Is Butter Really Back? Heart to Heart with Cardiologist Joel Kahn

America's #1 killer, heart disease currently kills 1 out of every 3 Americans; 70% of Americans are obese and getting fatter; and Studies forecast that by 2030, 50% of Americans will be diabetic or pre-diabetic. The great irony in all of this is that, as Dr. Kahn so astutely points out, 80-90% of all chronic health problems can be resolved via pretty simple diet and lifestyle alternations. The tricky part is translating these lifestyle alterations from theory to practice. I understand that it can be difficult for many, particularly when there is so much confusing information out there concerning about heath, nutrition and diet. So confusing in fact, that it becomes incredibly challenging for even the most savvy consumer to separate fact from fiction and truth from hyperbole. Just because good news about bad habits makes for tempting clickbait doesn't mean the information is reliable — its usually not. To help sift through all of this, I once again sit down for a heart to heart (pun intended) with cardiologist Joel Kahn, MD — you can listen to our first conversation (RRP #44) here. A Summa Cum Laude graduate of the University of Michigan's prestigious Inteflex program (a 6-year undergraduate / graduate program that developed doctors fresh out of high school), Joel has served as Clinical Professor of Medicine (Cardiology) at Wayne State University School of Medicine since 1993. He's authored over 130 articles on heart disease, is a frequent lecturer on heart disease and its prevention, has performed thousands of cardiac procedures, and has been advising patients on heart healthy programs for over 20 years. Not only does Dr. Kahn know what he is talking about, his basic message is elementary: if you want to experience true long-term wellness, then you must focus on implementing sustainable long-term preventive protocols into your lifestyle. This starts and ends with diet and active lifestyle. The specific thrust of this conversation focuses on separating truth from marketing with respect to certain zeitgeist trends in nutrition science. To wit: Is butter really back? What are the health impacts of a low carb / high fat diet? What are the risks (and benefits, if any) of trendy practices like putting butter and oil in your morning coffee? Is everything we thought we knew about saturated fat truly wrong? Who was Ancel Keys and what is the import of his nutritional studies? What is the true impact of dietary cholesterol on arterial and heart health? Finally, and most importantly, what specific dietary and lifestyle protocols does this veteran cardiologist recommend to maintain optimal heart health in a culture in which heart disease has become a wildly out of control pandemic? You'll want to tune in to find out. Amazingly informative, this is straight talk from a solid guy. An awesome and trusted and educated and experienced and entertaining guy I am proud to call my friend. I sincerely hope you heed the call and enjoy the conversation. Peace + Plants, Rich Learn more about your ad choices. Visit podcastchoices.com/adchoices

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

• 0:00Rich Roll?

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• 0:44Rich Roll?

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• 1:06Joel Kahn?

  Eighty percent of chronic diseases that are costing our country a fortune, causing people to lose relatives, and lose limbs, and lose loved ones, and work interruptions, and all kinds of tragic situations, are entirely preventable by simple, inexpensive lifestyle steps.

• 1:21Rich Roll?

  That was Dr. Joel Kahn, and this week, it's all about heart health on episode 128 of the Rich Roll Podcast.

• 1:38Joel Kahn?

  The Rich Roll Podcast.

• 1:41Rich Roll?

  Hey, everybody, I'm Rich Roll, your friendly neighborhood ultra-endurance athlete, bestselling author, wellness evangelist, husband, father of four, dog owner, plant eater. Thanks for tuning in. What do I do here? Well, each week, I sit down with somebody really amazing. Sometimes, it's somebody you've heard of, sometimes not. But collectively, in my opinion, together, these people constitute some of the brightest, most forward-thinking minds in health, wellness, fitness, sports, nutrition, and sometimes even the arts and entrepreneurship.

• 2:17Rich Roll?

  All people looking at the world differently, all challenging the status quo, breaking paradigms. Why do I do this? To help you discover, uncover, unlock, and unleash your best, most authentic self. Thanks for listening. Thank you for spreading the word to your friends, to your colleagues, to your coworkers, to your family members on all your social media networks. And thank you for clicking through the Amazon banner ad at richroll.com. Come on, you guys. What's up? If you're not doing that, get with the program. It's totally free. Takes no extra time. Does not cost you a cent extra on your Amazon purchases. But Amazon kicks us a little loose commission change, and that really helps us out, helps keep the lights on over here.

• 3:02Rich Roll?

  So, thank you so much to everybody who's been doing that.

• 3:12Rich Roll?

  All right, you guys. You've heard me say it a million times. Despite all this interest, all this intrigue out there that's revolving around wellness and health and diet and nutrition and fitness, the simple fact remains that, in the United States at least, we are in the midst of an almost unspeakable healthcare crisis. Let's look at heart disease, America's number one killer. Well, heart disease kills millions of people annually. Millions. In fact, one out of every two Americans will suffer from some form of heart disease in their life. And one out of every three deaths in the United States is attributable to heart disease. 70% of Americans are obese,

• 3:55Rich Roll?

  and indications are we're getting fatter. And studies forecast that by 2030, 50% of Americans will be diabetic or prediabetic. So, right now, what does this mean? Well, 75% of all healthcare costs are attributable to just four chronic conditions: heart disease, obesity, diabetes, and two forms of cancer, prostate and breast. And the great irony in all of this is that 90% of all chronic health problems can be resolved by a pretty simple diet and lifestyle alterations.

• 4:34Rich Roll?

  But here's the tricky part. Amidst all of this is a ton of confusing information about health and nutrition and diet. And it's really difficult, if not altogether impossible, for even a very, very savvy consumer to separate fact from fiction, to separate truth from hyperbole, to divine the difference between good information on the one hand and good news about bad habits on the other hand. Because those are two different things. So today, to help me sift through all of this, I sit down with my good buddy, Dr. Joel Kahn. If you're a longtime listener of the podcast, you might remember that I had him on the show, it must have been a year and a half ago.

• 5:19Rich Roll?

  It was episode 44. So if you want his whole origin story, go back and listen to that episode. But real quick, who is Joel? Well, Joel is a guy who calls himself an interpreventional cardiologist. What does that mean? Well, it means, basically, that he treats his patients with a blend of traditional interventional cardiology, in other words, things like stents, and also preventive cardiology. And it's this rare combination that makes him pretty unique in his field. This is a really smart guy. He graduated summa cum laude from the University of Michigan's prestigious Inteflex Program,

• 6:00Rich Roll?

  which is this crazy six-year undergraduate/graduate program that basically develops doctors fresh out of high school. It's like you graduate from high school and you're immediately in medical school. And Joel has served as Clinical Assistant Professor of Medicine in Cardiology at Wayne State University School of Medicine since 1993. He has authored over 130 articles on heart disease. He is a frequent lecturer on heart disease and its prevention, and he has performed thousands of cardiac procedures and has been advising patients on heart-healthy programs for over 20 years. So what am I saying? Well... Basically, I'm saying Joel is a guy that knows what he's talking about.

• 6:42Rich Roll?

  And his basic message is, look, if you want to experience true long-term wellness, then you're going to have to focus on implementing sustainable, long-term preventive protocols into your lifestyle. And this starts and ends with diet and active lifestyle. This is not brain surgery, you guys. But today, the main, and really the specific thrust of our conversation is focused on what is really going on in nutritional science? What is truth and what is marketing? In other words, or for example, is butter really back? And what are the health impacts of a low-carb, high-fat diet versus a plant-based diet?

• 7:24Rich Roll?

  What are the risks and what are the benefits, if any, of hyped-up trends like butter and oil in your morning coffee? What is going on with this idea that suddenly everything we thought we knew about saturated fat is wrong? And now suddenly, it's our best friend? And this related idea that dietary cholesterol intake has no bearing on heart health? This is like the new idea that's out there right now. I really wanted to get his opinion on this subject, as well as his opinion on the optimal protocol to maintain heart health in this culture in which heart disease is literally an epidemic that has already spiraled far, far out of control. So this is a good talk. It's straight talk. Joel is awesome.

• 8:09Rich Roll?

  This one's not only educational, it's completely fun and as well as informative, and I hope you enjoy it. So let's tap into Joel and see what he's all about. So this is a unique situation. I checked my Instagram this morning. I noticed my good friend Joel Kahn happens to be in Los Angeles for unknown reasons. You're greeting the sunrise in LA. So what do I do? I immediately email you and go, what are you doing here? Are we doing a podcast or what?

• 8:41Joel Kahn?

  Yeah, I'm in the witness protection program. I'm not actually privy to explain why I'm in LA. And I'm using a pseudonym.

• 8:48Rich Roll?

  Well, I mean, you know, Detroit this time of year, you gotta escape. And look at this terrible weather that you brought with you.

• 8:54Joel Kahn?

  I know. I actually, I sadly rented a Mustang convertible thinking it was gonna be the big stud going up and down 405. But Big Stud had the top up, unfortunately.

• 9:04Rich Roll?

  Yeah, yeah, yeah. So this is cool. This is our second time on this little merry-go-round. And thank you for making the time. Usually I sit down, I do a lot of deep thinking, pondering what the podcast is gonna be. Plenty of research, but this is all very spontaneous. You, I want to talk about what you were doing earlier today, but you drove up here. We're kind of having a little bit of a, not a party, but we have some friends over, some of which you know, actually. And we're just all hanging out. We're like, hey, let's do the podcast. All right, so it's a, this is a Saturday night at the Roll household, so welcome.

• 9:36Joel Kahn?

  Doing lines of cacao. I've never quite seen that done before, but I'm feeling good.

• 9:40Rich Roll?

  Yeah, good. All right. Well, if you start to, you know, see stars or slur, we'll, we'll, we'll adjust.

• 9:47Joel Kahn?

  No problem.

• 9:47Rich Roll?

  Yeah, but you did sign the release, right?

• 9:49Joel Kahn?

  It's all good. I'm a...

• 9:51Rich Roll?

  Cool. So you came in town to, you were speaking this morning at Saddleback Church, right?

• 9:56Joel Kahn?

  You got it.

• 9:57Rich Roll?

  Tell me about that.

• 9:58Joel Kahn?

  Yeah, it, um, there's a great story that about three and a half years ago, Pastor Rick Warren, who is famous for a lot of good things and a book he wrote that sold 35 million copies.

• 10:09Rich Roll?

  Did it sell that many?

• 10:10Joel Kahn?

  Thirty-five. Yeah. I think it's the best-selling book other than the Bible.

• 10:14Rich Roll?

  Really?

• 10:15Joel Kahn?

  Something like that.

• 10:16Rich Roll?

  Wow.

• 10:17Joel Kahn?

  Even bigger than Grain Brain and Weed Valley. But, um, uh, the story goes that he was baptizing 850 people one Sunday about three and a half years ago and dunking them and bringing them out of the tub. And he realized that not only had he become quite corpulent, as they say, but his church was oversized and his shoulder was killing him. And he had this vision that he had to clean up this 30,000 megachurch and introduce good health. So, uh, long before I knew of that, he brought in Dr. Dr. Oz, Dr. Mark Hyman, Dr. Daniel Amon, and some others. Got a director by the name of Dee Eastman, who's just a doll of a human being.

• 11:00Joel Kahn?

  And really, they created a vision that they were going to use this church as an experiment in lifestyle change and behavior change. What they had, which was awesome, they had about 10,000 small Bible study groups all over Southern California. And they instituted a program that some portion of every Bible study group had to be dedicated to cleaning up your diet, your exercise, stress management, better sleep. With a formal curriculum called the Daniel Plan, which a lot of people have heard about. And in that first year, some excess of 250,000 pounds were lost by about 16,000 of the congregants signed up in the first week. So, just this mass action.

• 11:38Rich Roll?

