Neal Barnard, M.D. On The Power of Nutrition To Prevent & Reverse Heart Disease, Diabetes & Alzheimer’s

There's nothing I can do — it's genetic. Without a doubt, many of us have predispositions to developing certain diseases. But predisposition is a far cry from predetermination. In fact, you might be surprised to learn the vast extent to which we can control the expression of genetic inclinations when it comes to so many of the chronic illnesses that are unnecessarily killing millions of people annually — including modern-day plagues like heart disease, diabetes and Alzheimer's. This week I'm thrilled to sit down for a long overdue conversation with my friend Neal Barnard, MD to discuss the innate, incredible power we all possess to prevent and even reverse the onset of these illnesses through implementation of fairly simple simple diet and lifestyle alternations. A pre-eminent authority on the impact of diet & nutrition on atherosclerosis, diabetes, cancer and Alzheimer’s, Dr. Barnard is an adjunct associate professor of medicine at the George Washington University School of Medicine and Health Sciences as well as the founder and president of the Physicians Committee for Responsible Medicine, where he leads programs advocating for preventive medicine, good nutrition, and higher ethical standards in medical and scientific research. Over the course of his career, Dr. Barnard has led numerous research studies investigating the effects of diet on diabetes, body weight, and chronic pain. He’s authored over 70 scientific publications as well as 17 books, including the New York Times best-sellers Power Foods for the Brain ,21-Day Weight Loss Kickstart*, and the USA Today best-seller Dr. Barnard’s Program for Reversing Diabetes*. If that's not enough, Dr. Barnard recently christened the Barnard Medical Center, a brand new, ground-breaking non-profit primary care medical practice where board-certified physicians, nurse practitioners, and registered dietitians help patients prevent and reverse serious health problems, leveraging a holistic approach that involves tackling the actual causes of illness, with extra attention on nutrition. Chock-a-block with life-altering information, this is a profound conversation about food as medicine. It's about the impact and importance of self-sovereignty — prioritizing personal responsibility for what we put in our mouths, how we move our bodies and advocate for change. And it's about the incredible power of nutrition to heal ourselves. One of the most intelligent, articulate, tireless and well-respected voices on the subject of optimal wellness and disease prevention, it's an honor and privilege to share my friend's abundant wisdom and practical experience with you today. So break out the notepad and enjoy this powerful exchange. Enjoy! Rich Learn more about your ad choices. Visit podcastchoices.com/adchoices

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

• 0:00Rich Roll?

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• 0:44Rich Roll?

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• 1:05Speaker 01

  The good news is that these diseases are often reversible, even quite late in life. Dean Ornish's work... You know, Dean Ornish is, in my view, a genius, a wonderful, wonderful human being, who, when he was a medical student, he set out to see if you could reverse heart disease. And you can, with a combination of a healthy diet, plant-based diet, dealing with stress, getting exercise, throwing out the cigarettes, and just getting some support for this. So for anyone who thinks, "No, no, no, I've been eating badly all my life, there's nothing I can do," wait a minute. Those arteries can open up again, your blood pressure can come down. Now, you never know how far you can reverse this process, but let's get started.

• 1:50Speaker 01

  And I don't care if you're 95 years old, those arteries can open up again.

• 1:54Rich Roll?

  That's Dr. Neil Bernard, and this is the Rich Roll Podcast.

• 2:09Rich Roll?

  The Rich Roll Podcast.

• 2:14Rich Roll?

  Hey, everybody. How you guys doing? What's going on? My name is Rich Roll, and I am your host of the podcast where I have the great privilege, the great honor of going long-form with some of the most interesting, some of the most thought-provoking and inspiring thought leaders and positive change makers all across the globe. And I like to think of it, or at least my goal or my aspiration for this podcast, is to create a sort of multidisciplinary masterclass in personal and professional development that's all designed to help you and me unlock and unleash our best, most authentic selves. So, thank you so much for tuning in today, for sharing the show with your friends, for reviewing the show, for subscribing to the show on iTunes, and of course, for always

• 2:58Rich Roll?

  using the Amazon banner ad at richroll.com for all your Amazon purchases. Above and beyond that, if you're inspired to support the mission even further, now you can donate to the Rich Roll Podcast on Patreon by going to patreon.com/richroll.

• 3:23Rich Roll?

  Okay. Very, very excited about today's guest. And I know I say that a lot. I think I say that almost as a preface to every single guest that I've had on the show, and it's always true. But this is one that I have wanted to do from the very first day that I started the podcast. It's a phenomenal conversation with my good friend, Dr. Neil Bernard, M.D. So Neil is an adjunct associate professor of medicine at the George Washington University School of Medicine and Health Sciences in Washington, DC. He is a globally-recognized preeminent authority on diet and nutrition, and its impact on all kinds of chronic illnesses

• 4:04Rich Roll?

  like arthritis, sclerosis, diabetes, cancer, and Alzheimer's. In other words, all the chronic diseases that have become modern-day plagues. He's also the founder and president of something called PCRM, the Physicians Committee for Responsible Medicine, where he leads all kinds of really cool programs that advocate for preventive medicine, and good nutrition, and higher ethical standards in medical and scientific research.

• 4:30Rich Roll?

  And over the course of his career, he has led numerous research studies investigating the effects of diet on everything from diabetes to body weight and chronic pain. He's authored over 70 scientific publications as well as 17 books. That's amazing. Including the New York Times bestsellers, Power Foods for the Brain and The 21 Day Weight Loss Kickstart, as well as the USA Today bestseller, Dr. Barnard's Program for Reversing Diabetes, which is just an incredibly powerful read. And last year, he expanded his reach by opening the Barnard Medical Center, which is a nonprofit, very interestingly, a nonprofit, primary care medical practice where board-certified

• 5:15Rich Roll?

  physicians and nurse practitioners and registered dietitians help patients prevent and reverse serious health problems by leveraging a holistic approach that involves tackling the actual causes of illness. Imagine that. With extra special attention on nutrition. So I've known Neil for years and years. He is just amazing, a phenomenal individual, one of the most respected, intelligent, and articulate voices out there when it comes to optimal wellness and disease prevention and reversal and nutrition. And I had the honor of speaking at his recent international conference on nutrition and medicine in Washington DC a couple of weeks ago.

• 5:56Rich Roll?

  And I'm just so pleased that I was finally able to wrangle him, to sit down amidst his incredibly busy schedule, and share his copious and abundant wisdom and experience with all of you guys today. So at its core, this is a conversation about the incredible power of nutrition to heal our bodies, to not only prevent the onset of so many of the chronic illnesses that tragically and unnecessarily plague way too many of us, but also how so many of these conditions can actually be reversed, which is just so incredibly powerful and profound.

• 6:39Rich Roll?

  So I encourage everybody to get out the notepad, prepare to geek out, put on the propeller hat, and please enjoy this conversation with the great Dr. Neil Bernard.

• 6:53Rich Roll?

  So we're here in the official PCRM headquarters in Washington. Thanks so much, Dr. Bernard, for taking the time to talk to me today.

• 7:00Speaker 01

  Well, thank you, Rich. It's delightful to be with you.

• 7:02Rich Roll?

  I think we've tried to schedule this multiple times over the course of two or three years. It's taken a little while, but it finally happened.

• 7:09Speaker 01

  Great.

• 7:10Rich Roll?

  So, super excited. Thank you so much, first of all, for inviting me to participate in this past weekend's conference. It was quite a success, I would imagine. How many people? You had like 700 people in attendance?

• 7:22Speaker 01

  Yeah, between 700 and 800 people, mostly physicians, medical students, some dieticians and so forth. But, Rich, you captivated them. So, thank you. It was fantastic to have you there. And they, let me say, they needed to hear what you had to say also.

• 7:36Rich Roll?

  I appreciate that. It was, it's definitely encouraging and makes me feel optimistic to see so many people in the healthcare field interested in this subject matter. And, you know, I would qualify that as a pretty seismic shift from even, you know, maybe five years ago. I mean, what is your perspective on how it's grabbing the attention of your profession?

• 7:58Speaker 01

  It's been really huge. You know, you think back, Physicians Committee was founded in 1985, and at that time, there was really just a handful of people talking about this kind of thing. And, by this kind of thing, I mean, plant-based diets or even nutrition in general, really. But that is changing year by year by year, and we hear from people all the time in all aspects of the medical profession who are echoing this sentiment that other people have too, which is, we've got to rethink our diets, whether they're coming from the health standpoint, the animal standpoint, the environmental standpoint, social justice, whatever it is.

• 8:38Speaker 01

  Somehow, the time has arrived, and we're seeing this in the medical community.

• 8:44Rich Roll?

  How does that work with, you know, the typical doctor is operating in this, you know, MO of diagnose and prescribe, right? Where time is very short, and they're always watching their bottom line, and there just isn't, you know, that much room to get too much into underlying causes and preventative measures. So, how are, you know, how are you seeing that change? And how are you working to help other doctors get on board with preventative approaches?

• 9:15Speaker 01

  I think what really has to happen is that the doctor has to be a little off the hook. The idea has been, "I'm the doctor, I get it, I really would need to talk to my patients about diet, but they need more time and more handholding than I have, and I don't get reimbursed for it, so I'm not going to do it." And that was where the discussion kind of ended. However, if you think about it, the doctor isn't doing x-rays or labs, other people are doing that for the doctor. So why should the doctor do his own or her own nutrition instruction? So the model that we have been pioneering says, "Okay, you're the doctor. You can read the blood tests and you can tell the patient what their diagnoses are,

• 9:59Speaker 01

  but you refer them to somebody else who does that teaching." And as long as that structure is there in their office, in the form of a dietitian, or a health coach, or somebody who's got a class ready for you to come to, then the doctor can see you for seven minutes and tell you've got diabetes and you're 40 pounds overweight and engage in this program, and then they can take it from there. And that makes it simple. So that support piece, classes and dieticians and so forth, has to be built into the medical practice.

• 10:32Rich Roll?

  Right. I've seen that happen with great success with some of the other doctors that I've talked to, like Dr. Robert Osfeld and Michelle McMackin are experiencing great success with that model. So, yeah, providing the solution for them.

• 10:46Speaker 01

  We're doing that here. It's been so cool to see. We opened the Barnard Medical Center in January of 2016, and that's the way it works. You know, we have the doctors who are there, and unlike so many other practices where doctors feel really, just they're running around, seeing patients as fast as they can, and they have nowhere to send them for what the patients really need, we have that structure in place, and so the patients can just...

• 11:15Speaker 01

  Relax and get plugged into a really good experience of rethinking their diet and trying new things and the doctors are quite comfortable too.

• 11:24Rich Roll?

  Right, and so is that what the Fit for Life program is, essentially training practitioners to be able to fill that void?

• 11:30Speaker 01

  That's part of it, and they also work in the community. We started the Food for Life program quite a number of years ago, really just so that people could teach at their local church, synagogue, YMCA, community center, library, whatever it is, and we've got about 300 or so of them all around the country and in some other countries as well.

• 11:54Rich Roll?

  So, maybe we should explain what PCRM is and what it does?

• 11:58Speaker 01

  Yeah, it has, this organization has the worst name in the world. People can never remember, the Physicians Committee for Responsible Medicine. I take complete blame for this mouthful of a name.

• 12:12Rich Roll?

  Well, I think you're stuck with it, though. It has a certain gravitas to it.

• 12:15Speaker 01

  I think we are stuck with it now. I started it in 1985. I was just out of residency. I went to medical school here in DC, and I moved up to New York and I was practicing there. And I decided there needed to be a group of doctors who didn't want to just wait until the heart attack comes in the emergency room door and then we deal with prevention. I wanted also to redirect research a little bit, or more than a little bit, to make it human-focused, but also I was concerned about ethical issues I had seen in research, which maybe we can touch on. But it was going to be a committee, like a dozen doctors or 15 doctors issuing white

• 13:00Speaker 01

  papers, but we've grown a lot, and, but nonetheless, that's still the mission, is to...

• 13:07Rich Roll?

  And the day-to-day work of PCRM involves what?

• 13:11Speaker 01

  Really, three big areas. We do nutrition education, but that also means, education includes twisting arms on Capitol Hill sometimes.

• 13:20Rich Roll?

  Right.

