Heal Your Gut: Dr. Alan Desmond On Optimizing Your Microbiome Through Plants

As rates of chronic disease continue to rise, What should I eat? has become one of the most important questions we can ask ourselves. Here to help us cut through the morass of diet confusion to provide clear and actionable counsel is the very wise and articulate Dr. Alan Desmond. Certified in both Gastroenterology and General Internal Medicine, Alan is a gut health expert specializing in the role diet plays in the prevention and treatment of digestive diseases—more specifically the overall health benefits, of a whole-food plant-centric approach to nutrition. Today he teaches us how we can harness the power of a healthy gut and optimize our overall well-being by simply eating more plants. We dive into the nitty-gritty of the microbiome, its relationship to digestive health, and the fundamentals of a healthy diet—in other words, what to eat and what to avoid. My hope is that this conversation leaves you with the information, strategies, and protocols you need to adopt better nutrition habits with staying power—because health isn’t a diet, it’s a lifestyle. Enjoy! Show notes + MORE Watch on Youtube Newsletter Sign-Up Today’s Sponsors: BetterHelp: https://BetterHelp.com/richroll Birch Living: https://BirchLiving.com/richroll AG-1: https://drinkAG1.com/richroll Plant Power Meal Planner: https://meals.richroll.com 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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• 1:18Speaker 01

  Every day we get out of bed and we ask ourselves, what should I eat? To be able to digest your food comfortably and efficiently is the essence of being a healthy human. Dr. Alan Desmond.

• 1:28Speaker 02

  Alan Desmond. Dr. Alan Desmond. He's a plant-based gastroenterologist.

• 1:33Rich Roll?

  He's the author of the new book. The Plant-Based Diet Revolution.

• 1:36Speaker 03

  He incorporates whole, plant-based nutrition to treat your problems, not just the symptoms.

• 1:42Speaker 01

  I don't accept that concept, that to build meat, you gotta eat meat. If we aren't able to go and enjoy our food, it has such a dreadful impact on our quality of life. The statistics on gut health are terrible. One in 15 to one in 20 people in the US develop colorectal cancer in their life. One in 10 Americans have type 2 diabetes. It can reduce your life expectancy by seven years. If you have access to all of these foods, then choosing plants first is definitely the way forward.

• 2:15Rich Roll?

  I've got a couple more things I would very much like to mention before we dig into this one, but first.

• 2:24Rich Roll?

  Okay, Dr. Alan Desmond. As rates of chronic disease continue to rise, the question, "What should I eat?" has become one of the most important questions we can ask, a question that is often and quite unfortunately met with conflicting advice that leaves too many of us with more confusion than clarity. So here to help us cut through the morass of diet confusion to provide clear and actionable counsel is the very wise and articulate Dr. Alan Desmond. Certified in both gastroenterology and general internal medicine, Dr. Alan Desmond is a gut health expert who specializes in the role that diet plays in the prevention and

• 3:05Rich Roll?

  treatment of digestive diseases, more specifically, the overall health benefits of a whole food, plant-centric approach to nutrition. He's presented at numerous international conferences alongside renowned plant-based advocates and past podcast guests such as Dr. Michael Greger, Dr. Michael Klapper, Dr. Kim Williams, and Dr. Neil Barnard. And he's an ambassador for Plant-Based Health Professionals UK, a not-for-profit group that educates the public health professionals and policymakers on the incredible health benefits of a plant-based diet. Today, Alan teaches us how we can unlock the power of a healthy gut and optimize our overall well-being by simply putting more plants on our plate.

• 3:50Rich Roll?

  We dive into the nitty-gritty of the microbiome, its relationship to digestive health, and the fundamentals of a healthy diet. In other words, what to eat and what to avoid. Recorded during our Plant Power Retreat in Italy this past spring, Alan, by the way, was a fantastic value add to that week-long experience, this is an illuminating conversation on the power of your plate to impact every facet of your health. My hope is that it leaves you with the information, the strategies, and the specific protocols that you need to adopt better nutrition habits with staying power. Because health isn't a diet, it's a lifestyle.

• 4:33Rich Roll?

  All right. Hey, everybody. My name is Rich, I'm Julie's husband.

• 4:42Rich Roll?

  But I thought it would be also good for me to contribute to this retreat on some level, right?

• 4:53Rich Roll?

  And it is called Plant Power Italia, right? There's this word "plant" in it. And despite the fact that we've been eating plants, we barely mention the fact that this is sort of an integral piece in our approach to lifestyle, to well-being, to longevity, to kind of everything that we're about. And most of you, if not all of you, kind of know our story. There's been many rungs on the ladder to deliver us to this place here today. But plant-based nutrition is absolutely a central element in all of that. And when I adopted a plant-based approach to my diet over 16 years ago, it was nothing short of revolutionary

• 5:38Rich Roll?

  and remarkable, the impact that it had almost immediately on my health. And I've been an avid supporter and evangelist of this way of eating for that entire period of time. And it's been a fascinating journey to not only kind of grow and develop in lockstep with a movement that now has truly become mainstream. And it's not that it didn't exist 16 years ago when I started it, but certainly it's very different now than it was then. And that's very gratifying to see. When I started, I looked to certain mentors who are now kind of aging up. And over the years, it's been a delight and a pleasure

• 6:19Rich Roll?

  to see a new generation of healthcare professionals, cookbook authors, influencers, athletes, filmmakers, content creators, kind of shoulder the responsibility for espousing the benefits of this lifestyle. And certainly, the great Dr. Alan Desmond, who's here today, is one of those people. I've been following his career for quite some time and watched his kind of ascension from somebody who was just sort of flirting with the idea of, "What is this lifestyle? And how would this work or fit into how I'm treating my patients?" To truly one of the most prominent figures in the movement. So when I said earlier that it's an honor to have him... With us this week, you know, I very much mean that.

• 7:04Rich Roll?

  And so it's a delight and a pleasure to introduce him today in a conversation that I would like to be informational, but also highly practical for all of you. So we're going to chat for a little while, but then we're going to open it up to questions. And so I want everybody here to think about the question that they might want to ask Alan and try to make it kind of not so specific or particular to you that like, nobody else will have that. You know, it's like you could pull him aside later for that one. But maybe think about the more kind of broadly applicable daily conundrums or questions you might have about how you're thinking about your relationship with nutrition. So, thank you, Alan.

• 7:47Rich Roll?

  And to kick it off, maybe tell us a little bit about, you know, your background and the evolution of your relationship with plant-based nutrition and how it kind of became a central component in how you think about medicine, treating patients and, and just, you know, well-being in general.

• 8:06Speaker 01

  Thank you so much. Like, what a kind introduction. I really, really appreciate that. And good to know that people have been noticing all this hard work we've been doing. You know, it's the kind of new vanguard, as you call it, the plant-based diet revolution, whatever we want to call that, you know. So I'm a gastroenterologist, a gut health specialist. And my journey towards recommending a plant-based diet was driven by my patients. So I became, I was a young doctor, 2001, 2002, graduated 2001. And you go through this process where you work in different specialties. So you do nephrology, respiratory medicine. And when I arrived for my first job on the gastroenterology ward,

• 8:49Speaker 01

  I saw people who looked healthy on the outside. But they were really unhealthy on the inside. So there's this old concept in medicine, very old concept in medicine, that all health begins in the gut. And these are individuals who are struggling with really at the sharp end of dysfunctional gut health. So in hospital with problems like ulcerative colitis, Crohn's disease, end-stage liver disease, often driven by non-alcoholic fatty liver disease. And these are patients who get really, really sick. So they're some of the sickest patients in the hospital. They're some of the patients who need the most intensive support. And what drew me into gastroenterology as a specialty, first of all, was witnessing how much individuals' quality of life improved

• 9:34Speaker 01

  and how much their prospects improved if you could restore their gut health. And there was a few patients in particular who I watched on that journey getting better. And it was so transformative. I was like, I really want to work in this specialty for the rest of my career. So pretty early on, I was hooked on gastroenterology. So that was like 2003, 2004. And of course, the next piece to that is I'm learning all about the procedures, the medications, the diagnoses. And I'm explaining these to patients for the first time. And I realized very early on that every patient with a digestive health problem will eventually ask you on the first conversation or the second conversation, "What about food, doc? What should I eat? What should I avoid?"

• 10:18Speaker 01

  And that's a really powerful question because the patients made the connection because they've got a digestive health problem. There's a straight line there for food. And they're asking you, "Well, what can I eat to feel better today? What can I eat to feel better in the future? You've just told me I need medication. I might need surgery. I'm going to come into your clinic for the next few years for regular checkups. What can I do with food?" And I wanted to have evidence-based answers for that question.

• 10:44Speaker 01

  There was one case in particular that always stuck with me, and I think it kind of sowed the seed for me, was when I was the like the most junior doctor on the team that was taking care of patients. There was this one young man in his early twenties who was hospitalized with pretty severe inflammatory bowel disease. And so he's got this condition, it's causing inflammation in his bowel. We're giving him steroids and other medications to tamp the inflammation down. He's got abdominal symptoms and diarrhea. He's losing weight. His family are worried about him. And like a lot of young people, he was in, he was supposed to be at university or in his first job or getting on with his life, but instead he's in hospital. So we'd been giving him the steroid medication, and the medications are great, don't get me wrong, they're transformative. And he'd been getting

• 11:27Speaker 01

  steadily better for three days. So the message on the ward round with the attending with my boss was, things are going the right way, you're getting better, the inflammation is reducing, we're going to give you this great biologic drug, we've got some great drugs for inflammatory bowel disease, they make a huge difference to people. We're going to give you this, this new drug tomorrow, and we don't think you're going to need surgery. So he turns to my boss and says, you know, I'm feeling hungry again. Is there anything I should eat? And his mom, who was there to support him, kind of looked in askance to my boss. And my boss said, it doesn't matter. Eat whatever you like. What he's got some calories into you. And turned to this young man's mother and said, does he

• 12:09Speaker 01

  like McDonald's? Do you want to bring him in some McDonald's? Because we need to, we need to build him up a little bit. And he was surprised, his mom was surprised, I was pretty surprised as well. But, but I'm, I'm the, I'm the new kid, you know, I, well, I'd been like six years in medical school, but I'm the new kid. It wasn't my, my position, but I was a little bit surprised. And that was a missed opportunity, I now know, all these years later, right? So at that point, I started looking for those evidence-based answers for my patients. And around that time, there was this paper published in a journal called Gut, which is one of our leading gastroenterology journals. It is what it says, okay? It's all about the latest research in digestive health. It's called Gut.

• 12:53Rich Roll?

  Those clickbaity scientists.

• 12:55Speaker 01

  Yeah.

• 12:55Rich Roll?

  Trying to get you to read their studies.

