Plant-Based vs. Ketosis: Diet Wars With Cardiologist Joel Kahn, MD

Recent years have seen the ascendency of low-carb, high fat diets. Indeed, the ketogenic lifestyle has been heralded as a veritable health panacea. In parallel, we bear witness to mainstream acceptance of the plant-based approach to vitality, lifestyle disease prevention and reversal. The debate pitting these distinct approaches to nutrition is as emotional as it is divisive — an impassioned war for hearts and minds waged across the scientific literature, mainstream publications and the internet that can leave even the most intelligent and well-intentioned consumer utterly baffled. So who's right? To help divine the line between truth and fiction, Joel Kahn, MD joins the podcast for his third appearance. Dr. Kahn is an Interpreventional Cardiologist, Clinical Professor of Medicine at Wayne State University School of Medicine, Founder of the Kahn Center for Cardiac Longevity in Michigan, and a Summa Cum Laude graduate of the University of Michigan’s prestigious Inteflex program (a 6-year undergraduate / graduate program that developed doctors fresh out of high school). He’s authored hundreds of articles on heart disease, is a frequent lecturer on heart disease and its prevention, has performed thousands of cardiac procedures, and is the owner of GreenSpace Café in Ferndale and Royal Oak Michigan. In addition, Dr. Kahn is the author of five books, including The Whole Heart Solution* and his newest offering, The Plant-Based Solution*. This a comprehensive and highly instructive conversation that endeavors to provide needed clarity when it comes to the aforementioned debate — a deep dive into the veracity of nutritional research findings to provide the information you need to promote maximum health, hinder lifestyle disease, and abet longevity. In addition, we explore emerging research on the benefits of intermittent fasting and why everyone should get a coronary calcium scan. Amazingly informative, this is straight talk from a trusted and experienced man I'm proud to call friend. As a final note, this podcast episode is also available in video format on YouTube. If you are enjoying the video version of the show, please subscribe to my channel at youtube.com/richroll to be alerted when new videos post. Finally, if you missed our previous conversations, check out episodes #44 & #128. For the visually inclined, you can watch watch (& subscribe!) to the podcast on YouTube here. I sincerely hope you find our conversation instructive — because health is wealth. Peace + Plants, Rich Learn more about your ad choices. Visit podcastchoices.com/adchoices

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

• 0:00Rich Roll?

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• 0:44Rich Roll?

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• 1:03Rich Roll?

  Quick announcement before we get into it. I am very excited to announce that Julie and I have a brand-new cookbook coming out, April 24th. It's called The Plant Power Way Italia. We're very proud of it. If you enjoyed our first book, The Plant Power Way, I think you're going to freak for this one. It's inspired by our retreats in Tuscany and the cuisine of the Italian countryside. It's super next level, incredible photography, 125 entirely new, and of course delicious, plant-based Italian recipes. And it's available for preorder now from all your favorite online booksellers. You can learn more at richroll.com. Preorders are very important to the book's viability, and so it would mean a great deal

• 1:45Rich Roll?

  to us if you reserved your copy today. Thank you so much. I greatly appreciate it. And now, on to the show.

• 1:56Joel Kahn?

  The single most powerful activity you can do to prolong your life is eat less every day. And that's a message that is so needed right now. And then we can talk about what that is, but start out with that in your mind. Shut your mouth, your kitchen, your refrigerator, and watch your health bloom.

• 2:14Rich Roll?

  That's Dr. Joel Kahn, this week, on the Rich Roll Podcast.

• 2:29Joel Kahn?

  The Rich Roll Podcast.

• 2:32Rich Roll?

  The conversation that tends to swirl around nutrition is as emotional as it is confusing, capable of confounding even the most intelligent and well-intentioned among us. So, in an effort to gain some much-needed clarity in this battle over hearts and minds in which we find ourselves embroiled, today we focus on the impact of our dietary choices on a number of things: maximizing health, promoting longevity, and preventing disease. My name is Rich Roll, and today's co-pilot is my friend Dr. Joel Kahn, making his third appearance on the show, his first being back in August of 2013, episode 44, and then again

• 3:12Rich Roll?

  in February of 2015, episode 128. Dr. Kahn is an interpreventional cardiologist and clinical professor of medicine at Wayne State University School of Medicine, as well as the Director of Cardiac Wellness for Michigan Healthcare Professionals. He is a graduate summa cum laude of the University of Michigan School of Medicine, and lectures widely on the cardiac benefits of vegan nutrition, mind-body practices, and heart attack prevention. He is the author of The Whole Heart Solution, and his newest book is entitled The Plant-Based Solution. We cover a lot of interesting ground in this one. I'm excited for you guys to hear it, but first...

• 4:02Rich Roll?

  Okay, Dr. Kahn. This is a good one. It's a wide-ranging, comprehensive discussion about diet, nutrition, lifestyle, disease prevention, particularly heart disease. We talk about intermittent fasting. We talk about eating for longevity. Plus, we dig into how to sort fiction from fact when it comes to evaluating the veracity of nutritional research findings, and... Successfully seeing yourself through the muddled, confusing, and often incredibly emotional debate that swirls around what to eat, what not to eat, so that you can live your healthiest, longest, most vibrant life. As a final note, we did video this conversation, so if you'd like a more immersive experience,

• 4:45Rich Roll?

  you can enjoy it on my YouTube channel at youtube.com/richroll. And that's it. I love Joel. I love this conversation, and I hope you do too. So, let's talk to him.

• 4:58Rich Roll?

  Ready to go?

• 4:59Joel Kahn?

  I'm so happy.

• 5:02Joel Kahn?

  Yeah, me too. Good.

• 5:03Rich Roll?

  All right, Joel Kahn, I think this is your third appearance on the podcast, but it's been a while.

• 5:08Joel Kahn?

  Yeah, it's been, I don't know the numbers, probably two years, right? You came to a hotel in LA, and then once I came to your garage.

• 5:14Rich Roll?

  Right. That first time, that had to be four years ago, at least.

• 5:17Joel Kahn?

  Yeah, it's like, maybe number 38. Don't quote me on that, but it was pretty early.

• 5:20Rich Roll?

  And congrats on the new book.

• 5:22Joel Kahn?

  Thank you. Yeah, book number five.

• 5:23Rich Roll?

  Comes out tomorrow, right?

• 5:24Joel Kahn?

  Actually, it came out last week.

• 5:25Rich Roll?

  Oh, it did? Oh, cool. Awesome, man.

• 5:27Joel Kahn?

  The new one.

• 5:28Rich Roll?

  You've written like, four books or something? Fifth book? Five books? Wow, that's amazing. Well, we're gonna get into it.

• 5:32Joel Kahn?

  Yeah, that's no problem. Good. I have no time. Cool. You can go long, set a record. I'll do Tim Ferriss, whatever. Yeah, Joe Rogan.

• 5:40Rich Roll?

  Will you cry for me?

• 5:42Joel Kahn?

  Yeah, it was powerful stuff. I'll cry.

• 5:45Rich Roll?

  Good. Well, I'm excited to, uh, to reprise, uh, our ongoing conversation. And I think a good way to kind of get into this is to kind of canvas what's going on right now in the conversation around nutrition at large. Because I feel like, and I know you agree, there is a war afoot for hearts and minds. And the battle lines seem to have been drawn. And on the one side, we have the ascending popularity of the low carb, high fat, slash ketogenic, slash intermittent fasting camp. And amongst the proponents of that,

• 6:27Rich Roll?

  Philosophy or approach to nutrition. We have people like Dr. Asim Al Hojta, cardiologist, yes. We have Professor Tim Noakes, we have Gary Taubes, we have Robert Lustig, people like Mark Sisson, Dr. Mercola. On the other side, we have the plant-based camp. We have yourself leading the charge. And at the tip of that spear also, we have Garth Davis, we have Dr. Michael Greger, we have Dr. Dean Ornish, Dr. Esselstyn, Dr. Michael Clapper, Milton Mills, a whole bunch of other people I'm sure I'm forgetting. But this seems to be kind of where things are at in the current dialogue or debate around what is the optimal

• 7:07Rich Roll?

  way to eat, right? And you have been pretty vociferous and active in terms of your blogging, and television appearances, and books, and you know, your stuff, I don't know where you find the time to write all these blog posts, MindBodyGreen, and OnThrive Global, and Medium, everywhere I look, every other day, I get a text or an email from you, new post up. So you're very active in trying to communicate and participate in this dialogue. So how do you see things now? What's going on?

• 7:43Joel Kahn?

  Yeah, I agree with you. And that's the list you read, and the two sides of which there's many, you know, great luminaries, Robert Osvelt, cardiologist, plant-based, and many others.

• 7:55Rich Roll?

  There's so many other. If I start naming them, then I'm going to forget people.

• 7:58Joel Kahn?

  And I definitely would add Nina Teichels on the dark side, for sure, big fat surprise. It's very confusing. I think, forget the most important topic, which is where's the truth in the discussion for human health, and human well-being, and longevity, and joy, and freedom from medication, and need for medical procedures, which is really the real issue, as close as we can get to knowing the answer to that, is the best service we're going to be doing to ourselves, our family, and the public.

• 8:31Joel Kahn?

  It is a ugly, ugly situation that's very polarized. Yet, there is middle ground. And I mean, I don't want to, you know, begin at the ending. But the thing I'll acknowledge, if you go back to Lauren Cordain and the Paleo Diet book, which frankly, if most plant-based people read it, they'd say, "I agree with 90% of this book." Is the shunning of hyper-processed fast food. The thing that's decimating the health of the Western world. Both camps will agree are exited. Although, I'll say, of course, there are junk food vegans that have confused both the mission and the argument.

• 9:14Joel Kahn?

  We have that this is a very healthy lifestyle. And the other side has confused it by reintroducing dairy and bringing butter back. And now, you know, even cheese, when originally that was never a part of the low-carb, high-fat, and certainly paleo-to-diet.

• 9:30Rich Roll?

  Yeah, paleo-shued dairy altogether.

• 9:31Joel Kahn?

  They shued dairy. But now, you know, depending on, you know, what version of that, all of a sudden goat cheese is back and goat milk is back. And certainly butter is back in various versions. So, I mean, the common ground. I had the opportunity about a few months ago to go over to Googleplex in Mountain View. And it was arranged via Kip Anderson. And there was a conversation in front of 100 of the Google young people, but beamed all over Google Worldwide. And the conversation they set up for us was, you know, these are real people, real health issues, real health concerns, real goals. Don't just have a fight and leave them confused. Because what does the public do when they're confused? They do whatever the heck they want. And that's the point I wanted to make.

• 10:14Joel Kahn?

  We are left with this polarized discussion that leads most people, and very intelligent people, and people even in this sector of the health world, and the food world, and the medical world, to say, "You guys are so disparate. I will moderation everything. I'll do whatever I want." And that's unfortunately not serving us well. So I'd rather highlight, you know, the common ground, which is, none of us are into excess sugar. Define non or low, but none of us are into excess sugar. None of us are into fast food. I don't know that anybody on their side or our side is talking about eating fried food with any regularity. I mean, they're not big into bacon, and I don't think they'd advocate hot dogs and salami

• 10:57Joel Kahn?

  and bologna, and obviously that's not even on our menu, which is all in advance. I mean, and then there are a lot of leafy greens. I would not stop at leafy greens. I'd go on to lots of fruits and lots of root vegetables and starchy vegetables. But, I mean, maybe the first step is for all united parties to say, you know, school kids, hospital patients, airports, vending, people in the workplace, whether they're of low socioeconomic, high socioeconomic, we need to get this junk out, which is, you know, an impossible job when you've got Wendy's and KFC and McDonald's and, you know, these gigantic, multi-billion dollar conglomerates. Then I think, you know, it'll take 10 years and they'll be doing a better job, not a perfect job.

• 11:42Joel Kahn?

  Anyways, there is a lot of commonality. Yet, you're absolutely right. I wake up every morning after a few minutes of gratitude and spend a few minutes perusing the internet, what's new overnight, and I kind of have my sequence to go through. And it's either a hot new article on ketogenic, or it's a hot new article, usually about another vegan restaurant opening in London or somewhere. But they're very, they're very separate, and there isn't much discussion. This Google talk with Dave Asprey of Bulletproof Nutrition Group and Kip Anderson and myself is one of, you know, one of the rare times. You're not going to see you talking at Paleo FX or me being invited to go into the lion's den. So I look forward to that happening. I think, without doubt, we have science on our side, and we can, you know, that's always

• 12:25Joel Kahn?

  my touchstone, recognizing it's very hard to parse out, there's deficiencies, we don't have large randomized studies in many of these topics. Do we know enough to talk about what is the optimal diet for the human species? And we do, and it's much more weighted towards our choice of diet. Even if you just talk nutrition, take away the environment, take away animal rights, just talk nutrition, we are on the right path. And I'm emboldened by that, by some recent scientists who've come out kind of independently, with no ax to grind, that the diet, you feed your family rich a diet, I feed my family and in my restaurant in Detroit. The public will be able to identify that this is where they need to move towards,

• 13:10Joel Kahn?

  even though all this confusion exists.

• 13:12Rich Roll?

  Well, I think it's happening. I mean, the ascendancy of just plant-based awareness in the last couple of years alone has been pretty dramatic. And I think it's showing indications that it's not a fad, that it is here to stay, and it's building. And that's really cool. But there is this debate. The debate gets very emotional. It gets heated. And that's the spirit in which I pulled up YouTube and decided to watch your event at Google with you and Kip and Dave. And I guess I had a preconceived idea that it was going to devolve into not mudslinging, but kind of get a little bit heated in that regard. And I was quite

• 13:52Rich Roll?

  pleasantly surprised to find that that was not the case. You were kind of the peacemaker, I felt like. But I found Dave to be pretty amenable to almost everything that you were saying. I mean, Kip and him, you know, kind of butted heads a little bit over some of the environmental stuff. But overall, I found you guys coming to, you know, a common sensibility on most of the top-shelf, big-ticket items.

• 14:18Joel Kahn?

  Yeah, I agree. And that was set up as, please try and give us practical and important tips. Again, this wasn't Hollywood and a TV show where ugliness can be quite successful in terms of a marketing strategy. This was, you know, real people needing real advice. And, you know, I don't agree with a lot of what Dave Asprey does and talks about. And there's, you know, no science that he's produced that can support butter in your coffee and his experience in Tibet with yak tea and all the, I think, nonsense that all that story is. And, you know, how the public loves a great story. But when you talk about a diet

• 15:00Joel Kahn?

  very high in cruciferous vegetables and whole foods and absent excess sugar and absent

• 15:06Joel Kahn?

  You know, junk food. I mean, there is that. I would eat at his house, he would eat at my house. In fact, the untold story there is when we went to the Google cafeteria after that hour-long talk, and we were catching them in the last 10 minutes, he had the toughest time of all of us. I mean, Kip and I had no problem eating there, but We were trying to find something that would Yeah, fine, fine. You know, everything that met. His list was tougher to me than ours. And in fact, he found a big plate. I think it was just greens, and he always carries MCT oil of his own derivation. And it was like he was the most orthodox kosher of the group kind of impression, because he puts, as I said, we are all teaching rather, unfortunately, now, I call it elitist diets. I mean, I don't know how many people we speak to. Do we speak

• 15:51Joel Kahn?

  to 10% of America? Sorry, I just knocked something over on your desk, and My little Yeah, you have a Yoga army, man. A soldier, a yoga, yeah, it is, of course. You know, how many are we talking to? But, you know, I hope we can expand the conversation and reach out to, you know, close to 100%, when the right thing to do is the easy thing to do, when McDonald's has healthy options, when, you know, schools and hospitals have healthy options. I think the food industry is like a bright light of what's going on. They're ignoring this debate and just putting more and more, you know, healthier options, plant-based options out there. But yeah, it was a, it was a good experience. There's the other backstory, just to make your audience laugh, is I still use my AOL email. So I know I'm the only speaker ever to be invited

• 16:36Joel Kahn?

  to an @GoogleTalks who set it all up via my AOL. I have Gmail accounts. I just like, I like the appearance of AOL. And in the retribution I had Steve, I had Steve Kaysan, I know. Of course, I asked him, do you still use AOL? He's like, yeah. A surprising number of closet people like me. I think they should just rename it AOLD, because if you're old enough to have one, just be proud of your seniority, call it AOLD. And the final retribution was that they were supposed to post that talk the day it happened. It took them six weeks. They had a YouTube flaw. And, you know, they kept apologizing, and I kept responding in my AOL email. Well, I'm pretty high-tech here. I'll just be patient and wait. They ultimately got it up to YouTube. But

• 17:21Joel Kahn?

