The Rich Roll Podcast – Plant-Based vs. Ketosis: Diet Wars with Cardiologist Joel Kahn, MD

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The Ketogenic Diet vs. A Plant-Based Diet
  • Check out Joels’ blog
  • Joel gave a talk at Google with Dave Asprey (founder of the Bulletproof brand) and Kip Andersen (co director of the What the Health documentary) debating the ideal diet
    • Joel does not agree with most of what Dave Asprey talks about, “There’s no science that can support putting butter in your coffee”
    • It’s VERY hard to travel and maintain a ketogenic diet, yet alone do it without traveling – for more on the ketogenic diet, check out these Podcast Notes
  • “What does the public do when they’re confused? They do whatever the heck they want.”
    • There’s so much information out there, what’s really the right way to eat?
  • The common ground between the two diets
    • No excess sugar, no fried or fast food
    • Eat lots of leafy greens
    • What they can agree upon – we need to get junk food out of schools, airports, hospitals etc.
  • Joel believes the optimal diet for the human species is geared more towards plant-based
  • You have to consider what kind of ketogenic diet you’re doing – a high fat, low carb+protein which has benefits, or a high fat+protein, low carb which “probably ages you quicker than any other diet on the planet”
    • If it’s an animal based ketogenic diet, there’s evidence that you’re at risk of shortening your lifespan
    • “It doesn’t matter if it’s grass fed or not, it’s the basic constitution of animal muscle that can age you, and the science is well known”
  • The ketogenic diet does have several dozen published studies on treating drug resistant epilepsy
  • Virta Health claims you can reverse type 2 diabetes with a ketogenic diet, and published a study in what Joel claims is a very low end journal
  • At the Harvard School of Public Health, you are able to fill out a questionnaire and allow them to track you long term. You’re more likely to die in follow up if you describe your diet as “high fat, low carb” than if you describe it as “high carb – hopefully complex plant based/Mediterranean style.”
  • “There needs to be data that addresses the increase in death rate associated with a high fat diet, and until there is, I could not in any good conscious advise anyone to do an animal based, low carb, ketogenic diet, particularly if it’s high in protein”
    • Protein activates aging pathways – biochemical pathways found to cause accelerated aging
      • It also activates cancer promoting pathways
    • The amino acid leucine is the main trigger – even grass fed beef has tremendously more leucine than the amino acid structure of plants
  • Lots of discussion of the What the Health documentary on Netflix
  • Check out The Longevity Diet: Discover the New Science Behind Stem Cell Activation and Regeneration to Slow Aging, Fight Disease, and Optimize Weight by Dr. Valter Longo
What about animal protein causes the increased aging?
  • The MTOR Pathway – mamillian target of rapomysin
    • When you eat animal protein, growth hormone is activated, and leads down the IGF-1 pathway
    • We don’t want that much cell growth when we’re 20+ years old
  • There is a society in Ecuador (The Loran), and their cells lack the receptor for growth hormone
    • Their cells cannot respond to the growth hormone the body produces, making them very short
    • Because their cells are deficient in growth hormone, they have low IGF-1 levels their whole life
    • They don’t get type 2 diabetes or cancer
  • Sugar activates the protein kinase A (PKA) pathway
  • High animal protein eating adults have a high mortality rate, low animal protein eating adults have a low mortality rate
  • “High protein diets accelerate again through these pathways and our inability to clear damaged cells through cell autophagy”
    • Vegetable based protein is fine
  • As adults get over 50-60, protein becomes more important because at these ages, we really start to lose muscle mass – at this point it might be really important to emphasize eating vegetable protein (beans, greens, nuts, seeds)
Calorie Excess Causes Type 2 Diabetes
  • Americans eat 800 calories a day, on average, more than they did in 1970
  • Most of this is processed food rich in sugar
  • “It’s not specific to sugar that leads to type 2 diabetes, its deterioration of the American diet, and moving away from home cooked meals”
  • One study from 2017, in China, looked at 600,000 Chinese people
    • The more whole fruit they ate, the lower their risk of developing type 2 diabetes
  • Joel recommends Presto! How I Made Over 100 Pounds Disappear and Other Magical Tales by Penn Jillette of Penn and Teller
Heart Disease
  • Statistics dictate one out of three people will die of heart disease
  • The average age of survival, of a US citizen, went down for the second year in a row, although it was a very small amount
    • The opioid epidemic is blamed for this
  • “A heart attack after age 80 is an act of God. A heart attack before age 80 is a failure of the medical system.”
  • “The medical system is a mop and towel kind of system”
    • If you were to notice your faucet running and sink overflowing, you wouldn’t run out to get mops/towels and address the problem this way. You’d deal with the root cause and turn the sink off.
    • Why are there Wendys in hospitals?
