Eradicating Lifestyle Disease with Cardiologist Robert Ostfeld, MD

Newsflash: heart disease is still America’s #1 killer. Despite groundswell interest in all things wellness, the incidence of atherosclerotic disease is at an all-time high. One out of every two people in the United States will suffer some form of cardiac ailment. And one out of every three people will actually die of heart disease. Meanwhile, we are exporting the standard American diet overseas like it's the next blockbuster installment of The Avengers. The result? The developing world is now facing rates of lifestyle-related illness unprecedented in the history of humankind. This is a disaster. The great irony of course is that 80-90% of chronic illnesses like atherosclerosis, type-2 diabetes and obesity are preventible and oftentimes even reversible via simple diet and lifestyle alterations. I can preach all day, but to truly capture the attention of the mainstream, catalyze seismic cultural change and put an end to avoidable disease, we desperately need more highly qualified medical professionals who understand the complicated mechanisms that lead to these diseases and are compelled to implement the preventive measures required to combat and avoid them. This is where cardiologist Robert Ostfeld, MD comes in. A summa cum laude graduate of the University of Pennsylvania with a medical degree from Yale and a Masters in Epidemiology from Harvard, Dr. Ostfeld did his internship and residency at prestigious Massachusetts General Hospital and his cardiology fellowship and research fellowship in Preventive Medicine at Brigham and Women's Hospital – both teaching hospitals of Harvard Medical School. An insanely smart dude with mad skills and a bulletproof resume, Robert had his pick of the litter when it came to choosing where to hang his professional hat. Most would have chosen the highest paying, most coveted cardiology department in the country. But this guy had different plans. Instead, Robert headed north of Manhattan to The Bronx to work with underprivileged populations at Montefiore Hospital, while also serving as Associate Professor of Clinical Medicine at the Albert Einstein College of Medicine. That right there says a lot about what kind of guy Robert is. But there's more to the story. Despite training with the best at Yale and Harvard, Robert was nonetheless left with little understanding when it came to nutrition. For years thereafter, he applied evidence-based medicine, recommended a “healthier” lifestyle (which typically included a Mediterranean-style diet), and watched somewhat helplessly as his patients’ diseases all too often progressed. Frustrated and dissatisfied with his patients' consistent inability to achieve true health, he started to search for alternative means of combating chronic disease. This search led him to The China Study* by T. Colin Campbell; Learn more about your ad choices. Visit podcastchoices.com/adchoices

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

• 0:00Rich Roll?

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• 0:44Rich Roll?

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• 1:06Speaker 01

  65% of 12- to 14-year-olds in the U.S. have early signs of cholesterol disease in the blood vessels that feed their hearts with blood. And we know that from pathology studies of kids who died for other reasons.

• 1:17Rich Roll?

  This is the Rich Roll Podcast.

• 1:29Rich Roll?

  The Rich Roll Podcast.

• 1:33Rich Roll?

  Hey, everybody. Welcome or welcome back. I am Rich Roll. I am your host, and this is the mission: to help you live and be better. So each week, I sit down with the best and the brightest across all categories of life, health, and excellence to blow the ceiling off your personal potential. Thank you for subscribing to the show on iTunes. Thank you for spreading the word. Thank you for subscribing to my newsletter. Thank you for clicking through the Amazon banner ad at richroll.com for all your Amazon purchases.

• 2:03Rich Roll?

  So I just got back from the USA Olympic Training Center in Colorado Springs where I spent about three days. It was a great weekend. It was great. It was amazing. I got to spend time with the fastest young swimmers in the United States, national team members and national junior team members, all of whom are kind of in residence prepping for this summer's World Championships, or the World University Games, or just honing their craft in preparation for Rio 2016. It was really cool to observe. I got to give a cool speech to the kids. I got to hang out with some of the best athletes on the planet. I got to watch them train. I'm talking about guys like Ryan Lochte, Tyler Clary, Connor Dwyer, Katie Ledecky, Jessica Hardy. If you follow swimming, then you know who these people are.

• 2:46Rich Roll?

  If you don't, trust me, there's a lot of gold medals there, a lot, some serious Olympic glory. And I also got to spend time with some of the best coaches in the world to see how they do things at USA Swimming Headquarters and the USOTC in general. Guys like John R. Banscheck, who's been an Olympic team coach and was the coach at University of Michigan. It was an extraordinary privilege to be around him. And also, and most notably, and personally for me, I got to connect with a guy called Jack Roach. He's the one who invited me out for the camp. And he is a legendary figure in the annals of USA Swimming. He's been around the sport for a long, long time. In many ways, he is the spirit, he is the soul, and some would say the shaman of US Swimming.

• 3:31Rich Roll?

  He is beloved by coaches and swimmers of all generations. And it was just such a treat to get to hang out with him, get to know him a little bit, and participate in this national junior team camp. And what's interesting about Jack is, he's a longtime plant-based guy. This guy's the original OG in the vegan movement. He's been plant-based since the mid-'60s, and he's this extraordinary runner. Every year, to celebrate his birthday, he runs his age and distance. And so he turned 67 this year, so he ran 67 miles on his 67th birthday. This guy is as spry as a 35-year-old. So it was great to hang out with him. And I also got to see one of my coaches from my youth, this guy Pete Morgan.

• 4:15Rich Roll?

  He was one of my club coaches when I was a kid. I've known him since I was 10 years old, and I hadn't seen him in probably like 20 years. So here's the thing. I was never a good enough swimmer to be invited to attend the Olympic Training Center to train. And at my age, 48, to be able to be invited to participate in one of these camps, to contribute in some small way, to contribute to USA Swimming and the USA Olympic Swimming Movement, that's something I could have never predicted in a million years. I would have never imagined that my life's trajectory would lead me back to swimming in this way. And it just blows my mind. It just blows my mind.

• 4:57Rich Roll?

  It's been this like crazy, full-circle experience for me. And I was really emotional about it yesterday. And I'm really in touch with the gratitude of having had that experience. I'm really feeling the gratitude. And I think it's important to express gratitude when you feel it. And so that's what I'm doing. So thanks for indulging me on that.

• 5:26Rich Roll?

  Newsflash: Heart disease is still America's number-one killer. In fact, heart disease rates are through the roof. One out of every two people in the US will suffer some form of heart disease, and one out of every three will die from this disease. This has got to stop, you guys. It's insane. And it's guys like Robert Ostfeld that are going to help put an end to this avoidable disease, a disease we can prevent. We can even reverse through some simple lifestyle and diet alterations. So who is this guy, Robert Ostfeld? What do I need to know? Well, the first thing you need to know is, he's super smart. He graduated summa cum laude Phi Beta Kappa from Penn. He got his M.D. from Yale. He got his Master's in Epidemiology from Harvard. He went on to do his internship and his residency at Mass. Gen., one of the most prestigious

• 6:10Rich Roll?

  hospitals in the country, and his cardiology fellowship and research fellowship in preventive medicine at Brigham and Women's Hospital, both teaching hospitals of Harvard Medical School. So this dude's got mad skills, right? With his resume, he could have done anything, gone anywhere, cashed in big time.

• 6:29Rich Roll?

  Instead, he made the unlikely choice to head to the Bronx, the Bronx, New York, to work with underprivileged populations at a hospital called Montefiore, where he is now the founder and director of the Montefiore Cardiac Wellness Program, as well as Associate Professor of Clinical Medicine at the Albert Einstein College of Medicine. In this capacity, Robert started working with his heart patients in new and innovative ways, in a preventive capacity, treating them with a prescription of plant-based nutrition and lifestyle alterations that has reaped extraordinary results, extraordinary results. Robert was gracious enough to sit down with me to talk about the science behind his prescriptive

• 7:10Rich Roll?

  protocols, his practice, and I'm honored to share his powerful insights with you guys today. So, without further ado, meet the sagacious, the perspicacious, Robert Ostfeld, M.D.

• 7:28Rich Roll?

  So you said you have a date later on. Where do you typically take your dates to? I'm getting off, I'm gonna kick it off strong. Do you make your dates go to a vegan restaurant?

• 7:38Speaker 01

  Diving right in.

• 7:39Rich Roll?

  Are you flexible with that? Like, what's the approach? Come on, I've been married a long time.

• 7:44Speaker 01

  All right. Oh, my gosh. This is great. Well, she's on an airplane right now, so that's good. At least she's not hearing this in real time.

• 7:51Rich Roll?

  It's not live. It'll be weeks before this is up. Either you guys will be living together by that time, or not speaking. Who knows, right?

• 7:59Speaker 01

  Yeah, totally. So, I do like to go to vegan restaurants, but I'll definitely go to ones that are not. But usually, especially in New York, it's really easy to order vegan options on a menu.

• 8:13Rich Roll?

  So easy here, yeah. But it's, you know, no, I think it's an interesting question, because, listen, you know, there are a lot of people that listen to this show that are plant-based people, or hardcore plant-based people. Maybe they're in relationships with people that aren't. Maybe they're married to people that are less interested or more interested, you know? So navigating, like, I think, like...

• 8:34Rich Roll?

  Your sort of home life, or your relationships, or your social life really becomes so determinative of these habits, you know, for the better or for the worse. So it, you know, I didn't mean to put you on the spot with that, but I think I was actually genuinely interested, like, you know, where you kind of, how you, how you, I don't know, broach that subject, or kind of ride that fine line, you know, especially with someone who's, maybe they're not, you know, into it.

• 9:00Speaker 01

  Yeah, it's been really interesting, actually. And I found, I guess I've been really lucky, but I find that if you are really passionate about something, and the people that I've gone out with, I won't sort of spring it on them necessarily, but I'll let them know what my thinking is, and, you know, what I believe, and why. And it's been great to see, you know, sort of people evolve with me. And I've found that people are extremely receptive to it. And it's not like I'm having a conversation with them that's, you know, fanatical, really try to explain why I feel like it's a really healthy and wonderful way to live. And I found that most of the people that I go out with really resonate

• 9:45Speaker 01

  to it, and begin to shift how they're eating. And the person I'm going out with on a date later tonight, she's not vegan, but we've been out to dinner two, three times, and each time it's been a vegan restaurant. She's totally open to it. She wants to cook together, vegan meals. So it's really, it's a, it's a great adventure. And I found that people are really receptive to it. And I've seen that dichotomy, as you're talking about, in relationships really manifest in the wellness session that I have, that we'll, we'll get to, I guess, in a little bit. But, you know, it's when, just like you were saying, like, if, if the wife is really into it, or the husband is really into it, and the rest of the family is not, it can be a real hurdle.

• 10:30Rich Roll?

  Of course.

• 10:31Speaker 01

  Cooking different meals, and being supportive or not supportive. So that, that's a really challenging thing to navigate, and kind of bringing people along in regard to the health avenue, at least from my perspective, I've found to be extremely helpful. And I often recommend that when there's a real split in regard to the spouses, you know, of course, they can bring their spouse with them when they come and see me or to one of our wellness sessions, but also to watch the documentary film Forks Over Knives.

• 11:02Rich Roll?

  Right.

• 11:02Speaker 01

  I feel like it's such a wonderful intro.

• 11:04Rich Roll?

  Right, right, right. Yeah, I mean, I think, you know, we'll get into, you know, sort of the specifics of the program that you run and all of that. But while we're on the subject of kind of relationships, I suppose, with respect to health habits, you know, I get that question all the time. Like, I really wanna step it up. I want to improve. But my husband, my girlfriend, my whatever, my boyfriend, like, they're just not interested. You know, and just like, what do I do? And like, you know, that's a tough question to answer.

• 11:33Speaker 01

  That's a tough scenario. And most everyone that I've been out with has been very open-minded. And I think it's an attractive thing when someone is passionate and exciting, excited about something, whether that be art, or politics, or plant-based eating, or what have you. It's a really exciting thing to learn and grow with someone like that.

• 11:55Rich Roll?

  I think it's kind of a litmus test for a relationship, too. Because if you're, if you really care for somebody and wanna be, then you wanna be supportive of their interests. And if you're not, like, I think, like, you're gonna find out, you know, where people stand. And, and eating habits, food, it's such an emotional thing, you know? It's so much more than, you know, the macronutrients and micronutrients on your plate. It's representative of love and how you grew up and, you know, how you interact with people socially. And so with all of that, it becomes very complicated, I think, to kind of unravel.

• 12:30Speaker 01

  Yeah, I definitely agree. You know, when, you know, people have limited exposure to it, you know, sometimes when you bring it up, it's as if it's coming from left field.

• 12:42Rich Roll?

  Right.

• 12:42Speaker 01

  Other space will look at you like you have five heads. And you'll get the typical intro questions, you know, well, where do you get your protein? Or why, why do you eat this way?

• 12:56Speaker 01

  But I guess at the end of the day, I've been really lucky that people have been super open-minded to it. And when, you know, I have the opportunity to talk with them about it, and you know, why I'm really doing this, they resonate to it.

• 13:10Rich Roll?

  Right, right, right. And, you know, it's not like you're practicing medicine up in Topanga Canyon, you know, like you're up in the Bronx. And so it would be great if you could kind of paint the picture about, you know, your practice, the wellness center that you're the director of, Montefiore, is that how you say it, hospital, and kind of the neighboring, you know, kind of environment in which you're, you know, pursuing your specialty?

• 13:37Speaker 01

  Yeah, no, thanks. I mean, so I work, it's a tough one to pronounce Montefiore, and then I've heard it pronounced in all sorts of different ways. I think the consensus is that it's Montefiore.

• 13:46Rich Roll?

  Montefiore.

• 13:47Speaker 01

  Montefiore, yeah.

• 13:48Rich Roll?

  A silent E at the end.

• 13:49Speaker 01

  Exactly. And it's a wonderful health system at as many hospitals. It's actually quite huge. I think it employs somewhere in the ballpark of like 28,000 people.

• 13:59Rich Roll?

  Oh, wow.

• 13:59Speaker 01

  And it has just an incredible social mission. They really are dedicated to taking care of the people in the Bronx, you know, regardless of what their socioeconomic status may be. They reach out a ton to the community in regard to helping kids be healthier in schools, the Green Cart program, working with the city on that, having farmers markets, and tons of initiatives like that. They really put their money where their mouth is, if you will. And that's something that drew me very much to the hospital. And, you know, I guess I'm, I can get into how, you know, we kind of got this program going.