  How long, that was, how many years ago was that?

• 11:40Joel Kahn?

  About two and a half years ago. And then, they had such a remarkable success with this kind of lifestyle change plan. Kind of, you know, food being the focus, but not the only component. In fact, they talk about food, fitness, focus, friendship and fellowship and such, the five F's, the five pillars. That they've developed a yearly health rally, just to kind of keep people on track and focused and all. So, I came out as a guest last year and participated a little, but I got to be on the stage, the dais, for any of my Jewish friends, the Bima.

• 12:12Rich Roll?

  And as a Jewish, as someone of the Jewish persuasion, being in this, I mean, it's like a mega church, right? I mean, I've never been inside it, but give me an idea of like, how many people are there? Like, this dais is enormous.

• 12:24Joel Kahn?

  Yeah, well, you know, there's, I understand there's multiple sites for Saddleback Church. This is the main site in Lake Forest, California. And it's in itself a huge complex. I mean, kids' centers and ministry centers and all. But we were in a room that probably holds about three or 4,000, and it was packed to the roof. Incredible stage. It was about a three-hour event, celebrating health. And we had four chefs on stage. That's the part I did, I was the John Madden of color, kind of conversation. It was kind of fun, what Mark Hyman spoke for a while about clean diets and. Daniel Aiman spoke about good brain health. But I was working with the chefs and they would basically show a before and after. What's in your pantry now?

• 13:09Joel Kahn?

  What's in your refrigerator? What can you substitute? And I got the job of being the person to destroy the bad food. So I was jumping on bags of Lucky Charms in front of church congregants. You know, that's what I trained for in medical school. The funniest thing was I was handed a box of Lunchables and a chance to talk about how wonderful that highly processed food that most kids eat for lunch nowadays in school. And it inspired me that I should just throw it on the ground and just destroy it. So I jumped on it with my full force, not knowing it would just explode all over the front row, kinda like Nickelodeon and the goop.

• 13:45Rich Roll?

  This is your Broadway moment. Now I know why you're really here, right? The former entertainment lawyer in me is coming out and I'm going to squire you into town tomorrow and find you an agent and your career is about to take a whole new turn, Joel.

• 14:00Joel Kahn?

  We're gonna be destroying processed food, kinda like Led Zeppelin crashing guitars. So it was a great event. I mean, they do great stuff down there.

• 14:08Rich Roll?

  Uh huh, cool. And so who else? So Mark Hyman was there. Who else was speaking?

• 14:14Joel Kahn?

  Daniel Aiman. Dr. Oz was involved in originating it, but he doesn't come out very much. And then a tremendous fitness team. There was, you know, dancing and zumba going on and a couple of behavioral psychologists were speaking. John Townsend wrote a book called Barriers, really good advice about how to kinda control yourself and control your kids with reasonable approaches to them. It's fantastic this is occurring in a church and I give these people amazing credit. My connection was I did the Daniel Plan in my synagogue in Detroit. We were the first Jewish faith-based institution to kinda use their system.

• 14:54Rich Roll?

  And what is the Daniel Plan? Like, how do you synopsize that?

• 14:59Joel Kahn?

  Eliminating bad, putting in good in terms of both food and fitness and positive mental focus for change. So, I mean, the core elements would be eliminating dairy, eliminating processed food, upping your fruits and vegetables. I mean, most of it is completely, you know, wonderful stuff. But it's fascinating that it's coming out of, you know, faith-based community as opposed to why isn't the hospital doing this?

• 15:23Rich Roll?

  Right.

• 15:24Joel Kahn?

  Why isn't the medical center as involved in the community as this? So, I think it's tremendous and I'd support as they are trying to spread the word and have this reproduced all over.

• 15:34Rich Roll?

  Yeah, it's super interesting when you can see that kind of impact happening on a community level, coming through, you know, an organization like that. I think it's, I think it's really cool.

• 15:42Joel Kahn?

  Yeah.

• 15:43Rich Roll?

  First the Pope, you see what the Pope's doing and now see what Rick Warren's doing, what's going on?

• 15:47Joel Kahn?

  Yeah. Unfortunately, Rick was there last year. He actually, all that baptizing, he had to have his shoulder operated on last week.

• 15:55Rich Roll?

  Oh, really?

• 15:56Joel Kahn?

  And even though, even though his community has gotten a bit thinner and it's a bit easier to put him, pull him and put him out of the baptismal, he had to actually have some kind of surgery. So, we wish him well and a quick recovery.

• 16:07Rich Roll?

  Interesting. Well, I haven't seen you since the Mind Body Green Revitalize Conference, but you're looking well. You're looking fit.

• 16:15Joel Kahn?

  It's a lot of chlorella.

• 16:16Rich Roll?

  Yeah.

• 16:18Joel Kahn?

  It is a lot of chlorella.

• 16:19Rich Roll?

  Well, that, that prompts a spontaneous question out of me. Like, I Instagrammed, like, "Oh, smoothie of the day." And I said, "Oh, this, this one happens to have spinach in it, hemp seeds, chia seeds, blueberries, strawberries, and spirulina." And I got a bunch of comments about, like, "I gotta, I gotta watch out with the spirulina." So, tell me what's going on.

• 16:40Joel Kahn?

  Yeah, there's, there's been some contamination. Even our good friend, Dr. Joe McCullough has written about it. I mean, it's been out there in the web that some sources in Asia of spirulina have been contaminated, I think, with a fungus.

• 16:53Rich Roll?

  There's some toxicity issue or something like that?

• 16:55Joel Kahn?

  Yeah.

• 16:56Rich Roll?

  Yeah, I think Dr. Greg Erk did, did a video on it as well, which I should, which I should go and check out. But people were saying, "Yeah, you might want to opt for chlorella, not spirulina."

• 17:04Joel Kahn?

  Yeah, there's been that word. I actually can't give you the latest world's update on if our spirulina sources are now clean. I actually do take spirulina, you know, pretty regularly also.

• 17:14Rich Roll?

  Yeah, I have been for some time, but now I'm worried.

• 17:17Joel Kahn?

  You're looking pretty good. You saw what I wrote.

• 17:19Rich Roll?

  I don't feel toxic.

• 17:20Joel Kahn?

  You saw my comment. What was my comment on your Instagram?

• 17:22Rich Roll?

  Uh, I don't know. What was it?

• 17:24Joel Kahn?

  You're looking kind of 18 for a guy that's 48.

• 17:26Rich Roll?

  Oh, yeah, now I remember. How could I forget that?

• 17:28Joel Kahn?

  Yeah, that was true.

• 17:29Rich Roll?

  Yeah, and now here you are doing a podcast. I mean, how does that work?

• 17:32Joel Kahn?

  Who would have known?

• 17:34Rich Roll?

  Mysteriously, right?

• 17:35Joel Kahn?

  That's right.

• 17:36Rich Roll?

  Um, and how's the relationship with Dr. Hyman? Because I know the last time I saw you, like I said, it revitalized. You were, you were, you were kind of doing this program with him where it was sort of vegan versus paleo. And it was you and, uh, and Dr. Hyman and

• 17:51Joel Kahn?

  Frank.

• 17:51Rich Roll?

  Our friend Frank Lippman, who has also been on this podcast. You guys had a jovial, uh, kind of banter and, uh, and now you're doing events with him.

• 18:00Joel Kahn?

  Yeah, no, uh, Mark's been a mentor, Dr. Mark Hyman, uh, to me. And, um, you know, he's a force. He's tremendous. I mean, if you take the view that highly processed food is creating the obesity crisis in America and job number one is getting rid of, uh, you know, the, uh, the, the team of PhDs that are making addictive and hyper-processed foods that dominate what kids are eating and adults are eating. We're all one team because, you know, the Daniel Plan's a clean diet in terms of that. And, uh, uh, so is everything that Mark writes about. What he's doing now and it's really fascinating is you may or may not know, he's been appointed the head of functional medicine for the Cleveland Clinic.

• 18:44Rich Roll?

  I didn't know that.

• 18:45Joel Kahn?

  I had a chance to talk to him about it and there are amazing things that they're supporting it financially. Just incredible. So again, we're talking about getting into kind of the grassroots, uh, causes of disease, which is going to go to nutrition and fitness and stress and sleep as opposed to just giving a pill for everything or getting a laser and operation for everything. And, um, I think you're going to see a great model coming out of there. The medical system has to change. It's just unbelievably, uh, locked into the idea that we got 10 minutes with a patient and the easiest thing to do is prescribe something as opposed to kind of address the root cause. So I mean, I hope he's widely successful there.

• 19:24Rich Roll?

  Yeah, I do too. And I think that brings up a really important point, which is, you know, let's focus on the big things. You know, we can, we can get into the debate and split hairs over, you know, high carb, low carb, high fat, low fat, all these sorts of things that we love to kind of obsess about. But let's, let's bear in mind that, you know, I don't know what's going on now, but I think there was a McDonald's in the Cleveland Clinic. And, you know, most people are eating fast food on a, on a regular basis and, and really don't even have, you know, the first aspects of education when it comes to the kind of things that we're talking about. So I think it's much more productive to focus on how we're going to all get together and, you know, in the sense of community, which is

• 20:06Rich Roll?

  how we kick this podcast off, start to talk about and address these problems and solve them together, hand in hand, as opposed to bickering amongst ourselves over, you know, this aspect versus that aspect.

• 20:18Joel Kahn?

  Well, I agree. I mean, from, you know, you and I are of one mind when you talk about the environment, you talk about animal rights and animal cruelty. There's only one approach you can really take if you want to be consistent and authentic there. But when you get to health and what's happening, and you put on blinders about those two critically important issues, you know, there are multiple pathways to health that appear to work. And the unifying statement is, we've been just, you know, led down a path of unbelievably horrible food for 60 years. And it is epidemic, and it has to turn around. And if the Cleveland Clinic and the CEO there is a cardiac surgeon, and he's just like, supporting this to the max,

• 21:00Joel Kahn?

  which is such a rare example. But I hope other hospital CEOs take note and play catch up, because we need it everywhere.

• 21:08Rich Roll?

  Right, right. Interesting. Right, for sure. For sure. And then, you know, so, so there is that kind of on the, you know, the mass level. But, you know, I'm also trying to parse through like, all this stuff that's going on with nutrition right now. And I've been known to email you from time to time, like, hey, I'm hearing this. What do you think? And one of the interesting kind of email chains that I've been lucky enough to be on with you recently has to do with something that's going on right now that's really popular, which is this idea that, you know, per the cover of Time Magazine, that butter is back and everybody's drinking bulletproof coffee with MCT oil or grass-fed butter in it and

• 21:49Rich Roll?

  that this idea that saturated fat is bad is not true. Saturated fat is your friend and that cholesterol does not contribute to heart disease is, you know, in a most general sense, kind of, is it fair to say that those are ideas that are kind of popular at the moment? And they fly in the face of kind of what I was led to believe was the truth. And so I would reach out to you, hey, what do you think is going on here? What, you know, what's the truth? And if you go online and research it, you're, you can find support for whatever perspective, you know, you're coming from. So it's very difficult. You know, I'm not a doctor, I'm not a nutritionist, but I'm relatively savvy when it comes to

• 22:32Rich Roll?

  these things. And even for me, it's difficult to parse truth from fiction. I can't imagine just the average consumer, you know, that they're really at the prey of whoever is the most effective at marketing. So I'm interested in your perspective on this and kind of, you know, how we should approach this.

• 22:50Joel Kahn?

  Yeah, and that's a very well said introduction and very diplomatic. And it is very difficult. I'm not even sure, you know, if you just stop people on the street and said, how many of you give a hoot about this? Or do you even know that there's this like controversy? Because I agree, you and I obsess about it.