  You know, but it is the, you know, in Silicon Valley where we had this discussion. I mean, Business Insider, Magazine and such, the ketogenic diet is very popular right now. The idea that really strictly eliminating carbs of, and we always have to be careful in the definition, carbs are, you know, plants have, food has usually carbs, protein and fat in almost every food until you refine it. Coconut has all those and olive has all those. Once you refine it, you may end up with only fat. So all foods have the three macronutrients. I don't think there's any exception to that, maybe different percentages. So a low carb diet, of course, many of them continue to eat a decent amount of greens in their diet, but they're eliminating all the whites and they're hyper vigilant about it.

• 18:06Joel Kahn?

  The big difference in the ketogenic diet, are you doing high fat, low carb, low protein, which we can talk about, and with a plant-based approach may actually have some benefit in science, or are you doing a low carb, high fat and high protein diet, which probably ages you quicker than any other diet on the planet? And that isn't always parsed out in their conversation. So the scary skeleton in the ketogenic diet closet is you'll lose weight, you may have some boost in energy for a period of time, you may be increasing your mortality risk. And they just don't talk about that with great regularity. So it's a, it's a difficult diet, and I think Dave Asprey trying to eat in the Google,

• 18:49Joel Kahn?

  I don't know that he'd want to be cornered as a ketogenic diet proponent. He has his brand bulletproof diet. But, you know, the difficulty he had, my patient's telling me, this is, you know, on the road, it's easier to be plant-based than it is to eat a strict ketogenic diet right now of, you know, a high fat options, you're gonna have to carry around your own food. But the gravest concern is, is it a healthy pattern? Is there any natural population that even slightly approaches it and has done well long-term? Kind of a bullet shot at the plant-based movement, show me a society that's been plant-based for centuries and has thrived.

• 19:22Rich Roll?

  That's one of Nina's big points.

• 19:23Joel Kahn?

  Big points, but show me a, a community that's, you can talk about Eskimos and the Messiah who lived to age 30 or 40. Well, that's not kind of the example we're talking about. Show a Okinawa-type population that was 90% plus plant-based and thrived. Great, we have our example that approximates the way we eat. They have great difficulty with that. In fact, the scientific data is it's the converse that they are at-risk shortening their lifespan. If it's an animal-based, low-carb diet, particularly if they're emphasizing foods that they feel are high in protein, which are typically going to be meats of a variety of kinds. No matter whether it's grass-fed or not, it's the basic constitution of animal muscle that can age you excessively, and the science is well-known.

• 20:08Rich Roll?

  So, a couple of observations on that. First, with respect to the degree of difficulty of maintaining a ketogenic diet. It's an interesting thing to talk about because you're right. To actually do a ketogenic diet properly requires an incredible amount of forethought and planning and discipline. It's not easy to really dial that in and make it work compared to a plant-based diet. And yet, I feel like the plant-based diet gets unduly criticized for being restrictive and too difficult and something that people are just never going to be able to maintain long-term, despite the fact that both of us have done that.

• 20:51Rich Roll?

  But people are very quick to jump on the ketogenic bandwagon and try it with enthusiasm without that same concern being applied.

• 21:01Joel Kahn?

  Yeah, I agree completely. Just a couple of examples. Joe Rogan had a surgeon on Sean Baker. And I don't know Sean Baker very well. We go at each other a little bit on Twitter. And he said very casually even, he's an MD. And the ultimate example of these diets is there's a whole group of people eating nothing but meat, three meals a day, and literally nothing but meat. And for reasons I don't completely understand...

• 21:29Rich Roll?

  He's the carnivore guy, right?

• 21:31Joel Kahn?

  Yeah, and he's one of many. I mean, he's not the only one that shows up there. They can claim short-term, some pretty impressive pictures of their abs and weight, and some of them have... Some heart CT data. Of course, there's nothing published in the literature. I want to come back to that. But, you know, Dr. Baker said, "I didn't even bother to check my labs." Joe Rogan says, "You've been doing this for a year?" He goes, "No, I didn't check my labs." "Well, I have patients that do that and they get their labs checked, not under my advice." And I have one that I'm going to write up, maybe on the airplane flight back to Detroit later this evening. His cholesterol went from 250, I've never seen this, 250 to 750 during the two months he did a meat-only diet, trying to approximate what he was hearing on these, you know, rogue, not Rogan kind of podcasts. And it's insanity and it's like

• 22:16Joel Kahn?

  religious fervor and follow the leader without thoughtfulness. The only medical condition that has any data, everybody can verify this, PubMed.com, put in ketogenic diet, refractory epilepsy in children and some degree adults have a number, I mean, several dozen published studies on a impact if standard drugs like Dilantin don't work. And in fact, before Dilantin, ketogenic diet was a reasonable choice for kids with epilepsy. As soon as drugs came out, it kind of faded off and it's come back for that use. Daniel Amen, very famous local psychiatrist and a friend, has a grandson that had refractory seizures, rather sadly and ironically, ketogenic diet was very beneficial. You go beyond that,

• 23:01Joel Kahn?

  you're just, you're absent data. So, another startup that's hot and it's worth talking about because your listeners will hear this is Virta Health, V-I-R-T-A, backed by Stephen Finney, MD. I don't know much about him. He appeared in Dr. Malhotra's documentary about visiting the home of Ansel Keys, one of the most distorted and misleading documentaries ever done, called The Pioppi Diet, P-I-O-P-P-I. Don't read it, don't watch it, it's a waste of time, money, and honesty. But Virta Health claims with a ketogenic diet that you can reverse your type 2 diabetes with a high frequency and they've got a lot of backing and they've got an app and they've got, you know, a coaching system. So, they have published

• 23:44Joel Kahn?

  a study in a journal that is so obscure and so non-reputable, but it is a journal. Which is a proliferation of scientific journals that are open and you can either pay to publish an article or get access. But it's a small study of six months duration, actually originally 10 weeks duration, non-randomized, no control group. In the scientific world, this is about as low as it goes. And yes, with the dietary plan they advocated, very high dropout rate in the group studied. They showed some drop in measures of diabetic control towards the better with their ketogenic diet coaching system. And on that, I speak to like brilliant people and they say, well, the debate's over. Verta Health has shown that ketogenic diet can solve multiple health problems.

• 24:29Joel Kahn?

  It's so overblown and in fact, what's missing is the six, seven studies that suggest, to get to the point, big studies, hundreds of thousands of people, these are association studies. Group of people ate a certain way, questionnaires, food questionnaires, once, food questionnaires, several times during a number of years, follow these people up Harvard School of Public Health, Tufts School of Nutrition, very prominent places. Dramatic rise in long-term mortality by peoples whose food pattern, it can be called a low carb, high fat diet. A rise in death rate. If you've had a heart attack and you fill out questionnaires at the Harvard School of Public Health and they follow you long-term and your diet can be described as a low carb, high fat diet, you're much more likely to die in follow-up than people that describe

• 25:13Joel Kahn?

  diets that are closer to high carb, hopefully complex plant choices, though these aren't vegans, you know, more like a Mediterranean-style diet. So that's the untold story. For anybody listening and that's falling for this optimization of performance and metabolism and control of cardiovascular risk, the data needs to be addressed about death rate. And until there's a study that resolves that issue and says that's wrong, six, seven different studies in different parts of the world, I could not in any good conscience advise somebody do a animal-based, low-carb ketogenic pattern, particularly if it's high in protein. Protein activates aging pathways.

• 25:54Joel Kahn?

  Protein activates biochemical pathways that right here in the city of the angels have been found from yeast to mice to humans to cause accelerated aging and aging in every... Aspect of our body and it is animal protein rich in an amino acid called leucine is the main trigger and you can't get around it. Grass fed beef, free range chicken and line caught fish all have tremendously more leucine than the amino acid structure of plants. They have it, but they don't have near the same amount.

• 26:24Rich Roll?

  So when you raise those concerns and those issues and make those points, what is the retort?

• 26:30Joel Kahn?

  Um, association is not causation. You know, so what I've done a few times is take the argument that particularly Nina Tykles, the author of The Big Fat Surprise, number one nonfiction book in the health arena in 2014, and to this day, still celebrated as some kind of heavenly light that the nutrition world has accepted as despite absence of PhDs or nutritional science backgrounds and she'd argue you don't need those things, you just need to study. Lots of people talk nutrition that don't necessarily have MDs, PhDs, RDs and all the rest, um, has been accepted to the point that in late 2017, the British medical journal

• 27:12Joel Kahn?

  Lancet, one of the most respected in all, wrote a review of her 2014 book three years later, as if it had just come out, as if it was novel, praised it, as if she had bought an ad in the leading medical journal in the UK. It's, it's just insanity. So she will argue and dissected the movie, what the health? And first, what thing she did, and I'll get back to you. This is the answer to your question. I don't remember if it was 39 major health claims made in the movie, what the health? She threw 37 of them away because either Dr. Bernard, Dr. Gregor, myself, Dr. Mills or and all vegan doctors can't be trusted to give credible medical research summaries because we're biased. So she, that was one of her rules.

• 27:56Joel Kahn?

  She has a second rule, a statistical rule. If the risk described in a, if, if you drop your risk of diabetes by less than 50%, it's not strong statistical data. And, and so she only was willing to give us one or two of the claims in the movie, what the health is possibly scientifically valid. Of course, anything that is. Association, not causation. You have to do like a randomized study and understand the basic mechanism. So I've gone to some of the ketogenic data and a study called the PURE Study that really confused the world in late 2017. Said, "Let's apply Nina's rules." Okay, Dr. Saleem Youssef, the lead author, eats meat, so we have to

• 28:38Joel Kahn?

  throw him out. Anything he's... You know, it becomes farcical. I mean, and I've said this publicly, and I'll say it again, the day that Dean Ornish does a randomized study that says heart artery blockage reverses with beef, chicken, and pork, my obligation as a cardiologist is probably to advise a patient, "There's new data that's credible and you should consider," even though it kills me and it kills the animals and it's bad for the environment. It's not the case. And we don't need to go down that path. So what do they say? Association, not causation, vegan doctors, weak data, or they don't respond?

• 29:19Joel Kahn?

  Because they have their events. And as you've pointed out with other people who've interviewed, they seem a little more organized and a little more manly and a little more vibrant. But I think we're coming on strong in the medical health, plant-based world with hunky people like you and Scott Stoll, former Olympic athlete and such.

• 29:46Rich Roll?

  The contention, the argument that no medical authority, no doctor who is a longtime vegan or plant-based person can be trusted or is inherently conflicted because of that point of view, and as such, you know, their perspective or their opinion on all of these issues should be invalidated, is disingenuous because the level of investment that the other side has in their own movement is equal, if not, you know, if not more entrenched. So if you're going to apply that rule, you know, equally, it would just...

• 30:28Rich Roll?

  Eradicate everybody, but human beings were, you know, we, we, we flock to our tribes. We inherently want to be a member of a team and that doesn't necessarily serve anybody. And once we become entrenched, whether you're plant-based, ketogenic, whatever, it becomes more and more difficult to be objective. Like, I'd like to think, like yourself, if evidence came out that what I was, the way I was eating and living was harmful to myself, or to the planet, or anything else, that I would have the objectivity to then really look at that, take ownership of that, and, and make changes in my life.

• 31:00Joel Kahn?

  Yeah, so, um, and you-

• 31:02Rich Roll?

  But would I? I don't know. You know, like, people would say, "Well, I'm so, you know, this is my brand now. There's no way that I could ever, you know..."

• 31:08Joel Kahn?

  There is that. I mean, that's, you know, watching when What the Health came out, and there was a lot of praise for the movie for about two weeks, and then those that have a following have to respond. I mean, they have to.

• 31:18Rich Roll?

  And, and What the Health, we should get into that, because I think that documentary really has crystallized this argument, because a lot of these media opportunities, whether it's you at Google, you know, Garth Davis on the doctors, these things that are happening are a result of that documentary, which is creating this, this debate. And so, in the wake, like you were, I can just finish your sentence, like, in the wake of, of the acclaim or the attention that that documentary garnered, there was a backlash that, that sort of hit with quite a bit of severity.

• 31:49Joel Kahn?

  Yeah, there absolutely was. And, and, you know, maybe some were offended by statements in the movie, but I think a lot of it was the obligation, "You're in a corner that says animal products are healthy, grass-fed's good, uh, it's better for the environment, because animals pooping restores the, uh, the soil," all kinds of crazy statements. Um, and yeah, there was one after another, whether it's Dave Asprey, whether it's Nina Taichols, whether it's The Diet Doctor, whether it's, um, On and On, David Perlmutter, they all had a voice in, and, and the movie took some hits, um, although they were largely inauthentic and easily answered, as I did in a, a blog I wrote, um, to some degree. Um, I actually was pleased to see just yesterday morning, there was a review of the movie, I mean, it's

• 32:32Joel Kahn?

  seven months later, why people are reviewing it like it's a new movie, very positive. Um, yeah, but that, that- has done a lot to raise the conversation. And we can come back to what the hell. I just want to say, one of the, I think, breakthroughs that your audience, I would imagine, doesn't know, and a person that I would put as one of the highlights in 2017, I called a new friend, is right here in Los Angeles, you have at USC, something called the Institute of Biogerontology, a research institute about aging. In fact, there's a word, juvenology, the study of remaining youthful, juvenile, youthful. We should all be juvenologists, vegan juvenologists, we probably are.

• 33:12Joel Kahn?

  And that's all led by an Italian-born scientist, Walter Longo, PhD, who came to the United States at age 16 to be a blues jazz guitarist from Genoa, spoke no English, but could blow some riffs on his guitar in these Chicago bars. But by age 19, was fascinated that he never saw disease in his family in Italy, and he was living in Chicago, and his relatives were getting sick and bloated. And he had the foresight, he's 50 years old now, so whatever it was 31 years ago, to say, this nutrition stuff, this aging stuff, this is more meaningful than becoming a jazz guitarist. And he totally shifted his career, went to Texas, and then went to LA and got a PhD with some very famous calorie restriction longevity experts at UCLA, and then he set up his lab

• 33:57Joel Kahn?

  at USC. And anybody can go read about him, he's one of the most fascinating, credible, authentic, Nobel Prize nominated scientists. Last year at age 49, came in second, it's called the Jubilee Award, because the same field he concentrates on was also being studied by some 90-year-old scientists in Japan, and they gave it to the scientists that had been in the field a little longer. He will win a Nobel Prize. But he has kind of risen to the light as a unbiased, I think, spokesman for clarity, saying, you can't judge, he goes, number one, don't outsource your nutrition to amateurs, is the example he gives. If your neighbor's an engineer, an automobile engineer in Detroit, you're not going to go fly in an airplane that he designed between Detroit and New York.

• 34:42Joel Kahn?

  I mean, get a professional to build that plane. Don't outsource your nutrition to amateurs. And base Any evaluation nutrition on what he calls five pillars. One pillar is basic, basic science, which he is the leading world scientist on many of these aspects. What does sugar in the diet do to basic pathways? And the answer is it's not very healthy for us. What does animal protein do to basic pathways? The answer is it activates aging and cancer promoting pathways called mTOR, called PKA ras, sirtuin pathways. He's a superb scientist. So you've got your basic science. You've got your association studies epidemiology, flawed, but you can't ignore them. You've got centenarian studies.

• 35:24Joel Kahn?