• 14:42Rich Roll?

  Right, right.

• 14:43Speaker 01

  But I think that social mission, you know, coupled with what we're doing with the wellness program was really a nice, a nice mix.

• 14:50Rich Roll?

  Right, right. So, did you, I mean, we can kind of get into the origin story here a little bit, but I, I mean, you came out of Yale Medical School, and you got your masters at Harvard.

• 15:02Speaker 01

  Yes.

• 15:02Rich Roll?

  In something specific, right?

• 15:03Speaker 01

  Yeah, epidemiology.

• 15:04Rich Roll?

  Epidemiology, okay. And then you did your residency at Mass Jan.

• 15:08Speaker 01

  Right.

• 15:09Rich Roll?

  And so from that, did you go directly to Montefiore? You came back to New York after that experience?

• 15:14Speaker 01

  Pretty much. I did my cardiology fellowship up in Boston at Brigham and Women's Hospital.

• 15:22Speaker 01

  And during that-

• 15:23Rich Roll?

  Is that another teaching hospital adjunct of Harvard or?

• 15:26Speaker 01

  Yes, yes.

• 15:27Rich Roll?

  Right, okay.

• 15:27Speaker 01

  And so after that, I came down back to New York City. And, you know, I grew up, I grew up in New Jersey, so it's okay to be jealous. I get that a lot. But I meet all my families around here and I always wanted to come back closer to home when I was done with training. And then I looked at a number of different medical centers in the area and really the social mission of Montefiore. And also just the, the people there. I just had this, you get this sort of spidey sense vibe. And I had this spidey sense vibe that their hearts are really in the right place. It was just a wonderful group of people. And there's lots of amazing medical centers in New York City. But for whatever reason, Montefiore really resonated with me. And then one thing led to another and came down and started working there.

• 16:11Speaker 01

  And I've been there for about 11 years.

• 16:13Rich Roll?

  Wow, I mean, for people that are listening, you know, most people, I don't know, most people, but a lot of people probably know, but maybe, you know, quite a few people don't. I mean, to have, to, to, to have the experience that you had to have, you know, gotten your training at such amazing institutions and then to do your residency, residency, right, at Mass Gen. I mean, that opens a lot of doors. Like there, you had, I mean, let's be honest, you had a lot of opportunities. You could have done many, many different things and gone to any number of places with your pedigree.

• 16:47Speaker 01

  Well, I mean, well, thank you for, for saying that. And I was, I was very lucky and, you know, I really, I, I remember walking around Boston while I was in medical school and, you know, looking over at Mass General and just wishing so hard that I'd have the opportunity to go there. And, you know, I got lucky and things worked out. And those are wonderful, wonderful places to train.

• 17:10Rich Roll?

  Yeah, it's like, it's the medical equivalent of, of clerking for the Supreme Court on some level. You know, it's a very prestigious thing.

• 17:18Speaker 01

  Well, I mean, well, thank you for saying that.

• 17:20Rich Roll?

  Yeah, yeah, but I mean, the point that I'm making really is that, you know, I think it's a testament to your character that you would say, listen, you know, I want to go up to the Bronx and I really like what these people are doing. And I like the community minded aspect of, of this institution. You know, I think that that's not- Probably typical of some of your classmates, you know, perspectives.

• 17:42Speaker 01

  Yeah, well, I mean, well, thank you. And I really wanted to be a part of a system that was taking care of a group of people that really needed it. And, you know, the Bronx unfortunately is a pretty unhealthy area and they need more medical care there. There's probably like maybe 1.5 or 2 million people who live in the Bronx. And for those who aren't, you know, familiar with New York City, it's just one of the boroughs of New York City and it's, you know, right next to Manhattan. And so, you know, about 1.5 to 2 million people there. And I remember a number of years ago, I think it might have been Time Magazine, they ranked

• 18:23Speaker 01

  counties, I think it was counties by state in regard to their health. They had a variety of measures that they use. It seemed reasonably scientific. And there were 50 or 51 counties in New York State that they ranked, and the Bronx was last.

• 18:37Rich Roll?

  Right.

• 18:38Speaker 01

  And, you know, it is an indigent area. According to the 2000 census, there were a number of zip codes in the Bronx where the per capita income was less than $10,000 a year. And in that kind of context, that can sometimes limit access to care. That's one of the things about Montefiore that I really love because they make tons of outreach efforts to try to, you know, help bring health to people.

• 19:07Rich Roll?

  Interesting. You know, I'm not surprised that, that, you know, Bronx came in last because nutrition and health, these are socio-economic issues. And despite the Bronx's proximity to Manhattan, I think it's probably fair to characterize it as, as one of these quote unquote, like food deserts that you hear about where really the options available are, you know, fast food oriented or, you know, the bodega on the corner with packaged processed foods, you know, that are cheap because of some, the farm subsidies, et cetera, which creates this situation where, you know, people are simultaneously malnourished and obese and sick.

• 19:50Speaker 01

  Yeah, I mean, sometimes I look at obesity as starving in the midst of plenty of tons of calories, but very few nutrients.

• 19:56Rich Roll?

  Mm-hmm.

• 19:57Speaker 01

  Yeah, I totally agree. I mean, there are parts of the Bronx that are food deserts, limited access to healthy foods, and there are a variety of hurdles that can get in the way. In addition to maybe not having access, a handful of my patients live in areas where they don't feel secure or safe to go walk the distance they may need to to get to somewhere where they can get healthier foods. So there are, there are a variety of challenges that, you know, require both, you know, medical education, but also, I don't know the right term to use, but government or societal input to try to help improve things.

• 20:38Rich Roll?

  Mm-hmm. And so how long were you practicing there before you had this sort of epiphany or idea that you wanted to create this wellness program?

• 20:47Speaker 01

  Probably about six or so years. And I guess backing up a little bit, so I'd been interested in health for a long time. And when I was seven, I had a younger brother die from an incurable disease. And his name was Daniel, and he was three at the time. And I remember his funeral, and I wanted to throw stamps in so he could write us, you know, but I was too shy to do it, I didn't do it. And ever since then, I've kind of been moving in the direction toward health and wanting to help people.

• 21:30Speaker 01

  And I thought about other things a little bit, but by the time I hit college, I was, you know, I started off right away, pre-med, and that was, that was, that was great. And actually, I remember I had this one kind of wild experience when I was volunteering in an emergency room. Um, the uh, there was this, there was a woman who was there and she went into and now I, I was in college and maybe my precise memory of the exact diagnoses could be off, but she uh, she went into cardiac arrest, the kind of thing like you see on the TV dramas, they have to shock the heart back. So her heart started beating in a funny way that would be fatal. And so the,

• 22:13Speaker 01

  you know, the whole emergency room activated and everyone's rushing over and they're, they're rushing the, the code cart over to her so they can shock her heart. And then the cord of the code cart gets stuck on something and, and it flies in the air. And it's one of those things where it's like, you know, probably was like three seconds in real life, but it felt like an eternity. And like just time seemed to stop and everybody's eyes was on this cart and it's going through the air then boom, like it crashed on the ground, the loudest crash, so loud. And then the, the woman who was in cardiac arrest went out of cardiac arrest.

• 22:54Rich Roll?

  Oh my god.

• 22:55Speaker 01

  Everyone's like, I can't believe it. It was just this loudest crash.

• 22:59Rich Roll?

  Like the ruckus of the crash, like shocked her out of her arrhythmia or whatever it was?

• 23:03Speaker 01

  Yeah, yeah. And so for, for, for all my electrophysiology friends who may be listening to this.

• 23:09Rich Roll?

  Explain that.

• 23:10Speaker 01

  I'm certainly not advocating, yeah, please explain that to me. Uh, but I'm certainly not advocating that as a treatment for cardiac arrest. It was just one of those remarkable.

• 23:18Rich Roll?

  When all else fails, like.

• 23:19Speaker 01

  Yeah, loud.

• 23:21Rich Roll?

  So, but the impact of that on you was what?

• 23:24Speaker 01

  Well, it, it just, uh, it, it just reinforced my desire to be in a position to help people and, and just that whole many weeks when I was in the ER seeing people come through and, um, you know, watching the docs and, and the nurses and the physician's assistants helped them feel better. So that was great. Um, and then one thing led to another. And I went to medical school and it actually, I guess, as a side note, this is, is, it was really sad. You may have heard the news in Boston, there was a doctor there at Brigham and Women's Hospital, a surgeon named Dr. Michael Davidson, who was just shot and killed Mm-hmm, yeah.

• 24:06Speaker 01

  Last week. He's a medical school classmate of mine. Oh, wow. A really sweet guy. Yeah, what happened? Well, all I know really is what has been in the press and so I don't know the details specifically, but from what I've heard from the press is that he had, I guess, done surgery on a patient and the patient's son maybe was unstable or something, I'm not quite sure, but then a couple of months later, that patient's son came to Brigham and Women's Hospital,

• 24:47Speaker 01

  I'm not sure exactly what inspired him to do that, but he sought out Michael, Dr. Davidson, and had a gun and shot him. The idea be like that he didn't, he didn't save his father or didn't perform surgery properly, or? I, I mean, I don't know any details about the case and I know that Michael was just a tremendous student and trained incredibly well, so, you know, I doubt that that would be the case and people do, you know, die, you know, as, you know, the death rate's still 100% of course, but I think that, you know, I think the mother may have died a couple

• 25:32Speaker 01

  of months after the surgery. I don't know if that had anything at all to do with what Michael did and I would doubt it specifically, but.

• 25:42Speaker 01

  Anyway, he was disgruntled, the patient's son, and came in and sought out Michael specifically. And they were talking, and then I guess people heard yelling, and the press is very much about how Michael was such a hero, yelling people to get out, get out, and then he was shot and killed.

• 25:58Rich Roll?

  Right, oh, wow.

• 26:00Speaker 01

  And so my heart goes out to his family.

• 26:03Rich Roll?

  Mm-hmm, that's terrible. I mean, I think that, you know, do incidents like that occur in your hospital? I mean, you're sort of in a, you know, relatively high crime area compared to the typical hospital location.

• 26:17Speaker 01

  Yeah, I mean, fortunately, no, I haven't seen anything to that extreme. But sometimes situations can get a little uncomfortable. And often, you know, sometimes a patient, we give patients a little more leeway, you know, they're not quite themselves, they're sick, and they may act out in ways that are, you know, if you just met someone over dinner, would be highly inappropriate. But we kind of give them, you know, some freedom in that regard. And hospitals have pretty large security services, but obviously, it's not perfect.

• 26:47Rich Roll?

  Right.

• 26:48Speaker 01

  One of the scariest experiences that I've ever had in that regard is when I was actually a resident in Boston, and a guy came into the emergency room. He was, had basically already died, and they were coding him, and we continued the code, but he was already dead. And so we, you know, did everything we could, but he just, his heart wasn't responding. And so then his son came in, and I needed to tell him that his father died. And so it was me and the son in a very small room.

• 27:26Speaker 01

  And his son was a, is a big guy, probably about like 6'2", 250, big guy, young guy. And so, you know, I told him his father passed. And then the son stood up, took a step, an aggressive step, right toward me, and was literally two feet from me, pulls his arm back like he's gonna punch. And I just had this spidey sense that he wasn't gonna hit me, I don't know why. And then he punched the wall right over my head so hard, we had to x-ray his hand.

• 27:58Rich Roll?

  Oh, my god.

• 27:59Speaker 01

  But it was scary.

• 28:03Speaker 01

  But you know, that's the exception, not the rule.

• 28:05Rich Roll?

  Right, right.

• 28:06Speaker 01

  You know, most patients are incredibly grateful.

• 28:09Rich Roll?

  And so where, where along the line do you start to get interested in cardiology as a speciality?

• 28:16Speaker 01

  In, in medical school, I really, I loved the pathophysiology of it and I loved with my hands and the stethoscope, being able to examine people and try to figure out what was going on without having tons of tests. And you know, being able to use tests as supplements to, you know, what your history and physical exam suggests might be going on. And I had some great mentors there, this guy Jim Oregi, who's an amazing teacher. And then when I hit residency at, at Mass General, I had the chance to work with lots of incredible docs. And there's this one guy, Dr. Roman De Sanctis, who in my mind is one of the, you know, the gods of cardiology, if you will. Just like the wonderful combination of like incredibly gentlemanly and incredibly brilliant and skilled.

• 28:58Speaker 01

  And he was just beloved. And he was, I, I got to work with him some. And it's experiences like that. And actually, I remember the sentinel moment when I decided, okay, cardiology is, it's going to be, I was deciding between endocrinology, like the hormone stuff, and cardiology. And I was on the endocrine consult service to try to like help myself figure it out. And I walked into a patient's room for an endocrine issue, but they went into rapid atrial fibrillation, which is an abnormal heart rhythm and they were feeling short of breath. And so I was the only one there. So I, you know, dealt with that. And I just enjoyed the cardiac aspect of the case more than I did the endocrine. So I'm like, all right, well, that's a sign.

• 29:39Rich Roll?

  Yeah, there, yeah, you're being sort of guided, I guess, right? And that was, that was that.

• 29:44Speaker 01

  Yeah. And then, um, so then went down the path to cardiology and it's, uh, you know, then we have these matches and stuff where you, you know, apply and it's kind of nerve wracking and stuff. And you, you know, you get a letter in the mail or maybe it's probably by computer these days.

• 30:00Rich Roll?

  Right, right.

• 30:00Speaker 01

  And you get a letter, it says where you're going to go. You know, these things are, it's a big deal because wherever you match, it's going to be where you go. And depending on where you apply, it could be California, it could be Florida, like you don't know. So you get this, and that's where, the letter, and that's where you're going to be for three years. So like we're all, like all your residents and colleagues, it's a big day, you know.

• 30:18Rich Roll?

  Does everybody get the letter at the same time?