• 12:57Speaker 01

  Yeah, exactly. They know how to suck you in. So there was a paper published in Gut, which is the journal you're reading as a budding gastroenterologist, right? That's where all the new science is. And there was this interesting paper and it was UK data. It showed for patients with inflammatory bowel disease followed over the course of a year, those who ate red meat were three times more likely to be hospitalized. Those who ate processed meat, bacon, sausage, processed meats, et cetera, were five times more likely to be hospitalized. So even at that point, I now had one answer that I could give to those patients. So I started talking to my patients about that, even as a very young trainee doctor. And that paper, the references and the mechanisms it was describing led me down some rabbit holes.

• 13:41Speaker 01

  And then it was a very, very gradual process. It takes another six years after that story for me to graduate and become a gastroenterologist, 2012, until I am a gastroenterologist. And on a continuing journey to give my patients evidence-based answers, I would read all the journals, all the articles, consume all the information. And there's two consistent messages in terms of keeping your gut healthy and helping to restore your gut health. It's number one, yeah, food is really important. Food really, really does matter. And I had learned to speak to my patients about unprocessed food, avoid the junk food,

• 14:23Speaker 01

  and eat more plants and get your protein from plants because that supports good gut health. So when I first heard the phrase "whole food, plant-based" in about 2015, it was like a lightning strike, you know, because "whole food, plant-based", that's what I've been trying to explain to my patients. It kind of led on from there.

• 14:48Rich Roll?

  Yeah, there's an inherent kind of fascinating irony in the fact that the gut, your digestive system, which is inside our bodies, is actually outward-facing, right? It is external to our bodies. It is the interface between the outside world and the interior world through which... Nutrients pass and the idea that you know food wouldn't matter when this is the basically this is where your body meets food in the most important way seems totally insane and yet it is somewhat of a new idea. Over the last 10 years, we've seen this explosion in not only

• 15:30Rich Roll?

  the interest around the microbiome, but also a deepening appreciation for the complexity and importance of the microbiome with respect to every facet of health and well-being. And I see you as somebody who's kind of right at the center of this very important movement where the science is rapidly evolving and kind of coming out almost weekly with new understandings because it is so complex around how and why the microbiome is so important. So when you were talking about the relationship between food and gut, let's take a step back and explain why gut health is important to overall health.

• 16:14Speaker 01

  That's such an awesome question. I mean, it shouldn't surprise us, but yet it seems surprising, right? So I mentioned earlier, you know, Hippocrates, two and a half thousand years ago, all disease begins in the gut, or if you will, all health begins in the gut. So that's very, very ancient wisdom. Okay. But in recent years, we've come to realize that there was so much wisdom in that ancient wisdom because we now know that not only is our gut really important for regulating our appetite, not only is it responsible for absorbing nutrients, it's also in many ways a control center for human biology. It's the home of the gut microbiome,

• 16:56Speaker 01

  which we can talk more about in a few minutes, but that seems to be an incredibly important part of gut health and good gut health equals good immune health is good coronary vascular health. I mean, I when I go to conferences now, and I've been going to conferences for years talking about gut health and the gut microbiome, I usually now have to if it's a general medical conference, I have to sit there and watch the cardiologists talk about the gut microbiome. Neurologists talk about the gut microbiome, I watch the endocrinologists talk about the gut microbiome. And it's got to the point, there's so much science coming out now that we're getting, you have to be like a gut microbiome subspecialist, you know, you can't read all the research, you just can't, there's too much coming out. I was very lucky early on in my career to work for a guy called Professor Fergus Shanahan.

• 17:39Speaker 01

  So even when I was, you know, around in two thousand four, two thousand five, my supervisor, one of my mentors, was at the very cutting edge of microbiome research and I went on to work for him for a number of years. So it's been there from the start. But on a very human level, food, food and gut health really, really matters. We eat breakfast, lunch, dinner, we think about food, certainly everyone in this room thinks about food all the time. And if we aren't able to go and enjoy our food, it has such a dreadful impact on our quality of life. Every, I mean, people get embarrassed about gut health, but look, just take it from me, everybody eats food, everybody burps,

• 18:22Speaker 01

  farts, poops, uses the toilet, these are normal human functions. And to be able to digest your food comfortably and efficiently is the essence of being a healthy human. So we've got this concept, number one, that all health begins in the gut. And then we look at the state of gut health right now. And it, it doesn't make sense, right? So if to have an efficient, comfortable digestive tract is human and an essential human trait. We look around, like you look at the United States right now, the statistics on gut health are terrible. So about one in five people in the US is living with daily gastroesophageal reflux symptoms.

• 19:04Speaker 01

  The number one selling medication or one of them in the US is an acid suppressing medication to switch off a normal digestive function to try and put a lid on digestive symptoms. About one in fifteen to one in twenty people in the US develop colorectal cancer in their life. Diverticular disease is so common that people don't even refer to it as a disease anymore. They refer to it as diverticulosis. It's, it's normal, but it's not normal, it's not inevitable. There are places in the world where people don't get a particular disease. It wasn't always an inevitable part of the human condition, yet it hospitalizes people. It costs the US economy nine billion dollars a year now. And when, again, when you go and you look at the evidence for, well, look, does food matter?

• 19:46Speaker 01

  Is the way I eat going to help protect my gut health and keep me out of hospital? So I substantially reduce my risk of colorectal cancer, substantially reduce my risk of all of these problems. Food matters. Patients are right. Food really matters. And how do we eat to support, prevent, preserve our gut health? It really is, I mean, a whole food, plant-based diet. It doesn't have to be exclusively plant-based. And we can get into that. But if you are eating the same healthy diet that we recommend for heart health and brain health and lung health, a healthy whole food, plant-based diet, you're getting, I mean, half your food from fruits and vegetables, but a third your food from healthy whole grains. You're getting your protein from healthy plant-based sources, maybe a little bit of fermented food,

• 20:30Speaker 01

  a little bit of healthy plant-derived oils. And if you can establish that healthy dietary pattern, and there is room for small amounts of animal products in there as an option, but far less than people think, then you are eating in a way that is really going to support, protect and preserve your gut health, for sure.

• 20:46Rich Roll?

  Yeah, I think, I think what's the key point here is, for me at least, is agency. Because we can go down this microbiome rabbit hole, and it's super fascinating, these studies and what they're telling us about the, you know, the intricacies of what's happening inside of our bodies. But what I kind of extract from all of this and, and kind of leverage in a practical way is the mutability of the gut microbiome. So I had, I had Tim Spector on the podcast recently, but it was really compelling to hear him talk about his developing understanding of the importance of the microbiome

• 21:27Rich Roll?

  in the context of studying twins and trying to understand why identical twins would have different health outcomes throughout their life, thinking that this is emanating from, from genetics, right? It was a kind of nurture nature study, as you know, I'm sure you know all about this. But what was discovered was the differential in those outcomes really could be rooted to the differential in their gut microbiome. So we're all very different people. We look different, but ultimately the DNA that we have is almost identical to each other. And yet our microbiomes, if we were to sample all of that, would be wildly different in this room. But it's very responsive,

• 22:10Rich Roll?

  right? When you talk about food, the reparative kind of mechanism around the microbiome is such that if you start to treat it right, you can reverse, prevent, like sort of set yourself on a different trajectory. You can't change your genes, but you can change the nature of your gut microbiome to kind of course correct wherever you're at and get on a better track, which I love. And when you were talking about all these diseases, diverticulitis, or it's like you think about what's causing this from overuse of antibiotics to environmental toxins and Zach Bush would say glyphosate, or the types of foods that we're eating, the ultra-processed foods and

• 22:52Rich Roll?

  everything that's going on, we're like assailing our microbiome continually. And to the extent that we can be more mindful about what that looks like and make better choices, we can actually change the trajectory of our health, back to that notion of agency, which I think is really cool.

• 23:10Speaker 01

  Yeah, it's incredible. And you know, I love Tim's research and I consume it voraciously. And then as a clinician, I've got to take all of that high level research and try to bring it to my practice on a daily basis. And it's interesting because the things that help to build a healthy gut microbiome also build a healthy human. So I mean, when you hear microbiome researchers speaking, they've talked about eating a varied plant-based diet, getting enough sleep, spending time in nature, avoiding unnecessary medications. I mean, antibiotics are great, they're lifesaving, but not taking them if they're unnecessary. We also Know from research that Tim is involved, the American Gut Project, that eating animal

• 23:52Speaker 01

  products brings antibiotics into your digestive system and into your gut microbiome. And those are practices that preserve a healthy human as well as a healthy gut microbiome. And again, that shouldn't surprise us, right? And I know you've gone deep on the microbiome, but I mean, it's something that's been on my mind since the early part of my career, but should be on all of our minds. I mean, so the gut microbiome, you've got your, maybe the numbers vary depending on the latest count, but maybe 60 trillion bacteria, yeasts, viruses, and archaea, living predominantly within your large bowel, your colon. They, these bugs have been on this earth for like two to three billion years. They're far more ancient than humans.

• 24:36Speaker 01

  We've been around for maybe 200,000 years. So if you think about where the microbiome came from, Rich, I mean, it gets a little bit meta, doesn't it? Because you think about this, the first two primitive cells on this planet that gave rise to every human and every other animal on the planet, when those two little cells got together, they were surrounded by viruses, yeasts, and you know, the archaea and the bacteria, they were part of the gut microbiome, part of the microbiome. The meta. The macrobiome. The macrobiome, right? The macro, the, I've lost it. The meta macro. The meta macro microbiome. And you know, so that's incredible. That's incredible.

• 25:19Speaker 01

  And we are still carrying those bugs with us in our digestive tract every day. And we only really found out about it maybe 600 years ago with the advent of microscopes, you know. What did the scientists do? They started looking at poo under the microscope, you know, 600 years ago. And they saw these tiny living creatures that were coming from the digestive tract. They called them animalcules, right? Like molecules, little tiny little animals. And it's only, yeah, right? I wish they'd stuck with that name instead of bacteria, yeast, and viruses, but animalcules. What a lovely old name for these little bugs in our gut. And then in the last 10 and 20 years, and you know, my former mentors like Fergus Shannon and obviously Tim Spector.

• 25:59Speaker 01

  People like Ted Dynan, people like Professor Tom Cotter, who I'm very lucky to be working on a project with now, have led the charge on that research. And thanks to the, you know, the advent of the new genetic analyses and the costs have come down and throughput has come down, that we've learned so much about the gut microbiome in the last several years. And just like one little statistic that kind of crystallizes it for me, which was only like research published in the Netherlands just a few weeks ago. So these researchers looking at the impact of the gut microbiome and health. So they measured plasma metabolites. Okay. So if you go to the doctor and you get a blood test, so we're measuring different molecules in your bloodstream.