• 23:09Rich Roll?

  Right, we're, we're in, you know, we're in it. But, but, but you're, I mean, to be fair to you, you're, you're on the front lines. Like, you're a cardiologist. You're the person who is looking inside these people's chests and saying, and seeing these clogged arteries and trying to address the problem. You're, you're, you're right there, front and center. So I would imagine that you're more connected to this issue than most people.

• 23:30Joel Kahn?

  I agree with you. And, you know, I don't know if it's fair to say I care more, but you're right. I do, I do want to give the right advice to my patients. I do want to help them. And actually, I want a wider audience than just my patients. I want to be an influence leader for the country because it's a critically important question.

• 23:50Joel Kahn?

  And again, I think in the bigger area, do we need to, if we had to sort out the low fat, high fat, low carb, high carb, or just get donuts and Lucky Charms and Skittles out of the schools? I mean, let's, we gotta do both. I mean, there's, there's a different issue there of just getting rid of all this crap that's surrounding. And again, I keep coming back to kids. It's just making kids develop diabetes and early heart disease. But if you get down, you know, to the question you asked, I mean, I'm just gonna take a couple of minutes and go through it. I mean, my understanding, and I've been a pretty good student of it, and probably this has come up on the podcast before, but there was this

• 24:31Joel Kahn?

  kind of concept until the 50s that heart disease was an age-related disease, that you lived old enough, you got it, and it wasn't something under your control. And that was at a time that maybe people were living 50, 55 years, 60 years is their average lifespan. A couple of forces challenged that. The Framingham Study in Massachusetts started studying 6,000 people who lived outside of Boston and determined who got heart disease and follow up, and what were their habits, and what did they eat, and what was their lifestyle. And out of that, in about 1960, came the first publication, the Framingham Heart Study, that actually clearly connected smoking to heart disease, diabetes to heart disease, blood pressure to heart disease, high cholesterol to heart disease, a close

• 25:14Joel Kahn?

  family relative that had heart disease to your own risk. And we realized about 1960 on that heart disease wasn't just an age-related thing, that there were factors that influenced your chances, and that suggested there were factors that you could take control of. You could work to avoid diabetes, high blood pressure, smoking, obesity, and the rest. That was kind of a whole new concept in 1960. And part of that was the nutrition issue, which was kind of going on simultaneous. And we get back to the famous figure of Dr. Ansel Keys, who was far from the only Um, person, but probably the most prominent. And again, I'm not sure when I was on your podcast before we talked about that, but I've read a lot about the man. And I mean, the man's incredible.

• 25:57Joel Kahn?

  He lived a hundred years, died in 2004. He didn't just have one PhD, he had two PhDs. One from, uh, actually right here, Southern California, actually in oceanography, his first PhD. And then he went to Oxford and got a PhD in nutrition. And he came back to Minneapolis. That's some bizarre swift. From oceanography? Like, how does that work? Yeah, he was out here, uh, studying, uh, you know, health of animals and then changed it to health of humans. Um, went back to Minneapolis in the early 40s and started studying, he did a fame, one of the first studies of executives in Minneapolis and their risk of developing heart attacks and relationships with food and all. And this was really kind of novel work. And, you know, as some of the listeners know or not, um, another thing he did, because he was

• 26:42Joel Kahn?

  at that point a pretty well-recognized expert in starvation, a well-recognized expert in nutrition. Um, he developed for the army, the K rations, and the K is for keys. Right. Uh, it was a 3,500 calorie kit that a soldier could carry with them and survive for three, four days with enough nutrition to make it in the, uh, in service and undoubtedly saved lots of lives in that. But he started studying executives in Minneapolis and I believe, uh, he had a trip to Naples in the very early 1950s and discussed with some professors in Naples that they just basically never saw heart disease. And he was so intrigued by that concept after having studied executives in Minneapolis who had heart attacks and heart disease. Um, and

• 27:23Joel Kahn?

  really the, the very first seeds of what the Mediterranean diet might do for heart disease came in that early part. Mm-hmm. He published this very famous study in 1953, um, where he analyzed the rates of fat intake in the diet, the rates of heart disease in six countries. Um, it was not a prospective study, it was governmental data, something called the FAO, um, organization, which had a database of data on the topic. And he presented that he seemed to see a correlation between increased fat intake, he didn't, I'm purposely not saying saturated fat, because that wasn't even on his map. Increased fat intake in the diet, increased heart disease risk, and he

• 28:05Joel Kahn?

  presented it. And then he got this incredible pushback that, um, that wasn't correct.

• 28:11Joel Kahn?

  That was 1953. That is not the seven country study. As it turned out, as many people have heard this story, there were actually 22 countries in the database. And he later wrote why he didn't use 16 of the 22. And a lot of it was unreliable data. For example, Mexico was one of the 22 countries. Mexico didn't have death certificates at that time. Pretty hard to judge who died of heart disease when you're dealing with a country that didn't have death certificates.

• 28:37Rich Roll?

  Did it still correlate, though?

• 28:39Joel Kahn?

  So, in 1957, two other researchers by the name of Yuro, Shalmi, and Hillebu, Hillebu, published a paper that criticized Key's data. They added those 16 countries. And they showed that there was a correlation between fat and the diet and heart disease. They showed it a little bit weaker, but it was still statistically very valid. They actually didn't disprove anything. What isn't discussed much is when you looked at all 22 countries, which were not cherry picked by Keys, but were picked based on scientific invalid reasons, that actually animal protein was even more strongly related to heart disease than fat.

• 29:22Joel Kahn?

  And animal fat was more strongly related to heart disease than plant-based fats. In fact, plant-based fats were not. So indeed, in some way, Hillebu and Yuro Shalmi, these critics at the Paleo and Weston Price people rally around, actually moved the field ahead also by pointing out it maybe was a more, a data, a point you could get more specific about. Animal protein, animal fat were related to heart disease in all the data. All of that led Ansel Keys to try and scrap together a few dollars at a time that there was very little research going on. The NIH was funding almost nothing. And in 1958, he kicked off the seven-country study. And at the time, nobody appreciates how unusual it was

• 30:07Joel Kahn?

  to do this kind of research. And there was very little of it ever done. Went to, I want to say, 16 communities, 12,000 men. And they sent these forces into the field. They would go to a city in Italy, and they would go to every male in the city. And they would draw blood. They would do an EKG. They would do urinalysis. Like just mass epidemiologic associations of data points, way before computers. Everything's on paper. Everything's on... Cards and over the years, in fact, from 1958, it took 12 years, they published a paper in 1970 with just phenomenal amount of data that supported in a prospective, on the field

• 30:48Joel Kahn?

  way that there indeed was a relationship between animal saturated fat intake and coronary heart disease. The seven countries study, which is not what everybody points to in 1953, that was a different paper, that was six countries, that was just a retrospective analysis, is actually still ongoing, there's still data points being accumulated on these people from 1958 even to the current day, there's updated publications, it's been a phenomenal basis of research. And by about 1970s, 1971, the American Heart Association, seeing this gigantic database come out, adopted over the time the philosophy that Americans should try and decrease the

• 31:30Joel Kahn?

  amount of saturated fat in their diet to decrease amount of coronary heart disease. I don't see any problem with any of that that's gone along. The other interesting thing that started to happen, I'll just bring, is that, was anybody ever talked about North Karelia on your podcast? No, I don't think so. At that time, Finland had the highest rate of heart disease in the world. I mean, absolutely blew away every point that was out there. And a province in Finland called North Karelia, which is in South Finland, and I can't tell you why that occurs, the entire province, and I believe there's about 100,000 people that live there, they got together as a community because, you know, it's easy to say they had the highest risk of heart disease in the world.

• 32:14Joel Kahn?

  What that actually means is people your age and my age were dropping dead of heart attacks like flies. These strapping farmers, working in the fields, thin and fit, were dying of heart attacks. It didn't take much effort to realize why, they were adding butter in their diet, typically 10 teaspoons of butter a day on bread, they had a reasonably high smoking rate, they drank whole milk. Like banshees, it was the culture of Finland.

• 32:42Rich Roll?

  Mm-hmm.

• 32:42Joel Kahn?

  And the, um...

• 32:43Rich Roll?

  Not a high carbohydrate culture, right?

• 32:46Joel Kahn?

  Not much fish in there either.

• 32:48Rich Roll?

  But imagine like a lot of fish in that diet, right?

• 32:51Joel Kahn?

  Um, probably, probably, you know, being close to the water, there probably was. I can't really tell you that for sure. But animal saturated fat was sky high. And as a community effort, first in this province of North Korea, ultimately in the entire country, they got together as a community health project to say, perhaps you should use, um, uh, polyunsaturated margarine instead of whole butter. Perhaps you should try skim milk instead of whole milk. Um, perhaps you should quit smoking and, uh, and some other hygienic measures. They dropped around the same time, the risk of heart attack very quickly by eighty-five percent.

• 33:26Rich Roll?

  Eighty-five percent.

• 33:27Joel Kahn?

  Eighty-five percent. This is all published in peer-reviewed literature. The data still is coming from North Korea. It's by far one of the most compelling databases to say that reducing animal saturated fat in the diet reduces coronary heart disease. You know, there's so many other points to talk about, but when you take Keys' data, the North Korea data, the American Heart Association got on board with this concept that it should be a principle to limit animal saturated fat.

• 33:53Rich Roll?

  All right, so, so in the most general sense, Keys was like this gigantic figure in, in terms of, of sort of moving the ball forward with respect to research and heart disease. And, and I think it's fair to say probably a lionized figure who, at some point in our history, very recent history, there's been a revisionist kind of approach to this. And that lionization has gone to demonization. And, and there's a lot of finger pointing saying, all this research that led to, uh, the American Heart Association, et cetera, saying that we should be eating a low-fat diet is the cause of why we're having all of these problems because it led to, uh, I guess you could link

• 34:37Rich Roll?

  it to the amount of sugar that we're now eating as a result of packaged foods, trying to be low-fat and compensating with sugar and other processed, you know, uh, ingredients, et cetera. And suddenly we find ourselves in a position where the pendulum is swinging absolutely in the other direction. So what is it that happened? Why is this happening now? And what is the argument that is being, uh, used to say that Keys' research was wrong?

• 35:05Joel Kahn?

  Yep. So as I see the take, I mean, the American Heart got on board and started telling Americans, decrease the amount of fat in your diet. Well, Entenmann's cookies popped up and Pop-Tarts popped up and all these other things. Of course, nobody included that as what you should, I mean, somebody should have stood up and said, eliminate or decrease animal saturated fat and eat more fruits and vegetables.

• 35:29Rich Roll?

  Right.

• 35:29Joel Kahn?

  Eat more nuts and seeds, eat more hemp, but that wasn't the message.

• 35:33Rich Roll?

  Right. These packaged food companies would basically say, they want to be able to label their food as low fat.

• 35:39Joel Kahn?

  Right.

• 35:39Rich Roll?

  So how do you do that and make it taste good? Well, you gotta put a lot of salt in it and you gotta, or you gotta put a lot of sugar in it. You gotta make it taste good somehow, right? So suddenly, these foods, for the sake of being low fat, become unhealthy in a different respect.

• 35:52Joel Kahn?

  Absolutely. And what actually happened is the amount of saturated fat in the diet during this time that the American Heart Association was saying, limit it, it didn't go down. So that's the first point that nobody recognizes. The current health crisis of obesity and diabetes was not the result of the success of this message. It did not decrease. Standard American diet is about 35% fat, which is similar to 30 years ago. But the amount of sugar went up because people, and the amount of calories per day went up. But it was just adding in more and more, all the choices in the grocery store of prepackaged and highly processed food. And we're suffering from that. So that's one aspect, is that we actually

• 36:36Joel Kahn?

  never followed these recommendations. No surprise there. A recent story has come about that really the pendulum has shifted. I think it's been about the last two years. It's just really seems to be swinging, that this whole story was wrong and it was all

• 36:52Rich Roll?

