask is,

• 1:20:17Rich Roll?

  You know, I always like to give people some simple takeaways. So if somebody's listening to this, you know, they're one of those people who's been mired in the confusing morass of conflicting information that's available out there. They're just looking at me like, just, just tell me, just, just give me like the thing I should do first, or what's the, what's the most important thing? Is it exercise? Is it diet? Is it, is it dairy? Is it meat? Is it processed? You like, just give me a couple marching steps that I can easily digest and implement into my life.

• 1:20:47Speaker 01

  I really, we would like to have more comparative data, but we have some. And it does say that, that principle that you can't exercise your way out of a bad diet, there's some truth to that. I mean, you can mitigate a bad diet, but you can't, you're, you're going to have a bad outcome ultimately. It's not going to absolve you. And so I would say that nutrition is the most important decision that we can make. If we could change one thing, it would be to have heart health, the information coming out and, and have that be a real definition. And so for the individual patient, finding out where they are and seeing what are the elements that are going to create more and more diseases, similar to what brought them

• 1:21:32Speaker 01

  to my office in the first place. And, and I understand that this, this is not primary care. This is not family practice and that, you know, these are people who already have heart disease when they're seeing me. And so I have a little easier job because they're already motivated. The fact that they're in my office means that they're motivated to try to make some kind of change. They're expecting to come out of there with something different that's going to change their outcome. Not every physician has that advantage, but it's something that we all should take advantage of because, you know, almost everyone has had a, you know, a family member who suffers from heart disease or has had heart disease or has sudden cardiac death. And so just trying to get them to understand that there is a relationship between your lifestyle and your outcome. Just make that connection.

• 1:22:17Speaker 01

  If we can do that, we would all be so, so much better off.

• 1:22:19Rich Roll?

  Right. It's a great answer. And the final one, if you were to wake up in some strange, parallel universe to find yourself the new surgeon general, what's the first thing that you put in motion?

• 1:22:35Speaker 01

  That's a good one. The previous surgeon general was a good friend of mine, Regina Benjamin. She was very concerned about, she's African American, as you might recall, and she was very concerned about delivery of healthcare and getting health equity. I would really want to continue the momentum that she had started in terms of getting people to understand the whole impact of healthcare disparities. We actually, and it's interesting that it's racial segregation and educational depression and all sorts of things that led to these healthcare disparities, not just genes, okay? All of this can actually be

• 1:23:19Speaker 01

  improved by lifestyle. And if we could get that word out there. There was a wonderful analysis of this published in circulation in 2015 called the REGARDS trial. If you look on their website and try to find the paper, it's buried in like 200 publications that they did. They're so, so good at getting stuff out there. But the REGARDS study was looking at racial and ethnic risk for stroke. And what they found is not just stroke, it's stroke, heart attack, and death. And it is related to diet, and that southern diet that the African American, you know, southern meaning the south side of Chicago, as far as I'm concerned, because that's what we were eating there. That diet is so damaging

• 1:24:04Speaker 01

  that if you could just fix the nutrition, the gap in healthcare disparities would change almost on a dime.

• 1:24:14Rich Roll?

  Dr. Kim Williams, you're an inspiration, sir.

• 1:24:18Speaker 01

  My pleasure. I really appreciate you having me.

• 1:24:20Rich Roll?

  Yeah, thank you so much. Please keep doing what you're doing, spreading the healthy, powerful message that you do. We need you and we need more people like you. So, thank you very much.

• 1:24:32Speaker 01

  And thank you for all that you're doing.

• 1:24:34Rich Roll?

  It's my pleasure. If people want to connect with you online, where's the best place to find out information? I mean, you go to the Rush website, I would imagine.

• 1:24:45Speaker 01

  The Rush website has each of the faculty members and, you know, there's actually one of our faculty members, Jeff Sobel, just put up a whole thing on plant-based nutrition. It was really wonderful to see that. And we are, have a big presence there. If they just Google "Kim A. Williams, M.D." you'll get a few million hits and a couple of them are my son, who's a neurosurgeon, first out in practice.

• 1:25:07Rich Roll?

  Oh, wow.

• 1:25:07Speaker 01

  I'm sure in the next few years, he'll be taking over those Google hits.

• 1:25:11Rich Roll?

  Uh-huh. Yeah, it's Kim Williams, Sr.

• 1:25:13Speaker 01

  Kim Williams, Sr., right.

• 1:25:15Rich Roll?