• 13:21Speaker 01

  So that policymakers are educated about what a healthy diet can be. So that's the first area, is educational things. So we have our online Kickstart program, we have lots of books and DVDs and all that. And then the second big area is research. So, we bring people in who have...

• 13:44Speaker 01

  Weight problems, cholesterol problems, migraines, we test how they do on with various diet interventions, but always focused on a plant-based diet. And we publish the results in the medical literature and present them, and that has to be done quite rigorously. And the third area is what I'm going to call research ethics, and that means particularly alternatives to the use of animals in research and getting research on a better track. And the way these things fit together is really as long as research is focused on trying to find the answer to diabetes in a mouse, then why the hell should I worry about my

• 14:28Speaker 01

  diet? And conversely, as long as diets are completely out of whack, as they have been, then there's this tremendous impetus for more and more and more research to find the right drug. And so I felt we need to deal with nutrition knowledge and the research enterprise all together, and we've been doing that. And to those three areas, the education and the research and the research ethics, I'll add a fourth, and that's our new medical care, which we do through our medical center.

• 14:59Rich Roll?

  And what was the impetus to launch the medical center? I mean, this is a relatively new enterprise, right?

• 15:06Speaker 01

  Yeah, we had a lot of patients coming here to be in our research studies. The study might be 16 weeks, and we track how your diabetes is doing, you're so much better. At the end of the study, goodbye. And so the patients would say...

• 15:24Rich Roll?

  Wait a minute, you're leaving me hanging.

• 15:26Speaker 01

  Right. And also, if you weren't one of the 50 people in that research study, you couldn't get anything. So I thought, we need to fix that, number one. Number two, there were so many doctors who wanted to get involved, but to tell you the truth, where they are really in their element is in working with patients. And I wanted to provide an environment where doctors and dieticians and patients could work together with a completely different paradigm. And by the way, I don't want people to get the idea that all we prescribe is asparagus. You know, you've got a urinary tract infection, go plant-based. What we do is... If you have a twisted ankle or a urinary tract infection.

• 16:11Rich Roll?

  Kale is not gonna fix that.

• 16:14Speaker 01

  Kale is not gonna fix that. You need regular medical care and we will provide it. And we provide the full range of medical care. However,

• 16:26Speaker 01

  so many people are sick with food-related issues. The reason a person has diabetes isn't, it's not a metformin deficiency. It's because they've been eating foods that caused insulin resistance in their cells that led to diabetes. And if I give you drugs only, then I guarantee you will never truly be well. We will just be managing your illness until you are dead. And that is unfortunately the paradigm in every medical center in the civilized world, really. So, we do provide medications, but where food is the issue, we always tackle that first. And we tackle it comprehensively. And one other thing, Rich, I gotta tell you. A person comes here and I see the pack of cigarettes in their shirt pocket.

• 17:12Speaker 01

  We say, before you leave, you know, your urinary tract infection is not gonna kill you, but the cigarettes might. Would you like to set up an appointment to tackle that?

• 17:21Rich Roll?

  How dare you?

• 17:23Speaker 01

  The patients appreciate, they really appreciate that you noticed. And also, you have exactly the same conversation about their diet. We will also say to every single patient, regardless of why you may have come in, would you like to take a little time to rethink your diet? And would you like to sit down with the dietitian to go over things? And they say, wait a minute, no doctor has ever offered that to me before. Well, we're gonna offer it here. And then, the patients are like a person at the edge of the swimming pool in August. It looks like so many people are having fun in there, but I'm not sure, do I really wanna jump in? A diet change is like that. It looks like it'd be a good idea, but I'm a little nervous. Do I want to jump into a diet change? And so we try to make it easy by giving them an appointment with the dietitian, giving them

• 18:08Speaker 01

  a class where they can drag their reluctant spouse in, and then the classes are all free. So you take away every barrier, and it's just super life-changing.

• 18:17Rich Roll?

  Yeah, the accountability in the community is everything, right? To help them, encourage them, and get them to stick with that shift. That's amazing. How do you think we got to this place where the idea that a doctor would talk to you about your diet or nutrition is just anathema? Like, what happened along the way?

• 18:38Speaker 01

  It really is a terrible place to be, but the light is at the end of the tunnel. And how we got here, I think, it started with bacteria. A century ago, what was killing people wasn't bacon, it was infections. People would get pneumonia, or they would get other kinds of infections, and they were dead. And if you look at infant mortality, or mortality in early adulthood, it was much, much higher than it is today. Antibiotics stopped that.

• 19:07Rich Roll?

  Right. The acute nature of the doctor visit.

• 19:11Speaker 01

  Exactly. And then, so we carried that model forward. "All right, you're sick, there's some kind of infection, I'll knock it out with a prescription, let me deal with this," and then you leave and you're fine. Well, that does not work so hot if the issue is diabetes. But it's still the same model. "Let me give you a prescription and you'll be on it forever." And then, money entered into it. And the idea was, "Great, let's set up a pharmaceutical industry, let's try to make some drugs that you don't take for three weeks." You take it forever. And there's serious money in that. And that has then led doctors' continuing medical education to be completely taken over by people who have something to sell.

• 19:56Speaker 01

  So this whole idea of, "Let's knock out bacteria, make you well," is still being applied at a time where that's not the disease we're talking about. We're talking about lifestyle-related diseases. We've got to change that. Plus, one other thing. Doctors are in their element...

• 20:12Speaker 01

  Fixing things rather than addressing complicated or more ingrained lifestyle issues.

• 20:20Rich Roll?

  Right, and I think that you have a pretty unique perspective. When we talk about money in the industry and the rise of the pharmaceutical companies, because you're in Washington DC and you're proximate to Capitol Hill, I think you have a lot more clarity and involvement with policy and what's going on on K Street with the lobbying efforts. I mean, the sort of conventional consumer idea is that there are these pharmaceutical company reps that are knocking on doctors' doors and offering them vacations to the Bahamas to come to this conference and incentives for them to hand out these prescriptions. What is the

• 21:03Rich Roll?

  reality of that today? Has that changed at all? And what are the kind of policy and legislative barriers that still exist in terms of reconciling that industry with what's in the best interest of the typical patient with a chronic illness?

• 21:19Speaker 01

  You raise a really terrific point. And historically, it really was quite a serious problem that the drug industry was effectively paying off doctors to prescribe their products. And there has been a great deal of scrutiny and there's been some reform. What that has meant is that people have to find trickier ways of doing it. So the pharmaceutical industry is still there.

• 21:43Rich Roll?

  It's just gone a little bit more under, it's not as in-your-face.

• 21:47Speaker 01

  Yes, that's exactly right. But where you will see it is you go to a typical medical conference, or a dietetic conference, or the American Diabetes Association, you look at their list of sponsors, and it's all up and down in two groups: the drug industry and the food industry. And what that means is the people making sodas and candy and pork chops and fried chicken, whatnot, the people who are causing the very problem that we're tackling, they're all sponsors.

• 22:17Rich Roll?

  Right.

• 22:17Speaker 01

  And the hidden message is, "Don't attack us. We're your friends." And then the other sponsors are the drug industry, who are making money from this. And then when the presenters get up to the microphone...

• 22:31Speaker 01

  To talk about how we are going to tackle diabetes, how we'll tackle high cholesterol, how do we approach high blood pressure? And they are required to give their potential conflicts of interest and to disclose them. Some of them have drug industry connections as long as your arm, and people unfortunately just accept that now.

• 22:51Rich Roll?

  Right. It's absolutely insane to me that these nutrition conferences and dieticians conferences are there's a are sponsored by these companies. There's a dietitian nutritionist named Andy Belotti, do you know Andy? And he does a great job on social media of always taking pictures of when he goes to these things, you see, oh, McDonald's sponsored this, or Pepsi is sponsoring this, you know, talk by or this panel by these group of people, and it's just, it blows my mind that that is still the case.

• 23:19Speaker 01

  As bad as that is, there are many, many professionals who are now speaking out against that. And I've been working with the American College of Cardiology recently, and you might say, well, this is a group that's going to make a whole lot of money from people if as long as they've got heart disease. And yet, they have been really a breath of fresh air, saying, let's look at what's causing atherosclerosis, what's causing heart attacks, what's causing these, and they are really focusing very, very much on nutrition. And they're not interested in selling out. And I kind of what you were saying earlier, Rich, I think the world is changing.

• 24:00Rich Roll?

  Yeah, that's a that's a positive step in the right direction, right?

• 24:03Speaker 01

  Yeah.

• 24:04Rich Roll?

  Well, let's take it a step back. You know, I want to get into, you know, why and how you got interested in plant-based nutrition as as your calling, so to speak. I know it happened, you know, early on, a little bit prior to medical school or early in medical school, but you grew up on a cattle farm in North Dakota, right?

• 24:22Speaker 01

  Well, I grew up in Fargo. I don't know if you've ever been there. I can't say entirely recommend it, but that's where I grew up. And my dad grew up in the cattle business and his dad, as far back as I can trace, everybody raised cattle. And my father, my father didn't like it. As soon as he was ready to say, you know, like enough of this guys, he left the business. There still is Barnard stock farms in the Midwest, which you will see.

• 24:53Rich Roll?

  Oh, wow.

• 24:54Speaker 01

  Yeah, it's still there. I mean, they're good people, but hooked to a very...

• 24:59Rich Roll?

  Goes back generations.

• 25:00Speaker 01

  Yeah, not such a great product. Anyway, my father left. He went to medical school and he became the diabetes expert for Fargo and pretty much the whole state. Parenthetically, I never once heard my father say that anyone with diabetes ever got better. Because it was insulin, you know, here are needles, here's your drugs.

• 25:22Rich Roll?

  And when we're talking about diabetes, are you talking about type one or type two?

• 25:26Speaker 01

  Well, he saw both, but nowadays we have come to realize that you can look at type two completely differently and you can make this disease get a whole lot better and sometimes it goes away. And with type one, we have found ways that will greatly reduce the likelihood it will ever occur. And all these relate to food. They blow people away if they never heard of it, but it's now kind of mainstream. Anyway, so that's where I grew up. And I hunted as a child, ate meat, had a job at McDonald's, came home every day with grease all up and down my clothes. The year before I went to medical school, though, I had a job in Minneapolis in the basement of the hospital, Fairview Hospital. I was the autopsy assistant. And

• 26:11Speaker 01

  one day, so my job was to help the pathologist do autopsies. Guy died in the hospital. Of a massive heart attack. Probably from eating hospital food, but it's another story. So anyway, we have to examine the body and the pathologist takes this clipper. It looks like a garden clipper and he goes crunch, crunch through all the ribs and pulls off this big wedge of ribs off the chest and sets it on the table. And that exposed the heart. And the pathologist knew that I was gonna go to medical school, so he gave me this very graphic demonstration of what was in this man's body. He took a scalpel, sliced open one of the coronary arteries and explains to me, coronary,

• 26:54Speaker 01

  it's crowning the heart, Neil, pay attention. And so he opened up this coronary artery and inside was what looked like chewing gum, but it was hard like a rock. You know, so I had my gloved finger in there feeling this stuff. And he said, Neil, this is your bacon and eggs in there. Neil, you know, this is lard in here. You know, it was not literally, but it was, the point he made was that this is all diet that caused this. And we saw it in the carotid arteries to the brain and the arteries to the kidneys, the arteries to the legs. And so he writes up all his findings and then he walks out of the room. So here I am with his body and I had to clean up everything and I put the ribs back in

• 27:36Speaker 01

  the chest to fit with the other ribs and sewed up the skin and then I went up to the cafeteria where it turned out they were serving ribs for lunch. Right. And it, it smelled, it smelled like a body and it looked like a body and I suddenly realized, this is a body. And I, I just couldn't eat it. I didn't become a vegetarian on the spot, but I just got this zinger in my gut that I just couldn't eat this stuff. And then also I became troubled because I had experimented on animals as well in college. And in medical school, one day they told us it was dog lab. And we knew exactly what that meant.

• 28:19Speaker 01

  It means you take a living, healthy dog and you experiment on them, a small group of students, and you kill him. You kill your dog in the afternoon. He's put in a trash bag and left out. And when they announced this, I said,

• 28:35Speaker 01

  Hello, I am not doing that. And the instructor said, "This is a required laboratory." But just as the words were leaving his lips, another student said, "He's not doing it. I'm not doing it either." And so we had a movement. And I, anyway, as you know... So what, hold on. So what happened? Did you get out of the class? I refused to go. I wasn't, I just refused to go. And so I wrote up all the findings. I said, "This is what is going to happen." And I turned it in, and I passed the course. I'm on the faculty there now. They got rid of the damn lab. This is at GW? This is, yeah, George Washington University back in the 70s. And I made a resolution at that time.