  • 63 million Americans have elevated Lipoprotein(a) levels (20% of adults)
    • This is largely genetic
    • Statins do not lower this
    • There is strong evidence that niacin, a B vitamin, used at high doses can lower it
    • Joel advices to get your levels checked
  • There are so many advanced cardiovascular technologies, but we need to work more on the root of the problem
  • Check out The Widowmaker documentary on Netflix
  • Joel recommends getting a Coronary Artery Calcium Scan (CACS), it’s fairly cheap ($70ish) and it some states you don’t need a prescription for this
    • The result is a number (0 is best), in relation to the level of calcification of your arteries
    • The degree of calcification is a sign of aging in your body
    • The higher the number, the higher the risk of kidney problems, developing cancer etc.
    • It’s a good way to judge your “real age”
    • You can have very high cholesterol levels, and still be relatively healthy due to a low calcification score
    • 10% of Americans have extremely high “silent heart disease”
    • Especially get this test if you’re 40 plus
  • Runners live longer than the average American
  • Long term endurance exercise can accelarate calcification of the heart arteries
    • There’s concern that long term endurance athletes are chronically inflaming their body, but Joel says it’s probably just acute inflammation
  • Athletes tend to have better blood pressure, better cholesterol, and blood sugar levels 
  • Multiple studies show that at the end of a marathon, an enzyme from the heart that leaks during heart attacks is present (troponin)
  • 10 minutes of exercise is better than 0
  • “Just because you’re a high level athlete, don’t not know your lipoprotein(a), your homocysteine, C reactive protein inflammation, and don’t not spend the $70 to get a calcium scan”
Saturated Fat
  • “Animal based saturated fat promotes a high blood cholesterol which causes atherosclerosis (hardening of the arteries)”
  • Long story short – avoid or limit your saturated fat intake, from animals and coconuts 
  • There are many types of saturated fats – the longer chains are the most “proatherogenic”
    • Palmitic acid is the most proatherogenic
    • “There’s no doubt people eating a large amount of coconut oil raise their blood cholesterol” – this favors the development of atherosclerosis
  • Why did coconut oil become so popular?
What the Health
  • Check it out on Netflix
  • Joel agrees with the What the Health documentary
  • In 2012, there was a study published linking egg consumption and carotid plaque
    • “It’s pretty darn hard to find a credible egg study in the last 10-15 years” 
  • “If you don’t want to develop type 2 diabetes, cut out processed meats” – hot dogs, balogna, salama, bacon
  • 2 strips of bacon a day,  which is around 50 grams, raises your risk of developing colorectal cancer by 18%
  • Processed meats have to be banned from hospitals
  • In your own life – don’t eat processed meats, but if you do, couple it with antioxidant fiber rich foods (green leafy vegtables etc.)
  • There was a study 5 year ago showing that an hour after eating a hamburger, you are able to document that your arteries are dysfunctional
    • If you’re going to eat a burger, eat it with lettuce or an avacado
  • All of the claims from What the Health are validated and backed up with citations on their website
Intermittent Fasting
  • Look at the history of humans, for most of time, there existed periods when food was not abundant and we were forced to fast
  • “There is no species, in a research model, that if you restrict their calories, they don’t live longer”
  • Fasting accelerates autophagy, the clearing of damaged cells
    • If we could improve autophagy, we can extend human life
  • Fasting Mimicking Diets (FMD) – eating 800 calories or less, 5 days a week (in a row) once per month
    • These 800 calories come from a plant-based diet, low in sugar/protein, containing whole food fats (olives, nuts), and moderate complex carbs (the carbohhydrate calorie load should be 35%)
    • Get the benefits of fasting without the pain/risk of a complete fast
    • Favors losing visceral fat around the belly
    • Muscle mass is not lost
    • IGF-1 levels go down
    • Results in a flood of stem cells from bone marrow into the blood stream – these go to injured and damaged parts of the body to clear out damaged cells
      • Data that suggests Multiple Sclerosis may be responsive to a FMD for this reason
  • Joel reports while on a FMD, his plantar fasciitis went away after two months
    • Joel has done a FMD 7 of the last 11 months – his blood results have improved, he’s down 25 pounds
  • It has been found that chemotherapy patients get a better kill rate from the chemotherapy drug, and less adverse side effects while on a FMD
  • Check out the documentary The Science of Fasting 
  • “It’s far better to skip a meal than compromise”
  • It’s just conventional wisdom that we need to eat 3 times a day – Ray Cronise would agree
  • “The single most powerful activity you can do to prolong your life, is eat less every day”
The Plant-Based Solution
  • Joel’s new book
  • 150 pages of science on the benefits of a plant-based diets in relation to diabetes, the heart, the brain, sex, and autoimmune diseases
  • Includes recipes for 3 weeks of cooking while on a plant-based diet
  • “The human body has an amazing ability to heal itself. You can’t heal plant and nutrition based diseases with pharmacology, you have heal them with nutrition.”
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Notes By MMiller

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