  I mean, if you've got a diet, ketogenic diet, let's find a population in the world that's living to their 90s and 100 and climbing mountain tops and eats anything that could be called approximating that the way it's being described by these meat eating, you know, bloggers nutritious. It doesn't exist. It does exist in Okinawa and other places, Loma Linda, where we have many examples that approximate the diet weed. I mean, let's talk about randomized studies, which are pretty uncommon, but let's include those. And there's a fifth pillar. I don't really remember right now. His book came out a week ago. And he concludes, you know, that in about one paragraph, you can just slash away what is commonly done in the paleo and the low carb, high fat ketogenic diet is an extremely

• 36:06Joel Kahn?

  dangerous, age accelerating, high mortality eating pattern, if done with animal products and if done chronically. And he concludes, we should all be eating, and he's not a member of our, you know, traditional vegan community. He concludes, we should be eating whole food, plant based, enjoy life, have a little wine if you want, have a little sugar if you want. He likes fish one or two times a week. He says in a very broken English, or not so broken, vegan fish. I'm a vegan fish eater. And he grew up on the coast of Genoa and maybe it's a little bit of that, a little bit of science. A lot of us have concern about fish and its toxicity and fish and its depopulation of the oceans and there's arguments there.

• 36:49Joel Kahn?

  But, you know, knowing that this shining light future Nobel laureate has parsed through this and challenges this other side who don't even know that his argument is this profound five pillar assessment of nutrition. And really, there's maybe five people in the world can really say, I've done all these studies and this is my conclusion. Dr. Longo is one of them, is I think just a tremendous. A way that people so conflicted and confused in the public can say, I need somebody to listen to. So go read The Longevity Diet by Dr. Longo after you read your new edition in my book and you won't be confused anymore.

• 37:29Rich Roll?

  Yeah, you just showed me that book. I gotta get that guy on the podcast.

• 37:33Joel Kahn?

  I can help you with that. He's a high-energy, he still plays a mean, mean jazz guitar. Maybe you can get him to bring it here and have a little fun. I mean, he lives by LAX and I can work hard to set that up. In fact, if you'll interview him about his book, I can guarantee you it'll happen.

• 37:50Rich Roll?

  Oh, yeah, absolutely. So let me ask you this then, and I don't want to go too down.

• 37:55Joel Kahn?

  Can somebody who eats fish two times a week be a guest on your podcast?

• 37:58Rich Roll?

  Yeah.

• 37:59Joel Kahn?

  Okay, cool, cool, cool.

• 38:01Rich Roll?

  I have an open. What is it about eating meat or animal protein specifically that causes the aging? Like, what is his thesis on that?

• 38:12Joel Kahn?

  Yeah, and you know, I'll go short, so you can go Longo with Longo. It's kind of funny, the world's only expert in longevity is named Longo.

• 38:19Rich Roll?

  Yeah, of course. It's like, you know, Dr. Toothache or the dentist.

• 38:21Joel Kahn?

  Yeah, right, right, right. Dr. Smelzy, the foot doctor. We have a urologist in Detroit whose name is Rod Stiff.

• 38:30Rich Roll?

  That cannot be true.

• 38:31Joel Kahn?

  Cannot be a better name for urologists.

• 38:34Rich Roll?

  It's really his name?

• 38:35Joel Kahn?

  I trained with him.

• 38:35Rich Roll?

  I pity that guy growing up.

• 38:37Joel Kahn?

  I think it's your best calling card. But there you go.

• 38:40Rich Roll?

  He didn't have a choice in what he was going to become.

• 38:42Joel Kahn?

  Yeah, absolutely. So the basic tenet is, he's used, besides the word juvenology, the study of anti-aging or staying youthful in life, staying youthful in your brain and activity. In other words, nutra-technology, that you can use food to activate pathways that either lead to healing, regeneration, rejuvenation, stem cell production, or you can use food that activates pathways. So there's a pathway called mTOR, mammalian target of rapamycin, pretty sciency term. Rapamycin was from, I think, Easter Island, Rapa Island, and they found this fungus that makes this molecule that has actually therapeutic

• 39:24Joel Kahn?

  benefit. It's used in transplant patients, mTOR. But you need, when you...

• 39:31Joel Kahn?

  When you're growing, you need your growth hormone. When you're a child, you need growth hormone. There's a receptor in cells for growth hormone. And when you eat animal-based protein products, growth hormone is activated, leads down the path to maybe something you've heard about IGF-1, insulin-like growth factor one. Great thing when you're growing, great thing to maybe your 18 or 20. But eating animal products, particularly with this amino acid leucine, continue to trigger the growth hormone down through the IGF-1 pathway. And, you know, we don't want too much cell growth when you're 45, 50, 55, because we've got

• 40:07Joel Kahn?

  these little cells that are waiting to transform into a line of cancer. And leucine is in meat. It doesn't matter grass-fed, doesn't matter if it's free-range, it's in meat much more, you're going to find it in beans and greens. Sugar will activate other pathways. It's called the PKA pathway. So diets, and you know, nobody in the health field, I think, is a fan of sugar, and nobody spouses it. That became a debate about the what-the-health movie. Certainly, Dr. Barnard and Dr. Davis were not advocating high-sugar diets, but it's a different kind of topic about sugar and the development of type 2 diabetes. And

• 40:47Joel Kahn?

  then there are some other... So you can create a diet, low in sugar, low in animal-based amino acids like leucine, low in protein, and what they've shown in humans. So what Dr. Longo did that's fascinating is when he started his career about 25 years ago or so, they were studying a lot of mouse models. Still pretty complex, even though it's a lot less of a mammal than the human. He went backwards to yeast, single, simple-cell yeast, and said, "This will allow me, a model, to study..." And nobody knew the word mTOR or these terms they used. And he's the one that identified these pathways that are now known to be fundamental in aging, healing, generation, this field of juvenology. And

• 41:28Joel Kahn?

  it turns out, the reason that his science has been so mind-blowing is these pathways in the yeast are completely preserved in the human species. So what he found in this single-cell organism is the same biochemistry That's occurring in your and my cell right now, and it has profound dietary implications. So he went on, like I said, these five pillars, that was some of the basic biochemistry. In, I think it's October 1, 2016, a study was published in a major journal, JAMA, Internal Medicine. Take 6,000 free-range adults, do very careful assessments, high animal protein eating, free-range adults have a high mortality rate. Low animal protein eating adults have a low mortality rate. That's a very profound statement.

• 42:13Joel Kahn?

  Those that eat a lot of vegetable-based protein didn't have that relationship, whether they were low or high, they had a survival advantage over the meat-eating group. But high protein diets accelerate aging through these biochemical pathways, cell death, our inability to clear damaged cells out, that's called autophagy, that won the Nobel Prize, that Dr. Longo came in second on. Vegetable protein doesn't seem to activate it. There is, and just to finish that conversation, as adults get over age 65 or 70, protein becomes a more important nutrient to sustain their health long-term. So Dr. Longo and some other experts, because you lose muscle mass, you don't want to be

• 42:54Joel Kahn?

  a frail, muscle-depleted elderly person, you'll be very prone to pneumonia, infection, and other things, falling, breaking bones. So you want to emphasize, and I would say, just emphasize vegetable protein your whole life, eat beans, eat greens, eat nuts, eat seeds, eat whole grains, because you're going to be in the sector where this accelerated aging phenomenon doesn't exist. So fancy stuff, but it's led to, and that nutrient technology, that nutrient-sensing pathways, high animal protein activates his aging through biochemistry, it's well-described. I don't know how many rabbit past seconds go down, there's these people in Ecuador called the Loran. Israeli scientist V. Liran described these people forty years ago.

• 43:38Joel Kahn?

  They had, their cells lack the receptor for growth hormone. So their body, their brain produces growth hormone, their cells can't respond to it. So they're very short people. Because their cells are deficient in growth hormone, they have unbelievably low IGF-1 levels their whole life. And there's nearly, and now a scientist in Ecuador, Amy Gueveras, and Dr. Longo goes down to Ecuador now all the time, has described these people do not get type 2 diabetes. These people do not get cancer at a rate unbelievably less than the general population of Ecuador. So all these pathways are just another piece of those five pillars. We can do that with food. When we, we can eat a diet that is naturally low in producing levels of IGF-1.

• 44:23Joel Kahn?

  When we eliminate dairy, when we eliminate animal protein and emphasize the diet you and I eat, we're eating a longevity diet, which is exciting to know and that the body of science is profound on that. And it's totally, totally missed by our carn, carnage eating carnivorous friends with loud voices.

• 44:41Rich Roll?

  Yeah, just on an anecdotal level or a population studies type sociological survey of the situation, it's pretty self-evident when you look at the work that, that Dan Buettner has done with the blue zones. Like you just look at these cultures, look at how they're living, look what they're eating. Look at their, their social, you know, structure, their social, their community-based, you know, way of life. And these are the people that are living the longest. They tend to be the people that are the most content and fulfilled in their lives. And it's almost to me, like, I don't, I don't need the inquiry to go much further than that. But it's good to know that there are studies out there that I had never heard about the, this Ecuadorian population. That's fascinating.

• 45:23Joel Kahn?

  It really is. And it's, it's the layers of support for what you've chosen to do with your life and your career and what I've chosen to do with my cardiology practice and career is profoundly more established than the general public believes. And I really do believe Dr. Longo, if that voice is heard, is going to do a lot. To clarify, I was with some business people in Los Angeles this morning, extremely intelligent people in the organic, not food world, but organic world of consumer products. And they threw up their hands and they said, "We're totally confused. Guide us." And, you know, so what the rank and file doing with this issue?

• 46:06Joel Kahn?

  Either not paying attention, which I can understand, there's other issues in life when your paycheck is an issue, or they're just throwing their hands up like everybody says, moderation, everything, I'll do what I want, which is a very dangerous statement to make for health.

• 46:20Rich Roll?

  It seems to me that this current divide in philosophies around diet, nutrition, et cetera, can be tracked back to the debate that occurred in the 70s between sugar and fat. And the kind of high carb, or not high carb, high fat, low carb community will point to the sugar industry as the culprit who sort of conspired, for lack of a better term, to point the finger at fat as being, you know, the evil contributor to poor health. At the time, which led to our 1970s, you know, low fat craze.

• 47:05Rich Roll?

  And this camp will say that that actually contributed to our obesity epidemic, when in fact, sugar was what we should have been looking at all along. So can you, I have my own opinions on this, but can you share your perspective on that?

• 47:21Joel Kahn?

  Yeah, and I'll reference...

• 47:22Rich Roll?

  First of all, was that inaccurate?

• 47:23Joel Kahn?

  Yeah, I think we covered a little bit of this, and we did, I think, talk about Dr. Ansel Keys on the last time we chatted with you, so...

• 47:32Rich Roll?

  We've sort of been, in that early one...

• 47:34Joel Kahn?

  I don't want to go too far down there.

• 47:35Rich Roll?

  He was taken down, his amazing work was taken down, and you were trying to explain, like, how that was...

• 47:40Joel Kahn?

  Right, so what we've learned since then, rather shockingly, and I think it appears to be real, is three researchers at Harvard in 1965 wrote an article, a two-part article in the New England Journal of Medicine. I've actually tried to read the article. It's such dense science, maybe a thousand people in the world ever read it. This wasn't an article that, you know, got headlines. This was an article that influenced a lot of rank and file people at all. But nonetheless, some researchers found some records that those three researchers took about $5,000 apiece from the sugar industry, which might translate to $50,000 nowadays in terms of equivalent economic value, to perhaps bias the conclusion of this extremely

• 48:25Joel Kahn?

  dense scientific article towards favoring anything other than sugar being a health issue for biochemistry of the human condition. One of them, a guy named David Heggested, was a peer of Ansel Keys, not a co-researcher, and was the head of the nutrition department at Harvard, and, you know, shines poorly, but has been exploded to say, "All research, all researchers, Dr. Ansel Keys, everybody involved with the American Heart Association, everybody's in the same situation," as if everybody was a hashtag "me too," you know, across the board, every guy is in the same boat. I mean, that's unfair. Everybody gets to live their life and judge and have authentic, hopefully, careers and

• 49:10Joel Kahn?

  all. So it's been overblown. I think it's a very small drop in the bucket of a larger issue. Again, bringing it back to what we were just talking about, I mean, sugar as a... when this... there is a statement, as anybody who's seen the documentary "What the Hell Knows?" by Dr. Neil Barnard, "Sugar doesn't cause type 2 diabetes." It's the fat, and Garth Davis gets in the topic. So I had to dig into that a bit, and it's relevant to what you just asked, because I'm just a humble cardiologist advising patients, putting in stents. I'm not an endocrinologist. And, you know, frankly, I traveled to the website of the American Diabetes Association. A little button there says "myths about type 2 diabetes."

• 49:53Joel Kahn?

  We used to call it "adult diabetes," but kids are getting it now. And the first myth they exposed, "Sugar causes type 2 diabetes." Myth? That's American Diabetes Association. Well, that's what Neil Barnard just said. Went to the Johnson Diabetes Center website, which is out of Boston, same exact statement, myth, it's not the case. The, the diabetic association of the UK, same exact response. So I actually, you know, felt that I didn't have too much doubt that Neil answered appropriate based on the science. But I called up a guy named Gerald Schulman. He's the head of endocrinology at Yale. He's from Detroit. He speaks at Wayne State University, the medical school that I'm a faculty member of quite often. And I discussed this with him and he said, just to put it all together, he goes calorie excess causes type two diabetes.

• 50:38Joel Kahn?

  Americans eat 800 calories a day, more than they used to on average. You don't, I don't. I mean, some people are eating 1,500 calories a day, more than they did in 1970. Most of that is processed food, rich in processed oils, sugars, refined grains. It's a whole gamut. If you actually designed a diet that you ate so much excess sugar that you packed on 25, 30 pounds, you'd be very likely to develop insulin resistance. But it could happen with other diets that were just, you know, processed oil and fat heavy. It's not specific, there's nothing unique about sugar that leads to type two diabetes. It's, it's, it's deterioration of the American diet and moving away from home cooked meals, garden meals, the whole, you know, response we see.

• 51:23Joel Kahn?

  So the sugar issue is overblown because it's an easy target. Now, I mean, it's not a nutrient that you need to eat.

• 51:30Rich Roll?

  It's not to say that sugar is, when we're talking about sugar, we're talking about refined sugar. We're not talking about the sugar in an orange or an apple. But to be clear, nobody's saying sugar is a health food. You shouldn't be eating refined sugar.

• 51:43Joel Kahn?

  I mean, glucose in your bloodstream is an essential nutrient. You don't have glucose, you will die. And we, that sometimes gets confused. We're talking sugar and food. You know, a study came out in 2017 from China, the first author Dao or Do, D O U, I think it is, 600,000 Chinese, the more whole fruit they ate, the lower was the risk of developing type two diabetes. Those that had two type diabetes, those that ate the most fruit had the lowest risk of complications of type two diabetes. Dr. Longo seems a little bit shy on fruit, more vegetables, less fruit, couple, three servings a day might be all that you choose to put in your diet. I was interested in seeing that. But yeah.

• 52:25Joel Kahn?

  Nutrition is complex, but sugar has gotten backlash that is excessive.

• 52:33Joel Kahn?

  And what's the message for, you know, can you enjoy an occasional sweet and an occasional,

• 52:39Joel Kahn?

  you know, deviant from the best? That's probably the only area I'd say moderation occasionally is not going to be very harmful with sugar. I'd rather you be, I'd rather you be more meticulous about added fats of animal origin, processed oils, not whole foods. We all agree. We all love avocados, we all love nuts, we all love olives, really without exception.

• 53:00Rich Roll?

  I think on top of that, the idea that the low-fat craze contributed to the obesity epidemic is reductionist and patently false in the sense that it presumes that people actually ended up eating low-fat diets as a result of that kind of edict coming down from on high, which is actually not what people were doing. There was a proliferation of low-fat and fat-free foods, but that doesn't mean that overall, if you broke down somebody's daily caloric intake, that it ended up being low-fat, because this meets the ascension of the processed food landing on the shelves at the grocery stores.

• 53:43Rich Roll?

  And a lot of those foods were, you know, the foods that we ended up binging on.

• 53:51Joel Kahn?

