← The Rich Roll Podcast
The Rich Roll Podcast
Dr. Matthew Nagra Makes The Ultimate Case For A Plant-Based Diet: Busting Nutrition Myths Around Seed Oils, Soy, Protein, & More
02:21:33
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- [00:01]
Rich Roll
We are going to talk about gut health for a second. Now, you guys know at this point that I am passionate about longevity, performance and taking care of my body from the inside out. But if we're going to be real about it, none of that really matters if your gut isn't functioning properly. Because as the emergent science is making abundantly clear, the quality of your gut health is crucial to almost every single other aspect of health. So we got to do everything we can to ensure that our microbiome is thriving. And part of that everything is supplementing it with the best prebiotic and probiotic we can find. All of which is why I turn to seed and their DSO1 daily symbiotic. As an essential aspect of basically every day, my daily routine, Seed really is different. Their science team is top notch. The testing is rigorous and evidence based on. And their formula really isn't like others, which is usually in most cases just random bacteria thrown together. The DS01, however, is a two in one symbiotic that combines both probiotics and prebiotics with 24 specific strains that actually survive the journey through your gut thanks to their clever capsule and capsule design. Since starting with Seed, I have noticed some pretty real changes in my digestion. More regularity and a little bit lighter after meals. So whether you're pushing your body in training or grinding through work projects, or just trying to make it through a challenging day, I would tell you based on personal experience that you really can feel the difference when your foundation is solid. Plus there's the added bonus of being able to just throw them in my bag when I'm traveling. There's no refrigeration needed and it's good to know that seed is all meticulously tested for over 500 contaminants. It's simple, effective gut support. So here's what you're going to do. You're going to go to seed.com richroll and then you're going to use the code richroll25 for 25% off your first month of DSO1. We're brought to you today by the wonderful folks at GO Brewing. Let me tell you a story. A few years ago, this guy, Joe Chura rings me up out of the blue and he asked if I'll fly out to Illinois and speak at this event that he was hosting called go, which ended up being this really incredible weekend, oriented around taking inspired action. Joe and I hit it off, but, you know, that was kind of that and it wasn't until I ran into him a couple years ago at Jesse Itzler's Running man event that I realized that he had taken inspired action himself by creating this new enterprise that was also called Go. Go Brewing in fact, which from Go has grown into what it is today. One of the most exciting revolutions in craft brewing. One of the many things that makes Go Brewing extraordinary is that they don't outsource. Like most companies, they handcraft from scratch in small batches. In fact, this commitment to quality has fueled their growth into one of America's fastest growing breweries. Now in over 5,000 locations across 20 states and available online. The Salty AF Chilada earned the untapped number one non alcoholic lager in the United States. And they're constantly creating bold new flavors almost every month that push the boundaries of what non alcoholic beer can be. Double IPAs, mouthwatering sours, all with zero added sugars and none of the junk. Hear that incredible stuff. The non alcoholic revolution is here people. I am proud to help champion it alongside Joe. So get on board by getting with go by going to gobrewing.com where you're going to use the code rich roll for 15 off your first purchase.
- [03:48]
Dr. Matthew Nagra
Go. Shifting 3% of calories from animal protein, especially red meat protein, to plant protein sources could lower risk of mortality from it was a ballpark of 10 to 15%. There is not good evidence to support the carnivore diet. If we look at messaging from the carnivore community or the animal based community, it's often about really quick fixes. We're not considering the long term risk and they're promising people immediate results, which is really enticing. We have so much research now around like what makes up a healthy dietary pattern that we can make really good informed decisions. Really when it comes to nutrition, it's pretty simple at least. The foundations are eating a diet that's rich in whole grains, fruits, veggies, legumes, nuts and seeds that is the foundation of a healthy dietary pattern. Let's control the ldl, let's manage blood glucose, let's drop that blood pressure. Let's take care of all this stuff.
- [04:41]
Rich Roll
Hey everybody, welcome to the podcast. It's been a minute since my last nutrition oriented episode, so I think it's kind of about time to dip back into a little fact versus fiction myth busting based upon the best evidence based research out there so we can put matters to rights when it comes to understanding the difference between what is misconception and what matters most and is meaningful to understand. My guest for this journey is Dr. Matthew Nagra, a Vancouver based clinician with a BS in Microbiology from the University of Victoria, an ND from the Bucher Institute of Naturopathic Medicine, and also a guy who is certified in plant based nutrition from the T. Colin Campbell center for Nutrition Studies at Cornell. So I first came across Matt from his many appearances on my friend and frequent pod hero Simon Hill, his show the Proof podcast, as well as Matt's presence on social media, particularly Instagram, where he does a pretty fantastic job of translating the latest nutrition research and tackling misinformation around diet and nutrition. So today we're going to cover many popular topics that seem to have deranged the minds of too many in my opinion, including seed oils, protein, specifically animal versus plant protein, bioavailability, dosage and more. We address LDL cholesterol and what I would consider a degree of LDL denialism when it comes to the risk elevated LDL poses to cardiovascular disease. We talk about the arguments that swirl around the supposed nutritional deficiencies of eating plant based, what gets missed in the arguments against processed foods, how plant based meat analogs measure up nutritionally against their real meat counterparts as well as everything omegas3and6 and many other topics. My goal in this discussion is to hopefully resolve some confusion on these subjects and Matthew to my mind is very effective in providing much needed clarity. So I hope you find this useful. And with that, this is me and Dr. Matthew Nagra. Matt, it's great to have you here. It's been a minute since we've done a plant based deep dive and you're just the guy to do it with. But before we even launch into it, maybe just share a little bit of your background and how you got initially interested in plant based nutrition to begin with.
- [07:13]
Dr. Matthew Nagra
Yeah, it goes back to my teenage years. So when I was younger I did have some health issues. I struggled with my weight, my skin allergies, asthma and actually at one point my asthma got really bad to the point that my doctor warned my parents it might be hospitalization and quite serious but fortunately made it through that. And I had a personal trainer who around that time, so I was about 15, really pushed more plant based eating. He wasn't 100% but predominant and you know, being a teenage boy I didn't care too much about what he had to say for the longest time until he wanted me to record my food. And so for about two weeks there I had to record everything I ate. And I was thinking, oh my God, he's going to kick my Butt once he sees how bad my diet is compared to his recommendations. And so for those two weeks, I was like, I'm going to impress him. I got rid of all of your kind of classic ultra processed foods, potato chips, sodas, I cut my dairy intake, I reduced my meat intake, having a lot more fruits and veggies. And just within those couple weeks, I started losing weight. My skin was clearing up, I felt like I was breathing easier. And that's what initially triggered that idea that, hey, you know, diet might actually be important, which is something that, you know, as a 15 year old, I hadn't really thought about. And so I really continued with it from then on for the next couple years until I went to university. And at that point I'm back to cafeteria food. I'm drinking with all my buddies on the weekends. And after the first four or five months, I kind of noticed like, you know, I'm not feeling as good as I was just a few months prior. Maybe I need to go back to what I was doing. And that was actually the time. It was February 24, 2011. And I've, I've noted that day, wow. That I went 100% plant based because for me it was easier to be that strict than to give a little bit of leeway and, you know, splurge and then that becomes more of a habit. So that was the point that I went 100%. And you know, initially maybe I was looking to blogs and YouTube for a lot of information like probably a lot of other young men and women do. But as the years went on and as I got more educated in nutrition and statistics and so on and started reading the literature, that's when I shifted towards what I would consider a very balanced plant based, predominantly whole foods diet.
- [09:29]
Rich Roll
So there's the personal aspect of this, but how does that translate into this becoming a career trajectory for you?
- [09:37]
Dr. Matthew Nagra
Yeah. So another thing that happened shortly after I made those changes when I was about 15, 16, was my dad actually had a cardiovascular issue as well. And funny enough, I was in the hospital for surgery on my ankle after I'd broken it skateboarding. And when I came out of surgery, my dad was in the hospital. So he was in the waiting room for me and he actually went down with what they thought at the time might have been a heart attack. Turns out it may not have been, but it was certainly a scare. And he started finally seeing results after changing his diet as well. Because initially there was a lot of anxiety around his health. He wouldn't, he didn't know exactly when he would be, if he was having a little chest discomfort or something, is that going to land him in the hospital again? And when he started actually changing his diet, taking that same trainer's advice goes back to him, that's when he started seeing improvements in his markers, feeling better and so on as well. And that led me more into like the long term chronic disease sort of prevention area. Now fast forward, you know, seven, eight, nine years when I'm in school seeing patients, I saw that there was so much misinformation, people were so confused about what is right for them to do or what is healthiest for them to do. Even to this day I get questions about soy and protein and, and all the common questions that you probably get as well, seed oils. And that is, is what led me to wanting to help correct the record and provide this information for people so that they can actually make informed choices. You know, it's one thing to choose to smoke when you know it's bad for you, but what if you didn't know it was bad for you or you were convinced that it was maybe good for you? Right. And that's sort of where we are with a lot of the nutrition is just people are confused, they don't know what's right, what's wrong. And I want to help others get, get the sort of clarity that I myself and that my dad ultimately got.
- [11:26]
Rich Roll
So before we dive into the weeds and start to identify certain subject matter, I mean my intention for this is to provide a basic education but also to do a little myth busting or truth versus fiction with respect to certain nutritional claims. But before we do that, I'd like to kind of apply that more broadly like what is true versus hyperbole when it comes to a plant based diet in the context of whether it's longevity, performance or chronic lifestyle disease prevention. My sense is that it is very real and very powerful and I've lived it myself and hosted many people with similar experiences and experts like yourself. But I think that the vegan and plant based diet diet tribe is not dissimilar from any other diet tribe out there and has a tendency to overstate claims or exaggerate or extrapolate upon the available research to kind of underscore or overemphasize in a certain way that might not be in the best interest of the public. So where do you see that and how do you kind of give words to that?
- [12:43]
Dr. Matthew Nagra
I 100% agree. I think that there is exaggeration in a lot of areas of the plant Based camp, just like there is with any other diet tribe. And what we can say pretty confidently is that a plant exclusive diet, or vegan diet, if we want to call it that, is associated with great long term health outcomes. Not necessarily better than, but comparable to things like a Mediterranean diet or dash diet or these other healthy dietary patterns. So I view it as there's, there's a range of diets all centered on plant foods, fruits, veggies, whole grains, et cetera. Some include some animal products, some don't, but they're all predominantly plants and they all lead to similar outcomes. The reason to go exclusively plant based really is ethical or environmental. From a health perspective alone, I don't think you can make a strong argument. And I think that's where there's a bit of an issue sometimes, where people will paint this plant based approach as the best approach, bar none. And like that's a, you know, something that we can conclude really strongly. And I just don't think that we can because we haven't seen. But at the same time, when it comes to athletics, that was another thing you mentioned. We see that a plant exclusive diet can lead to the same sorts of results that you get on an omnivorous diet richer in animal protein. So we don't have to necessarily make the argument that it is the best and stands above all the rest, but we can say that it is one of the best options. And because of these other benefits like the ethical, environmental, there's a good reason to choose that approach.
- [14:08]
Rich Roll
I think it's important to what you just said, especially in terms of credibility and trust, if you're going to talk about this to be grounded in reality. Because if you're overstating claims or just a little bit out over your skis because you're an evangelist or an advocate or perhaps an activist in some regard, it makes it easier to critique or kind of not pay attention or dismiss what follows in terms of what you're going to say. Right. And the whole movement would kind of be better off if they were just grounded in greater clarity around what you just what you just shared.
- [14:45]
Dr. Matthew Nagra
Yeah, I agree because I look at it as if we exaggerate or lie about some of the results. We actually give fodder to people like the carnivores or anti vegans to say like, hey, this person's dishonest or they're wrong about this. But if you're accurate and truthful, what do they have? They're the ones that are going to have to bend the science to try to prove their point. And so if we're just honest and we stick to what we know, and we have really, really good reasons to choose this approach, they then they have nothing. And I would rather be on that side.
- [15:15]
Rich Roll
You mentioned a few moments ago that nutrition is complicated. It certainly is more so than I suspect, we realize, and for many reasons. And some of that has to do with the limitations of the kind of science that we can perform on human beings. But the upshot of this is that it often leaves even the most earnest of us out there in search of guidance more confused than informed. And this is kind of what we're seeing being played out on the Internet across the world at the moment. And I think that this is not always because the science is unclear as much as it is an unfortunate byproduct of our information landscape, which is more and more based on social media and our algorithmically determined informational feeds. As we know, the Internet loves to traffic in trends. And when it comes to nutrition, there's more than a few trends that surface, many of which range from a loose relationship with evidence to downright wrong or dangerous. And I think as a public service, it's important to put matters to rights with respect to some of these trends, which is something that you do quite effectively in the many videos that you share on social media as an antidote to this infection. So I'd like to begin, as we wander into the wilderness of this, with what you see as the current most onerous or malevolent misconception that's out there that our algorithm overlords are favoring at the moment.
- [16:47]
Dr. Matthew Nagra
There's a number that I could list up there and I could change this order any day. So I won't say that this is number one, but the one that seems to permeate all diet camps. You can take whole foods, plant based, you can take carnivore, you can take animal based or whatever. They pretty much all agree on this idea that seed oils are toxic and that they're going to kill us, cause cancer and so on. But I mean, that's the one case where I would say they're pretty much all wrong based on the current evidence base. I think the evidence is very strong and actually quite compelling for the inclusion of seed oils to lower things like cardiovascular risk and improve mortality risk. And so that would be one that really stands out.
- [17:26]
Rich Roll
All right, well, let's dig into this one. This is quite the topic. It's being bandied about pretty rigorously on the Internet and it also is controversial within the plant Based community. There are the whole food plant, plant based OGs, you know, the, the Dr. Caldwell Esselstyn strain of whole food plant based who are rigorously kind of anti oil. And then there are the pro olive oil plant based people. And then there are the, you know, the broader group of like vigorously anti seed oils, you know, like in extremis. So why don't you, you know, kind of paint the picture of this? How did this issue come about? What is being argued and what is the truth here?
- [18:13]
Dr. Matthew Nagra
Yeah, so there's different arguments presented by different diet camps. Like the plant based community will talk more about the oil's effects on artery function. And maybe we can get to that in a moment. But I think the main argument that's brought up, or one of the main two arguments that's brought up, is that we see this Trend through the 80s and into the 90s where seed oil consumption was increasing in America and heart disease rates were increasing in America, and they sort of draw that correlation and they'll say that, well, seed oils are the problem. But there's a serious issue with drawing that kind of conclusion here. So that's what we call an ecological association. You're just taking two variables, tracking them over time, and ultimately drawing the conclusion that A led to B. Problem is, there are a lot of things that could have changed over that time, one of them being that we're living longer or that infant mortality is lowered. And these are things that can lead to chronic disease later in life. If most people aren't even making it to those ages initially, then we aren't going to have as many heart attacks. Right. So that's one possible issue. Another one is that we are now treating risk factors earlier on for say, other diseases that might end up leading you to living to that point where there's a cardiovascular event. At the same time, we can look at cross country comparisons of smoking, for example, and longevity, and we see that per capita cigarette consumption is associated with longevity. It's the same type of correlation. But the issue there is that, yeah, countries where there's more cigarette consumption, they're also more affluent. There's other factors that are leading to a better life. So we need to look at studies that actually adjust for those other variables and sort of level the playing field. And we have plenty of those where you're looking at seed oil consumption or polyunsaturated fat consumption over time within a defined population, and you're adjusting or sort of equalizing factors like smoking status, exercise and so on, and you find that Those with the highest consumption do have a lower risk of cardiovascular disease and a lower risk of mortality. So the question then is, well, why do we see this trend in seed oils and heart attack, at least over time? One of the factors there, and not the only factor, is potentially that most people get their seed oils from ultra processed foods. So as ultra processed foods become more prevalent in the food supply and people are eating more and getting too many calories and gaining excess body fat and, you know, developing cardiometabolic diseases, we can't then say it's the seed oil specifically that are the problem. Right. It would be like pointing to Coca Cola and saying that water is detrimental because it's the main ingredient in Coca.
