Dr. Michael Greger, welcome back to the Plant Yourself podcast.

Thank you so much. Happy to be back.

I thought you wrote a book, but you actually wrote a 4-year course in science and nutrition. I have to admit, I'm not quite done. I gave myself a week and I kept going down the rabbit hole of all your citations. This is a remarkable book.

How Not to Diet: only four thousand nine hundred ninety citations.

I don't know what the problem is. You guys really slacked off. You could have made the 5K mark.

Well, it's not about numbers. It's about quality.

There you go. So I have way too many questions for the time we have. But I guess the first question is, you wrote at the very beginning, "I hate diet books that purport to hate diet books, yet not yet relish in the sea and all the same absurdities."

And you acknowledge that marketing is very effective and that before and after, pictures and stories and anecdotes are effective. Why did you decide to write a book that is kind of the A.I. diet book with only studies and narratives about science rather than anecdote and inspiration? What are you what did you hope to accomplish?

Yeah. You on testimonials and before and after pictures, you come to the wrong place. I'm not interested in anecdotes. I'm interested in evidence. Right. When it comes to making life and death decisions like what to eat for yourself and your family. So that only one question was the best available balance of evidence suggests right now. And so this is a book for people who want facts, not fantasy, filler or fluff. You know, I was just so sick and tired of the nutritional noise and nonsense out there. I just wanted there to be a evidence based diet book. Right. And I said literally thousands of studies digging up every possible tip trick tweet, take a proven to accelerate loss of body fat, to give people every possible advantage and basically build the optimal weight loss solution from the ground up.

So when I was reading it, I was thinking in terms of, you know, your daily videos, which are kind of reviews of the literature and also thinking about how not to die, which was looking at 15 different causes of death. And this book seemed very different. And that's something started happening around halfway through that. It felt like there was this emergent property that you and your team of researchers knew like knew more than the diet industry. Like, you know, Garth Davis often sends me like slides from obesity, conferences, nonsense. It's like this. Was there something in putting together this project and I know you have a list of maybe 40 or 50 volunteers and other people who helped out that kind of brought you. This sort of raises our understanding of obesity and weight loss treatments that goes beyond just the collection of all this disparate evidence.

Yeah. You know, I went into this thinking that I would just, you know, end up railing against all the gimmicky snake oil out there and, you know, pretty much put out the same standard advice to trim calories and hit the gym. So I mentioned what would really kind of set this work work apart would be kind of its comprehensiveness and strict grounding in science. But, you know, my research team uncovered just this treasure trove of buried data, you know, like, you know, simple spices proven in randomized placebo controlled trials to accelerate weight loss for pennies a day. But there was so little profit potential this. No wonder these studies never saw the light of day. But look, the only profiting I care about is people's health. That's why 100 percent of the proceeds I receive from all my books, including this is all donated to charity. I just want everyone to have access to this life saving, life changing information.

Have you seen an impact from this? I know its books only been out for a little while, but I assume you sent out advance copies to people from like medical professionals, health care professionals who aren't necessarily in the vegan plant based camp. Is this moving the needle with folks?

Well, I have. So I have a city book tour and I completed three weeks of it, mostly Southern California and Arizona so far, and actually going back to southern Cal in a few weeks. And I spoke spoke a lot of hospitals. And, you know, most of it is just, you know, dispelling ignorance. Just had no idea. Mean you weren't taught about this in medical school. So really starting from scratch. So it's it's you know, it's it's kind of funny. I give the same talk to lay audiences that I do to medical audiences, because the medical audience or lay audience is when it comes to nutrition and weight loss.

Right. You have this wonderful line that at M.D. before after your name is an anti-credential for a diet.

All right. Oh, my God. Right. It just displays to the world your total lack of training and ignorance. And it says, I learned everything I know about nutrition from the checkout aisle magazines. Basically, that's all it advertises.

So what if you had written this book 10 years ago? What would have been missing? Like what? What are the latest? Greatest?

Oh, yeah. So, I mean, so there's been a revolution in our understanding of the microbiome. Chronobiology is relatively new field. Optimal timing for both therapeutics and lifestyle interventions like meals and exercise regimens.