  Yeah, absolutely. I mean, I agree with you 100%. Dr. Dean Ornish presented that if you go to the USDA and look what happened since about 1970 and on, even though it was advised to eat a low-fat diet to protect your heart, Americans didn't listen. The amount of fat in the diet went up, as did calories, as did refined foods, as did sugar. We simply ate more of everything. The abundance of restaurants and no longer cooking at home and convenience of grocery stores where the middle are packed with grab-and-go kind of items, we shifted our diet in an adverse way. There are people that are sugar addicted, and just like every other food addiction, it's real, and are probably best to have extreme care in avoiding added sugars and they're hidden.

• 54:34Joel Kahn?

  And everything barbecue sauce and dressings and 57 names for sugar that the food industry is allowed to use fructose and corn syrup and multodextrin and for those that find that eating foods and sugar are just not resonating with their diet. I own two restaurants. I've had dessert in my restaurants, maybe three times in two and a quarter years. I just don't go there. I'm not addicted, but I know it's not, you know, on my food plate is a very, you know, it's not the health group that I'm going to do very often and I'm there every night or many nights. I want to point out one of the, maybe you can get Penn Gillette on your, on your podcast of Penn and Teller, but he, I just finished his

• 55:16Joel Kahn?

  book. Yeah. Well, I'll tell you the connection. You, your, your neighbor in Calabasas, Juliana Hever can get him to you.

• 55:22Rich Roll?

  I just had her and Ray on recently. I haven't, I haven't put that episode up.

• 55:26Joel Kahn?

  Okay. Yeah. Cause I think Ray, Ray Cronis is one of the most fascinating food thinkers out there now. And so, yeah, so Penn Gillette and the book presto. So I don't know that that book hasn't really hit a lot of people's nightstand. It hit mine recently and one, it's one of the funniest books you'll ever read. He's outrageous and he's, his language is his, his ling, his chapter on Ask Me About Protein, which has more F bombs. Did you read the book?

• 55:54Rich Roll?

  Yeah. I read that chapter.

• 55:55Joel Kahn?

  Yeah. Oh my God. Is that funny? But the whole book's like that. And he has a chapter on Joel Furman. And I just was with Joel Furman in Detroit last couple of days. He didn't know there was a whole chapter on him. And even though in some ways it's very, very respectful and praiseworthy of the bookie to live in Joel Furman. It's Penn's nature to make fun of people and change names. So I tell him, he's ordering the book to read it. But that experience of a sugar addicted human who had to follow an extreme, but also extremely effective, you know, ultimate high complex carb, sugar-free diet, also oil-free diet. I mean, that's necessary for some people that are battling, you know, the 130 extra

• 56:38Joel Kahn?

  pounds that he was carrying around and was going to kill him and others. So yeah, the sugar story has been overblown, except I wanted to be sensitive to people that really do feel that their physiology is affected and their psyche is affected. So just stay away. Eat fruit and nothing more. Or don't eat fruit. You can survive without fruit.

• 57:01Rich Roll?

  Let's talk about heart disease. You are a cardiologist.

• 57:04Joel Kahn?

  Thank you. I was hoping we'd get there.

• 57:06Rich Roll?

  Your expertise.

• 57:07Joel Kahn?

  Well, we're preventing, our discussion we just had is about preventing heart disease.

• 57:11Rich Roll?

  Sure, of course.

• 57:11Joel Kahn?

  We didn't call it that.

• 57:12Rich Roll?

  In the global sense, of course. So are we still in a situation where the statistics dictate that one out of every three people will die of heart disease?

• 57:22Joel Kahn?

  Yeah, you know, there's, there's good and bad news. Last few weeks, the survival of the average US citizen went down for the second year in a row. Now, a very small amount. Opioid addiction, opioid deaths got a lot of the headline for it, but it's rather distressing with all the progress and what I've seen in my 30-year medical career, and devices and procedures and all that overall lifespan is going down. You know, we live in a very, very tough time. But that's the bad news. Cardiovascular disease actually seemed to be a little bit better than the year before. It's still number one. Canada's switched. Canada cancer's number one, cardiovascular disease is number two. We're, we're close, but I don't see it shying away. And yes, the cardiologist in me, and I was hoping we'd

• 58:06Joel Kahn?

  get there, I always want to talk about how you can identify silent heart disease so you don't become the statistic. I'm trying to think of the last celebrity, I keep talking about Blake Kirkorian, a very famous investor in LA who was walking from the beach to his car with a surfboard in his arm about a year ago, and aged 48, worth $500 million, dropped dead of an acute heart attack. I mean, you know, I, I feel less bad about the business aspect. He had a bunch of little kids. You know, tragedies where there's young children left without, usually a father, it could be a mother, it's just the way the disease goes in your 40s. I want everybody to listen to this quote. Paul Dudley White was the cardiologist

• 58:47Joel Kahn?

  MD taking care of President Eisenhower in the 50s, and he said emphatically, "A heart attack after age 80 is an act of God. A heart attack before age 80 is a failure of the medical system." He said that in 1955, that we already know the majority of the science what causes heart attacks. He had no idea about the technology we have nowadays to identify heart disease early. But man, a heart attack before age 80 is a failure of the medical system. We've had a completely unsuccessful medical system. I can in the next three minutes tell everybody who's listening how to change that outlook for their own health, which is critical.

• 59:22Rich Roll?

  Yeah, and we're going to get into that.

• 59:23Joel Kahn?

  Good.

• 59:24Rich Roll?

  And just as a way of launching into that, I had our mutual friend, Kim Williams, on the podcast a little while back.

• 59:30Joel Kahn?

  Wonderful.

• 59:30Rich Roll?

  And, yeah, what an amazing human being that guy is.

• 59:33Joel Kahn?

  Right.

• 59:33Rich Roll?

  And, you know, one of the things he said, that I'm sure you will agree with, is that there have been these amazing, dramatic leaps and bounds in the science and technology of how we treat heart disease in the form of stents and medications and surgical procedures and the like, that have reduced the mortality rate of people who suffer from this disease. But at the same time, a blind eye being turned to the actual root cause and how to prevent people from actually getting to the situation where they need all of this.

• 1:00:09Joel Kahn?

  Absolutely true, which is why our initial conversation is what Dr. Dean Ornish, and even before him, Dr. Burkett, Dennis Burkett, a British physician who did amazing nutrition work in Africa, talked about the faucet, that, you know, if you walked into your bathroom and the sink was overflowing, you wouldn't run out and go get mops and towels and address the problem. That way, you go turn the sink off and deal with the root issue that the sink's overflowing because somebody left the faucet on. The medical system is a mop and towel kind of system. You've had your heart attack. What amazing technology. Well, what about the Wendy's in the lobby of the hospital, like the hospital I practice at, Harper University Hospital? That's a faucet. What about...

• 1:00:51Rich Roll?

  So Wendy's still there?

• 1:00:51Joel Kahn?

  It's still there, and I've been so successful with my social media campaign. They put a Chick-fil-A this year next to it. And I'll give a shout out to my friends...

• 1:01:00Rich Roll?

  I don't know why I'm laughing.

• 1:01:01Joel Kahn?

  Beaumont Hospital in Royal Oak, Michigan, just contracted with Mark Wahlberg to put in a Wahlburgers at our medical complex, which is no better than Wendy's, although it's got Mark's Q's face and a lot of the posters. You know, when you get government-issued cheese, which is basically Velveeta, and you're serving that to the nurses walking over from the hospital to the strip mall. It's outrageous.

• 1:01:22Rich Roll?

  Shocking.

• 1:01:23Joel Kahn?

  So, off the beaten path, that's how you turn off the faucet, is everything we talked about. But the technology, the faucet isn't the same faucet. We've got better technology upstream. It's always upstream. We can, um, let's talk for a minute, maybe, you know, you've got your notes, but I want to talk about like Bob Harper and what he went through real quick. And, you know, how do you prevent Bob Harper? If he doesn't mind me using him as an example, Biggest Loser, fitness trainer, age 51, ripped guy in the past, always with a green juice in his hand and all, and working out at a gym February 2017, drop dead. He has a cardiac arrest on the treadmill by the grace of heaven above. Next to him on the treadmill was a cardiologist and on the wall in front of

• 1:02:06Joel Kahn?

  him was an external defibrillator. And within about the shortest time any human could have, he's got a trained professional on top of him with the pads that say shock and he came back to life, rushed to the hospital. I believe he had a stent. I haven't actually read that. And he was on the ventilator, but he's just one lucky dude. Brain, kidneys, everything kinda came back. And he went on the Oz show, March or April 2017 and said, the obvious question, how could you have had a heart attack with all your workouts and muscles and all those years on the Biggest Loser show with J D Roth and your buddy and all that? Um, and he said, I found out I have a genetic kind of cholesterol nobody ever checked called lipoprotein A. It's a, if you, whatever doctor you're seeing, the routine

• 1:02:50Joel Kahn?

  cholesterol panel doesn't include that. LPA, sticky cholesterol, lipoprotein A, they're three terms for the same molecule. Costs about $25 to run the blood test. He, normal levels in most labs, less than 30. I have dozens of patients whose blood levels are 300, 400, 500, and it just erodes their arteries and ages their vascular system and it will never show up on a routine physical unless you read, you know, the New York Times recently talking about Bob Harper blogs I've written. Thank you, Bob Harper, for bringing up the issue. There is a lipoprotein A foundation. How common is it? 63 million Americans have elevated lipoprotein A levels, 20% of adults. It's genetic. So you can eat well. That's

• 1:03:31Joel Kahn?

  the kicker. You're Bob Harper, you're Rich Roll, you're Joel Khan, you've got plants, you work out, you do yoga, you've got love and happiness in your heart and you've got a lipoprotein A level of 400. You still can suffer stroke and heart attack. So that's one way.

• 1:03:47Rich Roll?

  I don't even know.

• 1:03:48Joel Kahn?

  You haven't had it. And you know, and I can.

• 1:03:52Rich Roll?

  And I'm 51.

• 1:03:52Joel Kahn?

  Yeah, and I can, you know, reach out a blood slip. But so can any doctor you know do it. You can go to Cedar, you can go anywhere. It's a simple test. You don't have to go to any exotic lab. That's upstream. That's turning off the faucet. Because if you're elevated, the typical response right now is make sure the rest of your lifestyle is perfect because you've got a genetic risk that can't be dealt with. Be sure you eat well, be sure you meditate, be sure your blood pressure, cholesterol, blood sugar, inflammation markers like C-reactive protein. Make sure everything else is spot on. And that's all valid and important. And I think that's the path that Bob Harper talks about on his social media since then. There is a drug in investigation.

• 1:04:32Joel Kahn?

  Statins don't lower lipoprotein A, so take them off the list for that, things like Lipitor. There is pretty strong data that niacin, a B vitamin used at high doses lowers lipoprotein A. That's one approach I use in my own clinic, my own patients. And I can see their levels come down dramatically. The science hasn't yet designed a proper study to say that's going to mean somebody's going to be less likely to have a heart attack, stroke, and live longer because nobody funds a study with a drug like niacin that over the counter in a drugstore costs pennies.

• 1:05:06Rich Roll?

  Yeah, you can't make any money out of that.

• 1:05:07Joel Kahn?

  Can't make any money.

• 1:05:08Rich Roll?

  So just to be clear, though, if you have this lipoprotein A lifestyle, diet, I'm sure it has some, you know, has a benefit on your overall health, but that is not going to be a.

• 1:05:21Joel Kahn?

  It won't protect you from that single. There's a supplement company I like that has this dramatic poster with the heart and 19 daggers pointing at the heart, of which blood pressure, cholesterol, blood sugar, LDL, HDL. But lipoprotein A is one of those daggers. So it won't protect you from that one dagger. It may, you know, ameliorate and turn the faucet or slow the faucet from, you know, seven or 10 or 12 of the 19. But homocysteine is a blood test, an amino acid genetically kind of monitored that you should know and you should check. These things cost pennies or a few dollars in many of them. Like lipoprotein A, you do it once. You're 400, you got a problem. You're four, you have no problem. And you won't have a problem because it's genetic.

• 1:06:04Joel Kahn?

  So that's why, I mean, that's how we doing, I don't, in my 30 years, we have cooler stents. We can put in heart valves without cracking the chest more and more. Some places do robotic bypass, but we're still filling coronary care units, emergency rooms and operating rooms with procedures that, you know, from 1990, we know could be prevented 50, 60, 70, 80% of the time using Dean Ornish data and Dr. Esselstyn data. But it's frustrating that we're seeing that being grabbed onto by medical students. I'm very encouraged by medical students. They are the future. So if we wait a generation, we may actually get a lot of plant friendly or plant only doctors in the communities, but it's pretty rare right now.

• 1:06:49Joel Kahn?

  So just to follow this theme, another way to turn that faucet off of people dropping and requiring acute cardiac care is the specialty that Kim Williams is an expert at. There are these CAT scans of the heart. I'm passionate about this topic. You're 51, you should have one. You don't look 51. That's actually.

• 1:07:08Rich Roll?

  No, I've been thinking, you know, just even in thinking of you coming over, I was like, you know, I should really get one of those scans.

• 1:07:13Joel Kahn?

  So there's a great documentary called The Widowmaker and everybody can watch it on Netflix after they watch what the health. At UCSF, they designed a CAT scan 20 years ago and perfected it. It doesn't exist anymore because every standard CAT scanner does this now. You lie down on a gurney, you go in the machine, you hold your breath for 10 seconds, you go home. There's no IV, there's no iodine, there's a very small amount of radiation from the CAT scan equivalent to like a mammogram that a woman has. And you get a number. Are my heart arteries calcified? Zero is the winning number. I wrote a blog called The Biggest Celebration of the Heart, calcium score is zero, because it is that your chance in the next 10 years of having a heart attack, and in fact, the data goes, it's a sign of aging of the body, not just heart arteries.

• 1:07:55Joel Kahn?

  Your chance of having kidney problems, cancer, brain diseases are extremely low because you have a youthful biochemistry. Things are working out for you. And it's a very complex. Process to really judge what's your real age. I mean, you're 51, I'm 58, but internally, are we 10 years younger than that? Are we 10 years older? Calcium score is a measure of true aging of our system and certainly our arteries. And if your calcium score is, as I have patients 1400, 1600, 1100, these are very, very, very degraded arteries with a process that needs to be investigated. Rarely leads to need for bypass, need for stent, but is the ability to wrap around all kinds of lifestyle and even more than

• 1:08:39Joel Kahn?

  lifestyle if needed measures. So this calcium score in my city costs $70. Who doesn't need it? You've had a bypass, you've had a stent, you've had a heart attack. You know the answer to the question. Do you have heart disease? You're off the table. I don't even think in my practice, the ultra healthy should avoid it because it's such a count. Those 19 daggers. Have you had all of them measured and assessed? Not you personally, but the public in general? No. So I don't care where people are listening, with Chautauqua, Kansas, and Gainesville, Florida, you can get a CACS coronary artery calcium scan, no iodine. In Indiana, South Bend, it's $45. You don't need a prescription. My state, you need a prescription from a doctor. And I literally hand these prescriptions out when I give

• 1:09:24Joel Kahn?

  a talk, people hear it. I'll write them a script because I mean, it's a service for them to either be reassured that they're doing great. And I have patients with a cholesterol 300, calcium score is zero, and the stress you take off of them. Doc, so I can get off the prescription drug and really, really focus on lifestyle for three months or six months and try and whip this thing, but I don't have to-

• 1:09:46Rich Roll?

  How could you have an elevated cholesterol like that?

• 1:09:49Joel Kahn?

  Because there's 19 daggers and cholesterol's never been the only one. It's always been one of the ones.

• 1:09:55Rich Roll?

  And these things are more complicated than we want them to be?

• 1:09:57Joel Kahn?

  No, it's really pretty simple. Nobody's ever said cholesterol is the only risk factor for heart disease. I mean, the American Heart Association picked five back in the 60s. Smoking, diabetes, family history, blood pressure, cholesterol and age kind of factors. It's always been a complex predictive calculation. But this CAT scan cuts through all that and says, let's get real. Let's, you know, take $70, take, you know, literally a minute, and don't risk it if you're the 10% of Americans that have extremely high silent heart disease, you know?