- [20:41]
Rich Roll
Cola or the Cola ingredient in it, as opposed to. Yeah. So in the context of ultra processed foods, there are seed oils, but there's also refined grains and salt and sugar and all these other. And all these other kind of additives and preservatives that, you know, enhance the unhealthy nature of these foods.
- [20:59]
Dr. Matthew Nagra
Exactly. And they're hyper palatable. So that combination of the fats with the salt especially gets people to eat more and more and more. And food scientists are very aware of this when they design their products because they want you to eat more of those products. Right. So they sort of prey on those senses. Now, moving past these sort of gross kind of correlations, we can look at the mechanisms at play. So one of the arguments that's brought up is that these omega 6 fats in seed oils are inflammatory. So the linoleic acid, which is one of the polyunsaturated fats, and the theory goes that linoleic acid could be converted into arachidonic acid, which is another omega 6 fat, and that is pro inflammatory. The problem with that is it's been studied in humans numerous times in numerous randomized controlled trials and has never been shown to raise arachidonic acid levels or inflammatory markers. With the exception of a case where they put oils through 20 repeated cooling and heating cycles over and over and over again, and then had people eat them. But at that point you're really kind of destroying or damaging the oils there. But in normal use, whether it's for a stir fry or in salads or whatever, they appear to be health promoting. And then finally we have actually long term randomized controlled trials showing this. One great example is the LA Veterans Administration Hospital Study. So they had about 850 people that were split in half and they were living in an institution and half of them were randomized to one cafeteria, half to the other cafeteria, and they didn't know what they were getting. But what the researchers had done in the seed oil group was they actually extracted saturated fats from the foods and infused vegetable oils. So they're getting essentially the same food but different fat. And they found about a 30%, if I recall, reduction in cardiovascular disease, like atherosclerotic cardiovascular disease over the course of eight years. That's massive when you're considering an old population where the number one killer is cardiovascular disease.
- [22:53]
Rich Roll
Yeah. There's studies out there that show, you know, the people who are have the highest intake of plant oils see significantly lower risk in total mortality, cancer mortality, et cetera, this veteran study. But it's always in the context of what these seed oils are replacing. Right. If they're replacing foods high in saturated fat, then you're going to see these reductions. But it's not the plant oil itself that is leading to the reduction in mortality or cancer rates. Right. Like it's sort of, I mean, so like tease that out a little bit because is the oil the panacea or is it what the oil is replacing that makes it the healthier option leading to these better health outcomes.
- [23:40]
Dr. Matthew Nagra
So compared to saturated fat, like you said, butter, tallow, et cetera, then the seed oils are better because they lower LDL cholesterol and apob and they lower risk of cardiovascular events as we see in these longer term studies. However, if we look at comparisons between even these seed oils and things like avocado, there was the nurses health study and health professionals follow up study where they looked at the substitution of avocado for different types of foods, including seed oils. There was no significant difference in cardiovascular risk between whether it was avocado or seed oils that were. It was about a quarter of an avocado, I believe that they substitute for equivalent amounts of the oil. There's also the predimed study now this is looking at olive oil, but I'll bring it to seed oils in a second where they compared to a Mediterranean diet with olive oil to a Mediterranean diet with nuts and seeds and there was no significant difference. Both were beneficial. And the reason I bring up the olive oil is that we also have comparisons between olive oil and seed oils and they're roughly similar. So we don't have a good reason to conclude that the seed oils would be worse than these other healthy foods. They're just one of those healthy foods. But I wouldn't say that if you were to replace olive oil or nuts or whatever with seed oils that you're going to be better off, they're just. It's not worse. And that's really what we could conclude there.
- [24:52]
Rich Roll
So articulate the best argument for those that are advancing the seed oils are the root of all evil argument.
- [25:02]
Dr. Matthew Nagra
The best argument I think that anyone can make around oils, period, is that they're calorie dense. So in about a tablespoon, you're getting 120 calories right there. Compare that to a whole banana, you're getting even a bit less than 120 calories. So. So if you were to use tons of oils, just pouring it on your foods, or frying with a whole bunch, or deep frying perhaps, where there's a lot of calories being added, that could be problematic, for sure. I would agree with that. Now, we don't see that in trials, in clinical trials, probably because of the way that they're used. If you're using oils to stir fry some veggies, the calorie density of that meal is still very low. But if you're just throwing oils on everything, you're having six, seven, eight tablespoons a day. I mean, that's a ton of calories, and that could be a problem, especially if it's leading to fat gain.
- [25:46]
Rich Roll
In the health hierarchy of seed oils, my understanding is that olive oil stands above. Is that true? Is there a qualitative difference? Does it have to do with polyphenols? How do you think about this in terms of parsing all the various seed oils from canola to sesame and everything else?
- [26:08]
Dr. Matthew Nagra
It's interesting. When we look at outcomes, again, actual heart attacks or strokes, we see that olive oil and canola oil are pretty comparable, actually, even for total mortality. Now that I'm jogging my memory, I'm.
- [26:19]
Rich Roll
Old enough to remember when everything was canola oil and then canola oil was the root of all evil. You need to stop putting canola oil in food.
- [26:29]
Dr. Matthew Nagra
Yeah, and that's largely because of concerns over the fact that how they're extracted or processed, or concerns over the Omega 6 content, again, comes back to those mechanistic concerns. But when we step back and look at actual heart attacks, actual strokes, mortality risks, so the actual deaths that occur during a study, there doesn't seem to be a meaningful difference between olive and canola. And there's a couple possible reasons for that. So olive oil is richer in certain polyphenols, especially if it's extra virgin. However, canola actually lowers LDL cholesterol a bit more. So maybe you're getting a bit of an advantage with the canola oil with LDL cholesterol, But then the polyphenols and the olive oil exert other benefits on say, arterial function. So the net result is about the same. And this is why I always advocate for people stepping back and looking at the final outcomes, not just a certain marker. But does it lead to less heart attacks, does lead to less strokes, less cancer diagnoses, et cetera. That's ultimately what matters because you could have a million different mechanisms working in different ways. We want to see the net result.
- [27:26]
Rich Roll
Is there something special about the health promoting aspects of extra virgin olive oil that does separate it? It seems like very much a health benefiting oil.
- [27:38]
Dr. Matthew Nagra
Yeah. One of the things that I've seen with olive oil, but I haven't seen many comparisons to others, so I can't say it's necessarily better, but I would say there's more evidence for it is actually blood pressure lowering. There does seem to be something there. And that could be again due to the polyphenols in there. When it comes to neurodegenerative disorders, we see that while not statistically significantly different, There was a study, I believe it was also the nurses, health and health professionals follow up study where olive oil did tend to be a bit better in that regard, but then canola actually tended to be a little bit better, or vegetable rather. Oil tended to be a bit better for cardiovascular events, but they weren't statistically significant, the differences there. So it's hard to say, is that a chance finding or is that true? Like there might be some unique properties either direction, but they don't seem to be very larger or super meaningful.
- [28:26]
Rich Roll
You mentioned omega 6 fats and the sort of deleterious health impact that those can have. My understanding has always been that we're eating way too much of the omega 6 fats and not enough of the omega 3. So while we need to reduce our omega 6 intake, we also need to buttress our omega 3 intake. And that there's something about enhancing the omega 3s that buffers the negative impact of those sixes. Is that true or how do you describe that?
- [29:00]
Dr. Matthew Nagra
So I used to be very much in that camp.
- [29:02]
Rich Roll
Yeah, I mean, that was the idea. Right. And I believe that wisdom has now shifted on this.
- [29:08]
Dr. Matthew Nagra
Yeah. So that was because the omega 3 fat ala, which is found in things like flax and chia and walnuts and soy products, that competes for the same enzyme that this omega 6 fat linoleic acid does for conversion into the case of the Omega 3. It's EPA and DHA, which we typically get from fish or algae based supplements. And then linoleic acid can get converted into that arachidonic acid, that inflammatory omega 6. Theoretically it doesn't end up happening, but that could be the case. Now, the theory was that if you're having more Omega 6 and less Omega 3s that the Omega 6s are going to take that over and you're not going to convert the Omega 3s into the EPA and DHA. The issue with that is now, as we have more research and actually monitoring how much gets converted, the differences are not very big. It seems to be the absolute amounts that matter. So if you're consuming enough ala or the omega 3 to meet your needs, it doesn't really matter too much how much Omega 6 you're having. It doesn't seem to impact the conversion to any sort of meaningful degree. And something else that's come out very recently, this was last year, there was a really good study on this that looked at the actual health outcomes, again going back to things like cardiovascular risk. And they found that both are beneficial. So the Omega 3 are beneficial and the Omega 6 are beneficial. However, the Omega 3 are more beneficial. So if you look at the ratio, a better ratio of omega 3 to 6 is going to look better because the omega 3s are more beneficial than the omega 6s. That doesn't mean that the omega 6s are harmful. They can still be beneficial and we need a certain amount of them. But more people would benefit from placing emphasis on the omega 3s simply because people don't get as much of them in their diet and they might exert additional benefits.
- [30:45]
Rich Roll
And the Omega 6s that we're getting are all in these ultra processed foods. That's the problem.
- [30:50]
Dr. Matthew Nagra
Yeah. So it's the package that they're coming in. Of course. So if you're using them again in cooking, stir frying, et cetera, that's fine. But I wouldn't be getting the majority of my calories from these ultra processed foods.
- [31:00]
Rich Roll
Well, with respect to cooking with them, whether it's stir fry or something else, talk a little bit about oxidation points because you know when you heat these things, they become something different. Right. There's a difference between putting olive oil on your salad right out of the bottle versus the stir fry version. And these oils vary in their oxidation points. Yes. So in the process of heating them, like is there something that we need to be aware of or a preference that we need to make in order to make the best, healthiest choice?
- [31:33]
Dr. Matthew Nagra
Yeah. So it's actually funny. The olive oil, because it's rich in monounsaturated fats, but lower in polyunsaturated fats, it's often sort of separated from the vegetable oils because they're richer in the polyunsaturated fats. And it's thought that those polyunsaturated fats are the ones that can oxidize at high temperatures and cause problems. And that might be true to a degree, but it doesn't seem to be meaningful. It doesn't seem to actually lead to a meaningful increase in these reactive species. However, if you were to put them through several repeated cycles of heating, cooling, which might be practiced in certain fast food restaurants or where they're frying with them all day, that could potentially lead to an increase in these compounds. And there is a study showing that it can increase inflammatory markers when consumed. We do not see that with more typical cooking patterns of stir frying for 30 minutes or something. So I don't actually put a lot of weight into those concerns at this point. And I would say that they're fine to use for cooking. And in fact, there was the NIH AARP study where they looked at different cooking fats, and they had over 400,000Americans in that study, and they found that, again, these vegetable oils, they had canola, corn, and then they also looked at olive oil. They all led to benefits for a number of different outcomes, cardiometabolic outcomes.
- [32:46]
Rich Roll
Is there any oil out there that's commonly used that you would say, yeah, stay away from that one, opt for this one?
- [32:53]
Dr. Matthew Nagra
I would say the. Not necessarily of those groups of the vegetable oils and the olive oil, but the saturated fat rich oils. So things like coconut oil or butter on the animal fat side.
- [33:04]
Rich Roll
Yeah, coconut oil does have considerable saturated fat in it, which does distinguish it. It does have a higher heat point, though, which I had always thought that makes for a healthier option in terms of cooking. And there's something about the saturated fat, the composition of the saturated fat, that makes it more readily available as an energy source and less likely to, you know, kind of do the negative things that saturated fat tends to do. Like, is that. Is that a myth that has been debunked now, or is that true?
- [33:36]
Dr. Matthew Nagra
So there's some truth to that. So the fatty acid composition, even the saturated fat composition, is different than something like butter. And we have trials showing that coconut oil can actually lower LDL cholesterol compared to butter. So it does appear to be a better choice there.
- [33:50]
Rich Roll
That's strange, because it's you know, it's like the intake of saturated fat, you know, in a reductive sense, should elevate your ldl.
- [33:58]
Dr. Matthew Nagra
Yeah. So there's, there's three main types of saturated fat that raise ldl, but there's others that are neutral. So for example, stearic acid, which is the main saturated fat in cocoa, in chocolate, that actually doesn't have an impact. It's neutral for LDL cholesterol. But then things like palmitic acid being one of the primary fats in butter that can raise LDL cholesterol. So that composition actually does really matter. Now, I wouldn't take that and say that we have to look at the composition of every different food. Most of the ones that are rich in saturated fat are rich in those ones that can raise ldl. There are very few exceptions, the chocolate being one. And to a lesser degree, cheese might have less of an impact on LDL cholesterol than other high fat sources. So when you understand the differences between the different types of saturated fats, it's not that surprising really to see differences in results.
- [34:45]
Rich Roll
Butter is sort of back, right? And there's a lot of people celebrating this. Finally, we're putting seed oils in their rightful place and we're going back to what our grandmother always cooked with, which is butter. And we're all better because of it.
- [35:01]
Dr. Matthew Nagra
Yeah. So that came from the butter is back headline from Time magazine. I think it was in 2014 or somewhere in that ballpark. And that was based on a meta analysis of observational studies that did not identify an association between butter and cardiovascular disease. And this is actually something really important to understand about. A lot of the research on nutrition and cardiovascular disease is they did something called over adjustment. So when we're conducting research, we'll adjust for confounding variables. As I mentioned earlier. Right. We want to level the playing field, make sure that, like, exercise habits aren't impacting the results, make sure that smoking habits aren't alcohol intake and so on. But they adjusted for LDL cholesterol levels or other markers that are similar to LDL cholesterol level. The reason that that's problematic is that you and I, if we ate the exact same diet, we might have different LDL cholesterol levels just based on genetics. Right. And so let's say my baseline, my genetic baseline is lower than yours, I could eat a bunch of butter and end up with the same levels as you. And by adjusting for ldl, that's essentially what that study would be comparing. It would be comparing People with the same LDL but different levels of butter intake. And if butter increases cardiovascular risk by increasing LDL cholesterol levels, you're removing that variable, right? If A leads to B and B leads to C, but you make sure B is identical for everybody, you won't link A to C. And so we can't over adjust for variables that are literally on that pathway. And that was unfortunately what was done in that study. Now when we don't do that and we do proper adjustment models here, we see very consistently that saturated fat or butter intake increases risk.
