Prevent Disease & Thrive: Michelle McMacken, MD on Holistic Lifestyle Medicine & Promoting Optimal Wellness Through Plant-Based Nutrition

We need more doctors like Michelle McMacken, MD. Board certified in internal medicine, Dr. McMacken is an assistant professor at the NYU School of Medicine, an attending primary care physician at New York City's Bellevue Hospital Center and director of the Bellevue Adult Weight Management Clinic, where she specializes in plant-based nutrition and lifestyle medicine. Interestingly, Dr. McMacken wasn't always all that intrigued by nutrition. Not surprisingly, her medical school experience was woefully lacking in this regard. But after eight years of medical practice, she was becoming progressively distressed by her obesity clinic patients' general inability to get — and stay — healthy. Determined to find better, more sustainable solutions for her patients led to a search engine result for “lifestyle change” that prompted Michelle to attend the American College of Lifestyle Medicine Conference– a game-changing experience that enlightened her to a holistic, disease preventive perspective on patient care that ultimately reinvigorated and forever altered her medical practice. Beyond her one on one work with patients, many of which are underprivileged, what is uniquely inspiring about Dr. McMacken is her grant-funded commitment to study evidence-based nutritional protocols and apply the practical knowledge to faculty, colleagues & resident doctors. In other words, she is devoted to educating not only her patients about healthy nutrition, but her fellow medical professionals as well — filling the much needed gap in our current system of medical education. This is an enlightening and highly informative conversation that explores: * the state of medical education with respect to nutrition * the responsibility of doctors to practice holistic, preventive medicine * the significance of a plant-based diet in promoting optimal wellness * Dr. McMacken's personal & professional path to plant-based nutrition * the health impact of high protein diets, ketosis & glycogen depletion * the differences between animal & plant protein * alkaline/acid-forming foods and their impact on metabolism * paleo vs. vegan – finding common ground * the truth behind dietary cholesterol & saturated fat * the importance of aligning actions with values * plant-based patient case studies I sincerely hope you enjoy our discussion. What is preventing you from a more holistic approach to long-term wellness? I'd love to hear about your personal challenges in the comments section below. 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?

  It's kind of an amazing thing. For listeners of the show, all you special people, we're offering an exclusive $20 off an annual subscription right now. To get it, go to meals.richroll.com, take your quick personalization quiz, and enter promo code RICHROLL20 at checkout.

• 1:05Speaker 01

  You know, I have this passion about this way of eating. When you take like the health aspect, the sustainability and the environment, and you take, you know, compassion and concern for other living beings, and you mesh them all together, this is really the only way of eating that brings that all together. So for me, this was finding ultra. This was my ultra.

• 1:27Rich Roll?

  That's Dr. Michelle McMcKinnon, this week, on the Rich Roll Podcast.

• 1:45Rich Roll?

  Hey, everybody. How you doing? What are you guys doing? Are you on the treadmill? Are you riding your bike? Are you commuting to work? Maybe you're listening to the show while you're at work? Maybe you're preparing a meal for your family? I don't know. It's Rich Roll. I'm back at you. I am your host. Welcome to my podcast. At this point, you guys know the deal. This show is all about conversations with some of the brightest minds out there. People who are inspiring positive culture change, people who are lighting the path so that we can all just live and be better. And the idea is to help all of us unlock and unleash our best, most authentic selves. So, thank you for subscribing to the show on iTunes. Thanks for spreading the word on social media, for gathering around the water cooler and

• 2:29Rich Roll?

  chatting about it. And thank you for always clicking through the Amazon banner ad at richroll.com for all your Amazon purchases. It's a great free way to support the mission, and you can make it super easy on yourself by just bookmarking the link from the banner ad on my site. That way, it's right up there at the top of your web browser, and you don't have to go to my website, and everybody wins. Michelle Mc Mackin, she's really great. Michelle is a board-certified internal medicine doctor. She is assistant professor of medicine at the NYU School of Medicine. She is an attending physician at the Bellevue Hospital Center in New York City, where she practices primary care.

• 3:14Rich Roll?

  And she's also director of the Bellevue Adult Weight Management Clinic, where she specializes in plant-based nutrition and healthy lifestyle medicine. And beyond her one-on-one work with patients, many of which, much like the work of her friend and colleague, Robert Ossfeld, who is a guest on this podcast, episode 140, a lot of the people that she works with are underprivileged. And what's really inspiring to me is that she is also, on top of her daily practice, secured grant money to aid in educating her fellow doctors and medical professionals about nutrition, something that is sorely lacking in current medical education, and of course, desperately needed. So, this is a fun and enlightening conversation about the state of medical education with

• 3:58Rich Roll?

  respect to nutrition, the role of today's doctors in promoting holistic health and disease prevention, and the significance of diet. And in particular, a plant-based diet in promoting optimal wellness. So, let's step into the world of the most delightful Dr. Mc Mackin, and prepare to be enlightened.

• 4:23Rich Roll?

  Tell me a little bit about your practice right now.

• 4:28Speaker 01

  Sure, so I work at Bellevue Hospital. I don't know if you or your listeners are familiar with it.

• 4:33Rich Roll?

  Well, all I know about Bellevue is like that was the insane asylum.

• 4:36Speaker 01

  That's usually the first.

• 4:38Rich Roll?

  You have this conjured image of like Bellevue where they lock you up, right?

• 4:42Speaker 01

  Yeah, that's usually the first thing people think of, so I have to spend time kind of dispelling that.

• 4:47Rich Roll?

  Yeah, disabuse me of this idea of the iron gate.

• 4:50Speaker 01

  Yeah, so Bellevue is, it's actually the nation's oldest continuously operating hospital, and it's also the oldest public hospital, so it's.

• 5:00Rich Roll?

  Wow, how old, like when?

• 5:00Speaker 01

  Like seventeen something.

• 5:02Rich Roll?

  Oh, wow.

• 5:03Speaker 01

  Yeah.

• 5:03Rich Roll?

  Is the original structure still?

• 5:06Speaker 01

  Yeah, yeah. So, and, you know, I think the key things to know about it are it's an extremely mission-oriented place. So, in being a safety net hospital, we basically take care of everybody regardless of ability to pay. Right, and, and the people that that kind of hospital attracts, like the doctors and the nurses and the other staff that it attracts are people that I feel like I have a lot in common with.

• 5:35Rich Roll?

  Like more service-oriented?

• 5:36Speaker 01

  Exactly.

• 5:37Rich Roll?

  Yeah, yeah, yeah.

• 5:38Speaker 01

  Yeah.

• 5:38Rich Roll?

  But it's right in, it's like on the east side, isn't it?

• 5:40Speaker 01

  It's on Twenty-seventh and First.

• 5:42Rich Roll?

  Uh huh.

• 5:43Speaker 01

  And so, it's, it's, so my practice is, it's a primary care practice. I'm trained in internal medicine, which is basically like, you know, you're the person that takes care of sort of everything. So, you're taking care of the whole body, you're taking care of all the organ systems, mental health, you know, so, like a lot of social stuff, you're kind of the quarterback of like the healthcare team.

• 6:07Rich Roll?

  Right, right, right. So, do you have a, like a private practice outside of the hospital? Or your office is in the hospital?

• 6:14Speaker 01

  All Bellevue, all the time.

• 6:15Rich Roll?

  So, if somebody comes to see you, is it like, like an acute situation, like an ER situation? Or, because, I mean, it's not usual for somebody to book an appointment and go to a hospital to see a doctor.

• 6:28Speaker 01

  Right, so, so there's a very large ambulatory care practice as part of Bellevue Hospital. So, it's a regular doctor's office.

• 6:37Speaker 01

  There's internal medicine, there's OBGYN, there's all the medical specialties, surgical specialties. So, basically, coming to see me is like going to see like any visit to the doctor.

• 6:49Rich Roll?

  Right, you're just like your general practitioner sort of situation.

• 6:52Speaker 01

  Right, right, right. So I take care of adults only, that's internal medicine. And, um, and yeah, I mean, I basically take care of people from all walks of life. So, you know, I'll have, most of my, most of my practice is actually Spanish speaking because I speak Spanish. And, um, but really a day doesn't go by where I'm not on the interpreter phone in like Tibetan or West African dialect or Chinese dialect, French, Polish. So it's an extremely diverse patient population. And in terms of education and literacy, there's a huge amount of diversity as well.

• 7:30Rich Roll?

  Uh huh. But in general, I would imagine kind of lower on the socioeconomic scale, right?

• 7:35Speaker 01

  I think that's, you know, there, we have people from, you know, coming from all walks of life. But yeah, I mean, most of my patients have either no insurance at all, or are, have a government sponsored insurance like Medicaid.

• 7:46Rich Roll?

  Mm hmm. And if somebody comes in with no insurance, there's no, you still treat, you still treat them and then?

• 7:52Speaker 01

  That's what we're there for. Yeah, it's, it's awesome. So everybody gets basically state of the art care. Like they have this access to a hundred percent of the same services you'd have anywhere.

• 8:04Rich Roll?

  And are they afraid they're gonna get locked up in the looney boat and out of the room? Get in the straitjacket?

• 8:09Speaker 01

  I, I, they don't express that to me, but.

• 8:11Rich Roll?

  Does that aspect of the hospital still exist, though? Like, is that just some kind of wives tale? Or, I mean, that must be rooted in some kind of reality back in the day.

• 8:20Speaker 01

  Yeah, I mean, it has, I think Bellevue, I don't want to misquote, but I think Bellevue has one of the largest number of inpatient psychiatric beds. And so it has a long tradition of treating mental health.

• 8:32Rich Roll?

  Right.

• 8:32Speaker 01

  Um, issues. But.

• 8:35Rich Roll?

  Like, that was what it kind of originally made its name.

• 8:37Speaker 01

  Yeah.

• 8:37Rich Roll?

  Doing, right?

• 8:38Speaker 01

  But like, you know, Bellevue is also a leader in, you know, TB back in the day, tuberculosis, and even now, like in the 90s when TB came back, Ebola, you know? We've done amazing things with treating Ebola patients.

• 8:52Rich Roll?

  Wow, that's interesting. So, so was that, was Bellevue kind of front and center when that recent sort of scenario?

• 8:59Speaker 01

  Very front and center.

• 9:00Rich Roll?

  Wow, so what was that like?

• 9:01Speaker 01

  That was us.

• 9:02Rich Roll?

  That must have been pretty, you know, interesting and heightened.

• 9:05Speaker 01

  Yeah, it was intense. I think there was a lot of, there was a tremendous amount of fear, obviously, around it. And you'd hear things, I mean, just even being in New York, like you'd hear, you'd overhear conversations on the subway about, oh, you know, this person who had Ebola was in the bowling alley in Brooklyn, and I was there the day before, and there's just wide.

• 9:25Rich Roll?

  Right, right, right. The guy was a doctor, right? Was he a doctor at Bellevue?

• 9:28Speaker 01

  No.

• 9:29Rich Roll?

  I remember that story.

• 9:30Speaker 01

  Yeah.

• 9:30Rich Roll?

  Wow.

• 9:31Speaker 01

  But we, we treated him, and it was a huge success, obviously. And now we're sort of a flagship hospital for future, potential future Ebola cases.

• 9:40Rich Roll?

  So were there, like, medical practitioners walking around in hazmat suits in the hospital and stuff? Or is that like a, like a closed off wing?

• 9:47Speaker 01

  It was a very, very, yeah, very closed off, very controlled situation, extremely well thought out. Because obviously, the consequences are, of not thinking it out well are pretty strong.

• 9:58Rich Roll?

  Right. So how did you end up at Bellevue? Like, where did you go to medical school? And what kind of led you into, you know, towards your path?

• 10:05Speaker 01

  Yeah, so I went to med school at Columbia, here in New York. And then I trained, you know, it's kind of at, during med school, I actually originally set out to do public health work. And then, pretty early on in my training, realized I wanted to essentially, like, treat asthma in the Bronx, like, do very basic primary care for people who otherwise may not have it. And I felt like I could probably have the most impact that way. And it used my own skill set the best. And so I went into training in internal medicine. I trained at Cornell, actually.

• 10:42Rich Roll?

  Cornell here in the city.

• 10:44Speaker 01

  In Manhattan, yeah, yeah. Well, Cornell Medical Center. And then. Graduating from residency or finishing residency, I looking for a job, I knew I wanted to be at an academic center. Basically, you know, for me, it was like the mission of service, but also the mission of teaching. So Bellevue was a really perfect fit because obviously the mission of service and then Bellevue is a teaching hospital for NYU. So my typical week looks like, you know, half the time I'm seeing patients in the office and then the other half the time I'm teaching. I'm basically residents or doctors in training are coming to me, they're seeing patients and they're presenting, you know, their plan and their assessment to me and I'm giving them feedback, so.

• 11:29Rich Roll?

  Right, right, right. Yeah, I want to get into all of that, but like just sort of sticking with the the evolution of Dr. Mc Mackin. My only point of reference is is law school and I know from my experience in law school that, you know, sort of when you when you enter law school, there's a lot of people who are kind of service oriented and they're like, I'm going to go work for this nonprofit or, you know, this pro bono, you know, organization or something like that. And then, you know, by year three, everybody's shipping off to be associates at at big prominent law firms with big, you know, sort of salaries and and the rationale is generally like, I'm in so much debt, you know, I I'm just going to go do this for a couple of years and then I'm going to go do, you know, what makes my heart beat.