• 1:10:32Rich Roll?

  How- I mean, is this somebody that people, is this something that people who are like in their twenties should do? Like, should everybody do it?

• 1:10:39Joel Kahn?

  Great question.

• 1:10:39Rich Roll?

  There's a certain age where this becomes more relevant.

• 1:10:41Joel Kahn?

  I've rarely personally, I've ordered thousands and thousands and thousands and thousands of these studies over the years. Cause it's been available in Detroit and every major city for 15 years and now even medium sized cities. Usually at a hospital, doctors don't own CAT scanners, hospitals have CAT scanners. So I make no money, you know, this is not an economic thing. This is a plea to turn the faucet off upstream.

• 1:11:05Joel Kahn?

  Rarely, I mean, if I had a 28 year old and his cholesterol was 600, there are a few, you know, I might find a reason to do this if they're EKG or something. Usually it's a test for somebody 40 and up, 50, if you're, you know, great lifestyle, 40, 45. A whole lot of people have heart attacks in their early 40s that almost always the presence of disease could have been identified. The reason you don't hear about it much is not availability, it's not cost, it's not science. 2,000 scientific studies, and again, Dr. Kim Williams is an expert in the field of CAT scanning of the heart. It's that the ultimate study, let's take 5,000 people, everybody get a CAT scan. Half will get the results and get a program to try and work on it.

• 1:11:49Joel Kahn?

  Half will not get the results and let's see if it makes a difference in terms of death or heart attack. That kind of study hasn't been done, but every study that says, let's look at cholesterol or blood pressure or any other measure other than this CAT scan. The CAT scan wins the day as being by far the most accurate, which is intuitive because you're actually looking at the heart directly, not indirectly. So, yeah, there is some data, you've got a lot of high level athletes and I'm sure are listening, that actually multiple endurance athletic events may actually accelerate calcification of heart arteries. It's very confusing data.

• 1:12:28Rich Roll?

  I know you've written a little bit about this.

• 1:12:29Joel Kahn?

  Yeah.

• 1:12:29Rich Roll?

  It's like, I'm almost afraid to read those articles because, you know, I'm, look.

• 1:12:34Joel Kahn?

  We need you around, Russ.

• 1:12:36Rich Roll?

  I know, like, what am I supposed to do about that?

• 1:12:38Joel Kahn?

  There is good news, we know that, you know, exercise, please exercise. We know that people that, runners, live longer than they Average American runners are leaner.

• 1:12:45Rich Roll?

  Remember Jim Fix?

• 1:12:46Joel Kahn?

  Well, Jim Fix ate like a pig. He was 52. Yeah, he was very famous for saying, "I can eat whatever I want because I exercise so much." I don't know if he had lipoprotein A or just a bad diet or a high cholesterol or homocysteine. But he had severe advanced three-vessel coronary disease at death. Tragic, tragic, tragic. And I use that example, and the other one is Winston Churchill. Fats, smokes cigars, and he doesn't die of heart attack and lives till 92. So if you rely on sensible calculators, we screw up terribly. The cat scan cuts through all that nonsense. The good news about athletes is they are lean, they have better blood pressure, they tend to have better cholesterol, they tend to have better blood sugar.

• 1:13:27Joel Kahn?

  But whether ultra-endurance exercise is inflammatory, whether sometimes the diet isn't as green and clean as yours, and how many athletic events end with donuts and pizza and things that celebrate the survival of the event but don't really heal the body. So it opens a can of worms to be tested, and one has to, just like any almost genetic testing, you have to be resilient and say, "I'll deal with the data and find the best course to take with it." But better to know than not know.

• 1:14:03Rich Roll?

  In the context of, in the athlete example, so there's calcification, and that's a result of constantly submitting your body to so much exercise-induced stress that it creates kind of a chronic inflammation problem where you're always dealing with trying to recover from these workouts? Or what is it specifically that is leading to this conclusion?

• 1:14:28Joel Kahn?

  Well, I don't know that the answer is known. Why are there now probably three dozen studies easily of analysis of heart arteries in ultra athletes and calcification being the easiest thing to measure and it being elevated beyond expectation, even sometimes elevated beyond people exercising less or not exercising, which is rather distressing data. Don't stop exercising.

• 1:14:52Rich Roll?

  I know, he's like, "Am I gonna have to stop running now?"

• 1:14:54Joel Kahn?

  Right, and maybe go back to eating burgers and fries. I mean, more back to throwing our arms up, because exercise is another topic. Is there a sweet spot? Is exercise a moderation in everything for the public? Not for, you know, the really trained athlete, not for the professional athlete, not for the one who's passionate, but is the message to the public moderation and exercise that, you know, I tell people do 10 minutes as opposed to zero because the feeling is if I don't get 60 minutes in, it's not worthwhile. 10 minutes is worthwhile. But back to the issue, you're probably not chronically inflamed, you're probably acutely inflamed. Multiple studies say at the end of a marathon, if you draw blood on a person presumably

• 1:15:35Joel Kahn?

  healthy, a lot of them will show the enzyme that comes from the heart that leaks during heart attacks will be present in the bloodstream of healthy people after a marathon called troponin, and indeed, it's stressful. They were nutritionally depleted, as they didn't train adequately, and there's some data that those that train more, that's less common. If you do an MRI or an echo of the heart right after a marathon, and a lot of these have been done that way, actually, the right side of the heart's actually a bit dilated and not looking so healthy. 24 hours later, it looks like it recovered real well. But the question is, if you do it repeatedly and repeatedly and repeatedly, are you laying on layers of scar? I mean, it's, so it's not chronic, you probably are not chronically inflamed.

• 1:16:18Joel Kahn?

  You're intermittently inflamed from, you know, a high level of sustain. And we're talking, you know, the kind of stuff frankly that you do and your friends do, not an hour at the gym. It's not, but the data's very murky that that's still, you know, let's go to blue zones. I mean, of course, there's not too many ultra athletes in blue zones, and there is some sense there.

• 1:16:39Rich Roll?

  They're just in like this low-grade perpetual motion.

• 1:16:41Joel Kahn?

  But in terms of longevity, and I'd love you to ask Dr. Longo that question when you get him on, but there's no reason to worry people that you're shortening your lifespan. You may be calcifying your heart arteries, but... And it may be a bit of an aging process. I mean, I think you'd probably agree, some of what you do is putting your body under stress and the ultimate course of it all. But, you know, I'm going on record, it's great to exercise, but don't just because you're a high-level athlete, not know your lipoprotein A, not know your homocysteine, not know your C-reactive protein inflammation, and don't not spend $70 and get a heart CT scan, recognizing you're going to need to dig in and get a little research about what do you do with

• 1:17:26Joel Kahn?

  it if it's abnormal. It's what I do every day, but it's not clear-cut. I try and base it on science, but just like nutrition, maybe we got three pillars, not five pillars, but do the best we can.

• 1:17:38Rich Roll?

  Let's talk about saturated fat.

• 1:17:40Joel Kahn?

  Whoa, okay.

• 1:17:41Rich Roll?

  I feel like I have this conversation every time I have a doctor on this show.

• 1:17:46Joel Kahn?

  Right.

• 1:17:46Rich Roll?

  And I'm still trying to get clear on this. I know your perspective.

• 1:17:51Joel Kahn?

  Right.

• 1:17:52Rich Roll?

  And then I look at, you know, Aseem Malhotra's Twitter feed.

• 1:17:59Joel Kahn?

  Malhotra.

• 1:18:00Rich Roll?

  Malhotra is how you say his last name, who I've met and seems like a nice guy. He's a bright guy. And he'll say, we now know saturated fat has no impact on dietary cholesterol. In essence, he's saying, all this worry about saturated fat is misplaced. This is not something you need to concern yourself with respect to cardiovascular disease.

• 1:18:20Joel Kahn?

  Right.

• 1:18:21Rich Roll?

  True or false?

• 1:18:22Joel Kahn?

  False, false, dangerous, distorted, and instantly gets you international media attention, which he's very good at. And that in and of itself may be no accident. It may be part of the food industry and such that, you know, get a cardiologist to write in the journal or do a talk about animal-based foods and saturated fat in animal-based foods, you know, being maligned and actually being healthy will, you know, support a whole lot of industries that are suffering right now, which is great. I hope they're suffering and wither up, but it's a popular thing. So again, not going there, but Ansel Keys and many

• 1:19:07Joel Kahn?

  Many other researchers, because he himself always had seventeen, eighteen other co-researchers of tremendous fame that never took money from the sugar field. So, his coworkers that are still, many of them alive, in Italy, and Henry Blackburn, who's Dan Buettner's neighbor, at age ninety-three in Minneapolis, one of the most amazing scientists and such, many of them are alive, parsed out very clearly in all kinds of, again, like five pillars, basic science and epidemiology and all. Animal-based saturated fat promotes a high blood cholesterol, which is associated with and would be reasonable to say, causes atherosclerosis, heartening of the arteries, limit your animal saturated fat. Ansel Keys' diet was very rich in olive

• 1:19:49Joel Kahn?

  oils, it wasn't, it's build a low-fat diet, his cookbooks are clearly not low-fat diets, they're not vegan diets, but they were low in, they never included coconut oil, it's not a Mediterranean diet food, and Ansel Keys described to America the Mediterranean diet, that most of us agree is a reasonable place to sit in the middle if you've got to sit somewhere. But then came along 2008, if you talked to a scientist, I'm blanking on his name for a minute, but exposed by Michael Greger in one of his nutritionfacts.org Youtubes, there was a meeting in Mexico City in 2008, the dairy industry saying, you know, we're losing the battle, people are drinking less dairy, we need to find sympathetic scientists,

• 1:20:32Joel Kahn?

  we need to find sympathetic bloggers, we need to presumably support them, invite them to meetings, fund their travel, and we need to put dairy, for sure, back on the map. Within a few months, a scientist in Oakland, California, Ronald Kraus, M.D., runs a big pediatric lipid lab in Oakland, is talking to the National Dairy Council and giving keynote talks that he's being paid for on, you know, the health aspects of saturated fat, and specifically dairy, which is typically rich in saturated fat. And then 2010 comes a meta-analysis review by Patty Sieri Torino, and who's the last author, Ronald Kraus.

• 1:21:17Joel Kahn?

  Who John McDougall calls Dr. Lard, he doesn't respect Dr. Kraus much as a scientist and feels since almost every paper he writes is funded by the Dairy Association and all, comes his 2010 article and then that questions, "We can't verify that saturated fat is associated with increased risk of heart disease." It's a meta-analysis, it's not new science, it's just a way to play with existing studies. A study that was so bad that the journal it was published in, published right with it, a complete and utter disembowelment and critique, which is very rare. People write letter to the editors to the journal afterwards. But here's the science, here's Jeremiah Stamler, a very esteemed epidemiologist scientist,

• 1:22:02Joel Kahn?

  who just dissected the study. They accepted it, but then they really allowed a extreme criticism. But that all gets lost. So we've got this paper, there's this, you know, that's, and then 2014, another paper of a similar bent by an author named Chowdhury. That's really the bedrock of this idea that we have it all wrong and saturated fat is okay. They're both meta-analyses, kind of a weaker style of science, it's not original data. The meta-analysis by Chowdhury was so bad that the chief of the Department of Public Health at Harvard, Walter Willett, M.D., one of the most respected scientists, called for it to be retracted. But it doesn't matter. It's, you know, the feathers in the pillow- And what year, how long ago was this? 2010, 2014. So there's butter on the cover of time-

• 1:22:47Joel Kahn?

  Right, so this is what precipitated- The butter on the cover. And between 2010, 2014, all kinds of hullabaloo. And Mal Hottra, that's all he's got. I mean, he doesn't have any new data that says when Dean Ornish took away, well, actually, you can go way back, when Nathan Pritikin, even before Nathan Pritikin, a internist in Los Angeles, Lester Morrison at Cedars, took away saturated fat from his heart patients, finally lived 50% longer. In 1949, 50, 51, Nathan Pritikin, 70s, 60s, 80s, showed that his heart patients did dramatically well. There's no new data that says that's wrong and we can now feed heart patients coconut oil and butter and lamb and- Turkey and even fish, which can be high in saturated fat. There's no new data that says

• 1:23:32Joel Kahn?

  that. There's these two confusing studies and you know, some ancillary ones. If you really go back to what's been since 2014, this definitive series of association studies from the Harvard School of Public Health that have confirmed without doubt, when you are eating butter, lard and ghee, your risk of cardiovascular disease is high. When you replace it with olive oil, it goes down about 9%. When you replace it with vegetable oils, it goes down about 23%. Now, they didn't go to the next step. What about if you have a diet that is absent added vegetable oils? Because that was uncommon in these, and these were a data set of over 100,000 people followed for more than 30 years. Yes, it has flaws.

• 1:24:14Joel Kahn?

  And there's occasionally a Harvard researcher that takes some money from Unilever that makes one of the vegetable oils. I mean, it's hard to find scientists that are lily white in terms of some funding of research. But nonetheless, you know, why that message still remains so confusing? Truly, the biochemistry of fats confuses me. The biochemistry of fats, you know, gotta sit down, we gotta, we gotta separate trans fat. Everybody hates. Then we gotta understand what are saturated fats? Well, some plants have saturated fats, like avocados, olives, olive oil is 15, 16% saturated fat. And certainly coconut oil is 82% saturated fat. And so that's difficult. Then we gotta get to the polyunsaturated fats

• 1:24:59Joel Kahn?

  and separate the, you know, the MOFA, the monounsaturated fat like olive oil and the POFA's that are omega-6 and omega-3. But this stuff is just, it's so confusing that literally I gotta sit down and write it all out and keep repeating it over and over. What does the public do? And then there are still room to discuss, is olive oil on the health menu or not? Dr. David Katz at Yale, absolutely. Valter Longo of Italian origin, absolutely. We've got the cardiovascular data. We've got, you know, other authentic and caring scientists that would say in an obese society, you don't need. You know, 120 calories per tablespoon of olive oil when you can do it with water,

• 1:25:42Joel Kahn?

  vegetable stock, or just steam foods and save yourself some of this calorie excess. So I'm still on board, clearly. My message to my patients is avoid or completely eliminate saturated fat containing foods, which are animal foods largely, and coconut and palm from your diet.

• 1:26:02Rich Roll?

  On the, this issue of the complexity of all of these oils and how they all work, polyunsaturated, monounsaturated, even in the saturated fat world, we have lauric, we have myuristic, we have palmitic, we have stearic. Like, are there differences between those four different types of saturated fats? Or do we know?

• 1:26:25Joel Kahn?

  Yeah, it's the length of the chain, 16s and 18s. The longer chains are much more pro-atherogenic. So palmitic always loses. Palmitic acid is the most pro-atherogenic. It's, I'm not sure if it's 16 or 18 of the long-chain fatty acids. Where stearic, which is one that does exist in chocolate, and is in some beef and used by pro-beef people to say beef, which has a combination of fatty acids, it may not be as bad, but you know.

• 1:26:57Rich Roll?

  And lauric is the one in coconut oil.

• 1:27:00Joel Kahn?

  Because, you know, coconut oil, that's what the MCT medium chain, they're not long chains. The ideal chain length is 12 carbon in coconut oil, in terms of maybe being neutral to atherosclerosis. And that, we don't know for sure. But the problem is, you go buy coconut oil at the store, I guarantee you, it's not going to tell you it's 100% 12 carbon length, or 14 or 16. These are mixtures, you're taking a risk when you're buying it. An organic label isn't the issue, it's the mixture in there. There's no doubt people eating a large amount of coconut oil raise their blood cholesterol, and raised blood cholesterol is going to favor the development of atherosclerosis.

• 1:27:39Joel Kahn?

  If your calcium score is zero, and your homocysteine lipoprotein A and cholesterol is ideal, you want to put a little coconut oil in your diet, go for it. But the problem is, people are doing it with either known heart disease, known diabetes, known obesity, or More commonly unknown risk and they're they're taking a risk.