• 26:43Speaker 01

  So various, you know, cholesterols and lipids and inflammatory proteins, CRP, you're familiar with hearing about those. There's lots of other metabolites that you don't really hear about at the lab when you go to see your GP. So these researchers measured everything they could measure in the plasma in their lab and determined that of the 1,200 metabolites that they could measure in the lab, two thirds were directly dependent on the individual's diet and microbiome. So two thirds of the 1,200 metabolites flowing through your bloodstream are determined by your diet and your gut microbiome health compared to less than 5% determined by your genetics.

• 27:26Speaker 01

  So it's no surprise that our gut microbiome and the food that we eat have such a measurable impact on our health and longevity.

• 27:35Rich Roll?

  Great. Well, let's, let's dive into that a little bit then. Let's say somebody just heard what you said and they are thinking, wow, I've never thought of that in that way before. So first of all, how do I find out the state of the union of my, you know, gut microbiome? I've never thought about it before, so I would like to have it tested. And if I go have it tested, how do I do that? And what should I be looking for? And then sort of secondary to that, we can get into kind of just best practices and protocols to improve or maintain. Maintain a healthy gut microbiome.

• 28:11Speaker 01

  Yeah, well, I would say the first, the second bit comes first. Okay, so it be, I think before you, you start to inquire into your current gut microbiome health, you probably want to get those best practices dialed in first. Okay, because that's, you want to know the things are on point. Now, these things we sometimes refer to as the basics. But of course, they're not basic anymore. They're really unusual. It's really difficult in the current food culture and in our current lifestyles to actually live in a way that supports our overall health, let alone our gut microbial health, even though often it's the same thing. I mean, when you, I mean, one of the key things is the diversity of plants in your diet.

• 28:56Speaker 01

  And, you know, Tim was involved in the research that brought that concept into the public sphere. So

• 29:03Rich Roll?

  The thirty plants a week.

• 29:04Speaker 01

  The thirty plants a week, right? So that came from the American Gut Project. So 11,000 citizen scientists sent their poop to the lab. Okay, citizen scientists contributing to understanding the gut microbiome. And one of the key findings from that paper was that the diversity and health of your gut microbiome crucially depends, the number one determinant, depends on the diversity of plants in your diet. And individuals who consume more than thirty plants per week unlock certain gut microbial benefits that other people don't get. I'm sure if people have just listened to podcasts with Tim and they're listening to this now, there's a repeat there, okay? But even in that paper, fewer than one in 250 people were hitting that mark.

• 29:50Speaker 01

  So that's really, really rare. And if you look at the evidence on how much a healthy diet and lifestyle impacts your health and longevity, which is substantial, I mean, a healthy plant powered diet can add ten to fourteen years of life expectancy. Which is incredible, 10 years of healthy life expectancy, which is incredible. I mean, who doesn't want 10 extra years of healthy life? I mean, that's the difference between seeing your grandchildren finish grade school and being there when they graduate university or have their first art exhibition or write their first book. That's, I mean, that's, that's powerful medicine, right? But when you look at all of those studies, what you see is the people who are getting

• 30:31Speaker 01

  the greatest benefits from their diet and lifestyle in those studies are in a tiny minority because our current diet and lifestyles just don't support health and longevity anymore. So in order to, you asked a really good question, I'm going to give you a really long answer, I apologize. But before you embark on discovering the secrets of your personal gut microbiome, I would suggest that you spend some time before you get any of those tests done, just working on your daily routine and making sure that you are eating and living to support a healthy gut microbiome.

• 31:17Rich Roll?

  Yeah, I love that. This notion of diversity being paramount is so interesting to me for many reasons. But as you're, as you were sharing about that, I'm thinking about, I mean, we're in Italy. Julie and I and our family, we were in Florence for a couple of days before the retreat started and we were going to galleries and museums. And so we have, you know, the David and Michelangelo and Da Vinci on our mind. And I'm thinking about the Vitruvian Man and the proportions that sort of scale up in different ways in nature. And when you talk about the importance of diversity in your diet as a marker for gut

• 31:55Rich Roll?

  health, this is a, a truth or a notion that also appears throughout nature from the micro all the way to the macro. Ecosystems are healthier with diversity. Human populations are more robust and, and healthier when we have a diversity of perspectives, et cetera. Like- This is like, it's sort of like the Fibonacci sequence, right? Like, this is like a truth that is core and important for every component of like how we navigate the world to what we eat, right? So I love that idea. And the simplicity of just thirty plants a week kind of roots it in your consciousness. So you can kind of very easily reflect upon that every time you're making a food choice.

• 32:40Speaker 01

  Absolutely. And that's maybe the first point or the first practice, building a plant diverse diet. Of course, a healthy whole food plant based diet ticks that box and then some. Okay, so if you're eating like a healthy whole food plant based diet, as you and I both espouse and promote and live, you're going to be eating sixty or seventy or eighty different plants per week. You know, we probably had thirty to forty plants yesterday here together, eating gorgeous, diverse, plant based food, which was delicious and beautifully prepared, but ultimately was pretty simple. It was like pasta and tomatoes and garlic and onion and seasoning and some leaves and some other leaves and some more leaves.

• 33:24Speaker 01

  And that really helps to build it. And it's no surprise that vegans or people who eat plant based hit that marker consistently. They hit the plant based diversity marker consistently. How do we know that? Well, we look at the dietary intakes of plant based eaters versus carnivores or omnivores, I should say. And we've known since the nineteen seventies that about the average fiber intake for an omnivore in a high income country is about twenty grams of fiber per day, maybe a little bit lower than that. But we've known since the nineteen seventies that even in the UK, there was data looking at dietary fiber intake in vegans. And even then, they were hitting like forty four grams, which is a much more representative number of what we should eat for a healthy gut. We've seen that validated even recently.

• 34:09Speaker 01

  The huge study across the US, Europe and Asia, again, vegans, vegetarians, particularly vegans, get way more dietary fiber than people who are not vegan. That's one of the key reasons why people who eat plant based are less likely to develop diverticulitis. ...cancer, colorectal cancer, why a healthy diet helps to prevent conditions like inflammatory bowel disease, Crohn's disease. And that comes back to the diversity piece as well. There's definitely an overlap there. But of course, I'm not blaming people who have these conditions. My God, as I said, it's really, really difficult to hit those numbers in the current food culture. So that's the plant diversity aspect. The second aspect is ditch the junk. I mean, the junk food, which now, or junk food also known

• 34:53Speaker 01

  as junk, which makes up like 60% of the calories that we consume in high income countries. So the processed chips and dips, the, you know, the pep, well, I won't mention a brand, but those little salami sticks that you can buy at the drugstore, all of that stuff, okay?

• 35:10Rich Roll?

  Slim Jims? Why are you sheepish about the brand? Are you afraid of big Slim Jim coming after you?

• 35:15Speaker 01

  Yeah, yeah, I don't, I don't, I don't want Slim Jim adding me, you know, coming at me, you know, I'll have to leave Twitter. But so those, those junk foods, they're junk, make up 60% of the calories consumed in high income countries right now. They have no business in the human digestive tract. The modern food industry has been pumping chemicals like maltodextrin, polysorbate 80, carboxymethylcellulose, caraginin, lecithins, these artificially produced flavor enhancers and emulsifiers into the food system since the 1950s and 60s. They take stuff that isn't food and makes it taste like food, makes it soft and moist and flavorsome, makes it

• 36:00Speaker 01

  shelf stable, easy to ship, cheaper to produce. And we, we love it. I mean, it's, it's very carefully designed to appeal to our primitive monkey brain that likes sweet things and salty things and fatty things. And we love eating it, but no business in the human digestive tract. And then when you look at individual components of those junk foods and the mechanisms, what they do to our digestive tract, I'll give you an example, okay? So there's a, there's an artificial sugar called maltodextrin. It's been described in the US as a ubiquitous food additive.

• 36:36Rich Roll?

  I've had a lot of that in my lifetime because as an endurance athlete maltodextrin is sort of a lower glycemic carbohydrate that you can mix with water and kind of sip on throughout a very long, you know, sort of session. So I've probably had more than a fair share of human dosage of that over the course of my lifetime.

• 36:59Speaker 01

  Oh dear.

• 36:59Rich Roll?

  You're making me worry.

• 37:00Speaker 01

  Yeah, yeah. Well, let's talk about maltodextrin then. Let's talk about Rich's gut microbiome.

• 37:08Speaker 01

  So what we know is you're not alone in that because the average US citizen consumes maltodextrin three times a day because it's in almost every processed food. You flip over almost any processed food and you will see maltodextrin, the slow release, stable, artificial carbohydrate that's made in a chemical factory, this powder that's added to our food. So what does it do? Well, one of the things that it does in our gut microbiome is it promotes the growth of a bacterium called adherent invasive E. coli, AIHC. So this bug now becomes prevalent within our gut microbiome. When we consume a lot of maltodextrin, for some reason, that bug enjoys eating the byproducts of maltodextrin. So why does that matter? Well, adherent invasive

• 37:53Speaker 01

  E. coli is just one of the components that helps to trigger the abnormal immune response that one sees in Crohn's disease. So Crohn's disease can be a very devastating GI condition, predominantly emerges in people in their twenties and thirties. The young man I mentioned earlier in the story was on the ward with Crohn's disease, hospitalized. About only 25% of people with Crohn's disease say that they have good overall quality of life. It's very, it's very, very impactful on people. So it's a multifactorial illness and genetics play a part and there are other components, obviously, but the adherent invasive E. coli has a role to play in that disease. And then you add to that, Rich, in order for that bug

• 38:34Speaker 01

  to cause mayhem in your digestive tract, it needs to get really close to the cells Line your gut. Of course, the cells that line your gut have this lovely protective layer of goo called mucin that prevents abnormal interactions with pathobionts, harmful bacterium, harmful bacteria. But guess what? The junk foods also contain emulsifiers like polysorbate and carrageenan and lecithins that degrade the mucin layer. Okay. And also, we know that in a fiber deficient diet, your gut microbiome isn't receiving the microbiome available carbohydrates that it thrives on. So it turns to the mucin

• 39:16Speaker 01

  layer for food and starts to degrade it. So that allows this adherent invasive E. coli to come in contact with the micro pore cells in the lining of your terminal ileum. And that is a key part of the development of conditions like inflammatory bowel disease.

• 39:33Rich Roll?