You know, I mean, so, for example, the microbiome most bugs in our gut are actually own cultural meaning. You cannot grow them outside of the human gut like in a petri dish or something. So it's very star hard to study them. In fact, very even hard to know what's in there. It was like the dark matter of fecal matter.

But then we have DNA fingerprinting techniques. And so for the first time, we able to say what you say, well, you know, what kind of bacteria are in people's guts? And, you know, does it matter? Are some bacteria correlated to certain disease states or certain diets? And what's the connection? And then we started doing fecal transplant studies to actually prove is the microbiome, because you can actually know swap microbiomes between people. And so, you know, that's been a great understanding. And the bottom line is that we need to eat diets that are high and probiotics. But our good gut bacteria eat.

That's resistance stars and fiber found in all unprocessed plant foods, but particularly in legumes, beans, but peace, chickpeas and lentils and whole grains, particularly whole intact grains.

Right. And that's the fiber feedback loop. Right. So that when you have when the fiber hits down, you can you describe it as if the illegal break.

Oh, yeah. Ilya Boik is awesome. So so basically when your body detects calories all the way down in the ilium, which is the last part of the small intestine for dumps into the colon, your body thinks all my guy must be full from stem to stern and dials down our appetite. You can show this experimentally. You can prove it by sticking a nine foot tube down people's throats, squirting in a little. Any kind of calories, fat, protein, carbs. And compared to squirting little water as the placebo control, people eat significantly less. And all you can eat buffet. They just don't feel as hungry. I just doesn't do much for them because their brain is trying to stop them from eating. And so how can we take advantage of this illegal break? Well, the medical industry said how we gonna get, you know, nutrition, how we're gonna get no calories into the last part of small test and. Well, why don't we just cut out the intervening, you know? You know, you know, 20 or so feet of intestines. And so they created this little bypass surgery. The first thing is called the general will bypass the first bariatric surgery. The first weight loss surgery where they just cut out the small intestines and detach the beginning of the intestines all the way to the end. So basically, anything you weight went straight to the ilium activated the ilium break. Awesome. Until people started dropping dead from liver fibrosis, taking about one in three people. Disastrous. Thousands of people died. And it is a real dark blot on the history of surgery. People don't realize there is no like FDA approval for new surgeries. Any surgeon can come up with any surgery and just do it. No one asked even me like, oh, why do we do this and put this pipe here and anyone can do anything.

And there's no regulation here. And so angulation around like plumbing and electricity in my house, probably.

Right. You have got to get permits for that kind of stuff. Right. And so. Yeah. Anyway, so. So there a healthy way to do it without chopping out your intestines. Why, yes there is. We can eat fiber ridge foods and what fiber does because fiber is not absorbed in the small intestine. You have this mass of Joe fiber moving through your digestive tract and calories are only absorbed when they come in physical contact with you with the wall of your intestine to have all these calories, these fat, carbs and sugar mixed in in protein, mixed into this gel, massive fiber, which goes all the way through you and ends up down in the ilium. And these calories continue to hit the wall and be like, oh, wow, a little break. And in fact, that's how, of course, we were meant to eat. See a lot of the fiber rich foods. There is no such thing as a Twinkie, an African savannah. And so, you know, we were meant to have this satiety signal from eating. But now we don't have it because we don't eat fiber rich foods.

So I think one of the main themes of the book. You know, the sort of the thrifty gene hypothesis and you quote, do John ski in the beginning that nothing in biology makes sense except in the light of evolution. And so it's like this to do is there's this mismatch between what our bodies are meant to do and the environment in which we're in. And the big fight in the world is between things that we do to harm our bodies, to make us thinner. I'd like the journal illegal surgery or this, you know, this this wonderful.

Was it orlistat that causes anal leakage, too, which is like fat not getting absorbed. There's all these ways in which, okay, so we're in this weird environment. So let's let's damage our body so you don't take in so much versus what you have. You you're the 17 factors, the 21 tweaks. These are things that are that are if mostly held almost entirely health promoting. Some might be a little bit neutral, but like it's it's almost almost like skating. The line between like strenghts, sticks, straight nutrition, excellence and biohacking.