  With Keys. Keys was wrong.

• 36:53Joel Kahn?

  The forceful personality of Keys slamming this down the throat of the American Heart Association, therefore the public heard about it. And if we had only just left everything alone, like Finland, just leave it like Finland and let everybody have their heart disease. So there is allegedly, I'm gonna share this, and I'm sure this hasn't been discussed in this podcast, a meeting in Mexico City in November 2008 of the world dairy producers, where they were very concerned that the American Heart Association was saying, and other bodies, the European Society of Cardiology, that we should limit our saturated fat in our diet to less than 7% of our total calories. That is the recommendation until just recently.

• 37:33Joel Kahn?

  Um, and apparently they devised a plan to increase funding of researchers that were milk-friendly researchers, not so much necessarily to influence what they were going to publish. Nobody's claiming that they actually were in there manipulating the data, but you know, you can pick people that are friendly and not friendly and give them funding or not give them funding.

• 37:54Rich Roll?

  The milk, the milk-friendly scientists.

• 37:56Joel Kahn?

  Milk lobby, the big milk, the big milk. And out of that, there's a feeling that a couple key publications, really in the last 12 to 18 months, have come out of that influence. And highly criticized studies, one in 2010, so that's actually a little bit longer. And then this Choudhury study that came out early last year. These are what are called meta-analyses, reevaluating the link between saturated fat and heart disease. Both of these studies, um, by an author named Siri, S-I-R-I, and one by Choudhury. Both of these allegedly identifying that when you take all the world data, that really

• 38:38Joel Kahn?

  when you look at it in a big perspective and in a statistical model called a meta-analysis, not new data, not going back on the field and measuring all these health parameters in 12,000 people or all, that they could not substantiate. Now, clearly, number one, the authors did not identify that eating more saturated fat was good for your health. They were questioning whether the link was true or not. Both of these very highly quoted studies have had a lot of critics. A cardiologist named Stanford in 2010 immediately jumped on that meta-analysis and pointed out all the flaws. And then the one that was published, I think it was March of 2014, again, it's called the Choudhury study.

• 39:22Joel Kahn?

  Harvard School of Public Health very quickly just sliced and diced it, and it's continued to be sliced and diced, but the word was out. And they, if you want to say the damage was done, um, in terms of making New York Times, Wall Street Journal, media all over, that, um, you know, media loves controversy. So all of a sudden, we got new data that saturated fat isn't so bad for you, which Wasn't the message, it's good for you, but you know, it was one more break in the armor that we had a consistent story since Keys and all of a sudden it wasn't consistent.

• 39:54Rich Roll?

  It's, it's really interesting. It's fascinating. I almost feel like I want Malcolm Gladwell to study what happened. Like, how do these trends, how do these ideas get lodged in people's minds and what accounts for the idea that takes root and becomes the one that, that, that starts to spread like wildfire. So, basically what you've just said is, there were some studies out there that people like, sort of who do what you do, or who are in the know, go, "Oh yeah, I know, you know, oh, that was a pro milk dude that did that." And, "Oh yeah, that, well, that was discounted." And, you know, quickly, we dismiss that. And yet, despite, you know, maybe you and what your peers may know, these ideas get

• 40:35Rich Roll?

  spread. And, and suddenly, everyone is adopting this belief that, that, that you must be sitting there saying like, "Well, how did that happen? Didn't we all agree that that study should have been, you know, kind of dismissed?" So, so, I mean, when you, if you're like a forensic scientist and you're analyzing this, like, how do you, what do you make of this?

• 40:54Joel Kahn?

  Well, you know, there's an old Yiddish tale about being careful about gossiping about people, that is, about a gossiper that the rabbi, and I hate to share a rabbinic story with you, but the rabbi took him up to a tower, took a feather pillow, slid it open, let all the feathers out, and then said to him, "I want you to go and get every one of the feathers and bring it back." And the guy, man said, "It's not possible." The point being, same thing with gossip, same thing, once it's out, it's out. And the analogy is pretty clear. These studies got headlines, these studies got Time Magazine, these studies got blasted all over the place. Even as Harvard School of Public Health pointed out, dry,

• 41:36Joel Kahn?

  boring, statistical statements of weakness in the studies, the feathers were everywhere. And they continue to be blown all over the place. You know, there's a few bright points out there. God bless John McDougal and Santa Rosa and the McDougal Clinic. But he's had a colleague of his named Travis, a statistician, just recently go through all the data and... There's no question in that data set that there continues to be a valid and strong connection between increased animal saturated fat, increased blood cholesterol, increased heart disease. Message being clear, be wise and limited. I think it's also fascinating, the American Heart Association for about 10 years has

• 42:19Joel Kahn?

  said, eat less than 7% of calories of saturated fat. They came out with new guidelines last year, didn't get a lot of attention. Do you think they loosened the guidelines? This is a panel of 15 august scientists looking at the world's literature, including these meta-analyses and everything else. They actually tightened the guidelines. They actually recommended we decrease further our saturated fat intake down to 5 to 6% of calories. You know, that message isn't heard anymore. That label, warning label, American Heart Association recommends less than 5 to 6% of your calories coming from saturated fat, because the data's so strong. I mean, put a person in a metabolic unit, give them a high saturated fat diet, their cholesterol will go up, and you watch them long enough, they'll have heart disease.

• 43:04Joel Kahn?

  Those studies were done 20, 30 years ago, they're unquestionably accurate.

• 43:08Rich Roll?

  All right, so a couple things. First, if this is so clearly the truth, why is it so difficult to get people to understand this? Is it just because people like hearing good news about their bad habits? Or this is just the trend of the moment? Second is, you know, what is it exactly that Ansel Keys did that is being pointed at to vilify him? And thirdly, what's with this idea that cholesterol is not linked to heart disease? Because that's sort of the meme of the moment right now, like, hey, you know, guess what? Cholesterol is not linked to heart disease. Everything you thought you knew about that is wrong.

• 43:48Rich Roll?

  And that's, I see that spreading around the Twittersphere and the, you know, the internet like crazy. So, you know, educate me.

• 43:58Joel Kahn?

  She asked three questions. I'm going to test my memory, see if I remember.

• 44:01Rich Roll?

  Yeah, sorry.

• 44:01Joel Kahn?

  So, you know, why?

• 44:02Rich Roll?

  I didn't want to forget them, so that's why I spent them all at once.

• 44:05Joel Kahn?

  Thank you.

• 44:06Rich Roll?

  We'll go back.

• 44:07Joel Kahn?

  We're here a little late at night in the roll garage and I'm, uh...

• 44:10Rich Roll?

  You've been eating, uh, rock cow beans.

• 44:12Joel Kahn?

  Yes, I think they're going to help me through this. So, you know, why is this happening? One, it's a big dollar business and any way you paint it, there's a lot of influence from big beef, big dairy, big cheese, big, uh, um, big pork and turkey. I mean, there's a lot of money involved here in the struggle for the public consciousness on limiting or not. Um, and I, undoubtedly, I think there's a story that hasn't been told and maybe it will be Malcolm Gladwell or some, maybe it'll be Food Babe or some investigative reporter that's going to someday find some documents, like smoking documents, about, you know, the food industry planning, um, a public relations, um, kind of attempt that's looking

• 44:56Joel Kahn?

  very good for them right now and confusing the public. And, and I think also, once you have research out and published, like we said, it's very exciting when it comes out. It's very hard, uh, to get the public to pay attention for another five minutes when, uh, reviews and critiques come around that aren't quite as exciting. So, that's one aspect. Um, number two, well, let me go to the third one because I remember it, which is, um, there is no doubt that cholesterol is linked to heart disease. There's databases all over. What I have to go back to and, um, what most people probably aren't real familiar with, there are, there are rare genetic disorders that raise your cholesterol. There are children

• 45:38Joel Kahn?

  that have cholesterals of 400, 500, 600, 700, 800. What happens to those children when they're nine or 10? They have heart attacks, they get bypasses, and they usually don't live past their teens. When I was a cardiology fellow in Dallas in the late 80s, I took care of a very famous girl named Stormy Jones who had her first heart attack at age nine, had a heart bypass at age 11, didn't make it past about age 14 or 15. Very sad story. Wonderful kid, was famous all over the world. She didn't smoke, she didn't have diabetes, she wasn't overweight, uh, she wasn't stressed out. She had a cholesterol of 700, 800. I mean, that's the most extreme example you need, but elevated blood cholesterol will cause, uh, coronary artery plaque will...

• 46:21Rich Roll?

  So, why, why are people saying that it doesn't? Like, what is the, what is the basis for that argument?

• 46:26Joel Kahn?

  You know, these meta-analyses mainly. You know, it's just you can cut the argument down one by one. If saturated fat isn't as bad as we thought, then it's... And if saturated fat raises cholesterol, then a high cholesterol isn't as bad as we thought. I mean, there is no controversy in the cardiology world that lower cholesterol by healthy living, exercise, weight control, or medication when appropriately used without side effects reduces heart disease outcomes. Now, it's true, you may have to treat 50 people that have one person that doesn't have a heart attack and die, this kind of number to treat concept. But it's...

• 47:09Joel Kahn?

  I mean, I live between the integrative world and the standard world, but it is not controversial. It is just being... What's happened is, and I hate to cast on, certain people out there are writing books, the cholesterol myth, and they're selling like hotcakes and...

• 47:23Rich Roll?

  And there are functional medicine doctors out there who are echoing this.

• 47:28Joel Kahn?

  Yeah, you know, if we want to go off down that road a bit, and there are, and I know some functional medicine docs that actually treat their patients with cholesterol pills. It's the craziest thing I've ever heard. Mrs. Jones, here, take this cholesterol.

• 47:40Rich Roll?

  Not cholesterol-controlling pills, but actually giving them...

• 47:43Joel Kahn?

  There's pure cholesterol pills that raise their cholesterol to give their brain more. You know, these are complex and deep topics, but it looks like you need a blood cholesterol of maybe 80 or 90 to provide all the cholesterol you need to make your vitamin Ds and your steroid hormones and your cortisols. Because there are healthy populations that have blood cholesterol of 100, Okinawa 110. These people are not testosterone deficient, brain deficient, and vitamin D deficient. You don't need a cholesterol 300 to provide the precursor to those hormones.

• 48:17Rich Roll?

  Right, I mean, is there an argument that elevated cholesterol does enhance brain function or brain health? Or, you know, isn't that part of sort of the idea behind that?

• 48:26Joel Kahn?

  That is what's being said. I mean, it's not a scientifically strong foundation. Yes, the brain has a lot of fat in cell membranes. All cells have... Have fat in them, but do you, you know, do you need a, at what cholesterol level do you provide adequate substrate and what cholesterol level puts you at risk? And as I said, most of the studies that I've read have been somewhere around a hundred, a hundred and ten is all you need in anything, because there's plenty of both natural societies and some people with genetic abnormalities that run these low cholesterols and they actually live longer than average. So I think it's been very distorted. And again, the public likes, we know that the, our willpower to avoid foods that are

• 49:09Joel Kahn?

  so tasty and fat-filled and fat tastes wonderful in the mouth and mouth feel and all these comments. We've really made the message very murky. And those that are making the message tend to be authors that are selling lots of books and maybe they're well-intentioned, maybe not, but you know, you and I both know we could start writing the bacon biking book and you'd probably sell as many as Finding Ultra perhaps. And if I wrote the bacon heart book, I'd sell tons of copies. It's just, it's not an authentic message.