  Wow, that's fascinating. You mentioned you sort of with a slip of the tongue, you said carnivore a minute ago. And you also mentioned sort of a low fiber diet. So I want to get into that a little bit. I think irrespective of whatever your your diet proclivity is, everyone would basically unanimously agree that ultra processed foods, the UFPs, the junk, has no place in in on a healthy plate, right? And once we depart from there, though, opinions start to flare in all sorts of different directions. And I'm imagining the well intentioned person who opens up their social media on their phone or their Instagram, and and they

• 40:15Rich Roll?

  see a clip of Alan saying exactly what he just said, and they scroll, and then they see Dr. B, and he's talking about 30 plants a week, etc. But then keep scrolling. And there's Dave Asprey saying how kale is is toxic, and Dr. Gundry, who's talking about lectins and why we shouldn't eat beans. And then there's the carnivore enthusiasts and the Liver King, who are telling you, you need to eat organ meats, and everything you've heard about fiber is incorrect, and we need to rethink cholesterol and etc. My point being that For somebody who is in the process of a good faith like desire to kind of understand like, hey, what should I do? Like on a very, I just want, just tell me like, what's healthy,

• 40:57Rich Roll?

  what's not. I go online, everybody's saying something different. These people are all crazy and it reminds me of, you know, that kind of famous, well-known, you know, tobacco industry campaign where the advertising agencies understood and learned that like doubt was their product, right? And so I think all the conflict, the sort of conflicting messaging out there sort of roots people in a certain paralysis where it's like, well, I'll just keep doing what I'm doing because these people, you know, they can't, they can't get their shit together and agree on anything. So I'll just wait until there seems to be a little bit more clarity.

• 41:35Speaker 01

  Well, we'll come to the carnivores in a minute because there's, there's a lot to be said about that. So every day we get out of bed and we ask ourselves, what should I eat? And my patients ask me, what should I eat? And some people go on social media to figure out, what should I eat? So that's a really, really important question and food is in many ways, the number one determinant of our health and longevity. And it's really, really important. Food is powerful medicine and that's true for gut health, but overall health as well. We touched on that already. So in 2019, one of the most prominent and longstanding medical journals in the world, the Lancet Medical Journal, very respected

• 42:16Speaker 01

  journal, it's been around for centuries, set up a commission and published the report to that commission. And the Lancet, because they're such a well-respected and high-powered journal, every now and then they will set up a commission to look at a very, very important question in medicine, health and nutrition. And the question that they were trying to answer with this commission was, what should I eat? Not just you, not just me, but the eight billion humans on Earth. What should we eat to be the healthiest possible version of ourselves? And that goes for the 3.5 billion people on Earth who are living with diseases of excess because they're eating too many calories

• 42:59Speaker 01

  and too many of their calories are coming from unhelpful sources. It also goes for the 800 million people on Earth who are living with the health impacts of not having access to food and not having access to sufficient calories and sufficient healthy calories in their day-to-day life. So for and everybody in between, what should we eat? They chose 38, you know, well-respected, hand-picked academics from august academic institutions like Harvard and UCL, Imperial around the world, and asked them to go and look at decades of scientific evidence and come back with a blueprint for a healthy diet. So they published that in 2019, the Report of the Eat Lancet Commission. And they were very, very clear

• 43:44Speaker 01

  that a healthy diet consists of getting about half your food in the form of fruits and vegetables, about one-third of your food from whole grains and the whole diversity of whole grains that exist by making sure that the rest of your food is predominantly made up with higher protein. I mean, all plants contain protein, but higher protein plants, your legumes, your beans, your chickpeas, your lentils, your black beans and all that good stuff, that you need to have some healthy plant-derived oils, so extra virgin olive oil, et cetera, can be added in small quantities to that healthy dietary pattern. And then when it comes to the animal products, as I said earlier, there is a place,

• 44:27Speaker 01

  and this is true in gut health practice, but also on this big question. There is a place, if you have that healthy dietary pattern established, for small amounts of animal products in there. So what kind of amounts are we talking about? Well, bacon and processed meat, zero. Bacon, processed meat, ham, salami, sausage are probably responsible for about 640,000 deaths every year. On earth, predominantly driven by coronary vascular disease, cancer and complications of type 2 diabetes. No dietary recommendations include bacon. It's just not on the plate at all. So then when it comes to red meat, so your pasture raised buffalo, cow, lamb, et cetera.

• 45:09Speaker 01

  They said, yep, you can have it, but we would recommend, based on the evidence, that you would limit your consumption to about seven to 14 grams per day. That's less than half an ounce, quarter of an ounce to half an ounce. So that would add up to maybe one small serving of red meat per week. Okay. And but in the body of the report, they said, look, the safest amount of red meat to consume is probably zero, but it's difficult to demonstrate harm at low levels of consumption. So we've allowed this within the within the within the healthy plate. When it came to eggs, they reckoned about a half an egg per day. When it came to fish and chicken, one to two ounces per day. But it was clear, reading the report, that if you are lucky enough and privileged enough to live in a situation where you have access to all of these foods, and not everybody

• 45:54Speaker 01

  does, that's for sure, but if you have access to all of these foods, then choosing plants first is definitely the way forward. Now, that international panel of experts reported that if they could flick a switch and get everybody on earth the resources and the ability and the government policies and the food structures to support that, it would prevent 11 to 12 million human deaths every single year. Again, due to preventing so many cases of various cancers, colorectal cancer, which I deal with all the time at work, type 2 diabetes, heart disease, et cetera, et cetera, et cetera.

• 46:37Speaker 01

  But also, it would prevent hundreds of millions of trips to the emergency room, coronary catheterizations, coronary artery bypass grafts, prescriptions for statins, courses of chemotherapy, you know, colonic polypectomies, which is something I do. So. There's that. Now, for years as an advocate of a healthy whole food plant-based diet, when that report came out, I was astounded because it was another one of those moments where throughout that report, they used the term "whole food plant-based". It's all over the report and they give resources for governments and health organizations to support their individual economy, to support that way of eating. So that was a real, another

• 47:20Speaker 01

  lightning moment for me because I was like, "Well, this makes sense to me because this is how I've been asking my patients to eat. This also supports really good gut health." So when that report came out, the meat component was actually very, very low, right? Like seven to 14 grams. But for years, people have been saying to me as an advocate for a healthy whole food plant-based diet, you know, what about, because you mentioned carnivore. For years, we would be asked, "Well, what about paleo?" That was the thing, paleo. And obviously, the paleo diet doesn't match up with what I just described. It doesn't match up with a healthy whole food plant-based diet, but there's an overlap, okay? So I would look

• 48:01Speaker 01

  at the paleo advocates and I think, "Actually, we agree on a lot of stuff and you agree and I agree on a lot of stuff, which also agrees with the public health and epidemiology and mechanistic stuff, okay?" So we both agree junk food is bad, added sugar is bad, added salt is bad, junk food is out, no dairy. I mean, milk is for babies. That's, I mean, that seems very clear to me, you know, milk is for babies. Humans as adults don't need to consume milk. And we agree that people should have some fruits and leafy greens and a variety of plants even, as mentioned by the paleo proponents. So the only place we really differed was where should we get our protein? So from the plant-based perspective,

• 48:41Speaker 01

  we would say you need to get your protein from plants because the data shows that the more of the protein that we get from plants, the healthier we are. And that goes for bowel cancer, diverticulitis and all of those conditions. Whereas the paleo folk would say, "Oh no, you should get your protein from meat and, you know, because you..."

• 49:03Speaker 01

  Mammals are made out of meat, so we should eat meat, I think, basically. But is the argument.

• 49:07Rich Roll?

  There's a corollary to that, which is that that plant protein is inferior in terms of its bioavailability and in terms of its ratio of essential amino acids. So I think it would be helpful to kind of speak to that question. It is the low hanging fruit. Where do you get your protein kind of recurring, you know, looping question? But yet, you know, that question persists. There are a lot of people, I think, that are, you know, either predominantly plant based or or plant based curious, but are still kind of reticent because they're concerned about

• 49:45Rich Roll?

  not just how much protein they're getting, but is this the type, the quality of protein that I need to maintain my muscle mass? And I think, you know, in fairness, there is a lot of emerging science right now coming out that as we age, that we should increase our protein intake and and that it's very important to maintain muscle mass to prevent, you know, like, you know, basically like if you fall, breaking your hip as you're an older person, etc. So as you get older, you start thinking about that more and I and I can see how that would push a certain individual either towards meat or back to meat because of that concern or consideration. So do you have thoughts on that?

• 50:26Speaker 01

  Where do you get your protein? I always welcome that question because it's such an important question. But of course, being protein aware doesn't mean being meat aware. Those aren't the same thing. So we've known for a long time that even people who eat very strictly vegan or vegetarian without, you know, trying, without taking protein shakes or whatever, just ordinary folks going about their day to day business are getting about 70 to 80 grams of protein per day, average, some more, some less, probably the top 5% getting about 100 grams of protein per day. And that comes from Canadian data, from the Seventh Day Adventists in Canada, similar data out of Germany confirming that, and lots of studies showing that, you know, vegans

• 51:07Speaker 01

  and vegetarians eat lots of protein without having to think about it too much. So there's that. So they're getting protein. And then there's this idea that the protein that we get from meat is higher quality of protein. I mean, the epidemiological evidence and the health outcome evidence tells the opposite story. And I'm very confident in saying that the protein we get from plants is high quality protein. It is the high quality protein. Because the research shows us that, well, first of all, among young men, vegan young men don't have lower body muscle than non-vegan young men. We've seen emerging data in recent years showing that if you put athletes into the gym

• 51:52Speaker 01

  and you put them on a high protein diet, whether that high protein diet is vegan or meat-based, they get the same muscular gains and performance gains going to the gym. You talked about muscle loss as we age. Now, of course, muscle loss when we age is more about weight-bearing exercise than it is about diet, but diet is important. And we saw a study published last year showing that in older folks, the higher proportion of their protein calories that they get from plants, the lower their risk of age-related sarcopenia. The concept that we don't get all the amino acids that we need to get from our plant-based diet is also a fallacy. I mean, gram for gram, you know, if you eat a piece of meat,

• 52:35Speaker 01

  if I eat a piece of my arm right now, I'm going to get the perfect balance of amino acids for a human, obviously. But you get that from a plant-based diet too. I mean, even 20 years ago, when the American Medical Association published their dietary guidelines for reducing cardiovascular disease, they mentioned the concept of the whole protein concept. So that you need to eat meat, and if you don't eat meat, you should have quinoa or soy, because those have the full complement of amino acids. Incomplete. Incomplete sources of protein. But I think it was, I can't quite remember which doctor it was, but a doctor wrote to them and said, "That's not true." And they wrote back and said, and the data, that response letter was published,

• 53:20Speaker 01

  it was Dr. John McDougall wrote to them and called them out and said, "That's not true." Because all plants contain all of the amino acids that humans need to be healthy, including the essential amino acids in different proportion. And if you are eating a varied diet that includes fruits and vegetables and three servings of whole grains and legumes, you will get all of those amino acids. So if you're going to use the whole protein analogy... A whole food plant-based diet is a whole source of protein. And then there's the outcome data. So replacing animal protein with plant protein, once you've established that healthy dietary pattern, that's a really smart move. Even replacing small amounts of animal protein with small amounts of plant protein

• 54:06Speaker 01

  has very significant benefits on reducing your cardiovascular disease, stroke, type 2 diabetes, et cetera, et cetera. So I don't accept that concept that to build meat, you gotta eat meat. And the longevity piece and the long-term health piece is really interesting. But the carnivore crowd or advocates have taken it to another extreme, right? They've gone further than paleo and they're now saying that we should only eat meat. So from a GI perspective, as a gastroenterologist, first of all, I'm just a little bit suspicious. Because, yeah, a little bit suspicious. So the human GI tract produces enzymes to digest food. There's three broad types.