Yeah. Yeah. No, I think that's a really good way to describe it. Yeah. The whole 13 gene IPOs is a hypothesis suggests that this evolutionary mis mismatch like got no polar bear in a jungle. Well, where all that fat and fur was really helpful living off in the Arctic, but decidedly disadvantageous in the tropics. And the same thing with us are craving for calorie dense foods so we don't starve to death in a famine 2 million years ago. And our craving for salt because there weren't salt shakers and KFC. And in West Africa, you know, so we had these cravings to keep us alive. But you plop those same biological traits down and, you know, you know, bacon, butter, Big Mac country and that craving for salt is gonna kill you. That craving for sugary foods, that craving for fatty foods, calorie dense, which is gonna kill you. But that's how these industries make money. The food industry is the largest industry in the world, more than petroleum, more than made it multi-trillion dollar industry.

And they make money not by selling us produce that can go bad, whereas the money and they can't Patnaik can't branded what makes money as a snack cake that lasts for a few weeks on the shelf. Good for shelf life, not good for human life.

All right. I made a note in the margin that when you're talking about, you know, the big, big food industry, that obesity is really a willpower problem, but it's not the willpower of our society and elected officials to stand up to big food, not not individual eating.

Exactly. I mean, the way they want to present it like that is because then they can feed us this endless parade of quick fix fads that always sell because they always fail. Right. I mean, repeat business is the whole model. The business model of the diet industry. Yet people just kind of continue to get lined up to get fooled again. You know, I want to make it clear that obesity is not some kind of moral failing at the Battle of the Bulge is a battle against biology. We are living in a toxic food environment, floating in the sea of excess calories, drowning in a sea wall, being bombarded by ads for fast food. Candy about becoming overweight is a normal natural reaction to this abnormal, unnatural ubiquity of sugary fatty foods concentrated in calories.

So one thing you write about is there are two satiety pathways, the homeostatic and he dolnick and he dolnick tends to overwhelm the homeostatic because it's triggered so often. Can you kind of explain that?

Yeah. So I'm mean, the homeostatic system, just like temperature, for example, we get too hot, we start to sweat, we get too cold, we start to shiver. These are ways where our body keeps it right. And just the right balance. And similarly, there are mechanisms are by we get too skinny, we wrap up our appetite to eat more. We get too fat as well there. The way our body dials down our appetite to eat less so we can, you know, escape predation, for example, run away from saber tooth tigers. What do we need to do?

And there's an evolutionary advantage to being slim and healthy. And so but at the same time, we evolved in the context of scarcity where we never knew where the next meal necessarily would come from pre agricultural days. And so, you know, we can. Go days without eating, maybe one meal a day. And so there was. So should we stumble across a blueberry bush or something? Ripe fruit. But we are driven to overwhelm are kind of homeostatic drive. We should be like, well, don't eat too much, buddy. Bud. Look. Oh, my God, that he doney drive this craving for sugar, for fat, for salt overwhelms that because we want to stuffin as many calories as possible because who knows when the next time we're gonna eat is. And so we're hardwired to have this overdrive mechanism to be it to overwhelm our bodies, kind of natural urges to stay slim in hopes that we can pack on pounds to survive the next famine. But of course, the next famine never comes anymore. And we just keep packing it on.

All right. And I guess there's there's some evidence. I don't think you talk about it in the book, at least not for 400 pages that I've read so far around when we do or not that with when we do have this he dolnik response. It also creates very strong emotional states and memories. So we remember. Right. So it becomes it becomes even more self fulfilling that this you know, the Snickers bar that I had from the candy machine today is going to make my brain smarter about getting it tomorrow.

And right. And you'll try you'll see that that vending machine will be triggered with cravings. Right. You can stick people in an MRI scanner that's functional MRI scan, the brain scanner, and you can see those reward pathways light up when even shown just a picture of a milkshake. Right. I mean, our by our lizard brain, we may intellectually know that's just a picture, but our lizard brain just sees, you know, fat and sugar and calories. And we get em and we get the same kind that you put in alcohol. Can you give me a wit, a little a whiff of whiskey or you take a cocaine addict and you show them like drug paraphernalia, get the same lineup pathways.