• 1:28:01Rich Roll?

  So what is the history or the story behind how coconut oil became considered to be this health elixir, this panacea?

• 1:28:09Joel Kahn?

  Yeah, it's there actually is a book in the 90s, The Miracle of Coconut Oil, and it's written by a naturopathic doc, although he doesn't put his degree there indeed. The book he wrote before that is how to take balloons and fold them into animal shapes. So he's written a whole bunch of interesting books. And there's really a true story. If you were to go to Amazon and go to like the earliest coconut oil short book and go just one before it by the same author. So I don't know the man and if he's still around and I'm not making fun of him because I don't know his history, but it wasn't the chief of public health at Harvard School of Public Health. And there really is, and we don't have a definitive study that says for most people

• 1:28:52Joel Kahn?

  who are trying to avoid heart disease and aging, it's a healthful or unhealthful food. We know that it raises cholesterol. We know it's not part of blue zones. We know that it's not part of the Mediterranean diet, even though Dr. Malhotra introduces coconut oil to his version, which is nothing other than another Atkins version. It's not a Mediterranean diet. And that all crystallized June 25, 2017, when the president of the American Heart Association, who that's another story, ended up having a heart attack in December at age 52 as the chairman of the President American Heart Association, John Warner from Dallas. But when he called a group of 11 scientists to say, we need an updated conversation on

• 1:29:35Joel Kahn?

  saturated fat in the diet, that's called the Presidential Advisory, it was published in June 2017. They talked at length about this spectrum of eating butter, lard, ghee as your mainstay of fats in the diet. What's the impact of converting? And I went through that data and 25 page document, 250 references. All of that was discussing and concluding reducing saturated fat in the diet is still the proper conversation by a cardiologist with their patients. One paragraph out of 25 pages said, We have to conclude that the absence of data that coconut oil in a diet is helpful for heart patients leads us to recommend don't include it in the diet.

• 1:30:14Joel Kahn?

  And that's what the blogosphere, the keto-sphere, the, you know, the paleo-sphere went bananas about to the point Dr. Mahatra agreed with a statement that the American Heart was a terrorist organization worse than ISIS, giving bad advice to the American public.

• 1:30:30Rich Roll?

  What is the basis of that?

• 1:30:31Joel Kahn?

  And our friend Mark Hyman chimed in and agreed with that. And it offended me. Chris Kress, people were sharing this meme that the American Heart Association was a terrorist organization over the coconut oil. It's a scientifically valid statement to say we don't have a definitive answer. You can argue, does that mean that you should avoid a food that's very high in saturated fat till science fills the void? That's what the American Heart, I think authentically was arguing. It was a pretty august group of scientists from Harvard, from Northwestern, from Tufts, some of the best nutrition schools in America, and they didn't seem very conflicted in the long and detailed conflict of interest page that was at the end of the article.

• 1:31:10Joel Kahn?

  I think it's a reasonable conclusion, but god, it did ignite a very conflicted, very inauthentic response to the larger issue in the paper, which never got really discussed, which is go back to eating less meat, go back to eating less animal products, and find those amazing substitutes that are showing up everywhere in grocery stores, which are naturally going to lower your saturated fat intake, which remains as valid as a statement today as it did in 1970, when Ansel Keys published a seven-country study with his co-authors.

• 1:31:44Rich Roll?

  Is there any evidence to support that somehow the American Heart Association was conflicted or corrupted somehow? Like, the vehemency of the response was so...

• 1:31:57Joel Kahn?

  What you saw and what the health is real, they're not, I mean, to Dr. Kim Williams' credit and the American College of Cardiology, they weren't in that movie because they've avoided some of the funding and the conflicts and the recipes. The American Heart Association has a little different mission, public education and nursing education, CPR. But those recipes are on their website, and I've been to American Heart Association meetings in the Coca-Cola Health tent, and, you know, you need to fund these organizations. And, you know, there weren't companies around like Memphis Meat and Beyond Meat and...

• 1:32:31Joel Kahn?

  The Mayo Company and the Impossible Burger and such, you know, they need funding, but they've compromised their integrity and they've lost that little sticker on Fruit Loops that says it's a whole grain cereal with American, I mean, they've lost a lot of credibility doing that. Doesn't mean the scientists have lost their credibility and that's hard sometimes for the public to distinguish, or it's easy, let me say, it's easy for the bloggers to attack and just throw everybody under the bus. It's pretty hard to throw Walter Willet under the bus, University of Michigan grad, I'll emphasize.

• 1:33:06Rich Roll?

  Well, the blogosphere has been loud and unequivocal in its, in its criticism of, and its takedowns of Ansel Keys. I mean, we went into that in length.

• 1:33:19Joel Kahn?

  Yeah.

• 1:33:19Rich Roll?

  In the first, I think it was the second time we did the podcast, so I don't want to rehash that. And also, Dean Ornish, you've also written about that extensively, and I believe we've talked about that. But maybe we could talk, and the China study, I would say.

• 1:33:32Joel Kahn?

  Right.

• 1:33:34Rich Roll?

  But maybe we could talk about what the health, because that's sort of top of mind for a lot of people. A lot of people have just seen it, they're in the new year, maybe a lot of people are seeing it for the first time. And, you know, I think the hot button issues that, that, that people found to be alarmist were some of the more, some of the more controversial aspects of the movie, were the kind of visual imagery that surrounded the processed meats by putting like, you know, cigarette or cigar in a hot, in a hot dog bun, and this link between processed meats and, and cancer equivocating to, what was it, I can't remember exactly, five cigarettes a day to eating one hot dog or something, or a piece of bacon.

• 1:34:16Joel Kahn?

  Yeah, it was one egg a day equals five cigarettes for cardiovascular risk, and then the processed meat cancer risk. So, you know.

• 1:34:23Rich Roll?

  People got pretty excited about that.

• 1:34:25Joel Kahn?

  Pretty excited.

• 1:34:27Joel Kahn?

  I don't know Kip Anderson well. We've become acquainted in 2017. It's not the first round. He's made of a movie. His website has lots of references. It's a documentary, but I think it was a very accurate and highly done documentary. So whether you like it or not, Dr. David Jenkins, M.D., a very prominent research scientist in Toronto, published a study in 2012 of over 1,000 people, tracking how much plaque they had within their carotid and how many eggs they ate. And he created kind of an index, how many eggs per week, per year. And there was a relationship, an association, egg years and carotid thickening, an artery that's to your brain that you'd like to keep youthful and all. And when he

• 1:35:10Joel Kahn?

  equated it in the same data set to those that responded, they smoked, and how did those two risks associate, one egg equaled five cigarettes a day. And there was a statistical, published, peer-reviewed, not plant-based, not non-plant-based. It was scientific data. Like all association studies, it raises questions, it's hypothesis generating, but it doesn't mean for Kip to put it in the movie was inappropriate or scientifically fraudulent. It's indeed the data. And with the huge number of nutrition studies funded by the Egg Board, it's pretty darn hard to find a credible egg study in the last 10 or 15 years. There were a lot of them 20 years ago, but the Egg Board really started funding these studies

• 1:35:55Joel Kahn?

  since then. A lot of conflicted studies. The processed meat goes back, maybe your listeners remember, October 2015, World Health Organization, after years of studies suggesting processed meat was linked to a rise in the risk of cancer and other syndromes, heart disease, congestive heart failure, very strong risk, maybe number one in the diet. If you don't want to develop type 2 diabetes, cut out processed meats with the hot dog, bologna, salami, pepperoni, bacon. But that was crystallized when the World Health Organization put out a paper. We reviewed 800 studies. We have 22 world experts. We're not a vegan. We're not, this isn't, you know, the plant-based movement.

• 1:36:37Joel Kahn?

  You can't cast, probably nobody knew really the scientists, they're just authentic nutrition scientists. Conclusion, you know, processed red meats are class one carcinogens. Not suspected, but proven to cause cancer, particularly colorectal cancer. Extended to prostate, extended to pancreatic, extended to breast cancer, but statistics for highest because that processed meat is sitting in the colon, so presumably it's the organ most exposed to risk. Since then, the World Health Organization has published follow-up studies that confirm, without a doubt, this was a valid conclusion. There are more people die every year worldwide of smoking and cancer-related diseases than there are that die of processed meats.

• 1:37:20Joel Kahn?

  Maybe 50,000 people a year worldwide die of processed meats and cancer. Do we ignore that? Do we say that that's not as many as, you know, a million, so we don't address the issue?

• 1:37:31Rich Roll?

  Right, there was a, the issue was that it was hyperbolic in the sense that the increase in susceptibility was relatively statistically minor.

• 1:37:39Joel Kahn?

  Well, about two, yeah, two strips, less than two strips of bacon a day, it's 50 grams. Raises in a relative value, a risk of developing colorectal cancer by 18%. Now, that may be from 5% to 6% in the general public. That in and of itself may not sound impressive. I like my bacon so much, I'll take a 6% risk, not a 5% risk. But it is statistically valid and the wealth of data. But nobody will extend the conversation. Let's talk about heart disease, erectile dysfunction, type 2 diabetes, obesity, dementia, and congestive heart failure, another cardiac syndrome I care a lot about. So what's the immediate step? I mean, hospitals, this, this has to be out of hospitals.

• 1:38:22Joel Kahn?

  Has any hospital since the World Health Organization banned processed meats? None that I know of. The Cleveland Clinic was going to, but I think they've capitulated. What do you do in your own life? You know, eat less, eat none. That's for each individual to decide. And anytime you eat a food like that, if you do, couple it with an antioxidant fiber-rich choice, like green leafies, fruits and veggies. Brightly colored foods. There's this fascinating study, five years ago, that if you walk down to a hospital lobby and pick a hamburger and eat it, within an hour, you can document that your arteries are dysfunctional, something called endothelial dysfunction. A rather shocking statement that the food served on a patient tray directly can be

• 1:39:04Joel Kahn?

  shown to harm arteries. If you eat that same burger with a big slice of lettuce or a big slice of avocado, you actually don't see that same drop. So it's kind of a rule, if you're not following a perfection diet and you slip up, you know, take the antidote. And the antidote is garden foods and produce foods. And I'm certainly not encouraging people to eat those foods, but eat them infrequently if you are, and eat them balanced with nature's own antidote.

• 1:39:30Rich Roll?

  Right. It's worth saying that all of the claims that are made in What the Health are validated and backed up with citations on the What the Health website. If you go to, I think, is it whatthehealth.com or whatthehealthmovie.com or something, you know, I'll put it in the, a link in the show notes, but they have a section where you can go. And they basically parse out every claim that they make throughout the movie and then support it with a variety of citations.

• 1:39:58Joel Kahn?

  Yeah. And I agree. And the worst example I saw, and this got Garth Davis involved, was a Z-Dog, Z-Dog M.D., this M.D. in Las Vegas, hospitalist, who's developed an enormous YouTube following, because he can be pretty darn funny, singing and acting like a buffoon, but he took on What the Health and eviscerated not just the concept as a clearly non-trained nutritionist, non-trained epidemiologist, but he made fun of the people in the movie, particularly Michael Clapper. He was just, Michael Clapper, one of the most high-integrity physicians at, you know, practicing in Santa Rosa, a man of such integrity. And it just

• 1:40:38Joel Kahn?

  so offended me that Garth Davis responded vigorously in the YouTube and a blog. I responded vigorously in a blog. And he seems, I actually think the pushback's working, I've been told, that Nina Tykles and Gary Topps actually read when we get angry, and they're a little more careful about what they say. And it clearly sends Z Dog has backed off, which is why we need to be vocal aggressive and sometimes obnoxious.

• 1:41:03Rich Roll?

  Right. I think he, but he achieved his goal, which was to get a bunch of attention and views.

• 1:41:07Joel Kahn?

  Right.

• 1:41:08Rich Roll?

  You know, by being controversial and then Garth, who's a bulldog and you know, God love him. That guy speaks his truth and doesn't hold back and, and you know, that's why he's, he's the best. And you know, if anybody who saw him on, on the doctor saw, you know, like that, that kind of went sideways for everybody and.

• 1:41:25Joel Kahn?

  Crazy.

• 1:41:26Rich Roll?

  It's like, well, actually plant-based nutrition news, which is a YouTube channel, did a video about that experience of Garth on that show. That's pretty interesting. I'll link that up in the show notes as well. Everyone should check that out because I think Garth did better than even Garth. You know, sort of, I know Garth didn't have a good experience on that show. It was kind of a hatchet job. They were going to come after him, but he stood his ground quite strongly. And with respect to Z Dog, you know, Garth kind of went right back at him.

• 1:41:54Joel Kahn?

  Yeah.

• 1:41:55Rich Roll?

  And then Z Dog sort of backed down because now he had all this attention and realized like, oh, like Garth actually watched, you know, watched my video. And Garth was the one who said, let's debate. I'll debate anytime. Bring anybody else. Or he, he wanted to debate. This is how I understand it. I hope I'm not butchering this, but. Garth suggested that he could come on Z Dog's show and debate him. And then Z Dog sort of backed down and said, well, you know, I'm not the best person to defend these claims. You know, sort of admitting like, maybe he was a little bit out of his element or his area of specialty. Uh, and then Garth said, well, bring on anyone you want. And I think there was a conversation about maybe having Rob Wolf or somebody like that, join it. And then it never came together for whatever reason. I don't know why.

• 1:42:36Joel Kahn?

  It's probably better. Just be another more attention seeking.

• 1:42:38Rich Roll?

  Everybody wants to have these debates, right? There's a lot of energy, but like, let's get all these people in a room. Uh, but in my experience, I don't know that that's really, it's, it's interesting because we all have these silos. And in certain respects, these silos are not serving us. Like we do kind of need to get together in the way that you did at Google with Dave Asprey. And have a mature conversation, but a lot of times these, these, these conversations devolve into shouting matches and, and, and everyone's so dug in that. Nobody, it's like, it's like watching political television on, you know, any, any network.

• 1:43:11Joel Kahn?

  It is. It's that, right. The view, the view. Medical conversations should try not to devolve. To the viewer, you know, that may not be the best example. I will give, on a similar path, I got invited on The Doctors about a month before Garth to take on Steve Gundry and the Plant Paradox, which we haven't talked about, it was worth maybe two minutes.

• 1:43:30Rich Roll?

  Yeah, I've been sharing, I shared quite a bit of my roll call email every time.

• 1:43:33Joel Kahn?

  Okay, right. Yeah, just, you know, the idea that legumes are dangerous because they've got hidden anti-nutrients called lectins, and if you eat five kidney beans, you can die if they're not properly cooked. And this is coming from a man who was chief of one of the more prominent cardiovascular departments in the United States, in Loma Linda, kind of ironic, the Center of Plant-Based Science and the Adventist Health Study, now an anti-aging kind of guru out in Hot Springs, California. But his book got all the accolades, and I went on the show to debate him, and I was prepped and primed, and he was relaxed and not on his game. And it was not the shouting match, but it cleared the air that this is another confusionist

• 1:44:18Joel Kahn?

  approach to nutrition, when every blue zone eats legumes, the very center of Dan Buettner's chart is legumes in every, you know, pocket of centenarian length. Let's clarify that for the public real quick. So that was a fun experience, not in handling the man, because I actually have esteem for him and some of the work he's done, but for just, you know, trying to turn the, you know, trying to stifle that as quickly and efficiently as media and TV lets you do.

• 1:44:47Rich Roll?

  Right, the basic message from that book is stay away from beans and legumes.

• 1:44:51Joel Kahn?

  Or cook them with such care that you might not choose to cook them at all, because there's the, the fear has been put. Message, everybody listening, don't eat raw beans. It's really, really bad to buy a bag of red kidney beans and eat them, but I don't know any society in the world or any human that would try and do that.

• 1:45:09Rich Roll?

  Well, I'd be in big trouble if I had to stay away from those foods, because I eat those every single day.

• 1:45:13Joel Kahn?

  Right, no, eat, eat cooked ones, or pressure-cooked ones, or soak your beans and cook them, but there's not really much health risk with the typical human experience. Or you might get some diarrhea and nausea if you rush the process of it.