• 49:39Rich Roll?

  Right, certainly it's, it's easier to, you know, sell a message that is making people feel better about things that they like, that they like doing, but you know, I, I don't, and I don't want to be dismissive out of hand to, you know, very intelligent, accomplished people like Dr. Peter, Peter Attia and others out there who are saying, listen, you know, ketosis is not, you know, there's, this is something that you can do and, and could be beneficial to your health. Like, I'm not, I'm just not, you know, I don't have the degrees, I haven't spent the years reading the research to, to know the truth from, you know, whether that's true or not.

• 50:17Joel Kahn?

  Yeah, I mean, we had a, in the cardiology world, we just had in November, a study called Improve It, published eighteen thousand people with heart disease, they were either going to get one cholesterol medicine or two, and the combination, the two, really lowered their cholesterol more. What did they find? Well, when you drop the LDL to about 50, which is the, you know, the cholesterol we believe is most harmful, there was a clear-cut improvement in outcome versus the LDL cholesterol, 70 to 80. It was a gigantic study that once more said that if you want to avoid heart disease, or if you have a heart disease and you want to prevent the bad outcomes, get your cholesterol down, which you're not going to get down

• 50:58Joel Kahn?

  if you're eating tons of butter, tons of beef, tons of turkey. And turkey is actually, excuse me, chicken is probably the largest source of cholesterol on the American diet right now.

• 51:07Rich Roll?

  That's interesting. And that's another marketing thing that people don't really realize. They think they're actually doing themselves better by eating chicken versus...

• 51:14Joel Kahn?

  Yeah, you know, gram for gram, it's very close to beef.

• 51:24Joel Kahn?

  So the second point you made, and I remembered because of the Panama cacao beans that we shared, you asked about Keys, and just to wrap that up, because you'd go on and on. It's, again, there's tremendous misinformation. The statement always is, Dr. Keys, the seven country study, this really phenomenal prospective epidemiologic study that's still ongoing, that provided tons of data points that really nobody questions, but he cherry picked the seven countries, he had many more countries to pick from. That's actually totally wrong. That was the 1953 paper that he presented. That was just a hypothesis generating paper

• 52:04Joel Kahn?

  where he used this database. There was only seven countries, and there were only 16 communities, and there were only 12,000 men, and it never varied from its original design, which was absolutely phenomenal. And why, upon his death, have they picked him to be the whipping boy of the "we can eat whatever we want and don't worry about it, feel good" movement is really unclear. I mean, he was a real pioneer and a real contributor to medical science.

• 52:32Rich Roll?

  It's interesting. It's almost analogous to the manner in which Denise Menger and the Weston Price Foundation people have tried to... You know, pick apart the China study, isn't it? It's a similar kind of approach to dismantling.

• 52:48Joel Kahn?

  They've actually, you're absolutely right. They actually haven't done that with the seven countries study because it is scientifically so solid and it was actually a prospective study. The China study was more of a zillions of associations and yes, 23 year old Denise has decided to take on probably the most esteemed biochemical nutritional scientists in the country and you know, it's laughable, but you know.

• 53:14Rich Roll?

  But again, that was another, something that really, you know, got traction.

• 53:19Joel Kahn?

  Yeah.

• 53:19Rich Roll?

  And, and what I'm seeing here, to bring it back to Malcolm Gladwell, is like a marketing and communication problem as much as anything else because I believe what you're saying, but somehow it's not connecting, you know, it's, that message is not getting communicated effectively. It's almost like you need to hire a Hollywood publicity firm to, you know, sort of make sure that people are, are understanding what's, what's actually happening here.

• 53:46Joel Kahn?

  Yeah, and I couldn't agree more that we've, we, the result of all this for those that care, and I'm still not sure if it's 10% of the public that even cares about these issues or even knows that they're controversial because again, we spend so much time and your listeners do too, you know, us hackers of improving our health and shooting for 120 years with good health. For the rest of the world, I mean, I'm not sure they know it, but they have not gotten a consistent message. I mean, the American Heart Association is not exactly like you say, a kind of a sexy group that's got Bruno Mars doing their, doing their video and education or something that people can relate to, but they need that because they've lost the battle of, of

• 54:29Joel Kahn?

  the headlines and the headlines are always going consistently to the idea that we screwed up and go for it, enjoy your steak and your cheese fries and, and your milkshake.

• 54:40Rich Roll?

  All right, so a couple of things. Is there any logic or rationale whatsoever that, that somebody should add MCT oil or grass fed butter or coconut oil to their morning drink, whether it's coffee or otherwise?

• 54:57Joel Kahn?

  So, is there any logic? It appears without personal experience that many people say that they...

• 55:06Joel Kahn?

  Aren't hungry for what I'd call a real meal. Cause I mean, where's the

• 55:10Rich Roll?

  Well, it's a 800 calorie.

• 55:13Joel Kahn?

  How much butter you put in, but you know, that it sustains them till mid afternoon when you can then have a meal that may be rich in fruits and vegetables.

• 55:21Rich Roll?

  I understand, I can understand that.

• 55:22Joel Kahn?

  Yeah, you know, there's a strategy there that it um that it may help you maintain or lose weight because usually lose weight because you're uh you're you're you are developing ketotic state every morning with that as your breakfast.

• 55:35Rich Roll?

  It probably puts the caffeine on a slower drip, right? Does it, does it, does it slow down the the the metabolizing of the caffeine in the coffee?

• 55:46Joel Kahn?

  I'm not sure about that. I think, you know, the idea is you're just feeding your brain some brain friendly, you know, sustaining ingredients in a no carb way that allows you to be use an alternative fuel for your brain ketones. Is there a rationale, is it, so number one, I mean, I I wrote this in Mind Body Green a couple of weeks ago. Low carb diets scientifically, I hate to keep bringing up science, but low carb diets are associated with a higher rate of dying in the literature. You can go to multiple large studies that involve hundreds of thousands of people looking at all the data. And it's out there, there's no

• 56:19Rich Roll?

  Yeah, but Joel, it'll make you skinny.

• 56:21Joel Kahn?

  Yeah, but you know, that's right. You know, who cares about dying? We're caring, we're caring about performing at work and the rest. I mean, it's hate to be Debbie Downer, but there are no data that say long term, low carb diets prolong life or

• 56:34Rich Roll?

  To be fair, is that because that study has not been done? Or it hasn't, there isn't a study that, that it hasn't been around long enough to be able to evaluate that?

• 56:42Joel Kahn?

  No, there, there's a multitude of studies when you add them all together in these multi, in these meta analyses, they actually show an increased risk of death. So that's an important message. It's not out there. Um, so that's one. Two is, you know, that kind of approach is an extremely high saturated fat breakfast. It's uh, from what I've read, it's about 50 grams of saturated fat if you're just using two tablespoons of butter. Um, you know, blows away your daily load that the American Heart Association would talk about or anybody else reasonable. And what I have seen that's posted in the blogosphere is cholesterol goes up.

• 57:22Joel Kahn?

  Pretty rapidly, pretty predictably, and often pretty dramatically. I mean, if you want to raise your cholesterol 100 points very quickly, that's a great approach. Now, no medical scientist that I consider holding their weight would suggest that you drive your cholesterol up 100 points in a month as any kind of therapeutic strategy for long-term health benefit, cancer prevention. I mean, high cholesterol levels in women with breast cancer is associated with greater metastatic potential and all, let alone what it's doing to your arteries. Of course, the big unknown is, cancer takes five, 10, 15 years, heart disease takes five, 10, 15 years. This has all been a trend in the last two, three years. Am I concerned? Yeah, I'm very concerned that people are going to consistently

• 58:03Joel Kahn?

  follow this diet, are putting themselves at tremendous risk for developing premature coronary disease. We just can't see it yet. We haven't studied it, followed it long enough, and I think it's a rather dangerous thing to do. My reading of medium-chain triglyceride, the whole coconut oil issue is a difficult issue, and part of it is, you go to the store and you buy coconut oil, you're not actually sure what's in there. The optimal, it's very biochemical and scientific, but the optimal length of your fatty acid chains should be six or eight carbon fragments long, maybe 10, but you don't know what you're getting in the bottle. And if they start to get 10 and 12 and longer, then they're getting into

• 58:46Joel Kahn?

  the kind of long fatty acids that are in animal saturated fat, even though it's a plant-based product. So, you're not sure. There is a product out there that's in the butter coffee that is an eight-chain fatty acid, high-quality group, and it's been used in some medical situations, but, like liver disease and others, but nobody's studied it in people. This is an experiment that has no, you know, no outcome data to know what's going to happen. And there are people clearly reporting they feel more energized, and their weight's under better control, and a whole lot of other testimonial stuff, but... As a physician, as a scientist, as a cardiologist, as somebody who cares about people's arteries,

• 59:28Joel Kahn?

  very, I mean, it can be tested. As you know, there's been studies done, for example, eat a Big Mac and you can measure arterial function 30 minutes later and demonstrate damage. That hasn't been done with anybody doing these kind of very high plant-based saturated fat. Well, this is a mixture of plant and animal because of the butter being animal.

• 59:49Rich Roll?

  It's super interesting. I mean, the whole coconut oil kind of dialogue is, is, is really amazing to watch too, because on the one hand, you have the thought that this is a very high caloric food with very little nutritional value other than its calories and its fat content, right? There's no micronutrients in this. And my understanding is that the saturated fat component of coconut oil is comprised of loric acid, which is a more easily metabolized version of saturated fat than some other versions. So it does, it's, it's less likely to be stored as body fat and more likely to be used as energy, right? Is that, do I have that right?

• 1:00:33Joel Kahn?

  Yeah, you do.

• 1:00:34Rich Roll?

  Versus the other side of the, the coin, which kind of says, this is a superfood elixir and this is going to cure all sorts of ailments. And, you know, where do you, where do you, you know, like, where do you find the truth, you know, in that? And, and it goes around the merry-go-round, right? Like, we can, we can have this whole debate around that as well right now.

• 1:00:54Joel Kahn?

  There's a nice study, nice if you like to have heart disease, with palm oil, which is a plant-based tropical oil. Again, I'll point out, the American Heart Association last year specifically recommended avoiding tropical oils. That's coconut and palm. Okay, so maybe they're, maybe they've got it all wrong and they've had it all wrong for 70 years since. Uh, Dr. Keys designed this nefarious project, but I'm telling you, the largest and most respected cardiology body in the country says limited tropical oils. Um, but at least with palm oil, there's been clear data that it accelerates heart disease. And that's a tropical oil, plant-based, highly saturated fat product now.

• 1:01:38Rich Roll?

  And what is the chemical difference between palm oil and coconut oil?

• 1:01:41Joel Kahn?

  I can't give you the biochemistry.

• 1:01:42Rich Roll?

  Right.

• 1:01:43Joel Kahn?

  But, um, you know, it's good to say, I think, you know, for the listeners, keep it simple. Eat your berries, eat your chia seeds, eat your flax in the morning, make a smoothie, put it on, you know, uh, steel cut oatmeal. I think, uh, it's a very dangerous path to go down this last couple of years of pendulum swinging to you have no rules anymore, go enjoy all, you know, and it merges into this entire bacon, uh, filia out there, which is not part of any healthy paleo diet and it's not part of any, um, heart healthy diet. But, you know, where do you draw the line? If, if, if grass-fed butter's okay and coconut oil's okay, then bacon's okay? We've really just circled around to having no rules. I think it's just terrible.

• 1:02:27Rich Roll?