And in fact, that's what many drugs of abuse do, is they actually kind of commandeer those same kind of addictive pathways that keep us alive. We need to be addicted to breast milk. We need to be addicted to calorie to calories. Otherwise, we would we would die. In fact, they actually produced transgenic animals without a dopamine reward pathways in their brains. And they just starve himself to death. I mean, food was just completely uninteresting to them and they just died. I mean, they didn't even think about it. So, I mean, these are critically important to be it to have that, you know, for a body to crave foods that are calorie dense. But of course, what does that mean? Calorie dense means ripe fruit, starchy roots, you know, things that, you know, we did not yet have Fruit Loops back in the Miocene era. Twenty nine years.

I'm almost I'm feeling a little bit like almost offended for humanity that like the universe said, you know, we have to infantilized the species, otherwise they're just not going to make it. So we're going to create all of these, you know, impulses and adaptations to make sure the babies drink their milk, to make sure the grown-ups don't starve to death.

And you talk about there are there are foods that we can add today that kind of have the same effect without our having to have thought and willpower. You can like you. So they're foods that spontaneously cops cause weight loss without trying.

Right. So, for example, Thilak Quads, which are part of Greenleaf membranes in green leafy vegetables or photosynthesis takes place, actually binds to to an enzyme in our gut called light pacer's to the fat digesting enzyme. And so it slows the absorption of fat. So again, activates the olio break. So eating a half a cup of cooked greens every day is shown to significantly accelerate weight loss and decrease urge for sweets. Decrease urge for chocolate. My people eat less at all. You can eat buffet and over time they lose more weight. So greens don't just have the five or low calorie density. Lots of water. I mean, there's all sorts of benefits from eating food like that, but there's these particular benefits from certain foods like greens that act as starch blockers or fat burners or these metabolic boosters. And so that's really the second half of the book. So once we have a healthy diet, healthy slimming diet, then what are the kind of things that we can do regardless of what we eat? To accelerate fat loss even further.

So the specific foods I talk about sort of to cover more weight loss topic and then get to a sort of a more general questions about research exercise. So you you bust a lot of myths about. Exercise and weight loss, give us give us the CliffsNotes on that.

Yeah. So, you know, moderately obese person, moderately, intensely exercising a very brisk walking or biking burns about three inch count, 350 calories an hour, where, as you know, typical beverages, snacks, you know, processed foods are consumed at a rate of about 70 calories a minute.

So in five minutes, you just wiped out an entire hour of exercise. That's why, you know, you can't really outrun bad diet.

I mean, one of the things I was thinking is like, you know, so just like, you know, people want to change their diets and go just moderately better.

So like, you know, skinless chicken, like we know that doesn't work. Right. Like, I think David Katz prefers to the tiny parachute effect.

Right. Right. Right. Right. But also in terms of exercise, like we're like if we exercise like real humans, it would have been like you talk about, oh, two hours a day, like you like to meet two hours a day, so. Oh, my God. What am I going to find the time? You know, you're you're I don't know if you're on a treadmill or on the stepper right now. I'm on my treadmill. Okay. But for like a normal human in their ancestral environment, of course, we'd be up at about eight to 10 hours a day just doing our business.

Right. Yeah. I mean, we were built to move. What's unnatural is sitting around all day like most people do so. Right. So this recommendation, I have 90 minutes of moderate intense to exercise every day. You know, if anything is really kind of undershooting the activity. But look, we were we evolved to be lazy. Why expend excess calories when we don't need to? That's why we're going for the most calorie dense foods instead. I mean, what's the point of foraging, you know, for 10 hours to get enough food that only gives you nine hours worth of energy? I it just doesn't make any sense. And so, you know, basically we evolved exercising really just kind of for fun or because we had to. And so that's where you. That's how you incorporate exercise. You do it for fun. You do with friends. You play sports. You, you know, listen to a podcast, walk the dog, you know, things that make an enjoyable or you force yourself to like you park far away and a parking spots. You gotta walk back and forth. You take the stairs instead of the escalator. You work on a day, you know, treadmill desk like I do. And you just, you know, walk without even realizing it. You know, I mean, you just kind of have to find ways to get movement into your life.

