The Joe Rogan Experience: Chris Kresser & Dr. Joel Kahn – The Great Debate

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Key Takeaways
  • The medical system is broken. We’re just pushing pills, and not even asking patients how they eat/sleep.
  • The majority of Americans are overweight and obese –  The standard American diet is slowly killing people
  • When you consume processed meat, it’s best to consume it with vegetables to prevent a variety of negative side effects on the body
  • It’s absolutely insane that hospitals are serving processed meat to people receiving chemotherapy
  • There are so many factors that affect your health – whether you smoke/drink, your diet, your relationships, whether you exercise – so be careful what you attribute a cause to
  • Joel believes that on average, when you consume saturated fat and dietary cholesterol, your cholesterol will rise
    • “50,000 feet elevation view – you’d be wise to limit the amount of saturated fat you eat, and that’s endorsed by every major medical society in the world”
  • Chris thinks differently – “There is no evidence that consuming dietary cholesterol increases blood cholesterol levels in most people, and even when it does, there’s not evidence it increases the risk of a heart attack.”
  • The top sources of saturated fat, according to Chris
    • 33% comes from pizza, deserts, candy, burritos, tacos, and tortillas
    • 24.5% is unaccounted for but it most likely comes from processed foods
    • 13% comes from chicken or mixed chicken dishes, and eggs/mixed egg dished
    • 10% comes from sausage, hot dogs, bacon, ribs, and burgers
      • So the vast majority of saturated fat Americans are eating, comes from junk
  • The highest nutrient dense foods in order – organ meat, shell fish (clams, oysters), fatty fish, lean fish, then vegetables
    • If you were a vegan, and allowed yourself to eat 1 clam, 1 oyster, and 4 grams of liver a day, you’d completely meet your needs for vitamin b12, zinc, copper and choline
  • 16 of the top 25 sources of selenium come from ocean fish
  • Why put the animal products on your plate?
    • Animal protein is more nutrient dense
    • Animal foods are higher in vitamin B12, bioavailable zinc, iron, calcium, choline, taurine, and creatine – not just higher in the amounts, but higher in the amount you’d absorb
    • Plant foods tend to be higher in carotenoids, polyphenols, flavinoids, and fiber
    • If you removed animal products – you’d be more prone to vitamin B12 depletion
      • 11% of “average omnivores” are depleted in vitamin B12,
      • 77% of vegetarians are depleted in B12
      • 92% of vegans are depleted n vitamin B12
  • Whole fat, fermented dairy is one of the best sources of iodine in the diet
  • Calcium, iron, zinc, choline, taurine, creatine, retinol, EPA, DHA – all of these are shown to be lower in vegetarians and vegans than they are in omnivores
  • A vegan diet is superior to the standard American diet, if the vegan is supplementing wisely
Intro
  • This is a debate between Dr. Joel Kahan (@drjkahn) and Chris Kesser (@chriskresser)
  • Joel is a proponent for a plant based vegan diet, and Chris recommends a paleo based diet (with meat)
  • Everybody’s body is different, and will have different needs
  • “If you’re trying to answer the question of what’s an optimal diet for everyone, I think that’s a terrible question, and it’s an unanswerable question” – Chris
    • There’s no one size fits all approach, but there are optimal themes
  • You can find much of what Chris mentions in the podcast here
  • You can find much of what Joel mentions here
Who is Dr. Joel Kahn?
Who is Chris Kresser?
What do they both agree on?
  • They’re both respectful of root cause/functional medicine
  • “We’re just pushing pills, and not even asking people how they eat and how they sleep” – Joel
    • “I don’t think 2% of doctors in America will have a patient enter the office, and ask what they ate that day”
  • There’s an imprecision of language in scientific literature
    • All they’re looking at is the calories: 100 calories of fat from an avacado =100 calories of fat from a cheeseburger at McDonald’s….but you can’t say this, they’re not the same
    • Something like a “low carb diet” can mean many things
    • You need to differentiate between animal protein and plant based protein, and the literature doesn’t
  • They both have problems with epidemiology (observational) studies
    • These are studies that look at a certain group of people and try to draw inferences from their behavior about associations with a disease
      • These are the most common types of studies
    • You have to be careful what you interpret from them
      • You likely don’t know everything about the participants involved (do they smoke? do they exercise? do they smoke weed? how much do they sleep? etc.)