- [36:44]
Rich Roll
This past year I unlocked a major life dream which was to build my own home gym. I got to tell you, it's the greatest thing ever. Just this gift that keeps giving to be able to wake up before the sun, walk just a few feet and have my own space to get right into my morning fitness routine. When it came to selecting the equipment for my gym, which is this customized 40 foot shipping container trainer, I looked at a lot of stuff and home fitness, it's come a long way and I really wanted to outfit my limited space with the smartest, most immersive gear that actually enhances the way that I could train. And what came out on top was NordicTrack, not only because they've led the at home fitness space for like 50 years at this point, but because what they're doing right now is truly next level, exemplified by my favorite piece of kit, their commercial X32i treadmill, which simulates real world terrain with an incredible 40% incline and 6% decline. The S27i Studio Bike mimics road conditions with a 20% incline and a minus 10% decline. And the RW900 rower, it's smooth, it's fluid and built to keep momentum effortless list. But what really sets us apart is iFit Pro. Their new AI coach builds personal plans, schedules, workouts and keeps you accountable all through simple text exchanges. I'm even training with my buddies, friends of the pod people like Tommy Ribs, Knox Robinson and Dan Churchill with the machines that automatically adjust to match their workouts in real time. So stop stalling your progress because you don't know what to do Next next. With NordicTrack and iFit, all you have to do is press start and the trainers and tech take care of the rest get 10% off with any purchase of $999 plus with the code RICHROLL. There's something anthropologically interesting about the way in which we as tribal beings tend to champion the arguments or the ideas that reinforce our tribal View. And this is across the board, like I said at the outset. But there is something weirdly like when people are like, yes, it's like our team is winning kind of thing, you know what I mean? When it should just be like what's true, what's not. This should be a dispassionate sort of pursuit to understand what's in our best interest. But the culture has really shifted quite a bit. I mean, I don't know, six or eight years ago there was this real rise in interest in plant based nutrition and we were seeing all these new food products come on the market and plant based restaurants. And even today, now of course most restaurants have plant based options, et cetera. But there has been a precipitous sort of decline in enthusiasm in recent years. The culture has shifted and it is very much about butter is back right now. This seems to be kind of the predominant paradigm and within that that we've seen this very strange kind of celebration of beef tallow. Right. Like we all saw rfk, I can't remember what fast food chain restaurant. Yeah, like they're now going to make their fries with beef tallow. Like let's put matters to rights on what beef tallow is and what happens when you eat it. Is this a move in the right direction? Matt, what are we doing?
- [40:23]
Dr. Matthew Nagra
It is a saturated fat, rich animal fat. It's very similar in composition to butter with, with small differences. And from now we don't have a lot of long term trials or long term observational studies on beef tallow and outcomes. So someone could throw their hands up and say, hey, we don't know. We don't know if it's necessarily harmful. But we can draw conclusions based on our prior knowledge. We know that saturated animal fats raise LDL cholesterol levels. We know that they ultimately lead to cardiovascular events, especially with that rise in LDL cholesterol levels. And if we were to replace something that has been shown to do the opposite with those foods, chances are it's going to be worse for us. Now am I going to say that having ultra processed foods with beef tallow, especially hyper color or hyper palatable ultra processed foods with beef tallow is going to be significantly worse than having hyper palatable ultra processed foods with vegetable oils? Probably not, because there's a lot of other factors that are going to be the same between them. I mean if you're going to a steak and shake or a McDonald's or whatever, whether it's beef tallow or seed oils, I don't think is going to make the biggest impact. But if anything, I think we can expect it to be even worse for you, which is sort of the irony there.
- [41:33]
Rich Roll
The message really should be like, stop eating at these fast food chains. Not like, oh, now it's great, you can go get fries with beef tallow. This doesn't seem to be moving the ball in any positive direction.
- [41:46]
Dr. Matthew Nagra
Forward, exactly. That was the biggest issue I think with that whole sort of campaign was, I mean, you have RFK Jr going in there and advertising this fast, fast food joint and eating their meals. And I think that's going to send the message that like, hey, you should go here, it's good stuff. Where you know, it's still going to be problematic if you're having that regularly.
- [42:04]
Rich Roll
So the reason we're talking about seed oils, or maybe before we kind of pivot here, talk a little bit about the controversy within the plant based community. Why is it that there is that cohort I referenced earlier that is so adamantly against seed oils in any regard? It seems to me that the emergent evidence, since, you know, that became kind of of the paradigm has changed and perhaps there's a resistance to really objectively looking at that library of evidence. What's going on there.
- [42:36]
Dr. Matthew Nagra
Yeah, I mean, that's been kind of the status quo in the community for many years, since I first got into it, which was over a decade now. And it comes from a couple things. So one of the studies that they often reference was by Vogel and colleagues and this looked at a rather large dose of oil and it was actually olive oil, even your traditional seed oils. But they looked at about a quarter cup of olive oil along with bread and there were some other foods served with it. And then they measured artery function, so the ability of the arteries to dilate after consumption. And they found that temporarily there was an impairment in the artery's ability to dilate fully. And from that they drew the conclusion that hey, you aren't able to get what's called, or as good of what's called flow mediated dilation. Therefore it's going to be worse for your cardiovascular risk. The problem is this is a temporary reduction in that dilation through a very high intake of fat in that meal. And that has never been shown to translate to actual cardiovascular events. We know that in a fasted state. So if you measure first thing in the morning without food and you're not able to dilate correctly or to that same degree, that can increase your risk of cardiovascular disease. But these short term changes after a meal have not been shown to do so. And then again, we can step back further and look at, well, what does the broader evidence say about actual heart attacks and strokes? And we see a reduction in risk. Right. So that goes back to the outcome versus mechanism argument. So that was one of the things that they sort of based their argument on. The second thing that they come to is they look at say the work of Dr. Dean Ornish or Dr. Caldwell Esselstyn and displaying these positive results in people adopting a low fat plant based or plant predominant diet. And I would say, yeah, you see reductions in risk of cardiovascular events. In the case of Ornish's trial, it was diet plus, plus some exercise and other lifestyle factors. And that's great. But we also see similar reductions in trials on say the Mediterranean diet where there is a lot more olive oil and other things. So we can't say that those results are better than necessarily including oils because they weren't directly compared to each other. Ornish didn't compare a low fat plant based to one that's richer in olive oil or other oils. It was standard care versus the lifestyle.
- [44:46]
Rich Roll
Right. And I mean Ornish got amazing results, but there's co founding variables there that involve lifestyle shifts.
- [44:52]
Dr. Matthew Nagra
Exactly, exactly.
- [44:53]
Rich Roll
Yeah.
- [44:53]
Dr. Matthew Nagra
But when we look at the evidence we have on oil specifically, including substituting oils for healthier or whole foods like say avocado, we see that they're comparable as I mentioned earlier. So I don't think there's any good evidence to point towards this oil free approach being better than the oil inclusive approach.
- [45:10]
Rich Roll
In fairness, one thing is true though, which is that polyphenols aside, oils are very calorically dense and not necessarily nutritionally dense. And a lot of the, the people who are at highest risk for a cardiovascular event are also obese. Like obesity is driving so many of these poor health outcomes. And the first thing you need to do is get these people down to a reasonable weight and removing oil from the diet is an effective way to do that. So I think there is a decent rationale for eliminating or at least reducing oil in acute cases. But I know personally when I try to go oil free, it becomes very difficult and hard to sustain over time.
- [45:57]
Dr. Matthew Nagra
Yeah. And that's one of the things that I think we see with oils is that they make vegetable consumption more appealing. If you're cooking them up with some oils and you're adding spices and stuff and the oil will help soak up some of those spices, that makes it a lot more fun to consume those healthy foods, whereas without the oils Maybe not so much. But I agree with you that, yes, they are calorie dense and that could possibly be a reason to limit intake if needed. If it is a case of potentially needing to lose some excess body fat. But outside of those cases, I think it's fine to include and it can be an absolutely promoting.
- [46:30]
Rich Roll
Well, the reason we're talking about oils and butter and beef tallow is because the number one killer is cardiovascular disease. This is what is the reason behind why most people die. And to the extent that we can make lifestyle changes to circumvent falling into that, into that trap, we should all do so. And in order to do that, we need to understand our blood markers, like you mentioned, ldl. So let's talk about ldl. What is ldl? Because I think this is another misconception out there. There's a lot of LDL denialism in terms of its relationship to cardiovascular disease, particularly from the more carnivorous food tribes out there who would have you to believe that this is something you needn't worry. And just because your LDL is elevated, it's not necessarily related to that cardiovascular risk. So here we go once again, like set matters to rights here. What does the science say? What is your perspective and how should we understand this?
- [47:35]
Dr. Matthew Nagra
So LDL stands for low density lipoprotein. And when we have cholesterol in the bloodstream, it needs to be carried by something. I have a glass of water here. If I poured oil in it, the oil wouldn't dissolve. It would separate from the water. And so fats in our bloodstream are kind of the same, so they need some sort of carrier to transport. And LDL is one of the transporters for cholesterol and other fats. And now what's unique about LDL and a few other lipoproteins is that they contain a protein called apob. And I know this has been brought up when you've spoken with Simon Hill.
- [48:05]
Rich Roll
Yeah, Simon and I have talked about it, but it's been a minute and not everybody listens to everything. And I always think, well, we already talked about this, but like, you know, we need to keep talking about it. So continue, please.
- [48:16]
Dr. Matthew Nagra
Yeah, so apob, it's sort of like a protein tag, and it has a charge on it. Like, you know how a magnet will have a positive and negative charge? Well, it has a charge that interacts with the opposite charge on proteins inside the artery wall. So when that LDL particle slides in, because it can slide in and out of that outer lining of the artery, it can sort of bind due to that charge and it gets held in that, what's called sub endothelial space. And when it's there, it triggers an immune response. Our white blood cells come in, they eat it up. And that sort of initiates the progression to a PL plaque. And over several decades, obviously that plaque grows and can eventually rupture and cause a heart attack. So that's the very quick version of ultimately what that does. Now, the more of these LDL and other apob containing lipoproteins that we have in our blood, the more are going to end up in there and cause problems down the road. So that's sort of the mechanistic understanding. But how do we know that it actually leads to cardiovascular disease? Well, we have multiple lines of evidence here. We have observational studies where you, you measure people's levels, follow them for many years, and you see that those with higher levels have higher risk of cardiovascular events. We also have drug trials and different types of drugs. We have statins that might lower LDL cholesterol from like 30 to 45%. You have PCSK9 inhibitors, which just abolish your levels down to very low levels. And then you have other medications that lower them less. And you have diet as well. So we've shown that lowering LDL cholesterol through pretty much any of these means leads to a reduction in cardiovascular events. And the reduction that we see in events is dependent on how much we lower ldl. So the more you lower ldl, the lower your risk gets. And then finally we have genetic studies, so Mendelian randomization studies, where they'll look at people with genetic variants that lead to higher or lower levels throughout their entire lives. And in those with lower levels, we see significantly lower risks of cardiovascular disease, because that's carried out through the entire life and isn't influenced by a change in medications down the road or diet and so on. The evidence is incredibly clear and consistent there. And that's independent of other variables because we're talking randomized trials and genetic studies where it's not going to be influenced by so much of differences between people's exercise habits or whatever.
- [50:32]
Rich Roll
So what is the best version of the argument that LDL is a red herring? How are people advancing this argument and getting mind share around this?
- [50:43]
Dr. Matthew Nagra
So a couple of the things that are brought up is people often compare, say, the risk of having elevated LDL cholesterol to the risk of having insulin resistance or the risk of other markers being either elevated or too low. And the problem with that is that these are often compounding issues. So if you look at elevated LDL cholesterol alone, and you can take again, yourself from. Or myself, relatively healthy individual, but let's say genetically you have just a higher ldl, you can take that by itself and it's going to increase your risk to a certain degree. But you exercise, you eat well, you do all these other things that are going to lower your risk. So that elevation might not be sky high, but it's still there. But then you take, say, a group of people with insulin resistance. They're. They're insulin resistant and they often have high LDL and other lipoproteins with that, and they have high blood pressure and they have all these other things going on. And so the risk of that individual is going to be higher. That is, one argument that's often used is like, oh, ldl, small impact, don't worry about it. Compared to all of these other bad things. Well, why not care about all of them? That's how I would look at it. Let's control the ldl, let's manage blood glucose, let's drop that blood pressure, let's take care of all this stuff. And so that is what I see is most often the argument, but I just don't think it's a very good one.
- [51:58]
Rich Roll
Right. So from a mechanistic point of view, though, is there an argument that ldl, LDL and CVD is an overstated correlation that is more red herring than, you know, alarm?
- [52:12]
Dr. Matthew Nagra
So one of the arguments there is that it's either inflammation or oxidation of the LDL particle that is the problem and not LDL itself. There's an issue with that though, is once that LDL ends in the subendothelial space and it's held there, it triggers inflammation and will be oxidized. It's going to happen. Now, the reason it's happening is because you had too much LDL and ended up in that space in the first place. Place. So it's still the too much LDL that was initially the problem. And how we actually know that it's the concentration that matters more so than whether or not it was oxidized or whatever, is because you can do studies where you adjust for oxidized LDL and in that case, APOB concentration. So having elevated Apob, again, that protein on ldl, that still is associated with risk even after you adjust for oxidation. Whereas if you do the opposite, if you adjust for Apob, but you look at oxidation, it's not associated with risk. So that tells us that what matters is the amount of APOB containing lipoproteins, of which LDL is the main one matters most.
- [53:13]
Rich Roll
So in other words, this is given voice by saying something like, when you measure ldl, that's just measuring basically, like serum levels of it. Right. And serum levels don't necessarily correlate to cardiovascular disease. What we need to look at is cholesterol that becomes oxidized and therefore adheres to the arterial wall and creates these block edges or hardened.
- [53:41]
Dr. Matthew Nagra
Yeah, sort of.
- [53:42]
Rich Roll
Is that like, you know, but. But it, like my armchair, you know, attempt to, like, parse this, but it.
- [53:47]
Dr. Matthew Nagra
Doesn'T make sense because it's the LDL concentration that does correlate very strongly with risk. And we can see that manipulating the amount in your bloodstream has a significant impact. Right. That's what leads to it being in the artery wall and ultimately oxidizing and, you know, progressing onto a plaque. So, yeah, you're, you're kind of getting the right idea there, but it still comes back to like, we have very strong evidence for the actual concentration of LDL being a problem.
- [54:13]
Rich Roll
So we should get our, our blood tested. We want to know what our LDL is, but more importantly, we want to know what our APOB is. That is a more definitive marker of, you know, our, our situation. It seems like, like, you used to have to kind of ask for apob. This is a new marker. But is that now being mainstreamed, where if you go in for a typical blood panel, they're just gonna, they're gonna do it, you know, as a matter of course.