• 30:21Speaker 01

  Yeah, they do. And, and now that it's on computer, like everyone gets it at exactly the same moment. And everyone wants to know, you know, where you go, where you're going to be. It's, it's really an exciting. Exciting time. I remember reading my letter and it said I was gonna be at Brigham and I was just so excited about that.

• 30:37Rich Roll?

  That's where you wanted to go?

• 30:38Speaker 01

  Yeah, very much so. And so there, I became more and more interested in prevention and just incredible people I got to work with there. You know, my fellowship director for a time, Jim Fang and Lynn Warner Stevenson, brilliant heart failure doctor, and Peter Libby, our chief, Paul Rittker, who really helped me get interested in prevention even more. Just lots of incredible people. But so then, you know, I graduated fellowship and came down to Montefiore where I work now as, I guess you could say, an academic cardiologist, non-invasive, meaning I don't do invasive procedures like cardiac catheterizations.

• 31:19Speaker 01

  And, you know, I did, I worked with incredible people. I did all the things that I was trained to do, guideline-based medications, healthier lifestyle. But to me at that time, that was maybe Mediterranean-style diet.

• 31:35Rich Roll?

  Right. So to be clear, you weren't on the plant-based trip yet. Like, you're a Western, you know, diet guy for a long time.

• 31:44Speaker 01

  Yeah, I mean, I grew up Western diet and then I was, you know, switching to Mediterranean style, which, you know, it's certainly healthier than a Western diet. And that's kind of how I was taught. And I didn't really, I got to train with great people and at great places, but I didn't really learn about the plant-based diet.

• 32:02Rich Roll?

  Right. Yeah, what I wanted to ask was like, all right, so you do your pre-med undergrad at Penn, then you go to Yale Medical School, and then you're getting your masters at Harvard. And, you know, amongst those three, you know, unparalleled institutions, what is the nutrition curriculum, you know, look like? Like, what are you being told during those years about, you know, what the best way to eat is?

• 32:25Speaker 01

  Well, times are changing. But when I was going through Very little. There was very little.

• 32:31Rich Roll?

  I think most people are really surprised to hear.

• 32:33Speaker 01

  Yeah, I mean, in medical school, I mean, maybe we had two or three lectures for four years of medical school devoted to nutrition.

• 32:43Rich Roll?

  Two or three lectures in four years.

• 32:45Speaker 01

  Yeah. And, you know.

• 32:46Rich Roll?

  That's amazing.

• 32:47Speaker 01

  And it probably like was woven into some other lectures a little bit, but it was mostly like if you had a deficiency in this, a deficiency in that. It wasn't like, what's the optimal diet to promote health? It was like, you know, what is vitamin C deficiency look like or this or that? Things nowadays you almost never see. So in, in medical school.

• 33:10Rich Roll?

  Like scurvy, like drink scurvy.

• 33:13Speaker 01

  You know, drink lime juice if you're going out on the high seas.

• 33:15Rich Roll?

  Right.

• 33:17Speaker 01

  So barely anything in medical school. And, you know, residency and fellowship, some, but, you know, maybe I missed it. Maybe I missed that day or something, but I certainly didn't learn about the impact of a plant-based diet. And so, but, you know, speaking for, well, I guess we could touch on like education about that stuff in a, in a bit. And so I'm practicing medicine for a bunch of years at Montefiore and really enjoying it, but I'm starting to become disillusioned frankly, because although patients, maybe we're slowing the pace of disease a little bit with medications and Mediterranean-style diet, people don't seem to be getting profoundly better, which is why I went into it in the first

• 34:01Speaker 01

  place. And I was kind of getting a little depressed about it and like, what am I doing?

• 34:07Rich Roll?

  You're just in this sort of diagnose and prescribe modality?

• 34:11Speaker 01

  Yeah, you know, that and, and encouraging people to have a Mediterranean-style diet, which in my experience didn't profoundly impact their health. I'm sure, you know, it's healthier than, you know, a Western diet, but it was, they didn't come back and say, wow, I feel so much better.

• 34:31Rich Roll?

  And then look at their blood panels or whatever and see vast differences.

• 34:35Speaker 01

  Wasn't vastly different at all, at least in my experience. And then it was right around that time that I stumbled across this book, the book called The China Study by Dr. Campbell. And. And I just loved it. It's a book, of course, about the health impact of a plant-based diet. And it really, really resonated with me. I'm like, wow, this is amazing. And I did more research into it. And I used to run cardiology grand rounds at Montefiore for a bunch of years. And I thought, wow, this would be great stuff to get out to the faculty. And I wanted to learn more about it. So I somewhat selfishly invited a bunch of people in this arena, you know, Dr. Esselstyn and the amazing work that he's done. And of course, Dr. Campbell

• 35:19Speaker 01

  and others. And we're very fortunate that they came and they gave cardiology grand rounds. And so our faculty got to learn more about it. And Dr. Esselstyn was just so helpful. And I had the chance to go out to his home in Cleveland and visit his wellness program. And with all that information, I approached my chief, Mario Garcia at Montefiore. And I told him I want to start this wellness program. And they couldn't have been more supportive. They said, you know, go for it. I just felt really lucky to be to be there.

• 35:54Rich Roll?

  So it was really inspired by reading that book?

• 35:56Speaker 01

  That book.

• 35:57Rich Roll?

  What catalyzed that whole thing?

• 35:59Speaker 01

  Absolutely.

• 36:00Rich Roll?

  And I want to get into how that's influenced how you practice medicine and treat your patients. But just to kind of camp out here on the China study, you know, idea for a minute. When you said you like, you did a little bit of your own research and looked around, I mean, what, what kind of stuff did you do? Because what I want to kind of get into is this idea that the China study has been debunked, you know, and if you sort of talk to people that are of the, you know, Weston Price Foundation mindset, or the Denise Minger, you know, and followers kind of tribe, I guess, there's this sort of what I would call faulty consensus that, that, that the China study is really no longer relevant,

• 36:44Rich Roll?

  and it has been sufficiently debunked.

• 36:47Speaker 01

  Well, that's news to a practicing cardiologist who sees.

• 36:54Speaker 01

  Hundreds of patients and many, many patients get profoundly better when they embrace a plant-based diet. So that's news to me. But less anecdotally, you know, with any kind of study, you can poke a hole in it. And that's the nature of science. And, you know, when you have these big epidemiologic observational studies, they're wonderful to learn things from, but you can't necessarily control for everything. And so, you know, if these 15 behaviors are associated with less disease X, Y, or Z, you know, maybe it's not really those 15 behaviors. Maybe they were doing some 16th behavior that was doing the trick, but nobody ever realized.

• 37:39Speaker 01

  So there's always some inherent uncertainty with epidemiologic studies, or even these, you know, kind of a gold standard would be a randomized controlled trial. Well, even there, there are weaknesses, pluses and minuses of all sorts of studies. And we spend a lot of time in our journal club going through the, these kinds of strengths and weaknesses of a study so you can try to incorporate it thoughtfully into how you care for patients. But when you kind of look at the totality of the evidence, and any given study has its weakness, when you look at the totality of it, there are basic science and mechanistic studies that support the benefits of a plant-based diet.

• 38:21Speaker 01

  So on that level, then there are not many, but certainly the one by Dr. Ornish randomized trial supporting the impact, the highly beneficial impact of a plant-based diet on patients. There are multiple, multiple observational studies or cohort studies where you follow patients over time, like the work of Dr. Esselstyn that, and his larger cohort with about 200 patients was published just this, was it this past July? Yeah, it was past July in the Journal of Family Practice. Which highlighted the profound benefits that patients have. And let me give you a comparison.

• 39:08Speaker 01

  Now, I'm going to compare two different studies right now. So it's a little bit of comparing apples and oranges. They're different patient populations. So it's just hypothesis generating, but just as a basis of comparison. And Dr. Esselstyn's work where he followed about 200 people. And I think around 170 or so were compliant with a whole food, plant-based diet. And Dr. Esselstyn, of course, also encourages people to not have oil. And in that study, there was about, I think, well, and those patients had what we call stable coronary artery disease. Stable blockages in the blood vessels that feed their hearts with blood. So cholesterol blockages in their heart.

• 39:50Speaker 01

  And then I want to compare that to a study that's called the Courage Trial. Which was a larger randomized controlled trial, I think about 2,000 or so patients where they randomized people also with stable coronary artery disease. So I think the populations are somewhat similar with stable coronary artery disease. They randomized them to maximal medical therapy. And encouraging a healthier lifestyle, but nothing like whole food, plant-based. So maximal medical therapy and healthier lifestyle versus maximal medical therapy, healthier lifestyle and stents. Now, this is stable disease. If you're having a heart attack right now, you want a stent right away. This is stable disease.

• 40:31Speaker 01

  And in that study, the Courage Trial, there was no difference between those two arms. So whether you did or did not get a stent, you didn't live longer, it didn't make you less likely to have a heart attack. Right. So, but those patients, to me, seem somewhat similar to those that were in Esselstyn's study. Now, apples and oranges. In the Courage Trial, though, they had about a 19% event rate, meaning around 19% of the patients overall in the Courage Study had a heart attack or stroke or something during the three or four years of the study. In Esselstyn's, there was

• 41:09Speaker 01

  The number, depending on how you define it, but one patient, the formal report is one patient of about 107, so about a 0.6% event rate in Esselstyn study, people with stable coronary disease versus a 19% event rate.

• 41:26Rich Roll?

  Yes, super dramatic.

• 41:27Speaker 01

  Very.

• 41:28Rich Roll?

  And the qualitative difference really is simply the difference between kind of advocating a quote unquote healthier lifestyle versus a very specific like plant-based diet routine.

• 41:38Speaker 01

  Exactly right. And if you look at weight gain in those studies, in Courage, the patients gained on average three or four pounds and in Esselstyns, they lost about 18 pounds over, this is three or four years of the study. So, a healthy lifestyle can take on all kinds of stripes and sizes. And one other kind of related study, there is a well discovered, a very, what's the term I'm looking for, a study that got a lot of attention called the PRETIMED study of the Mediterranean-style diet out of Spain, now maybe about a year and a half ago. And they basically randomized people to, with no known heart disease. They had no known heart disease.

• 42:21Speaker 01

  Now, keep in mind, at Esselstyns, they had heart disease. No known heart disease. They randomized them to a Mediterranean-style diet versus a typical Western diet. And shocker, the Mediterranean-style diet did better than the Western. But those in the Mediterranean arms still had about a 3.5, 3.5% event rate.

• 42:39Rich Roll?

  So, still statistically so much dramatically higher than the Esselstyn population.

• 42:46Speaker 01

  Exactly. And they didn't have known heart disease. So, to me, that speaks to the profound impact of this lifestyle. And that's just one of many studies mechanistic, so basic science mechanistic, observational, small number of randomized trials, pointing all in the same direction. And it's not just for heart disease. There's this thing that I like to do called the CAL Scan. So, we're all familiar with CAT scans, you know, where they do a big radiologic picture looking at Looking for a problem in your body, whether it's the chest, belly, or something like that.

• 43:28Speaker 01

  Well, I thought, wouldn't it be cool if we could do a cal scan? Which, instead of looking for a problem, could look for ways that a plant-based diet might be beneficial for you. And so I looked through some of the studies. And so, like we were talking about, a healthier diet doesn't just point to heart disease. So if I could, I'll go through the cal scan. And these are things that a plant-based diet has been associated, not necessarily unequivocally proven, but just other things pointing in the right direction associated with improving. So first of all, it's been associated with less mortality, less death. And so I'll start from the top down. Many of us are on social media, on Facebook. We were talking about Facebook just before. So a lot of us saw the ice bucket challenge.

• 44:12Speaker 01

  Well, a plant-based diet, elements of that, have been associated with less ALS, less stroke, less depression, less cognitive decline over time, less Alzheimer's, improved skin complexion, less acne. In fact, some investigators suggest that acne is so tightly linked to the Western diet that it's not actually a vestige of teenage angst, but actually your body crying out for help from lack of nutrition. Fewer ear infections, less periodontal disease, less laryngeal cancer, less heartburn, less

• 44:53Speaker 01

  lung disease, less lung cancer, less breast cancer, less heart disease, of course, less obesity. And the former surgeon general, Dr. Carmona, said that this generation will be the first to live fewer years than its parents because of sequelae of obesity. Seventy percent of our population is overweight or obese.

• 45:16Speaker 01

  Less high blood pressure. We call high blood pressure the silent killer because you don't feel it, but it can kill you. And it's important that all listeners get screened from high blood pressure. But now, there's a statistic that I read that blows my mind. If you're a 55-year-old adult in the US, your lifetime risk of developing heart disease is about 90%. And that's based on information from the Framingham Heart Study. And every time I read it, I have to reread it. It's just so high.

• 45:41Rich Roll?

  That's unbelievable.

• 45:42Speaker 01

  And but if you eat a plant-based diet, you are anything but the average adult. And, you know, for example, blueberries can lower blood pressure. There's less diabetes, there's less colon cancer, less inflammation, less constipation, less prostate cancer associated with less prostatic hypertrophy. And so guys may recognize that of having to wake up four or five times at the night during the night to pee because I can't pee all the urine out because the prostate's big. Improved sexual function in men and women. And we call, of course, erectile dysfunction the canary in the coal mine for heart disease. And getting

• 46:25Speaker 01

  an erection is a psychological event, it's a neurologic event, and it's a vascular event. And by the time you have a blockage in the artery to the penis, because the artery to the penis is smaller than that to the heart. And by the time you have a blockage in the artery to the penis, giving erectile dysfunction, it's extremely likely you have such blockages in your heart that just have not yet clinically manifest.

• 46:43Rich Roll?

  Right. Your body's just trying to tell you that you have something that you need to deal with.

• 46:48Speaker 01

  Exactly.

• 46:49Rich Roll?

  And the solution is not to take a small blue pill so that you can forget about it, but rather to do the opposite, which is to heat it and try to, you know, take a look at what you're eating and how you're moving your body and maybe make some changes.

• 47:03Speaker 01

  Totally agree.

• 47:04Rich Roll?