    • The tool used to collect data is often a questionnaire
      • Memory is not precise and accurate
      • For example, we all have the tendency to under report how many calories we consume daily
    • Another problem with them – people who partake in behaviors that are unhealthy, are more likely to participate in other behaviors that are perceived as unhealthy
      • For example – people who are less physically active tend to smoke more
      • Therefore, it’s hard to pinpoint what’s causing the problem being investigated
    • Last problem – Much of the studies that say something like “red meat causes cancer”, could be talking about a correlation that only showed an 18% increased risk
      • Think: What else might these red meat eaters be doing? (smoking,, eating sugar, etc.)
    • There was a study done that showed 43% of findings coming from observational studies were portrayed in the media as being causal
      • No one will click on a headline that says “Small association between eating red meat and cancer, but we don’t know what it means, but please read the article anyway”
    • When we take away observational studies, we’re left with…
      • Basic science
      • Randomized clinical trials – these are expensive and rare
      • Studying centenarians
        • 10x more people live to be over 100 in Loma Linda, California compared with Los Angeles, it’s a blue zone
  • The majority of Americans are overweight and obese
The Debate Begins – Round 1 – Does processed meat reduce life span?
  • Chris begins by citing a bunch of studies that show there is no difference in life span between vegetarians and omnivores (people who eat both plants and animals) when you control for the many potential variables (smoking, education, physical activity level etc.)
  • The World Health Organization has declared you have an 18% increase risk of developing cancer when you consume 50 grams of processed red meat per day (hot dogs, salami, balogna) – Joel
    • Why? Chris gives the reasons and a good reminder that context is everything
      • Consuming processed meat increases the production of N-nitroso Compounds (NOCs) which damage the gut lining – Chris
        • Chris brings up a good point – There’s evidence that chlorophyll rich green vegetables, prevent myoglobin in meat from being turned into NOCs – context matters
        • If you’re eating processed meat, but you’re also eating kale and broccoli, the processed meat won’t have the same effect on the body
      • Cooked at a high temperature, meat forms heterocyclic amines (HCAs) which damage the gut microbiome – Chris
        • Chris has another point – Cruciferous vegetables reduce the formation of HCAs
        • So the same scenario as above applies
      • The heme iron content in meat can cause oxidative stress – Chris
        • Fruits and vegetables reduces the oxidative stress, and also reduce the absorption of heme iron in the gut
      • So in effect – processed meat with vegetables is safer than processed meat without vegetables
        • Up your veggies when you eat processed meat
    • Another trick Joel recommends
      • Marinate your beef in dark beer before grilling it 
    • “I’m open to the possibility that a lot of processed meat can be problematic, but you have to consider the context. It won’t have the same effect if someone’s eating a ton of fruits and vegetables vs. someone on a standard American diet. There are no studies that separate that out.” – Chris
    • “That’s still 50-60,000 people a year that get colon cancer, that wouldn’t get colon cancer if they just stopped eating hot dogs” – Joel
    • It’s insane that hospitals are serving hot dogs to people getting chemotherapy
A Round 1 Tidbit
  • The USDA used to advise people to limit their cholesterol intake -they don’t now (after a 2015 revision) – Chris
    • The USDA releases guidelines every 5 years – these guidelines are then used for helping colleges, elementary schools, and hospitals determine what to serve, food wise
    • Prior to 2010 the USDA recommended people limit total fat intake, but that has since been changed
    • Chris is saying that the science changes over time, what was once thought to be true, may very likely be false
  • Also of interest…
    • “There is not a single study that compares relatively equivalent groups of people that shows vegetarians or vegans have a life span advantage, period” – Chris
Cholesterol and Saturated Fat – Round 2
  • Heart attacks weren’t really common until the 1940s – Joel
    • Every 39 seconds, an American dies of heart disease
    • “80% of them are preventable. The biggest enemy is smoking and crap diets.”
    • In became apparent in the early 1950s that diet might play a role
  • Enough data piled up, that guidelines began to suggest we should limit saturated fat intake – Joel says the below..
    • The Institute of Medicine advises to eat as little saturated fat as possible
    • 21 international statements (from either the American Heart Association, WHO, etc.) suggest we should limit saturated fat intake
    • Why? – Basic science. When you eat foods rich in saturated fat (meat, cheese, eggs, etc.), cholesterol receptors on the liver go down (these move cholesterol from the blood to the liver to be metabolized), so cholesterol stays in the blood and builds plaques
    • Joel advises everyone read Clarke 1997 –“When you add saturated fat, cholesterol in the blood sky rockets, on average”
    • Joel mentions how populations that tend to live over 100, don’t eat foods rich in saturated fat
    • Saturated fat tends to come from animal products – eggs, steak, chicken etc.