• 12:12Rich Roll?

  And more often than not, that, you know, sort of doesn't happen, you know, you get stuck in into that lifestyle. I mean, is that similar, is it similar in medical school? I mean, do you see that kind of attrition?

• 12:23Speaker 01

  Yeah, I think, well, I mean, you brought up the debt issue and I think that's a real, it's a very real driver of a lot of people's choices in terms of what they specialize in and how they formulate their practice. And it probably should have been an issue for me, but I just, I just said, you know, I just went straight to the what made my heart beat.

• 12:43Rich Roll?

  Right. And where where does that come from? I mean, is that, do your parents raise you well? Like, how does it, how do you?

• 12:49Speaker 01

  They definitely did.

• 12:50Rich Roll?

  You know, where does the kind of compulsion to to be in service derive from if you had to articulate that?

• 12:57Speaker 01

  Yeah, I mean, um. I'd like to say it's, you know, it's like I'm born with a noble impulse, but really I just feel like, you know, you can be in service in a lot of different ways, right? I mean, you can be within medicine and it, you don't have to have a practice at a hospital that serves the underserved to be in service of others, of course.

• 13:18Rich Roll?

  Well, by its very nature, it's, you're in service just by being a doctor.

• 13:22Speaker 01

  Right, right. And, um, but I think for me, there's something about, um, being in, being the person that has the opportunity to offer something where no, where maybe someone else wouldn't have the cha-, you know, they wouldn't have the chance to get that. So, for example, a lot of my patients, I'm, you know, I'm the first doctor that has ever sort of called them back with their lab results, for example. I mean, that sounds crazy, right? I mean, you go to the doctor and don't you expect a call saying, you know, like your blood work was good, or this is a problem. And so, time after time, when I call my patients back with their lab results, they're like, "You're the best doctor ever. I can't believe you called me." And I just think that-

• 14:05Rich Roll?

  Doing the thing that you're kind of supposed to do.

• 14:07Speaker 01

  Right, and so I guess what I'm getting at is, um, it feels really good to be, to be offering that to people. I mean, people deserve that, right? People deserve that kind of relationship and, um, and I'm also, it's just a, it's just a great platform to educate people about things that are really important to their health and to me. Which I know we'll get into.

• 14:27Rich Roll?

  Yeah, I mean, it seems like there's kind of a, you know, systemic problem when it comes to just basic patient care and palliative care, right? Like, like just general rules of human decency, you know, seem to get cast aside. And I don't know whether that's because, you know, it's a numbers game and you're just seeing so many patients, or, or what kind of happens, but, you know, the typical patient experience is not always so positive, particularly when it comes to, you know, sort of bedside manners and all of that.

• 14:58Speaker 01

  Yeah, I think, and we'll probably get into this, but I think the system is broken in a lot of ways, and the system doesn't really allow us as physicians to interact with patients, I think, the way we probably should. And, you know, it takes time to, it takes time to deliver individualized care and to call people back with their lab results. And yet, time, there's no reimbursement for that, and so therefore, time isn't carved out for that. And that's understandable at the hospital level, or, you know, and it's not just our hospital, it's every medical system, for the most part.

• 15:35Rich Roll?

  Right. I think it's, you know, easy to just say, "Oh, well, you know, they're selfish," or "There's some kind of god complex with doctors," but I think when you really look at the system and what's driving it and what's pushing them, like, they're just trying to, like, get through the day.

• 15:50Speaker 01

  Right.

• 15:50Rich Roll?

  You know, they're good people, it's like, you have to be, you know, of a certain mindset to even get into this to begin with.

• 15:56Speaker 01

  Right.

• 15:56Rich Roll?

  So, that's why, you know, I said it's systemic, I think. I think it's just the structure within, you know, the rules that apply to practicing don't really necessarily provide for that.

• 16:06Speaker 01

  Yeah, I completely agree. I completely agree.

• 16:09Rich Roll?

  Cool. So, all right, so you're at Bellevue, but at the same time, you're a professor, right, at NYU?

• 16:15Speaker 01

  Assistant professor.

• 16:16Rich Roll?

  Assistant professor. Well, come on, we can call you professor.

• 16:18Speaker 01

  Thanks for the promotion.

• 16:20Rich Roll?

  That's just semantics. You're a college professor, or a medical school professor.

• 16:27Speaker 01

  School of medicine, yeah.

• 16:28Rich Roll?

  Right, so, and so, tell me what you teach at NYU.

• 16:31Speaker 01

  So, most of my teaching goes on at the level of the residency, so, those are, so basically, people that have graduated from medical school, so the fully fledged doctors, but, who are in their training program.

• 16:44Rich Roll?

  Mm-hmm.

• 16:45Speaker 01

  And, some of it is didactic, but the vast majority, majority of it is really just hands-on, clinical, day-to-day, how do you take care of patients?

• 16:54Rich Roll?

  Right. So, you're walking these, like, new doctors through the kind of daily routine of what it means to be a resident?

• 17:02Speaker 01

  Yeah, and you're just, you're watching, you're watching what they do with a eagle eye. You are ultimately the one responsible for the care that they're delivering, so you are, you're, you're trying to help them learn. And yet make it a beneficial situation for the patient, obviously.

• 17:21Rich Roll?

  Mm-hmm. And so you're balancing practicing medicine with assistant professor duties. I mean, that's a, that's a lot, right? So, I mean, what's a, what's a typical day or a typical week look like?

• 17:33Speaker 01

  Yeah, I mean, it's, it's direct patient care. So me sitting down in my office, in my exam room, and seeing patients for half a day. And then in the afternoon, for example, I would then move to a larger area where residents or doctors in training come to me and present cases. In other words, they'll, they'll see a patient, they'll come up with their own assessment, they'll present the whole situation to me, and I'll say, hey, that, you know, I think you're, you're on target here.

• 18:03Rich Roll?

  Right.

• 18:03Speaker 01

  I like your plan.

• 18:04Rich Roll?

  Kind of like a doctor house, kind of.

• 18:06Speaker 01

  Yeah. Only, only, there's very, there's, there's not as many mysteries. It's not quite that exciting. There's definitely some mysteries.

• 18:13Rich Roll?

  But that's in the same hot, so you're in the same hot, you're not going to, in like, like a different building.

• 18:18Speaker 01

  Same, same exact area.

• 18:19Rich Roll?

  Uh-huh.

• 18:20Speaker 01

  Yeah.

• 18:20Rich Roll?

  Interesting.

• 18:22Speaker 01

  So, yeah, like I said, I mean, most of the, most of the time, it's a very hands-on practice. And there's, there is didactic stuff, but it's mostly just hands-on.

• 18:31Rich Roll?

  Mm-hmm.

• 18:32Speaker 01

  Guiding people.

• 18:34Rich Roll?

  And, and so let's get into kind of the plant-based.

• 18:37Speaker 01

  Yeah.

• 18:37Rich Roll?

  Slant.

• 18:38Speaker 01

  Good.

• 18:39Rich Roll?

  Where you're coming from. I mean, where did, you know, what's the origin story there? Like, how did you get interested in plant-based nutrition? And, you know, where did that begin?

• 18:49Speaker 01

  Yeah, I mean, looking back, I mean, I think it really, there's almost like two parallel roads that I've been on that it didn't really converge until fairly recently. So, the professional story, which is a little bit less interesting, we've kind of already gone through some of it, but, you know, I, I went to college, I was an English major, English literature major.

• 19:17Speaker 01

  Graduated at the height of the recession in the 90s, like, did odd jobs, worked at a used bookstore, eventually.

• 19:24Rich Roll?

  So you didn't know, the doctor thing wasn't.

• 19:26Speaker 01

  No.

• 19:26Rich Roll?

  Part of the college experience.

• 19:28Speaker 01

  That was not, not at all.

• 19:29Rich Roll?

  You weren't like a driven, type A, pre-med person?

• 19:32Speaker 01

  I was a driven type A person, but not pre-med.

• 19:34Rich Roll?

  But not pre-med?

• 19:35Speaker 01

  Yeah.

• 19:35Rich Roll?

  Interesting.

• 19:35Speaker 01

  I mean, I. I took a semester of chemistry in college because my dad's a biochemist and I felt like I've gotta just honor that, you know? And my mom is too. So I felt like it's maybe-

• 19:49Rich Roll?

  How did you do?

• 19:50Speaker 01

  I actually did well, but then I didn't take the whole year. I just was like, you know, I've done it. I proved that I can take a half a science class and excel at it.

• 19:59Rich Roll?

  I'm a liberal arts person.

• 20:01Speaker 01

  Yeah, I'm a humanities person. I love, you know, I love novels. I love the story. But then graduation happened and I was like, oh whoops, you know, I need a job. Like what? So eventually, I lived in Atlanta at the time after graduation and I eventually just stumbled on a job at the Centers for Disease Control down there as a writer editor. And I worked there for about three years in my early twenties and that was, that was the experience that got like the gears turning around going to med school. And yet I still had not taken a science class.

• 20:40Rich Roll?

  Right. Interesting. So, so at CDC, I mean, that must have been like, that's a crazy place, right?

• 20:45Speaker 01

  Yeah. It's an intense place. Well, it's like a cross between intensity and like government, you know? The government environment. Yeah. But yeah, I mean, people do amazing stuff. They go out on outbreaks. I mean, they're the folks that are dealing with Ebola, like we were talking about before and all kinds of stuff. So it was pretty inspiring and that's where I thought, you know, hey, you know, this is completely unexpected, but maybe I should consider getting involved and knowing that that kind of decision was at least a 10-year commitment. And I was already at that point, whatever.

• 21:22Rich Roll?

  Right. And you hadn't taken all the prerequisites in college, right? For med school. So how did you have to, you had to go back and kind of do that, right?

• 21:30Speaker 01

  Yeah, I did, I did a post-baccalaureate pre-med program. And those programs are great because you're surrounded. It's like you and 24 other humanities majors.

• 21:41Rich Roll?

  Who made this decision?

• 21:42Speaker 01

  Who were all questioning, exactly, like, what am I doing? I can't believe, you know, I'm doing this. And the one I went to at Goucher College in Baltimore was great because you took every pre-med prerequisite in one year.

• 21:55Rich Roll?

  Uh huh.

• 21:56Speaker 01

  Like chemistry, organic chemistry, physics and biology, all in one year.

• 22:00Rich Roll?

  Uh huh.

• 22:00Speaker 01

  And it's like, I like, it's like ripping off a Band-Aid. Like, just get it over with.

• 22:05Rich Roll?

  Right, that's intense.

• 22:06Speaker 01

  And yet I loved it. I didn't, I, you know, I actually found out that I was really good at science and my parents were pretty proud.

• 22:14Rich Roll?

  Yeah, I was gonna say, your dad must have been happy, right?

• 22:15Speaker 01

  Yeah, he was, oh, I finally understood what he did.

• 22:18Rich Roll?

  Yeah.

• 22:18Speaker 01

  I could finally understand, like, his publications, you know, not completely.

• 22:23Rich Roll?

  So he's, he's like a lab scientist?

• 22:25Speaker 01

  He's an academic biochemist, yeah, so he does, he does a lot of work with gene replication, DNA replication.

• 22:33Rich Roll?

  Right, and, and here you are, expressing, expressing this.

• 22:37Speaker 01

  It all comes out.

• 22:38Rich Roll?

  Yeah, this recessive gene that now is coming to, coming to be expressed, right?

• 22:42Speaker 01

  Well, my mom has it too, so.

• 22:43Rich Roll?

  Yeah.

• 22:44Speaker 01

  Yeah.

• 22:44Rich Roll?

  She's a scientist as well?

• 22:46Speaker 01

  Yeah, yeah, she's a biochemist, that's how they met.

• 22:47Rich Roll?

  This was inevitable.

• 22:49Speaker 01

  No doctors, no doctors in the family. So, yeah, so then I, you know, I finished up that program and I moved to New York, got a, you know, a great, like, one-year position in, at the Department of Health as a health educator here in New York. And then that year I applied to med school and within about a week of moving to New York, I realized I was never gonna leave. Like, just love it.

• 23:13Rich Roll?

  You love it here.

• 23:13Speaker 01

  Love it here.

• 23:14Rich Roll?

  Yeah.

• 23:15Speaker 01

  So, enrolled at Columbia and.

• 23:19Rich Roll?

  I like how you just said you just enrolled.

• 23:21Speaker 01

  Just, just, just enrolled.

• 23:22Rich Roll?

  Yeah, because I just decided to.

• 23:24Speaker 01

  Yeah.

• 23:24Rich Roll?

  Well, it's interesting, looking back on your resume, like, even though you had this, you know, humanities background with the CDC and then working in public health in New York and then having all the prerequisites, I mean, that's a pretty solid basis to get into a good med school.

• 23:38Speaker 01

  Yeah, and Columbia was great because there were a lot of other post-bucks there too, so it felt like a community and it felt, I think there's something about. There's a lot of things about being a humanities major and going to med school and and starting med school at the age of 27, which to me now sounds young, but at that time, you know, you're whatever, you're six years older than everybody else.

• 23:58Rich Roll?

  Yeah.