  So when I look at, I mean, a couple of observations. First of all, it's, you know, thank you for that. Rundown, I mean, it's so compelling. And when I hear that, and I think, you know, I put it in context of, you know, heart disease is America's number one killer. And thinking of that study and the 90% figure, it's just astonishing. And I wonder, why isn't everybody, you know, doing this? Like, what is the impediment to people adopting this? And, you know, that's the, that's the sort of frustration that I experienced, and kind of what I was getting at with the people that are out there trying to, you know, sort of debunk the China study,

• 47:43Rich Roll?

  or poo poo the, you know, the, the, the fantastic benefits of eating a plant-based diet. So when you see that, whether it's on Facebook, or, you know, some blog on the internet, or whatever, like, how do you, you know, what do you do? What is that? How does that make you feel? What do you think?

• 48:00Speaker 01

  Well, it's very frustrating to me, having some background in, in some of the science of it. And we're ramping up our research arm of our wellness program, too. But, but I think that people oftentimes like to have the, the behaviors that they're doing, whether they be good or bad, reinforced. People kind of like to get praise for whatever.

• 48:25Rich Roll?

  Good news about their bad habits.

• 48:26Speaker 01

  Yeah, exactly. Right. Exactly. Yeah, you know, eating that animal product, yeah, that's great for you. Go for it.

• 48:32Rich Roll?

  Well, right now, we're seeing, you know, some, some really interesting things happening that I, you know, I wrote down, jotted down, I wanted to make sure that I asked you about, which is, you know, this, this sort of, uh, rising popularity of the high-fat diet, this idea that, you know, everything you ever thought you knew about saturated fat is wrong. Uh, this idea that dietary cholesterol does not contribute to heart disease. Uh, the idea that, you know, butter is somehow a health food, butter is back on the cover of Time Magazine. All of these ideas kind of flying in the face of some of the things that, that you're saying.

• 49:12Speaker 01

  Yeah, I mean, I think, I think those things are misguided. And so why do I, why do I think that? Well, the study that kind of put, there was a meta-analysis, I think, looking at saturated fat, and a meta-analysis is where they take a lot of studies looking at, you know, I think it may have been low carb versus more higher fat diet. And that, I'm actually, I'm mixing that up, but in this meta-analysis where they looked at the saturated fat, it was so resoundly debunked. The, in fact, the head of the department of the Harvard School of Public Health Nutrition,

• 49:56Speaker 01

  and Dr. Walter Willett, said that this meta-analysis should not only be retracted, but its, its findings should be publicly denounced by the authors. And this is, this is the study that's being pointed to as sort of supporting this idea? That's the study that's being pointed to that's supporting butter is back. And, but, you know, it didn't get, that, that kind of reduction thing didn't get much attention at all. And, you know. Because that's not a, you know, that's not clickbait on the internet, right? Exactly. And it's also a little bit reductionist. Now, I don't know anyone who just isolates and eats saturated fat. And some of it is the company that it keeps.

• 50:41Speaker 01

  And when you eat saturated fat, you know, that is almost exclusively in animal products with the animal protein, which has been widely demonstrated in basic science studies to promote atherosclerosis or cholesterol blockages. And all of the things that we ran through before with the cal scan, it's switching from, you know, switching to a plant-based diet is associated with improving and not having the animal protein with its cholesterol, with its saturated fat, with the endotoxins that are in it.

• 51:26Speaker 01

  So it's, I think, very important to, the...

• 51:30Speaker 01

  You know, the isolated nutrient studies are very interesting mechanistically. And there are actually some, some older studies that show the more saturated fat you have, that's associated with higher cholesterol, cholesterol. But those are interesting mechanistically, but nobody just eats saturated fat. You eat a, a whole diet. And so if you eat saturated fat, which typically comes in animal products, that means you're getting all the, on other associated unhealthy things. We can get into how it's pro-inflammatory for the body. Mechanistic studies supporting how it is associated with increased risk of cancer. Well, I'll just get into now, there's a relatively, a very new study. There's a carbohydrate moiety in animal products.

• 52:14Speaker 01

  It's new five, NEU5GC. Moiety, what does that mean? Compound. It's a carbohydrate compound in animal protein called NEU5GC. That has just been described to be highly inflammatory for humans. And when they may, but other animals, we don't have that in our body. When we eat the NEU5GC in, in animal protein, it creates inflammation. And when they built a, a mouse model of not having the NEU5GC, and then they exposed them to that, they had a profound increase in cancer formation. So that's one of multiple mechanisms.

• 52:58Speaker 01

  So when you're eating the saturated fat, you're getting a whole variety of things that are unhealthy for your body. And you're also excluding the incredibly nutrient-dense plant products. So it's really kind of a global holistic picture, if you will. And to isolate it down to a nutrient here, nutrient there is, can be highly misleading. And so I think the focus on saturated fat, although interesting academically, is somewhat misguided because it so doesn't take the bigger picture of the overall health. And here's another really interesting thing in terms of, you know.

• 53:36Speaker 01

  Another way that eating animal products might be unhealthy for you. There's a relatively recently identified compound called trimethylamine oxide, TMAO. Some of your listeners may be familiar with that. And there was this really interesting study where they took people who were either omnivores or vegans for a year and they fed them a steak. And the people who were omnivores, they made, ultimately made something called trimethylamine oxide or TMAO. Who cares? Well, TMAO is toxic for your blood vessels. It helps cholesterol deposit there. And we know the higher your levels of TMAO, the worse your vascular outcomes. But when they fed the vegans the steak, they made virtually no TMAO.

• 54:21Speaker 01

  So what's going on? Well, what's going on is your gut bacteria. We've got like a trillion, so you and I are here, there's two trillion gut bacteria hanging out, those right now. And so the difference is the gut bacteria. And when you eat a plant-based diet, you select for gut bacteria that make virtually no TMAO. But when you have an animal-based diet, you select for bacteria that do. And if you switch from a plant-based diet to an animal-based diet, that change in gut bacteria can happen very quickly. So even in just a couple of days, you can start making TMAO.

• 54:54Rich Roll?

  That's amazing. I mean, this is, you know, the gut biome and everything that's going on with that is so incredibly fascinating and the impact that it has on your overall health. I mean, that's just amazing.

• 55:06Speaker 01

  I totally agree. And it's, you know, we're at the tip of the iceberg with that. There's going to be so much to learn about that. You know, there was a study that various artificial sweeteners by selecting for gut bacteria may promote diabetes. And it's just the tip of the iceberg. And one thing that I found kind of, so, so I guess getting back, I, I think that the whole saturated fat is back and I think these are just fads.

• 55:32Rich Roll?

  What about this idea that dietary cholesterol does not contribute to heart disease? I mean, that's kind of a subset argument, I suppose, of the saturated fat argument, but that's the one that really seems to carry.

• 55:43Speaker 01

  Yeah. So I don't, I don't agree with that either. And it is a little reductionist too. But look, I mean, there are so many observational and interventional studies that basically show. The higher your cholesterol level, the higher your LDL bad cholesterol, the worse your vascular outcomes are. And when we lower that level through lifestyle, through medications, and don't get me wrong, like a lot of the patients in my clinic are on medications. I mean, there's a time and a place for them. Some of them work incredibly, incredibly well. But when we lower those LDL cholesterol levels through a variety of different mechanisms, patients do a heck of a lot better. And it's nearly a linear line how that works.

• 56:26Speaker 01

  And with different medications, whether it be from a statin-type medication, or an oral absorption-type blocking cholesterol, blocking absorption medication, gets you to the same place. So I think that to, sure, there's a little bit of reductionism with looking at it, you know, focusing just on cholesterol, but there's so much science behind that. The deleterious effect of LDL cholesterol on your body that I don't buy that it has nothing to do with it at all. I think that that's just very, very misleading. It can lead people down a very dangerous path. I mean, if you think about it mechanistically,

• 57:07Speaker 01

  when, simply from my myopic focus on heart disease, when your endothelial cell gets damaged, you know, the LDL cholesterol particles can then burrow into the wall of your blood vessel where it's sort of like a splinter. It's very irritating. And when they're there, that irritation creates inflammation and calls in more cells. Various white blood cells go in, it weakens the blood vessel. Second by second, every day, the plaque can grow and grow, and eventually, some random Tuesday afternoon manifests as a heart attack. And cholesterol is one of the key drivers of that. So, to me, I don't think saturated fat

• 57:51Speaker 01

  should be back. I do think cholesterol is intimately involved in the pathophysologic process of the promotion of atherosclerosis, which can lead to heart attacks, stroke, erectile dysfunction, peripheral arterial disease. Gut ischemia, you know, fill in the blank issue. And I think it's very misleading and can do real harm to people. But it's important, as we're talking about, to take a holistic approach to it because when you have the meat product and you're not having the plant product and all this other stuff, so it kind of crowds that out.

• 58:23Rich Roll?

  To the extent that, yeah, we can avoid being as reductionist as possible about it, you know, and still be talking about these important things. I mean, when you kind of did your rundown, your litany of all of these, you know, deleterious conditions, everything from acne to arthritis, and the alleviation of them by way of a plant-based diet, I was thinking, well, what's the common denominator in all of these things? And something that keeps coming up, and I've heard you say it a couple of times already, is inflammation, right? So, and it seems to me, in my sort of layperson, you know, kind of an armchair, you know, quarterback analysis, that that does seem to be something that kind of runs through as a common theme in all of these things.

• 59:08Rich Roll?

  The, you know, the extent to which inflammation provoking foods or lifestyle habits are significant contributors to all of these negative health impacts.

• 59:21Speaker 01

  I totally agree. And ever since I started doing this, I look at disease a little bit differently. You know, in medicine, we are somewhat siloized, or we live in different silos, you know, there's the belly doctor, and the cancer doctor, and the heart doctor. And when-

• 59:40Rich Roll?

  Because it's reductionist. Our whole scientific method is based upon that, right?

• 59:45Speaker 01

  That's a great point. And, you know, it's really the Renaissance doc, who knows multiple silos? And those are fewer and farther between these days. But I look at it now as when we pound away at our body in a negative way with an unhealthy, sad, or standard American diet pounding and pounding away, it's, you know-

• 1:00:10Speaker 01

  We're making ourselves unhealthy every second of every day. But I look at it, what is our resistance for the weakest? What is our weakest link? And I feel like when you eat that way, you bring out that weakest link. Is your weakest link cancer? Is your weakest link heart disease? Is your weakest link lung disease? You know, is it arthritis? Whatever the weakest link is, is promoted by the healthier diet. And just because you necessarily unhealthy diet, and just because you get cancer, excuse me, unhealthy. Just because you get, you know, cancer, unfortunately, but doesn't mean that heart disease is all that far behind. It's probably, you know, running neck and neck. It's just that the weaker link in terms of your own body's protective mechanisms may be cancer.

• 1:00:51Speaker 01

  So I really look at it as kind of a, like you were saying, a similar pathophysiological driver to multiple, multiple chronic diseases. And along the lines of what you're saying, you know, we know that if you embrace a handful, just a handful of healthier lifestyle measures, such as exercising better, not being obese, not smoking, you can lower chronic disease rates by about 80%.

• 1:01:23Rich Roll?

  And what is the impact of, you know, people say to me all the time, well, it's like, well, I'll do, you know, I'm mostly plant-based, but I like to, I gotta have my, you know, wild salmon, or I need to have that once a week, or, you know, I do most of it. Is it, I mean, how does the sort of evidence bear out in terms of the health impacts of doing it 100% versus the guy who's doing it 70 or 80%? You know, a lot of times when people say like, I do, I'm mostly plant-based, like, well, if you actually wrote down what they're doing, it's maybe not so mostly, but.

• 1:01:56Speaker 01

  Exactly. Some people will say, I mean, Dr. Esselstyn will say, well.

• 1:02:01Rich Roll?

  Well, he's the hardcore, the hardcore. He doesn't suffer fools on this kind of thing at all.

• 1:02:06Speaker 01

  Well, he'll say, well, do you want a moderately sized heart attack or moderately sized stroke?

• 1:02:09Rich Roll?

  Exactly.

• 1:02:10Speaker 01

  And, you know, I think it's a continuum and we lack. Lots of studies looking at, well, this person, you know, this group of people are 60% and this group is 70%, but I look at it as a continuum. And if you look at the Pretty Med study, you know, Benetroning style diet did better than a typical Western diet. And then if you extrapolate-

• 1:02:27Rich Roll?

  But does anything do worse than a typical Western diet, you know?

• 1:02:31Speaker 01

  Wow. Um, I don't know if you smoke.

• 1:02:33Rich Roll?

  Western diet plus smoking, I guess.

• 1:02:35Speaker 01

  That's the slight, yeah.

• 1:02:37Rich Roll?

  With a dusting of alcoholism.

• 1:02:39Speaker 01

  Right, yeah. It's like, it's like slow suicide. But, uh, so, so I can speak better to that anecdotally. I mean, there, there certainly are various studies that you can piece together that the more you embrace this healthier diet, the better you do. But at least anecdotally with my patients, which is the most experience that I have seeing varying degrees, I ask them all the time, you know, what percentage are you embracing the lifestyles? You know, 20% is it 80%, whatever it is. And, you know, maybe they're going to give me a little higher number because they want to, you know, be nice.

• 1:03:13Rich Roll?

  They want to impress you, yeah, yeah.

• 1:03:14Speaker 01

  But I've found that even if patients go part of the way there, it's better than nothing. Something is better than nothing. And I don't want, you know, Dr. Ellis, listen, if you're listening, close your ears.

• 1:03:24Rich Roll?

  He's probably not listening. I doubt he's listening to a podcast.

• 1:03:27Speaker 01

  Well, so, I don't want perfection to be the enemy of really good. And yes, I would unequivocally love it if my patients would go all in. And I really ask them all to. But, you know, not, not everybody's going to do that. And if they're going to go 70% of the way there, hey, I'll take it. It's better than 20% of the way there. And it's, that's fantastic. And, you know, patients do have improvements when they go, you know, 70% of the way there. Their medication doses may come down, their cholesterol comes down, their blood pressure gets better, their symptoms get better. Um, uh, so I'll take it. And there's this one example of a patient I have who is literally the picture of compliance, picture of compliance, has heart disease, was having symptoms, went on a plant-based diet, got

• 1:04:08Speaker 01

  much, much better, now rides bike for two, three hours, no symptoms. Um, but-

• 1:04:16Speaker 01

  Uh, once a month has to have a meat-based sandwich. And that's what keeps him otherwise fully, uh, adherent to the lifestyle.