• 29:19Speaker 01

  I am going to stop this damn thing, not just here, but at every medical school. Because it was this hazing experience that, A, it killed the animals, B, it kills something in a young doctor's life. You should feel compassionate. You should feel that it is your mandate to stop suffering when you find it, not cause it. You should find an answer that may not be in front of you, which is, "How can I confront this problem without killing anybody?" And instead, it does the opposite. It says, "Accept death. Accept that you're going to do things that are disgusting." I thought, "Screw that. I'm going to change this now." And, anyway, to come back to what you're saying. When I got out of medical practice, when I got out of medical school, I thought, "As

• 30:04Speaker 01

  I'm entering practice, I want to fix a few of these things. I want a different attitude, a different approach. I want to bring diet front and center." And in those intervening years, I was rethinking my own diet, and I eventually, I went vegetarian, and then eventually just threw out all the animal products altogether, and quit smoking, cleaned up in other ways, and never looked back.

• 30:36Rich Roll?

  It's interesting because most doctors who kind of arrive in a similar mindset to the one you're describing do so only after they've been beat down after years or perhaps decades of practice, but you had this realization very early on in your career.

• 30:53Speaker 01

  It's been a good thing, I have to say. I've also been really heartened by how many other doctors have felt the same way. And there are a lot of folks who had had hard times. A lot of doctors, we've had a lot of battles, both in advancing nutrition. Initially it was scandalous, I gotta tell you. We had a press conference here in downtown Washington, it was 1991, and I brought over Dennis Burkett from England. He's the researcher who discovered the value of fiber in the diet. And Colin Campbell came, 1991. And Oliver Alabaster, an oncologist, and what we announced, a block away from the White

• 31:38Speaker 01

  House at the Willard Hotel, we announced that there should be four healthy food groups: grains, beans, vegetables, and fruits, and meat is not required. It's totally optional, same with dairy. Today that sounds so obvious. At that time it was scandalous, the AMA came out saying, "This is terrible. This is fringe advice, this could be dangerous to your health." Those days are gone, completely gone. And I'm happy to tell you, the AMA later embraced effectively the same viewpoint.

• 32:10Rich Roll?

  Right, right, right.

• 32:11Speaker 01

  But back then, you know, 20 some years ago.

• 32:13Rich Roll?

  Yeah.

• 32:14Speaker 01

  It was some...

• 32:15Rich Roll?

  Revolutionary.

• 32:16Speaker 01

  Well, it sounded like that, and there were a lot of doctors who had kind of a rough time, but those days have changed and there are, the federal government itself has now said vegetarian diets are one of the major healthy ways to go.

• 32:31Rich Roll?

  Right, and that's, I mean, how long, how long, how long has it been in the making to get, I mean, when, when did they first say that? Do you know?

• 32:42Speaker 01

  Every five years, the government reformulates its guidelines, as you know. They develop the dietary guidelines for Americans, which dictate what kids eat in school.

• 32:52Rich Roll?

  Right, what is commonly known as the food pyramid originally.

• 32:55Speaker 01

  Yes, the graphics that go along with it, everything. And, Rich, you should see it. They pick a committee, and the committee sits on a stage in front of this auditorium, and there's a microphone planted in front of them. And they have effectively a hearing, and one by one, people come up and they get their three minutes. The first person says, "Hello, I'm from the National Dairy Council, and I'd like to point out that Americans aren't getting anywhere near the calcium they need, and therefore you must have milk in the guidelines." The next person comes up and says, "I'm from the Chocolate Manufacturers Association." We all know that sweets are what life's all about. And the next person comes up, "From the liquor industry, and then the fisheries, and then the Salt Institute, and the Sugar Association."

• 33:40Speaker 01

  I'm not making this up, these are real. And the committee is listening to all of this. And in 2000, the year 2000, we sued, we, the Physicians Committee, sued the federal government because we had looked into the CVs, the resumes of the 11 members on that committee. Six of them had financial ties to meat, dairy, or eggs, the industries. And in federal district court, the government had, I don't know how many attorneys, we had one attorney, but it helps when you're right. And very rapidly, we won that lawsuit. The government has rules about an advisory committee, and they cannot just be in the pay of industry.

• 34:25Speaker 01

  So we won that very quickly. That has broken this process open. And they now, it's not perfect, and industry still brings all those people to stand up at the microphone, but the committee itself is better. And in 2010, they devoted two full pages to vegetarian and vegan diets, and this last one was the best we've ever had. They said, first of all, the committee report actually cited our research and said, "Vegan diets really do lower blood pressure, they have a lot of other benefit." And when the final guidelines came out, they said there are three healthy dietary patterns: vegetarian,

• 35:01Speaker 01

  Mediterranean, which I'm going to call vegetarian light, and a third was healthy US, whatever that means. But a vegetarian diet is now absolutely mainstream. And not just in federal policy, but that means schools, hospitals, everybody should be taking notice of this.

• 35:19Rich Roll?

  Right. I mean, what is it called now? Is it called the plates?

• 35:23Speaker 01

  Yeah.

• 35:24Rich Roll?

  They call it the plate, right? I think most people would be shocked to discover the extent to which that process is politicized and, you know, to kind of disabuse people of this idea that the USDA is some kind of consumer watchdog that has our best interests at heart. It's really kind of a quasi-privatized organization, right? It's not even fully governmental, is that correct?

• 35:50Speaker 01

  The USDA is in an impossible position because by law, they do have to provide nutrition advice. Also, by law, they have to promote American agricultural products. Like ice cream.

• 36:06Rich Roll?

  And those are at odds with each other.

• 36:08Speaker 01

  They are completely at odds with each other. It puts them in a hopeless position. So what they will do is they do have what are called checkoff programs. So you're a dairy producer, all the dairy producers by law have to kick money into programs that the US government then administers to promote cheese, to promote milk. When beef prices fall, the US government buys beef. They stick it in schools and suddenly kids are eating hamburgers five days a week. Why? Because it's good for health? No. Because it's good for the economic interests of industry. And by the way, the plate, my plate, my plate, came out in 2011, but I think the reason

• 36:53Speaker 01

  it came out was that in 2009...

• 36:58Speaker 01

  We went to the White House and to the USDA and said the pyramid, which was its predecessor, it's a nice shape, but people, first of all, people eat off a plate. Secondly, the pyramid had a meat group and it had a dairy group despite the fact that people who don't eat meat and don't eat dairy are healthier than people who do. So, we offered a plate that had just four quadrants for grains and vegetables and fruits and legumes. And so, we submitted this to the US government in 2009. We didn't hear back from them. So, in 2011, we filed a lawsuit against the US government, simply to compel response. And they came out with

• 37:40Speaker 01

  something called my plate, which if you compare it to our plate, it is fruits, vegetables, grains, and instead of legumes, they called it protein, which could be meat, but could also be beans, or tofu, or nuts, or high protein foods. There is no longer any meat group. There is not a meat group in US dietary guidelines.

• 38:03Rich Roll?

  Right.

• 38:04Speaker 01

  There's a dairy group, but it was off to the side, and it includes soy milk explicitly. So, we're not perfect, but things are getting better. And the message I take from this is it doesn't happen unless you push, twist arms, and sometimes sue the bastards.

• 38:19Rich Roll?

  Yeah. Well, it's progress, you know, it's progress. And, you know, I would imagine on some level, you know, the lawsuits and the protests have their place, but on some level, and as somebody who lives in Washington, has lived in Washington for a long time, I would imagine you understand that, you know, there's some hand wringing and some sort of politicking that has to go on where you're working with these policymakers on some level to, you know, push for incremental change.

• 38:48Speaker 01

  The most important thing is to be right. To me, that's the most important thing.

• 38:55Speaker 01

  It is beyond question now that people who include meat in their diet are not as healthy as people who avoid it. Their risk of obesity, their risk of certain cancers, their risk of heart disease and diabetes is substantially higher. People who have more dairy in their diet, men are at higher risk for prostate cancer. There are many other risks. People who follow a completely plant-based diet are healthier. So, anyway, job one is to make sure that that's clear, to make sure that the studies are there and understood. So, once you get that out, then it's just politics working against you. And so, we do have to fight that battle. But we can also do it with numbers.

• 39:37Speaker 01

  The past few times we've been at the Dietary Guidelines meetings, and the committee's up there on the stage, and they're hearing all of this industrial nonsense, there have been so many people, Rich, you should see them, a person will stand up and say, "I am an eighth-grade teacher from Phoenix, Arizona, and I see so many kids here who are obese, where I didn't see that a generation ago, and I want you to remember that." And somebody else will stand up and say, "I'm a small-town doctor where I'm dealing with problems that we didn't have before." And because you're right, and because you can also show that we are at a turning point where people want to have helpful messages, I really think that it's an unstoppable force.

• 40:20Rich Roll?

  And yet, at the same time, if you walk into a public high school gymnasium, you won't be surprised to find a big poster that says "Got Milk" on it.

• 40:29Speaker 01

  Yeah.

• 40:30Rich Roll?

  That's just cra- like, how is it possible, how is it legal to advertise in a public institution like that?

• 40:37Speaker 01

  Industry works very, very, very hard, and that's why it seems like our work is never done. We have made a lot of steps forward, that's for sure true, but... But they are trying very hard to advance their cause. And the proof of it is on television every single night in any news broadcast you care to watch. Half the commercials are snack foods and the other half of the commercials are medications

• 41:04Rich Roll?

  Right.

• 41:04Speaker 01

  to undo the effects of the snack foods. And that's the world that our children have grown up into and that the majority of Americans still subscribes to, even though there is a growing number of people who say, "That is not me. I'm going to take my health into my hands."

• 41:24Rich Roll?

  So let's talk about diabetes. This is an area of expertise for you and you have some really interesting ideas about this that I think, you know, fly in the face of a lot of people's understanding about how diabetes works, why we get it, and, you know, how we can sort of combat it and potentially even reverse it. So, you know, tell me a little bit about this disease that is afflicting so many of us unnecessarily.

• 41:53Speaker 01

  Sure. Diabetes means there's too much sugar in the blood. That's glucose. And glucose in the blood is actually a good thing because glucose goes into your cells, the muscle cells, to power your movements. It goes into your brain cells and without it, it's like a car without gasoline. It can't function. So glucose is a good thing. The only problem in diabetes is the glucose can't get into the cell. So it stays in the blood and you do a blood test and your blood sugar is really high, but because the glucose couldn't get into the cells, you feel tired and you can't think straight and whatever.

• 42:33Speaker 01

  So up until now, the approach has been, okay, what foods have sugar in them? Well, bread, starch in general, potatoes and whatnot, they will release sugar into your blood. And so don't eat that stuff because your blood sugar will get too high. And then we'll medicate you to try to keep your blood sugar down.

• 42:59Rich Roll?

  And the idea being, sorry to interrupt, but the idea being that eating a diet high in sugar is the causative element to this disease in the first place?

• 43:08Speaker 01

  Yes, that was the naive idea, that that caused it and that that aggravates it and keeps it out of control. However, there's a couple of things wrong with that. The first is when you look around the world, the people eating the most carbohydrate have the least diabetes. I'm talking about rural Japan, 1950. Everyone's eating rice all day long, relatively little meat, no dairy at all, rice and noodles all day long, very high carb diet, very little diabetes, even among people who are not physically active. The barber in downtown Tokyo doesn't have diabetes, he's not obese. As soon as the fast food chains came in and American eating habits, high in meat, high in dairy products came in, diabetes started going through the roof.

• 43:52Speaker 01

  We're seeing that now in China, where a country that historically couldn't afford much meat and had a diet based mostly on rice and other plant-based foods, they are now trading those away and pork and other meats coming in in a huge way. And they're seeing obesity and heart disease and diabetes. So the first thing is epidemiologically, when we look at populations, we know that a fatty, meaty diet brings this disease on. But at Yale University, Gerald Schulman, who spoke at the conference, and his research team, did something amazing. They used a technique called MR spectroscopy. It's a special scanning device.