• 23:59Speaker 01

  Which is a big difference at that time in your life. But I think for me, being a humanities major really kept me on my edge because I always thought, you know, how am I going to compete as far as like passing tests and with people that were, you know, molecular biology majors. And the first couple of years were, you know, I did well, but it was, I really put a lot of work in. And then towards the clinical years, which are the third and fourth years of med school, where you actually start talking to patients, that's where everything just kind of like blew up in a great way. Like, I was like, this has really been the right decision.

• 24:41Rich Roll?

  And yeah, you just realize like, this is what you're made to do.

• 24:44Speaker 01

  Yeah, yeah. So, so that's sort of the, we kind of covered the professional.

• 24:52Rich Roll?

  The resume, the part.

• 24:53Speaker 01

  Yeah.

• 24:53Rich Roll?

  How we got here?

• 24:54Speaker 01

  Yeah, how we got here. And then I think the personal story, you know, just leading up to, to where I am now as far as nutrition and plant-based, you know, plant-based eating. You know, I think I'm, I'm one of those people who probably like a lot of, you know, a lot of people or kids are sort of, don't have the, it seems a little strange to make a distinction between, you know, the food on our plate and the animals that we see, right? And so I was kind of like one of those people that never lost, like that just kind of it seemed a little bit strange, like that the food on my plate used to be an animal that was running around. I never kind of lost that sense that it was weird. And

• 25:36Rich Roll?

  But you weren't like somebody who was like, you know, a vegan animal rights activist in high school or something?

• 25:41Speaker 01

  No, I, I became a vegetarian at a really young age, like 13, mostly because it just intuitively felt like I just couldn't imagine that I was eating the food that, you know, like I was eating an actual being that used to run around. It just didn't seem, it just didn't seem right. And it didn't, it just didn't resonate with me. So. I was a vegetarian for, I've been a vegetarian for a very long time. And I think, you know, when you're a vegetarian in the 1980s, you, you got a, you got a, like, very quickly, you realize you got to learn something about nutrition because you're gonna be asked a lot of stuff. And

• 26:19Rich Roll?

  And it's not like your parent, do you have brothers and sisters?

• 26:21Speaker 01

  I do.

• 26:22Rich Roll?

  You do?

• 26:22Speaker 01

  I have two sisters.

• 26:25Speaker 01

  I think we, three of us, my mom and my youngest sister and I sort of all made this leap around the same time. So I had a lot of support. Yeah. Yeah.

• 26:37Rich Roll?

  In support of you, or it was like a collective decision?

• 26:42Speaker 01

  It was a collective, sort of, you know, just, we all kind of, I may have been the first one, but they followed pretty quickly after. And not necessarily in support of me, but just

• 26:52Rich Roll?

  Where did you grow up?

• 26:53Speaker 01

  Baltimore.

• 26:54Rich Roll?

  Baltimore, okay.

• 26:54Speaker 01

  Yeah.

• 26:55Rich Roll?

  Uh huh.

• 26:55Speaker 01

  Yeah.

• 26:56Rich Roll?

  Interesting. So, all right, so you had some support in the house, but maybe not, you know, in the, in the hallways at, in high school?

• 27:02Speaker 01

  Not a lot of support in the hallways of high school, but not, not like, I'm not gonna, I'm not gonna say I had, I was excessively ridiculed, or, you know? It was just kind of like, I think for people, it was just kind of a, an anomaly that was curious, but not, people kind of let me do my thing.

• 27:20Rich Roll?

  Right, but it wasn't driven by health considerations?

• 27:23Speaker 01

  No.

• 27:23Rich Roll?

  At that time. It was just sort of an ethical glitch that you felt like needed to?

• 27:29Speaker 01

  Yeah. It was just, you know, it was just being, just living, sort of, living in line with my values, I guess.

• 27:38Rich Roll?

  And, and so where does that, at what point does that, you know, lifestyle sort of intersect with, you know, your, your medical education?

• 27:45Speaker 01

  Where I am now.

• 27:48Speaker 01

  It's, so it, it did not intersect for a very long time. And actually, I was, you know, continued being a vegetarian and went through college and all this stuff in between before med school and med school. And then residency training and all this time didn't really change my eating pattern, didn't really Use what I knew about sort of the growing understanding of health benefits around being vegetarian to translate that to my patients. It was just kind of like, this is a personal choice. I'm going to kind of keep it to myself and just, you know, like, keep working and...

• 28:25Rich Roll?

  Right. But along the way, you had mentioned, like, early on, you started to, you took it upon yourself to kind of educate yourself about how to do it in a healthy way.

• 28:32Speaker 01

  Yeah, yeah, absolutely. I mean, you had to, I mean, you really, I think at that point, you really had to. I mean, I definitely had my, like, you know, naters where I would be eating, like, white rice and cheese, you know, in the college dorm. But things weren't like they are today, but I definitely educated myself a lot and...

• 28:49Rich Roll?

  What were the sources of education back then? Like, what were the books that were available?

• 28:53Speaker 01

  Yeah, you're right. I mean, there wasn't, certainly wasn't the internet. And I think, you know, there were, there were like a couple of guides out, but...

• 29:02Rich Roll?

  You were kind of...

• 29:04Speaker 01

  Kind of, kind of winging it, but then as I got to med school and residency, there was more stuff out there. But again, it really wasn't, it really wasn't a huge priority in the sense of something that I took upon myself to learn a great deal and then translate to my patients. I think, I think, you know, at the same time, I was starting to realize, you know, how little I knew about nutrition in general and how little doctors are trained because, A, we didn't have any nutrition classes in med school. And then in residency, I remember, you know, for example, having, you know, seeing a patient that had a new diagnosis of diabetes and then going back to present the case to my supervisor back

• 29:46Speaker 01

  then and saying, you know, this is the situation. And they would say, okay, well, why don't you just talk to them about, like, what to eat and so that they don't have to go on pills. And I would go back to the room and like knock on the door and go in and say, hi. And not have any idea what to tell them. Like, I have no idea. And, and that struck me as being really bad.

• 30:06Rich Roll?

  Right. So let's park it here for a minute because, you know, it brings up so much about the, you know, our system of medical education and how we train doctors. And, you know, it's something that I've talked about quite a bit on the podcast, which is this, you know, kind of appalling, you know, scenario in which...

• 30:23Rich Roll?

  We're not training doctors on nutrition, like irrespective of whatever your dietary proclivity is, the simple fact that there is no formal education in nutrition whatsoever for aspiring doctors is just such a gaping hole, like it's so crazy.

• 30:38Speaker 01

  It really is.

• 30:39Rich Roll?

  You know?

• 30:40Speaker 01

  I think.

• 30:41Rich Roll?

  So zero, there was, there were some, did you have electives? Like I've talked to other doctors, like, oh, maybe a couple hours or I had to take this one thing, but it was really nothing.

• 30:50Speaker 01

  Unless I'm, unless I'm completely like just repressing it or not remembering it, I don't think we had any. And I think that, I think, I think the figure is something like 25% of med schools or one in every four med school does not meet the recommended number of hours of nutrition. And the recommended number of hours is something like 25 for your whole four years.

• 31:11Rich Roll?

  Right, super low.

• 31:12Speaker 01

  Yeah.

• 31:12Rich Roll?

  But that recommendation isn't like set in, it's not like a prerequisite, right? It's just recommended.

• 31:18Speaker 01

  Right.

• 31:18Rich Roll?

  So the medical schools don't have, they can choose to follow that or not? Is that how it works?

• 31:23Speaker 01

  I believe so. I believe so. I think that's starting to change, but I think, I think the other issue is that what is taught in those nutrition classes or those hours of nutrition teaching, I'm not really sure. I mean, I, I know that, you know, a lot of med schools teach people and even residency programs teach people about like, you know, vitamin deficiencies and stuff that you're probably never going to see unless you practice somewhere outside the United States.

• 31:52Rich Roll?

  Right. That's what Garth Davis was telling me, like, oh, you know, for scenarios that arise, like if someone has gout or like just rare, more, super rare conditions where they have like an extreme deficiency.

• 32:03Speaker 01

  Yeah. I mean, I'm not like, I haven't seen scurvy in my whole career, like, you know, I mean, or maybe I have and I just didn't recognize it. But I, I think that, I think, I think the most, I mean, what my mission is and what I think people, what doctors need to learn is just nutrition to prevent and treat the chronic diseases that we're taking care of all the time. I mean, you have to understand that like a typical day for me is. Diabetes, high blood pressure, high cholesterol, gout, kidney stones, heart disease, Alzheimer's. You know, everything is related to diet. So the fact that we, just to echo what you're saying, I mean, the fact that we don't,

• 32:48Speaker 01

  we're not given the training to use what is almost universally acknowledged as probably the most powerful tool is, is crazy.

• 32:57Rich Roll?

  That is crazy. That is crazy. But you are doing something interesting to change that. Yeah. So you have this, this grant, right, to teach or to do a study and then teach medical profession, professionals about nutrition. Is that accurate?

• 33:14Speaker 01

  Yeah, yeah, that's accurate.

• 33:15Rich Roll?

  So, so let's talk about that.

• 33:16Speaker 01

  Yeah. So if I could back up, I'll tell you sort of what got me to that point, which is,

• 33:21Rich Roll?

  Yeah, we're all over the place in the time.

• 33:24Speaker 01

  That's okay. I'm sure everyone's keeping up. Just press rewind. So, yeah, I mean, I think that, you know, it wasn't, my practice was still, even though I value this stuff so much, my practice was still very like pill-based and very treating symptoms-based until a couple of years ago. And I have to talk about this because it was such a breakthrough moment for me. I went to, I don't know, I had some conference money and I was like, what's a great conference, medical conference I can go to? And I Googled lifestyle change on a whim. And the first hit was American College of Lifestyle Medicine was having their annual meeting. And as I, I signed up for it, I went to the conference and it was a huge turning point in my career because it was

• 34:08Speaker 01

  a group of, I don't know, 400 or 500 other health professionals, mostly doctors, that are interested in using lifestyle to prevent and treat disease. And then the speakers at the conference were so inspiring. You know, I heard Dean Ornish, Neil Barnard, Michael Greger, who's hilarious and so smart and just captivating. And, you know, a number of other great speakers. And, and I remember the first day of the conference being just feeling like I was zinging. Like, I went back to my hotel room after the conference and just, like, was reading articles and emailing stuff and felt like a manic episode was coming on. I mean, it just, it was like I finally had found, it, it took me realizing there's

• 34:52Speaker 01

  a whole community of people interested in the same thing and seeing these inspiring speakers and.

• 34:58Speaker 01

  I think the second day I sat down for lunch, like the conference lunch, and I sat down and looked across the table and it was Caldwell Esselstine was sitting there and like T. Colin Campbell's son who co-wrote the China study. So it was just one inspiration after another.

• 35:12Rich Roll?

  How many years had you been a doctor at that point?

• 35:15Speaker 01

  Um, I want to say eight.

• 35:18Rich Roll?

  Wow.

• 35:18Speaker 01

  Well, eight after, yeah, eight after my training, after, so a lot of years.

• 35:24Rich Roll?

  Right, right, right, many, many, many years. And you're, you know, in some respect, you're already living this lifestyle. You're interested in these things. And yet, completely unaware that this world with all of these, you know, incredible people exists out there who are, you know, trying to change the system in a certain regard, and that was news to you.

• 35:40Speaker 01

  Right, and I-

• 35:41Rich Roll?

  That's amazing.

• 35:41Speaker 01

  Well, and I was also running, I mean, I've been, I still do, run an obesity clinic. I run a weight management clinic and I run it on lifestyle change. Um, but I think that the, you know, when I'd gone to national, like, obesity conferences, there's not, there was, I remember one that I went to, there was not a single mention of food.

• 36:01Rich Roll?

  Mm-hmm.

• 36:02Speaker 01

  Not a single mention, and-

• 36:05Rich Roll?

  How is that even possible?

• 36:06Speaker 01

  I know, right? Well, I mean, to be fair, I think it was a bariatric, you know, of weight loss surgery-based conference, but still, you still have to eat and it still matters.

• 36:15Rich Roll?

  Right, I mean, Garth always talks about all those, he, because he goes to all those, those conferences on bariatric surgery and obesity. And I guess, you know, what he says is that they're, they're really pushing kind of the, the high protein, you know, high fat, low carb diet. But then he always takes pictures of the breakfast-

• 36:33Speaker 01

  Yeah.

• 36:34Rich Roll?

  -at the conference and it's this, you know, massive amounts of bacon and eggs-

• 36:37Speaker 01

  It's crazy.

• 36:38Rich Roll?

  -and like, you know, all kinds of crazy, you know, high saturated fat foods and all this sort of stuff. And he's like, this is what they're serving at the conference-

• 36:45Speaker 01

  Yeah.

• 36:46Rich Roll?

  -on obesity and bariatric surgery.

• 36:48Speaker 01

  Why are people, why are people unpacking weight loss from chronic disease? Like, I don't understand it. Why are you using, you know, foods that promote chronic disease just because in the short term they might help with weight loss? And, and not, and they don't even necessarily always do that either.

• 37:06Rich Roll?

  Right. Um, but- Yeah, I think there's confusion about the difference between weight loss and health.

• 37:12Speaker 01

  Yeah.