  And you're on Twitter @cardio10s.

• 1:25:18Speaker 01

  That's right.

• 1:25:19Rich Roll?

  Cardio10s, the number 10s, right?

• 1:25:21Speaker 01

  That's right.

• 1:25:22Rich Roll?

  So you can hit them up there.

• 1:25:22Speaker 01

  Absolutely.

• 1:25:23Rich Roll?

  All right, thank you so much. Well, hopefully, we can have a, will you come back and talk to me some other time?

• 1:25:28Speaker 01

  Absolutely. I'm sure there'll be more data. I'm hoping so.

• 1:25:31Rich Roll?

  All right, thank you. Peace. Bye.

• 1:25:33Speaker 01

  All right.

• 1:25:35Rich Roll?

  Great.

• 1:25:36Speaker 01

  Well, fantastic. That was so much fun. Thank you very much.

• 1:25:40Rich Roll?

  All right, I hope you guys found that not just enjoyable, but impactful. I hope that it left you with more than a few things to think about, to wrestle with, to really ponder in the context of your own personal health journey and the choices that we make every single day around diet, nutrition, and lifestyle. As always, please check out the show notes to take your edification and your infotainment. Beyond the earbuds, we've got tons of links and resources there to dig deeper into this important issue of cardiovascular health. And if you found Dr. Williams so compelling that you're finally ready to take that leap into plant-based nutrition, but you're just not quite sure how to do it, well, I've got good news for you. Our Plant Power Meal Planner is just the thing.

• 1:26:26Rich Roll?

  It's this incredibly powerful, robust, online, mobile-friendly resource that takes all the guesswork out of making this transition to a more plant-centric lifestyle. When you sign up, you get thousands of plant-based recipes right at your fingertips, unlimited meal plans and grocery lists. Everything is metric system compliant as well. And it's also totally personalized and customized based on your goals and your food preferences, your allergies, your time constraints. We have an amazing team of customer support experts that are available to you seven days a week. These are people with graduate degrees, athletes, moms, people that live and breathe this stuff. We even have grocery delivery in I think up

• 1:27:06Rich Roll?

  to 60 metropolitan areas at the moment. Life-changing stuff, a really powerful, compelling tool. And it's also incredibly affordable, just $1.90 a week when you sign up for a year. So for more information and to sign up, go to meals.richroll.com or click on Meal Planner at the top menu at richroll.com. If you would like to support this show and my work, share it with your friends and on social media. You know what would be really cool? I love when people post on Instagram like a picture of where they are when they're enjoying the podcast and they tag the podcast because it allows me to kind of step into your world. So that's really cool. If you can take a second and do that, I would love that. Also, leave a review on iTunes. That's very helpful. And make sure you hit that

• 1:27:51Rich Roll?

  subscribe button on iTunes or whatever app you use to enjoy your podcast content. We also have a Patreon set up. Thank you to everybody who has contributed to that financially. In exchange for your contributions, everybody on Patreon, I'm going to start doing a monthly AMA video, Ask Me Anything show. The first one is going to be on November 9th at 2:00 PM Pacific Standard Time. And again, that's only available for contributors on Patreon as a sort of thank you for helping me out. I really appreciate that. If you would like to receive a free, short email from me periodically, I'm no longer saying weekly because I've missed too many times. I send one out pretty regularly. It's called Roll Call. It is basically

• 1:28:36Rich Roll?

  a list of five or six things that I've come across over the course of the week, some articles I've read, a documentary I've watched, a video I saw, a product that I'm enjoying. No affiliate links, no spam, totally free. People are enjoying it. They seem to really dig it. So you can sign up for that. At on my website, just put your email in any of those email capture windows. That's it. I want to thank everybody who helped put on the show today. Jason Camillo for audio engineering, production, interstitial music, and help on the show notes. Shawn Patterson for all his graphic wizardry. David Zammatt for his portrait photos and for now conveying the podcast in visual format on YouTube.

• 1:29:17Rich Roll?

  All the podcasts going forward are now available in full video on YouTube at youtube.com/ritual. And that is David's work. He's doing a great job. And theme music, as always, by Analemma. Thanks for the love, you guys. As of today, it's Halloween. On the day that I'm recording this, Tuesday, doing it early because getting on a plane tomorrow morning, heading to Miami for the Seed Food and Wine Festival. So hopefully I will see some of you guys there. And until next week, be well, live well, and take care of yourself. Go easy on yourself. Peace, plants, and all the stay.