  Right, right, right. So, so just to be crystal clear, when a patient walks into your office and says, hey, doc, uh, I'm loving my, you know, my grass-fed butter and my coffee this, and I hear it's doing great things and, and this is the way to be healthy. Your response to that is what?

• 1:02:43Joel Kahn?

  Do you have life insurance?

• 1:02:44Rich Roll?

  Right.

• 1:02:45Joel Kahn?

  No, I, uh, you know, in my field and I, you know, it's clear, still clear, there's only one group of data that demonstrates you can prevent and reverse established coronary disease and it is the Dr. Ornish and Dr. Esselstyn plant-based, low-fat diets that, um, aren't how to, you know, it's very easy to say, and I hear many of my friends in the functional medicine world, oh, crazy old Dr. Esselstyn, crazy old Dr. Ornish, they did those studies years ago, they're just not valid anymore. Excuse me, I mean, Dr. Esselstyn just published a paper updating his data in July 2014. Dr. Ornish is doing the most amazing research on epigenetics with his original plan and, uh, it's a

• 1:03:28Joel Kahn?

  Totally changing the course of prostate cancer when you eat a low fat, plant-based diet. It's the most cutting-edge science out there that everybody's quoting. No, everybody in the world quotes Ornish. Nobody mentions that it's a plant-based, low-fat diet that's demonstrating the ability of our environment to influence our genetic makeup. And that's what I educate every one of my patients to do and to learn about and to read. Watch Forks Over Nyes, read Ornish's book, read Esselstyn's book, get educated. We can talk about, I've got this really amazing event that's occurred in the last 12 months where a patient asked me to develop a support group for Ornish and Esselstyn heart patients with serious heart disease and just challenged by the fact that it was more than ever kind

• 1:04:13Joel Kahn?

  of socially unacceptable to say in a restaurant, I don't want oil on my food and I don't want butter in this. And we started up this plant-based support group in Detroit in February 2014. I got a little room in the hospital, thought about 20 people were going to show up. We had no PR, very snowy, cold night, and 135 people showed up. And I don't know where they came from, and I don't know how they heard about it. And we realized, this gentleman who was just a member of the public but a heart patient and myself, I said, we got something here. And turns out, we basically formalized the group, said we're going to meet once a month, we're going to volunteer a time to lecture. So we now have 700 members in this group. It's probably the largest dynamic support group for heart patients to fight the culture

• 1:04:58Joel Kahn?

  and eat the way that science says. Rip Esselstyn came in September and we filled an auditorium with 500 people. And then Dr. Esselstyn's coming in two weeks. We've got 1,000 people already registered, no charge. Just, it's like people are coming out of the woodwork. So there is actually that, I mean, I'm very hopeful that there are people that are discerning. You know, all they got to do is go to the bookstore, or go to PubMed, or talk to a competent physician, and they're actually getting that there is a real path to improve your heart health through nutrition, and it isn't all the things we were talking about. So it's been a very hopeful and very exciting thing to see this dynamic mass of excited people.

• 1:05:41Joel Kahn?

  My role is kind of the medical advisor and kind of one of the people that founded it is. Every time we meet, I tell them, you know, there's a bad world out there that's gonna hold a butter stick and gonna hold a piece of bacon and gonna, you know, tempt you with this or that based on the Wall Street Journal or Time Magazine and let me review for you the data and how you need to be strong so you can respond to this kind of counter push.

• 1:06:05Rich Roll?

  Right, strong like emotionally to be able to kind of weather that and stand your ground and make the right decision.

• 1:06:11Joel Kahn?

  If nothing else, um, Dr. Khan says it's okay, I'm gonna do it, but I want him to understand a little bit more than that. So, you know, they know the data, they've seen these amazing pictures of angiograms. I mean, I'd like to see, again, these crazy diets and some angiograms a year apart.

• 1:06:24Rich Roll?

  Yeah, let's see the, let's see the before and angiograms that you see when you crack Dr. Esselstyn's book.

• 1:06:30Joel Kahn?

  Yeah, absolutely.

• 1:06:31Rich Roll?

  I mean, it's, it's amazing and I'm not seeing that anywhere else.

• 1:06:33Joel Kahn?

  Well, that question I have them ask, I said, if any of your relatives, friends, coworkers question what you're doing, just politely ask, I like what you're doing, can you just show me the angiograms of before and after so I know it's okay for my heart to eat the way you're telling me to do?

• 1:06:47Rich Roll?

  That's a pretty good response.

• 1:06:48Joel Kahn?

  Of course, shuts them down pretty quick, cause there's no science to these crazy things going on.

• 1:06:54Rich Roll?

  All right, so, answer me this. If you were the Surgeon General, what would you change? What would you do?

• 1:07:02Joel Kahn?

  Um, I would use the power of legislation as Surgeon General. I, I know we're not supposed to interfere in people's lives and tell them what to do or not. I would dramatically change, if there's any way legally to shut down or alter, um, food. I mean, I would get fast food out, change, mandate, tax it, do something that it is no longer possible to walk out with a bucket of fried chicken and feed a family.

• 1:07:29Rich Roll?

  Like just downright socialist approach to the whole thing?

• 1:07:32Joel Kahn?

  The, the, the reason I think you need draconian measures that will upset people and raise these questions of freedom and liberty and all the rest, is we've got a real problem in this country. You know, you can just look at one issue, which is diabetes, and there's about 30 million diabetics in the United States of America. Uh, the original prediction was that within about 25 years, we're gonna have 100 million diabetics in the United States. About a third of all people, about 2050.

• 1:07:59Rich Roll?

  By 2030 or something like that, a third of Americans, like one of every three people.

• 1:08:04Joel Kahn?

  Exactly. Now, the latest prediction is it's 40%. Sorry, we underestimated 40% of Americans. In the African-American and some of the Latino communities, it's 50%. We're talking about medication, shortened lifespan, work difficulties, hospitalizations, amputations, heart surgeries and all the rest. This is, you forget about Obama and any other alterations in the healthcare. This is a actual national issue that has to be addressed, that we are not going to be able to sustain 18%, 20%, 25% of the gross national product on healthcare. So, I mean, it may take draconian measures to get into schools, hospitals, workplaces, vending machines and all the rest, and put friggin' fruits

• 1:08:46Joel Kahn?

  and vegetables. We need a national task force. I mean, forget the drug war for a while, let's work on the food war and really get honest and get authentic. I mean, that's what I do. It's not gonna happen and...

• 1:08:56Rich Roll?

  Not gonna hap- what about, what about the FDA? What about the USDA? What would you do with these regulatory bodies that are sort of quasi-government, quasi-private?

• 1:09:05Joel Kahn?

  I, I, I don't see it happening, but we just gotta split up the fact that the, you know, the same institution that's doling our dollars to dairy and beef and pork producers is also the one that's making food policy and regulating food rules. And it's just, you know, the level of conflict is not contrable. And, you know, we gotta, again, there has to be a national discussion at the highest level. I'm glad we've got, you know, the first lady involved in this, but this is something that, you know, I think from president on down to, you know, recognize that this is threatening the very health and liberty of the country over the next 20 to 30 years if we don't get control over this problem.

• 1:09:45Rich Roll?

  Yeah, it's insane. I mean, 40, you're talk- we're, we're basically talking about half the people. Yeah, almost half the people are having, you know, chronic disease, overweight, you know, diabetic, whatever it is, like, we're basically half of our population essentially either incapacitated or severely limited in their ability to not just enjoy life, but to properly even function.

• 1:10:09Joel Kahn?

  Yeah, and, you know, the hopeful side is, we don't need high-tech to solve this problem. We need to limit and alter the food source, the food education, the food habits of America. But the solutions are very simple. And, you know, in the past, it started with a publication in 1993, but there's been a talk about other medical literature that's very important. There's been just paper after paper after paper lately. It's very easy to say that heart disease, 80% is preventable and related to lifestyle, and cancer, 60%, and diabetes, 90%. Those are things a lot of speakers like myself say. But actually, there have been a treasure trove of papers of 20,000, 30,000,

• 1:10:53Joel Kahn?

  50,000, kind of large studies have consistently shown this magical number that about 80% of chronic diseases that are costing our country a fortune, causing people to lose relatives, and lose limbs, and lose loved ones, and work interruptions, and all kinds of tragic situations, are entirely preventable by simple, inexpensive lifestyle steps. So one of my passions is speaking about heart attack prevention. I mean, it's a shame if you have a heart attack at age 55 and drop dead. It's a shame if you survive but are limited in all the rest. And there have been a series of studies that say it's about six or seven lifestyle habits that will make you nearly heart attack proof. And nothing's

• 1:11:35Joel Kahn?

  high-tech, and nothing's a laser, and nothing's a bypass suite, and nothing's the kind of things unfortunately hospitals invest in.

• 1:11:41Rich Roll?

  Well, that's not sexy.

• 1:11:42Joel Kahn?

  It's not sexy.

• 1:11:43Rich Roll?

  Who's gonna make money off that?

• 1:11:44Joel Kahn?

  It's not sexy. Which is, again, why I'm kind of hopeful about the Cleveland Clinic that this message will come out. But now just list them, and you won't be surprised with them. And there's, you know, just, don't fall asleep out there, because these are boring. Don't smoke. Wow. But that's one that's gotta be on everybody's list. Eat more than five servings of fruit. Some vegetables a day. That's on every scientific list. Keep your weight trim and your waist under forty inches for a man, under thirty-five inches for a woman. That's on every list. Move thirty minutes a day as part of a fitness program, and we can actually add a little ask risk there. You probably ought to stay on five, ten minutes a day if you've got a job that keeps you at a desk, or in a chair, or driving a truck. Move as much as you can. Sleep seven hours a night. That's number five, and I hate to bring up

• 1:12:27Joel Kahn?

  number six, but almost all these studies in the last fifteen years say that an occasional alcoholic drink is on the side of preventing heart attack risk if you can manage it and avoid the obvious downsides that exist.

• 1:12:40Rich Roll?

  Now, I feel bad for not giving you a glass of wine this evening.

• 1:12:43Joel Kahn?

  No, no, no. Totally fine. The cows got me buzzed, and I'm glad I didn't have to stop and bring you a bottle of wine as I drove up here. I thought about it for a minute. I said, not in a restaurant.

• 1:12:52Rich Roll?

  No, I was at the wrong, wrong.

• 1:12:54Joel Kahn?

  Wrong house, that's right. Leave it at the neighbors. But I just listed five or six simple things, and study after study. You can be in England, you can be in Sweden, you can be in, you know, United States Centers will show that that will, if you want to live a heart attack-free life, that does about eighty to ninety percent of it. Then we can add anti-aging, then we can add chlorella and spirulina, anything else we want to talk about.

• 1:13:17Rich Roll?

  Yeah, but I want the super-secret VIP thing that no one else knows.

• 1:13:22Joel Kahn?

  I know.

• 1:13:23Rich Roll?

  The sexy thing. What's the thing I can buy?

• 1:13:25Joel Kahn?

  Yeah, the one thing of the day that then you have to have a show next day and tell you the one thing. I mean, these are the six or seven things that work consistently and need to be shouted from the rooftop. And that's what I'm, I've got a new book coming out in three weeks that is-

• 1:13:38Rich Roll?

  I didn't know it was coming out that soon.

• 1:13:39Joel Kahn?

  Yeah, well, I'm self-publishing this one, so.

• 1:13:41Rich Roll?

  Oh, you are.

• 1:13:41Joel Kahn?

  First one called Hall Hard Solution that Reader's Digest published.

• 1:13:44Rich Roll?

  Yeah, I know that.

• 1:13:45Joel Kahn?

  It only came out in September, so it's not like it's an oldie-moldie, but this one's called Dead Execs Don't Get Bonuses: How to Survive the C-Suite with a Healthy Heart.