• 37:13Rich Roll?

  You think or?

• 37:14Speaker 01

  I, well, I think that certainly, you know, certainly there's an argument to be made that if you are obese and probably if you're overweight, you, you know, losing weight is beneficial. But I, I think, you know, A, it's about, we'll probably get into this, but A, it's about sustainability, right? And B, it's about what are, you know, what you're doing to lose weight. All those approaches are not equal in terms of chronic disease prevention. So for some people, I mean, there's such a desperation around weight loss, which is completely understandable, that I do think people separate that out.

• 37:48Rich Roll?

  Mm-hmm. Well, I guess if you're, you know, if you're in a, in a critical situation, that weight loss takes priority over everything else, right?

• 37:56Speaker 01

  Like, like, critical, meaning like you have a wedding coming up or something?

• 37:59Rich Roll?

  No, I know. I mean, if you weigh 400 pounds and you're looking at, you know, blood markers that are really bad, it's like, you gotta get the weight off, right? So, you know, listen, you know, Atkins or those kind of protocols are very effective at doing that. But, but that's not necessarily the healthiest way or the most sustainable way to do it. But you'll lose the weight, right?

• 38:19Speaker 01

  Well, you'll-

• 38:20Rich Roll?

  But unless you switch your lifestyle to something that you can sustain, you're gonna gain it back.

• 38:24Speaker 01

  Right. And I've seen that, you know, many, like, literally hundreds of times.

• 38:31Speaker 01

  So, yeah, I went to this, you know, I went to this conference. I was completely energized. I remember coming back that Monday morning after the conference, like, my first, my nine o'clock patient was this patient with uncontrolled diabetes and her sugars were, you know, in the 200s all the time, which is very high. And she was already maxed out on all her pills. And I think, like, you know, literally four days before, I probably would've said, okay, you gotta go on insulin. And, but that morning, I just remember feeling so empowered to say to her, like, let's sit down and talk about what you're eating and go through it. And it sounds so obvious, right? But, but it- The paradigm that we, that most doctors practice in is, is it doesn't, A, it doesn't

• 39:15Speaker 01

  support that and we're not, we're just not trained to think about it that way. So, um, so as I, I started incorporating this stuff more and more into my practice with great success and, and you know, started thinking like this is not, you know, this, I'm just one person and I'm doing this with my patients, but I have obviously a fraction of the patients that are being cared for at this hospital. I have a, you know, and we have to spread this, like other people have to find out about this and I'm in a great position to teach people because I'm teaching people 50% of the week. So that's why I decided to apply for that grant. And, um, the grant is, it's a very small grant and it's, it's a colleague and I who's

• 39:57Speaker 01

  also interested in this stuff. Um, it's the, the idea is to study, like take the first year of the grant to just study all the evidence behind different nutritional approaches. And then in the second year to translate that out to people in a way that's really practical and usable. And we're going to offer it to our faculty colleagues and to the resident doctors as well.

• 40:19Rich Roll?

  Right. So the idea is to actually teach medical professionals, not, not average people, right?

• 40:26Speaker 01

  It is. Our primary goal is that, but I think that, what I hope is that in, in their learning about it, then they'll teach it back to their patients.

• 40:38Rich Roll?

  Right, right, right.

• 40:39Speaker 01

  That's obviously the ultimate goal.

• 40:40Rich Roll?

  Right, right. But it's the, the idea is to like create a different kind of culture around diet and food and lifestyle within the profession.

• 40:46Speaker 01

  Exactly.

• 40:47Rich Roll?

  Right? And so how do you approach the, you know, daunting prospect of studying different nutritional protocols and their impact on health? Because certainly there's no shortage of these kinds of studies out there and we could go down the rabbit hole on, you know, that whole world, but you know, how are you kind of approaching that?

• 41:05Speaker 01

  Yeah. I mean, I, it's, um, it really is a rabbit hole and, um, I feel overwhelmed a lot of the time. And, and I think if I feel that way, it's understandable that other people feel that way. And I think for me, the, you know, what I'm trying to, um,

• 41:26Speaker 01

  What really anchors me is the concept that there really is, there really is broad consensus, I think, around the healthiest ways of eating. And so I want to understand where that consensus came from, and I want to look to the literature and see, you know, why do people say, for example, that, you know, whole grains are so important? Why does everyone agree that vegetables and fruits are so important? I mean, it sounds, you know, people who are kind of in the know take that for granted, but I think when you're sitting down and talking to a bunch of medical professionals, they're going to want to know some of the evidence, not...

• 42:03Rich Roll?

  And I, well, and I also think, like, I would say that there is a consumer notion out there right now that is gaining popularity that would contravene that and say, you shouldn't eat grains, and, you know, fruit is just as bad as candy, and you shouldn't eat that too. I mean, there's so many crazy ideas out there.

• 42:21Speaker 01

  Right.

• 42:22Rich Roll?

  So it becomes difficult to even begin to approach, you know, any of it.

• 42:25Speaker 01

  Yeah, I mean, I think, I think that, you know, the, the media and popular culture sort of hang on to the tensions, right, and the differences. But if, if you really start looking at most of the literature, it really, it, it really does, there is broad consensus around what we should be eating. And there is a lot of overlap between paleo and vegan or plant-based. And we can get into why, you know, reasons why I think plant-based is, is my approach, but, and I think is a better approach. But, but there is consensus, and I think that's the main message. You know, that is one message I want to impart to my colleagues and the trainees, and I

• 43:10Speaker 01

  think just the power that this has to affect change is the other message.

• 43:14Rich Roll?

  Okay, so if someone's listening, you know, the question that's coming into their head right now is like, all right, well, what is the consensus? Like, if you could tell me, you know, let's cut through all the, you know, crazy ideas on both sides of the equation, and all the warring and infighting and all of that, like, what are the, you know, I don't know, five or six things that, you know, basically the studies that you've looked at all kind of agree on?

• 43:37Speaker 01

  Okay. Number one... Eliminating processed foods. So by processed, because this question comes up a lot, you know, when I talk to patients, what is, what is a processed food? So what I tell my patients is just eat as close to its natural form, eat food as close to its natural form as you can. So I tell them, you know, if you're, if you're, if it's a, if it's a piece of bread, did it, you know, think about the food in front of you. Did it grow in a tree or from the earth, you know, in that format? And just keep reminding yourself of eating in the format that's most, that's closest to the earth. So processed foods, there's a tremendous amount of evidence around eliminating those because what we're saying, when we're saying processed foods are refined carbohydrates

• 44:21Speaker 01

  and processed meat. And those are, and I mean, processed meat probably trumps everything. Like if you had to tell somebody to just eliminate one thing, it would be processed meat. And again, there's broad consensus on that.

• 44:34Rich Roll?

  Right. So that's hot dogs, cold cuts. What are the other things?

• 44:39Speaker 01

  Yeah, I'm glad you said cold cuts because a lot of people don't even realize that. Like you get a, like a deli, like deli turkey slices on like whole grain and they, you know, people are, that, that is a processed meat. So bacon, salami, sausage.

• 44:56Speaker 01

  Hot dogs, like you said.

• 45:00Speaker 01

  So these are very, there's, there's nearly unequivocal data that these are, increase the risk of cancer and heart disease and early death. So that's kind of a slam dunk. Refined carbohydrates, probably as bad for you as saturated fat. I don't know if you're going to look at the studies.

• 45:21Rich Roll?

  And the, the, the top of the list on that would be what, like crackers and, you know, kind of snack foods or, you know, what are the, what are the worst processed carbohydrate foods?

• 45:33Speaker 01

  I mean.

• 45:34Rich Roll?

  Like white bread, things like that.

• 45:36Speaker 01

  Yeah, I mean, a lot of the like.

• 45:37Rich Roll?

  Where does pasta fall on that?

• 45:39Speaker 01

  Yeah, I mean, I think that, you know, the, the white, you know, sort of you take a whole grain, you remove the outer. Layers that has fiber and B vitamins and phytonutrients. You're left with a product that's rapidly gets converted into sugar in your blood. And causes insulin spikes and that's the idea. So examples are, you know, a lot of like breakfast cereals. Anything where the first ingredient is flour or milled rice or, you know, the white bread. All the pastries, the white rolls. Of course, like, you know, soda is the ultimate example.

• 46:23Rich Roll?

  Right.

• 46:25Speaker 01

  Beverage, like, you know, all the bottled beverages that people drink and ice, sweetened iced teas and things like that.

• 46:32Rich Roll?

  Okay, so processed meats, processed carbs.

• 46:36Speaker 01

  Yeah, then there's broad consensus that we should be eating more fiber. And, you know, I think, like you talk about all the, you know, things that were really the deficiency that Americans have that we should be learning about. It's not, you know, it's not the vitamin deficiencies you may learn about in med school if you're lucky, it's fiber, right? I mean, the average American, I think it's like 15 grams of fiber a day. And that's a pretty, that's a pretty pathetic amount.

• 47:07Rich Roll?

  Yeah, there's some crazy stat out there that like, I don't know what it is, you know, 80 plus percent of people are fiber deficient.

• 47:14Speaker 01

  Right, I think it's even higher.

• 47:15Rich Roll?

  Yeah, yeah, but we're all worried about protein.

• 47:17Speaker 01

  Right.

• 47:18Rich Roll?

  But like, nobody's protein deficient.

• 47:19Speaker 01

  Right, right, right. I, you know, you're protein deficient if you're like not eating enough calories.

• 47:25Rich Roll?

  Right, if you're starving. It's a starvation thing.

• 47:28Speaker 01

  That's right, that's absolutely right.

• 47:31Rich Roll?

  But the protein thing is really the big barrier, I think, you know, mentally for people to kind of, you know, grapple with the idea of going plant-based.

• 47:39Speaker 01

  I mean, they get a lot of messages to, to make them concerned.

• 47:43Rich Roll?

  Yeah, everywhere you turn.

• 47:46Speaker 01

  Right, and I think people have this magical idea that you You know, the more protein you eat, the more like basically more muscles you're going to have and more built. And, you know, I see patients all the time who are drinking protein shakes and they're sort of adding that on to their normal diet and gaining tons of weight and it's not muscle. I mean, it's going to turn to fat.

• 48:08Rich Roll?

  Right, so let's talk about that. Like, what is the, what is the implication of, you know, exceeding your recommended? Well, first of all, what is the recommended daily allowance of protein and what is the impact of exceeding that in the health context?

• 48:23Speaker 01

  Yeah, so the, you know, I think when they, when you look at, when, when the Institute of Medicine came up with recommendations on how much protein we need, it was based on nitrogen balance studies where you kind of feed people protein and you see how much nitrogen comes out in the urine and you're trying to find a place where you're, you're neither in negative balance or positive balance. So you're, you're getting the protein that you need for your normal cellular activities in your, in your day. So the number that they came up with for most people was about 0.6 grams for every kilogram of body weight, for the average person. And then they decided, you know, let's, let's round this up just to make sure we cover everybody. It's a bell curve, you know, there's going to be people at either end, so let's make it 0.8.

• 49:06Speaker 01

  And so I think people, people who look at that number, if you even look at that number, think that that's the minimum amount, but really it's actually the amount where everyone will be getting, you know, the 90, I think it's like 95% of people will be getting the amount of protein that they need. So it's more of an, it's, you should think of it more as an optimal amount. Of course, there are special situations, you know, in athletes and bodybuilders and so forth where you may need a little bit more, but I think that what, the overestimation that people do is so great and, and they're already eating more protein than they need to begin with. So I think it really, for most people, it's a midpoint and the average, the average person that I take care of and the average person, I think in this country is, I think the statistics

• 49:51Speaker 01

  are that they're getting, you know, 70% more protein than they need.

• 49:55Rich Roll?

  And so what happens when you're exceeding that, you know, limit?

• 50:00Speaker 01

  So...

• 50:03Rich Roll?

  For the average person, I'm not talking about a bodybuilder or an endurance athlete.

• 50:07Speaker 01

  Sure, sure. So for the average person, I mean, the extra protein is extra calories. And if you don't need them, they will be, they'll turn to fat, or you will either metabolize them by your kidney or your liver and get rid of them, some combination of that. And there are, there is such a wealth of data around what happens when you eat an excess of protein, and particularly animal protein. This has not been shown for plant protein specifically. And the things that the totality of the data show are that your, your risk of diabetes goes way up. And I mean, and this is data from studies of hundreds of thousands of people over years. It's not like one, you know, small study. It's, and it's been replicated

• 50:52Speaker 01

  in numerous studies. So that's a big one. Almost all studies show that your risk of heart disease goes up with higher doses of animal protein. There are studies showing that mortality goes up. There's a pretty concerning link with cancer. And, you know, the thinking behind that, there's this molecule called IGF-1. I don't know if, you know, it's insulin-like growth factor one. And protein, animal protein very clearly increases this growth factor. And you do need some of this growth factor, but you'll make it if you eat a, you know, in a, in a recommended way. And so if you make extra of it, it's very closely linked with cancer. So I think that, and then of course, obesity, which I alluded

• 51:34Speaker 01

  to before, if you had to select out, you know, the studies show that if you have to select out one type of food that is most associated with waking, both cross-sectionally, so like at one point in time, and over the course of, you know, prospectively, over the course of a number of years, it's meat.