- [54:41]
Dr. Matthew Nagra
It's not standard. I've seen it a lot, like patients of mine who are also being managed by a cardiologist, I'll see that the cardiologist does do it quite often, if I hadn't already. But from like a standard kind of GP practice, I don't think most will measure apob. It's not really a part of clinical guidelines yet. I do will be. But what is a part of that normal lipid panel is your total cholesterol, your LDL cholesterol, which is a pretty good marker, and your non HDL cholesterol. So it's your total cholesterol minus hdl, which is very closely approximated to apob. Like, it's a pretty good alternative if you can't get the apob. And in most cases, just. Just to be, to be honest here, the, the LDL is good. It's a pretty good approximation in most cases. But in people with metabolic syndrome and people with elevated Triglycerides, it's not necessarily going to be accurate. It can be underestimated because if your triglycerides go up, they start taking up some of the or they start being taken up by the ldl. And so you kind of get a skewed measure there. But by and large, LDL is pretty good. Non HDL is better. APOB is the best.
- [55:47]
Rich Roll
What about having an elevated LDL but also having a very healthy high hdl, the so called good cholesterol does, does that buffer that? How should we think about that? You get the test, you get your ldl, you get your HDL and you get your total cholesterol. So you have these three things. You want APOB in there? Of course. But in case you didn't get it, how do we make sense of how those numbers interact with each other to decode how to move forward?
- [56:15]
Dr. Matthew Nagra
Yeah, so we used to think HDL was important, at least the concentration was important. And that's because high HDL does associate with good outcomes in the long term. In most observational science studies, however, things like exercise raise hdl, not smoking leads to higher than if you were smoking and other healthy behaviors increase that hdl. Also genetics impact hdl. So with ldl, like I said, we have the genetic studies, we have the randomized trials, we have a lot of evidence pointing towards modifying LDL and how that can impact risk. But they've tried drug trials to raise hdl. They didn't seem to lower risk of cardiovascular disease. People with genetically higher HDL cholesterol appear to be protected from cardiovascular disease. So the HDL concentration isn't actually a great marker. It generally associates with good outcomes because it's associated with healthier behaviors. But it doesn't. If you were to modify that number, it's not necessarily going to translate into better outcomes, if that makes sense.
- [57:11]
Rich Roll
LDL is important. APOB is the marker to pay most close attention to. But in terms of assessing your overall CVD risk, you want to look at family history, of course. And in the context of that, like where does getting a calcium scan fall? Like, you know, what are other some, what are other things that we should be doing to really know exactly where we're at?
- [57:35]
Dr. Matthew Nagra
Yeah. So to first off, estimate risk based on those measures that you can get through a blood test or family history or blood pressure, there's some great calculators online. I know the American College of Cardiology has one. I actually research really like the European Atherosclerosis Society calculator and these are free to use online if you wanted to kind of plug and chug your own numbers and see where it comes out. So that's one thing. But when it comes to say, coronary artery calcium scans, one problem with those, and I think it can be a useful tool, especially in elderly individuals who are higher risk, is that if you measure at a younger age, say in your 30s or 40s, as we see a lot of people in the carnivore community, they'll measure it and be like, hey, it's zero. Well, it's probably going to be zero because that's the, the late stage plaque, that's the calcified plaque that's been there for decades before it finally did calcify. Just because you have a calcium score of 0 does not mean you don't have plaque. In fact, the non calcified plaque is the most dangerous plaque. That's the one that's going to break off and cause a clot and ultimately leading to a heart attack or stroke. The calcified plaque is actually more stable. In fact, medications like statins, while they lower LDL cholesterol, they actually can lead to an increase in calcified plaque which stabilizes them. And that's one reason that you might not have as high of a risk of a cardiovascular disease disease or a cardiovascular event after that. So it can be useful in certain high risk individuals, especially Those like over 60, 65, but at a younger age, it's not super useful unless you are a very high risk individual. And if you pick up on some calcified plaque there, that's really problematic because that means you probably have a whole lot of uncalcified plaque.
- [59:05]
Rich Roll
Are there any other scanning techniques that are coming or would be good to explore? It seems like, like there should be some imaging that would be helpful here.
- [59:16]
Dr. Matthew Nagra
I mean, there's some studies looking at like certain ultrasound techniques. There's a recent keto study, maybe, maybe we want to get into that, used CT angiograms, but these aren't very easy to get. These aren't things that are going to be widespread. Whereas something like a calcium score is actually pretty easy to get. There's a lot of private labs that do them. So unfortunately, I'm not aware of like what would be a risk, a really easy, simple test like that to do for most people. But you can make good decisions around treatment based on risk factors as well. And if you were a high risk individual, then you can maybe get a referral to one of these more advanced tests.
- [59:52]
Rich Roll
All right, so Cliff notes on seed oils not so bad, but not too much better than butter and beef tallow. Nothing to get too crazy about, but certainly not something to overindulge in. LDL once again, important apob, et cetera. Etc. What's next in the hierarchy of misinformation or topics that you feel it's important for people to kind of understand? Truth versus fiction.
- [60:20]
Dr. Matthew Nagra
I think a big one is the whole plant, animal, protein debate. I think it's one of the most powerful changes you can make in your diet to actually improve your long term health. But then there's so much misinformation around like well, plant protein doesn't work as well as animal protein or, or basically name your fallacy when it comes to.
- [60:39]
Rich Roll
Those amino acid deficient, lower absorption rates, you're gonna have to eat so much food just to meet your daily requirements, et cetera, et cetera. Animal protein is superior is basically the bottom line here.
- [60:52]
Dr. Matthew Nagra
Yeah, I think maybe before the health stuff. Yeah. Let's talk about the whole muscle and strength aspect. I think there's three sort of questions that we have to ask that one is can you get the same amount of protein from plant foods as you could from animal foods? That's maybe the main concern for most people and I would say it depends on what you're replacing. So if you just go to a buffet and you decide that you're going to eat plant based now and you just load up on whatever is labeled as vegan, you're probably going to end up with less protein if you're having a lot of rice and veggies and things like that. But if you swap out meat, let's say your standard 80% lean beef for tofu and you eat the same amount of calories, which would be a bit of a larger serving for the tofu, but the same amount of calories, you get about the same amount of protein. Now if you replaced even extra lean beef with say seitan, which is a wheat based protein for those who aren't familiar and really nicely mimics sort of a meaty texture, you can match lean beef so actually have more than your standard beef. If you use textured vegetable protein, which is like soy or with much of the fat removed, that also has a meaty texture and matches roughly the lean beef for protein content. So that's, that's easy enough. Now we can also look at dairy. If you replace your say 2% or 1% milk with soy milk or pea milk, you get about the same amount of protein. Skim milk has slightly more, but it's it's not too far off. Now, if you were to choose oat or almond milk. Yeah, you're getting less protein there. So that's where that sort of decision making comes in. If you look at eggs and replace that with a tofu scramble, you get more protein. So I just like to emphasize a bit of focus on those higher protein plant foods. It doesn't have to make up your whole diet, but where you would normally have some, some beef or some chicken or some fish, make sure you're replacing that with some of those higher protein plant foods and you can get around the same amount of protein.
- [62:36]
Rich Roll
Yeah, but Matt, leucine. This is the thing, right? Leucine. Most plant foods are insufficient sources of leucine, and without leucine, you can't form complete proteins.
- [62:49]
Dr. Matthew Nagra
So leucine, one of the amino acids that's important for triggering muscle protein synthesis, it is found in quite significant amounts in certain plant foods. Like seitan is actually very high.
- [63:00]
Rich Roll
Yeah, but nobody eats seitan.
- [63:02]
Dr. Matthew Nagra
Sure. Just mentioning one example. But soy is also quite a good source.
- [63:06]
Rich Roll
Yeah, but that's estrogenic.
- [63:07]
Dr. Matthew Nagra
We'll get to that.
- [63:08]
Rich Roll
Okay, keep going.
- [63:09]
Dr. Matthew Nagra
But yeah, so, like, that can be a good source. I believe adzuki beans are pretty good. But I want to also highlight that we don't need to necessarily hyper focus on leucine because there's a threshold to how much is actually beneficial at a meal. So it's about 2 to 3 grams, and that's the amount you can get through a pretty simple meal with some grains, some tofu and veg. The tofu alone can often provide about that amount, depending on the proportions that you're having. So you can meet that leucine threshold relatively easily. And I don't want to jump too far ahead to the outcomes part, but we actually have a trial where they monitored leucine intake as well. And I will definitely touch on that in a second. But the point being here is that on the amounts of protein, protein, you can get roughly the same amount. Then it comes to a question of amino acid content. Right. Do plants contain all of the essential amino acids? So there are nine essential amino acids, meaning these are the nine building blocks of protein that we cannot make ourselves. We need to get from food. And all plants contain all of the essential amino acids, full stop. So that. That's one of the biggest myths out there, is that plants don't contain all of them. Now, the pushback there would be. Well, they don't all contain a lot of. Lot of all of them. And that's fair. But if you're eating a varied diet throughout your day, if, and not even at every meal, but if you're having, you know, certain things for breakfast, let's say you're having, I don't know, some, some oats with, you know, whatever nuts and seeds you're throwing in there. And then for lunch you have some beans or lentils with, with rice or whatever. Those will all combine and complement each other. You don't necessarily have to have this variety at every single meal. And we don't see that that's a problem at all with getting enough of the essential amino acids throughout the day, as long as you're eating some variety and not focusing on a single food. And then the third thing that gets brought up, so the last thing before we get to the actual outcomes is digestibility. So do we absorb much plant protein relative to animal protein? And the concerns over that are stemming primarily from two measuring systems or scoring systems for protein digestibility. I'll try not to get too in the weeds on this, but just roughly or, or briefly describe them. So one of them is called the Protein Digestibility Corrected Amino Acid score, or the PDCAs, and the other one is called the Digestible Indispensable Amino Acid score, or the dias. Don't, you don't have to remember them. Don't worry about it. I'm just throwing it out there. Now, you will find that based on these measuring systems, a lot of plant foods will score lower. 60, 70%, maybe in that ballpark. Except soy scores in the 90s, it scores quite high. And maybe one or two other plant broken proteins, whereas animal proteins score very consistently in the 80s to 90s or sometimes even higher. Now, the problem with those scoring systems is that I'll start with the PDCAs for one. It's typically measured in rodents. In animal models, we aren't rodents. We have different digestive tracts, we have different growth rates, we have different protein needs. And so we can't necessarily translate that to humans. And in fact, this goes across the board. So when people are making nutrition claims online, I would always look at, are they talking about humans or are they talking about animals? Because a recent review found that only about 5% of results from animal trials translate to humans. So most of the time they either don't work, there's unwanted adverse effects, or they just don't work as good as other things that are already out there. So animal trials, it's a starting point. It's not necessarily translatable to humans. The second issue is that they don't just measure digestibility, they measure the digestibility of the lowest available amino acid. And this is critical. So let's say you had a report card, and let's say there were nine subjects. We'll call them the nine amino acids. And let's say you score straight A's on eight of them, but you got a C on one of them. Your score on the PDCAs for the aggregate would be a C. It wouldn't be like a B or whatever the actual average would be. They would score you based on the lowest number. So if you take a plant food like beans, that have low amounts of methionine but are higher in the other amino acids, you'll get scored based on how much methionine is there. Right. So that's a huge disadvantage to plant foods when it's not even a problem if you're eating multiple foods. Right. They'll complement anyway. So that's a big problem because you'll.
- [67:17]
Rich Roll
Be eating something else that is high in methionine.
- [67:20]
Dr. Matthew Nagra
Exactly.
- [67:21]
Rich Roll
Whereas an animal source of protein may be more complete in the sense that all of those things are in equal proportion.
- [67:30]
Dr. Matthew Nagra
Exactly, yeah. And that's a point that I've never seen somebody mention when citing the PDCAs or the DYAs to support their view on the animal proteins. The third issue with the PDCAs, it's not maybe as big of an issue, but they measure digestibility from mouth all the way through the other end. So basically, they feed foods. They measure how much protein goes in and how much comes out, and the difference is presumably what's absorbed. But near the end of the small intestine, or, sorry, the large intestine, there's some bacteria that will chew up some of the proteins, so it can skew results a little bit as well, so that there's issues around that. Now, moving on to the dyas, and I'll go through it quickly because it's largely the same, but it's typically measured in pigs. It has that same issue with the limiting amino acids, so it docks points based on amino acid profiles. They do overcome the whole issue with the bacteria and the digestive tract because they insert a tube through the abdomen to the end of the small intestine and they suck out the protein from there versus going all the way back through. But then the other problem is they typically use raw foods. So they use raw beans, raw lentils, raw grains, and by cooking those foods, you make the protein more digestible. So they're also skewing results, particularly for Plant protein sources that do become more digestible with cooking. And when we look at the limited research we have in humans where they're looking at the digestibility of the whole protein so not the individual amino acids, we see that high quality plant protein sources like soy, pea or wheat based proteins, they high have, you know, about a 90 or even above a 90% digestibility. That's only a few percent off even the highest digestible animal proteins. So the difference is we're talking a few percent here. It's hardly anything with that. We can speculate that, well, maybe the results will be the same, maybe plant protein will be slightly worse, but not too far off. But that's why we ultimately test these in the clinical trials where you pit a vegan or plant predominant diet against an omnivorous diet and measure actual strength and muscle gains. And we now have two trials that have done that. And in both cases, the plant protein, as long as they're eating the same amount of protein, led to the same muscle and strength gains as the animal protein, with no significant differences in any outcome. So if at the end of the day, let's just for sake of argument say yes, plant protein's somewhat less digestible, let's say that it doesn't have as balanced of an amino acid profile. If at the end of the day you get the same results, same muscle gain, same strength gains, who can cares, who cares about these individual mechanisms? Maybe there's mechanisms working in the opposite direction for plants. Maybe the carbohydrates that are packaged with plant foods a lot of the time help spare some of that protein so it can be used and integrated into your muscle like there's a possible mechanism there. Ultimately, I don't want to speculate too much about what these mechanisms could be because I don't think we know for certain. But who cares? The results are the same.
- [70:11]
Rich Roll
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- [75:07]
Dr. Matthew Nagra
It was funny because I feel like these trials, these more recent ones, were sort of responses to those initial criticisms around the powders. So when we look at trials on pea, rice or soy protein in comparison to whey protein, we see no significant differences there. But one of the criticisms was always that, well, maybe when you isolate the protein it's more digestible, so it's going to function better than a whole food. It's sort of the opposite of what you're suggesting there. And so when they conducted this, this, we'll say the first of these two new trials in Brazil is published, I believe in 2021. They, yes, they supplemented the vegan group with some soy protein and they supplemented the animal group or the omnivorous group with some whey protein. Most of the food or most of the protein in both groups came from food and that's, that's critical. So if there is a difference between plant food consumption and the, say, protein quality there and animal foods, we should see a difference in that trial since the majority of their protein came from those sources and we did not in any outcome. So I think that's pretty compelling evidence that no, you can get the job done with plant protein as long as you're eating sufficient protein, which in this case was 1.6 grams of protein per kilogram of body weight, which is typically recommended for those looking to pack on muscle.