• 1:04:24Rich Roll?

  Just psychologically, he needs to hang his hat on that.

• 1:04:27Speaker 01

  Exactly. So, once a month has a meat-based sandwich. Uh, and, uh, you know, then the rest of the time.

• 1:04:34Rich Roll?

  Is it because he thinks he needs it for like biological reasons? Or it's a psychological thing?

• 1:04:40Speaker 01

  It's more psychological, like he really likes the taste of it. Um, even though your taste buds can change and you start to like other things, but for him, he really likes it. And also there's a, a family dynamic issue there as well. That his family is not really all that on board with it. And so it lets him, um, you know, partake and they have, they really look forward to these monthly.

• 1:05:03Rich Roll?

  Right. He doesn't have to wear the scarlet letter. He does that, at least does that.

• 1:05:08Speaker 01

  Exactly.

• 1:05:08Rich Roll?

  Interesting. That's really interesting. Uh, what about this idea that, you know, I need to have, I need to, I need my omega threes. Like I've got to get it from the fish or I have to take fish oil or, you know, there's no way that I can be 100% plant-based because, because it's nutrient deficient or it's, it's deficient in some sort of important, uh, you know, whatever.

• 1:05:31Speaker 01

  Yeah, no, I mean, to me, it's the most nutrient-dense way to eat. More nutrients per calorie than any other way that I know of eating. Um, and a whole food plant-based diet. And the omega threes are incredibly important. And the, but I encourage my patients to get them through a couple of heaping tablespoons of hemp seeds, chia seeds, or flaxseed meal each day. And your body has to convert that, uh, to the omega threes. And if you take a little turmeric, it turns out that that can even help the conversion process. And I've never seen anyone have a deficiency. Um, and when I initially started doing this, uh, the, our wellness program,

• 1:06:13Speaker 01

  I screened for, you know, omega three, omega six deficiencies. And a number of patients never found it. Um, and it, it became, it's a test that's a little challenging to get. And sometimes patients have to pay out of pocket. So since I never saw it time and time again, I just stopped ordering it. And I've never seen anyone have an issue with it. Um, and so. There's, you can get it through, through that, you know, through walnuts and healthy fats that are in a plant-based diet. And in regard to, you know, the fish oil specifically, there are newer studies that suggest it does not have incremental benefit on top of modern medical therapy in people with heart disease.

• 1:06:53Rich Roll?

  Omega threes, fish oil or omega, fish oil?

• 1:06:57Speaker 01

  I don't know of a vegan omega three study specifically looking at heart disease. So if my patient is particularly worried about it, I'll say, okay, fine, you know, have a vegan omega three.

• 1:07:10Rich Roll?

  Like an algae-based?

• 1:07:11Speaker 01

  Exactly. But I don't, I don't think it's necessary. The only supplement that we recommend having is vitamin B12, and that's important. As you know, and I'm sure your listeners well know, you need to supplement that because B12 lives in the soil. And now that we wash our vegetables so much, we don't get it. But animals get it because they eat the soil or other animals eat soil. And so, and it's important for DNA and for vascular health. But, you know, I usually just have my patients take 500 micrograms three times a week and periodically check levels, and it's never been an issue.

• 1:07:47Rich Roll?

  And beyond B12, is there any other supplement that you're supportive of, or are you like a no supplement guy?

• 1:07:54Speaker 01

  Pretty much no supplement.

• 1:07:55Rich Roll?

  What about D, vitamin D people talk about?

• 1:07:58Speaker 01

  Yeah, that's a big one. And it's very controversial. There are a variety of studies that suggest it may be helpful. And we certainly know that particularly in the more northern places where we're, you know, wearing coats and stuff like, you know, we've got our coats draped over the couch right now, we're not getting a lot of sun. And that's a really great way to get it. And with a plant-based diet, you know, maybe fortified milks, maybe mushrooms, but there's not a ton of ways to get, you know, outside of the skin and sunlight exposure. But there are a couple of randomized trials going on right now, looking at vitamin D supplementation. I think one is called Vitatops and sponsored by the NIH. So I don't really know the answer to that yet.

• 1:08:40Speaker 01

  And I'm kind of waiting to have that information from these ongoing studies before I come down and make a more formal recommendation. So I don't really check it.

• 1:08:49Rich Roll?

  You know what, I gotta tell you that it's super refreshing to hear you say that you don't know, or that you're waiting to hear, you know, what the evidence or the research bears out, as opposed to just having some kind of hardcore opinion because you feel like you have to.

• 1:09:03Speaker 01

  Oh, well, thank you. And yeah, I mean, I just, I'm honestly not sure. And it kind of, like, if you look back at the story of vitamin E or beta carotene, other supplements, there were, there was lots of observational studies.

• 1:09:16Rich Roll?

  But it's back to this reductionist approach to sort of analyzing the impact of those in isolation.

• 1:09:23Speaker 01

  Exactly right. And you know, maybe vitamin D will turn out to be awesome. Maybe not. I don't know. Vitamin E, beta carotene, those studies found them not to be helpful and in some situations may be harmful. And there's separate reasons to think that vitamin D might be helpful because.

• 1:09:41Rich Roll?

  A lot of people are deficient, right? Like when they run these panels and they realize that they are. So why wouldn't you just, if that's the case, and you're living in, you know, Chicago in the wintertime, you know?

• 1:09:53Speaker 01

  Yeah, I mean, I don't actively look for it, but if my patient has a very low level, what is very low? I don't really know. Maybe less than 20, then, you know, I will supplement it. But I don't know if I'm doing the right thing.

• 1:10:04Rich Roll?

  Right. And this is not a plant-based thing. This is like everybody.

• 1:10:07Speaker 01

  Yeah, that's a great point. Yeah, it's everybody. It's not plant-based.

• 1:10:11Rich Roll?

  So all right, so let's get into kind of, you know, what a typical day is like for you at the clinic. I mean, you're also a professor, right? You're teaching at the, at the medical school?

• 1:10:22Speaker 01

  Yeah, yeah.

• 1:10:23Rich Roll?

  And I want to hear like what, you know? What the typical sort of patient is, if you could so generalize, like what you, what would be normal for you to see in somebody who's like new to coming into you, see you for the first time?

• 1:10:36Speaker 01

  Fair enough. Yeah, there's a lot of really exciting things about, about my job. So I'll give you, for a typical week, there's a lot of variety. I'm, I'm lucky and you know, I'll get a chance to teach medical students, residents, fellows, see patients in clinic, which means like if you go to a doc and you're sitting in the waiting room, reading whatever magazine and you go in and see them, that's, that's clinic. One day a week I'll read ultrasound pictures of the heart and other weeks I'll be on service. And I was on service a number of weeks ago and what that means is a patient's admitted to the hospital and if someone has a question, they'll consult the cardiac service. So I thought to myself, okay, on any given day, I'm going to count how many patients I see.

• 1:11:20Speaker 01

  These are new patients coming into the hospital with some sort of cardiac complaint. So they're a little bit enriched for cardiac issues. But I'm like, okay, I'm going to count how many I see and then I'm going to pick these four disease processes. I'm going to pick diabetes, hypertension, high cholesterol, or obesity. And I'm going to just see how many of them have one of those four problems on just one day. And so I saw 20 patients that day in the hospital and not 12, not 15, but all 20 of them had at least one of those diseases that may have been prevented or reversed with a plant-based diet. And then the very next day, a patient in their early twenties came in with a garden variety heart attack.

• 1:12:01Rich Roll?

  Early twenties?

• 1:12:02Speaker 01

  Early twenties. Came in with a garden variety heart attack. There wasn't, you know, some peculiar, very uncommon genetic predisposition.

• 1:12:11Rich Roll?

  Obese?

• 1:12:12Speaker 01

  No, a little overweight, but not obese. And there weren't any illicit substances involved. It was just a garden variety heart attack. And I'm going to ask the, the listeners, that what percentage of 12 to 14 year olds do you, in the Western world of US, do you think have early signs of cholesterol disease in the blood vessels in their heart?

• 1:12:36Rich Roll?

  Want me to answer that?

• 1:12:37Speaker 01

  Yeah, sure.

• 1:12:38Rich Roll?

  I would say very high percentage.

• 1:12:40Speaker 01

  Okay. Yeah, so you're definitely on it. And someone, someone will be thinking 1% because they're going to do like the prices right thing. All the prices right, you know.

• 1:12:47Rich Roll?

  Yeah, you gotta go low, right?

• 1:12:51Speaker 01

  So, but you're absolutely right. It's about sixty-five. Sixty-five percent of twelve to fourteen-year-olds in the US have early signs of cholesterol disease in the blood vessels that feed their hearts with blood. And we know that from pathology studies of kids who died for other reasons. And then, I mean, you don't have to worry because it gets worse. Because as you were pointing out, heart and blood vessel disease is the number one killer of adult men and women. And there are about two heart attacks every minute in the US. So maybe we've been talking for sixty minutes. That's one hundred and twenty heart attacks have occurred in the US during this one hour that we've been speaking. So a typical patient that I'll see-

• 1:13:31Rich Roll?

  Hold on one second. Like, let's just, let's break that down a little bit, because that's so shocking and extraordinary. And simply, you know, I want to like emphasize this idea that heart disease begins, you know, at a very young age, with the habits that you form as a youngster, with respect to your lifestyle and your diet. And, you know, we have lots of friends that are super healthy parents. They love their kids. And they struggle with trying to, trying to implement healthy eating habits in their kids. You know, like, ah, you know, we eat so great, but, you know, I just can't get my kid off the Chicken McNuggets, you know. And part of that is like, there's an innocence to that, like, ah, just let him have the, you know, like, it's, I'm tired, I've worked all day, like, I just want, just let him have the Chicken McNuggets, you know, I can't deal

• 1:14:16Rich Roll?

  right now. But when you think of what you just said, that really reframes that discussion. And I think it really turns the volume up on the level to which that needs to be a priority in parenting our children.

• 1:14:32Speaker 01

  I agree. I think it's, I mean, I'm an adult doctor, so I refrain from making specific recommendations in pediatrics, but I believe it's never too early to start, and it's never too late. And when I, you know, see kids eating those kinds of foods, the animal-based products, the nutrient-not-dense, the processed foods, it just really bums me out. And I know at the end of the day, sometimes you just gotta get the kid to eat. But I wish that they would be plant-based. And-

• 1:15:08Speaker 01

  There's just every reason to believe that taking that approach from as early as possible is going to be the most healthful for the kid. And I'm not, I don't want to get specific into pediatric recommendations. And just along those lines, I have some friends who have raised their kids plant-based. And, you know, it takes some work. But now when the kids are hungry and they want a snack, they're like, oh, mom, could I have some cantaloupe? And I'm like, wow, like, what you've taken on, you know, you are taking on the onslaught from society of, you know, eat this animal product, eat this processed chip.

• 1:15:47Rich Roll?

  Just the marketing machine alone, when you turn the television on.

• 1:15:51Speaker 01

  Exactly right.

• 1:15:52Rich Roll?

  Is overpowering.

• 1:15:53Speaker 01

  And they've been, and the, you know, influence from their friends and stuff, they've been able to counter that. I think is so impressive.

• 1:16:00Rich Roll?

  Yeah, it's a very, it's difficult, it's, it's not easy, but it also is doable. It's not impossible, you know, we've, and it's a, it's not, it's not an overnight thing either. But I think when you, you know, to use the example of the kid who's eating the Chicken McNuggets, it's, it's about a lot more than that one instance of that person eating that thing. Because every time you make that choice, you're reinforcing a habit. And when you're young, those habits, you know, are fluid, but they quickly become cemented. And then, as you and I both know, when you're, you know, later in life, it's a lot harder. You know, it's like, try to learn a language now versus when you're 12, you know what I mean? Like, it's a different thing. So it's that precious time where you have that kind of influence over your children

• 1:16:44Rich Roll?

  and you can set them on, you know, a better trajectory. And I think it deserves, you know, like hitting the pause button on, you know, the timeline of what we were going through with you to kind of just bear witness to that.

• 1:16:56Speaker 01

  I totally agree. And I mean, like, especially when the kid's really young, that's a lot of brain development. I mean, from a 10,000 foot view level, it sure makes sense to me that you want to bathe that kid in as many phytonutrients and antioxidants as you possibly can to maximize their, their, their, their brain development and their vascular development as, as much as you can.

• 1:17:17Rich Roll?

  Yeah, and I, I mean, I, I want to acknowledge that, that it is difficult and challenging, especially with school lunch and, you know, I mean, it's, you know, what you have to say no to throughout the day is, can be overwhelming, you know, not everybody is out in Queens at PS 123, 122, what is it?

• 1:17:36Speaker 01

  144?

• 1:17:37Rich Roll?

  144? 2.

• 1:17:40Rich Roll?

  I don't know, they're doing it right there, though.

• 1:17:41Speaker 01

  Yeah, it's just amazing.

• 1:17:43Rich Roll?

  And, and Muse, do you know Muse?

• 1:17:45Speaker 01

  Is that one in LA?

• 1:17:46Rich Roll?

  Yeah, yeah.

• 1:17:47Speaker 01

  I heard about that.

• 1:17:48Rich Roll?

  It's kind of like right in our backyard where they're, they've just, they, I had lunch there the other day and it was incredible, like.

• 1:17:54Speaker 01

  That's so great.

• 1:17:55Rich Roll?

  Fully plant-based, they just prepared it all organic, uh, organic produce in their kitchen, you know, it's a private school, so it's not, this is not something that's widely available, but at least it's a start and hopefully will, you know, is the beginning of catalyzing some kind of change and momentum.