• 51:51Rich Roll?

  Interesting. Because right now, everybody thinks that it's sugar. It's all about sugar right now. In our kind of reductionist culture of trying to pinpoint one thing, I would say that's, you know, enemy number one right now. So when somebody comes in to your office, and that's their notion, I mean, I'm not defending sugar. I mean, sugar's a huge problem. How do you usually kind of, you know, discuss that?

• 52:21Speaker 01

  Yeah, I'm not a fan of sugar either.

• 52:24Speaker 01

  I think that I try to put it in perspective for people. So a typical scenario might be, you know, a person comes to me and they're concerned, you know, they're concerned about, you know, preventing diabetes and because they have a family history or whatever. And so the first thing they'll ask me is, you know, I'm, can I, should I use Splenda instead of like a teaspoon of sugar in my morning coffee? And if that's all the sugar they're having in their whole day, I'm not that worried about it. That's a very small amount of sugar. And I think there's a miss, people completely miss the boat because the message isn't out there, that it's other things that they're doing, like the animal proteins or refined carbohydrates that are driving that disease risk.

• 53:06Speaker 01

  So that said, I also have plenty of patients that are, you know, guzzling soda and that's a pretty, you know, I would say in terms of lifestyle changes to target, it's actually a pretty easy one to help people change. So it is kind of the low hanging fruit of the nutrition counseling world.

• 53:25Rich Roll?

  Just saying, you know, stop drinking soda.

• 53:27Speaker 01

  Yeah.

• 53:27Rich Roll?

  Yeah, yeah.

• 53:28Speaker 01

  Yeah.

• 53:28Rich Roll?

  Very specific thing that everyone can kind of understand.

• 53:31Speaker 01

  Yeah, and people don't realize, I mean, people are starting to realize about soda, but then I think, you know, people don't realize about all the other sugary drinks that are out there that are just tantalizing you all the time, like everywhere, the delis and the, you know, the grocery stores and they taste good and people like them and they don't realize that how many calories they're getting and what they're doing to their metabolism with those. So those, that's kind of the low hanging fruit and I always target that.

• 53:58Rich Roll?

  Right.

• 54:05Rich Roll?

  All right, well, back to the protein thing. You're sort of, we're talking about the difference between animal protein and plant protein. I mean, what about this idea that plant protein is inferior to animal protein? That, you know, especially for, you know, if you're, if you're... Athletic, or you want to be fit, or you want to perform at your peak. There's this idea that if you're only eating plant proteins, that you're really not getting what you need in order to, you know, build muscle, you know, recover quickly, all these sorts of things.

• 54:37Speaker 01

  I mean, you're, you know, people like you are, it's awesome that you guys are spreading that message and really showing people that that's not true. Biochemically, that's not true.

• 54:48Rich Roll?

  Is there any difference, other than the fact that animal protein comes with all sorts of other things?

• 54:54Speaker 01

  Right.

• 54:55Rich Roll?

  Like, you know, saturated fat, etc.

• 54:56Speaker 01

  Right.

• 54:57Rich Roll?

  And depending upon where you get the meat. But with respect to just the protein aspect of it, are there differences in bioavailability? I mean, there's going to be differences in the percentage of, you know, you know, essential amino acids and all of that, like, I understand that. But like, what are these differences? And should we care?

• 55:15Speaker 01

  No, I mean, we should, we should, well, we should care to the extent that, when you, again, when you look at studies, the evidence just trumps the fact that we have to, like, animal protein is not conducive to long-term health. And the, you know, if you're going to look at the biochemical level and absorption and synthesis and cellular function, you know, you do need to get all your essential amino acids, but on a plant-based diet, you get them. And it's not, you know, I think there's this tendency to think that we need to make it as easy as possible for our bodies to get the food, but you know what? Sometimes it's not good to make it as easy as possible.

• 55:56Speaker 01

  So if you take, if you eat a steak, you know, you're getting what we call a complete protein. It has all the essential amino acids, because it's muscle.

• 56:06Rich Roll?

  Mm-hmm.

• 56:07Speaker 01

  Right? It's, it's an animal's flesh, and so you, you are necessarily getting all the essential amino acids, but we are able to group them together, and if we get, you know, some of them, if we have a bowl of, you know, beans, and then later on, we have a whole grain, you can, your body has the ability to pool it all together, and in a way that long-term studies show actually promotes health, rather than, so I-

• 56:32Rich Roll?

  Now, you're just crazy talking.

• 56:36Speaker 01

  Sorry about that.

• 56:37Rich Roll?

  Um, so, alright, so, I mean, basically what you're saying is, this is a non-issue.

• 56:45Speaker 01

  It's a non-issue.

• 56:46Rich Roll?

  I don't want to mischaracterize your, your words, but...

• 56:48Speaker 01

  No, that was a fair characterization. It's 100% a non-issue. I think, you know, if you're, if you're trying to build a lot of muscle and you're really, you know, you're, you're training and you're a bodybuilder and, you know, we all, you've featured on your podcast and we all know about, you know, the huge movement around vegan bodybuilding and, um, NFL stars and, and so forth. I mean, yes, you, you do need more protein, but there's no evidence to say that it's, to my knowledge, that it's better in the short term even to have animal protein. And certainly in the long term, it's not better.

• 57:22Rich Roll?

  Mm-hmm. Yeah, I mean, all I have to go on is my experience and then the testimony of the people that I've spoken to or I've had on the podcast. And, you know, when I talk to all these plant-based athletes, I mean, they're basically echoing what you, what you're saying. And my experience is that it just, it doesn't really seem to, it, I don't feel like it's impeded me, you know? I feel like eating plant-based has allowed my body to recover more quickly. I feel like I repair myself more quickly in between workouts.

• 57:49Speaker 01

  Right. And, and if it's impeded you, I'd like, I'd like to know what else you could possibly do other than what you've already done, you know? I, I, I think that, um, you bring up a great point, which is it's not, you know, people tend to reduce it all to, to protein, but what about, um, other things that are essential to recovery and to performance, um, that you'd find in other plant foods?

• 58:11Rich Roll?

  How do you feel about, um, this idea of, you know, alkaline-forming foods versus acid-forming foods and the impact on metabolism?

• 58:24Speaker 01

  Um, to be honest, I've never, like, I've never been in that, I've never gotten swayed by that whole acid versus alkaline.

• 58:34Speaker 01

  Um, argument, but to me, it's just, again, another marker for the benefits of eating plant-based because plant foods tend to be alkaline. And again, looking at the evidence, we know that the foods that tend to be acidic, which are animal proteins, tend to cause, cause harm. So if you're, if that helps you, if that's a framework that helps people understand, you know, a healthy way to eat, then great, they can use that, you know, that framework. But I, to me, it's just a marker for the same concept.

• 59:05Rich Roll?

  Right. I mean, the idea is that by eating alkaline-forming foods is very, um, is very anti-inflammatory, right? As opposed to eating acid-forming foods, which provoke inflammation. And then there's this nexus between chronic inflammation and all the lifestyle disease that you alluded to before.

• 59:26Speaker 01

  Right.

• 59:26Rich Roll?

  And when you're kind of

• 59:27Speaker 01

  Right.

• 59:27Rich Roll?

  reducing that inflammation in an athletic context, uh, it expedites your body's ability to kind of bounce back and heal itself.

• 59:35Speaker 01

  There's a, definitely a connection between chronic inflammation and illness and, um, and probably lack of performance in, in athletic endeavors. But, um, I think that there's more than just the acid-base status of the food that drives inflammation. And there's a lot we don't understand, but we know that, you know, even oil, for example, you know, you, they've shown that after a very high-fat meal that's mostly animal fats, um, but even also with vegetable oils, that your blood vessel's ability to, um, to dilate or, or to open up is impaired for about six hours.

• 1:00:16Speaker 01

  So, you know, there's a lot of different ways that food can cause inflammation, and I think, you know, the acid-base theory or argument is just one of them.

• 1:00:24Rich Roll?

  Mm-hmm. Interesting. Well, I want to segue a little bit into kind of, um, Diet philosophies in a more macro sense and you know you said earlier that you know there's a lot of similarities between eating plant-based and eating paleo and there's a lot of paleo people that listen to this podcast and so let's talk about what those similarities are and what that common ground is.

• 1:00:47Speaker 01

  Yeah, I mean, I think the common ground is a lack of processing of food. So you know, eating foods as close to their origin as possible and focusing on vegetables and hopefully fruits, you know, and eliminating dairy, obviously, that's a common thread there. You know, the whole, the whole grain argument is one that I don't really buy into because I think the evidence is so strong that eating what we call cereal fiber, which doesn't, it's not like Special K, you know, it's, it's, it's fiber that comes from grains. That's

• 1:01:30Speaker 01

  the, when people do big studies, that's what they're referring to when they say cereal fiber. The evidence is so potent for these, for this in preventing disease. For example, you know, when you look at what, what is the number one, you know, the foods, the food category that's best at preventing diabetes, it's actually whole grains. And so it kind of turns our conventional understanding of, you know, what a diabetic should avoid or what someone should avoid on its head, right? I mean, because you, everyone always thinks right away, right away carbs, but really, those are some of the most protective foods. So to me, eliminating that whole category is a problem.

• 1:02:07Rich Roll?

  Well, it seems like there's a lot of, when you say grains, I mean, that's sort of an umbrella term for many, many things. I mean, that could mean, you know, Wonder Bread, or it could mean, you know, some kind of heirloom millet. So, so, you know, there's a whole, there's a whole panoply of, of, you know, subcategories within that. And I think, you know, I think it is.

• 1:02:29Rich Roll?

  You know, okay to say, or you know, fair to say that today's wheat is, you know, not our grandmother's wheat, that it's highly hybridized and, you know, in, in certain respects, it's been stripped of much of its nutritional value and it's growing in soil that is not as nutritionally dense as it once was and it's higher in gluten and all these other things. So it's, it's different, you know, it's different than it once was. So what grain are we talking about? Where did it grow? Is it sprouted? Is it whole? Or is it, you know, stripped and refined?

• 1:03:00Speaker 01

  Um, you know, your point is well taken, but I think, I think we need to remember that really very little that we eat now is what it used to be.

• 1:03:11Rich Roll?

  Mm-hmm.

• 1:03:12Speaker 01

  I mean, right? I mean, everything-

• 1:03:13Rich Roll?

  Yeah, yeah, yeah, that's true.

• 1:03:14Speaker 01

  Everything is hybridized. Meat's not the same.

• 1:03:16Rich Roll?

  Yeah.

• 1:03:17Speaker 01

  Certainly. We're, we're breeding, we're breeding animals to be the way that they're most profitable and have the highest fat, you know, now they have very high fat contents, they grow quickly and so forth. So the meat that we eat is not the same. Um, even, and even, you know, we can get into the whole like grass-fed movement, um, but even then it's still not the same as, you know-

• 1:03:40Rich Roll?

  Right.

• 1:03:40Speaker 01

  -what people argue we used to eat. Um, and so nothing's the same. So, you know, again, I just have to keep coming back to what the evidence shows and there are a lot of different kinds of grains, but no one, like, at the end of the day, we're talking about grains in their most intact form. I think it would be optimal to eat food that's, you know, as close to nature as possible. Um, you know, the whole GMO overlay is another thing. Um, but when you just strictly look at the evidence, I think there's a lot of evidence for just eating whole grains. And, and I think we also have to remember, and I, you know, I, because I'm such a nutrition nerd and I'm reading stuff online all the time, I, like, it is very anchoring for me to go back to my practice on, you know,

• 1:04:24Speaker 01

  a Monday morning at nine o'clock after reading nutrition stuff all the time all weekend. And then, I mean, I do other things, too.

• 1:04:31Rich Roll?

  I was gonna say, is this your Saturday night?

• 1:04:32Speaker 01

  I do other things, too.

• 1:04:33Rich Roll?

  What'd you do last night?

• 1:04:34Speaker 01

  (laughing)

• 1:04:34Rich Roll?

  It's Sunday morning here, so what, how, you know, how did you spend last night?

• 1:04:39Speaker 01

  No, no, that's funny. So, uh, yeah, but I mean, I think it's very anchoring to walk into, to talk to real people that are living their lives and have stressful lives and go to work and, you know, and don't, don't necessarily think about all this stuff that we're talking about at a really high level and are just trying to make like affordable- Healthy choices for themselves. So they're not gonna, you know, it would be great if everyone could have like some, you know, artisanal millet, but I think that at the end of the day, like, they have to, they're gonna go to the grocery store in their neighborhood, who, you know, and there's a lot of issues with food access there too, and they're gonna have to make choices, and they're gonna have to be taught what are the healthiest choices there.

• 1:05:21Speaker 01

  So I keep it pretty simple, and I think I try to stay out of the, you know, I try to keep pulling myself back to reality.

• 1:05:28Rich Roll?

  Right, right, okay, so, back to the original question, which is like finding similarities between paleo and vegan, but actually grains is a difference, right?

• 1:05:36Speaker 01

  Right.

• 1:05:37Rich Roll?

  Paleo is no grains.

• 1:05:38Speaker 01

  Right.

• 1:05:39Rich Roll?

  Um, so, so you're saying gra- so we talked about grains, so in terms of other similarities, I mean, no processed food, uh, no dairy, you know, whole foods, lots of vegetables. Um, I don't know if it's, we agree on the fruit thing.