    • “To negate all of this, is to throw out every major health agency in the world’s recommendation – that’s 100 years of cholesterol research” – Joel
  • Chris’s turn…
    • Every food we consume has all the fats – poly/mono unsaturated, and saturated fat
      • 2 tbsp of olive oil has more saturated fat than a 7 oz. pork chop
      • Even fish, has lot’s of saturated fat
    • “There never was good evidence to suggest dietary fat and cholesterol are connected to heart disease”
      • Chris begins to list a bunch of studies which don’t support Joel’s arguement
      • “Even if 50 million people say a foolish thing, it’s still a foolish thing” – Anatoli France
      • “The history of science is really about most scientists being wrong about most things most of the time”
    • In 2010 the U.S. government removed restrictions on total fat
      • They acknowledged that not all fat was the same
      • In 2015, they removed the restriction on total cholesterol – and they did this very quietly
    • If you crunch the data in certain ways, meta-analyses of observational studies have found that almost ALL foods are associated with a higher degree of death
  • Joel responds
    • When heart attacks began rising in the 40s and 50s, research was done – there were observations made that there might be a connection between what you eat and heart attacks
      • Ultimately – it was shown that foods high in animal fat sources may play a role
    • If you could hold sugar consumption the same, and increase dietary saturated fat – heart disease risk sky rockets
      • If you hold dietary saturated fat consumption the same, and increase sugar consumption – coronary heart disease risk doesn’t increase
    • Joel points out that blocked arteries are caused by cholesterol – “I’ve never scooped sugar out of a blocked artery. 20% of every blockage is cholesterol.”
  • Chris punches back
    • It doesn’t mean the cholesterol is there, because people were eating it
    • Chris brings up a study that fed people 2-4 eggs a day, which showed that in 75% of cases, this had 0 effect on blood cholesterol levels
      • 25% of people are “hyper-responders” – the dietary cholesterol did increase LDL cholesterol levels modestly, but HDL cholesterol was also increased (lessening the risk of heart disease)
      • “This is why the guidelines on dietary cholesterol were changed. There is no evidence that consuming dietary cholesterol increases blood cholesterol levels in most people, and even when it does, there’s not evidence it increases the risk of a heart attack.”
  • Joel keeps bringing up the fact that saturated fat increases blood cholesterol
    • “395 of the best done studies in the world say that if you eat more saturated fat, your cholesterol goes up. You eat more saturated fat, coronary heart disease risk goes up.”
    • In a sense – Joel is saying the studies from the 1940-50s are still very much valid today
  • Chris doesn’t think so…
    •  “These are observational studies done 50-60 years ago that suffered from all the problems we talked about. We have randomized control studies now. Observational studies were never met to prove a hypotheseis, they were meant to generate a hypothesis.”
    • One study showed that 0 of the 52 claims that were made in one particular observational nutritional study were replicated later, 5 were replicated in the opposite direction
    • “Science marches on, we learn more, we change, and now we have randomized control trials that are replacing some of the observational evidence from the 1950s and 60s”
A Quick Recap
  • Chris’ Take
    • Joel reciting all of these older studies, isn’t relevant, they are epidemiology studies, the new evidence is based on new understanding and knowledge
    • Early studies did show some relationships, but they were very short term
    • With longer term studies, there was no increase in cholesterol on average, when saturated fat intake was raised
    • When examined for an increase in heart attacks/death, there was no increased risk with increased saturated fat consumption
    • “There’s no meta analysis of randomized control trials that shows eating more saturated fat will increase the risk of death or heart disease”
  • Joel’s Take
    • Saturated fat in the diet, lowers LDL receptors on the surface of the liver, which allows LDL cholesterol to stay in the blood, and therefore get into the arterial wall to create plaques 
      • This is backed by 395 metabolic ward studies, and many epidemiology studies, as well as by observing centenarians/blue zones
    • “It takes a conspiracy attitude to say everybody’s gotten it wrong for 60 years”
    • “50,000 feet elevation view – you’d be wise to limit the amount of saturated fat you eat, and that’s endorsed by every major medical society in the world, and it’s not controversial”
  • Joel says the science agrees with the fact that saturated fat increases the risk for heart disease, Chris says it doesn’t
  • Chris – “We used to think the world was flat, we used to think ulcers were caused by stress; there are a lot of things that have changed over time as the evidence evolves and we become more educated and aware”
    • “It’s not a conspiracy, it’s just the advancement of science”
Back To It
  • Chris – The American Heart Assoc., The American Diabetic Assoc, have funding from big food (like Coca Cola)
    • Joel – Since 1990, 90% of egg studies on nutrition were funded by the egg board
  • Chris thinks that in 2020, the USDA will change their guideline recommending people limit the amount of saturated fat they intake
    • Joe (not Joel) thinks the USDA is relying on old science for their guidelines – this is why they eventually changed the guideline for total fat intake
  • Chris – “I’m not saying saturated fat will never increase LDL cholesterol  or particle numbers in certain people, it will in some cases.”