• 44:33Speaker 01

  The patient goes into the scanner and you can look at the muscle cells. And they light up with little fat droplets inside the muscle cells and that is what's stopping the insulin from being able to work. The insulin can no longer move the sugar out of the blood into the cell because these little fat droplets inside the cells are stopping it from working.

• 44:57Rich Roll?

  So it's literally like a physical impediment, like it's just gummed up the works?

• 45:02Speaker 01

  It's very much like, yes, the answer is yes. It's very much like, when I was a kid, growing up, there was a... Trick that some kids played on others. You put chewing gum in your front door lock when no one's looking. I hope you didn't grow up in a neighborhood like that, but this is a thing people would do. You get home with your key and you couldn't open your front door. And there's nothing wrong with your key. It's just the lock's all gunned up, gummed up. Well, you don't have gum in your cells. What you do have is chicken fat. Or beef fat, or fryer grease, or whatever it is. And these, this is not, this is not fat under your skin or on your thighs. It's inside the cell. So you might not be obese, but those fat droplets from food

• 45:47Speaker 01

  get into the cells with relatively little conversion. As they build up, the insulin key can no longer bring sugar into the cell and you get diabetes. And so, we have been using, NIH gave us a grant back in oh three, 2003, to test a completely vegan diet for plant, for type 2 diabetes. And you think about it, there's no animal fat in the diet at all. If you keep oils low, what happens in the cell just reverses. The cells get rid of that fat. The insulin starts working again. They suck the glucose out of the blood. It goes into the cell, your blood sugar goes down. And suddenly the patients, the blood sugars go down so low

• 46:30Speaker 01

  that they need to reduce their medicines, sometimes stop them completely. Sometimes the diabetes just goes away. And the world of diabetes treatment has just completely been revolutionized by this understanding. The problem we have is that the public and many doctors are still in the, well, I wouldn't call it exactly the Stone Age, but they're, they are just not up to speed. And they're still saying, you know, don't eat rice, don't eat bread, and just try to keep your blood sugar normal and take as many drugs as I can prescribe. That is a Band-Aid approach that is never going to get rid of the disease.

• 47:02Rich Roll?

  It's also founded upon this idea that, that people are just genetically predisposed to this, right? This sense of predeterminism, it just, it runs in my family. Which brings up something I know you've talked about before. The difference between sort of the dictator genes versus the, the, what do you call them? The committee genes.

• 47:23Speaker 01

  Well, it's, it's, it's an important concept. Because just what you said is what people imagine, that it's in my family. There are genes for diabetes, I'm stuck. But the genes.

• 47:35Speaker 01

  Genes for eye color, those are dictators. You're gonna have blue eyes, that's it. Those genes gave orders and you're gonna have that eye color. But the genes for diabetes are, I think of them as committees. There's a whole bunch of them. They sort of mean you could get diabetes if you eat in a certain way. But you can argue with them. And there are many, many disease genes that are in that category. The genes for Alzheimer's disease. If you look at Alzheimer's disease, there's a particular gene called the APOE Epsilon 4 allele. This will not be on the test. But if you've got this gene, if you got it from both parents, your risk is 15 times higher. So people thought, I'm stuck.

• 48:18Speaker 01

  You know, there's nothing, I can get tested and then I, what do I do? Make out my will? Wait, wait, wait. You discover that if people are not eating a lot of saturated fat and trans fats, even if they have the gene, their risk is dramatically reduced, according to the best research.

• 48:36Rich Roll?

  That gene just doesn't get expressed in that way.

• 48:38Speaker 01

  That's, that's one of the most exciting things in biology. You might have genes, but those genes might be turned on, they might be turned off. And if you think about it, that's happening throughout life. When you were seven years old, you weren't growing whiskers and things. Your, your, your body turns things on, it turns things off. And genes are in that category. And foods can play a huge role in that ballet, including for hormonal conditions like breast cancer. There are genes for breast cancer. Can I keep those genes turned off? Well, maybe. I mean, let's change our diet. There are genes for Alzheimer's, all of this stuff. Don't get me wrong, I don't mean to suggest that we have perfect control as long as we eat a healthy diet.

• 49:22Speaker 01

  No, things happen to us despite our best effort.

• 49:27Speaker 01

  But we need to use food.

• 49:28Rich Roll?

  I had a doctor, do you know Dr. Robin Shetcan?

• 49:32Speaker 01

  No.

• 49:33Rich Roll?

  Here in Washington? She specializes in the microbiome, gut health, and we were talking at length about the extent to which the microbiome influences the expression of certain genes. And obviously, the microbiome is most heavily influenced by the foods that you eat. But it's fascinating what's kind of developing in that area right now.

• 49:52Speaker 01

  And in the microbiome, they have their own genes. You know, the bacteria that come into your digestive tract bring their own genetic material with suggestions of their own.

• 50:03Rich Roll?

  Right. So, there's a distinction between prevention and reversal. I think people have an easier time understanding the link between the foods that you eat and preventing the onset of some of these conditions. But when you start talking about reversal, people's feathers get ruffled here, right? So, how does the mechanism of actually, if you have diabetes and you start treating it through nutrition, how does the reversal start to occur?

• 50:32Speaker 01

  Well, when people begin a plant-based diet, it's surprising. You start the diet on Monday, and by about Thursday, my phone is going to start to ring from a patient who got out of bed at 6:00 a.m. and they are shaking and they are sweating and they feel terrible. And they take their glucose monitor and they check their blood sugar. And it's really low. And they call me up and say, "Wait a minute, I have never had a low blood sugar ever since I was diagnosed with diabetes." Well, they got it now. Because when you get the fat out of your diet, your insulin sensitivity comes roaring back and they're still on as much insulin as they were on before.

• 51:11Rich Roll?

  Right.

• 51:11Speaker 01

  And so, the combination of a healthy diet and all the medications they're taking, it's so powerful. So, you've got to cut them back on their medicines. And of course, they're thrilled with that because they're on less and less and less medicine.

• 51:23Rich Roll?

  And this is four days in?

• 51:25Speaker 01

  Oh, yeah. Yeah, now, with different people, it's different. Everybody gets their own trajectory. And there are some people where they have had diabetes so long. That their pancreas is just not making insulin anymore and those people are going to continue to need medication. So everyone's different, but yeah, oh, it can happen within a matter of days and you have to warn the patient that this diet we're talking about is super powerful. Anyway, so as time goes on, what we believe is happening in the cell is that the fat droplets are dissipating, their insulin sensitivity is returning, and as they're gradually losing weight and their blood pressure is improving and their cholesterol is improving, the assault on their blood vessels is diminishing.

• 52:08Speaker 01

  So suddenly they can protect their eyes. The blood vessels to the retina, the blood vessels to their kidneys are all being protected and the disease process is reversing. Now, for some people, the diabetes will be, will become undetectable. Not for everybody. There are others where they're going to still need some medication, or maybe they won't need medication, but their blood sugars aren't quite in the normal range. But get to this as soon as you can and kind of come back to what you were saying, Rich. What if I get to this diet when I'm 10 years old? The likelihood you will ever develop diabetes is cut dramatically. When you look at large populations, the Adventist population has been studied because they're

• 52:53Speaker 01

  supposed to be on a healthy diet based on church teachings. Among those who ignore the church teachings and eat meat, the risk of diabetes is several times higher than those who follow even a rather casual vegan diet. So the point I'm making is you can prevent diabetes in the vast majority of cases.

• 53:11Rich Roll?

  Right. That reminds me of the Blue Zones and all the work that Dan has done in those areas where there's relatively no incidence of diabetes whatsoever.

• 53:21Speaker 01

  You can also prevent type 1 to a degree, I believe.

• 53:24Rich Roll?

  That was my next question. What is the distinction here between these two?

• 53:28Speaker 01

  Different disease process. In type 1 diabetes, the cells in the pancreas, the pancreas is right behind your belly button and it makes insulin. And that insulin goes in from the pancreas through the bloodstream to the cells and then acts like a key to let the glucose inside. In type 1 diabetes, those cells are dead. The insulin-producing cells of the pancreas, they're gone. But decades ago, researchers figured out why they're dead. They've been killed by antibodies. Something is, these little torpedoes, these antibodies have destroyed those cells. So then the question is, why do I have antibodies in my own body, killing my own cells?

• 54:12Speaker 01

  And it was 1992, in the New England Journal of Medicine, if I'm remembering correctly. Researchers looked at a large group of kids, all newly diagnosed with type 1 diabetes. And they found that there was an antibody to a foreign protein in their blood. The foreign protein was a dairy protein. Hmm. And suddenly, every, every single child had this, this antibody. And it suddenly raised this issue, okay, antibodies are there to attack foreign proteins, like viruses or bacteria. And what foreign proteins am I introducing into my body? Well, food is the biggest one.

• 54:51Speaker 01

  And some of these proteins were tolerant to, but the cow's milk proteins, they're not the same as, as mom's breast milk. And so some kids don't tolerate them well, they develop antibodies. And the theory is that those antibodies turn around and destroy the, the pancreatic cells. So, does that mean that breastfed kids have less risk of type 1 diabetes? That's exactly what it means. Right. And when you look, it's true. So, could I? And the statistics bear that out? They, they clearly bear it out. That's amazing. They clearly bear it out. So what I would do, now, don't get me wrong, I'm not saying there might not be other causes. There could be. Some people say there are viruses or other things, and genetics plays a role here too.

• 55:35Speaker 01

  But, I would suggest that parents should never give their children cow's milk. Now, we've all, you grew up with it, and I grew up with it, the idea that, of course you should give your child milk. Wait a minute. Nature cannot get it through her head, that, that human beings have the bad judgment to take milk from a cow and put it into this primate body, which is your...

• 56:02Speaker 01

  Your baby.

• 56:03Rich Roll?

  Mm-hmm.

• 56:03Speaker 01

  And that's what we do. And some kids tolerate it. But a lot of kids don't. And you see asthma, um, you see in older people, um, joint inflammation. You see people with all kinds of, of issues that they never connect to the dairy exposure. Um, there have been a number of studies on this and, and the best evidence is that if you avoid dairy products, a lot of these problems are just not going to occur.

• 56:28Rich Roll?

  Yeah, Dr. Klapper says it best, what he says that dairy has one purpose, which is to, you know, blow a baby calf up into a 2,000 pound, you know, animal as quickly as possible.

• 56:39Speaker 01

  And even, even that animal is not going to consume milk later on.

• 56:43Rich Roll?

  Right.

• 56:43Speaker 01

  The weaning process is there. So children should be breastfed by their mother. I know this sounds shocking, but that's it.

• 56:50Rich Roll?

  For women that have trouble with breastfeeding, what is the alter- the best next alternative?

• 56:55Speaker 01

  Well, the first thing, the first thing that should be said, um, is that women really should be supported in this. Um, there are some cases, quite rare really, where medically it's just not possible. The mother might have a, a condition that she's afraid of passing along to her, to her infant. But those conditions are rare. There's a lot of situations where it's just uncomfortable or your business isn't supporting it or whatever. In my view, every woman should be strongly supported to breastfeed her child as an important part of reproduction. Um, and it's not optional and it's not just a question of convenience. And it can extend for a long time. You know, you can do it for a couple of years. Um, that's normal. And that kid, that breastfed child,

• 57:39Speaker 01

  he's going to have the least risk of becoming obese, of developing diabetes. That kid's going to have a higher IQ, better immunity.

• 57:46Rich Roll?

  Mm-hmm.

• 57:47Speaker 01

  Uh, which is to say that if we don't do it, the kid's going to have trouble. But breastfeeding is not necessarily natural feeling. You know, it's awkward and kind of painful. Um, and

• 57:59Speaker 01

  The way species deal with this is that they have support of their other families. They get to model on this. But now increasingly, a couple is just mom and dad in Peoria and their aunts and uncles and grandparents are nowhere around. You don't get support for breastfeeding. La Leche League and others are helping. But bottom line, we should really get away from formulas. Support breastfeeding to the extent we can. Businesses need to be tolerant of it. They need to get over it. This is part of life.

• 58:31Rich Roll?