• 1:45:26Rich Roll?

  I wanted to touch on another issue that you've been, it seems to me that you've been getting more and more interested in, which is intermittent fasting.

• 1:45:35Joel Kahn?

  Oh, cool. Great.

• 1:45:37Rich Roll?

  Which is not like a, that's not a, that's a subject matter that's been embraced by the, the low carb, low carbers and the ketosis people, like they're all about that. There's a lot of science going on. The plant-based community hasn't really spoken to this, but I think what's going on in that world is super interesting.

• 1:45:54Joel Kahn?

  Super interesting, and it circles back to the conversation we had about Dr. Longo. You know, the, very brief bullet points. The observation that our experience in humankind often were periods of relative starvation, just on the nature of not being grocery stores a couple thousand years ago, or 10,000 years ago, and apparently we have an apparatus designed to put us into a different metabolic state to handle, you know, calorie deprivation. Many studies that suggest, there's no species in a research model that if you restrict their calories, they don't live longer. A yeast, you restrict their calories, they actually live 10 times longer. If you take a mouse and restrict their calories, they

• 1:46:37Joel Kahn?

  live 40 to 50% longer. You know, profound differences. The question is, is there a human experience that's possible and doable and compatible with life, and that isn't the biosphere where you come out, you know, grumpy and depressed and, and you, every day of the month you have to watch how many calories you take, and there are people that do that. So, what ultimately, and the only point really to talk about, because it's another really interesting part of the plant-based movement right now, is Dr. Longo seeing the biosphere experience, but also enjoying life as a typical Italian might want to be, played over the years in

• 1:47:16Joel Kahn?

  these yeast models, in these mice models, and recently in humans. And could we mimic fasting but still eat? Provocative, crazy idea. Could we create a diet that doesn't have the components that food causes, that accelerates the mTOR pathway, the PK pathway, these pathways that accelerate aging and destruction of cells? Could we create a diet that lets you eat some, and can we actually still benefit from what fasting seems to do, which is accelerate? ...a process, a fancy word, autophagy, the clearing of damaged cells to allow them to function better. That process, real quickly, that won the Nobel Prize last year, autophagy, is like the hot button right now of anti-aging.

• 1:47:59Joel Kahn?

  That if you eliminated every case of heart disease, cancer, and diabetes, we'd extend human life by 13 years. If we could end damage to cells and improve the efficiency of autophagy, to take your cells that are aging and restore them to a youthful state, would extend human life by 30 years. So the research is going now in this anti-aging world. And he created, bottom line, a diet that five days in a row of, in the human experience, 800 calories a day of a plant-based diet, low in sugar and low in protein, but containing whole food fats like olives and nuts, and containing moderate complex carbohydrates, so that the carbohydrate calorie load's about 35%, that he found in animal models and in

• 1:48:42Joel Kahn?

  a study published February 2017 in 100 humans, that you could see the responses you get with a complete fast, but you don't have the pain of a complete fast, you don't have the risk of a complete fast. He called that and patented that, FMD, fasting mimicking diets. And he has shown that not only do they favor losing visceral fat around your belly, which is what so many people are doing, 10-day belly bloats, five days in a row in a month, and you can do it as many months in a row as you can tolerate and all, and we're talking about eating a nut bar for breakfast, we're talking about eating soup and kale crackers for lunch, we're talking about eating soup, and occasionally a little cacao bar for dinner, these actually come prepackaged in a startup that he engaged in with the University of

• 1:49:25Joel Kahn?

  Southern California, that doing that five days in a row activates these primal pathways that actually not only favor improved metabolism, losing visceral fat, you don't lose muscle mass, which is fantastic, but you actually lower IGF-1 levels, which is one of the goals, and lastly, you actually create a flood of stem cells from your bone marrow into your bloodstream. Stem cells that people are going to Tijuana and paying a ton of money for, that will go to injured and damaged parts of your body and clear out damaged cells, so there's data now... In animals and some human data that multiple sclerosis may be responsive to a five-day fasting mimicking diet of plants, low in sugar, low in fat. That actually, brain growth occurs in animal models.

• 1:50:07Joel Kahn?

  And right now cognition is being studied in Italy using Dr. Longo's five-day fasting diet. In addition to just weight loss, that cancer patients, it's called ChemoLeve. It's a product they've developed and not released, it's being studied at the Mayo Clinic and other places. That if you're getting chemotherapy and you do this fasting mimicking diet and use plants and use low sugar, low fat, you actually get a better kill rate from the chemotherapy and you get less side effects. Profound data. Athletes are being studied in Verona, Italy right now to see if this enhances performance, if it'll enhance recovery and allow you to go back and do the next athletic event with more success. So, several hundred worldwide studies using this exact model.

• 1:50:49Joel Kahn?

  I would describe it, it's a plant-based cyclical ketogenic diet. Cyclical because it's five days a month and it's plants. So it's not the extreme of what you're seeing on the blogosphere. It's the plants and the plant proteins that don't seem to activate aging like animal-based protein. And it's 800 calories a day, it's not water fasting. So, there are people shouldn't do it, underweight people, pregnant people, brittle diabetics, brittle heart patients, 800 calories a day. I've done it seven of the last 11 months, I'm down 25 pounds. Wow. I have boundless energy, my labs show improvement, my blood pressure shows improvement. I have dozens of patients who have had the same experience. And you know, what do you do with a heavy vegan who's really doing it right?

• 1:51:34Joel Kahn?

  You've got to change their metabolism. And this is one of the hacks that might, you know, allow our movement, one, to have the scientific basis to say we're in the right sector of the food plate, and two, to actually help people get more out of it than they're getting. Because not everybody eating a whole food, plant-based diet, with oil, without oil, is going to achieve their optimal blood pressure, blood sugar and weight. And we need more tools, and this is one of the tools. That's fascinating. It's fascinating, and it's powerful, and it's, you know, as I said, Nobel Prize nominated science that will one day be rewarded with the award.

• 1:52:11Rich Roll?

  And is there any indication that these benefits can be enhanced by not eating at all or doing a multi-day fast? Or are we still just too early in the process to understand? Or like this protocol, which involves eating a little bit of food throughout the day, works just as well as completely cutting yourself off?

• 1:52:33Joel Kahn?

  It was designed to give the benefits of a complete fast without the risk of a complete fast. Because those that are doing prolonged water fasting, certainly in the chronic illness model, are doing it in an inpatient clinic like True North or places in Florida. And not everybody can access that and not everybody's gonna do that. This, a person does at home, I do it while I'm working, I'm seeing patients, I'm at my restaurant. You feel phenomenal, at least a lot of people feel phenomenal. You can get a little hangry. You're allowed to cheat a little with some celery and sliced cucumber, pretty calorie and nutrient sensing pathway neutral food. But it's a breakthrough. And I don't think the public even has a clue how profound a breakthrough this is.

• 1:53:17Joel Kahn?

  Because the joy is 25 days a month, you have no rules. I mean, you have your healthy diet rules. But these people that are trying, you know, and Dr. Longo would say the optimal time restricted period is 12 hours a day. You know, the days you're not doing this fasting mimicking diet, you know, whether you're totally plant-based, whether you're following a Mediterranean diet, the DASH diet, you know, 8 a.m. to 8 p.m. is your feeding period. He likes breakfast and dinner, skipping lunch. We're not talking about somebody burning 6,000 calories a day, training or performance. We're talking about, you know, the typical person out there. But you couple five days a month for optimizing your regenerative innate ability with 25

• 1:53:58Joel Kahn?

  days a month and you add, you know, a 12-hour feeding period, you may indeed have that longevity diet, particularly if you mimic it after, you know, the native cultures, the Blue Zone cultures, the Italian culture.

• 1:54:10Rich Roll?

  The stem cell aspect of that is unbelievable.

• 1:54:13Joel Kahn?

  Fascinating. I just say personally, and I know you've got to be very careful about anecdotes. I had a really refractory plantar fasciitis and after two months of this, it went away. Now, it didn't go away for the previous year and I've had patients tell me shoulder back and other parts. There is clearly data that damaged nerve cells in animal models of multiple sclerosis regrow, that damaged brain tissue in mice models called the hippocampus regrow. So, this is not totally conjectural that you may actually heal damaged parts of your body. There's actually animal data that a animal model of type 1 diabetes where there's no insulin produced responds with the production of insulin for the first time. And there's no human equivalent, so no type 1 diabetic should do this, but those research studies

• 1:54:57Joel Kahn?

  are underway. So, fascinating.

• 1:54:59Rich Roll?

  Yeah, I'd be really keen to see what the studies are going to say about the impact of this in an athletic performance context too, because the conventional wisdom is replenish your glycogen stores and your electrolytes and your protein within 30 minutes of training, right? And this is the way that you bounce back as rapidly as possible. But if you can stimulate that stem cell, you know, production and there is this, what is it? What's the term you used? The cells sloughing off?

• 1:55:28Joel Kahn?

  Autophagy.

• 1:55:29Rich Roll?

  Autophagy.

• 1:55:30Joel Kahn?

  Right.

• 1:55:31Rich Roll?

  What would that mean?

• 1:55:33Joel Kahn?

  Right. Are you literally turning the clock back and making you a better athlete? So, there is a study underway. I don't know the protocol, but yeah, I argue for what I've termed, and it's nothing special, vegan plus or whole food plant-based plus. You know, don't be dumb. Take your supplements. Don't be, don't get in a situation where you're deficient in B12 because you've heard you may not need to. I think that's one play that we need to emphasize. Vegan plus fasting, I think is a, not completely untouched. There are, there's a Facebook users page now with 20,000 people doing ketogenic plant-based diets, sometimes cyclical, which I think is safer. Go back to food and a normal schedule. I don't know that they're all doing that, but that's a growing group. Vegan plus organic,

• 1:56:18Joel Kahn?

  you know, vegan plus no oil. You know, the kind of enhancing this core data, I think are really fertile areas, but the fasting is by far the most scientifically solid. I mean, huge data. Amazing data.

• 1:56:31Rich Roll?

  I'm gonna look into that a little bit more. I mean, I've experimented with it a little bit, just in a very informal way of, of like not eating until dinner. You know, just do like eating one meal a day.

• 1:56:42Joel Kahn?

  Right.

• 1:56:43Rich Roll?

  And doing that while training and seeing how that impacts my ability to recover. And part of that is, is trying to, anecdotally, with an N of one study.

• 1:56:54Joel Kahn?

  Right.

• 1:56:54Rich Roll?

  Trying to see if that has any positive impact on, on, you know, the efficiency with which I can tap into my anaerobic zone to like enhance my endurance. By not so, in addition to the training that I'm doing, but through nutrition, getting, trying to trick my body into more efficiently using fat for fuel.

• 1:57:17Joel Kahn?

  Yeah.

• 1:57:18Rich Roll?

  And if you're not eating, right, that's what you're gonna be tapping into in order to propel you through your workout.

• 1:57:24Joel Kahn?

  I, I can't speak for him, but Dr. Longo's a long-distance runner, so you, to my, and I've never heard him talk about, uh, uh, his view on that for, you know, performance athletics, but you'll have an interesting conversation.

• 1:57:38Joel Kahn?

  No, I, I think it's, uh, if this were a drug that you could show did all that's been documented, uh, it would be a $20,000 a month drug. And we're talking about, there is a commercially available food kit that he has designed, cause he believes, you know, it's exquisitely important what those 800 calories are and how they're delivered. And he won't do it in powders, these are foods. Um, people have tried to mimic it.

• 1:58:05Rich Roll?

  If people are listening.

• 1:58:07Joel Kahn?

  There is a, he has a great Facebook page, Professor Volter Longo. He posts a lot of stuff. Uh, ProLon is the name of his research project. They have a website. It's very easy to find. He's a very hot commodity right now. He's been written up in the New York Times and Forbes and other places. And, uh, what you're gonna see coming out is good stuff, a lot of Youtubes. There's actually a documentary, another reason I'm sure he'll want to talk to you, called Fasting, that he's featured in, that's just about to be launched. Yeah, and there's a lot of different plays. There's a, another, UCLA has a researcher, Dr. Sachin Nanda, who's, LA is the center of, uh, the serious fasting science data. But, um, it's a good thing to add on, you know, you're unique.

• 1:58:50Joel Kahn?

  Most of us are dealing with calorie excess and exercise deprivation and we're getting fat and it's far better to skip a meal than compromise. It's far better to learn you can go with two meals a day, maybe breakfast, dinner as a routine, which I've adopted. There's a mindset doing this that I was not told about, but darn, five days, 800 calories. I just worked. I ate, though this program is three meals a day, but you know, they're not big by any stretch of imagination. That, I mean, I have the power to eat less and feel good and achieve the goals, weight or otherwise. And I hear that from patients all the time. I've completely changed my mindset. This was breakthrough for me psychologically

• 1:59:35Joel Kahn?

  as well as physiologically because I finally got away from, you know, if food's there, I won't eat it because it's better to skip than to eat in the culture we live in where there's food everywhere, all the time.

• 1:59:46Rich Roll?

  Well, we've just been taught that we're supposed to eat three meals a day. Like, I don't know who came up with that, but you look at Ray Cronis, this guy knows like, I don't know, 30 days or whatever on water. And, you know, I'm not advocating that people go out and do that, but I think it's important to like, look at that and say, and he loves it to say, look, our bodies are capable of so much more than we, you know, sort of understand. And to just explore the idea of what happens when you skip one meal or maybe two meals and go, hey, I'm still breathing air, you know?

• 2:00:16Joel Kahn?

  The single most powerful activity you can do to prolong your life is eat less every day. And that's a message that is so needed right now. And then we can talk about what that is, but start out with that in your mind. Shut your mouth, your kitchen, your refrigerator, and watch your health bloom.

• 2:00:34Rich Roll?

  Let's talk about the book.

• 2:00:36Joel Kahn?

  Cool.

• 2:00:37Rich Roll?

  Book's just out, The Plant-Based Solution. I just got it the other day, so I, I wasn't able to read it yet, but I have like paged through it and it's good. I think people are going to be really helped by all of the amazing.

• 2:00:51Joel Kahn?

  It's page-restricted book, just like we were talking about calorie-restricted. I don't have much patience to read thousand-page books. Or do I have the time?

• 2:01:00Rich Roll?

  I don't have time to write these books.

• 2:01:02Joel Kahn?

  So it's about 150 pages of science of plant-based diets and heart, plant-based diets and diabetes, plant-based diets and brain and sex and autoimmune diseases like lupus. And then my wife chipped in, God bless her, Karen, and put together a three-plus-week eating plan of recipes. It's not elegant like your amazing meal planner. That is an incredible resource we all appreciate. But nonetheless, people have asked me nonstop, you know, do you have a recipe book? So this is as close as I've gotten so far. Some recipes from my restaurant and it's been fun. It's actually gotten a lot of attention and good feedback.

• 2:01:42Rich Roll?

  Yeah, it's great. And what I like about it is that you've branched out beyond just cardiology and heart health. You're talking about diabetes, cancer, autoimmune diseases, gut health, MS, Alzheimer's, Parkinson's, aging, sex drive, like you're hitting all the buttons and the impact of food on these conditions in terms of prevention and reversal.

• 2:02:05Joel Kahn?

  Yeah, and the data's there. We always need more. We are an intertwined network. That's kind of the philosophy of functional medicine that people ask me all the time, what's the side effect of eating a whole food, plant-based diet for heart disease? The side effect is you're probably going to be thinner, more attractive, have more focus, have better sexual performance, have a lower blood sugar and less likely to develop diabetes and a whole series of litany. So that's the beauty of the human body is, you know, it has an amazing ability to heal itself. It will just rethink, you know, you can't heal plant and nutrition-based diseases with pharmacology. You have to heal nutrition-based diseases with nutrition.

• 2:02:48Joel Kahn?

  And we're starting to wake up that the last 50 years have been rather ugly.

• 2:02:52Rich Roll?

  Yeah, you got a great forward by John Mackey in there.

• 2:02:55Joel Kahn?