• 1:05:54Speaker 01

  Right, right, I, that's a good question.

• 1:05:57Rich Roll?

  It depends on what subset of paleo you're ascribing to.

• 1:06:01Speaker 01

  Right.

• 1:06:02Rich Roll?

  But I think overall, yeah, I mean, it's basically whole foods close to their natural state, you know, and

• 1:06:06Speaker 01

  Right.

• 1:06:07Rich Roll?

  And then you can get granular from that. Um, but, but then kind of, you know, sort of sidestepping away from that, um, you know, I thought it would be informative to kind of look at some of the, the nutritional trends that are seemingly getting a lot of traction in public awareness right now. And, you know, the number one thing that always comes to my mind is like the Time Magazine cover of, you know, butter is back, and, and, you know, within that, um, within that kind of, uh, framework is this idea that, you know, everything you heard about saturated fat is incorrect, um, you know, saturated fat is your new best friend, uh, it's really

• 1:06:47Rich Roll?

  all about sugar being evil, and, um, you know, eating a high-fat, low-carb diet is really the way to go. I mean, there's a lot of, that's kind of what's in the zeitgeist at the moment, so, and I'm sure that you have patients coming to you who, you know, perhaps are, are, you know, ascribing to this because this is what they're seeing and hearing.

• 1:07:08Speaker 01

  Right. Yeah, I mean, I think that

• 1:07:12Speaker 01

  As I was saying earlier, I think that, you know, it's very titillating for the media to take a headline like that, right? And people, I think a lot of people would love to hear that butter is back. And so it makes headlines, people, you know, want to hear that. I think that, you know, specifically to address the saturated fat issue, and I know Garth Davis talked about this a lot, too. But the two studies that sort of drove those headlines, there's been a tremendous amount of controversy at the level of nutrition research and the medical community about those studies and how they were designed, some sort of gross errors in data abstraction.

• 1:07:57Speaker 01

  There were a lot of concerns raised about industry ties, and particularly with the dairy industry. And there were concerns that key studies were left out of, because they were meta-analyses, you know, they were sort of grouping together the results of previously published studies. So they had left out key studies.

• 1:08:19Rich Roll?

  And I think Garth also said that even under, you know, the most, you know, sort of positive reading of it, it never said that saturated fat is good.

• 1:08:31Speaker 01

  Correct.

• 1:08:32Rich Roll?

  Right? It wasn't drawing that conclusion.

• 1:08:34Speaker 01

  That's right. That's right. Even if you found no problems with the methodology and you took those studies' results at face value, you would not be able to conclude that saturated fat is actually good for you. That is, you're absolutely right.

• 1:08:47Rich Roll?

  It was more a factor of how not being as harmful as we once thought or something like that.

• 1:08:54Speaker 01

  Right. And it's always relative. So whatever, it depends, you know, if you're eliminating saturated fat from your diet, and first of all, nobody has like bowls of like protein saturated fat whenever, like they eat food, right? So if you're eliminating stuff that has saturated fat, what are you replacing it with? And that's the key question. So if you take a study like that low carb, there was a low carb, low fat versus low fat study published last year, about 150 people, and they randomized them to either eat a low carb diet or a low fat diet. The people in the low fat arm were replacing the fat with refined carbohydrates. So sure, that's not gonna, they're never gonna win out.

• 1:09:37Speaker 01

  So it's always a question of that and it's always a question of how much people adhere to the actual diet, like the low fat arm didn't, they didn't even really reduce their fat that much.

• 1:09:44Rich Roll?

  Right, it wasn't that low fat, right?

• 1:09:45Speaker 01

  Exactly. So, um.

• 1:09:48Rich Roll?

  That's the whole thing too, just to, you know, sorry for interrupting, but there's this idea that, you know, oh, for the last thirty, however many years, it was all about low fat. Well, that didn't work, so, but it's like, no, it's just that no one did it.

• 1:10:02Speaker 01

  Right, right, right. People are always really surprised to learn that. You know, we, I think that if I'm understanding the numbers correctly, as a percentage of total calories, we've decreased fat over the, in like one percent or some very small number, but we're just eating more calories. So in terms of grams of fat, we haven't cut back at all. So, um, the other big issue with those saturated fat studies was, I mean, I think Garth mentioned this, was that in one of them, you know, about half the studies controlled for people's cholesterol levels. So if you take out the major, you know, the major way in which saturated fat creates

• 1:10:45Speaker 01

  heart disease and disease in general, if you control for that, of course, you're not gonna find a difference.

• 1:10:52Rich Roll?

  Wait, so let me understand that. So when you say control for cholesterol, that means that they selected for people that were with, already within a certain cholesterol range, or I'm not sure, I don't understand.

• 1:11:04Speaker 01

  So, um, basically because we know that our blood levels of cholesterol are highly correlated with how much saturated fat we eat, um, in these, in about half, or I think maybe like forty percent of the studies that were included in the big meta-analysis, they had actually statistically adjusted for people's cholesterol levels. So, for example, if my total cholesterol was two hundred and fifty and somebody else's was a hundred and twenty, they statistically have a way of eliminating that as a variable.

• 1:11:39Rich Roll?

  I see.

• 1:11:40Speaker 01

  So therefore, if mine is two fifty and yours is one twenty, and I'm eating a lot of saturated fat and you're not, but we control for the intermediate risk factor, which is cholesterol levels in the blood, then it's gonna... You know, you're not going to see, you're not going to necessarily see a big difference between the two groups.

• 1:11:58Rich Roll?

  I see, interesting. Well, one thing you said right there is being kind of contested by certain people out there, which is the relationship between saturated fat intake and serum cholesterol, right? So, in other words, dietary cholesterol is not as related to serum cholesterol as we once thought. This is this idea out there, right? So that eating saturated fat doesn't necessarily impact your cholesterol levels.

• 1:12:27Speaker 01

  So, so the, so separating out dietary saturated fat and dietary cholesterol, that is an important distinction to make because dietary cholesterol does not have such a predictable effect on our blood levels of cholesterol as saturated fat does. I don't know that there's too much evidence to support saturated fat not driving up cholesterol levels. That's pretty much universally acknowledged. So, both in terms of like laboratory, like controlled laboratory experiments where they infuse, you know, where they have people eat a lot of saturated fat and they measure

• 1:13:11Speaker 01

  their blood levels of cholesterol, you can see it like in a linear fashion increasing. So I don't think that there's, there's that much contest around that, but yes, that people's response to dietary cholesterol is more variable. And the problem is those things go together in food.

• 1:13:28Rich Roll?

  Right, so I'm, how do you eat dietary cholesterol and not eat saturated fat?

• 1:13:33Speaker 01

  You.

• 1:13:34Rich Roll?

  Are those?

• 1:13:35Speaker 01

  That's my homework. That's my homework, I'll try to figure it out. I, you can't, exactly. So, and again, like people don't, at the end of the day, people are not choosing foods based on like calories from, you know, saturated fat, they're just choosing food. And, you know, most people, and I don't think it's a useful construct to talk to people about, please get, you know, this percentage of calories from this nutrient and avoid, you know, I think we have to talk to people about foods that promote health and foods that don't, and take it back to like the, the bird's eye understanding.

• 1:14:07Rich Roll?

  Well, that kind of brings up this issue of ketosis and sort of setting aside the fact that like eating this way probably is.

• 1:14:19Rich Roll?

  Probably not getting a lot of fiber. Well, I guess if you ate a lot of vegetables, perhaps you could. But, but, you know, I got beat up a little bit on the internet because I was on a podcast and I, and I happened to say that I wasn't so sure that, you know, ketosis was a lifestyle that, that I really aspired to and that, that, you know, it seemed to me to be, you know, and not being a scientist or a doctor or any, someone with any kind of medical or, or formal nutrition education, that my understanding was that ketosis was kind of an emergency state of the body, where your body has to kind of, you know, scramble and shift the way that it metabolizes nutrients for energy to, you know, sort

• 1:15:02Rich Roll?

  of accommodate the fact that you're glycogen deprived and that, you know, the brain runs on glycogen and that, you know, I just didn't think that this seemed to be something that, you know, you shouldn't, like, natural man's not going around measuring their ketones all the time. Like, it just doesn't seem to me to be kind of a healthy way of living. And, you know, I got blasted by a bunch of, oh, you don't know what you're talking about and, you know, you don't understand.

• 1:15:24Speaker 01

  What was the, what, what was the criticism specifically?

• 1:15:28Rich Roll?

  The criticism, the criticism was that I didn't know the first thing about ketosis.

• 1:15:32Speaker 01

  I mean, what you've just described is my medical understanding.

• 1:15:37Rich Roll?

  Okay, good. I'm glad to hear that.

• 1:15:39Speaker 01

  So you did pretty well without any formal.

• 1:15:41Rich Roll?

  All right, well, so, so, because, listen, there's a, you know, there's a subset of, you know, maybe it's not paleo, it's all confusing, but of the kind of, you know, high-fat, low-carb diet protocol that a lot of athletes are kind of getting on board with, they're actually kind of really trying to get into that ketosis state and, and testing how their body performs athletically. And, you know, maybe they're, you know, looking at performance goals and not necessarily at longevity goals or long-term health goals, but. But, you know, let me, explain to me what ketosis is and what the kind of health implications of kind of being in that metabolic state are.

• 1:16:21Speaker 01

  Yeah, I mean, it's a, it's an unnatural, it's an unnatural state in that it's not the state that our bodies were designed to live in. We're designed to closely regulate our body's pH for optimal cellular function. So if you're depriving yourself of nutrients that your body has to go into an emergency state to start using to create ketone bodies because you don't have, you know, you, you don't have the nutrients you need that feed your brain normally, that is not a good, that is not an optimal state. That is an emergency state. It's, it's, it's like a backup generator. And no one wants to live on like a backup generator. That's not an optimal state. Now, I can't tell you, I don't think I've looked at, I don't even know if there are

• 1:17:06Speaker 01

  studies, but I haven't looked at studies showing that in the very short term, how that affects athletic performance. I can't really speak to that, but...

• 1:17:12Rich Roll?

  Yeah, I mean, the idea is that it helps with being fat adapted.

• 1:17:16Speaker 01

  Okay.

• 1:17:17Rich Roll?

  So if you're an endurance athlete, it's all about efficiency. And the more that you can become reliant upon your, your fat stores for fuel as opposed to glycogen, then you're, you can go longer and et cetera.

• 1:17:28Speaker 01

  Right. I mean, I would question, you know, all I can tell you is that when you see human beings in ketosis and you take care of people in ketotic states, they don't feel well. They're very, very sick. And maybe this is just a milder form, but I can only really speak to like long-term optimal health. There is, there is no way that that can be, can produce an optimal situation.

• 1:17:56Rich Roll?

  So when you say like they're, they're very sick, like what is that sickness?

• 1:18:00Speaker 01

  Yeah, I mean, they have...

• 1:18:01Rich Roll?

  What are the symptoms?

• 1:18:02Speaker 01

  Yeah, I mean, they have mental fogginess, they feel nauseous, they're often dehydrated. You know, they're just, you know, they're fatigued. So again, because of the type of practice that I have, I'm not necessarily talking about if you're doing it in a milder form for athletic performance, but I'm talking about more extreme cases, but...

• 1:18:27Speaker 01

  I just can't imagine that that's a good long-term strategy. And again, just again, taking it back to the big picture, the foods that put you in that state, you know, or depriving yourself of the foods to get yourself in that state is not evidence-based at all.

• 1:18:41Rich Roll?

  Interesting. So, uh, yeah, cause there's, there's, what are the names of, is it not David Perlmutter, but Professor Tim Noakes, are you familiar with his work?

• 1:18:52Speaker 01

  No.

• 1:18:53Rich Roll?

  He's one of the people out there that talks a lot about this. All right, anyway, so let's get back to like your practice and we kind of diverted way off the timeline there, but, but, you know, we, where we left it off was that you had gone to this conference and you were so inspired and then you began to sort of incorporate some of these tools that you learned into helping your patients. But at this point, were you completely plant-based yourself or is that what pushed you into kind of, you know, adopting a lifestyle in your, your own personal life or?

• 1:19:25Speaker 01

  Yeah, no, I mean, I think I'm, I'm glad you came back to that. So around 2007, I want to say, um, a shift, like a, like a switch went off for me around awareness of the foods that I was eating and what, what hap, like what was going on for me to be able to eat like cheese and yogurt. And, um, you know, as I mentioned, I'd already had, I was already a vegetarian, but I think I've, I really internalized the information around, you know, what actually necessarily has to happen for, to animals for me to eat dairy and cheese.

• 1:20:04Speaker 01

  And, um, and I think that, and eggs, and I, and I think when you, I still believe that for a lot of people, if you actually internalize that information, if you actually like don't shut it out and you take it in and you, you see it, it is very hard to eat those foods. Like that's the bottom line. And I was, I was like that.

• 1:20:23Rich Roll?

  Right. Well, the system's set up to prevent you from understanding that. They work very hard to create that iron curtain.

• 1:20:29Speaker 01

  Very hard.

• 1:20:30Rich Roll?

  Yeah.

• 1:20:31Speaker 01

  Yeah.

• 1:20:32Rich Roll?