    • For some people, with specific gene polymorphisms, this might be the case
    • He’s reporting on the science, on average
A Brilliant Point
  • The sources of saturated fat in the American diet, according to Chris:
    • 33% comes from pizza, deserts, candy, burritos, tacos, tortillas, and pizza
    • 24.5% is unaccounted for but it most likely comes from processed foods
    • 13% comes from chicken or mixed chicken dishes, and eggs/mixed egg dished
    • 10% comes from sausage, hot dogs, bacon, ribs, and burgers 
      • So the vast majority of saturated fat Americans are eating, comes from junk
  • When insulin levels are high, saturated fat tends to be stored more readily, rather than being burned as fuel
    • Insulin levels would be high if you’re always consuming sugar and refined carbs
  • So even if you see an increase in harm associated with saturated fat consumption – it’s tough to say if that same thing would be true for someone on a Paleo diet
    • “We have no research to show that saturated fat, in that context, is harmful”
Cholesterol – Round 3
  • Note from Podcast Notes – I recommend you read these notes first, as a cholesterol primer 
  • Check out this series of blog posts from Dr. Peter Attia
    • The summary – The cholesterol you eat, is not the same as the cholesterol in your blood. For most people, eating cholesterol won’t raise your blood cholesterol levels.
  • “Humans are the only free living animal on the planet with a LDL cholesterol over 80, because we eat, and we gorge, and we have jacked up saturated fat that drives up our cholesterol level” – Joel
    • You want an LDL cholesterol between 50-70
  • Chris counters – “The evidence is showing that on average, dietary saturated fat and cholesterol, do not raise cholesterol in the blood. And even when they do, it doesn’t translate into an increased risk of heart disease.”
    • It does sometimes, for some people, but on average, it doesn’t
  • Joel says how much your cholesterol raises, after consuming dietary cholesterol, depends on genetics, starting point, and your microbiome
    • If you don’t tend to eat much dietary cholesterol, and you eat 4 eggs, your cholesterol will shoot up
    • If you do tend to eat a lot of cholesterol, and eat 1 extra egg, your blood cholesterol won’t increase much
    • A toothpick is 100 mg – most people eat 300-400 mg of cholesterol per day
  • Chris brings up a controlled metabolic ward feeding study, which showed eating 2-4 eggs per day does not raise blood cholesterol levels in 75% of people
  • Joel advises people Google the Hegsted equation
    • This is an equation, meant to create a relationship between saturated fat intake and blood cholesterol levels
    • Chris counters – this equation came from old science, in the 1970s
  • In a sense, Joel is arguing that the biochemistry mechanisms don’t lie – eating cholesterol raises blood cholesterol
  • Chris brings up a good point – There are randomized control trial studies on the ketogenic diet (which involves eating a good amount of cholesterol), which show that eating cholesterol doesn’t negatively impact blood cholesterol levels
    • Joel – It’s been found that levels of TMAO in the blood correlate with how clogged your arteries are
      • TMAO impairs HDL-C so it doesn’t reverse cholesterol transport, and it causes LDL-C to enter the cell walls to create plaque
      • If you eat red meat high in l-carnitine (an amino acid) and eggs rich in choline, those directly lead your liver to create TMAO
    • Chris
      • Fish is high in TMAO, and increases TMAO in the blood, but consuming fish is also associated with a decreased risk of heart disease, and considered to be relatively healthy by the scientific community – “There are few things associated with a greater reduced risk of cardiovascular disease than fish consumption”
      • This image shows the increase in blood TMAO levels from eating eggs, beef, cheese, milk, and clams, cod, and halibut – cod and halibut increase TMAO much more than beef and eggs
      • TMAO is not fully understood, and you can’t say it’s causal of heart disease
      • High TMAO levels are thought to be indicative of a disrupted gut microbiome
        • Certain gut bacteria metabolize choline and l-carnitine into TMAO whereas others don’t
        • So a person eating a standard American diet (which would disrupt the gut biome), may see an increase in blood TMAO levels when they consume red meat. Someone with a healthy microbiome, might not see this.