  You know, the guy's a gem and I don't know him real well. I met him in Santa Rosa and then he actually has been through Detroit and he comes to my restaurant to eat. So he was eating at my restaurant, gave me the forward, next day he announced the Amazon deal. How he, you know, his wonderful book, The Whole Foods Diet. He was planning, as you know, this gigantic national tour and then all got interrupted by his need to go back to the business and and work on the deal and announce the deal. But I mean, he was just sitting there like a poker player, not mentioning anything. And he left and yeah, I'm very delighted that he's willing to do that because he is a very special human being.

• 2:03:31Rich Roll?

  He's an amazing guy and I, you know, I had him on the podcast to talk about his book right in the middle of that proxy war going on and I couldn't believe that he didn't cancel the podcast because I can't imagine the amount of stress he was shouldering at the time. Because he was really under fire and he didn't want to, he didn't, you know, he did, these, these, you know, investors were really just trying to do a pump and dump. And he was doing everything he could in his power to prevent that from happening.

• 2:04:02Rich Roll?

  And so, yeah, his, it coincided with his book coming out, which meant he couldn't do press except for like my podcast or maybe one or two other things. Because he had to keep his focus on that. But then I attended

• 2:04:16Rich Roll?

  his Conscious Capitalism Conference in Austin a couple of months ago. And what was fascinating about that is that he got on stage and did a panel with the guy from The Motley Fool. And talked about like his, you know, how he felt about this deal. It was the first time he'd spoken semi-publicly about it. And what was fascinating was some of the behind the scenes stuff where him, you know, he felt very aligned with Amazon and now he's thrilled. He's like, this is the best thing for the company. And now he gets to do what he likes doing, which is like grow the business and not have to worry about all this kind of stuff. So I think it all ended up for the best. It is amazing that Amazon now owns Whole Foods and it's going to be fascinating to see how that plays out.

• 2:05:00Joel Kahn?

  Yeah, I agree. I mean, when Campbell's buys Pacific Organic Foods, I think it's amazing. I mean, it's just more shells, more, you know, more stress off the entrepreneurs to let them focus on, you know, creativity and production. And who did one of the burger companies just sold to a Canadian firm? I mean, you know, it's controversial that sometimes these are companies that aren't plant-based and have a bit of a conflict, but

• 2:05:25Rich Roll?

  They gotta grow, you know.

• 2:05:26Joel Kahn?

  In access, right, right. To get it in every grocery store, in every Red Robin and every TGIFs. I mean, it's groundbreaking that we're seeing this happen. And they're not my favorite foods, but they still deal with the environmental and the animal rights issue and, and some of the health issue. You don't have leucine in a Impossible Burger to the level you have it in a beef burger. So you're not going to activate mTOR and all this kind of highbrow science we talked about at the beginning.

• 2:05:54Rich Roll?

  I think it's cool that Campbell's has made this really strong push into getting into the plant-based food world. I think there's some, what is it, plant-based food producers, some, some like organization that they

• 2:06:04Joel Kahn?

  They dropped out of the general one and entered the exclusively plant-based growers group. Yeah. Which is a phenomenal commitment. And they're serious. They have a big presence in Detroit, about a mile from my cafe, and it's growing. And they've got hundreds and hundreds of employees in Detroit, in Ferndale, Michigan, which is great.

• 2:06:24Rich Roll?

  How's the restaurant going?

• 2:06:26Joel Kahn?

  Uh, one about to become two. We're pregnant. So our 4,000 square foot green space cafe now two and a quarter years old, what I call my 401K cafe. I've had

• 2:06:39Rich Roll?

  Because you emptied your 401K into it?

• 2:06:42Joel Kahn?

  I don't have anybody else with me other than my son. And he's too young to have a 401K. So I've, uh, I've, I've let passion dictate some of my financial decisions. I produced a Broadway play in the back, past, we'll talk about that some future

• 2:06:57Rich Roll?

  I didn't know that.

• 2:06:57Joel Kahn?

  Yeah, that's a whole size story. Not worth going. There's no plant-based connection there. But I did have director seats on Broadway for 10 years, or producer seats. It's going very well. The public has really embraced it. What the Health drove a tremendous number of first timers in because my wife and I, we wander through every night. You've been here before. How do you like it? We just hired a Matthew Kenny trained chef, which I'm very excited about. Thank you, Matthew. Of course, a guest that you've interviewed and a great force.

• 2:07:25Rich Roll?

  I love Matthew.

• 2:07:26Joel Kahn?

  And very excited. And we're opening a small, fast, casual place, March 1, called Green Space and Go. So, we're committed. We're producing food and see this tipping point, which clearly has happened. I mean, this is, although Malcolm Gladwell speaks horribly about plant-based diets, I will embrace the term tipping point out of his lexicon and...

• 2:07:48Rich Roll?

  I didn't know that he had spoken at all about plant-based diets.

• 2:07:51Joel Kahn?

  Yeah, he has a podcast and he...

• 2:07:53Rich Roll?

  That hurts me. I love Malcolm Gladwell.

• 2:07:54Joel Kahn?

  He went really deep into the Nina Teicholz world and praised her beyond any expectation on a podcast about four months ago. And I beat him up on Twitter, but he didn't respond, you know. That's how it goes. I've been baiting Joe Rogan to just put one of us on and let us go at it. I don't mind being bloodied. Come on, Joe. Bring it on. Stop talking to these orthopedic surgeons that eat meat and don't check their labs. It's a bad public message.

• 2:08:19Rich Roll?

  I will say, he had Chris Cresser on a second time fairly recently.

• 2:08:25Joel Kahn?

  Yeah, recently, right.

• 2:08:26Rich Roll?

  And, you know, we both know Chris. I like Chris. And I found his, I found what he had to say. I agreed with like 99% of what he was talking about.

• 2:08:38Joel Kahn?

  Chris is a real good, sensitive and, you know, complete, you know, medical practitioner, without a doubt. I think he distorts the science a bit, but we're all subject to that criticism, although.

• 2:08:52Rich Roll?

  All right, fast casual. Where's the fast casual restaurant?

• 2:08:56Joel Kahn?

  It's only five miles away, up Woodward Avenue, which you remember with your Grosse Point roots.

• 2:09:00Rich Roll?

  Oh, my God. Yeah, I haven't heard that in like 40 years.

• 2:09:04Joel Kahn?

  Woodward Avenue?

• 2:09:05Rich Roll?

  Yeah.

• 2:09:06Joel Kahn?

  One of the coolest things in Detroit. Is coming up as the International Auto Show, which is as cool as can be. But in the third weekend in August, they've reproduced like American graffiti. So they have this thing called the Dream Cruise and 1.5 million people bring their hot rod cars from around the world and drive them up and down Woodward Avenue like in the 50s and Richard Dreyfuss. And we're right in that strip. And so it'll be, it's about a 1600 square foot, 20 seat, grab and go, drive through window. It's not, it's not fast food, it's fast casual, it's whole food. I'm pretty insistent that this is healthy food, you know, we have superfoods in the salads and the bowls and the wraps. We'll see, we'll see if we can make it go.

• 2:09:48Rich Roll?

  When is that open?

• 2:09:49Joel Kahn?

  March 1.

• 2:09:50Rich Roll?

  March 1, that's coming up, cool. Well, I love your restaurant. I only had the opportunity to eat there that one time when I came out for the-

• 2:09:56Joel Kahn?

  Yeah, Plant-Based Group.

• 2:09:57Rich Roll?

  Yeah, Plant-Based Nutrition-

• 2:09:59Joel Kahn?

  Support-

• 2:10:00Rich Roll?

  Support Group, which was an amazing experience and you put together this incredible dinner. And the restaurant is like, super top-notch, high-end, the food was like extraordinary.

• 2:10:12Joel Kahn?

  Yeah, we're LA, we brought a little LA to New York.

• 2:10:14Rich Roll?

  Yeah, like it was like, I was like, whoa, like you're doing it right, you know, like really right.

• 2:10:20Joel Kahn?

  And I'll just say, the coolest thing lately is professional athletes, Red Wings, Lions, and-

• 2:10:26Rich Roll?

  Not a Kyrie-

• 2:10:27Joel Kahn?

  Pistons. We don't have Kyrie Irving in, but we got Tobias Harris who's on the Piston-

• 2:10:31Rich Roll?

  I know, but the impact of Kyrie.

• 2:10:32Joel Kahn?

  Yeah, it's huge. And, but with Tobias Harris, a Piston, wonderful human in all the time, some of the Red Wings are coming in, we've had the coach of the Pistons in who's, you know, some of these are now plant-based athletes, Theo Riddick, a Detroit Lion, is now plant-based. And so we're seeing that and, you know, it's, I don't know that there's fasting and professional athletes, I think are the two coolest things going on in the plant-based world to shift the public mind.

• 2:10:59Rich Roll?

  Well, I think it's it's the what the health effect like the impact on the NBA and the NFL from that movie has been unbelievable.

• 2:11:06Joel Kahn?

  Right.

• 2:11:06Rich Roll?

  And I think a lot of it has to do with David Carter, like David Carter being in that movie and what he said, I think, really resonated with a lot of those guys. And it's so fascinating to see so many of them jumping on board. I mean, Kyrie, it's huge. Did you see the Nike ad?

• 2:11:22Joel Kahn?

  Yeah, it's crazy. Plant-based diet.

• 2:11:24Rich Roll?

  I mean, it's like the words plant-based diet are being uttered in a Nike ad.

• 2:11:28Joel Kahn?

  Right.

• 2:11:29Rich Roll?

  And it's being done in kind of a, they're sort of poking fun, you know, like it is flat earth thing and all of that.

• 2:11:34Joel Kahn?

  Yeah.

• 2:11:34Rich Roll?

  But I'll take it like that's that's kind of an amazing cultural moment.

• 2:11:38Joel Kahn?

  I agree. I celebrate all these little, little hopeful. And again, it isn't the war that we started with. But there is a war for the health of the planet. There is a war for the destruction and, you know, the cruelty of animals. And there is a war going on with health in America and it matters. Everything we've talked about and from the calcium score to the saturated fat to

• 2:12:05Joel Kahn?

  industry like Campbell's and others buying up companies. I mean, I'm very optimistic, as I know when Kim Williams talks. I mean, we're just, we're seeing this change. The last bastion is the health industry. And we're starting, I see medical students very aware. It's so distorted that it's the food industry taking the charge and they have professional athletes and the health industry limping along. Like we're talking about cigarettes and give us 25 years to change because, you know, no, we went through a 25-year period before they banned smoking in hospitals. It could have been done much earlier. Let's learn from that. No, they argue, let's reproduce it. So that's the last bastion when medical students at least get a fair shake at learning about this stuff.

• 2:12:46Joel Kahn?

  And I'm seeing that happen. I'm seeing, I lectured to a group of medical students about three weeks ago and Expected a very negative answer to the question of any of you tried eating vegetarian or vegan, 50% raised their hands and laughed, "Are you kidding? We're full-time plant-based." Like, "Whoa, I think there was an unusual group." Yeah, that's, that gets me fired up.

• 2:13:04Rich Roll?

  Wayne State has a program now, right?

• 2:13:06Joel Kahn?

  Wayne State is a gigantic medical school, but they will, they have not incorporated Paul Chatlin's plant-based curriculum yet, but they're much more open. I'm going down there in a few weeks to do lunch and learns and some of their curriculum, and some medical schools are even doing better than that. Some of the osteopathic schools are doing way better than that. But that's when the, when you go to your doctor and even if it's three minutes of nutrition conversation, and maybe you are directed to nutritionfacts.org, or Forks Over Knives, or What The Health, or told to read a book like The Plant-Based Solution, or, you know, How Not To Die, or something, you know, that's the army of soldiers we need to, really the critical issue of living the best life as a general community that we can

• 2:13:48Joel Kahn?

  offer. Greatest country in the world ought to have the greatest health outcomes in the world, and we're number 37. So, we've got some work to do.

• 2:13:57Rich Roll?

  But, interesting times.

• 2:13:59Joel Kahn?

  Hopeful times.

• 2:14:01Rich Roll?

  Yeah. Alright, we gotta lock this down, but I am going to shut this bad boy down with one final question. It's a question I've asked you before. It's the same question I ask every doctor that comes on the podcast. I can't remember what you said last time, but the question is this, you probably already anticipate it. If it was a parallel universe and you woke up to be Surgeon General in this crazy administration, what would you do? What would be the first thing that you would try to change or put in place?

• 2:14:31Joel Kahn?

  Yeah. I would tackle, and I didn't see it coming, the question, but I would tackle the fast food industry and legislate. I would, I guess it's all the one answer. I would take away food subsidies that create $19 McDonald family meals that should be $75. And I would let nobody left standing that fought in the way to take the dairy industry and the meat industry and all, and take away those subsidies that allow that absurd situation to occur. So, I think that's the single first thing I'd do. Bring some equity of pricing and a free market back. To the production of food, which would mean some farmers in the animal world would

• 2:15:11Joel Kahn?

  shut down and they can be converted to, yeah, politically, it's what has to happen, or we're just going to keep limping along with the same system, same system, same system. Number two would be to change healthcare to reward prevention, you know, to the degree that it should be, that, you know, $15 to talk to a patient and $1,500 to put in a stent and not talk nutrition, a world that I lived in and I was on the stent side while I was doing both, but is not a tenable model for the next, you know, generation.

• 2:15:43Rich Roll?

  All right. You're a good man, Dr. Joel Kahn.

• 2:15:46Joel Kahn?

  I appreciate it. You too, sir.

• 2:15:48Rich Roll?

  Thank you for coming here. The book is The Plant-Based Solution. Everybody pick it up wherever you buy your books and get your calcium scab.

• 2:15:56Joel Kahn?

  Thank you. Good plea to the public.

• 2:15:59Rich Roll?

  All right, man. Come back and, uh, come back anytime. We'll talk more. I have a list here of all these things I still want to talk to you about. We didn't even get to them. We're two hours here. All right, my friend. Peace and plants.

• 2:16:16Rich Roll?

  All right, we did it. We got it done. It's complete. I think we went there. I think it was pretty good. We covered a lot of stuff today. Hope you guys enjoyed that. Be sure to drop Joel a line on Twitter at Dr. J. Kahn on Twitter and let him know how this one landed for you. Pick up Joel's new book, The Plant-Based Solution, and also, as always, check out the show notes at richroll.com for plenty of additional links and resources on all the subject matters discussed today to expand your experience of this conversation beyond the earbuds. Once again, Plant Power Way Italia is now available for preorder. Reserve your copy today. It would mean a lot to us. Thank you so much. You will not be disappointed. And if you would like to support my work in general, please make a

• 2:17:01Rich Roll?

  point of subscribing to this program on Apple Podcasts or on whatever platform you enjoy. This content, this program, it really helps us out a lot with visibility, expanding reach, all kinds of stuff, and it only takes a second. And I would appreciate it. You can also support the show on Patreon at richroll.com/donate. If you need help with your diet and nutrition, please check out our meal planner. It offers thousands of custom tailored, plant-based recipes, grocery lists, even grocery delivery in almost every US metropolitan area. This incredibly powerful, robust toolbox with everything you need to eat the way that you deserve to live well, to be healthy, for just $1.90 a week when you sign up for a year.

• 2:17:43Rich Roll?

  To learn more, go to meals.richroll.com or simply click on Meal Planner on the top menu at richroll.com. I want to thank everybody who helped put on the show today. Jason Camiello, as always, for audio engineering, production, interstitial music, show notes, WordPress page configuration, all kinds of miscellaneous tasks that Jason performs. Shawn Patterson for help on the graphics. He creates all the beautiful assets that accompany each episode that I use on Instagram and Facebook and Twitter and the like. Michael Gibson for videography. He's the one who filmed today's episode and edited it and created the shorter clips that I'm sharing on social media. So, thank you, Michael. And theme music, as always, by Analemma. Thanks a lot. Love you guys. See you back here soon.

• 2:18:27Rich Roll?

  Eat well, treat yourself right, be kind to yourself, be kind to others, walk gently on this planet Earth, and be happy. And until then, I'll see you guys back here soon in a couple of days with another great episode. Peace, plants. Mahasay.