• 1:13:54Rich Roll?

  Wow.

• 1:13:54Joel Kahn?

  Really a short manual on what I just discussed and other ways to identify and avoid heart disease during your career.

• 1:14:01Rich Roll?

  So, three weeks, so- So what date is that coming out?

• 1:14:05Joel Kahn?

  I'm shooting for February 1.

• 1:14:06Rich Roll?

  February 1?

• 1:14:07Joel Kahn?

  Yeah.

• 1:14:08Rich Roll?

  Maybe I'll, maybe I'll release this podcast on that day.

• 1:14:11Joel Kahn?

  Wow, that's kind of you. But getting back to the important point.

• 1:14:15Rich Roll?

  No, but tell, all right, we'll finish that, but then I want to hear a little bit more about them.

• 1:14:18Joel Kahn?

  What would the Surgeon General, what should the USDA do? We should rally around and popularize and educate the world that that is the goal. Cause the sad statistics, even though everything I just said has been known for now for about 30 years, those six or seven lifestyle habits. When you look at these studies, typically 1% of the population studies does all six or seven. Or if you look at five or six, maybe five to 10%. It's a amazing small portion of the population does. I mean, nothing I mentioned was tough. It wasn't run, you know, a triathlon, five out of seven days or anything crazy. It was walk 30 to 40 minutes a day. And usually the biggest one people fail at is nutrition.

• 1:14:59Joel Kahn?

  That what's called by the government, a healthy nutrition pattern of five, six, seven servings of fruits and vegetables a day, it's under a percent. So get the basics done and then everything else is fluff.

• 1:15:19Rich Roll?

  Why do you think the nutrition part's so hard for people?

• 1:15:22Joel Kahn?

  I think it's skills. I mean, I think people know they should do it, but there's a skill to getting five, six, seven servings of fruits and vegetables a day. You know, it's something you now do without thought and I do too. But breakfast, you know, you've got Lucky Charms and Fruit Loops and toasted mini wheats and everything. Where's, you know, you've got to make changes. You've got to think about slicing up fruits and vegetables and getting a blender or NutriBullet or.

• 1:15:46Rich Roll?

  Yeah, I mean, it's not, you know.

• 1:15:48Joel Kahn?

  Homeless carrots and celery for breakfast. You know, you travel in Europe and you see the typical breakfast buffet is 60, 70% fruits and vegetables. It's a slightly different cultural approach to what breakfast is, so.

• 1:16:00Rich Roll?

  I mean, when you listed out your items to be essentially heart attack proof, this is not like, you know, the joke is it's not rocket science. We all know this stuff. And so it's not really an education issue. It's an implementation issue. It's an action issue. And, you know, maybe it's a willpower issue. I don't, you know, when there's Lucky Charms everywhere, how do you make the right choice? But, but it's not about not, it's not about not knowing what the right thing to do is. Or, you know, maybe it is with, to a certain extent, but I think that that. You know, that's, that's really not the main issue.

• 1:16:31Joel Kahn?

  I, I think the only knowledge deficit might be of how scientifically strong the database is, that it really does do this, 90% diabetes, 80% heart disease.

• 1:16:42Rich Roll?

  That it makes a difference.

• 1:16:43Joel Kahn?

  But that it really is not fluff. It is strong and repeated and up-to-date science publications in the last four weeks from Sweden that echo this over and over and over. But you're right, how do you implement it? And, you know, do you implement it through workforce wellness programs that will benefit by better health of their employees and lower their insurance costs? So healthier cafeterias, healthier vending machines, walking programs, no smoking programs? That's what's going on, but, you know, not completely effective. Obviously, my view always is hospitals ought to be the center point of all this education because they should get it better than anybody, but fried chicken and bacon and, you know, milkshakes are just as common, including the lobby of the Cleveland Clinic, and we've got a long way to go.

• 1:17:27Joel Kahn?

  Schools clearly should be, but, you know, then you're always fighting these darn lobbies and food programs and dairy dollars and school programs.

• 1:17:35Rich Roll?

  Yeah, so much of it tracks back to, to money and government.

• 1:17:38Joel Kahn?

  Yeah, you know, I think everybody just ought to download your Mind Body Green teaching video on how to eat plant-based, and we'd be a long way down the road. Shameless plug for you for having me in your garage in a cold, rainy California night.

• 1:17:51Rich Roll?

  The Whole Heart Solution and this new book. So what's, so tell me, walk me through the new book a little bit.

• 1:17:55Joel Kahn?

  It's, um, it's really a simple, well, I'll tell you what it came from, and we were talking about that before you started. It's certainly always been a passion of mine to teach this topic and lecture on this topic. But we had a very prominent executive and car designer in Detroit drop dead suddenly two years ago. Very fit, healthy appearing 60-year-old executive, led a big design center and was out from Michigan, but was in California riding his bike and just dropped dead of a heart attack. And his widow is now a very close friend of mine, and she was passionate about teaching the message that this was tragic and shouldn't have happened. He was seeing doctors, nobody detected it. And out of that came the focus to do this. So it's partly in memory of Imre Molner.

• 1:18:42Joel Kahn?

  His widow wrote the first chapter of his story in a plea to make that the last heart attack in America, which is possible. And then I go through the science of how to detect heart disease early using imaging, early CAT scans, early ultrasound, advanced blood work, the data on that you can prevent heart disease through lifestyle, data that you can reverse heart disease through lifestyle and advanced technologies, and kind of wrap it all together. And it's a pretty quick read. And, you know, it's a really important message that I just didn't see anybody talking about. And it doesn't have a nutritional philosophy that should divide people, but, you know, it's a little bit more aggressive than the way cardiology is practiced. We're dealing with a pretty big problem.

• 1:19:27Rich Roll?

  Yeah, I like it. Cool, Matt. Well, a couple of things that I want to kind of, you know, close this down with. And the first thing is, it's something that's increasingly more and more on my mind, which is, I'm 48, you know, I'm rounding the corner towards 50. What are the things that I need to start being more careful about? Or what should I be thinking about? Or what should I be asking my doctor about? Or, and what tests should I be getting? You know, I want to talk about this one CAT scan test that I think everybody should get with respect to their heart. That's really important.

• 1:19:58Joel Kahn?

  I think that's great. So, this is not Joel Kahn. This is the American College of Cardiology. This is a scientific body of data for about 20 years. But there's a type of CAT scan of the heart. So, I got to give a little background. Heart's a tricky organ. It's small. The arteries are very small. The heart's moving. It's a bit, what you want to know is, are your arteries clean? Are your arteries starting to develop blockage? And anybody that has a heart attack, a bypass, or a stent, has had the problem going on for years. The problem is, you go to your doctor, if you go, stethoscope doesn't show any of that, electrocardiogram may show nothing of that, even a stress test may come back showing total normal, although a stress test isn't part of a routine physical if your

• 1:20:41Joel Kahn?

  doctor decides to do it. You can miss extensive heart disease on a stress test. Unfortunately, we're just not very advanced in that approach. To heart disease, you want to find out if you have a colon polyp or a colon tumor, you do a colonoscopy, you look directly at the organ. Everything I mention in heart disease is indirect evaluation. So, fast forward, 20 years ago, a CAT scan method was developed. You lie down, you hold your breath for 10 seconds, and a CAT scan machine is turned on and off. No IV, no injection. It's called a coronary artery calcium CAT scan. 99-plus percent of the time, if you have plaque in your artery, calcium has been combined

• 1:21:24Joel Kahn?

  with the cholesterol and other elements of plaque. Calcium shows up on CAT scans, black and white. The heart looks very different than calcium. And in that very brief exam, you can find out if your heart arteries are calcified, which is early heart disease, silent heart disease. It's, I call it the truth serum. And if you come back and your score is zero, we have more than 1,000 published medical studies, some of which follow people for 15 years. If your calcium score is zero, you have very youthful heart arteries, your risk of heart attack or developing angina needing a stent are extremely low over the next five to 10 years. Of course, follow a healthy lifestyle, but a lot of things can be relaxed a little bit. You may not need medication and other things.

• 1:22:05Joel Kahn?

  If your calcium score lights up 100, or 500, or 800, or 1,000, you've got a problem. And you need to see a person that really cares about silent heart disease, and nutrition, and stress management, and exercise. And there's roles for supplements. There's this crazy therapy called chelation, which actually can be effective in certain settings, and is now science proven. So it's just a very aggressive approach, to use particularly this CAT scan. It's not covered by insurance in like 48 of 50 states. Used to be pretty expensive, $700, $800. My community, you can get it at one hospital for $75, another hospital for $100. So it's well worth, about age 50, maybe age 45, if you're a smoker, blood pressure diabetic, probably towards that younger age.

• 1:22:48Joel Kahn?

  It's not right for somebody that knows they have heart disease. So, I was talking to somebody in your kitchen, their father already knows he has blocked arteries in other parts of his body. Well, he needs the whole package of treatment. He's got hardening of the arteries. May not be necessary for somebody like that, but all the other people just saying, you know, I walked out of my doctor's office with a good physical exam report. Not very meaningful in terms of identifying silent heart disease.

• 1:23:13Rich Roll?

  And I'll tell you straight up, this test saves lives.

• 1:23:17Joel Kahn?

  It does.

• 1:23:17Rich Roll?

  Crazy people who do it and not enough people know about it. And I will just say that for a fact, straight up, it saved my friend Jonathan Schwartz's life, who is an early guest on this podcast, really successful business manager, local guy, friend of mine here, you know, marathon runner, you know, triathlete, super fit, healthy guy, was recommended to get this test, was shown to his shock and amazement that he had a pretty significant blockage and was really lucky to have caught it. Like it really saved his life and it was such a profound moment for him that he has started a foundation. And now I'm kicking myself because I can't, I think it's called the Heartstone Foundation.

• 1:24:00Rich Roll?

  I'll make sure, I'll, I'll research that and make sure it's in the show notes. But for anybody that, that can't afford this test, he feels so strongly about it that his foundation will support people to get it because it's not covered by insurance.

• 1:24:13Joel Kahn?

  Wow, that's awesome. I had not heard of that, but that is really a great thing to do. You know, it's again, everything boils down, follow the money. It's a test that doesn't really generate a lot of profit. It really hasn't caught the attention. It takes big machines at hospital zone because no offices have CAT scans and we just kind of, it hasn't really caught the attention most cardiologists and it's absolutely a shame.

• 1:24:36Rich Roll?

  Yeah. But you can get it, but I mean, it's, it's available, right? Like if you're near a metropolitan major hospital.

• 1:24:42Joel Kahn?

  Yeah. Any medium or large size hospital will offer coronary artery calcium scoring. The other thing is that there's a lot of good advanced blood work and we've gotten better and better at doing cholesterol analysis and other factors. So, you know, I, I love to see people around age 45 and 15, do kind of a two-stage evaluation, talk to them, examine them, you gotta kind of still be a doctor, but schedule them for the CAT scan, advanced blood work, sit down with them and design a program for them. That's kind of what's called personalized lifestyle medicine. You know, and it's very motivational both ways. If they come back zero, they're just like so frigging happy and they realize that they did everything wrong for 50 years, but they still have a second chance. And a lot of these people really grab on to better health for that reason, that it, you know, wow, I might make it to 80 or 90, I better really start taking care of my life now.

• 1:25:27Rich Roll?

  Right, right, right.

• 1:25:27Joel Kahn?

  And the, the other side is obvious. It's the scary message. You've got, you've got a problem and you need to wake up to it. And I ask them to put the report on their refrigerator and look at it every morning. You know, kind of have a reality test.

• 1:25:38Rich Roll?

  That's effective.

• 1:25:39Joel Kahn?