- [76:18]
Rich Roll
The argument that generally follows this is okay. Yeah. But if you're going to be making sure that you're eating enough protein on a plant based diet, then this is going to be difficult. Difficult. And you're going to have to eat like tons of food and be hypervigilant about what those foods are.
- [76:36]
Dr. Matthew Nagra
I would say you do have to probably spend or pay a little more attention, especially if you're coming from an omnivorous diet. As I mentioned earlier, there's certain plant foods that are higher in protein and certain ones that are lower. But to be hypervigilant, I think that's an exaggeration. If you monitor pretty much anyone's protein intake on a plant based diet where they're centering their meals around protein, and this is what I advocate to patients as well, is when you're designing a meal meal, focus it on the protein components. If you're having lentils and rice or some veggies, make sure that centerpiece is the lentil dish. Or if you're using tofu, make sure that's the center and then build around that. Add the fruits and veggies and other things around that. And if you're doing that, it's pretty easy to hit those targets. If you're aiming for that high, high end of 1.6 grams per kilogram, you could probably do well by adding a protein supplement. It doesn't mean that you need to, but it can help you get there without thinking about it much. And I do that and I never think about my intake anymore because it's so easy. And look, every gym bro who's using or who's going to the gym is using whey protein anyway. So it's not like it's really different than what the omnivores are doing. It's just a different type of protein.
- [77:43]
Rich Roll
Sure. If their omnivorous diet was so, you know, exceptional, there would be no need to be drinking these, you know, protein smoothies all the time.
- [77:51]
Dr. Matthew Nagra
Yeah. And even if they were already meeting their needs, like there's not really harm in taking an extra shake or something either. And I would say the same about people on a plant based diet.
- [77:58]
Rich Roll
Well, in terms of meeting your needs, like even in a performance, performance context, what does the science say is required in order to, you know, to, you know, produce the muscle synthesis that you want? And what does excess protein intake do for that or not do for that? Because, you know, look, if our friend Garth Davis will say that, you know, we're obsessed with protein and it's not helpful to us, the Recommended daily allowance is what, 0.8 grams per kilogram, which really isn't very much. But right now there's a lot of promotion of really doubling down on your protein. And perhaps there's a reason for that. As we age, like at my age, it becomes more important than it was 10 or 15 years ago. But what do you make of that argument and how we think about the amount of protein that we're intake?
- [78:53]
Dr. Matthew Nagra
Yeah, I mean, I know the, the RDA, I would say is a little bit low and there's been an argument for that now based on newer data that's come out than not the last five, six, seven years around especially bone health parameters and risk of frailty in older age. And so I do actually advocate for a little bit of a higher intake. Around 1.2 grams per kilogram is a pretty safe number for most people. And for most athletic endeavors, that's going to be enough as well. It's for those who are looking to squeeze out every ounce of muscle and strength gains that going up to 1.5 or 1.6 grams per kilogram is a reasonable thing to do. And there was a really good trial or, sorry, meta analysis of trials that was published just a couple of years ago by Tagawa and colleagues. And they looked at protein intake with and without resistance training. So in trials where they didn't add resistance training, but they just upped their protein, pretty much nothing happened. Very little. So you're not just gonna sit on your butt, slam protein shakes and hope to gain much muscle. It's just not gonna to happen. But in those who were resistance training, even in those with very low protein intakes, like 0.8 grams per kilogram or less, they still gain muscle. So that's the biggest lever to pull is actually lifting some heavy things. Right. But in those who upped their protein to about 1.5 grams per kilogram, they experienced the largest benefits and then there was no further benefit after that. So again, it kind of depends on your goal. I think resistance training is really important, but especially for bone health and so on. I, I would advocate for a little bit of a higher protein than that RDA of we'll say about 1.2, maybe 1.1 grams per kilogram.
- [80:24]
Rich Roll
Well, this brings us to the point in the podcast conversation where we have to talk about Nagra versus Norton. You've had some colossal beefs with our friendly Norton. Norton claims nagged by Nagra. Talk about, could we talk about this a little bit? Where do you guys guys disagree on this stuff? What Led to some loggerheads here, I would imagine, has something to do with.
- [80:50]
Dr. Matthew Nagra
Protein, actually more with red meat. I mean, protein to a degree as well, but it was red meat. I'll give some background on that. So there's a study that he and other people I don't want to just single him out, often cite to suggest that red meat, unprocessed red meat, is not problematic in the diet. And this is a study out of Canada where they looked at unprocessed red meat consumption and the risk of cancer. Cancer. But they did something interesting where they separated people into those who eat little fruits and veggies, moderate fruits and veggies, and then high fruits and veggies. And they found that in those with a lower intake of fruits and veggies, unprocessed red meat was associated with cancer risk. But in those with the highest intake, it was not significantly associated with higher risk. So Lane takes that to say that while at high, at even a regular intake of unprocessed red meat, if you're eating fruits and veggies and have a good diet quality, it's not probably problematic. But my criticism of that study, or rather that conclusion from that study, is that if we look at the amount of red meat that they were consuming, the high consumers were having, we'll say a little above 500 grams a week. That's less than a serving a day. So 100 grams is a typical serving. That's about, you know, a deck of cards size per day. And so these people were consuming less than that. And that's sort of the threshold for where we typically see risk. So I would argue that the men in that study weren't even consuming enough, and the women in that study were consuming even half as much, so even less. So that's problem one. The second problem is they lumped all the cancers together, or they did another analysis where they lumped 15 cancers together. The issue with that is if, let's say unprocessed red meat increases colorectal cancer risk, but doesn't impact these other cancers or most of these other cancers, well, then if you're looking at overall cancer risk, you're not going to see much. Even if you get an uptick in one cancer, it's going to be sort of washed out by the other ones. So I don't think it's fair to consume that. There's no risk there. And then the third problem is it's just cancer. What about cardiovascular disease or other outcomes? We can't conclude that it's safe for all of these other issues. So that is sort of what I made a post on. And this is back a few years ago now. It's funny, I'm surprised he even commented. I didn't have much of a following or anything at the time, but somebody tagged him and was like, hey, Lane talks about this. What do you think? Or they were maybe a bit concerned about the conclusions they'd heard from from him. And he just commented saying that I'm biased and cherry picking and there's other data that supports his position. And so I just replied, well, can you share that data? Because I haven't seen other data like that. And in fact, he often talks about that study because of its uniqueness in the way that they did the analysis. So it doesn't make sense that there would be other data that supports it.
- [83:21]
Rich Roll
Lane is somebody who's also going to say, you're going to want to be intaking more protein than this rda.
- [83:25]
Dr. Matthew Nagra
Yeah. And I think we agree. And that's the other thing I really want to be clear of. I think a of lot, a lot of the information he puts out is good. Right. I'm not to be super critical of him in general. I just think around the animal protein versus plant protein debate and the red meat stuff. I think there's maybe a bit of bias there or something. But yeah, I would very much agree with him on going a bit higher than the rda.
- [83:46]
Rich Roll
Most people believe that red meat is perfectly fine and appropriate as a part of a healthy diet. This could be a semester course here, but perhaps that's true. I'm interested in your perspective, but my sense is that we're just eating altogether way too much of it. And when you consider the fact that, you know, cardiovascular disease is the number one, you know, reason why most people are gonna die and the relationship between CVD and saturated fat and cholesterol and ldl, red meat intake is only gonna drive you in the direction of that rather than in the reverse. Yeah.
- [84:30]
Dr. Matthew Nagra
And I think a really important variable here is dose. Right. You mentioned eating too much of it. Like, do I think that someone. And I'll say this as a vegan, even when it comes to health, do I think you can include red meat, especially lean red meats, once, twice a week, something like that? Yeah, I don't think it'll have a meaningful impact. The problem is where you're averaging a serving a day. Like that's where really the problems start to creep up. And even with lean meats, we see. And there was a trial by Bergeron in 2019 where they actually compared red meat, lean red meat, white meat and plant protein and they match saturated fat, they matched fiber intake and still the plant protein lowered apob relative to the animal proteins. And so there's still a benefit.
- [85:10]
Rich Roll
What do you make of that? Like what would drive that differential?
- [85:13]
Dr. Matthew Nagra
I think a part of it is going to be the dietary cholesterol. So that's one thing that wasn't matched because it's inherent to the meat. And I know there's a lot of debate around dietary cholesterol and the impact that it has has and there's some nuance there. So if you take somebody who eats no dietary cholesterol, you take a vegan and you start feeding them cholesterol through eggs or other foods, their LDL is going to shoot up more. Whereas if you take somebody who's already eating about 400 milligrams of cholesterol a day and you add more, it doesn't do anything. There's a plateau effect. I see there's also genetic differences person to person, but that wouldn't show up in a trial like that because everyone was doing every diet. So it could be that little bit of a bump in apob could be due to the dietary cholesterol or potentially due to some of the phytochemicals in the plant foods maybe having a little bit of an impact or something as well. The exact mechanisms, I mean, I don't know that we'll tease out exactly what proportion each one contributes to, but those could all be factors.
- [86:06]
Rich Roll
Let's talk about plant meats, so called fake meats, the plant analogs to our favorite meat and dairy products. This is low hanging fruit. Fruit for the more omnivorously or carnivorously inclined to point a finger and say plant based diets are terrible. They're rife with processed foods, they want you eating bugs and all of these processed foods and this is what's destroying our health.
- [86:41]
Dr. Matthew Nagra
Yeah. I don't know if you're aware. Published a paper on this last summer in the Canadian Journal of Cardiology where we actually reviewed, viewed the research on plant based meats and cardiovascular risk in particular. And we looked at both the nutritional profiles of the plant based meats across the literature and the at the time available randomized controlled trials of which now there are a couple additional ones. And with nutritional profile what we found was that compared to the meats they're designed to replace, they were lower in saturated fat on average, obviously lower in cholesterol because that comes from animal Products a bit higher in fiber fiber and ultimately aligned with better cardiovascular profile. Then when we looked at the six randomized controlled trials on the topic, we saw that they consistently lowered LDL cholesterol compared to meat total cholesterol as well. No negative impacts on blood pressure, which was maybe a bit surprising because of the salt content of a lot of these products. And then there was also a little bit of weight loss in a couple of the trials. So from a simple swap of just replacing the meat with the plant based meats, we actually saw improvements in a number of markers. Now I'd love to see longer term data on outcomes as well down the road and hopefully we get that. But the data currently does point towards them being at least a more heart healthy choice. Yet there's still this very strong opposition to these products around their processed nature or name again your appeal to nature fallacy.
- [88:10]
Rich Roll
Yeah, I mean it's a Frankenfood. It's filled with all of these fillers and additives and preservatives. I'm looking at the nutrition label. I don't know what these things are, I can't pronounce these words. The studies show that in comparison to its meat variant that it actually is healthier. So it really is about what it's replacing. Like if you're just gorging on these plant based meats all the time and forsaking your, your more nutritious vegetables and fruit and you know, whole grains etc. Like this is not a good, good choice. But if it truly is replacing what you were eating prior, the evidence seems to suggest that it actually is a healthy alternative. Although it is processed by comparison. Although the meat you might be eating might be filled with hormones and you know, all kinds of other stuff. And of course it comes in a package that's higher in saturated fat. And you know, we've already talked about what that drives.
- [89:07]
Dr. Matthew Nagra
I think you know, a lot of especially competing in interest have really jumped on the consumer fear around things like processing or ingredients you can't list. So for example, there's this organization called the center for Consumer Freedom and they are backed by meat industry and other industries as well as many individual donors of whom are anonymous. But they have taken out plenty of ad campaigns. They took out ads in the Wall Street Journal bashing plant based meets. They took out a Super bowl ad of which I'm assuming they paid 5 to 8 million dollars to kind of create fear around. In the ad it was children at a spelling bee who couldn't spell certain words that were in the ingredients. And so there have been like these, these campaigns, I think to a degree have been quite effective at sort of inducing fear around these products or at least capitalizing on the already existing fears.
- [89:59]
Rich Roll
Yeah, I mean, certainly these products could be healthier and, and hopefully they will become healthier than their current versions. Like for example, I know Beyond Meat is working on a new version that will address the concerns that people have about the less than healthy aspects of that product. And I think that's great. But there is no doubt, and I know this for a fact with inside sources, that there was indeed an incredibly well funded and well coordinated attempt attack against the sort of plant based meat, fledgling industrial complex, for lack of a better word, to really create this idea that these were really unhealthy foods and that people should avoid them at all costs. That didn't happen by accident. That was very purposeful to get us from where we were when there was a lot of enthusiasm about these products to kind of where we are today. And I think what, what is really fascinating within that is really sort of a social experiment. Like it is the more conspiracy minded folks who are most vehemently against these products and these are people who have been manipulated by an actual conspiracy to believe what they believe.
- [91:19]
Dr. Matthew Nagra
Yeah, I've actually never heard it put that way, but that's perfect. And yeah, I think you also also hit the nail on the head with like say Beyond Meat trying to reformulate their products. One of the underappreciated aspects of these plant based meats and just processed foods in general is that we can reformulate them. Right. You can't just do that with a cow overnight. That's many generations of selective breeding and everything. So when you see companies like Beyond Meat or even Impossible Foods now, they have light versions of their products that are like lower in saturated fat. They're modifying these foods to actually be healthier. Now we have data on the older products showing that they're already healthier than the alternative. With the Swap meat trial, they compared Beyond Meat to even organic and grass fed meat products and the Beyond Meat fared better.
- [92:05]
Rich Roll
But Matt, you're a paid shill of Beyond Meat, right?
- [92:08]
Dr. Matthew Nagra
I've not received a penny. I did.
- [92:10]
Rich Roll
Wasn't that, didn't Christopher Gardner get accused of that with the Netflix series?
- [92:15]
Dr. Matthew Nagra
Well, I think he got accused of it because they had funded or at least partly funded one of the trials that he did. I don't think he received anything. Oh yeah, yeah, yeah. I don't want to speak too much on that. Because I'm not sure of the specifics, but that was my understanding. I have received zero, to be clear. I mean, people are going to say that regardless. I think we just have to stand by the science and make sure the methodology is good. And if that's the case, who cares where the funding's even coming from as long as that stuff is all in line. But I know that there's obviously going to be concerns around that regardless.
- [92:44]
Rich Roll
Right. It's really hard to shift people's minds around this. And I'm not saying, like, listen, you should just knock yourself out with these prices products. You should be sourcing your nutrition from whole foods close to their natural state as often and as much as possible. But I just wanted to, you know, shift people's perceptions of, you know, how they might be perceiving these products and to think about it a little bit more more clearly and critically in terms of, like, maybe what they're reading and hearing when it comes to these things.
- [93:15]
Dr. Matthew Nagra
Yeah. And I think you can ask the CEOs of these companies if they think people should center their diets around those products are beans. And I think they would side with the beans. These are supplemental things that can be included to enjoy.