  That curtain's coming down.

• 1:20:33Speaker 01

  Yeah, not in North Carolina.

• 1:20:34Rich Roll?

  Well, there's a lot of, I mean, there's, for every, you know, for every new ag gag law, there's a new drone that's, you know, with a GoPro on it.

• 1:20:42Speaker 01

  Have you watched that stuff?

• 1:20:43Rich Roll?

  Yes.

• 1:20:44Speaker 01

  Will Potter is like a hero and

• 1:20:46Rich Roll?

  Oh, he's amazing.

• 1:20:46Speaker 01

  Mark De Vries and his films, um, his drone stuff is, is great, but, so yeah, switch went off for me. I internalized the information and I just felt like, you know, I mean, I think Gene Bauer really says it best and, you know, I don't know if your listeners, I know you had him on the podcast, but he's the founder, one of the founders of Farm Sanctuary. I mean, he really says it best when you, you know, the point is living in alignment with your values, right? And I'm not, to me, the values are very simple and it's the same values I'm practicing when I'm a doctor, you know, I'm, I value compassion and I value connection and I value not causing harm. And to me, it's like, why am I separating that out? I mean, we're all interconnected. I'm not, I don't want to cause harm to the planet.

• 1:21:31Speaker 01

  I don't want to cause harm to other living beings. So to me, that was, that was a very sentinel moment. I made another, yet another dietary shift and went plant-based slash vegan. But again, I didn't, I wasn't, I didn't incorporate it into my practice until after that, this conference that I've been talking about. And so I feel like for me now, I feel like for me now, since like going to that conference and realizing that, you know, I have this passion about this way of eating that is, you know, when you take like the, the health aspect, the sustainability and the environment and you take, you know, compassion

• 1:22:14Speaker 01

  and, and concern for other living beings and you mesh them all together, this is really the, the only way of eating that brings that all together. So for me, like you talk about finding ultra, right? For me, this was finding ultra. This was my ultra.

• 1:22:31Rich Roll?

  You found your ultra.

• 1:22:31Speaker 01

  I found my ultra. Um, it was a long time coming, but I think

• 1:22:35Rich Roll?

  It was for me too.

• 1:22:38Speaker 01

  I think you actually got a couple of years on me. But um, but no, I mean, for me, it's like it's renewed my, my passion around, around practicing medicine and, and around life in general. I feel like, I, my purpose, I'm authentic, I'm living, like, there's no dissonance between how I, the choices I'm making and how, what I'm putting out there in the world.

• 1:22:59Rich Roll?

  Yeah, that's a really cool thing when you can kinda, like, I feel that now too. And if you told me many years ago, like, that that was even something that is important, like, I would have been like, what are you talking about? But there really is something intangible, um, but very real about aligning your values with your actions, you know? And when you don't have that dissonance, or that like, you know, when you're not, when you're, when you're saying one thing and doing another, and we all, to some extent, because we live in the modern world and nobody's perfect, there's some level of that in all of us.

• 1:23:32Speaker 01

  Right.

• 1:23:32Rich Roll?

  You know, and it's like, look, you know, I fly in airplanes and I drive a car and I do all these kinds of things that harm the planet. You know, it's like, I'm not standing up on a pedestal, like, I'm some, you know, you know, superior being, I'm very much not. But, but when you, when I make that choice to say, well, this is important to me, and I'm gonna make sure that my actions line up with that, like, there's a self-esteem that comes with that, and there's, you know, I don't know, there's something about that that really changes the quality of your life.

• 1:23:59Speaker 01

  It absolutely does, and I am far from perfect either. And I, I think that recognizing that is actually, um, is actually beneficial, because, you know, it doesn't mean, it doesn't mean do nothing, it just means get started. You know, just get started, just, just see, like, what are the changes that are possible for you to start with that are in alignment with your values? And you don't have to, you can decide where you're gonna draw the line. Um, for me, the line's at one place, and, um, and I feel great about living within that line.

• 1:24:30Rich Roll?

  And what I think is really cool about it is that it's not like making that choice has a negative impact on some other aspect of your life. Like, you can be an athlete.

• 1:24:42Speaker 01

  Right.

• 1:24:42Rich Roll?

  You can do what's right for the planet, and you can take out an insurance policy against disease. You can even reverse diseases that you've had, or things that have been, you know... Bother some for you your whole life.

• 1:24:54Speaker 01

  Right.

• 1:24:55Rich Roll?

  Whether it's like skin problem, like all these sorts of things. So it's like, yeah, maybe you crave a certain food that you like to eat. Like, that's basically the biggest negative aspect of the whole thing. But if you kind of can weather through that.

• 1:25:08Speaker 01

  Yeah.

• 1:25:08Rich Roll?

  You know, short term discomfort and get to the other side of it. There's a certain freedom that comes with that, that I think is a really beautiful thing.

• 1:25:22Speaker 01

  It's actually been pretty eye opening in terms of like the, just the diversity of foods that I eat now compared to before I went plant based slash vegan.

• 1:25:33Rich Roll?

  People don't, they don't believe that.

• 1:25:34Speaker 01

  I know. I don't know why they don't.

• 1:25:36Rich Roll?

  They don't buy it.

• 1:25:38Speaker 01

  Well, I mean, again, I can only speak for myself, but I, and then, you know, and I, when I talk to my patients and I, I do a lot of dietary surveys. I mean, informally, when I, because it's such a big part of my practice. And when I hear what people eat, there's a lot of repetition, a lot of repetition.

• 1:25:59Speaker 01

  So I think an argument can be made that you can actually broaden.

• 1:26:04Rich Roll?

  Right. Like people think they're eating a larger diversity of foods than they actually are.

• 1:26:08Speaker 01

  Right. They're having eggs in the morning. They're having a turkey sandwich, you know, a lunch. They're having a roasted chicken at night. And then they're repeating it like every other day or even every day.

• 1:26:20Rich Roll?

  Right. Well, let's talk about your patients a little bit. Like, you know, what is the, you, you would kind of mentioned like the typical things that you see elevated blood pressure, you know, diabetes, obesity, heart disease, things like that. Like, walk me through some of the success stories that you've had through the, you know, sort of the non invasive, you know, dietary counsel that you're giving.

• 1:26:43Speaker 01

  Yeah. So, so again, one of the great things about being an internist is that you are looking at all the organ systems and the whole person at once. From like mental health on down to like their feet, you know, I mean, everything. So when I, there'll be days when I will, I'll have a patient with, you know, constipation.

• 1:27:09Speaker 01

  Like, just general fatigue, bad sleep, um, high blood pressure, and, um, wants to lose weight.

• 1:27:18Rich Roll?

  Mm-hmm.

• 1:27:18Speaker 01

  Like, that's basically everybody. And, and I'll, it's, it's kind of one-stop shopping in the sense that I will prescribe the same way of eating for all of those conditions.

• 1:27:27Rich Roll?

  Mm-hmm.

• 1:27:28Speaker 01

  Right? Because it, all of those things get better with eating a whole-food, plant-based diet.

• 1:27:31Rich Roll?

  Mm-hmm.

• 1:27:31Speaker 01

  And, so I think some specific examples, um, and, and these are happening all the time, and it's so rewarding to see. I, you know, I'll meet a new patient. I met an, this, uh, this gentleman from Mexico, um, last December. And, um, checked his cholesterol, and I think his, his LDL, which is the bad form of cholesterol, was around 140. And, so I called him up, and I, you know, I said, "Hey, you know, you've gotta, gotta make some changes, and here's what I'd recommend that you do." And, I told him to, basically, cut back on animal products, and focus more on plant foods. And I have a speech, I have a way of saying that, and I, you know, I can do it across

• 1:28:16Speaker 01

  a bunch of different languages now, and...

• 1:28:18Rich Roll?

  How many languages do you speak?

• 1:28:19Speaker 01

  No, I, oh, sorry. Through the interpreter.

• 1:28:21Rich Roll?

  Oh, okay, you have a new interpreter.

• 1:28:23Speaker 01

  No, I speak Spanish and English.

• 1:28:25Rich Roll?

  Well, what is the general, like, like, what, like, the strategy that you employ to connect? Because people will say, and doctors will say, "Well, I can tell them to eat better, but they're not gonna do it." Like, that's the conventional wisdom, right?

• 1:28:38Speaker 01

  Yeah. I have not had that experience at all. I mean, sure, there's, there's lots of people that aren't ready to make changes, but there are lots of people that are, and just need, like, they just need support, and they, some of them are, it's as basic as they just need the information, like...

• 1:28:51Rich Roll?

  Mm-hmm.

• 1:28:52Speaker 01

  Um, so my strategy is, um, you know, I, I kind of follow this motivational interviewing approach, which is a, you know, a way of practicing where you're kind of meeting the person where they're at. So, that's my first question, always, is like, do you, are you interested in hearing about some things that you can change in your food choices that might help you feel better? So, depending on how interested they are, then I start giving out the information, and then I start figuring out, like, what, you know, I strategize with them, like, what are they ready to start working on? And I know there's a whole, you know, when you listen to podcasts, and you talk to experts, you know, there's a whole thing in the plant-based community about whether you should take small steps or dive in. And, um, that's a really interesting dichotomy to me, but...

• 1:29:37Speaker 01

  In my reality, I am helping people take small steps because it's not, it's not everybody that's ready to dive in. And so maybe one day they will be ready, but for now, even with some small changes, they can start getting benefits. So, so yeah, I'll kind of identify, you know, what are you, here are some things I think you could work on, which one of these broad categories are you ready to start working on?

• 1:29:59Rich Roll?

  Yeah.

• 1:30:00Speaker 01

  And then we kind of take it from there. So I have a bunch of tools and

• 1:30:05Rich Roll?

  Right. I think small steps is great because like, if you told people, look, you gotta do this completely right now, 100%, and then a week later, they mess up, then they're just gonna give up.

• 1:30:16Speaker 01

  Right.

• 1:30:16Rich Roll?

  You know, and if you're, if you're talking about the goal being sustainability, like give them one thing to master.

• 1:30:22Speaker 01

  Right.

• 1:30:23Rich Roll?

  You know, and then let them get on top of that, and then they'll create that connect, oh, that actually made me feel better, and I'm drinking almond milk now and not, you know, not dairy, and like, I can do it.

• 1:30:33Speaker 01

  Right.

• 1:30:34Rich Roll?

  So then they feel

• 1:30:35Speaker 01

  Empowered.

• 1:30:35Rich Roll?

  Yeah, they feel empowered to do the next thing, you know?

• 1:30:38Speaker 01

  That is, that is the basis of my practice, and I've seen it work. I, I think the argument for diving right in is also compelling in the sense that, you know, when you, when you're in, when you're in an environment where you do have a lot of support, like in, like in John McDougal's program or something, where you're actually like, you're immersed, you're in an immersion situation, people feel so much better so quickly when they transition that, that might keep them going. But I don't have the, I don't have those resources. So for me, this is a more

• 1:31:12Rich Roll?

  Right. Unless somebody's just hugely internally motivated.

• 1:31:15Speaker 01

  Right. And there are those people.

• 1:31:16Rich Roll?

  Or their, their health is in such disrepair that it's, that it's really critical.

• 1:31:20Speaker 01

  Right. But people need a lot of help because, I mean, as, as we all know, our, our food system and our society does not make it easy for people to make this switch. And you really have to be proactive and aggressive about making the changes.

• 1:31:36Rich Roll?

  Okay, so, high cholesterol

• 1:31:39Speaker 01

  Oh, my guy.

• 1:31:39Rich Roll?

  Goes down.

• 1:31:40Speaker 01

  Yeah.

• 1:31:40Rich Roll?

  So

• 1:31:41Speaker 01

  Yeah, I mean, he's just one example. So no, it was, it was really great because I, you know, I said, here's what I want you to do. I want you to crowd, you know, and I, I use the crowding out thing a lot, you know, where instead of making it so negative, like, stop eating this, stop eating that, I just say, you know, before you're, like, can you eat a bowl of, you know, of bean soup or lentil soup before whatever you would normally eat for dinner? And just start crowding it out gradually. So I gave him all that advice and I said, come back in two months and you know, we'll check your cholesterol. So a couple of months later, his results came in, like popped up in my computer queue and I looked at them and his LDL was 80. So it was one, went from 140 to 80.

• 1:32:22Rich Roll?

  Yeah, almost in half.

• 1:32:24Speaker 01

  And I just thought, and I looked at my note, I like started opening my note to remember what I had done and I thought, well, which statin did I put him on? Because this is a great response to a statin, you know? And then I looked at my note and I, I, and I realized I hadn't put him on any drugs at all. I was so, it was so incredible. Not just, and that, and that, I mean, that was very simple dietary advice and he, he was ready to run with it and did it.

• 1:32:49Rich Roll?

  Right. Like he did it though. Like that's the thing, right?

• 1:32:52Speaker 01

  Right.

• 1:32:53Rich Roll?

  Like he was, he was, he was a partner in this relationship and did the work as if, you know, you're the coach and he's the athlete. Like, you know, the coach can say whatever, but if the athlete doesn't show up for workout.