• 1:18:13Speaker 01

  Agreed, I mean, that's one of the reasons that, you know, your podcast is so great, it's helping to get the word out there about this and, you know, from a medical perspective, you know, patients and families can push for this, docs can push for it, you can come at it from all sorts of directions and it's, it's, you know, big platforms like this that are just incredibly helpful.

• 1:18:35Rich Roll?

  Well, at least, you know, sort of breaking down the barrier of access to information and democratizing that, you know, is, is important and, you know, that's what we're doing here today. All right, so the typical, the typical patient.

• 1:18:48Speaker 01

  The typical patient I'll say I see in clinic is, now the, the Bronx is a, I mean, it's a lot of people there, so all kinds of, of races and ethnicities, walks of life, but there's a very large Hispanic population there, so the, the, on average, a typical patient that I'll see is, is from the Dominican Republic or from Puerto Rico.

• 1:19:12Speaker 01

  And they typically have not had much exposure to a plant-based diet. And so when I bring, they come in to see me for the first time. Many patients will come to see me just because they're referred for whatever cardiac issue. Maybe they have high blood pressure or some palpitations or something. They're not sent specifically for the wellness program. And many patients are sent for that too, but many are not. So the typical patient who's not, you know, and I'll go into their medical issues, just like you would when you see your doc. And I'll start to then bring up the plant-based diet and how that may impact their health. And a lot of times they look at me like I'm from Mars.

• 1:19:46Rich Roll?

  Yeah, I would think so. I mean, this has got to be the most foreign thing ever, right?

• 1:19:50Speaker 01

  Yep.

• 1:19:51Rich Roll?

  Probably no one's ever talked to them ever about nutrition or anything.

• 1:19:56Speaker 01

  Well, certainly not a plant-based diet. I mean, they, they look at me like I'm nuts. And it's a, it's a process. And, and so I'll keep seeing them and I've had patients give me the Heisman for like two years about a plant-based diet. And then for whatever reason, it clicks for them. And then they come back and I'll look at them like, you know, they've lost 20 pounds or LDL cholesterol has plummeted. They're coming off their medications. It's just awesome. I mean, I literally have patients crying tears of joy in my office because they feel so much better. You know, nobody cried a tear of joy when I wrote them a script for a cholesterol medication. But they do when, you know, and I just, you know, I'm like just a cheerleader. They're the one doing the work. They're the one in control of it.

• 1:20:41Speaker 01

  But they're so happy because they're feeling better. So the typical patient would be, you know, someone with some kind of cardiac issue, high blood pressure, high cholesterol, maybe obese or something, and coming to see me without having any background in a plant-based diet. And what we'll do then is for anyone who, I'll, I'll see anyone 21 and over who wants to be healthier, whether they have a cardiac issue or not. And then what we'll do is we have these, I'll talk about the, the plant-based diet in clinic, but clinic is, we spend a lot of time on it. I probably spend more time than the average doc on this in clinic. It's a major focus of mine. But we will, we have these periodic Saturday

• 1:21:24Speaker 01

  morning sessions, which I modeled after Dr. Hasselstyn's in Cleveland, where they're four to five hours. And I speak for a while about why eating this way is good. I do the calc scan there. There's a nutritionist I work with, Lauren Graff, who speaks about, you know, practically living this way. We have a patient who's living this way speak, and I'd love to share some patient examples.

• 1:21:47Rich Roll?

  Yeah.

• 1:21:48Speaker 01

  And we serve a whole food, whole food, plant-based lunch. We have some handouts. We encourage patients to come with a friend or significant other to kind of help them along the journey. We set specific goals. And we, we don't charge patients for this. I fund it all through tax deductible donations. I'm not reimbursed for it. And like you were saying, want to democratize the information. I want to democratize the information about this.

• 1:22:14Rich Roll?

  So the, the program itself is, is functions like a nonprofit?

• 1:22:18Speaker 01

  Yes, exactly like a nonprofit.

• 1:22:19Rich Roll?

  And it's donation-based. And that's amazing. That's fantastic. So, so it's sort of this induction process.

• 1:22:27Speaker 01

  Right.

• 1:22:27Rich Roll?

  You know, slowly sort of indoctrinating people into these, you know, radical ideas for a lot of people, I would think.

• 1:22:34Speaker 01

  Indeed. And sometimes it can take, some people, you know, some people come and see me, they've already read every book, they've seen every movie, they're like 90% of the way there already. That's the minority. The majority have almost no if, or no exposure to it at all. And we kind of work with them to try to bring them along.

• 1:22:53Rich Roll?

  And your prescription pad is not going to really do very much in terms of prescribing willingness. They gotta, they gotta come, you know, come to you without on their own.

• 1:23:02Speaker 01

  Exactly. I mean, it's definitely a two-way street. If they just have no interest, it's just, you know, what can you do with it? You know, it's free will. People can live however, however they, however they wish. But you just hope that by educating them. And what, what I try to do in clinic is I try to get a sense about what's going to motivate this person, you know? And, you know, is their kid about to get married? Do you want to walk? Do you want to see your grandkids?

• 1:23:28Speaker 01

  You know, did dad have a heart attack and you're on that path? You know, I'll talk with them how their behaviors are making them sicker every second of every day.

• 1:23:38Speaker 01

  I try to find something that will resonate with any specific person. They have this particular medical issue. Maybe we can make that a go away. They want to come off their meds.

• 1:23:46Rich Roll?

  You need a, you need an on-staff psychologist.

• 1:23:49Speaker 01

  Yeah, seriously.

• 1:23:50Rich Roll?

  To help you crack that nut open.

• 1:23:51Speaker 01

  And I'll take a lot more donations.

• 1:23:54Rich Roll?

  All right, so, so share with me some of the success stories. I'm sure, I know you've had a couple of super dramatic ones.

• 1:24:00Speaker 01

  Yeah, I mean, it's just, it's totally rejuvenated me as a physician. I just love it.

• 1:24:08Rich Roll?

  And that, you know, I hear, I talk to a lot of doctors, friends of mine I went to school with that are doctors. And they're just like, it's not what I thought it was gonna be. And they don't like it, or they've already changed careers. So it's cool to hear you say that.

• 1:24:21Speaker 01

  Oh, thank you. And yeah, I mean, I've definitely heard about what you're saying. And there are like larger forces above the, you know, single doc like me that are shifting things in a way that make it not really as fun. You know, there's all this kind of time pressure and there's a certain kind of documentation pressure and a variety of other pressures that can suck some of the joy out of it. And actually, I mean, to be perfectly frank, I spend a little extra, a good bit of extra time with my patients going through this. And I personally take a financial hit, if you will, for it. But to me, I love it and it's the right thing to do, so I'm happy to do it.

• 1:25:04Speaker 01

  And the patients get turned around and it's, it's disappointing that those kinds of changes aren't currently as strongly reinforced or as they might be by the larger medical system. And maybe we can get into that. But like in terms of patient examples, there's so many. One, there's one story that is so dramatic, but there's so many. But one, one comes to mind right now. And there was this, this guy, he was in his 50s and he had heart disease.

• 1:25:36Speaker 01

  I know he has had a family history of heart disease and he understandably wanted to avoid it. And the guy Loved sports and so he would play two or three hours a day. You know, with the thought of preventing heart disease and he was thin. But then he started getting this tightness in his neck. And it got worse and worse. He would get it only after exercising for like thirty or forty five seconds. This guy could do two hours before. So he went to his doc, they did a stress test. It was so wildly abnormal that they sent him straight to the hospital for a cardiac catheterization. Where we take a, it's an invasive test where we look at the blood vessels that feed the heart with blood. So they did that. His was so wildly abnormal that they admitted him directly to the hospital to wait for coronary artery bypass graft surgery.

• 1:26:22Speaker 01

  So he woke up in the morning at home, he's going to sleep at night in the hospital, waiting for surgery. And, you know, it's boring in the hospital. And he goes online and he's like, maybe there's another way. And he reads about the plant-based diet. And he's like, that's what I want to do.

• 1:26:38Rich Roll?

  And Just sitting in the lobby at the hospital, like on his phone or something like

• 1:26:42Speaker 01

  On his bed, yeah.

• 1:26:44Speaker 01

  In the hospital bed, either on his laptop or his phone and it's like, wow, that's what I want to do.

• 1:26:51Speaker 01

  And so I'm not recommending that anyone do this. I'm not recommending anyone do this, every case is different. But he signed himself out of the hospital against medical advice hours before his bypass surgery. And decided to go plant-based, somehow found our clinic. And one thing I should touch on is there was an incredibly dedicated nurse who was seeing him, who begged him, begged him to stay. Called him up at home after he got home, begging him to come back and the patient politely declined. I'll circle back to that. So he came to see us and he went, the picture of compliance, whole food, plant-based, no oil. And when I first saw him, he could walk a block and then he would get the tightness in his neck.

• 1:27:35Speaker 01

  And now this is the most remarkable turnaround I've ever seen. They're not always this fast. But on a combination of meds and a whole food, plant-based diet, no oil. He was walking 25 blocks in after one week. One, I didn't, one, I didn't actually believe him at first and I just kept asking him in all kinds of random different ways to just, and he was completely consistent every time. He now actually speaks on occasion at our wellness program session. Fast forward three, four months, he is back to playing sports two or three hours a day, no stent, no bypass surgery. He feels great.

• 1:28:08Rich Roll?

  Wow, that's amazing. And so the, the, the pain in the neck or the tightness in the neck, that's a result of some kind of arterial blockage or what causes that?

• 1:28:18Speaker 01

  That's so, uh, that, that was a result of an arterial blockage in his heart. And like, so why are you getting discomfort in the neck? That's a little weird. The nerve receptors to the heart are a little diffuse, if you will, and they don't hyper localize necessarily right over the chest. So symptoms, typical symptoms of angina, angina is poor blood flow, the heart muscle can be chest pressure can be radiating to the neck or jaw or down the arm. So it's not necessarily right over the heart. So, you know, neck tightness would be a classic example of angina. And in his case, it was, you know, reinforced by the invasive data that we had from his coronary angiogram.

• 1:28:57Rich Roll?

  Wow, that's, that's just amazing. You know, that's just amazing. And I mean, obviously, you know, being sort of, you know, on the front lines of facilitating these kinds of experiences, you must feel like, I gotta shout this from the mountain tops, you know?

• 1:29:18Rich Roll?

  How is what you do perceived by your colleagues, not just at your hospital, but sort of, you know, the Manhattan medical community and maybe your medical school classmates? Like, how do they perceive what you're doing? Cause it, it's different, right? But you're, but you know, you're seeing these results, like you know, the impact that you're having.

• 1:29:39Speaker 01

  Yeah, it's disappointing to me. It's not further embraced and actually guidelines, like the cholesterol, the American College of Cardiology cholesterol guidelines highlight that lifestyle change is the first line of therapy. Now their lifestyle isn't necessarily quite as whole food, plant based as mine, but it's certainly, you know, healthier than a Western diet. And the reaction where I work has actually been quite good. And it's probably just because I know the people there. And, you know, I'm sure sometimes they're chuckling a little bit behind my back. You know, about, oh, there's Dr. Kale or whatever it is.

• 1:30:12Rich Roll?

  Right, but not only are you sort of undercutting the bottom line of the hospital, like you're doing this nonprofit thing, like, how does, you know, like, come on.

• 1:30:20Speaker 01

  Well, there are.

• 1:30:20Rich Roll?

  We make money off these surgeries.

• 1:30:23Speaker 01

  It's true. I mean, if we get too big, then they might not like me anymore. But it's, you know, I think there are a handful of things at play. And when education about this for doctors is extremely limited, you know, like we were talking about during my training. And now things are changing, but there's really, as far as I know, only a handful of medical schools that teach docs about this. And actually, I bugged one of my colleagues who runs the cardiac block for the second year medical students at Albert Einstein College of Medicine, where we have our academic affiliation. I bugged him, like, I want to give a preventive cardiology talk. I want to give a preventive cardiology talk. I didn't say exactly what I was going to talk about. And so he's like, okay, fine, then I needed one.

• 1:31:08Speaker 01

  So for the last three years, I've been giving a plant-based lecture to the second year medical students at Einstein. And then they go on and graduate and go to all sorts of other places. And hopefully, they're remembering a little bit about what I say. And so, and then there's other medical schools that have larger, more formal programs. I think Loma Linda and Tulane have excellent programs. And with our cardiology fellows, before they start fellowship, they don't know that they don't have to be scared of me. Like, once they meet me, they're like, not scared of me anymore. But they don't know that before they start. So I write a sternly worded email. And I'm like, you know, I expect you guys to read such. I send them one of Esselstyn's short editorials. I expect you guys to read this and we'll discuss this during the first week of orientation.

• 1:31:53Speaker 01

  So then, you know, then our, you know, we have, we have eight fellows a year, which by fellowship, cardiology fellowships, that's a big program. And so they all know about it. And then they make fun of me every year in the skit. So it just kind of keeps coming up.

• 1:32:04Rich Roll?

  Right, right, right.

• 1:32:05Speaker 01

  So there's an educational barrier, but that's, that's changing.

• 1:32:09Rich Roll?

  I mean, on the educational front, I would think that, you know, a huge leap forward could be made by the AMA or whatever, you know, sort of governing organization kind of has a say in terms of of medical school curriculum to just make that a mandatory aspect of your medical education. I mean, is it that there's too much disagreement about these things? Or, you know, what is preventing that from, you know, as a consumer, you go to your doctor, you just assume they know everything, you know, you don't know, you don't know that they don't, you know what I mean? And so, and you're giving your power over, you know, you just, you intuitively just hand your power over to your doctor and assume that whatever they're telling you, they know best.

• 1:32:51Speaker 01

  Right. Well, there's some good news afoot because the incoming president of the American College of Cardiology, Kim Eagle, is, oh, no, I got it wrong, Kim Williams, sorry.

• 1:33:02Rich Roll?

  I know, it's Kim something, right.

• 1:33:03Speaker 01

  A very well-known cardiologist, Kim Eagle, Kim Williams, excuse me, sorry about that. He's, uh, he's vegan.

• 1:33:09Rich Roll?

  And that in and of itself is a pretty powerful, just factoid.