- [93:29]
Rich Roll
If you sit down with Ethan Brown, who is the CEO and founder of Beyond Meat, incredibly smart guy, really has his heart in the right place, is trying to do good in the world, and has a very big mission. He could fill your brain with just a million facts about, you know, why this is a healthier option and how they crafted it in the way that they did, et cetera. But I think the problem, one of the big problems here is that whether it's Beyond Meat or any of these other companies, they've never been able to be in control of the narrative. And they've allowed that narrative to be created for them, and they're always responding to it rather than basically being in front of it. And I mean, that's like a PR thing, I guess, or like a branding thing. But the story that Ethan wants to tell isn't really penetrating culture in the way that all the stories about that are sort of anti Beyond Meat find their way across the Internet, I guess.
- [94:31]
Dr. Matthew Nagra
Yeah. I mean, I've seen the latest little short documentary they made, Planting Change, and a few other things that they're trying to get that message out there. But I think it is a question of is it permeating those circles outside our own? Right. We are seeing this stuff, but is it getting to those people that really need to hear it and I don't.
- [94:49]
Rich Roll
Know, I mean there isn't a lot of cultural receptivity right now, at least, you know, I don't know what, what, what's going on up in Canada. Yeah, you know, it is what it is, but it does raise another kind of ripple here which is the difference between processed foods and ultra processed foods. So when we hear the word processed food, processed bad. And certainly we want to avoid processed foods, foods and, and most definitely ultra processed foods in our diet. But there is a little bit of confusion when it comes to that word which is very loaded because pretty much everything short of fruits, vegetables and you know, I don't know, like meat, meat also, you know, like these things like so many foods are processed and there's a whole spectrum here of health and harm.
- [95:37]
Dr. Matthew Nagra
Yeah. The most used sort of classification is called the Nova system for classifying foods as like unprocessed, processed, ultra processed. And this came out of Brazil. And basically they have four different levels or four different groups. So group one foods are the unprocessed or minimally processed foods. Fruits, veggies, meats would be included in there, certain dairy products. And then group two foods are the ingredients. So like the culinary ingredients like sugar, salt, oil. Group three are foods where you add those culinary ingredients to the unprocessed, minimally processed foods. So even canned vegetables because of the salt and the, in the liquid that is considered now a processed food. And then you have breads, certain types of breads and things that would factor into there as well. And then ultra processed foods are foods that are essentially made in processing like facility or factory used primarily of industrial ingredients. And these can range widely from these plant based meat alternatives to sodas, to sausages and bacon, to pastries and on and on and on. And something to understand is that even within that group of ultra processed foods there are wild differences in the types of foods. Like a can of soda is not the same as a beyond meat, which is not the same as an animal based sausage, which is not the same as a donut. They're all very different. And what we've seen out of the last few years, and this is really interesting research, is that when they separate out the different types of ultra processed food foods, it's mostly the processed animal foods. So the like processed meats and the sodas that are the worst, those are the ones driving most of the risk.
- [97:14]
Rich Roll
What about, what about all the refined grain, processed foods?
- [97:17]
Dr. Matthew Nagra
So then when you get to the grains, refined grains are sort of in the middle of that spectrum. But then the whole grain products. So even whole grain cereals or whole grain breads are associated with lower risks. So we have some foods in this ultra processed category that can actually improve risk and then we have some foods that worsen risk and some that are kind of the middle. Now, refined grains in general, I tend to put them sort of at the middle of the spectrum because you always have to compare to something. Right. And because refined grains make up such a wide or a large part of the American diet, it's good to have that as sort of the centerpiece that you compare everything to, at least in my view. And that's not to say that it's nearly as good as like whole grains or other other foods. And they tend to only really increase risk, at least significant if they're leading to weight gain. So if you're adjusting for things like weight change over time, they're just pretty neutral. They don't seem to increase risk.
- [98:07]
Rich Roll
But they're always going to because we're talking about like Oreos and saltine crackers, like the hyper palatability aspect of it is going to cause you to overindulge on them.
- [98:16]
Dr. Matthew Nagra
Yeah. And so that's a possible criticism, right, for making the claim that, you know, in a calorically balanced state, these refined.
- [98:24]
Rich Roll
Grains, like, who are those people? Yeah, the guy who eats one Oreo and walks away and says, I'm good.
- [98:29]
Dr. Matthew Nagra
Not necessarily even Oreos and things, but even like white rice or white bread, like those would fall in that category too. So even within that there's a bit of a range. But yeah, I agree with you that generally speaking, refined grains are probably going to promote more of an over consumption pattern than otherwise. So generally going to be worse off with those.
- [98:46]
Rich Roll
Right. Did we say everything we need to say about that?
- [98:48]
Dr. Matthew Nagra
I think so. I mean, there's this fear around the fact that things are processed. But even just because something's processed, I mean, there's such a wide range of those types of products and there can be differing effects. Right, right. So just because something's processed doesn't mean bad on average, we can say yes.
- [99:05]
Rich Roll
Virgin olive oil is a processed food.
- [99:07]
Dr. Matthew Nagra
Yeah, exactly. Tofu is a processed food, which I think we still haven't gotten.
- [99:10]
Rich Roll
That's a loaded.
- [99:11]
Dr. Matthew Nagra
Maybe that's coming up. I don't know.
- [99:12]
Rich Roll
But you just, you know, exposed yourself as a target by saying that.
- [99:18]
Dr. Matthew Nagra
Yeah, there you go. But even like whole wheat pasta or whole wheat breads, I know there'll be some people that are concerned about the.
- [99:24]
Rich Roll
Well that, you know, that's also like, you know that that gets a lot of people in a lot of trouble, those foods.
- [99:30]
Dr. Matthew Nagra
It does, at least in the social media space. But generally speaking, those are associated with good outcomes. It's just a matter of, again, like we talked about earlier, stepping back and looking at the final outcomes, what are the results that we see with these foods? And we see generally those foods are associated with better outcomes.
- [99:45]
Rich Roll
Right. All right. Soy boy, defend your estrogenetic food. Favorite food.
- [99:51]
Dr. Matthew Nagra
Yeah. So soy. Soy does contain isoflavones. These are a type of flavonoid and they're commonly referred to as phytoestrogens. Phyto mean plant estrogen, obviously estrogen. And the reason they are termed that is because they have some similar structural characteristics to the estrogens that we create, but they are not identical. But because they have some similarities, they can interact with estrogen receptors in our bodies and so they can have some sort of a hormone modulating effect. The question is, what is that effect? Is it something that we're worried about? Worried about? And when we look at randomized controlled trials, in fact, a meta analysis by Reid et al, I want to say in 2020, maybe 2020 or 2019, not 2029, when we look at that meta analysis of it was like 41 randomized controlled trials, we see no clinically significant effects on testosterone, estrogen or other sex hormones. We see a similar data. There was recently a study on or a meta analysis on trials on women. Pretty much the same results, no clinically significant effect on hormone levels or measures of estrogen in things like uterine lining thickness, for example. And so we have really good data consistently pointing towards there's no real impact on hormone related outcomes. Now where does the concern come from then? Well, for one, it's just an extrapolation of the word estrogen, phytoestrogen and thinking that that is then estrogenic. And two, there were a couple pretty extreme case studies that were published a number of years back where there was like an individual who, who consumed 14 or plus servings of soy milk a day and like pretty much a soy diet. And he may have experienced some breast growth, breast tissue growth.
- [101:29]
Rich Roll
So he's patient zero for the soy boy phenomenon?
- [101:32]
Dr. Matthew Nagra
Pretty much, yeah. Yeah, pretty much. But here's the thing, we can't even based on that conclude that it was the soy necessarily. We weren't adjusting for any other factors. He's eating a very monotonous diet. Maybe there's other things that are lacking or in excess. We don't really know. But even if we granted that it was the soy, I mean, that's a ridiculous amount. Nobody's recommending that amount. The randomized trials we have go up to five servings a day or something, which is still quite a lot. And we don't see any meaningful impact there. So on that basis, the soy foods are quite safe. And then we can look at the long term data on breast cancer risk, for example, and we see that those with the highest soy consumption consistently have lower risk of breast cancer in men, we see lower risk of prostate cancer as well, and then we see lower risks of cardiovascular diseases on top of of that. So it's quite beneficial, sort of across the board. And we see improvements in bone health parameters. So lower risk of osteoporosis in older age, largely because the specific receptors that the phytoestrogens will bind to, they're concentrated in bone tissue amongst other tissues and they have proestrogenic effects in bone tissue, which is good, that actually helps maintain bone marrow density. Whereas in breast tissue they have anti estrogenic effects, which is potentially one reason why we see a lower risk of breast cancer.
- [102:47]
Rich Roll
People are very resistant to the idea that soy might be a healthy food product. And in thinking about like why that might be the case, there's a number of options. Either everything you said is incorrect and you're just wrong, right? Or people just don't like soy and they want to keep eating what they want want to eat and so they're just not going to hear it. Like there's just a people tune out around this. But I think that latter explanation gets to notions of identity like that we form or that have something to do with what we eat and the association between being a meat eater and how you think about your, you know, your role of manhood, you know, in our culture, which is a whole like, you know, kind of other podcast, which is not your expertise. But I spend a lot of time thinking about time and time again I have people like yourself on who say some version of what you just shared and have been sharing over the course of this podcast. And then I kind of cast my gaze out onto the world and wonder why is this message so difficult to hear or why is it so challenged in kind of penetrating the mind share of people, people when you're trying to help people be healthier, do you have a working theory of that or do you spend time thinking about that at all?
- [104:12]
Dr. Matthew Nagra
I do, but I don't know that I have a good answer. I feel like part of it is really what you said as the second sort of example and that I think people are really attached to the status quo of the meat consumption and to a degree the soy sort of counters that. And on top of that there is this sense of, you know, needing to be manly and masculine. And when you hear the estrogen word, maybe there's some fears that are created there. Like there's a number of possible explanations, at least on an individual level. And then I also wonder about an industry level. Like we talked about the plant based meats. I wouldn't be surprised if there's, you know, some, there are some maybe campaigns or have been in the past to really, you know, counter that more pro. Plant based.
- [104:56]
Rich Roll
Follow the money. Yeah, follow the money. Um, let's talk about deficiencies. There is this idea that a plant based diet is inherently deficient in nutrients. It's nutrient poor. It also contains plant toxins that, you know, these plants are out to kill you. You're not getting any B12 and you're not, like we mentioned leucine already, it's leucine deficient. Might not be the best way to get your omega 3. So if you need to supplement then doesn't that have something to say about the overall viability of this way of eating?
- [105:39]
Dr. Matthew Nagra
So I'm met with this all the time and I actually had a debate with a prominent carnivore proponent, Anthony Chaffee. It was quite a. It got heated at points near the end.
- [105:49]
Rich Roll
And I should say, sorry to interject, but like the carnivore will say, the carnivore diet is optimal because it is the most, most nutritionally complete and dense of all diets. So that's part of that narrative, isn't it?
- [106:02]
Dr. Matthew Nagra
Sure. On that note, I mean there was a recent study that looked at four different iterations of the carnivore diet and they consistently fell short in thymine, vitamin C, a couple other nutrients. I think iron was in some cases short. Potassium was short.
- [106:17]
Rich Roll
How could it be short in iron?
- [106:18]
Dr. Matthew Nagra
Yeah. So animal foods, while they aren't super rich in iron. So like per, per serving, like something like lentils is actually higher in iron. It's just the bioavailability of the iron is somewhat different. So as far as hitting the dose of iron, it is potentially a little bit harder, at least for the standard rex that in reality.
- [106:35]
Rich Roll
But it has the, what are the two types of iron?
- [106:37]
Dr. Matthew Nagra
It has the mix of the heme.
- [106:39]
Rich Roll
You're going to get your heme iron and you know, the lentils are the non heme iron. There's a whole other thing about that.
- [106:44]
Dr. Matthew Nagra
Yeah, but just as far as hitting the recommended intake, the absolute intake, forgetting the different types and everything, everything, it did in some cases fall short. And then like I said, there were, I believe, eight nutrients that they listed as falling short. And this was a very recent paper that came out. So that's to tackle the whole carnivore is the most nutrient dense. I mean, I haven't seen a single iteration of a carnivore diet that meets all nutritional needs yet. And I've analyzed a few people's like what I eat in a day and haven't seen anything. But that aside, I really want to tackle this idea of, well, if you need to supplement, clearly it's an insufficient diet or there's a problem with that diet. So in this debate I had with Anthony Chaffee, I actually, I did this thought experiment. I'm going to do it with you in a moment where I sort of challenged that notion. And he did not want to answer my question. He dodged it eight times. We counted it. And that's because it really, I think, pokes a hole in this ideology. So let's say that there's two diets. There's Diet A and Diet B. Now let's say Diet A provides most of the nutrients you need, but you might need to supplement one or two things, but it leads to a long and healthy life. Lower risk of cardiovascular disease, cancer, lower risk of frailty in older age. And then there's Diet B. Diet B provides all of the essential nutrients you need. You don't need to supplement anything, but it leads to a higher risk of cardiovascular disease, cancer, higher risk of frailty in older age. Which one would you choose? Of course, A. Yeah, so he didn't want to answer that. And the reason is because it tells me that what you care about are the health outcomes to you. The deciding factor between following a diet or not following a diet is not whether or not you need to supplement, it's whether or not you get good results at the end of the day. So if a vegan diet with appropriate supplementation like B12, obviously if it leads to good long term health outcomes, then who cares if you need to take one supplement or whatever a day, or maybe you take a multivitamin to cover your bases, it doesn't matter. What we care about are those health outcomes. So that sort of gets rid of that argument around supplementation as long as you're honest enough to answer that question.
- [108:41]
Rich Roll
Well, it's also a red herring because Omnivores and carnivores are supplementing anyway?
- [108:46]
Dr. Matthew Nagra
Oh yeah, carnivores are all over the place.
- [108:47]
Rich Roll
They tend to be be more obsessed with optimizing their nutrition through strategic supplementation. It's a thing. So it's not really relevant in my mind. And sure, take a B12 supplement, but maybe take a vitamin D supplement and a multivitamin and all these. We all have certain deficiencies that occur depending upon our environment and the circumstances of our daily life. I think even the most well intentioned and rigorous people with their nutrition. If you get a blood panel, there's going to be, you know, even if you're within, you know, the healthy range, you're going to be on one side of it more, more or less. And so that suggests that, you know, we're not always like hitting the bullseye every single day with everything that we're doing, regardless of how optimized your diet is.
- [109:41]
Dr. Matthew Nagra
Yeah, it's like it's a distraction. Yeah. And it's like when we talked about protein earlier, it's like every guy going to the gym almost is taking away protein. But when you're on a plant based diet, all of a sudden it's an issue that you need to take a protein supplement or maybe you are taking it to maximize your intake. It just seems to be a really easy thing to bring up when sort of faced with that idea of a plant based diet.
- [110:03]
Rich Roll
Right. Well, it's that thing that happens when the argument suits you. You'll serve it up, but when it's directed in your direction then you don't want to talk about it. And I suppose on some level everybody's guilty of this and we all have our blind spots. But this comes up a lot in terms of, you know, the research cited or the research dismissed within the hierarchy of, you know, kind of. I mean you could, there's a lot of cherry picking going on, but you can cherry pick anything because there's so much research out there and you're going to be able to find something that substantiates whatever claim you're trying to make. And this is something that, you know, you're always kind of banging on about in your videos. Like because somebody will make a video and say, well, so and so said this but like, but that research is nonsense, it's worthless and you shouldn't pay attention to it. And then that same person will make a video and say this new study came out and it says exactly what I've been saying all along. And suddenly the library of research is now valid and worthy of your attention.