  Right. It sounds kind of geeky to go down this diabetes rabbit hole, but this is no small thing, right? I mean, the statistics that I've seen say, estimate that 50% of the population is going to be diabetic or pre-diabetic by 2030. I'm sure you're much more immersed in the statistics than I am, and maybe those are incorrect. Maybe you can correct the record on that. But the extent to which our economy has been diverted to deal with this disease and what's predicted over the next several decades is quite dire, right? So this is a huge thing.

• 59:06Speaker 01

  And the stat you just gave, that's today in some populations. We're doing a lot of work with Native American populations. And in some of these populations, particularly those, say, over age 50, you can see diabetes in 75% of the population.

• 59:23Rich Roll?

  That's insane.

• 59:24Speaker 01

  And what does that mean? It means your eyes are being attacked now. It's the biggest cause of blindness. Your kidneys are being attacked now. It's the biggest reason you're going to end up on dialysis. Your feet are being attacked. I'm talking about the circulation to your feet. You're going to lose your toes. You're going to lose your feet. It's the biggest reason for amputation. And you're going to die 10 to 15 years sooner than other people on average. Now, you're a wealthy person in some other part of the world, and you get great medical care. I might be able to prop you up longer. But that comes with a cost, too. If you look at the premiums you're paying for your healthcare costs, or any employer is paying for it, we just accept it.

• 1:00:07Speaker 01

  Okay, 500 bucks a month for treatment. For what? For treating diet-related conditions. So there's a huge cost to all of this. That's the bad news. The good news is... We now have a really good and effective and inexpensive way of dealing with it. And that's to recognize the cause is a fatty animal-based diet. That if we change that, and we can change what happens in the cell, that whole dismal scenario can be changed.

• 1:00:39Rich Roll?

  You're able to see it so clearly, and the research that you're involved in demonstrates these results so completely and so clearly to you, and yet there still seems to be kind of a steep unwrap to getting other medical professionals on board with this idea. What is the problem in getting everybody to understand what you seem to so clearly understand?

• 1:01:03Speaker 01

  Part of it is, as you know, Rich, medical education doesn't include a lot of nutrition. That needs to change.

• 1:01:10Rich Roll?

  That has to change.

• 1:01:11Speaker 01

  And...

• 1:01:12Rich Roll?

  Is it changing?

• 1:01:13Speaker 01

  We're working hard to make a change. At the conference that we just had, we unveiled modules for lectures that medical school instructors will now be asked to use, as well as modules that people can do online. By people, I mean medical students in the more advanced stages of their careers. Free information. We're just pushing it like crazy. But there are other parts of this. The money aspect of it has really been corrupting, and not just in medications. But there's another thing, if you don't mind my touching on a slightly controversial area. The SNAP program, it used to be called food stamps.

• 1:01:55Speaker 01

  Now it's this Supplemental Nutrition Assistance Program. Sounds like a small thing, but it's one of the biggest federal expenditures we have. One in seven Americans gets SNAP. And I say, great, because I don't want somebody to go to bed hungry. Here's the problem. The retailers can take your little card, and you can get maybe as much as $150, $200 of SNAP foods. If I'm a retailer, I don't have to give you broccoli, or apples, or bananas, or brown rice, or sweet potatoes. I can stock potato chips, and candy, and meat, sausage, all kinds of stuff. And that's what I'm going to take your SNAP card for.

• 1:02:39Speaker 01

  In fact, I want to do that, because it's shelf-stable, and I can make plenty of money off that. And so, the people who have the highest... Risk of diabetes and obesity happen to be the poorest people there on SNAP. And that, if I could wave another magic wand, I would make it so that retailers, accepting the SNAP payment, can only accept it for healthy foods that you would feel proud for people to have. You would wipe out hunger, you would wipe out food deserts, because every gas station and liquor store that's getting SNAP payments now could only get it if they had cans of beans and rice and, you know, healthy things, and they couldn't do it for potato chips anymore.

• 1:03:23Rich Roll?

  My, uh, my friend Gennar Lovelace, who's the CEO of Thrive Market, you know Thrive Market, he's been very involved in that issue and lobbying Congress to change the laws on that as well, because you can't use those payments for online purchases either.

• 1:03:38Speaker 01

  Right.

• 1:03:39Rich Roll?

  For healthy foods.

• 1:03:40Speaker 01

  Yeah, but, but that, that can change. And many people are not really aware of, of SNAP and don't think about it, but it is huge. It's, it's, I think, one of the biggest, uh, drivers of really unhealthy eating habits and oddly-

• 1:03:56Rich Roll?

  And it just exacerbates the socioeconomic gap.

• 1:03:59Speaker 01

  It, it, it does. It, absolutely. Um, it means you're gonna get sick, uh, you can't work, you're gonna need then Medicaid, um, to, payments to, to keep you healthy. And it's, when we're on Capitol Hill, some of our fiercest opponents in trying to clean it up and get the so, you know, get the sodas out, get the cheese out of the program, some of the biggest opponents we have are hunger groups. And they will make this rather thin argument that it's patronizing to quote unquote, "tell" poor people what to eat. But if you just look a little bit beyond that argument, what you discover is they are very often getting-

• 1:04:39Speaker 01

  Funded by the food industry because Kraft and PepsiCo, Coca-Cola, they make a phenomenal amount of money off of SNAP. They don't want it to end, so they pay hunger groups to be their shills effectively.

• 1:04:53Rich Roll?

  Right, so if you live in an urban food desert and all you have is a liquor store and you can go there and buy chips and soda with your SNAP, that's what you're gonna do. If suddenly that was no longer an option, you're still gonna make the effort to, you know, travel the extra mile to the actual supermarket or whatever so that you could deploy those resources.

• 1:05:14Speaker 01

  I'm gonna argue that the liquor store or gas station or whatever it is that's selling chips, I think they should still be able to get, to be able to take SNAP cards. But they should be able to accept them not for potato chips or junk food. They should have to have healthy foods there. So, let's say I-

• 1:05:29Rich Roll?

  That's just crazy talk now.

• 1:05:31Speaker 01

  This is the easiest thing in the world. This is the easiest thing in the world. Let's say I'm running a liquor store. It's all liquor over here and on this, the other side it's all potato chips and licorice and candy. And that's what I'm accepting SNAP for. Right now, let's say the government were to say to people, "Throw out all that candy and you can, you can accept SNAP cards if you have four things. Vegetables. Now, that might mean cans of green beans. It might not be fresh organic stuff, but you can have cans of beans and corn and things like that. Grains? Okay, so you can have bread there, or pasta, or whatever the case may be. Fruits? All right, it can be maybe fresh fruit, or if you can't deal with that, it can be canned fruit. And beans, legumes. And they can be canned or

• 1:06:15Speaker 01

  they can be dried. Deal with it. You know, this is how you make money. And yes, there will be complaints, "Where are my barbecue potato chips?" But if, keep in mind, this is food that we are giving away free. And you can either hurt people, or you can help them. And I would argue that we should provide, if we're providing food for free, we should provide foods that we are not ashamed of.

• 1:06:37Rich Roll?

  Yeah, it would be great to, to implement that. And to find a way so it doesn't devolve into, you know, ketchup and Wonder Bread.

• 1:06:54Speaker 01

  Our enemies here are primarily the food industry and everybody that they're paying because they see this as an enormous part of their market and they make up silly things. It was a birthday and at a birthday, don't you really want to eat ice cream? And I say, wait a minute, the government does not have to give you ice cream for your birthday. The government should provide for people who are going to be hungry. Give them food that will nourish them and allow them to work tomorrow.

• 1:07:19Rich Roll?

  Let's talk about Alzheimer's a little bit. You touched on it earlier, but I'm interested in, you know, because this is another growing, you know, massive problem that we're seeing as, especially as baby boomers are aging up. You know, what are the, the causes of this and, you know, what is the extent to which we can control, prevent and reverse this condition?

• 1:07:45Speaker 01

  We are really on the frontier of a completely new era with Alzheimer's. The old view that many people still subscribe to is that Alzheimer's relates to being old and having bad genes. So if your parents became demented, this is going to happen to you. And the statistics are grim, you know, by age 85, about half of people in America have significant dementia. And, and when you got it, you have lost everything. You've lost everything.

• 1:08:15Rich Roll?

  It's devastating.

• 1:08:16Speaker 01

  It's devastating. You have, you can't, you can't function, you don't know anybody and you are sitting in a rocking chair in a nursing home, waiting to die. I saw this in my grandparents and I saw it in my parents. However, in this dismal scenario has come this tremendous ray of light. Starting in 1993, the Chicago Health and Aging Project, run from Rush University, started tracking eating patterns in a large group of people in Chicago. And they found this amazing thing that in Chicago, some people eat a fair amount of

• 1:08:56Speaker 01

  saturated fat, dairy, dairy fat really, and meat fat is what it is. And some people eat relatively little of that. And they looked at their Alzheimer's rates as the years went by and it was a day and night difference. The people who avoided the animal fat... At least to an extent, had half to a third the risk of Alzheimer's. Okay, that was number one. Okay, skip the bacon grease and maybe I can cut my risk. Then they, then they looked at trans fats in a lot of the snack foods.

• 1:09:28Rich Roll?

  Mm-hmm.

• 1:09:29Speaker 01

  Partially hydrogenated oils. Same story. If you avoided that, your risk was cut. And then they looked at vitamin E. Not, not pills, but vitamin E in foods. Like people who had vitamin E in nuts or seeds. And that had a, a, a large, very large influence. That was protective. And then researchers at the University of Illinois started looking at exercise patterns, showing that you could reverse brain shrinkage over time. And I'm just skimming the surface, but over the past several years, we have been adding up the tools that people can use to affect their Alzheimer's risk.

• 1:10:09Speaker 01

  And it adds up to, I believe, we could probably prevent about 80% of cases of Alzheimer's disease. And I'm speaking specifically of people who are at genetic risk for this disease.

• 1:10:22Rich Roll?

  That's amazing. So what is the, the, the biological mechanism that causes Alzheimer's? What's actually going on?

• 1:10:29Speaker 01

  Uh, when you look at, if you, if you look into the brain of a person with Alzheimer's, you see a couple of things. The first is, under the microscope, you could see in between the brain cells, these little round, they look like little meatballs. They're called beta amyloid plaques. They're collections of protein. That protein has been squeezing out of the brain cells and it collects in these little microscopic meatballs in the brain. Um, and then the second thing is, inside the brain cells, there are proteins, tau proteins, T-A-U, proteins that have become, ah...

• 1:11:09Speaker 01

  Twisted and malformed. And these changes have been recognized for a very long period of time. The question was, why? Why is this happening? And so after the Chicago researchers said, there's something with food. Researchers at Kaiser Permanente did a fascinating study. They showed that people who eat all these bad fats, unhealthy diets, have high cholesterol. In turn, the high cholesterol levels seem to do something in the brain. What we believe, the puzzle still has big gaps in it, but what we believe is happening is the very same high cholesterol level that's hurting your heart is causing changes in the brain.

• 1:11:52Speaker 01

  It's causing more beta amyloid to come out of the cells, more aggregation into these plaques, more destruction of the brain tissue. And in the same way as diet changes can protect the heart, we believe they can protect the brain.

• 1:12:07Rich Roll?

  So similar to the way that we contract atherosclerosis, right? The same mechanisms are at play. And what about somebody who's been eating some version of the standard American diet most of their life? They start to show or display signs of this disease. Is there a way to arrest it or potentially reverse it through these kinds of changes? Or has that train left the station?

• 1:12:35Speaker 01

  Researchers at the University of Cincinnati asked that question. They brought in a group of people. Their age, the average age was 78, and they were having memory problems. Not what you'd necessarily call severe memory problems, but lapses.

• 1:12:52Rich Roll?

  Like short-term stuff?

• 1:12:53Speaker 01

  Pretty much every day, like, what's the name of that actor? You know, I can't remember. Well, grandma's getting kind of old. She's, her memory's bad. But they might still drive, or they might still balance their checkbook. I mean, they know who you are, their personality's the same. This is called mild cognitive impairment. They brought them in and they did a diet change with these people. And in this, there have been many, many studies done. In this particular case, they were testing diets high in antioxidants.

• 1:13:26Speaker 01

  Grape juice, blueberry juice, they're high in what are called anthocyanins. And they showed that over a three-month period, you can turn the condition around. So you see better learning, better recall. At the University of Illinois, they tested an exercise intervention. A forty-minute brisk walk three times a week, and they showed that memory can improve. And when you scan the brain, you see in the hippocampus, which is at the center of the brain, and it's kind of the key to memory. It's the part of the brain that decides what needs to be remembered. It actually grows when people exercise more. Rich, your hippocampus is probably like enormous.