Random Yet Important
  • “Foods have multiple effects. They might have one impact that you might think would lead to harm, but it might have multiple other impacts that would be beneficial” – Chris
  • Meat you hunt has probably 8x less saturated fat than what you buy at a grocery store
  • 16 of the top 25 sources of selenium come from ocean fish
  • There are so many factors that affect your health – whether you smoke/drink, your diet, your relationships, whether you exercise – so be careful what you contribute a cause to
    • Take observational studies with a grain of salt – the fewer the things controlled for, the bigger the grain of salt should be
  • Within 5 days on a new diet, your microbiome can change
  • A Nutrivore Diet – a whole foods diet, fruits, vegetables, nuts. seeds. and animal meat – whole real foods with animal foods
  • The highest nutrient dense foods in order – organ meat, shell fish (clams, oysters), fatty fish, lean fish, then vegetables
    • If you were a vegan, and allowed yourself to eat 1 clam, 1 oyster, and 4 grams of liver a day, you’d completely meet your needs for vitamin b12, zinc, copper and choline
Vitamin B12
  • Chris thinks your plate should be 2/3-3/4 plants, and then animal products
    • “There’s no convincing data that shows completely removing animal products from that plate will lead to a longer life span or a significant reduction in disease”
    • Why put the animal products on your plate?
      • Animal protein is more nutrient dense
      • Animal foods are higher in vitamin B12, bioavailable zinc, iron, calcium, choline, taurine, and creatine – not just higher in the amounts, but higher in the amount you’d absorb
      • Plant foods tend to be higher in carotenoids, polyphenols, flavinoids, and fiber
      • If you removed animal products – you’d be more prone to vitamin B12 depletion
        • 11% of “average omnivores” are depleted in B12,
        • 77% of vegetarians are depleted in B12
        • 92% of vegans are depleted n vitamin B12
      • Even supplementing with vitamin B12, you can still be deficient
        • Studies have shown that the amount you need to supplement with is about 100x the RDA of 2.5 micrograms
        • If you’re deficient you need 200x the RDA
    • “It begs the question of whether we should be following a diet that can’t meet our essential nutrient needs,  that leads to deficiencies of many other nutrients much more common than an omnivorous diet”
  • Vegans have much higher rates of iodine deficiency
    • Whole fat, fermented dairy is one of the best sources of iodine in the diet
      • Why? – The dairy products don’t contain iodine, they’re stored in tanks where iodophor is the tank cleaner
    • Iodized salt is also a good source of iodine, as well as sea vegetables (kelp, nori)
  • Calcium, iron, zinc, choline, taurine, creatine, retinol, EPA, DHA – all of these are shown to be lower in vegetarians and vegans than they are in omnivores
    • You can supplement, but the supplements might not affect the body in the same way
    • “It’s better to get nutrients from food, because that’s the way we’ve been getting them for millions of years”
Joe is Baffled By the Carnivore Diet
  • It essentially involves eating only meat
  • Chris has a theory
    • The diet mimics some of the benefits of fasting, but allows people to persist for longer because it’s providing some nutrition
    • Meat is absorbed high up in the digestive tract – there’s nothing left over to irritate or inflame the gut
      • A lot of people benefiting from this, probably have a disrupted gut microbiome
      • So the carnivore diet is essentially like a gut rest or fast
  • It’s dangerous – nutrient deficiencies can take a while to develop
    • One of the biggest concerns is a lack of vitamin C, carotenoids, flavonoids, and polyphenols
    • The diet doesn’t allow for much fiber, which is important for the microbiome
  • Many people rave about it – such as Jordan and Mikhaila Peterson
    • Perhaps it just works for them (in solving autoimmune issues) because nothing else works, so it wouldn’t necessarily be good for everyone else
Conclusion
  • The standard American diet is killing people
  • A vegan diet is superior to the standard American diet, if the vegan is supplementing wisely
  • Time restrict your eating when you can
  • Just eat real food
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