- [111:02]
Dr. Matthew Nagra
Yeah, I do that a lot. And I actually try to point out these sort of double standards in a lot of my videos because I think, and maybe I'm wrong, but I think it's much easier to understand when someone's being perhaps dishonest or a bit shady in how they're presenting evidence than to actually go into all the methodological issues all the time. I try to do that too. I'll try to explain why one study is better than the other. But I really want to hammer hone like, like, hey, this person is saying is citing this type of, say, observational research when just last week they were saying that all of this research is trash. So why are they citing it now? Because it supports their view. And you can go on and on and on whether they're cherry picking anecdotes or whatever. And I think that's really easy for people to understand. Just the double standard versus necessarily getting all of the little intricacies of the research itself.
- [111:48]
Rich Roll
Was there anything else that came up in your debate with Chaffee?
- [111:51]
Dr. Matthew Nagra
Oh man, there was a lot there. Oh, there was a couple times. This was, this was kind of brutal. I, there were times where he'd cite research and I'd ask him very basic details about his own research that he's citing and he wouldn't know. Like I'd say how did they track meat intake or what were the results for this or whatever. And he wouldn't really know any of it. And that was really an example of somebody who's, who's sort of maybe reading an abstract or cherry picking a result and wanting to showcase it, but not really looking at the research in depth. And I've seen that a lot with his content. I'm trying to think he came up with the appeal to nature a lot. So appealing to. Well, historically humans have ate meat, so that should be good for us. There's a lot of things that are natural that aren't good for us. Whether it's natural plants or certain animals. There's exposure to a lot of heavy metals that are naturally derived. I mean, just because something's natural doesn't mean it's good.
- [112:46]
Rich Roll
Well, also we, we, you know, we developed to be incredibly resilient and able to eat many, many different things. So what we used to eat isn't necessarily determinative of what we should eat when we have the option to choose.
- [113:02]
Dr. Matthew Nagra
Yeah, I absolutely agree. And we have so much research now around, like what makes up a healthy top dietary pattern that we can make really good informed decisions regarding those outcomes versus relying on. Well, historically we've done this, so it should be good. I mean, you're kind of guessing in that case.
- [113:17]
Rich Roll
It seems like the Carnivore diet has been around long enough. I mean, we need obviously more long term studies on what's actually happening so we can actually point to like here's a canon of understanding that tells us what happens when you do this for 20 years or 10, 10 years or whatnot. But it's been around long enough where we're now seeing even some of the OG influencers making adaptations to their diet. I mean, most famously, Paul Saladino now eats fruit and honey and I guess a couple other things or whatever. So yeah, so it's like he went from, you know, exclusively like his whole thing was like nose to tail and now he's adapted and we'll see where that goes. I don't know who's still hanging on tooth and nail, but you probably know better than I.
- [114:00]
Dr. Matthew Nagra
There's a couple, there's a couple like Sean Baker, Anthony Chaffee, there are a couple that I can think of, think of who are apparently strict. But then, yeah, there's Paul.
- [114:07]
Rich Roll
Sean's got like a really high hemoglobin A1C.
- [114:10]
Dr. Matthew Nagra
He did?
- [114:10]
Rich Roll
Yeah. You would think like, oh, that would come from eating processed food and sugar. But like when you're eating, you're seeing like the, the consequence of a very high saturated fat diet on his type 2 diabetes risk.
- [114:23]
Dr. Matthew Nagra
Yeah. And I believe he had low testosterone on that earlier test as well.
- [114:26]
Rich Roll
Which is really weird. Right. Like you would think, like, well, testosterone is one thing that's going to take care of itself if you're going to eat this way.
- [114:32]
Dr. Matthew Nagra
Well, funny enough, when Paul Saladino was on Carnivore, he posted his blood test results and if you pause the screen, you see that his estrogen was actually elevated above the range. He didn't talk about it. He skipped right past that when he was reviewing his blood work. But it's in there.
- [114:44]
Rich Roll
What does that tell you?
- [114:45]
Dr. Matthew Nagra
I don't know if it says much about the diet or something else that they're doing, but it's just interesting that you're seeing these people who are always fear mongering over soy and estrogen and whatnot. You're seeing that their hormones are a bit off and, and they aren't, you know, providing any explanations around that or attempting to, and they're just kind of glazing over it. I just thought it was really interesting that that was still in the video. And maybe he didn't catch that it was there, but it was on his blood work. But yeah, I mean a lot of people have fallen off. There's Paul, there's Frank DeFano, there's a YouTube channel, 50 Plus Beauty, recently had a stroke while on the Carnivore diet as of a number of other people. There's the Carnivore kid, he went by Michael something, I can't recall his name. He had, I believe it was 95% occlusion or something like that of his lad. So like the widowmaker artery. And he was freaking out. And I'm not going to say that, you know, their time on the carnivore diet because it may have been a matter of a couple years is what led to that. But you know, it's still a problem that occurred while on the carnivore diet. And you'll often see these same people, people cite anecdotes of something even subjectively improving while on a carnivore diet and claiming that it was definitely the carnivore diet, whereas. Well, why don't you ever highlight these, these negative issues that come up and there's a lot of them.
- [116:01]
Rich Roll
So yeah, what is. There's an Instagram account, Carnivore Cringe. Yeah, Carnivore Cringe. And it basically posts like people's comments on like forums and Reddit subreddits and stuff like that. Like, hey, I haven't had a bowel movement like 14 days. Like, is this normal?
- [116:15]
Dr. Matthew Nagra
Yeah, yeah, no, there's tons of. It's actually wild. Some of the stuff that comes up on there, whether it's around blood work or hair falling out or insert whatever issue you can imagine and they're on there somewhere.
- [116:27]
Rich Roll
All right, so here's your second opportunity to look to camera and address the carnivore enthusiast out there. What's your psa?
- [116:35]
Dr. Matthew Nagra
My PSA is that there is not good evidence to support the Carnivore diet. The recent keto CTA trial showed that those following a ketogenic high animal based diet with high LDL had rapid progression of atherosclerosis. There's plenty of anecdotes for those who cite anecdotes suggesting potential harm. And until we have better data to support this dietary pattern, the existing data that we have on red meat consumption or the plant foods that are eliminated suggests that it is not a smart idea.
- [117:07]
Rich Roll
Conclusion of psa. When you mentioned the diet A, diet B, a few moments of ago, there's Also the, the, the diet, c, whatever composition that might take, which is the diet that drives short term results with long term detriments. Right. So in the context of anecdotal evidence, like I feel so much better. It, you know, my autoimmune symptoms have disappeared. Like this is something that happens in the plant based community too. I'm guilty of it. Like I, I have plenty of anecdotal evidence of how I felt better and you know, it changed my life, et cetera. The weight of that, you know, is dubious obviously, but, but when it's you, it's very personal and it's emotional and it has valence. Right. But I think what's lost in that is that, you know, these, this positive experience that you're having in the context of carnivore diet is at the cost of the long term consequences that, you know, humans aren't so good about. You know, kind of, of like gazing into the future and evaluating that when in the current moment they're like, this is working, you know, why shouldn't I keep doing this?
- [118:18]
Dr. Matthew Nagra
Yeah. And I mean, like you initially when I made the change was largely because I was experiencing these anecdotal benefits. And so I understand how powerful that can be both for myself and my dad, as I talked about. But we always have to consider that these are generally going to be short term things. You aren't going to notice that you're developing cardiovascular disease until you have it. And if we look at messaging from the carnivore community or the animal based community, it's often about really quick fixes. It's often about your gut health, weight loss, joint pains, it's things like that. It's, it's rarely going to be a lower risk of heart attack or, or whatever. Like that's something that they'll throw in once in a while, but it's not super common. And now they don't have good evidence to support those claims either. I want to be clear, there isn't good evidence that it's going to improve all of these things, at least in the majority of, of people. But even if it did, we're not considering the long term risk and they're promising people immediate results, which is really.
- [119:11]
Rich Roll
Enticing on the gut health piece. How do they substantiate that? Knowing what we know about the importance of fiber intake and plant diversity in terms of developing and cultivating a healthy microbiome. Like how does you know eliminating fiber and eliminating diversity in your diet contribute to gut health? Like the argument that how do they make that argument?
- [119:37]
Dr. Matthew Nagra
Again, I want to be clear that when it comes to these anecdotal experiences, which is largely what they cite to promote the improvements in gut health, it's not clear and we can't conclude based on anecdotes if that diet specifically is what's leading to benefit, if other similar or other elimination diets would also lead to those benefits, or if it was just chance and they were going to get better anyway. All of these are possible explanations. But let's just say for sake of argument that it was the carnivore diet or the elimination of fiber. We know that in certain conditions, especially certain inflammatory bowel diseases, that when there's a flare, actually reducing fiber intake or certain types of fibers can improve symptoms. That's not necessarily something you want to carry on through a lifetime, but during a flare, that could be a really good idea. Certain types of strict elimination diets that are low in fire, like elemental diet, for example, usually around like meal replacement shakes, or there's certain types of shakes that adhere to that protocol, like that can improve symptoms in certain cases too. But that's not necessarily a preventative diet, and it's not something that you necessarily want to keep up all the time, but you may need to shift towards, you know, intermittently when there is maybe a flare or acting up of these symptoms.
- [120:50]
Rich Roll
Yeah. From an elimination diet perspective, there is certainly the chance that you were eating something that was contributing or inflaming whatever underlying gut condition you were having. And by removing it, it settles down. But over time, to deprive the body of fiber is going to lead to some kind of poor outcome.
- [121:10]
Dr. Matthew Nagra
Yeah, exactly. And we have actually studies looking at eliminations in people, say again with inflammatory bowel disease. And we see that different people respond to different, different foods. So there's, you know, let's say you ate a pretty balanced diet and you removed everything. You're just eating animal foods. If for whatever reason, I don't know, wheat was bothering you, well, yeah, you're going to see improvements. But you didn't need to eliminate all the fruits and veggies and everything else that came along with it. Right. You could have isolated that food. And that's why it's really nice to, or really good idea to work with, say, a dietitian where you can do a proper elimination trial those foods one at a time. And there can be a strict protocol that could be catered to the end of the individual and really tease out what is the problem here, or can we even figure out the problem and then you don't have to do something that's so extreme and that might come to your long term detriment.
- [121:54]
Rich Roll
Yeah. The next thing I want to turn to is bone health. There was this EPIC Oxford study that came out that seemed to suggest that plant based enthusiasts and vegans fared less well or fared poorly in comparison to omnivores in terms of terms of bone health and bone like avoiding bone breaks. So help me make sense of this.
- [122:20]
Dr. Matthew Nagra
Yeah, so that one really spurred headlines. I was in 2019, I think it was, and the main headlines I saw were 43% higher risk of fracture. And that's actually true based on the findings. But there is some really important nuance here. So they looked at in the EPIC Oxford study, so these are people in the UK following different diets. They looked at V, vegans, vegetarians, meat eaters. There might have been a pescatarian group, I can't recall. And they found that the vegans had a higher risk of fracture. But the vegans also tended to weigh less, they had less vitamin D and calcium intake and they did a bunch of analyses to sort of rule in and rule out different potential explanations or components that were maybe missing. And it didn't look like vitamin D or calcium explained the totality of the results maybe a little bit.
- [123:09]
Rich Roll
But why were they lower in those?
- [123:12]
Dr. Matthew Nagra
Have to remember that with EPIC Oxford they were enrolled back in like the 90s. This might be before widespread fortification of like plant based milks and things like that. So their calcium intake much might be much lower because that is going to be the main source for a lot of plant based eaters. And then also with vitamin D, maybe it's a supplementation thing. I mean they're living in the uk, it's not super sunny. Hard to say they didn't actually track vitamin D levels in that study or vitamin D intake in that study. But past studies from that same cohort found that vegans did have lower vitamin D levels. So that's a possible contributor. But what I believe ultimately explains it is the difference in weight. So being a heavier weight reduces your risk of osteoporosis because you have more weight on the bones and your bones are going to be stronger. And when they separated the analysis to those with a BMI below 22.5, which is sort of middle of what's considered the healthy range or the normal range range, and Then those above 22.5, those in the higher range did not have a higher risk of fracture compared to meat eaters. So the vegans in that group seem to be protected, but in those with a lower bmi, there was a higher risk. And because of the way that the weight skewed between groups, it looks like it's quite possible that there were a number of actually clinically underweight vegans. And especially once you get below that bottom cutoff or BM bmi, your risk of osteoporosis goes up a lot or your risk of fracture goes up quite substantially. And so it looks like in the study they were probably comparing a number of quite significantly underweight vegans to some that might, some omnivores who might just be skirting that kind of border of what's considered underweight. And that would skew the results largely. But to further support the conclusion that it wasn't something inherent to the diet and it might be, that was the Adventist Health Study 2, which came out just a few months later. And this looks specifically at hip fracture risk. They found that there was a higher risk of hip fracture in women. This was not the case for men. And I want to highlight that with Epic Oxford. We didn't see that in men either. It was specific to women and. But they did another analysis where they looked at supplementation practices. So in those who didn't supplement any vitamin D or calcium, there was a higher risk of fracture in the vegans. For those who just supplemented calcium but no vitamin D, there may have been. It was not statistically significant, but we'll say for sake of argument there may still be a risk there. But then in those who supplemented both vitamin D and calcium, there was not a significant increase in risk over the meat eaters. And in fact there might even be a bit of a lower risk. And in this group there isn't a clear signal that there was a lot of people who were maybe in that underweight category. So this would suggest that if you're maintaining a healthy weight, if you're making sure you're getting adequate calcium and vitamin D, and that doesn't need to be through supplementation, it can be fortified foods. If you're taking care of those things, you can do just fine. Of course, exercise is also very important. Weight bearing exercise, we want to take care of those things as well. And I would say that that's probably the most important factor. But nutritionally speaking, I think we can take care of it.
- [126:06]
Rich Roll
What do you say when people come at you and just say, well, you're just a biased vegan activist, your whole worldview is skewed by whatever vegan propaganda you have consumed over the course of your life.
- [126:25]
Dr. Matthew Nagra
So for one, I wasn't always vegan. And in fact, a lot of the myths that we've sort of debunked today around seed oils and things, these are things that I did once upon a time believe. But I think ultimately the most, maybe the most convincing argument I can make for me being able to set my bias aside when it comes to at least looking at the nutrition literature is I can look you in the eye and say that fish is a health promoting food, that certain dairy products, especially fermented and low fat products, can be a part of a regular part of a healthy diet, that having meat once in a while isn't good to be to your detriment. I think there are other reasons to avoid consuming those foods, but I'm not going to lie or exaggerate on what the research says about their health value. So now at the same time, I think there are a lot of people in the online nutrition space who will claim that they aren't biased because they are omnivorous and they eat a little bit of everything. But I just want to point out that your bias could be for that. So when someone like myself maybe challenges the healthfulness of red meat or the superiority of animal protein or their inclusion, like say with Lane, for example, it might be the person in the middle ground who has a bias for that and they want to counter this more exclusionary argument that I might present. So I think I'm pretty good at setting aside the bias when it comes to the nutrition literature, but I do have a bias in that, yes, I am vegan and ideally I would like to see the world shift that way.