• 54:49Speaker 01

  There are the lipases, which break down oils and fats. There's the proteolytic enzymes, which break down protein. You've got like tripsin, chemotripsin and pepsin. And then you've got this group of enzymes called amylases. We were talking about this earlier before I came into the room. Amylases. So amylases break down starch, plants, carbohydrates. So as soon as food goes into your mouth, it's exposed to amylases, which are there to break down the starch and the carbohydrates. Yet the people who are promoting this meat-exclusive way of eating are saying, well, actually, the perfect diet for a human is like, don't eat any starch. It's so bad for you.

• 55:31Speaker 01

  But it seems like our bodies are intrinsically designed to digest it. And sure, they will talk about the mechanistic data. You alluded to some of it earlier. You know, the nutrient profile, the bioavailability. This is all kind of lab-based theoretical stuff. And it's interesting and some of it is patently false, to be honest. I mean, the nutrients that we get from our Plants are also absorbed, you know, and also get into our bloodstream. And people who eat a healthy plant-based diet get more fibre, more folate, more vitamin A, vitamin C, vitamin E, more magnesium, more potassium in their diet than omnivores do. And all of these things have tremendous health benefits. But when it comes to the meat-specific part to the story,

• 56:14Speaker 01

  if you want to know what a healthy diet looks like, you need to go out, look at real-world evidence. You've got to go and pursue scientifically what does a healthy diet look like? And this is a whole part of medicine, this is a whole science, which we refer to as epidemiology, has a big overlap with public health. It's been around for a long time. And what it tells us is that you've got to go in the real world and find out what's happening. So just a little bit of background to public health and epidemiology, so crucial to medicine. It's the starting point for public health advice. And if we go back to like 1855, there was this, have you heard of the Broad Street pump? Have you ever heard of that story?

• 56:56Rich Roll?

  I don't think so, no.

• 56:57Speaker 01

  So we're leaving gut health temporarily, but we'll come back, okay? So in 1855, there was a cholera outbreak in London. And, you know, thousands of people were dying, okay? And at the time, most of the medical experts, including a medical celebrity and influencer called Florence Nightingale, who was a real person.

• 57:20Rich Roll?

  Do you know the story?

• 57:20Speaker 01

  Okay, so it's a real person. They thought that the cholera outbreak was being caused by miasma. So unhealthy air, the stench from the Thames, basically. That's what they thought was causing cholera. But there was this young doctor called Dr. John Snow, and he had a different theory. So his theory was that it was being caused by bad water. There was a waterborne disease. So he had a controversial opinion, just like the carnivores, I guess, okay? So he went out into the real world. He didn't disappear into the lab to figure out in his head how water could be causing this problem. He went into the real world and he mapped out cases of cholera in London.

• 58:04Speaker 01

  And he found out that they were clustered around a water pump on Broad Street. Because people didn't have running water then, they had to go to the pump, which was essentially a well and pump water, that's how you got your water. So he found these cases clustering around the Broad Street pump. He petitioned the council to shut off the pump, they said, no, you're crazy, it's caused by miasma. Check with Florence Nightingale, you know, she'll, if you follow her on Instagram, she'll, you know, she'll, you know what's going on. She's got hot takes. Yeah, hot takes all day long, right? But, so they said, no, you know, your, your theory doesn't stand up, we already know what's caused. But, so he took bold action, I like to think he went out in the middle of the night, but what he did is he went, he took the handle off the pump.

• 58:47Speaker 01

  And he ended the cholera, the cholera outbreak in London and saved lives. And that was the beginning of public health epidemiology medicine. So you go into the real world, you don't just sit in your room theorizing, you find out what's happening in the real world, you intervene and see if it makes a difference. So 25 years ago, we had, there's this awful condition, you may be familiar with, I'm sure, sudden infant death syndrome, very tragic condition, not something I'm a specialist in, but I'm aware of the story, okay? So young babies found dead, very awful, right, just awful. So there was a big move to try and figure out why this was happening. And 25 years ago, a whole bunch of scientists did some incredible epidemiological work.

• 59:32Speaker 01

  They went into the real world and recorded everything about babies, everything they did, how they were born, how they ate, how they slept, how their parents ate and slept, their daily routine. And they discovered by observing what was happening in the real world was that babies who lay on their front were more likely to suffer this terrible illness. And that gave us the Back to Sleep campaign 25 years ago. And they encouraged parents to put their babies to sleep on their back. And they didn't even know why. But good epidemiology saved thousands of lives because the countries that implemented that advice, sudden infant death syndrome went down by like 78%.

• 1:00:14Speaker 01

  So when we look currently, when you look at the epidemiological science on nutrition and health, heart disease, type 2 diabetes, colon cancer, cluster around meat consumption in just the same way that cholera clustered around the Broad Street pump. But we have decades of epidemiological evidence that support that. And not only that, we've got the mechanistic data that shows us why meat is bad for you and certainly in excess. We know about the heterocyclic amines and the polycyclic aromatic hydrocarbons and what the heme iron does, increasing risk of colon cancer, about the nitrates and nitrates

• 1:00:57Speaker 01

  that are added to processed meat, which then combine with the bacon when you cook it to form these carcinogenic nitrous amines. We know what the standard western diet does to the gut microbiome and how that promotes a gut microbiome environment that is conducive to disease. So we've got the real world data as a starting point. We've got the mechanistic data that explains what we're seeing in the real world. And then we've got the intervention studies that show that you can turn it around. But the carnivore advocates just put their thumb over all of that and say, that's nonsense. I don't believe it. Why? Because it doesn't agree with their concept of what a healthy diet looks like.

• 1:01:42Rich Roll?

  Beautifully put. Thank you for that. That was a bit of a mic drop moment. I think this is an appropriate time to open it up to all of your questions. So yeah, so let's, let's, let's open it up. Let's, let's get your questions on the mic if we could, though.

• 1:02:06Speaker 04

  First of all, thank you. It's amazing to see doctors, more and more doctors defending this and I'm, it's really grateful for it. So.

• 1:02:20Speaker 04

  A little bit of a personal story, but I think it could be general. So I think during the pandemic, Anne and I, we were mostly doing plant-based diet. But then at the end of it or halfway through it, I got some health issues, kind of a burnout, and I ended up having very low gut bacteria diversity, so gut problems. So I truly believe on the diet, but I guess there's other factors that can impact the gut, probably the amount of alcohol that I started drinking during the pandemic while cooking. So I developed cooking skills, but I guess sleep and other things.

• 1:03:01Speaker 04

  What would be, other than the diet, other very important factors? Second question I would have is, I kind of discussed this with you, but I think it would be important to discuss broadly, what is being done in the medical community to even spread this word more? Thank you.

• 1:03:23Speaker 01

  Thanks, Paolo. That's a great question. And I mean, we've just been through this incredibly stressful three-year period for everybody, and the impact that stress has on our digestive health, it cannot be understated. I talk to my patients or with my patients about this all the time, okay? So you imagine someone who's got perfect gut health, like rock solid, and they walk out their front door and they see a terrible car accident, or they get some terrible news, they find out, you know, something dreadful has happened to a family member. And people will react to that with nausea, they may vomit, they may lose their appetite,

• 1:04:07Speaker 01

  they will go for, they'll meet their buddy for lunch the next day, and their buddy will say, "Oh, you're not eating?" And they say, "Well, I had this terrible thing happen to me yesterday." And their friend gets it. And say, okay, tell me about it. That's your gut-brain axis in action. That is your digestive health. That is your appetite. That is the peristaltic waves that run through your gut and do the do the house cleaning for your gut microbiome, changing due to a 100% emotional trigger, nothing else. So if you imagine that you're living with 10% of that stress, or 15%, or 20% of that stress on a daily basis, and you may not even recognize that,

• 1:04:49Speaker 01

  it changes the gut microbial environment, it changes your stool frequency, it changes your appetite, it changes the food that you consume, which is the number one determinant of your gut microbiome. So of course it matters. So we talked about, you know, food and fermented foods and diversity and all that kind of stuff. And that's, those are the basics. But stress management is really, really important. If we don't, you know, sort out the stress, we're not going to fix your tummy. And the data supports that. So there is a condition which a lot of gastroenterologists refer to as irritable bowel syndrome. I don't use that phraseology in my clinic. I call that a functional GI disorder. And we try to get into what's driving it. I don't think the term IBS is helpful. It's way more than irritable. Okay.

• 1:05:34Speaker 01

  Having poor digestive health. I mean, we've seen data showing that people with severe IBS would give 10 years of life expectancy to restore their gut health. So it's way beyond irritable. And I've seen so many people and patients who've been housebound and lost their jobs because of IBS. But it is the term that's used in the literature. Okay, so unexplained abdominal symptoms. And we've seen data showing that mindful meditation, gut-specific hypnotherapy are as effective, if not more effective, than medication and a huge adjunct to healthy dietary change in restoring your gut health. So for years, I've been recommending that my patients engage

• 1:06:18Speaker 01

  in gut-specific hypnotherapy or mindfulness meditation. And the data tells us that if we take patients with severe unexplained abdominal symptoms or functional GI symptoms, that about 70% of them will see marked improvement with stress management, particularly mindfulness meditation. They're calming the gut-brain axis. And the great thing about that prescription. Is the side effect of profile, which is better quality of life, greater understanding of others, et cetera, et cetera. So the stress component is huge. And a very short answer, alcohol is bad for your gut. Great. Oh, it's changing.

• 1:07:01Speaker 01

  I mean, we were talking, I was talking about this outside. I mean, in 2014, I think, Dr. Kim Williams, the most senior cardiologist in America, at the time President of American Medical Association, who's in charge of setting the guidelines to help prevent and treat the number one killer, cardiovascular disease, made that statement. There are two kinds of cardiologists, vegans and those who haven't read the data. Okay. And he said that, he said that as a, you know, to stir the pot a little bit. But within a short number of years, the American Health, the American Heart Association had published their dietary guidelines for cardiovascular disease prevention, which is incredibly important.

• 1:07:45Speaker 01

  And also connected to gut health, of course, that the gut-heart connection is real. We could talk about TMAO, the gut microbiome and all that. I'm sure you've heard that story before. But a few years later, they published their guidelines for preventing the number one killer. And they said diet is really, really important. And we know that people who eat a plant-based diet may be 50 to 60% less likely to ever develop coronary artery disease. So they recognized that and recommended a Mediterranean-style vegetarian diet, a vegetarian dietary pattern to prevent heart disease. You know, in 2019, the, the American, the panel in the US charged writing the guidelines for treating type 2 diabetes nailed their colors to the mast.