• 1:33:14Speaker 01

  Indeed. And that's one of, you know, there's the two main governing bodies of cardiology in the US are the American Heart Association, the American College of Cardiology, there are many others, but the two big ones are those. And so that's a big deal. That's a big deal. And he's spoken out, you know, in favor of the health of that. And, you know, the, the research isn't unequivocal, ironclad, and there is some debate about exactly which diet would be better. But the way I see it at this point is there's so much evidence in support of a plant-based diet, that that should be our de facto diet that we approach patients with. You know, our Hippocratic oath is first, do no harm. Let's approach them with a diet that appears to be the best for protecting you from heart health and

• 1:33:56Speaker 01

  health and all sorts of issues. And then you know what? Fine, let's prove it wrong. Maybe we're wrong. Maybe Woody Allen is right. Maybe fried chicken and ice cream really are the way to go. But let's prove that. And with the strongest amount of evidence to me supports a whole food, plant-based diet. And then, you know, if it's proven wrong, okay, but go with what we know, what I think is best.

• 1:34:14Rich Roll?

  Right now, there isn't any other dietary protocol that can show these before and after angiograms.

• 1:34:21Speaker 01

  Nothing that I've ever seen. I've never seen any, I've never seen any medication, anything come close to those pictures, you know, that Dr. Esselstyn shows and that, you know, that, you know, Dr. Ornish can show with his highly compliant patients.

• 1:34:35Rich Roll?

  And I mean, look, you're a Yale and Harvard educated cardiologist. Like, if you don't know, who does know? You know what I mean? You're the guy who would know.

• 1:34:45Speaker 01

  Well.

• 1:34:45Rich Roll?

  Would you not?

• 1:34:46Speaker 01

  I mean.

• 1:34:47Rich Roll?

  I mean, you're not a research scientist, but.

• 1:34:49Speaker 01

  Yeah, I know. I mean, we do do some research as part of our program, but it's a small, small part of it. But, yeah, I mean, based on my interpretation, look, there, I understand, there is some debate about what is the most optimal. But the Venn diagrams are so overlapping. They're like 90% overlap and people quibble about 10% here or the other. And the large part of the overlap is the whole food plant-based part. So.

• 1:35:14Rich Roll?

  Right, so the, the quibbling is over the minutia and the, you know, you know, talking about like the, some of the things we were talking about earlier. The omega threes or things like that. But the, the preponderance of kind of overall diet, you know, vegetables, like sort of macronutrient, micronutrients. There's agreement.

• 1:35:32Speaker 01

  Exactly. And there, there still is some, a good bit of support for a Mediterranean-style diet. But like we were talking about with the predimed versus the Esselstyn outcomes. You know, to me, we're comparing different studies, but the Esselstyn or the whole food plant-based approach is just so much more powerful. But yeah, you know, there's not a big randomized trial comparing whole food plant-based versus Mediterranean-style. So I can see why people, you know, have some degree of, of uncertainty.

• 1:36:03Rich Roll?

  Right. Here's one for you. And this might not come from one of your patients up in the Bronx, but it might, it might happen at a, a typical Manhattan cocktail party.

• 1:36:12Speaker 01

  Okay.

• 1:36:13Rich Roll?

  What about the paleo diet? You know, everyone's talking about the paleo diet. So I'm sure you get this question, so you probably have an answer to that or you've formed an opinion.

• 1:36:23Speaker 01

  Yeah, I mean, there is some overlap. You know, paleo, they do recommend is, I may be missing a little bit of it, but like they recommend vegetables. I think they recommend fruit. So, you know, that's.

• 1:36:34Rich Roll?

  No processed food, no dairy.

• 1:36:37Speaker 01

  So there's, there's a lot of overlap with, with that, which is, which is good. But I don't agree with the animal products for a variety of reasons. I don't agree that our ancestors were primarily eating animal products. I know that they had a little bit, but if you look at the anthropologic records, there was, you know, root vegetables on their tools, in their dental plaques, um, that, which obviously supports the fact that they ate that. Um, if you look at us anatomically, um, we, our, our snouts look different than carnivores. We have salivary amylase, uh, that's made by our mouth. That helps to digest carbohydrates, not animal protein.

• 1:37:19Speaker 01

  The pH of our gut is not as low as a typical carnivore. We don't have as many of the incisor teeth. Our guts, uh, our intestines are much longer than a carnivore because it, you know, it takes a little more work to digest a plant product. So I don't necessarily agree with that evolutionarily.

• 1:37:42Rich Roll?

  I would think that, uh, the common sense also, how about just, it's a lot harder to catch an animal to eat than to pull something out of the ground. So, uh, you know, I'm not an anthropologist and I certainly, I would imagine it was dictated by where you lived and what was readily available and what was difficult to get and what was easy to get, right? But overall, like sort of persistent hunting was probably a little bit more difficult than, you know, I don't know, planting a sapling.

• 1:38:10Speaker 01

  I totally agree. It's hard to catch a cheetah.

• 1:38:12Rich Roll?

  Um, yeah, I don't know. But anyway, go ahead. I interrupted you.

• 1:38:16Speaker 01

  I know. So I, I mean, but I totally agree. I mean.

• 1:38:19Rich Roll?

  So yeah, it's like more like not hunter gatherer, but gatherer, sometimes hunting, you know?

• 1:38:24Speaker 01

  Yeah, like the random thing that they would sometimes catch. Uh, and you're right, at the extremes of weather, like way northern Eskimos probably had way more, uh, animal products because they just, it's hard to grow a tree there.

• 1:38:35Rich Roll?

  The Inuit thing always comes up in this, in this discussion.

• 1:38:39Speaker 01

  And we can, I, I, I think there's reason to not. Support that and I can explain and

• 1:38:45Rich Roll?

  To to make it clear, though, that the idea that the Inuits were basically ate a very high fat meat based diet because it's just fish is that's basically what's available to them, right? And they had the the argument is that there was like very low incidence of heart disease.

• 1:39:00Speaker 01

  Exactly. There was a study from many decades ago that suggested that they had a very low rate of heart disease and they're eating primarily fish because that's really all they could get. And at the end of the day, I mean,

• 1:39:12Rich Roll?

  Yeah, there's not there's no kale up in there.

• 1:39:15Speaker 01

  And so, so, you know, that was a real like, how do you reconcile that with all this other data? Like, what's going on? So these Canadian investigators have the same question. And so they investigated the primary data. And they found out that I'm gonna have the exact numbers wrong, but I think at least 50% of the medical records weren't even available. These people lived in such remote areas that the investigators from decades ago didn't even have access to the medical records. And these patients, some of them would would die and they wouldn't be seen by a doctor for three, four days later. So the underpinning

• 1:39:54Speaker 01

  of how they died, it's not known. And if I were to submit an article to for consideration to an academic journal now, and I said, Okay, these hundred people died, and I don't know why 60 of them died, but I think that eating fish is good, they laugh in my face. And so that has, I think, you know, cut, I don't know the right, I mean, I mean, this in an aggressive way, but you know, cut the legs out.

• 1:40:22Rich Roll?

  Right. It's not that it's been disproved. It's just that it's the methodology has been called into question.

• 1:40:28Speaker 01

  Yeah.

• 1:40:28Rich Roll?

  To establish that result.

• 1:40:30Speaker 01

  Exactly right.

• 1:40:31Rich Roll?

  Interesting.

• 1:40:32Speaker 01

  And so then, along the lines of paleo, you know, when you eat the animal protein, you make TMAO, you create inflammation, you acidify your body just a little bit. You don't feel it, but your body does and it can leach calcium, it may leach calcium from bones to help buffer that acid. There are some people who speculate that acidic milieu may be cancer promoting.

• 1:41:03Speaker 01

  And you know, then of course, there is saturated fat and cholesterol with it. And we could just put those things aside for now. And there is evidence that eating a more an animal based protein diet can lead to more atherosclerosis and you know, the whole kale scan and various other studies we talked support how when you replace those things with a plant based diet, you do better. And you know, for athletic performance, you know, right up your alley. There is evidence that athletic performance is improved on a plant based diet. You know, we all run on fuel. Cars run on gas, you know, like liquid dinosaurs. And we run on ATP.

• 1:41:45Speaker 01

  That's our fuel and our mitochondria are our energy plants that make the ATP. And they have to use nutrients to make it. And if you, there are elements of a plant based diet that make that mitochondria more efficient. So with the same amount of fuel, they'll make more ATP. You're a more efficient machine. And then also with all the antioxidants and anti inflammatory components of a plant based diet, I think particularly watercress and blueberries, that you can reduce delayed onset muscle soreness after exercising. So you can get back at it sooner than you might've been able to.

• 1:42:19Rich Roll?

  You're, you're, you're cutting your recovery time down considerably. I mean, that's been my experience and you know, I'm not running a double blind study on myself, but my anecdotal, you know, evidence is compelling enough to me to continue to, to do it, to do it that way. And it's, I say the same thing to everybody. I mean, on a related note, what about the, what about the ketosis thing? Like the, this whole like high, kind of high fat, like low carb, you know, super low carb diet being, you know, in this ketogenic state. And I mean, we don't have to get too clinical about it, but I, it's very popular right now. And certainly my understanding is it's quite effective in weight loss.

• 1:43:02Speaker 01

  Yeah.

• 1:43:03Rich Roll?

  But it seems to me that it's kind of an emergency state for your body to be in and not something, it's not a, it's not something that I can imagine would be a healthy lifestyle choice, long term. But there's a lot of people that are that are doing this, talking about it, you know, sort of espousing the health benefits of.

• 1:43:22Speaker 01

  Do you mean like a low carb diet? Or do you just mean the lots of animal products so that you get into a ketotic state?

• 1:43:29Rich Roll?

  I don't know specifically. I mean, I hear that word sort of thrown out a lot, you know? And there's people like Peter Attia and Gary Taubes, who are kind of, you know, part of this movement of espousing this way of living for health and athletic performance, actually, like sort of training your body to to be fat adapted.

• 1:43:49Speaker 01

  I don't know of any study that that supports reversal of atherosclerosis on an animal based diet. I don't think that anyone has ever been published. I'm not the only one to say that. Multiple other investigators have said that. I'd be happy to see one that has. And to me, those kinds of diets really are some version of paleo. It's like Atkins or paleo where you're having a ton of animal protein, which will make you acidemic. And that's not a healthful state you're right to be in. Like, there's a reason that we have a very narrow range for the pH of our body. It's so that our enzymes can work appropriately and our electrolytes can be in the appropriate range.

• 1:44:32Speaker 01

  And, you know, I should make the caveat of that, you know, I'm not an expert in the ketotic state, but I would.

• 1:44:41Speaker 01

  And since it's I look at it as so much as just a Atkins diet in different clothes,

• 1:44:48Speaker 01

  that I I don't see how it could possibly be healthy.

• 1:44:54Speaker 01

  I can't get more specific.

• 1:44:57Rich Roll?

  I think that's pretty unequivocal.

• 1:45:00Speaker 01

  But but in terms of like the doctors and stuff embracing it, there, you know, there's the educational barriers. And then, you know, docs tend to be pretty conservative. And, you know, rightly so, they want to be proven that something is or isn't right to a reasonable degree. And and like, you know, if there's a new medication or new procedure, that's kind of in their wheel box, you know? Oh, OK, this medication is a little different, but I kind of get it. This procedure is a little different, but I kind of get it. But if I were to say, well, this patient doesn't want to have bypass surgery, let's use medications and some kale, like, you know, they'll look at me like I'm nuts.

• 1:45:35Rich Roll?

  Right.

• 1:45:36Speaker 01

  Because it's just so different and doesn't play into that whole.

• 1:45:42Speaker 01

  It's so out of the box, it doesn't play into a conservative approach.

• 1:45:45Rich Roll?

  Right, right, right.

• 1:45:46Speaker 01

  There are, I don't know the right term to use, but maybe social engineering components of it as well, as we were touching on, you know, the whole like, and doctors see this too, advertising, you know, the studly tough guy has meat, and you know, I want to be as strong as an ox, so I'm gonna eat ox meat, but you know, ox of course eat grass.

• 1:46:12Rich Roll?

  Right.

• 1:46:13Speaker 01

  And you know, gorillas and elephants are pretty big, but they eat plants.

• 1:46:16Rich Roll?

  It's, it's, it's so ridiculous, right? It's almost like, what, think this through here, you know, just because you're eating that doesn't make you that.

• 1:46:24Speaker 01

  Exactly, it's like you walk down the street.

• 1:46:26Rich Roll?

  Yeah.

• 1:46:27Speaker 01

  I like, like you see, you walk down the street, you see this like, jacked bodybuilder guy, you're like, I want to be just like that, so I'm gonna eat him. Like, it's just ludicrous.

• 1:46:39Rich Roll?

  That's so funny, yeah, I haven't thought of it like that, that's so true though. All right, well, we gotta, we gotta wrap it up, and you got a date to go to tonight. Where are you, what restaurant are you going to?

• 1:46:49Speaker 01

  Oh, well, we haven't finalized it yet, but there's so many great ones, I love the Candles, I love Blossom, but I think we might go to Peace Food tonight.

• 1:46:56Rich Roll?

  Oh, nice, somebody was just mentioning that to me yesterday, I haven't been there yet. I was at Candle, I went to Candle 71 last night, though.

• 1:47:03Speaker 01

  So great, it's so great.

• 1:47:04Rich Roll?

  Really good, really good. All right, but if, if somebody is listening to this, and they were on the fence before, and now you've made such a compelling case for, you know, adopting this way of eating, or at least stepping in more in the direction of it, like, what is your recommendation for taking that first step? Like, what's, what's one or two things that people can take away from this and incorporate into their lives to begin their own journey?

• 1:47:31Speaker 01

  Well, thank you for asking that, and I would, I would try to set, you know,

• 1:47:38Speaker 01

  Touch base with why it resonates with you. Do you want to live a little longer? Do you want to be or potentially live a little longer? Do you want to be healthier? Do you want to lose some weight? Do you have a bigger union coming up and you want your skin complexion to look better? You know, pick a pretty specific goal. And then, you know, think about the things that we talked about, how it might be able to help you accomplish that goal. And I've found that when people become more goal or target oriented, it helps especially in the beginning. So that's, that's important. Having someone to talk to it about with, you know, whether it's a friend or a family member who can help support you along the way. And it's useful.