- [127:39]
Rich Roll
Right. And you're relying on the anecdotal evidence of your own experience to inform why this is, is the best way to go.
- [127:47]
Dr. Matthew Nagra
No, I'm just saying. Okay.
- [127:50]
Rich Roll
I'm just, you know, I know like, I'm just, I'm thinking about my, like what the kind of things that I have to field and just, you know, how you internalize that and respond to it.
- [128:02]
Dr. Matthew Nagra
Yeah, I mean, like, ultimately I don't think there's anything I can say or do that would be better, you know, at convincing someone that maybe I'm able to set that aside as, you know, other than what I said about like fish and dairy and meat to a degree. Like, I can't see how someone who has that strong of a bias would be able to say those things very openly, you know, so. But I don't know. I don't know. There's some People I'm not going to convince.
- [128:30]
Rich Roll
What is a point of confusion in nutrition science that you wish we could glean clarity on? And like if you have in your mind, mind, like the ultimate study, if funding was no, you know, no problem, you know, what would that look like and what would you be trying to gain clarity on?
- [128:54]
Dr. Matthew Nagra
So it depends on if you're asking more from like a, a overall health longevity standpoint, which I think we know the foundations quite well. But there are some very new nuanced questions or things that I would like to see further research. So is there a specific kind of angle you're looking for?
- [129:14]
Rich Roll
No, I'm thinking in terms of people are really confused about this. I'm not sure I even really understand this. And if we could just figure this out by testing this against this, then we would know this and that would allow us. That would. There's a domino effect to that I think would be really helpful for people.
- [129:32]
Dr. Matthew Nagra
Yeah, okay. I think one, and if I thought about this longer, I might come up with five other ones that I think are more important. But one that I would really like to see is around the long chain omega 3 fats in vegans in particular. So the long chain omega 3 fats are the ones that people can often get from fish. They're in other animal foods. And then algae based supplements for vegans. Now there's debate.
- [129:53]
Rich Roll
And that goes to the deficiency thing, right? Like, you know, yeah, you can do the algae based omega 3s, but they're not really as good as the fish oil versions.
- [130:02]
Dr. Matthew Nagra
So they are, they've been studied and they're nutritionally equivalent. But, but where we don't have research is on if they're even beneficial or necessary in this population. So vegans are unique because we don't consume any of those long chain omega 3s in their final form. We consume ALA from things like flax. Then we convert them to a degree, to a modest degree, we'll say. And so a question I would have have is like how, how would say a, a vegan cohort who's supplementing compared to a vegan cohort who is not compared to maybe a pescatarian cohort? I think that would be really interesting to have those three.
- [130:37]
Rich Roll
It's kind of amazing that study hasn't been run. I mean, this is a common question we have.
- [130:42]
Dr. Matthew Nagra
Yeah, we actually don't have outcome, like actual long term outcomes in, in that sort of a study at this point. We have studies showing that you can raise, you can raise omega 3 status in vegans by supplementing. Supplementing algae based oils. We have research comparing vegans to pescatarians and they generally fare similarly in say the Adventist Health Study too. You can argue one slightly above the other for certain outcomes, but it's comparable. But we don't have the long term outcomes comparing vegans without supplements to vegans with supplements. And then I would like a third sort of group there of the pescatarians just for comparison's sake. That's something I would love to see because I think it would really help put to bed the debate or discussion around do you even need to supplement these, these things.
- [131:21]
Rich Roll
Paging Dr. Christopher Gardner. Yeah, he's like the perfect guy to do that.
- [131:26]
Dr. Matthew Nagra
Yeah, I mean he does a lot of the clinical trials. I don't know if he does a lot of the long term, like prospective cohort stuff. I don't think he does, but I.
- [131:33]
Rich Roll
Am sure he knows who wants to do that. That sounds like a lot of work.
- [131:36]
Dr. Matthew Nagra
It takes a lot of work.
- [131:37]
Rich Roll
You have to be in it for the long haul, right?
- [131:39]
Dr. Matthew Nagra
Well, it depends. So what will often happen is you have cohorts like the Nurses Health Study, for example, it's been running for like four decades and you have all this data collection over that time and then you, you can then analyze that data so you know what they were eating and to a degree what they were supplementing. I just don't think They've tracked Omega 3 intake and I don't think there were a lot of vegans in that cohort. So that makes it challenging in that case. Maybe you can do that type of analysis with like the Adventist Health Studies, Maybe they have that data on supplementation, I don't know. So it's not like you necessarily need to wait another 15, 20 years and start a new cohort. You might have that existing data, I just don't know. But it would be a really cool thing to see.
- [132:15]
Rich Roll
See, I think what is your sense of how AI is impacting our ability to synthesize these massive data sets and draw interesting conclusions from them.
- [132:29]
Dr. Matthew Nagra
So I was actually just talking with some colleagues the other day about this, who one of them is actually using it for a study they're running and it's really impressive on how you can get it to do a lot of the calculations and things like power calculations and that you probably at this point still want to double check a lot of that. I've definitely noticed issues with or mistakes with certain things when I'm using some of the AI software, but I think it's possible that in the coming years, we really use that to advance our knowledge and to conduct research that maybe we couldn't do before. I know they used it for a couple of recent studies looking at plaque measurements on a CT scan and things like that. So looking forward to it, but. But don't have too much experience with it yet.
- [133:12]
Rich Roll
Yeah. Is there anyone who comes to mind when you think of. Of people that are doing interesting research out there at the. At the cutting edge of our understanding of nutrition?
- [133:23]
Dr. Matthew Nagra
I mean, Chris Gardner, you. You mentioned. I think he's doing some really cool stuff. I know Robert Osfeld's working on a really cool trial right now.
- [133:29]
Rich Roll
Oh, he is? I didn't know that.
- [133:30]
Dr. Matthew Nagra
Yeah, he's working on a. I don't know.
- [133:32]
Rich Roll
I didn't even know that he was, you know, doing that kind of, like, research work at all.
- [133:36]
Dr. Matthew Nagra
Yeah. So before. Before COVID he was starting work on a trial, and then it kind of got sidelined because they couldn't enroll people for a while. And then I think they just finished with enrollment. I don't think I can say too much about the trial, but I think it's gonna be really, really cool, really interesting. And if they are done enrollment now, hopefully it's sooner than later that we get those final results. So he's doing some really cool, interesting stuff, I would say. And this is sort of a really unfortunate thing now is Kevin Hall. I don't know if you're familiar with him.
- [134:06]
Rich Roll
I know who he is. Yeah.
- [134:06]
Dr. Matthew Nagra
Yeah. NIH research researcher. He's recently stepped down. Early retirement, it seems, which is really. It's such a massive hit to the nutrition community. He was doing so much research around ultra processed foods. He was helping us understand not just what ultra processed foods impact our health, but, like, what components are responsible for that. So, like, is it the hyperpalatability? Is it the fat content? Does the protein content matter? Like, figuring out all those things because, again, if we understand those variables, we can make health healthier products. And so that's a massive, massive hit. And I think he was really on the forefront of a lot of that.
- [134:40]
Rich Roll
My understanding is that he resigned because he was put into position where he was going to be restricted in what he could study and what he could say. It wasn't that they were firing him, but he was being reined in in a way that was making him deeply uncomfortable.
- [134:58]
Dr. Matthew Nagra
Yeah, he said that there was some form of censorship, and he ultimately, ultimately had to report on certain things or report differently than he wanted to on results. And obviously I mean, he's a, he's a very, very honest, world renowned researcher. Like, you know, I would have loved to see what else he had coming down the pike here.
- [135:16]
Rich Roll
But I mean, you know, thanks a lot, Doge. You know, it's, it's this interesting thing with the, the Maha movement. Right. Like, you know, on paper, Maha's all about like, let's get rid of the ultra processed foods and here's the guy who's like doing the heavy lifting and help us understand this but for, you know, political expediency or whatever, you know, perhaps he just, you know, didn't fit the bill in every single category to make him palatable. It's, you know, it's, it's not awesome.
- [135:49]
Dr. Matthew Nagra
That was sort of the irony of the whole thing that I saw a lot of people posting about. It's like this is literally the guy that's helping us figure out what's wrong with ulcer processed foods.
- [135:57]
Rich Roll
Right. He should be, you know, waving the flag of this whole thing.
- [136:00]
Dr. Matthew Nagra
Yeah.
- [136:02]
Rich Roll
Anyway, that's a whole other thing. Last thing I want to ask you. Six days from today, I'm getting, I'm getting a pretty significant back surgery, L5S1 fusion.
- [136:17]
Dr. Matthew Nagra
Okay.
- [136:17]
Rich Roll
For an advanced spondylolisthesis that is unstable. So I'd be remiss if I didn't take advantage of the opportunity to ask you how I should be thinking about my nutrition leading up to this and my nutrition in the aftermath to be as healing, promoting as possible.
- [136:40]
Dr. Matthew Nagra
I mean really, the, the foundations are going to be adequate protein intake obviously for the, the structural components, hydration. There's no magic bullet there. It's just going to be really the foundations of making sure you're having a nutrient rich, healthy diet. Make sure you're getting adequate protein, hydrate appropriately.
- [136:55]
Rich Roll
You know, there's, there's some anti inflammatory foods. Yeah.
- [136:59]
Dr. Matthew Nagra
And there's some research around certain like supplements, glucosamines, things like that. But I wouldn't say any of the research is super impressive. So it's definitely not something I necessarily advocate for in these cases.
- [137:09]
Rich Roll
But I'm going to be taking all the supplements, trust me. Yeah, I've already got like momentous creating. I'm like, okay, tell me. You know, and like they, they now I'm in communication with their chief research scientist to kind of help me, you know, make good decisions or around like what I can do to. I mean, not that they're magic bullets or anything like that, but you know, I don't want to make any mistakes and I want to put myself in a position, you know, to heal as, as best I can.
- [137:36]
Dr. Matthew Nagra
Yeah, as long as you're not, you're not doing anything crazy and they're checking for interactions and stuff like that, maybe there's some benefit there. At worst, maybe there isn't, you know, so.
- [137:45]
Rich Roll
All right, cool. Well, this was great, man. Thank you so much. I feel smarter than I was two hours ago. Is there anything else you want to add? Did we miss anything or. I guess it would be good to allow you to end this with a thesis or a call to action for anybody who's listening or watching who maybe has been tiptoeing around eating more plant based or going all in on it, but for whatever reason hasn't been able to pull the trigger or has been under the influence of other influences and is now having a moment of clarity or around us.
- [138:21]
Dr. Matthew Nagra
Yeah, I think there's sort of two take home messages that I can give. One of them is that I know it's enticing and I know there's a lot of information online that could might seem like a silver bullet or a magic bullet, but might over complicate things. And really, when it comes to nutrition, it's pretty simple at least the foundations are eating a diet that's rich in whole grains, fruits, veggies, legumes, nuts and seeds that is the foundation of a healthy dietary pattern. Whether you include certain animal foods, some, some fish, certain dairy products, small amounts of meats like that, you can take it or leave it. But those foundations are incredibly consistent across the literature, across populations. The second thing I want to emphasize, and this is maybe for people who are looking to make small shifts, is that shifting even a little bit of your animal protein towards more plant protein can have profound impacts on your long term health. So if we look at even a small shift of about 3% of California calories based on the NIH ARP study as well, shifting 3% of calories from animal protein, especially red meat protein, to plant protein sources could lower risk of mortality from. It was a ballpark of 10 to 15%. So during the course of that study, 10 to 15% lower risk of dying over those years. And so this is a really, really powerful change that someone can make for what is ultimately maybe a deck of card size piece of meat for some plants.
- [139:42]
Rich Roll
Wow.
- [139:42]
Dr. Matthew Nagra
So just think about those two things like the keep it simple, focus on those foundations and if you can shift a little more towards plant protein.
- [139:49]
Rich Roll
Amazing. You can find all of Matt's stuff online at where's the best place to direct people.
- [139:56]
Dr. Matthew Nagra
Instagram's definitely where I'm most active. So Dr. Matthew Nagra. Dr. Matthew Nagra. And then I'm on all the other socials and everything.
- [140:03]
Rich Roll
I love your videos, man. You're like, you know, you're like, you do the, what is it called where you. It's just your head and then there's all this stuff going on the background. Here's what he said and like here's the, here's the study that actually kind of, you know, it's like, it's fascinating. I don't even know how you make those things, but I love it. Also, Matthew has been on Simon Hill's the Proof podcast many, many times. I don't know how many times, like six or seven or something like that. Recurring, you know, popular guests there where they go more in depth on this sort of myth busting exercise that, that we've been doing among, you know, many other interesting topics. So, you know, if you want to go de, I would suggest that's a good place to go. And you have your own YouTube channel where you put the videos up and stuff like that as well.
- [140:47]
Dr. Matthew Nagra
Yeah, it's the same. Just search my name on YouTube or TikTok or Facebook or Instagram or whatever and it's pretty much the same.
- [140:52]
Rich Roll
And we'll put links up to all of that stuff in the show notes. So again, thanks, man. I think you're an important voice in this ecosystem of effective health and science communication online. And not everybody is great with their communication skills, the people that know a lot about what's true and what's false, et cetera. But it takes somebody to figure out how to synthesize that and relate it in a way that the public can digest it and understand it. And I think you're really exceptional at that and there's a real need for that. So I appreciate you doing it and.
- [141:28]
Dr. Matthew Nagra
Thanks for having me on here too. I know it's been a dream for a while, so it's good to finally be here.
- [141:33]
Rich Roll
It's an honor. It's an honor, man. Thanks a lot. You're welcome back anytime. All right, peace plants. That's it for today. Thank you for listening. I truly hope you enjoyed the conversation. To learn more about today's guests, including links and resources related to everything discussed today, visit the episode page@richroll.com where you can find the entire podcast Architect archive, my books, Finding Ultra Voicing Change and the Plant Power Way, as well as the Plant Power Meal planner@mealplanner.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. And sharing the show or your favorite episode with friends or on social media media is of course awesome and very helpful. This show just wouldn't be possible without the help of our amazing sponsors who keep this podcast running wild and free. To check out all their amazing offers, head to richroll.com sponsors and finally, for podcast updates, special offers on books, the meal planner and other subjects, please subscribe to our newsletter which you can find on the footer of any page@richroll.com today's show was produced and engineered by Jason Cameolo. The video edition of the podcast was created by Blake Curtis and Morgan McRae with assistance from our Creative Director Dan Drake, content management by Shayna Savoy, copywriting by Ben Prior and of course our theme music was created all the way back in 2012 by Tyler Pyatt, Trapper Pyatt and Harry Mathis. Appreciate the love, love the support. See you back here soon. Peace Plants Namaste.