• 1:08:29Speaker 01

  I mean, one in 10 Americans have type 2 diabetes. It can reduce your life expectancy by seven years, land you in hospital, put you on permanent medication. You can end up in dialysis with this condition. So there are guidelines now, say, and have done since 2019. Every patient should be supported in attaining and maintaining a healthy body weight through a predominantly plant-based diet. You know, the research on this has come, there was a paper published out of the UK just last year, excuse me, last week, looking at how much healthier people are if they limit their meat consumption and eat more fruits, vegetables, whole grains and legumes.

• 1:09:08Speaker 01

  And the title of the paper is adherence to a plant-based diet and longevity and major comorbidities in the UK population or something like that. But the phrase plant-based is right there. And if you're curious, that that paper showed that, yes, people who eat more plant-based and limit their meat consumption are healthier, 22% less likely to die due to any cause during the 15 years of follow-up. So it's really getting out there. And there's, and you know, you mentioned the pandemic. And for me, the pandemic totally changed how I talk about food and food production and health. When I speak to patients and when I speak at conferences and when I talk, when I'm given

• 1:09:52Speaker 01

  the opportunity like this, have a microphone in front of me. So for years, as it, I mean, health and gut health and public health epidemiology and data brought me to recommending a healthy whole food, plant-based diet. So for years, I would avoid talking about animal agriculture because I was worried. Well, first of all, it's not my very expertise. And I was also a little bit worried that people would hear me talking about this and say, oh yeah, he said all that stuff about gut health and disease, but actually he's, he only cares about animals, you know, so he's biased or whatever. But when we went into the pandemic, it became very clear very early on that, number one,

• 1:10:34Speaker 01

  the diseases that are driven by the, you know, the animal-heavy, ultra-processed food-heavy standard Western diet like type 2 diabetes, heart disease, hypertension, various cancers, were suddenly even more dangerous because we already knew they were taking years off our life, but now they were also major risk. Factors for hospitalization and death. We saw that data coming out of China initially. Then we saw it in New York City when New York City was at the epicenter of the epicenter. My own experience during the COVID first wave as a frontline clinician, treating patients who were dying from COVID very much reflected that. So patients who already had these so-called pre-existing conditions, which were driven in large part by our standard Western diet.

• 1:11:18Speaker 01

  So there was that. And then in July of 2020, so we're maybe seven months into the pandemic, the UN issued a report talking about how to prevent the next pandemic. So how do we stop this from happening again? And the number one thing that they said we could each do as an individual or as a nation or as a government is to step back from animal agriculture, to step away from meat. So it's the same answer, right? So why is that? It's because the dietary pattern that requires 82 kilograms of meat for every adult in the UK, 100 kilograms of meat every year for every adult in the United States,

• 1:12:04Speaker 01

  100 kilograms, absolutely necessitates that we keep 80 billion animals in conditions, in cramped, unsanitary, unnatural conditions for their short lives before we turn them into food. So their diseases have never been more able to multiply and develop and modify and have never had greater opportunity to jump into humans, zoonotic diseases. It's a very old lesson. It's as old as animal agriculture. 10 years ago, I mean, I was on the front line during this pandemic. During the swine flu pandemic 10 years ago, I was there as a younger doctor, helping to treat people on the ITU with swine flu,

• 1:12:47Speaker 01

  killed 500 million people in the first year, mostly under the age of 65. I came out of a pig farm. Morbidilovirus, bovine morbidilovirus, became measles when we domesticated the cow, jumped into humans, killed unknown millions of people, mostly children, let a lot of children terribly disabled throughout their lives. Thank God, we have measles vaccination now, but we still have probably about 200,000 people a year dying from measles. So, mostly children. So, this whole zoonotic pandemic thing is a very, very old lesson. And the thing we can do is step away from meat. Now, Rich, you often say, and obviously I'm an

• 1:13:27Speaker 01

  avid listener, that you often say, and you guys have heard Rich say this, that, you know, we don't change until we hurt. We don't change until there's pain. And we don't change until we identify how our daily habit is driving pain. So, here's a question for everybody. We've, seven million people are dead. Seven million people have died so far in the COVID pandemic. 700 million people were affected by COVID, and many of them are living with long COVID and all of those debilitating symptoms, which quite honestly, we don't

• 1:14:06Speaker 01

  yet have an answer for in the medical community. We had to shut our businesses, we had to lock up our elderly in elderly care facilities. The elderly relatives who survived the first wave were then condemned to, you know, six to 12 months of solitary confinement, unable to see their loved ones. We had to teach our kids to socially distance from everybody, not to hug their friends, not to see their teacher. So, the question that occurs to me now, as we're crawling away out of this, is have we suffered enough? Have we experienced enough pain to recognize that our daily habit and the way we're treating food and treating

• 1:14:51Speaker 01

  animals?

• 1:14:54Speaker 01

  Brought all of this on us and it's not new. Happened 10 years ago as well. And the change needs to happen. I hope that people have learned something from this. During the first two years, the pandemic global meat consumption went down for the first time in decades. And I thought, well, that's good news. That's fantastic news because maybe the standard Western diet peaked out in 2019 and peaked out in 2020. And hopefully meat production is going to get lower and lower and lower and lower. And although, I mean, although the, you know, the alternative meat products may not be ideal for your gut health. I mean, I'm all about the whole plants. I know for a lot of people, they don't want to eat them, but, you know, and they're not

• 1:15:36Speaker 01

  for me, but for meat eaters, maybe that's a way out. I mean, I think it's ambitious to think that everyone on earth is going to stop eating meat, but everyone on earth should stop eating animal meat. Great. Thank you.

• 1:15:51Speaker 05

  Well, thank you, gentlemen. This is really informative and we're all convinced about plant-based and high-quality protein that comes out of, out of plant nutrition. Just kind of in a practical way, real simple question. Food combinations and having a healthy gut biome. Couple of food combinations you might suggest that people seek out? Or maybe a couple of combinations to maybe avoid so that we have a little more comfortable tummy?

• 1:16:20Speaker 01

  So the idea of food combinations, so combining foods. I don't think there's good science to say, oh, I should have my beans with my rice and that sort of thing. So as long as you're establishing that healthy dietary pattern, that can be really helpful. If you're suffering from bloating, you just said make my tummy more comfortable. So if you're referring to kind of bloating and excess gas and discomfort, then the first thing to understand is that, you know, I said this earlier, burping and farting and pooing, that's normal, that's human. Okay. So it's normal to get a bit of gas, it's normal to fart, it's normal to burp. That's a healthy human gut right there. But if it's getting to the

• 1:17:03Speaker 01

  Point where it's uncomfortable and causing distension. You lean back into all of those things we talked about. Good sleep, stress management. Make sure you're building your healthy diverse plant based plate, unprocessed plant derived foods, et cetera. And you work on that for a few weeks. And then if you're still having problems. And by the way, at this point, you should have talked to your doctor. We haven't said that yet. If you're struggling with digestive health problems, please go and talk to your doctor. Even if they know nothing about food, they're really good at detecting red flags, symptoms, and organizing the important tests and scans or poop tests that are needed to make sure nothing serious is going on. But if you have done all that, you've been to your doctor and you've had the basic tests and everything, you're given the okay. Then where do you go? I guess that's the question.

• 1:17:48Speaker 01

  Well, often for individuals who are eating a plant based diet, well, not often, I think. It often comes to me because I see the people having problems, right? I mean, a plant based diet supports good gut health. But when you are running into trouble with bloating and distension, there's a few things that can help. So mindful eating. So coming at your meal time with a bit of presence. We all have busy lives. We're kind of sitting at the computer on a Zoom meeting, kind of sneaking a sandwich in the side of our mouth. Now, we were speaking yesterday about how we eat with our eyes. You know, we're talking about beautiful food here with some of the attendees. But that is so true because digestion begins in the brain.

• 1:18:30Speaker 01

  So even before you eat food, your digestive system is kicking in. So if you close your eyes right now and think of that delicious meal that you had last night, you're going to start salivating. Your tummy is going to give a little gurgle. What is that? That is your digestive system preparing for food. And if you are eating unconsciously, you're just, you know, sneaking that sandwich in the side of your mouth or slamming that protein shake in between workouts and that's your lunch. You're not setting your gut up for success. You're not initiating the peristaltic waves. You're not producing the enzymes to effectively digest that food. That's number one. I'm going to give you another tip right now. Do you know those clickbaity things?

• 1:19:12Speaker 01

  Do this one thing to improve your gut health? Do this one thing to improve your gut health. Clip that.

• 1:19:22Speaker 01

  Put a footstool in front of your toilet, okay? So, squatty potty. So, humans are apes. We are designed to poop in a squatting position. The muscles and the anatomy to affect a comfortable and effective bowel movement, it's incredibly complex. I'm lucky enough to get to see that on scans, right? So you can see it on a scan. And when you do a colonoscopy, that's one of the nice things we have in gastroenterology, you get to look up close at the living organ that you're trying to fix with endoscopy. Okay, okay, a bit icky for some people, but I gotta tell you, it is absolutely fascinating.

• 1:20:05Speaker 01

  But, so, humans are designed to poop like an ape, to poop in a squatting position. The modern flush toilet that we have in the Western world has got a lot more to do with Victorian sensibility than human anatomy. It looks a bit like a throne, bit of a chair. In fact, Queen Elizabeth I was one of the first people to have a flush toilet in her house. Her nephew, John Harrington, invented it for Britain, you know, as elsewhere as well. The Chinese had it for years before, decades, millennia before. But the modern flush toilet, as we know, sits, you sit up straight, like you're on an armchair or a highchair, and you try and poo. You're not set up for it. So, if you don't have the ability to have a squatty potty, or squat in the woods,

• 1:20:51Speaker 01

  get your knees up, so put a footstool, it needs to be so that your knees are higher than your waistline, and you can lean forward and hug it in a little bit, and you're now in a squat position, and it will just slide right out.

• 1:21:09Speaker 06

  My question is for people that are sold and are deciding, okay, I wanna change this, I'm jumping in, I'm going plant-based. About how long can you expect effects to start taking place?

• 1:21:24Speaker 01

  So we touched a little bit on the gut microbiome earlier and I can refer you back to Rich's seven or eight other pods to go even deeper on that. But so how quickly does the food that we eat begin to change your gut microbiome? So the food, so the human digestive system is incredible. It is magical. We've got this surface area about the size of half a tennis court in our small intestine. And basically, if you feed it almost anything within reason, it will get to work. And it will extract the proteins and the carbohydrates and the lipids and the nutrients, the magnesium, the calcium and the iron and all that other stuff need to build a healthy body and repair a healthy body.