• 1:14:06Speaker 01

  Anyway, the point I'm making is that it's this gradual decline in memory loss can be reversed. However, I do think that there's a point that comes fairly soon, once Alzheimer's is being thought about as a disease, when a person not only has mental lapses, memory lapses, but they're losing their language ability, they are losing their visual spatial ability. So I say, can you draw a face? And they just can't do it. At some point, you're seeing so much destruction of brain tissue that you're not going to reverse that disease.

• 1:14:45Rich Roll?

  Right. It's sort of past the point of no return at that point.

• 1:14:48Speaker 01

  Yes, I think that's exactly it. So get to it early. Oh, by the way, researchers at Kaiser, who were looking at the cholesterol connection, showed that you could predict Alzheimer's risk to a great degree by drawing your cholesterol level when you are forty years old. Meaning, if you're eating the foods that give you a high cholesterol level in midlife, and you keep eating those foods, you're going to hurt your brain. So get on a healthy diet early and protect this delicate organ.

• 1:15:17Rich Roll?

  Yeah, which speaks to the notion that these chronic lifestyle illnesses are things that don't happen overnight. There are things that, you know, these begin very early on in life, right? Whether it's heart disease or what have you, you know, you start laying those plaques down, whether they're in your brain cells or in your, you know, coronary artery as young as being a teenager.

• 1:15:42Speaker 01

  Oh, earlier than that. There was an amazing research study from Australia that showed in newborns, newborns, within the first week of life, they have arterial thickening if their mother was on an unhealthy diet. That's the bad news. So, yeah, no, it happens right away. The changes aren't huge, but you could see them right away. The good news is that the diseases, these diseases are often reversible even quite late in life. Dean Ornish's work, you know, Dean Ornish is, in my view, a genius. Wonderful, wonderful human being, who, when he was a medical student, he set out to see if you can reverse heart disease.

• 1:16:21Speaker 01

  And you can, but with a combination of a healthy diet, plant-based diet, dealing with stress, getting exercise, throwing out the cigarettes, and just getting some support for this. So for anyone who thinks, "No, no, no, I've been eating badly all my life, there's nothing I can do." Wait a minute. Those arteries can open up again. Your blood pressure can come down. Now, you never know how far you can reverse this process, but let's get started. And I don't care if you're 95 years old. Those arteries can open up again.

• 1:16:52Rich Roll?

  That's a beautiful thing. You touched on cholesterol, and you mentioned Dr. Ornish, which kind of segues into the next thing I wanted to talk about, which is a lot of, there's a lot of confusion among typical consumers. They go online, they want to find out what's healthy, what should I be eating? They turn to the media, and it's very easy to get vertigo because there's so many conflicting opinions, right? So, maybe we could start this conversation with the impact of dietary cholesterol on these various diseases. You know, it's very popular right now, the low, this sort of low-carb diet, and this notion that everything you ever thought or heard about saturated fat is wrong, it's

• 1:17:37Rich Roll?

  perfectly healthy, there's no relationship between dietary cholesterol and blood serum cholesterol, and the incidence of these diseases. So, maybe you can help clarify some of this confusion.

• 1:17:51Speaker 01

  Well, where do we start?

• 1:17:52Rich Roll?

  And as far as Ornish, I mean, I've seen him getting lambasted in the media.

• 1:17:57Speaker 01

  For these ideas. Dean, you know, Dean Ornish was, sometimes people would, would try to fight with Dean ju- just because they might have had a different view of science, the, the kind of conclusions that they wanted to arrive at. But Dean is an extremely careful researcher, and his work has been published in the top medical journals and carefully peer reviewed. And one other thing, um, he very kindly, I think it was the late 1980s, he invited me to come out to meet some of his patients, um, when he was doing, uh, one of his early heart

• 1:18:36Speaker 01

  studies, and to see firsthand how patients' lives could be turned around, um, including patients who had been largely given a death sentence, um, with very severe heart disease, and to see it turn around. And the other thing is, people will say, ah, yes, okay, just, it's a strict diet, I'll believe it'll work, but nobody could follow it. Nonsense! These patients loved it. How hard is it to eat lasagna? You know, it's, it's just not cheesy lasagna anymore. It's your vegan spinach lasagna made, you know, without added oil. It's easy. The patients loved it. So, um, no, I, I think Dean's just tops, done a fabulous job. And also, he's gone further and, and has gotten Medicare to help reimburse the treatment, the, the treatments that he's pioneered. Oh, I didn't know that. That's amazing.

• 1:19:21Speaker 01

  Oh, absolutely. And there are many, many centers around the country, um, that, that offer this, and that's the way it should be. So, no, my hat is off to him. Okay. But you, you talked about some of these controversies, and these are often generated by industry. Um, where to start? Uh, one maybe started with... There's so many. There are. Pick one. Um, with low carb diets, the, the idea has been, okay, if you don't eat carbohydrate, if you don't eat bread, uh, and other carbs, you'll, you'll lose weight. And of course, it's true. If you, carbs, carbohydrate-rich foods are about half of what we eat. So, if I'm not eating any bread, or any pasta, or any fruit, or any potatoes, or any sweet potatoes, I throw out the cookies and the cakes, will I lose weight? Sure.

• 1:20:06Speaker 01

  But you only lose weight if your calories are actually falling. If you make up for it with Valvita, you're not going to lose weight at all. And moreover, when you leave out these healthy carbohydrate-rich foods and you're leaving in dairy products and meat, your cholesterol level, it might fall if your calorie intake is really falling. Typically, cholesterol levels will fall. But if you're making up for it with meats and dairy products, about one-third of low-carb dieters find their cholesterols go up, sometimes to a quite a dangerous degree. But the question of who loses more weight, low-carb dieters or low-fat dieters, was

• 1:20:47Speaker 01

  quite well answered by a researcher named Kevin Hall, who brought in people into his laboratory at NIH, where they track exactly what you're eating and they track what's going on in your body. And he put people on low-carb diets or low-fat diets, and the people following the low-fat diets, when you just tracked fat loss, it was significantly greater than the low-carbers. Which is exactly what you'd expect if you've really been looking.

• 1:21:16Rich Roll?

  Yeah, there's this idea that, you know, for decades, we were on our low-fat, you know, program, and it failed. And here we are, more obese and sicker than ever because low-fat diets don't work. But what that overlooks is that people weren't actually doing it, right?

• 1:21:33Speaker 01

  That's right. They weren't actually doing it. This is the mythology that the low-carbers use to sell books. They say, "The government told us to eat fat, and we all went out and bought dietetic crackers, and we gained weight on that." It's, frankly, it's mythological. I don't know anybody who bought that stuff. And during the whole, well, just decade after decade after decade, really ever since World War II, if you track, say, cheese consumption...

• 1:22:03Speaker 01

  And meat consumption, it has been on this steady climb. The idea that people were throwing out fatty foods and suddenly becoming vegan, at least at that time, is not true at all.

• 1:22:13Rich Roll?

  Or just low fat in general.

• 1:22:15Speaker 01

  Or just low fat in general, it just did not happen. What did happen is that people started adding sodas and things on top, so that the proportion of fat could be adjusted, but overall, people were eating more fat than ever, more fatty galop than ever. And the population that tended to stay slim was those people following vegan diets. Their body mass index was just super low. And a word about this question of dietary cholesterol, this was completely manufactured by the egg industry. Eggs have more cholesterol than any other food, and they wanted to make the argument that if you eat the cholesterol in an egg, that won't get into your blood and your blood cholesterol won't rise. Well, it just does.

• 1:22:56Speaker 01

  I mean, if you eat cholesterol, roughly half of that cholesterol will end up in your blood. Your blood cholesterol will rise. And the egg industry has funded massive amounts of research to try to make this go away.

• 1:23:09Rich Roll?

  And what is the relationship of having that cholesterol in your blood to the onset of these illnesses?

• 1:23:16Speaker 01

  Well, the higher your blood cholesterol level, the higher your risk of a heart attack. There are people who try to make all this go away, but you really just can't. It's true. Particles of cholesterol can oxidize, and then they attack the artery wall and cause the production of a plaque, which can rupture and lead to a heart attack, and you die. Or you get damaged. That's what happens. And there are people who try to make that go away, but the science is really, really, really clear.

• 1:23:49Rich Roll?

  So how do we arrive at this cultural moment where butter is on the cover of Time magazine and saturated fat is back?

• 1:23:59Speaker 01

  That's been a new phenomenon, and I blame statistics for this. People have gotten smarter. Food writers have gotten smarter. And they, to their credit, said, "Don't just give me one study. Give me a whole review that puts all the good researchers' research together." And they use a technique or-

• 1:24:19Rich Roll?

  A meta-analysis.

• 1:24:21Speaker 01

  Meta-analysis. That's the new darling of those of us involved in health. And meta-analysis is a good technique where you take studies, there could be dozens of studies that have tracked a certain thing, and you combine them all together to get one good result. And I want to say, we do meta-analyses here, here, at the Physicians Committee. I've done them. However, they can be abused. So if I take a meta-analysis of a study of cholesterol lowering in vegans and try to compare it to meat eaters in Sweden, and you can do, you could combine a whole bunch of studies that don't really go together, and you mush them together, you can easily make dangers disappear. And that's what happened.

• 1:25:06Speaker 01

  There were two of these meta-analyses published a few years ago, where they, they said, "We just can't make anything of saturated fat and heart disease because the studies were so disparate." The press bought it and said, "Gee, I guess butter is not a problem. You can eat all the cholesterol you want, you know, I'm not going to have any problem." That was a complete misinterpretation, but it, it was news people wanted to hear.

• 1:25:30Rich Roll?

  Mm-hmm. And my understanding is these studies never said saturated fat is good for you. They just called into question the extent to which those two things were linked.

• 1:25:42Speaker 01

  Well, there, there are tests that are so insensitive, they just can't detect a problem even when the problem is there. It's called a false negative. And some meta-analyses, if they're poorly done, just can't detect the issue. And that does not mean that butter is safe. It doesn't mean that bacon grease is not going to hurt you. It just means their statistics were so badly done that they couldn't detect it. And that's the appropriate interpretation.

• 1:26:09Rich Roll?

  All right. So just to be totally unequivocal about this whole thing, pop quiz. Saturated fat is A- Good for you. B, not so bad. C, bad. D, really bad.

• 1:26:24Speaker 01

  Well, saturated fat is really bad, D. It's a clear-cut contributor to higher cholesterol levels that lead to heart attacks. And saturated fat, as I was mentioning earlier, is a contributor to Alzheimer's disease. It's also, lots of fats can contribute to the insulin resistance that leads to diabetes. Saturated fat appears to be the worst actor. So, by the way, the number-one source of saturated fat is not bacon. It's dairy, especially cheese. So, kids eating their grilled cheese sandwiches and their cheese pizza are getting a huge dose of bad fat that they shouldn't be getting.

• 1:27:03Rich Roll?

  And chicken is a lot worse than people realize, right? Chicken is the thing, is sort of the go-to, you know, meat that people adopt when they're trying to eat a little bit healthier. So, what's going on with chicken?

• 1:27:16Speaker 01

  Oh, my God. Americans eat a million chickens per hour, according to US-

• 1:27:22Rich Roll?

  That is so crazy.

• 1:27:23Speaker 01

  A million chickens per hour, according to USDA statistics. And the argument has been it's not as bad as red meat. The leanest red meat is about 29% fat. With chicken, it's about 23 for skinless chicken breast. However, there was just a new study that just came out yesterday, actually, from Harvard University, where they looked at various protein sources: red meat, poultry, fish, eggs, dairy. And they looked at a very large group of participants in Harvard studies, more than 130,000 people. And they showed quite definitively that if you take animal protein and substitute even a small amount of it for plant protein,

• 1:28:08Speaker 01

  your risk of dying goes down. And that was true not only for red meat, but also for chicken. In other words, chicken is not moving your health in the right way. If you substitute plant protein for it, your risk of dying goes down. It's true for fish. It's true for eggs, it's true for dairy products.

• 1:28:28Rich Roll?