• 1:33:04Speaker 01

  And there's, and there's a lot of great reasons why people don't show up for, for their workout, you know? I mean, there's, I, I take care of people that are, you know, facing a huge number of barriers, like people that, you know, live in the shelter system or people that are dealing with, you know, single, they're single parents or they're on fixed incomes. And so I feel like my role and what I can best offer to my patients is to be a troubleshooter and to be, um, obviously as non judgmental as I can and kind of help them work through it.

• 1:33:35Rich Roll?

  Mm hmm. Well, that brings up another important thing, which is, you know, this unfortunate situation that we're in where, uh, you know, wellness is kind of being aligned with elitism, you know, and particularly plant-based or being vegan. It's like, oh, well, if you're going to do that, then you're going to be spending all your money at Whole Foods and you're going to be spending all day in the kitchen, creating these crazy recipes and, you know, who can afford that and who's got the time? And yet here you are, you know, treating, you know, for the most part, like, you know, an underprivileged community of people who are in dire health and who don't have the means and most likely don't have the time to, you know, live that lifestyle. So how do they navigate it and what's your perspective on that?

• 1:34:17Speaker 01

  Yeah. I mean, I, I actually specifically tell people that you don't have to shop at a, like a high-end. Grocery store to get, you know, healthy food. And I go as far as, and I have a little more time when I'm running my, in the obesity clinic setting than I do in my normal primary care practice. But I will literally, like, we'll sit down, we'll go on Google Maps and we'll, we'll just figure stuff out. And, you know, I would love to have like a health coach working with me who could do that, but for now it's me. And I think the message is that, you know, we can, you know, we can brainstorm this together. And there are definitely always options. There are always options.

• 1:34:59Rich Roll?

  Yeah, it's really similar to what Robert Osfeld's doing.

• 1:35:02Speaker 01

  Yeah.

• 1:35:02Rich Roll?

  I'm sure you know.

• 1:35:03Speaker 01

  Yeah, yeah, we're friends.

• 1:35:04Rich Roll?

  Yeah, he's great. And yeah, he's now, he has those health coaches now because he's created this program. So.

• 1:35:10Speaker 01

  Yeah.

• 1:35:10Rich Roll?

  I could see you doing something like that.

• 1:35:12Speaker 01

  Yeah. I, I can't tell you what it, um, how good it feels to be able to connect with people on this level because when you talk to people about food and lifestyle in general, but when you talk to people about food, you start, you have a window into their life that I don't think you really have when you're just saying like, hi, how you doing? I'm gonna, you know, I'm gonna get out my prescription pad. And are you taking your medicines or not? And it's like very binary. Like this is just an expansive understanding of people and you get to connect with them in a way that you might not otherwise.

• 1:35:41Rich Roll?

  Mm-hmm. So if somebody's on a super low budget, like what is the, you know, what's the first thing, like, what are the first things you're telling them to go to them? Like, are you telling them to buy certain things in bulk or like, how does that work?

• 1:35:54Speaker 01

  Yeah, I mean, like, it's a, it's a cross product of time, money and access. Right? So, you know, people that have, that don't have a lot of money, but have more time, have certain options. And then we work on the access together because there almost always is access. They just don't, people don't realize. But if you're limited on time and money, then it gets a little harder. Um, it's still not impossible.

• 1:36:24Speaker 01

  People have this perception that like if you can't buy organic like farmers market fruits and vegetables that you shouldn't bother, that it's worse for you to be eating normal. And I don't think, I don't think that's true, and I don't think the data support that. So I talk to people about, you know, especially in the winter, getting frozen, frozen vegetables. They're not expensive. They don't go bad. Keep them in your freezer and then you don't have an excuse for not putting them on your plate. You know, beans and legumes like lentils and chickpeas are not only like culturally very applicable for across a wide range of cultures, but they're obviously pretty cheap, especially in the

• 1:37:03Speaker 01

  dried form. And people are spending, people are spending money on things that don't promote health, like soda and Snapple and obviously, you know, and frozen meals and deli sandwich, deli like turkey sandwiches.

• 1:37:21Rich Roll?

  McDonald's, Wendy's and

• 1:37:22Speaker 01

  Right.

• 1:37:23Rich Roll?

  You know, whatever.

• 1:37:24Speaker 01

  Right. Right. And, and, and, you know, obviously those are artificially cheap and that's another whole conversation because of subsidies. But I talk to people about, you know, just start diverting some of that money. And maybe they won't be able to afford the most expensive vegetables out of season, but

• 1:37:41Rich Roll?

  Right.

• 1:37:41Speaker 01

  It is progress and people can make huge strides in their health in terms of just starting to navigate a little bit, pushing the needle.

• 1:37:49Rich Roll?

  We got to wrap it up here in a few minutes, but there's a couple of things I still want to ask you. And I think it would be really helpful for people if you could just leave them with, you know, I don't know, two, three, like really simple, but like powerful, you know, prescriptions for living healthier.

• 1:38:07Speaker 01

  Sure. I mean, I think that, I think the number one would be to

• 1:38:16Speaker 01

  To to find the joy in

• 1:38:22Speaker 01

  eating in a way and keep yourself open to eating in a way that's sustainable and compassionate and health promoting. So I know that's not that's like at the high level, that's not a practical tip, but that's what drives me. And again, that

• 1:38:38Speaker 01

  that I think is the message that I'd like to spread.

• 1:38:42Speaker 01

  When you think about eating across the diversity of colors of the rainbow, and that's what I tell my patients a lot, too. I think you can get a lot of mileage out of that because, you know, as long as it's not Skittles, you know, if you're eating.

• 1:38:57Rich Roll?

  Eat the rainbow.

• 1:38:58Speaker 01

  Yeah, yeah, I mean, I use that, you know, that PCRM poster all the time with people, but that gets you a lot of mileage because if you're doing if you're doing a diversity of colors and fruits and vegetables in the course of three or four days, you're getting a lot of fruits and vegetables, or you're getting more than you were before.

• 1:39:16Speaker 01

  Finding, you know, focusing on foods that are as as close to their natural state as possible and foods that come from the ground and from trees. Those are the foods that we know promote longevity and reduce disease.

• 1:39:33Rich Roll?

  These are just all crazy ideas. I mean, who are you?

• 1:39:37Speaker 01

  You know, and there's cra- there are crazy ideas out there.

• 1:39:42Speaker 01

  And, you know, there's, I I love, this is, this is, by the way, the same message that I give when I give nutrition lectures to doctors. You know, and you you can't believe some of the ideas that are out there because

• 1:39:56Speaker 01

  people have just have not been trained in nutrition at all, doctors. And so it's a, it's a powerful message, and I think it, keeping it simple and.

• 1:40:05Rich Roll?

  Yeah. Well, I'm really excited about what you're doing with, within the profession, you know, educating other doctors and and medical professionals. I think that's super powerful.

• 1:40:14Speaker 01

  Thank you.

• 1:40:14Rich Roll?

  That's exciting. And, you know, more people should be doing that, you know, it's like if the medical schools aren't going to do it, somebody's got to take responsibility for it. And the fact that you're

• 1:40:22Speaker 01

  Yeah.

• 1:40:23Rich Roll?

  investing in that, I think is really a special thing.

• 1:40:25Speaker 01

  Thank you. It's fun.

• 1:40:27Rich Roll?

  Yeah, it's great. And, you know, at the top level, like the first thing that you mentioned, just, you know, living, living more sustainably, eating more sustainably. I mean, it's just incumbent upon all of us to. You know, really grab that mantle of educating ourselves about where our food comes from, like however you're eating, you know what I mean? Like, we deserve to know where our food's coming from. Get interested in that. Learn how to read a nutrition facts label. And, you know, find out who these companies are that are producing these foods, how they're producing them, how they're shipped and manufactured and packaged and marketed and all of that. Because that knowledge is power, and that power will help drive your consumer choices.

• 1:41:08Rich Roll?

  And, you know, a lot of people feel, we feel disenfranchised. You know, we feel like we can't make a difference, or we just, let's just do what everyone else is doing and live this kind of matrix lifestyle. And it's easy to do that. It's easy to do that, you know? And, and I did it for most of my life. But when you finally say, no, I'm going to, you know, I'm gonna do what's best for me, and I'm gonna educate myself and make the right choice for myself. It's incredibly empowering and enlightening, and it will, it will change your life. And it can change the, the life of the people around you and your loved ones in, in doing so.

• 1:41:41Speaker 01

  Right. Well said.

• 1:41:43Rich Roll?

  Yeah, I mean, it's really powerful, and, you know, I just encourage everybody to go on their own, you know, version of your adventure and, and my adventure, and, and have their own experience with it.

• 1:41:50Speaker 01

  Yeah.

• 1:41:51Rich Roll?

  All right, so I'm gonna, uh, wrap this up with the final question. It's the same question that I asked Garth at the end, so if you listened to that?

• 1:41:58Speaker 01

  I did, but I don't remember it.

• 1:41:59Rich Roll?

  You don't remember? Well, you will remember in a moment. If you were Surgeon General, what would you do? What would be your big change?

• 1:42:07Speaker 01

  Yeah, oh, I loved his answer. I loved his answer, and so, um, well, I don't know that the Surgeon General has the power to do this, but...

• 1:42:16Rich Roll?

  Well, let's just, we're imagining a crazy universe, we're actually like, the, the, this official actually could actually do things.

• 1:42:21Speaker 01

  Okay, sounds, sounds like a great deal. Sign me up.

• 1:42:25Rich Roll?

  Yeah.

• 1:42:26Speaker 01

  I think the number one thing would be to, um, to, to stop artificially subsidizing the foods that are least healthy for our, for us. Right? I mean, I think that is where the number one driver, you know, that's one of the first things I would do, because people don't realize how much their food should cost.

• 1:42:49Speaker 01

  And that doesn't take into account like the healthcare costs that are that stem from those foods. So that'd be the first thing.

• 1:42:56Rich Roll?

  Have you read David Simon's book, Metanomics?

• 1:42:59Speaker 01

  It's one of my favorite books I've ever read.

• 1:43:01Rich Roll?

  And for people that are listening, I had him on the podcast. It was quite a while ago. I don't remember what episode number it is, but I'll put a link up in the show notes to that. But basically, his whole book is really looks into how subsidies drive, you know, economic, the economic machine behind kind of fast food and all of that. So in other words, that, you know, 99 cent McDonald's burger is really like a $7 burger because of everything that goes into it politically.

• 1:43:25Speaker 01

  Exactly. And and then there's also the, you know, the stepchild of that is the advertising, you know, the advertising. And so that we're actually, our taxes are going to advertising for those foods, not just paying at the level of subsidizing the production of the food, but actually paying for the advertisement for that food. So, you know, you'll be, you know, watching TV and you'll see an ad, you know, you'll see an ad for like a pepperoni cheese pizza, and then the next ad is for, you know, Viagra. And it's like, we can't, you know, we really have to start making the connection. So that would be the first, that would be the first rung.

• 1:44:05Speaker 01

  And and I think that I would also, I think that there has to be a way to start educating people about what the healthiest foods are and to use an evidence-based approach. Because there's a lot of evidence, like I said, for a common consensus. And I would use that platform to get the message out in a way that's really clear and get people to understand that, you know, it's not, it may not necessarily be in the headlines and just have a broad consensus around that.

• 1:44:38Rich Roll?

  That's a good answer. I think that's a beautiful way to wrap it up.

• 1:44:42Speaker 01

  Thank you.

• 1:44:43Rich Roll?

  So, yeah, thanks so much for spending some time with me today.

• 1:44:47Speaker 01

  Thank you.

• 1:44:48Rich Roll?

  Your work is really inspiring and and I really appreciate what you do. And I hope that you continue to do it. And I hope that your work inspires many others to follow in your footsteps.

• 1:45:00Speaker 01

  Thank you.

• 1:45:01Rich Roll?

  So, thanks.

• 1:45:02Speaker 01

  Likewise.

• 1:45:03Rich Roll?

  Thanks for being here. Peace. Blance.

• 1:45:11Rich Roll?

  That was great, right? She's awesome. I really like her. I hope you guys enjoyed the episode. Let me know what you thought of our conversation in the comments section on the episode page at richroll.com. Keep sending your questions for future Q and A podcasts to [email protected]. I'm going to be doing more and more of these, of course, and I love getting all your questions. So, let me know what you want me and Julie and other guests, hosts, that I'm going to be having on the show, what you guys want us to talk about. For all your plant power needs, visit richroll.com. We've got nutrition products, we've got signed copies of our books, we've got garments, 100% organic cotton garments, meditation programs, plant power tech tees, art prints, we've got sticker packs, all kinds of stuff.

• 1:45:55Rich Roll?

  Basically, everything you need to take your health and your life to the next level, we got your bases covered. If you're into online courses, I've got two of those at mindbodygreen.com, The Ultimate Guide to Plant-Based Nutrition, as well as The Art of Living with Purpose, both incredibly affordably priced and very, very helpful, and very proud of those courses. So, go to mindbodygreen.com and just click on video courses. You can find out much more information about them there. Thanks for supporting the show. Thank you again for telling your friends, for sharing it on social media. If you haven't already, take a second and give us a review on iTunes. That helps us out a lot. And keep using the banner at richroll.com for all your Amazon purchases. We greatly, greatly appreciate that. All right, you guys, I'll see you in a few days. Peace.

• 1:46:40Rich Roll?

  Plants.

• 1:46:50Rich Roll?

  You