• 1:22:06Speaker 01

  And what's left over, what doesn't get digested by the small intestine is the residue. We call it chyme or chime in medicine, right? So that gets delivered to your large bowel, to your colon, and now that becomes food for your gut microbiome. So the gut microbes go to work on it and start to digest it. And not only do they digest it, they turn it into other stuff, postbiotics. And some of those postbiotics now become food for other bugs. So it gets really complex really quick. But in essence, your, the food that you eat affects your gut microbiome in a very real way.

• 1:22:47Speaker 01

  And if you choose today to have a standard Western meal, so let's say steak and white potato with butter and gravy, something like that, okay? Or a Big Mac. So your body is amazing. It will get all the nutrients it can out of that meal to support the healthy body. What's left over contains some residual animal protein, contains a lot of bile, because when you eat those high-fat foods, you have to make a lot of bile to emulsify the fat and digest it. And there's hardly any fibre in there, there aren't any polyphenols, and, but your gut microbes can work with that, okay? They'll figure it out. But the microbes that thrive on that sort of food produce predominantly unhelpful

• 1:23:32Speaker 01

  Postbiotic substances, so things like secondary bile acids, which are carcinogenic. Trimethylamine, which enters your bloodstream, becomes trimethylamine oxide, and nitrogen oxide, which helps to promote cardiovascular disease. Not so much the short-chain fatty acids, which are really healthy. So that's a gut microbiome environment that is conducive to chronic inflammation and disease. It'll help to get you there. Okay. But then you, next day, you say, okay, I'm going to change all that, but eating like that for years, so now I'm going to have, you know, I'm going to have the lentil burger. And instead of the, you know, the white potato mashed up with butter and salt and cream, I'm just going to do some sweet potato. And I'm going to have that instead, and I'm going to have some greens. Okay. So now you're eating a completely different way.

• 1:24:17Speaker 01

  Your gut, your small intestine, your digestive tract, your stomach, do their thing. All the nutrients, the fats, the carbohydrates, the protein, the healthy plant-based protein, the magnesium, the folate, the vitamin A, all that good stuff, all gets absorbed, right? So now you've got a different residue for your gut microbiome from that one meal. You are feeding a different subset. There's a certain subset of bacteria that are now going to thrive on that residue. And that residue, there's hardly any bile in there, because it's not a high-fat meal. There's no animal protein in there, because you didn't eat animal protein. There's fiber, there's a diversity of fiber, there's microbiome-available carbohydrates, there's polyphenols. And now you're feeding a different subset.

• 1:25:00Speaker 01

  There's a subset of bacteria that you're now feeding differently. And what do they produce? They don't produce the secondary bile acids, they don't produce the harmful hydrogen sulfide gas, they produce vitamins, they produce short-chain fatty acids, which have so many benefits for health, way beyond gut health. But in essence, you're now building a gut microbial environment that promotes healthy cell metabolism, DNA repair, anti-carcinogenesis. You're building a healthy gut microbiome that is not conducive to disease. Those changes start after the first meal. Okay, and we know from a study that was done in 2014 that if you take people and put them on that healthy diet, you can measure the changes in their gut microbiome function within four days.

• 1:25:42Speaker 01

  A few years ago, there was a study done, a fascinating study where they went to, they got volunteers from Pittsburgh, Pennsylvania, African Americans, who very unfortunately have a high risk of colon cancer, about one in 15 would be the lifetime risk. And they then went to rural Africa and recruited an age-matched population of people living in rural Africa. So these were people who were living and eating very differently to each other. So everybody got a colonoscopy, what a great study to sign up for. So everybody got a colonoscopy. And what they found was that in the people living in Pittsburgh, Pennsylvania, half of them already had precancerous bowel polyps. Fifty percent had precancerous bowel polyps.

• 1:26:26Speaker 01

  In the people living in rural Africa, they didn't find one single precancerous bowel polyp, which makes makes sense because colorectal cancer is very, very, very rare in that locality. It's almost unheard of. They also analyzed their gut microbiome. And they found that the Americans were fully stacked in terms of their bowel cancer risk. So an unhealthy gut microbiome, low production of short-chain fatty acids, high production of secondary bile acids. And they also measured the proliferation rate in the lining of the bowel, and it was high in the Americans, showing that the gut was having to repair, repair, repair, repair, which is a sign, which is an indicator of cancer risk. And of course, the Africans, completely opposite profile.

• 1:27:07Speaker 01

  So what they did next with that study was fascinating because they just detailed everybody's diet. And then they did a food swap. So the Americans were now getting, I think, about 50 grams of fiber a day, they're eating African potato, salad, kale. They were, you know, it wasn't entirely plant-based, but it was pretty close. And what they did, they did that for two weeks, and the Africans had, you know, steak and mashed potatoes, and hot dogs and beans, and all that kind of stuff. And after just two weeks, they did another colonoscopy, again, a great study to sign up for, you got to get two colonoscopies in two weeks. And what they showed, and they did a gut microbiome analysis as well, and what they

• 1:27:52Speaker 01

  showed that in just two weeks, those profiles had completely flipped.

• 1:27:58Speaker 01

  So they had completely flipped. So now the Africans had a high-risk profile, okay, just during the study, but the Americans had a low-risk profile across the board. And the mucosal proliferation rate went down. So within two weeks, 14 days, you can establish that change. So just think, Becky, what you could do in 14 weeks, 14 months, 14 years. Yeah.

• 1:28:27Rich Roll?

  Beautiful. We have time for one more question. There's a lot of people who want to ask questions. You guys, you guys want to duke it out?

• 1:28:36Speaker 07

  Okay, so Alan, my family is plant-based and I want my friends and family to try a more plant-based diet because I see the benefits in my family and the health benefits and I just want them to be healthier. And a challenge that I've come across is sometimes, sometimes people will say, well, I tried it and I didn't feel good, or I tried it and I was tired all the time. Or, and so I don't really, that's a tough one because I don't want to sound uncaring, like, well, you're doing it wrong, just do it better. Or, or seem like, oh, I don't care if you, you know, it's still better for you, even if you're tired. How do you answer that?

• 1:29:12Speaker 01

  Yeah, that's a good question. And it kind of feeds into this kind of recent concept we've had, that there's the concept of precision nutrition, where everybody should eat differently. And in the precision nutrition piece is very interesting. The science is fascinating. The studies that are being published are really, really fascinating. But is it better than what you said, you know, just eat a plant-based diet, you know? So the, one of the world's leading, or one of the most prestigious precision nutrition companies, just a few months, or I think it was last year, okay, Preventomics, big European-wide company, seven incredible

• 1:29:53Speaker 01

  academic institutions, EU-funded, looked at that. Okay, so is there a certain way for people to eat? And what they do is they take your blood and they take your saliva, they do genetic testing, they figure out how you handle Sugar, how you handle protein, they measure your metabolism, they measure your gut microbial metabolites in your bloodstream. And they come back with your individual plan for you. They've got an app called the M system. It gives you meal ideas and you're told to cook like this. So you might be a bit lower, lower carb, a bit higher protein, you know. That's the precision nutrition thing, which is kind of the ultimate version of what you just described. Is it right for me?

• 1:30:36Speaker 01

  So in this trial that was published last year, they got a hundred people who needed to lose a bit of weight and improve their insulin sensitivity, et cetera. And they put fifty of them through this incredibly advanced multi-omics process. And the other fifty, they subscribed to a healthy plant-based meal delivery service. And there was no calorie restriction. And they told people, they supplied sixty percent of the food. And said, when you're not doing the free food, I want you to cook like the free food. So kind of a real world sort of thing. And what happened with that study is that everybody did pretty well. But the multi-omic individual nutrition people didn't do any better than the people who were just told.

• 1:31:20Speaker 01

  Eat more healthy plant-based meals, fruits, vegetables, whole grains, legumes, nuts and seeds. So the kind of outcome from that study is that the kind of precision nutrition advocates still have some work to do. To tell us that what they're recommending is better than just getting people to eat. The foods that have been supporting a healthy gut and healthy human body for millennia. Okay. So there's that sort of aspect. So I think some people think, oh, I should do that program to find out what I should eat, right? But I think if you're, if you are embarking on a plant-based diet for the first time, there's a few things that can really help with the success of that. The first thing to say is the paradigm that we've described, fifty percent fruits and vegetables. Like one-third whole grains, plenty of legumes, et cetera. That's incredibly versatile.

• 1:32:05Speaker 01

  That can accommodate any food culture, any preference, whether you like soft food or crunchy food. Umami food or sweeter food, it can accommodate. So one thing you can do is, okay, I like, I like lamb casserole. So instead of switching to a kale smoothie for my dinner, instead of having a lamb casserole, I'm going to Google for a healthy vegan casserole. Which is using, you know, probably black beans or lentils. If I like having chicken tacos, I'm gonna do maybe chickpea tacos. And I'm gonna just, so you're not turning everything on its head. You're still developing recipes that are like what you're used to eating.

• 1:32:46Speaker 01

  And then you will find by rotating through these recipes, oh, I like that. I can cook that. My family like that. The kids like that. I mean, you go through the same journey, whatever kind of food you eat, right? You're looking for meals that your kids and you can both enjoy. So with that, by involving the kids, and I'm just speaking about kids, I have three kids. But involving the kids in the process, you will find foods that serve you, serve them that you all enjoy. It's number one. Number two, get support. So sometimes you can feel like you're on a lonely furrow going plant-based. And not everyone around you is on the same journey as you in terms of learning, education, motivation, support, commitment. So find a buddy, you know, in your neighborhood, a friend, a cousin, someone you say, hey, I'm doing this plant-based challenge for 30 days. Can you join me?

• 1:33:31Speaker 01

  Because then it becomes fun. And now you're sharing recipes and you're bringing potlucks over to each other's homes. And it becomes a joyous thing. It shouldn't be about deprivation. And of course, the other thing is that a healthy, whole food, plant-based diet is a great way to eat if you enjoy food. Cause the meals are naturally lower in calories. So you get to eat more food. So don't forget to eat more food. Don't be hungry. You, you, you need bigger plates. Maybe you need two plates while you're doing this. And while you're filling up those big plates, I think a lot of people embark on a healthy, plant-based diet. And they've still got that carb phobia ingrained so deeply.

• 1:34:12Speaker 01

  And I agree that sweets and pastries and croissants and purified sugars are not good for us. They should make up less than 5 to 10% for calories. But the healthy, whole carbs, the sweet potatoes, the, you know, the tomatoes, the beans, all of those healthy carbs actually serve us really, really well. They're very satiating. They're very good for us. We know that, you know, plant-based populations that do really well actually eat a lot of healthy, whole carbs. So don't, so get the carb phobia out of there. So no carb phobia, eat more food, eat familiar food and involve some friends and make it fun. Awesome.

• 1:34:51Speaker 01

  Yeah, cool. Thank you.

• 1:34:52Rich Roll?