  Yeah, that study got quite a bit of media attention. CNN wrote a nice piece about it the other day, so that's sort of interesting and exciting. One thing I wanted to touch on is ketosis. This is an idea that has gotten a lot of traction, particularly in, you know, fitness circles. And there's a lot of people who are proponents of this as a lifestyle, as a way of disease prevention, and also athletic performance. So I'm interested in your thoughts on this trend. And what, you know, maybe explain exactly what it, what ketosis is and what's really going on here.

• 1:29:05Speaker 01

  Yeah, you may see more of it than I do because I'm here, I'm not seeing lots of elite athletes, or people really going in some of these athletic fads, if you don't mind my using that word. But in ketosis, your body's designed to function on glucose. And if you take the carbs out of the diet, you can throw the body into ketosis, where you are now, your body is running on ketones. And there are some people who try to suggest that that's at least something you can manage for a while.

• 1:29:36Rich Roll?

  I mean, people are taking exogenous ketones, actually.

• 1:29:40Speaker 01

  Yeah.

• 1:29:42Rich Roll?

  So, and doing this for, you know, purported health benefits.

• 1:29:46Speaker 01

  Yeah, I wouldn't go down that road at all. And when you look at the people who are frankly terrific athletes, look at people from Kenya who are just wiping the floor with other people in, you know, long distance running, they're not taking that stuff. These are people eating healthy, low fat, natural, plant-based diets. And that's where we have to come back.

• 1:30:10Rich Roll?

  So when someone says to you, "I eat pretty well, you know, I'm eating the paleo diet," what is your typical response to that? Because paleo is such a popular...

• 1:30:24Rich Roll?

  You know, so purported, you know, healthy diet to eat these days.

• 1:30:26Speaker 01

  It's a romantic notion, isn't it, that we're in our loincloths with spears and running around and capturing a gazelle and bringing it home to our appreciative family who's going to chow down on this meat for the rest of the week. It's really not based in anything other than fantasy. And there's a wonderful anthropologist from Oklahoma named Christina Warner.

• 1:30:50Rich Roll?

  I saw her presentation at the conference. It was fascinating.

• 1:30:53Speaker 01

  Just fascinating. She's looked at the fossil record and the paleo diet is clearly just imaginary. I mean, human beings did go through a paleolithic period, but what they were eating was plant-based foods for the most part. It's true, they weren't having dairy products, they weren't having very much meat, and they had really quite a high intake of plant-based foods. And if you look at our other biological cousins, chimpanzees, orangutans, gorillas, they're not eating ice cream, they're not eating cheese, they don't have dairy products at all, except mother's milk. And meat is really not their thing either.

• 1:31:33Rich Roll?

  The argument that always comes up is, you know, take a look at the Inuit, you know, the Inuit population who are essentially, you know, the vast majority, if not entirely, you know, their diet was basically entirely animal products and they had no incidence of heart disease. But my understanding is that most of them died pretty young or were not, you know, were not able to study them. But do you have any understanding of that population?

• 1:31:58Speaker 01

  Yeah, I think what you said is essentially correct. Populations in the very far north are in very unusual situation. Our species began in probably Eastern Africa and some people had the bad judgment to leave and ended up going over the Bering Strait into...

• 1:32:21Speaker 01

  Extreme North America. And then came down into North America and eventually into South America. And those who have stayed at extreme northern climates, I mean, there's not a lot to plant. And you're in a very unusual situation for a great ape to be in. Where I can't pick blossoms or fruit or anything. And human beings being fairly adaptable figured out to hunt and to fish. And that's what they have indeed lived on. However, this idea that they don't have heart disease is quite naive. When you look at these populations, they have massive heart disease. You see lots of heart disease.

• 1:33:03Speaker 01

  Now, they don't have necessarily great access to hospitals. So you don't have terrific records of having heart attacks. But no, this is not a healthy population. In some cases, they can stay alive despite having narrowed arteries. Because if you eat a fair amount of fish, you may have trouble clotting. Your blood may not clot very much. And if you can't clot, you can't have a...

• 1:33:27Rich Roll?

  Oh, that's interesting. I've never heard that before.

• 1:33:28Speaker 01

  You can't have a heart attack. Yeah. Some fish eaters or even people who have omega-3 supplements. You'll try this at home. You discover you cut yourself shaving and it like doesn't stop for a while. That's not a good thing. Sometimes you want to stop bleeding. But these notions that they may not have heart disease have persisted. But what you said is also true. They have very poor medical records. They very often die young of many, many other issues. The same is true of the Maasai in Africa. Often held up as a population free of heart disease. Despite the fact they're eating blood and whatnot. You look at the Maasai, they have massive atherosclerosis. They don't have very good medical care.

• 1:34:11Speaker 01

  And you don't see a huge incidence of diagnosed heart attacks in this population. But when people have done autopsy studies, they see atherosclerosis all up and down their arteries. And this is a very dicey way to try to make a nutrition prescription.

• 1:34:26Rich Roll?

  So if someone's listening to this and they're on board and this is new information for them and they're inspired to make a change, you have done a great job with the Kickstarter program and all the activities that you've done to create, like we talked about before, accountability and community, support to help people effectively and responsibly transition so that they can craft a sustainable lifestyle around this. But I'm interested in your thoughts on this. I have a couple of friends who know me well, they know what I do, they know what I stand

• 1:35:06Rich Roll?

  for, and yet they want to change, they're very unhappy eating the way that they're eating and living the way that they're eating, and they just can't get it, they just can't make the leap, or they can't make it stick. And it leads to a certain degree of despondency that, in my mind, conjures up this idea of addiction. Like, I really think they're so heavily addicted to these foods that are killing them, that it almost becomes an impossibility for them to break that cycle.

• 1:35:43Speaker 01

  I think that's true. We tend to think of addiction as meaning you're back in an alley behind a 7-Eleven buying a bag of heroin. But addiction is much more mundane than that, meaning widespread and common. And people can be addicted to sugar, and they can be addicted to chocolate, and they can be addicted to cheese, in my view. You could put addiction in quotes if you want, I just mean you're hooked on this and you're having it day after day. And there is a biological explanation for it, and you can show that when people eat certain of these foods, opiate levels in their brain do change, and in turn, dopamine levels respond by being increased, and people feel a need for that.

• 1:36:26Speaker 01

  And so you say, "Okay, why don't you eat healthy foods?", and you take away all of these things that have been propping them up, and they can feel cravings very much like withdrawal. And I think the way we deal with it is a couple of ways. Although I'm referring you to classes because I want you to get good education, what am I also giving you? I'm giving you a social support network. And dopamine arises in the brain, not just from foods and drugs, but also from its natural source, which is intimacy and social interaction. And from other healthy things like exercise and music. You can show it will cause dopamine to be released in the brain. Build healthy sources of dopamine into your life.

• 1:37:11Speaker 01

  And it doesn't mean that foods won't be attractive, but it means you've got a support system. So build that stuff into your life, support. And then what I always encourage people to do is two things. I break the diet change into two steps. And Rich, I've never seen anyone unable to do this. Step one, when patients come in here, I'll say, "Take a week. And just think about the foods that you can eat that are completely from plant sources, and put them on a piece of paper." So the paper has four headings: breakfast, lunch, dinner, snack. And they'll take a week and they'll write, "Okay, oatmeal, I can have oatmeal. No milk.

• 1:37:54Speaker 01

  I can have a bean burrito. And for dinner, I could have pasta with a marinara sauce, not the Alfredo sauce." So they're taking a week and they're just writing down all the possibilities. And after about seven days, they've got their list, and this seems possible. Step two, I say, "Take three weeks. Now let's take your list. Let's eat that for three weeks, all vegan, all the time, but the foods you know you like." At the end of three weeks, they feel healthier, they're losing weight, they're feeling good, and they discover their tastes are changing. And even though they vowed only to do it for three weeks, and it's a very manageable timeframe, they discover because their tastes are changing, they kind of want to stick with it and see how far they can go.

• 1:38:38Speaker 01

  And so the whole idea is explore, have fun with it, focus just on the short term, and then let's get our dopamine hit from all the other people we're doing this with. Exercise if you can.

• 1:38:52Rich Roll?

  Right, getting it emotionally.

• 1:38:53Speaker 01

  Getting it emotionally, and in a really good way. Now, the other thing. Forgive yourself. What if you went out with your friends and you goofed up and you did something really, you ate something you regret? That doesn't mean you're a failure. There has never been a smoker who just quit like that and never thought about it again. People goof up all the time. You don't give up because you went back and had a cigarette, or had a drink, or had drugs, or whatever. You stutter your way into success and there you are. And then the longer you stick with it, the more power you've got. And if you haven't had meat in a year or two, I mean, it doesn't attract you at all. You just don't care about it.

• 1:39:35Rich Roll?

  Right. It's very psychologically complex because if you do have that lapse, then the most common human reaction to that is some form of shame. And so, how do you deal with that shame? Well, you medicate it through eating more food that's not good for you, or acting out in some sort of way to mask it. And that perpetuates and exacerbates that vicious cycle.

• 1:39:57Speaker 01

  Shame, and one other thing. There's a little devil in, somewhere deep in the brain, that is just waiting for an excuse. You know, your cerebral hemispheres are saying, "Don't eat that. Let's use a little logic here, people." But there's a little devil, there's this saying, "Wait a minute. I think I can find a rationale here." And one big rationale is one slip. "Okay, I had a slip, so now, all week, I can just eat this stuff because I goofed up. It wasn't for me." The cerebral hemispheres have to come back and say, "Get a grip. Let's get back on a healthy diet."

• 1:40:29Rich Roll?

  Most people will say, you know, everything in moderation. Like, "I eat a pretty good diet. What's wrong with a little bit of this and a little bit of that?" And I think, first of all, when you put pen to paper and do a diary of what you're actually eating, the truth of what you're doing probably tells a very different picture than whatever moderation you had contemplated. But also, continuing to eat those foods that don't serve you perpetuate, if you really are addicted to them, then you're never breaking the cycle. So, the cheat day, or whatever, is only continuing to imprison you to habits that are leading you down a very dark path.

• 1:41:09Speaker 01

  Yeah, I think there's no question about it. First of all, when people eat a moderate amount of meat, or a moderate amount of dairy, they're...

• 1:41:17Speaker 01

  Whether you look at their waistline, or their cholesterols, or their risk of diabetes, they're just not the same as people who avoid these foods. Any, in the same way as a person who smokes occasionally. Their risk of lung cancer is not the same as a non-smoker. So moderation is not a, moderation is only good for healthy things. So broccoli, broccoli's good. Have broccoli in moderation. Have it, you know, but you don't, you don't wanna only eat moderation, you don't wanna only eat broccoli. Or, let's say, your, your child is practicing the violin. You know, after, you know, maybe a couple hours a day, okay, but if it's like sixteen hours a day, give it a rest. So moderation is a, a rule for good things.

• 1:42:02Speaker 01

  You don't have moderate heroin, moderate cigarettes. Secondly, you prefer to tomorrow what you eat today. So if you want to make yourself crave cheese tomorrow, best thing to do, have a little bit of it today, and tomorrow you're gonna wake up thinking, that was alright. Have, have more. If you want, if you want power to avoid it, avoid it today. You know, you can just fuel that desire by having it. So those people who say, ah, just, you know, you could celebrate one day a week, do it ninety percent, that's much harder. Ask a person who quit smoking to have one cigarette a week, it's torture.

• 1:42:41Rich Roll?

  Right, they'll just, they spend all their time thinking about when they're gonna get to do that.

• 1:42:45Speaker 01

  Absolutely, and the next day they're gonna have it again, they're gonna say, screw this, I'm just back.

• 1:42:48Rich Roll?

  Right.

• 1:42:49Speaker 01

  And the easiest way is just, don't smoke, and after a while, you're gonna get used to it, and then you've got power. A, a person who is abstinent from a bad thing that has hurt them, that's a person with power. A person who's dangling it in front of themselves every day is a person who's, who's really in trouble.

• 1:43:07Rich Roll?

  And the truth is, it's gonna be uncomfortable for a short period of time, but, you know, you're gonna, you're gonna be alright, you can weather it, you can survive it, and once you get to the other side of it, then there's freedom.