  It works.

• 1:25:40Rich Roll?

  Are you still writing prescriptions to people to go get spinach and stuff?

• 1:25:44Joel Kahn?

  Yeah, yeah, that's a, yeah, there's a number of us around the country. I got a shout out to Dr. Garth Davis.

• 1:25:50Rich Roll?

  Garth is doing it.

• 1:25:51Joel Kahn?

  Garth is doing a great program in Herman Hospital in Houston of actually prescribing fruits and vegetables that are provided by an organic producer in town. Yeah, it's, I use my prescription pad because people just pay more attention to that. I might write on it, you know, go see your video program or go watch Forks or Nines, whatever. And they just, it's much more effective than any other thing I've ever had because it's, looks official. It's on my prescription pad, yeah.

• 1:26:18Rich Roll?

  Cool, man. All right, man. So 50, what else, what else do I need to be thinking about?

• 1:26:23Joel Kahn?

  Well, you gotta do the bit. You gotta get your colonoscopy, whether you like it or not.

• 1:26:26Rich Roll?

  Yeah, I haven't done that.

• 1:26:27Joel Kahn?

  Yeah, well, you know, you got a couple of years. But it's kind of a fun little break. You get to sleep for a few minutes. It was no big deal. I mean, I absolutely would join Katie Couric in advising everybody to do it because it's no big deal. You know, in my field, it would be those two things, advanced blood work and that coronary artery calcium scan. What else is cutting edge? It's kind of the, you know, I believe we're at the verge of a real breakthrough and real true kind of anti-aging. I mean, we're, we're not just going to have, again, the hysteria of the moment that comes and goes. We're really getting people like Craig Ventner from Genome Project and Peter Diamandis from XPRIZE.

• 1:27:07Rich Roll?

  Right, XPRIZE, yeah.

• 1:27:08Joel Kahn?

  These guys are like really focusing on understanding.

• 1:27:10Rich Roll?

  Diamandis is really on it, right?

• 1:27:11Joel Kahn?

  Yeah, he was, he's working with Ventner. They got, they got a hundred million dollars to start with. And, you know, they, they really believe we're going to understand in more detail the process of aging and ways to interrupt the aging and cellular decay and, and extend life in a healthy manner. I mean, it's pretty big. My notion about how to do that and implications, how are we going to have 20 million people on this planet with deforestation and animal raising and all the rest. But nonetheless, I think that's really something to watch. And the best anti-aging plan is to follow the six or seven heart attack prevention steps, which is a lifestyle anti-aging plan.

• 1:27:50Rich Roll?

  We can't sit around and wait for, you know, those guys to solve the problem and slack off in the meantime, hoping they're going to fix it for us, right?

• 1:27:57Joel Kahn?

  Yeah, you know, the crazy guy Aubrey de Grey, you know who he is?

• 1:28:01Rich Roll?

  Uh, yeah.

• 1:28:02Joel Kahn?

  He's one of the world's leading anti-aging experts with his beard down to his knees with an English or Scottish accent, and I apologize to him, I'm not sure, I think he's English. But he says all the time, your goal ought to be to live about another 10 years with a really good body and brain, because there's going to be so many breakthroughs in this field, that you'll have another technique or tool to make it another 10 or 20 years. And it's going to be bites like that, that are going to make it more routine to reach 100, 120. Or just read the Blue Zones book and start doing it now, because that is the way.

• 1:28:33Rich Roll?

  Right, right. Cool, cool. Yeah, I'm getting, I'm going to have Dan on the podcast, Dan Buettner, soon, pretty soon. Yeah, I'm having dinner with him next week. I love that guy.

• 1:28:41Joel Kahn?

  So great, great stuff that he's doing.

• 1:28:43Rich Roll?

  Hey, man, I think we did it.

• 1:28:44Joel Kahn?

  We covered a lot of stuff.

• 1:28:46Rich Roll?

  We did, we did a lot.

• 1:28:47Joel Kahn?

  I hope we weren't too heavy.

• 1:28:48Rich Roll?

  No, it's good, man. We need, you know, we need, we need the science, we need the hard facts. We need, we need, we need a little reality check, you know. Look, heart disease, America's the number one killer. It's killing people by the millions. It's crazy, it's ridiculous, and it's also preventable. And so I appreciate your message. And, you know, it's, it's not like you stand to gain. You know, it's like, this is just what it is.

• 1:29:14Joel Kahn?

  I really care about people not dying.

• 1:29:15Rich Roll?

  It may not comport with like, your preference for what you want to have for breakfast, or what have you. But, you know. I believe that what you're saying is the truth. I live it and I'm glad that we had a chance to talk about it.

• 1:29:30Joel Kahn?

  I just would put a plug if anybody wants to follow up reading Dr. John McDougal's newsletter in November.

• 1:29:36Rich Roll?

  You sent me the link to that too, right? I'll put a link in the show notes to that. It's online though, right?

• 1:29:43Joel Kahn?

  Yeah, it's actually December 2014 has an amazing statistical evaluation of this saturated fat heart disease topic. It's heavy and most people, you know, may not enjoy going through it. And I'll leave you this too. This Nutrition Action Newsletter in April really did a nice job of parsing the issue of saturated fat heart disease. This dairy-based meeting that I mentioned in November 2008. And, you know, I think if people started, we can raise consciousness about some of this science that supports what I believe is the real basis for nutrition and health. We'll be doing a lot of good with this podcast, as you always do.

• 1:30:21Rich Roll?

  Yeah, very good. Is this Nutrition Action article online? Do we know?

• 1:30:25Joel Kahn?

  Um, yes.

• 1:30:27Rich Roll?

  Okay, we'll get the link for that. So check the show notes for this episode. Everything that basically Joel's been talking about that can be hyperlink will be hyperlink. So there'll be places for you guys to take this conversation, you know, further for those that are interested in doing so.

• 1:30:42Joel Kahn?

  Perfect. Thank you.

• 1:30:44Rich Roll?

  Right on, man. All right. So if you're digging on Joel and you want to connect with him, you want to learn more about his deal, the best way to do that is to go to DrJoelKahn, K-A-H-N, dot com, right?

• 1:30:55Joel Kahn?

  You got it.

• 1:30:56Rich Roll?

  Pick up his first book, The Whole Heart Solution, and the second book, which will be dropping probably around the time this podcast goes live. And the title of that book again is?

• 1:31:06Joel Kahn?

  Dead Execs Don't Get Bonuses.

• 1:31:08Rich Roll?

  There you go.

• 1:31:09Joel Kahn?

  And the third thing you can do, and we'll have to talk about that another time, you can come to Detroit and eat at my vegan restaurant that's opening March first.

• 1:31:16Rich Roll?

  We didn't even talk about that. We talked about it before. This is what happens when, see, look, here's the deal, right? Like, I have this fantasy that I want my podcast guests to just, I'll be sitting here, ready to go, and they just roll right into the chair. We can just begin, we just hit record from the get-go. But we end up chit-chat. That never happens, right? I always have like, you know, half an hour conversation ahead of time. And then I'm like, you know, we're gonna have to repeat all this stuff. So we talked all about the restaurant, which I'm really excited about for you. When is it opening?

• 1:31:43Joel Kahn?

  About March 1st. I have the pleasure of having developed a really world-class vegan restaurant that'll open about March 1st in Detroit called Green Space Cafe. And it's a dream of mine because it's gonna combine all my philosophy and teaching and a business enterprise with my son. And I really got a buzz in the Detroit community. We're gonna have just some, you know, you got the pleasure of living in LA where you got lots of choices all over the place. And they're wonderful, but we're gonna add a lot to the Detroit community. So, great stuff.

• 1:32:13Rich Roll?

  It's great, man. You know, it's fantastic to see that happening out there. And I love what's happening in Detroit right now with this renaissance.

• 1:32:20Joel Kahn?

  Yeah, so we're both restaurateurs now.

• 1:32:23Rich Roll?

  I know, can you believe that? It's crazy in some respects.

• 1:32:25Joel Kahn?

  Yeah.

• 1:32:25Rich Roll?

  Also, you can go to holisticheart.com. That's more like on your, that's sort of like the website for your book.

• 1:32:31Joel Kahn?

  Yes.

• 1:32:31Rich Roll?

  Yeah, and on Twitter, of course. It's Dr.J. Is it Dr.J. Khan? I never remember.

• 1:32:38Joel Kahn?

  D R J K H N.

• 1:32:39Rich Roll?

  Right, and Face, you're on, you're pretty active on Facebook.

• 1:32:42Joel Kahn?

  Yeah, my wife says that. My wife says I live on Facebook, not at home, but...

• 1:32:48Rich Roll?

  All right, we'll talk about that. Yeah, we gotta, maybe we have to work on an ID talk for you.

• 1:32:54Joel Kahn?

  I need to take a little break. I agree.

• 1:32:58Rich Roll?

  All right, well, we'll talk about that offline. All right, man, cool. Feel good?

• 1:33:02Joel Kahn?

  Peace out, it was wonderful.

• 1:33:03Rich Roll?

  All right, thanks.

• 1:33:04Joel Kahn?

  Bye-bye.

• 1:33:05Rich Roll?

  Peace. Plants.

• 1:33:10Rich Roll?

  All right, y'all, that's it for this week. I hope you dug it. Joel is great. No BS with that guy. Just good, solid information, and I appreciate that. Quick reminder, check out his book, The Whole Heart Solution. Link in the show notes to the Amazon page for that book. Click through the Amazon banner ad at ritual.com. And we all win that way, right? And also, make sure you check out his new book when that comes out, Dead Execs Don't Get Bonuses. Joel also is a frequent blogger for mindbodygreen.com, for forksovernives.com, and the Huffington Post. Guy's constantly putting up new articles, so you can read up on all his good stuff there.

• 1:33:52Rich Roll?

  I'll put links up in the show notes to some of the stuff that he's doing, so you can easily access it. Also, if you happen to be in Detroit this spring, check out his restaurant, Green Space Cafe. And if you happen to be in the West Valley area of Los Angeles, the Westlake Valley, the Westlake Village, I should say, area, come by our place, Joy Cafe, feeling awesome. It's right off the 101, the Westlake Village Boulevard exit. And more likely than not, if you come over at lunchtime, you're probably going to run into me or Julie. We eat there all the time. If not, say hi to Nick, Joy, have a great meal, engage them in conversation, expand your horizons, leave feeling great. It's all good for all your plant power provisions. Go to richroll.com.

• 1:34:37Rich Roll?

  We've got new t-shirts. We have these Plant Power California License Plate motif shirts that are pretty cool. We've got the tech tees and short sleeve and long sleeve. We've got nutritional products, of course. We've got the digital products, the meditation program, all that stuff. You guys know what's there. Go there, check it out. Also, go to mindbodygreen.com for my online courses. I've got two of those. The Art of Living with Purpose. It's about setting goals. It's about connecting with your inner self. It's about unleashing that authentic version of yourself. It's about how to properly set and achieve goals. And then, of course, my Ultimate Guide to Plant-Based Nutrition course, which is like three, over three hours of streaming video content. Everything you need to know to get more plant-powered into your life. Hit us up with a review on iTunes.

• 1:35:20Rich Roll?

  Send me your questions for future Q&A podcast production, audio engineering, music, sound design. Who did all that stuff? Tyler Pyatt did it. That's who. He's my son. He's rocking the production on this show. Thanks so much, Tyler. Additional production and editorial support, like the show notes, like figuring out the quote that goes at the top of the show, all that good stuff, that's Chris Swan. And of course, graphic art, as always, done by Sean Patterson. Thanks, you guys. See you next week. Read your food labels. I'm out. Peace. Plants. Later.