  And for people that aren't here who are listening, if they want to connect with you beyond the book, where would you like to direct those people?

• 1:35:01Speaker 01

  I've only got time for one social media platform.

• 1:35:03Rich Roll?

  Good for you.

• 1:35:04Speaker 01

  I'm super busy. So Instagram, if you just look for Dr. Alan Desmond on Instagram, you'll find me there. And you know, through the links, you can learn more about the book, about the incredible online course. I run with our mutuals, Stephen and David Flynn, and some of the live events that I run in the UK. Because if you're hearing this, I'd love to see you at one of those live events. So watch out for announcements. We've got Andy Ramage coming up next. We can't have an episode of Rich Roll without a shout out to Andy.

• 1:35:29Rich Roll?

  So Andy, who we just had dinner with in Florence the other day, told me the whole origin story behind his involvement and your kind of trajectory in the plant-based medical world, which is fascinating. So it all ties together. It is all one, right? Yeah.

• 1:35:44Speaker 01

  Yeah. Do you want to hear that story?

• 1:35:47Rich Roll?

  Sure, why not?

• 1:35:47Speaker 01

  So Andy, co-founder of One Year No Beer. So I was at a medical conference back in 2017, and I'd had one of these experiences that I often have at medical conferences, where I was at an industry-sponsored symposium. And again, the medications are great. I prescribe them all the time, but we need every evidence-based tool in the box to get healthy. So I'm at an industry-sponsored medical symposium, and a very prominent gastroenterologist gives a keynote on the eight studies that we need in GI health. And he didn't mention food once, or diet and lifestyle once. So I stood up and got the mic and said, hey, shouldn't we be, that's amazing, but shouldn't we be doing more studies and putting more funding

• 1:36:29Speaker 01

  into giving answers to that question that every single patient asks every single one of us? What about food? You know, shouldn't we be doing that? And if there was like a red button under the podium, he was probably pressing it. Because, you know, I felt like I just left off a stink bomb. Okay. So anyway, afterwards, a few people came up to him and said, hey, good on you. You know, and then we talked, connected some like-minded gastroenterologists, which was lovely. But I had a phone call with Andy later that afternoon, and we were talking about plant-based, Andy's plant-based. And he said, hey, you know, and I told him that whole story. He said, you should speak to Tom Hubbard. I met this doctor called Tom Hubbard on the Rich Roll Retreat in Ireland. And he's a plant-based doctor. And I said, okay, cool. I'll talk to Tom.

• 1:37:14Speaker 01

  Wonderful. So I spoke to Tom. Fantastic. Lovely chap, great guy. And we had a lot in common. And then he said, have you met Dr. Shereen Kazam in London? So she's an oncologist and she is trying to set up the first medical conference in the UK on the benefits of a healthy whole food, plant-based diet. You should speak to her because maybe you could speak at the conference. And I thought, wow, I can get to speak at a conference. This is amazing. I mean, I'd often been inspired by doctors and dieticians like Garth Davis and Neil Bernard and Michael Greger, Juliana Hever, Michelle McMac and Brenda Davis, all these people I discovered through the Rich Roll Podcast. And I thought, now I can, we're going to do this in the UK. Amazing.

• 1:37:57Speaker 01

  So I phoned Shereen and introduced myself and Shereen said, oh yeah, we're doing a conference. It's going to be King's in London. It's going to be great. It'd be great if you would speak. And I thought, oh, thank you so much for the opportunity. I'll be there. What I found out years later was from Shereen was that when she was organizing the conference, I was the first person to say yes. So I came off that call and was, yes, I get to speak at a plant-based conference. And Shereen came off that call and went, yes, we're going to have a conference. And you know, and it was so awesome. And at that conference, it brought together a whole community of doctors, including Shereen Kazam and Gemma Newman and myself.

• 1:38:39Speaker 01

  We had Andy Davis, who visited from Australia for that conference. And that was the formation of Plant-Based Health Professionals UK. There was about eight of us there initially. We now have over a thousand members. So shout out to Plant-Based Health Professionals UK. And it used to be, I knew everybody's name. Now I know hardly anybody's name in the organization and I'm still an ambassador for that group. And Shereen is doing incredible things with that group. But we can draw a line from there back to Andy, back to the retreat, the previous retreat you had in Ireland.

• 1:39:12Rich Roll?

  Yeah. Beautiful.

• 1:39:13Speaker 01

  Thank you.

• 1:39:13Rich Roll?

  I love that. Yeah. What a way to end it. Thank you. It all comes back to Plant Power Italia, the origin of it all, right? I gotta share something now.

• 1:39:22Speaker 08

  So just to mention, it's so profound, like so amazing. So Tom Hubbard, we had gone to Plant Power Ireland. We just did one retreat at Plant Power Ireland and it was really a blast, like really an extraordinary place. But Tom Hubbard, actually, his wife at the time, Carmella, had reached out to me and told me that he was very, very ill. And we had an open spot at the retreat. So we had met them previously. I was in Ireland for my friend's wedding. I have an Irish girlfriend who has four beautiful children and her husband promised her an Irish wedding.

• 1:40:04Speaker 08

  So they had it 12 years after they were together with all the kids. And she invited me to sing in her wedding and all of the kids, all of my kids and me, we went to Ireland. So we're in Ireland and I'm posting on Instagram. Rich was not able to join us. And I get this message on IG from this woman Carmel and she's like, why don't you come over and I'll make you a plant-based breakfast? So I kind of said, well, she sent me some of these coordinates and I said, okay, you know, we're on our way back to Dublin, but if it works and it's easy, then we'll figure it out. And so we had these coordinates. So we drove and we, she said, you know, my husband, Tom, will meet you at these coordinates.

• 1:40:47Speaker 08

  So we arrived to this location and there's this guy on a motorcycle and he says, come with me. And we drive through these gigantic tall like grasses, like you can't see, you know, it's like a tunnel. And we're driving and he's driving and he stops and we pull in and we arrive and it's two sisters with their husbands and one of the husbands is an artist from Brooklyn. And they prepared this amazing plant-based meal and we're all there and we have this amazing time. And then they say, wait, you can't leave until we take you to the magical forest. So we say, okay, so we drive and drive and on the hill in the horizon, you see this knoll of just, it's like all farmland and then this just independent forest.

• 1:41:32Speaker 08

  And I had my sitar with me and I remember we pulled out and we walked into a magical fairy kingdom that is not to be described. It was like trees, tree beans with moss all over them. I mean, it was, it was out of a movie. It was absolutely magical and I was like, I have to play my sitar and grabbed the sitar and we were all sort of like hanging on the trees and it was just a magical moment, like mind blowing beyond. And then they also shared with us that there were tunnels underneath this tree ecosystem that were reaching to these sacred places. I mean, it was crazy.

• 1:42:12Speaker 08

  So then, okay, cut two years later, we do the Plant Power Ireland Retreat and Carmel contacts me and she's like, Tom's ill, like he almost died, like he's a doctor and his levels were through the floor and he couldn't figure out what was going on. So I said, we have an open space, bring him. So he comes to the retreat and, and he's so happy to see us and he's eating our plant-based menu and the place is magical and we have this ritual circle and Tom's also a drummer. And so he brought his drum and he starts drumming and he ends up like on the table, sweating, like his whole body was just moving everywhere.

• 1:42:53Speaker 08

  It was like a work of art in every level and he was so alive and clearly just feeling amazing. So I sat down next to him at dinner and he tells me that it was the first time that he felt good in like maybe a year and that he really thought that he might be leaving his body. And I, and this guy was just like, he was dancing on the tables, crazy. And then he tells me, you know, Julie, he said, that time that you met me, you know, at the coordinates to come over to our house for the plant-based breakfast. He said, you know, I grew up in these cornfields and I've been, I've ...up there my whole life. And he said, "You were late, like you weren't there." And I was waiting and waiting, and you weren't there. And he goes, "And I wanted to go down

• 1:43:37Speaker 08

  to the creek." And he said, "So I started to walk down to this creek, or stream, or river." And he said, "A black crow came and flew over my head and hit me with its wings." And he said, "And then I kind of walked back to the space, and then you weren't there." And he said, "And I did it again." And he said, "The crow came six times to bat me on my head to make sure that I waited for you." And he said, "I just had to share that with you." I mean, this is the magical, mystical undercurrent of how we're being drawn together. And so it's lovely to hear that that's how you're here. So that's it.

• 1:44:17Rich Roll?

  Beautiful, fantastic. What a delight. I don't know about you guys, but I got a tremendous amount of value out of that experience. Alan's book is called The Plant-Based Diet Revolution. He brought a copy here. Maybe you leave it out and people can peruse it over the course of the next couple of days.

• 1:44:38Speaker 01

  I sure will, I sure will.

• 1:44:39Rich Roll?

  Pick it up in the meantime. And I'm sure plenty of people here are going to be tugging on your shirt tails to ask their questions that didn't get asked today. So you've been very gracious with your time. I appreciate it. It is a blessing and an honor to have you with us this week. And you have an open invitation to visit the studio sometime, and we'll do round two.

• 1:44:59Speaker 01

  Okay. I look forward to it. Round one was awesome. So let's do it.

• 1:45:03Rich Roll?

  Yeah, cool.

• 1:45:04Speaker 01

  Thank you.

• 1:45:04Rich Roll?

  Dr. Alan Desmond, everybody. Thank you so much.

• 1:45:07Speaker 01

  Thanks, Rich.

• 1:45:20Rich Roll?

  That's it for today. Thank you for listening. I truly hope you enjoyed the conversation. To learn more about today's guest, including links and resources related to everything discussed today, visit the episode page at richroll.com, where you can find the entire podcast archive, as well as podcast merch.

• 1:45:41Rich Roll?

  My books, Finding Ultra, Voicing Change, and The Plant Power Way, as well as The Plant Power Meal Planner at meals.richroll.com. If you'd like to support the podcast, the easiest and most impactful thing you can do is to subscribe to the show on Apple Podcasts, on Spotify, and on YouTube, and leave a review and/or comment. Supporting the sponsors who support the show is also important and appreciated. And sharing the show or your favorite episode with friends or on social media is, of course, awesome and very helpful. And finally, for podcast updates, special offers on books, The Meal Planner, and other subjects, please subscribe to our newsletter,

• 1:46:24Rich Roll?

  which you can find on the footer of any page at richroll.com. Today's show was produced and engineered by Jason Camiolo, with additional audio engineering by Cale Curtis. The video edition of the podcast was created by Blake Curtis, with assistance by our creative director, Dan Drake. Portraits by Davy Greenberg. Graphic and social media assets courtesy of Daniel Solis, as well as Dan Drake. Thank you, Georgia Whaley, for copywriting and website management. And of course, our theme music was created by Tyler Pyatt, Trapper Pyatt, and Harry Mathis. Appreciate the love, love the support. See you back here soon. Peace. Plants. Namaste.