• 1:43:17Speaker 01

  Yes, and let's face it, foods are the easiest habits to break. They are. Um, you know, if you're dealing with a serious addiction... You know, or even a mundane thing like cigarette smoking. I mean, that's addictive. That's hard to break. Foods can be addictive, but you know, there's always other stuff to eat. The problem we have with food is not that it really has such a big hold over us. We can break those habits. The problem we have is that we have a culture that puts bad stuff in front of us constantly. So we're just getting teased all the time. But to tell you the truth, to avoid it is really physiologically and psychologically pretty easy.

• 1:43:53Rich Roll?

  So if someone's listening to this and they're motivated to finally take that leap, what is the one thing, like what's the one most important first step or thing they can implement, the simple change they can do immediately?

• 1:44:07Speaker 01

  Well, you know, I mean, I think everyone has to get educated and that's where you've done a fabulous job with your podcasts and getting in from in your books and you know, you've gotten, you're really educating people in a great way. So people do need to get educated and then I think they need to, to tell you the truth, have fun with it. This is not like punishment. Have fun. There are books and websites and products at the store. Shop. You know, that's what Americans do so, so well. A generation ago, a health food store was a dingy little place where the cashier was named Sunshine and they had a few products gathering dust. Today, health food stores are cool. They got everything and try some of these products. Have fun with it. When you find recipes or products or books or

• 1:44:50Speaker 01

  websites or DVDs that you like, share them around and have fun with it. And so in your social circle, people are trying the new things that you found and you're starting a new culture that is fun and is uplifting. That's the beauty of diet change. It is, it's people who get into a healthy diet, they don't feel deprived. When I was a kid, growing up-

• 1:45:14Rich Roll?

  That's the big secret that needs to get exposed.

• 1:45:17Speaker 01

  When I was a kid growing up in Fargo, every day of my life, I ate roast beef, baked potatoes and corn, except for special occasions when we ate roast beef, baked potatoes and peas. You know, it was, it was a very limited diet. Once I started a vegan diet, I discovered I can have Thai food. Never had that in Fargo. You could have spaghetti with, you know, an arrabbiata sauce. You could have sushi, not the fish sushi, but cucumber sushi or asparagus sushi, whatever it is. You can have Vietnamese food, Sichuan food, Hunan food, all this stuff, Ethiopian food. The great cultures of the world have figured out how to turn humble lentils and grains and fruits and vegetables into delicious feasts.

• 1:46:01Speaker 01

  And if you told me, "No, you can't have any of that. You go back and have roast beef, baked potatoes, and corn." That is a diet of deprivation. A plant-based diet is not the extreme end of a dietary exploration. It's the beginning of it.

• 1:46:18Rich Roll?

  And if you want to get educated, the best place to start that exploration is at PCRM.org, of course, right?

• 1:46:27Speaker 01

  But we do have a lot of information.

• 1:46:29Rich Roll?

  And reading one of the 2,000 books that you've written, which one to start with? I guess Dr. Neil Barnard's Program for Reversing Diabetes is great, The 21-Day Weight Loss Kickstart. On the Alzheimer tip, you have a book called Power Foods for the Brain. And I don't know, how many books have you written?

• 1:46:47Speaker 01

  I just finished my 18th book.

• 1:46:49Rich Roll?

  You did? I'm feeling super lazy.

• 1:46:53Speaker 01

  Rich, I'm, yeah, don't be such a slouch, Rich. No, I'm super excited about this one. It's all about cheese. Because people come in here all the time and they say, "You know, you're right. I'm feeling great. I've lost weight. I'm feeling so good." But the one food I'm craving is cheese. So I've written a book.

• 1:47:10Rich Roll?

  I could do this, except I just can't give up cheese.

• 1:47:13Speaker 01

  Right. And so my question was, A, why is that? What is it about cheese? And I believe we know now.

• 1:47:20Rich Roll?

  What is it?

• 1:47:21Speaker 01

  Well, it's a few things. Really, three things, three reasons why we're addicted to it. One is it's extremely high in salt. You know how we like salty foods. Number two, it's quite high in fat. And to give you some numbers, a two-ounce serving of potato chips has 330mg of sodium. A two-ounce serving of Velveeta has 800.

• 1:47:45Rich Roll?

  I wouldn't have thought that.

• 1:47:47Speaker 01

  Yeah, no, it's true. And also, these fatty salty things, like french fries, like potato chips, we get hooked on them, and cheese has them all beat. But there's more to it. The protein in dairy, casein, breaks down to produce mild opiates called caseomorphins. That, yes, they do pass from your digestive tract into your bloodstream and into the brain, according to the best research we have. And they are, it's, they are in the same chemical class as heroin or morphine. They attach to the same mu receptors on the brain as other opiates. And they cause a mild calming effect and a very, I believe, a very mild addictive effect.

• 1:48:30Speaker 01

  They're in milk, but they're heavily concentrated in cheese. So I think of cheese as sort of dairy crack.

• 1:48:36Rich Roll?

  Yeah, I mean, there's, in my own personal experience, when I let go of eating meat, it really wasn't that big of a deal. And I realized, you know, I was, I'd been eating it for so long without thinking about it. And it's just in front of me and I ate it, you know. And letting go of it didn't seem to be that big of a deal, but cheese was a whole different story. You know, that was a process.

• 1:48:57Speaker 01

  It is, and that wouldn't matter if, if it weren't 70% fat, mostly saturated fat. So I personally believe that the rise in cheese consumption, which is a rise of about 30 pounds per person per year, um, over the past century or so, I think it's the biggest reason for obesity, or certainly one of the major contributors, especially for these pudgy little kids, whose parents are well-meaning and providing cheese pizza for them every night.

• 1:49:25Rich Roll?

  That's great. When is this book coming out?

• 1:49:27Speaker 01

  February 2017.

• 1:49:28Rich Roll?

  And what's the title?

• 1:49:29Speaker 01

  It's called The Cheese Trap.

• 1:49:30Rich Roll?

  I like it. We're actually working-

• 1:49:32Speaker 01

  It's a fun, I gotta say, it's a, it's kind of a fun book, too. Because I've looked, cheese is a quirky thing. It's made with bacterial cultures, some of which are the same ones that cause stinky feet. So there's, there's an amusing side of cheese, but there's also a- A heartbreaking side when you look at its health effects, its environmental effects, what the animals go through. But there's a fun side of replacing it. And I've been working with a beautiful, wonderful recipe developer named Drena Burton. And maybe you'd probably know Drena in Vancouver. She's just fabulous. And we've been having a blast with all these non-dairy main dishes and appetizers and desserts. It's just been so much fun.

• 1:50:17Rich Roll?

  That's great. And there's so much happening in the non-dairy cheese world right now. The products are getting better. I mean, forever, you know, the non-dairy cheeses were terrible, but now they're actually quite good. There's a whole, you know, variety of options out there. And we, and by we, I mean my wife, is currently finishing up a nut cheese cookbook.

• 1:50:39Speaker 01

  Wow, fantastic.

• 1:50:41Rich Roll?

  For the very same reason. Because this is the thing, right? People like cheese is what holds a lot of people back. And I think that there's a lot of ways to help people make this transition if you can solve that problem for them.

• 1:50:55Speaker 01

  It's true. And even though we can kind of bad mouth commercial pressures, here's the case where the industry is working for us in a really good way.

• 1:51:02Rich Roll?

  You're an inspiration. I really appreciate the work that you do. You've been so helpful to so many people. And, you know, your advocacy and everything that you're doing is very inspiring to me personally. And you're just a great example of service. And just from afar, you've been a mentor to me, and I appreciate that. And I wish you only the best and continue, I hope that you continue to blaze the trail that you've been blazing. So thank you for your time today.

• 1:51:31Speaker 01

  Well, thank you, Richard. Right back at you. You've inspired lots of people. And it's wonderful what you have done in so many ways. And every time I turn around, another person has been educated and inspired by the work that you've done and how you've gotten the word out. So thank you for that. You're making my work a whole lot easier.

• 1:51:47Rich Roll?

  I appreciate that very much. And we have a treat. We're gonna take people out. Neil has a secret life that he doesn't talk about too much, which is that he is a musician. And he is going to grace us with one of his songs. We're gonna take you guys out with a tune. Why don't you tell us a little bit about that?

• 1:52:05Speaker 01

  Yeah, when I was a little kid, my parents insisted that I study piano and then study Cello, and then I took up guitar of my own. And so all my life I've played music. And it's for me, instead of television, this is what I do. So I write songs. So I want to play a song that I wrote for a friend of mine does work with Vietnamese children and asked me to write a song for her, for this. And I wrote a song called "Song to a Sparrow." And it's about the fragility of life. And I think you might like it.

• 1:52:39Rich Roll?

  I love it. Thanks for sharing that with us. All right. We did it. How do you feel?

• 1:52:45Speaker 01

  Fantastic.

• 1:52:46Rich Roll?

  All right. Thanks. Peace. Plants.

• 1:52:56Rich Roll?

  All right, we did it. What do you guys think? I think that was pretty extraordinary, right? I really hope that it helped expand your horizons, perhaps got the gears of your brain churning when it comes to how we think about nutrition and the inherent power of the body to heal itself when treated appropriately. Absolutely fascinating stuff. And perhaps not the least fascinating aspect of this conversation, for me personally at least, was discovering that Neil has this whole other life as a musician. I mean, this is something I definitely did not know. And I would imagine most of you out there who are already familiar with Dr. Bernard and his work probably didn't know either.

• 1:53:38Rich Roll?

  So please, stick around to the very end, because I'm going to take you guys out with one of his songs. It's called "Song for a Sparrow." It's a tune that Neil wrote with beautiful, ethereal vocals, and it comes from his album entitled Verdun, which is this really eclectic collection of songs that feature a unique blend of rock guitar and electronica with a Vietnamese influence, which is super interesting. He even does a rendition of Hendrix's "Purple Haze." I mean, I know, right? Who would have thought? Anyway, you can learn more about Neil's music at verdunmusic.com. V-E-R-D-U-N music dot com. So check that out.

• 1:54:20Rich Roll?

  And if you like it, please give him a shout out on Twitter at DrNeilBernard, D-R-N-E-A-L-B-A-R-N-A-R-D, two As, and let him know. He's got a new album coming out in a few weeks, so maybe I can cajole him to come back on the podcast when that comes out and talk about it a little bit more.

• 1:54:41Rich Roll?

  Anyway, as always, please make a point of checking out the show notes on the episode page at ritual.com. I've got tons of links and resources that are derived from today's conversation to really help edify you beyond the earbuds. Lots of great stuff there to continue the exploration. As always, please make a point to subscribe to the show on iTunes if you haven't done that already. It really does help us out a lot, particularly in terms of boosting visibility on the iTunes platform. Just takes a second, click that subscribe button. And also, if you haven't done already, please don't forget to sign up for my newsletter. In addition to weekly podcast updates, you'll get exclusive access to something I call

• 1:55:21Rich Roll?

  Roll Call, which is a short, very brief email blast every Thursday that contains a bunch of instructive recommendations and resources, just a few things that I've discovered and enjoyed and found helpful. I'm not going to spam you ever. So if this sounds like something you might be into, you can sign up for it at ritual.com. Of course, go to ritual.com for all your Plant Power schwag and merch needs. We've got signed copies of Finding Ultra and The Plant Power Way. We've got cool Plant Power t-shirts and tech tees and stickers and just all kinds of fun stuff. I want to thank everybody who helped put on the show today. Jason Camiolo for audio engineering and production. He's doing a great job. Sean Patterson for all his help on graphics. Chris Swan for production assistance

• 1:56:04Rich Roll?

  and also for help with compiling the show notes, which is very important. And theme music, as always, by Anna Lema, but also this week's interstitial music by Dr. Neil Bernard. And of course, Song for a Sparrow, that's going to take us out today, by Neil from his album Verdun. In any event, thanks for all the support, you guys. I really appreciate it. And I'll see you back here soon. Peace. Plants.

• 1:56:59Speaker 02

  ... A tiny raindrop, A tear from heaven, Today you open your eyes.

• 1:57:33Speaker 02

  All is all of a change. Wherever winds lead you, On their way to nowhere. May your heart always be

• 1:58:03Speaker 02

  In love's wings. Take you over mountains. May your dreams Reach through the sky. Just before you leave.

• 1:58:46Speaker 02

  Oh, turn back my friend. May winds be gentle. May rains be gentle.