• 1:48:19Rich Roll?

  That's huge.

• 1:48:19Speaker 01

  Yeah, it's, yeah. And it's, it's useful to get reminders because you're going to hit about why it's helpful because you're going to hit up against so many naysayers, so many people who are, you know, suddenly experts and say, oh, you have to have animal protein, you know? But.

• 1:48:39Rich Roll?

  Translation, everybody, everybody becomes an expert.

• 1:48:42Speaker 01

  It's really incredible. And, you know, they're watching the documentary Forks Over Knives. I found that to be a wonderful intro. And I actually asked when I, there's a divergent in the family, like the, let's say the husband's Ford and the wife isn't, I'll ask them to watch that together. And that's, that's the documentary about the health impact. There are great books to, to read about it, you know, whether it's John Joseph's books or Dr. Esselstyn's books.

• 1:49:05Rich Roll?

  Of which you contributed so eloquently.

• 1:49:07Speaker 01

  Oh, thank you. That's, that's great. Look, I'm your forward is fantastic. And, you know, so having those things to, to remind you why it's, why it's good. And, you know, people get to a plant-based diet from different directions, whether it's health or environmental or ethical. And it's great, they all eat in the same place. So, you know, there's the incredibly powerful documentary Earthlings. That is, you will cry when you watch it, it's so amazing and powerful. And that touches on the ethical aspects of it. And I've heard that Cowspiracy is amazing, touching on the environmental aspects. I haven't yet.

• 1:49:44Rich Roll?

  I can vouch for that. Yeah, I had those guys on the podcast and I'm sort of tangentially involved in that movie, so. It's gonna be coming soon to everybody's computer screen.

• 1:49:55Speaker 01

  Oh, that's fantastic. So all of those things.

• 1:49:58Rich Roll?

  Yeah, like, so, yeah, so like, if the ethics speak to you, if the health aspect speaks to you, if the environmental issues are what's important to you, there's a, there's a, there's sort of a way to emotionally connect with it through any variety of means.

• 1:50:10Speaker 01

  Yeah, I wish I could have said it anywhere near that eloquently, but that's exactly right.

• 1:50:15Rich Roll?

  Cool. So, so how about like one, you know, like one or two, like, okay, I'm going home tonight, like, or I'm going to the grocery store right now, like a real tactile, as opposed to like an ephemeral, like, sort of habit, like, but like, what's something I can do today?

• 1:50:28Speaker 01

  Okay, so what I would do, and one thing that I love, I love to make it easy and tasty. So there is a, I will go to the store and I get, I don't know if I'm supposed to say this or not, but I get, there's a Garden of Eden, is a brand of, of rice and beans, that's vegan. And I get, and I, there's a variety of flavors, I get that, I dump a couple of the cans into a pot, I toss in some kale, keeping the stems in, because it's great crunch and texture. I'll toss the nutritional yeast and spices, I heat it up for five minutes. That's an amazingly delicious and filling dinner.

• 1:51:06Rich Roll?

  Cheap, quick, fast, nutritious, it takes like all the arguments away from, you know, why it's too difficult, or too expensive, or not accessible.

• 1:51:15Speaker 01

  Exactly right. And, you know, even if you live in a food desert, it's quite, if you can go just a little bit to a store, you can get a big sack of brown rice, a big bag of frozen vegetables and some hot sauce, some beans, that can be incredibly inexpensive and really easy to make. So you, you, there.

• 1:51:34Rich Roll?

  You can eat for two weeks on that.

• 1:51:36Speaker 01

  Yeah, and it's real tasty.

• 1:51:38Rich Roll?

  Well, you could walk out of the store for like, under 10 bucks.

• 1:51:41Speaker 01

  Absolutely.

• 1:51:42Rich Roll?

  It's, it's amazing when you start to realize.

• 1:51:44Speaker 01

  And Darshana Thacker wrote this great blog post on the ForxOverNive site. About, I forget the exact details, but basically living plant-based on like a dollar fifty a day or something like that.

• 1:51:54Rich Roll?

  I didn't see that post. I'd like to read that.

• 1:51:56Speaker 01

  That's really good.

• 1:51:57Rich Roll?

  Uh huh. In addition to that, you've written four or five articles for them, right?

• 1:52:01Speaker 01

  Yeah, I've been really lucky and some patient stories and kind of how I got into it in the first place. And they're just such a wonderful platform, much like your podcast, to, you know, help people learn about it.

• 1:52:13Rich Roll?

  Yeah, of course. So in addition to the documentaries, Forks Over Knives, the website, the blog, are there other online resources that you direct people to?

• 1:52:24Speaker 01

  Yeah, nutritionfacts.org is amazing. And what that is, is this guy, Dr. Gregor,

• 1:52:30Rich Roll?

  who's the best.

• 1:52:31Speaker 01

  Total rock star.

• 1:52:32Rich Roll?

  Yeah. He's been on the podcast, by the way. I gotta get him on again.

• 1:52:36Speaker 01

  Oh, I just, I love that guy. And he's got, as you well know, these three to five-minute, highly entertaining, highly educational videos about any number of medical issues. He's got like over a thousand videos about why a plant-based diet is good for issue X, Y, or Z. And they're just incredibly well-done. So, and then you could, you could sit there.

• 1:52:59Rich Roll?

  And they're all rooted in the science and in the medical journals and in the studies. It's not, you know, it's very fact-based.

• 1:53:07Speaker 01

  Exactly. He quotes articles. He has them up there. He shows you the references, the authors, everything. So, yes, it is, it is evidence-driven completely. Just like the China study book is evidence-driven, in my opinion.

• 1:53:20Rich Roll?

  Okay. Okay. Cause I wasn't sure if you were clear about that.

• 1:53:24Speaker 01

  And other, other websites, I know I'm blanking on some right now. Gosh, you know, Dr. Esselstyn's site, Dr. McDougall's site.

• 1:53:34Rich Roll?

  We'll put them up in the show notes. If you think of any other ones, I don't want to put you on the spot, but if you think of a few, you could email me and I'll put them in the show notes for the, for the, uh, for the episode. It would be good. I think that's pretty good, man.

• 1:53:49Speaker 01

  Thank you.

• 1:53:50Rich Roll?

  When are you, when's your book coming out?

• 1:53:51Speaker 01

  Oh, I don't know.

• 1:53:53Rich Roll?

  Come on, man. You gotta, you gotta, you gotta write a book.

• 1:53:55Speaker 01

  I would love to. And people have approached me about it. And, you know, there's just only so much bandwidth in life. And, you know, I, I love, I love my program, but it's on top of a lot of, of my job as a full-time cardiologist. So, there's, I'm gonna get to it. It's gonna happen.

• 1:54:14Rich Roll?

  That's a good answer. That's, that's the right answer for not doing it right now.

• 1:54:18Speaker 01

  Well, it's time will come and you know, if anyone's interested in learning about our program, I'll give you the website for the

• 1:54:26Rich Roll?

  Yeah, of course.

• 1:54:27Speaker 01

  The notes, but it's kind of, it's www.montefiore.org/ Cardiac Wellness Program.

• 1:54:33Rich Roll?

  We got to shorten that URL for people. All right. So Montefiore is M-O-N-T-E-F-O-R-E?

• 1:54:40Speaker 01

  F, close, F-I-O-R-E.

• 1:54:42Rich Roll?

  I forgot the I.

• 1:54:43Speaker 01

  Yeah, it's a hard one. .org/ Cardiac Wellness Program.

• 1:54:47Rich Roll?

  Mm-hmm.

• 1:54:48Speaker 01

  Yeah, I know, that's a tough one.

• 1:54:50Rich Roll?

  Right.

• 1:54:50Speaker 01

  And you know, it gets into a little bit about our, our program.

• 1:54:54Rich Roll?

  And are there other, like, you're not on, you're not like a big social media guy, are you?

• 1:54:59Speaker 01

  Not really. I'm on Twitter, @DrOstfeld.

• 1:55:02Rich Roll?

  Okay.

• 1:55:02Speaker 01

  I just, oh, of course, PCRM. Amazing. I just did a Twitter chat with them.

• 1:55:06Rich Roll?

  Oh, you did?

• 1:55:07Speaker 01

  They're amazing. With Dr. Barnard and that whole group. So I'm on Twitter.

• 1:55:12Rich Roll?

  PCRM.org.

• 1:55:13Speaker 01

  Yes, thank you. @DrOstfeld is me on Twitter.

• 1:55:17Rich Roll?

  That's your main thing, Twitter?

• 1:55:18Speaker 01

  And Facebook.

• 1:55:19Rich Roll?

  Oh, you're there too? All right.

• 1:55:21Speaker 01

  I just, I don't do it a ton though.

• 1:55:24Rich Roll?

  But you don't have your own website right now, do you?

• 1:55:26Speaker 01

  No.

• 1:55:26Rich Roll?

  Yeah. No, it's not going to happen?

• 1:55:28Speaker 01

  I think it might, but you know, I love doing it with Montefiore and as part of Montefiore and they've been so supportive of it and, you know, and so I like being part of that, of that system.

• 1:55:39Rich Roll?

  Have you written articles elsewhere beyond the Forks Over Nines site?

• 1:55:43Speaker 01

  Um, yeah.

• 1:55:44Rich Roll?

  And contributing to John's book, obviously.

• 1:55:46Speaker 01

  Yeah, that was great. There's, there's this book called Rethink Food. Shoshana Castle, and oh my gosh, I can't believe I'm blanking on the other woman's name. I spoke with her so many times, it'll, Amy, Amy Lee Goodwin. Their book, I was really lucky to be able to write a chapter for that.

• 1:56:03Rich Roll?

  Oh, cool.

• 1:56:04Speaker 01

  And we submitted a case report, our first academic article from our wellness program to an academic journal. It's under review right now and there's others that we have in the pipeline. And so what I'm hoping to do is grow the clinical arm, the, you know, the PR arm, if you will, just trying to help spread the word, but also the research arm of our program to You know, help fill in whatever gaps there might be and take people who may very reasonably and understandably be skeptical, help, you know, fill some gaps in this so they may be better able to embrace it. So we have some stuff in the pipeline that we're working on, but you know, where their time and resources, there are, there are limits, so we're doing our best.

• 1:56:46Rich Roll?

  Yeah, I like that. I like that. And if somebody's listening and they're inspired and they want to contribute to the clinic, can they do that through that URL? Is there a way for them to donate?

• 1:56:58Speaker 01

  That would be incredibly helpful. And, and you know, I like to keep it so the patients aren't charged. And the more resources I have, the more I'm able to grow the research and PR about it. And just, I'm not reimbursed for it. Yeah. So if they go to www.montefiore.org/ cardec wellness program.

• 1:57:15Rich Roll?

  Yeah.

• 1:57:16Speaker 01

  On that page, in teeny tiny little blue letters is support the program. And if they click on that, it's a tax deductible donation.

• 1:57:23Rich Roll?

  All right. Do they have to wear their reading glasses to find it on there?

• 1:57:26Speaker 01

  Yeah, well.

• 1:57:27Rich Roll?

  Read is on the webpage?

• 1:57:29Speaker 01

  Yeah, that's, that's on the list.

• 1:57:31Rich Roll?

  Yeah. All right. Final question. I'm going to let you go on your date.

• 1:57:35Speaker 01

  Okay.

• 1:57:36Rich Roll?

  If you were, if you woke up tomorrow morning and suddenly found yourself to be the surgeon general, what kind of changes are you making day one?

• 1:57:44Speaker 01

  I would be screaming from the rafters about the myriad of benefits of a whole food plant based diet. From a health perspective, how it can lower all the things we went through in the cal scan and more. And from an environmental aspect, because for many of us, that's a health issue too. Like, it's hard to live when Manhattan's underwater. And so I'd approach it from those two angles. And that, and I would, you know, I'd use that platform to talk about that.

• 1:58:21Rich Roll?

  All right, man. I think you can go on your date now. I'm gonna let you go.

• 1:58:26Speaker 01

  Thank you.

• 1:58:27Rich Roll?

  Thanks so much for talking to me. That was a pleasure. You're a hero, man. And I, you know, I don't, I don't say that lightly. Like, what you do is really important. And I appreciate it. And I have nothing but the utmost respect for you. And please keep doing what you're doing.

• 1:58:45Speaker 01

  Thank you very much. It's an honor to be here.

• 1:58:47Rich Roll?

  And when you do find a way to write that book, you're going to come back on the podcast and tell us all about it, won't you?

• 1:58:52Speaker 01

  Cool. I'd love to.

• 1:58:53Rich Roll?

  All right, man. Thanks. Peace. Plants.

• 1:59:01Rich Roll?

  All right, how'd you guys like that? I would say that was a pretty powerful, potentially life-changing conversation. I hope you enjoyed, Robert. I hope that he gave you some things to ponder and ultimately some things to implement into your life. Keep sending me the questions for future Q and A podcasts to [email protected]. We're going to post up another one of those this Wednesday night, April 15th, so look forward to that. I'm coming at you twice this week. For all the information, education products, tools, resources, and inspiration you need to take your health, wellness, fitness, and self-actualization to the next level, go to richroll.com, peruse our nutrition products, our education products, and yes, our garments. We've got some awesome stuff made with 100% organic cotton.

• 1:59:44Rich Roll?

  Also, if you're into online courses, I've got two of those. Go to mindbodygreen.com and check that out, The Ultimate Guide to Plant-Based Nutrition, and also The Art of Living with Purpose. If you like this podcast, give us a review on iTunes. Pick up the free app in the App Store to listen to episodes older than the most recent 50 that you can find on iTunes. And thank you for supporting the show. Keep telling your friends, using the Amazon banner ad, and share it on your social media. Keep Instagramming, you guys. Don't forget to tag me, @richroll. And I'll see you in a couple days. Thanks. Peace. Plants.