But that's mostly for longevity in terms of weight loss. Again, we have much more control over calories in. In fact, we have total control. Are you going to do nothing during the day? It's only a small fraction of calories out the other side of the equation. Is it? We actually have voluntary control over most of the calories we burn. Every day is just existing. If you line in bed all day, didn't get out of bed at all. You still burn a thousand calories a day just to keep your brain going, your heart pumping and all that stuff. And so actually the volunteer exercise component is actually just a very small slice, whereas we have all the control on the other side. And so that's why we just have to eat healthier.

All right. So I want four thousand nine hundred and ninety citations. My favorite study that you cite. So I haven't looked at all of them because I am a slacker as we as we've stockers, we've already established and established.

But I love this. The the study the aybe a study based diet where they had to throw out the results because the women in this study refused to go back to a to their old crappy diet.

All right. Yeah. No, no. Yeah, it works too good. It's hard to study. Yeah. So Physicians Committee for Responsible Medicine does a lot of those like the so-called Abia does I where basically, you know, you take people work gone. They did. They've done it for menstrual cramps. They've done for migraines. I've done it for a bunch of different things. So basically take people, even young, healthy people. You know, I mean, you can you can argue that, you know, after like a heart attack or something, it's easy to get people on the right diet because they're so scared for their lives. But we're talking young, healthy people. We're just not thinking about chronic disease. But, you know, have something like migraines is something you put them on a plant based diet. And, you know, migraines may get better if that happens. Wait a second. Was it just coincidence the migraines got better? Let's put people back on the original day and see the migraines come back. Then that would, you know, give you more robust evidence that the diet really was playing a role. And so you sign up to do this study and they explain how it's kind of go. But many people feel so good eating plant-based migraines gone away. They may have had chronic pain all the time, every single day. And also they don't do that. And hey, digestion is better sleeps better, more energy. They just feel better. That they said, OK. Now you guys go back to your vision. They're like, screw you. No way am I going back to the original date. And what the problem is that you have to throw out that data point. You have to throw them out of the study because they didn't complete the study, as they should know. And so only the people that were willing to go back to their original diet are included in the study. And so the results are actually not as robust as they actually found. But just because people weren't being compliant. But yeah, that's that's that's one of the problems. Hard to study plant based diet. Work is a little too good.

So what you're if you had a tag line, it would be let's put it to the test. Right. So a lot of your your your videos and I think there's the plot. Right. Like you're going to give us the right setup. And then, of course, that's the payoff. Now, of course, a lot of studies have not been done yet. So I'm really curious, like, if you if you were in charge of medical research, like what what directions would you like it to go and what do you think we still need to know more of?

Oh, you know, there's a lot of stuff there's a lot of studies that that we have. We have correlation, no causation yet. So we have some present. But low back pain is great example. You can very closely correlate the clogs in the vertebral arteries that feed the lumbar discs of the spine. You do an MRI, you see how clogged off those arteries are. And that correlates very closely with the gender of disc disease and low back pain. A leading cause of disability tracks very closely. You can do it over time and see those with the with the you know, with those squeezed off arteries are more likely to develop back pain. But the question is, you can't prove cause and effect. You put it to this. Meaning can we actually either prevent the development of back pain by improving people's that or even better, reverse it? What if we opened up those orders without drugs, without surgery, just a plant based diet and other healthy lifestyle behaviors? Wouldn't the back pain go away with those discs? Come back? What an amazing study. Think of many millions of people suffer from sciatica, low back pain. Imagine if we could reverse that crippling disability. We don't know. It's never been done. I'd love to see that study.

What? What else? What other weird?

Where else do you feel like frustrated that you we just don't know enough? Or do you think maybe like we do and there's everything else to sort of, you know, along the way.

We have those randomized controlled trials proving reversal of heart disease, number one killer of men and women. What else do you need to know?

Right. I mean, there's only one dye that's been proven to reverse heart disease in majority patients, plant based diet. Shouldn't that be the default diet and the proven otherwise? And the fact that we also so effective in preventing, arresting or reversing other leading killers like type 2 diabetes and high blood pressure would seem to make the case for clamping seeding simply overwhelming. So does it also help with back pain? Probably. We have no idea. But hey, you still don't want to die of heart disease, back pain or not. So you just do it right. But I'd love to see more reversal studies. We have some good case series on lupus. I'd love to see that. A randomized controlled trial. We have good uncontrolled studies on on relapse prevention brochure. Kleiss and Crohn's Disease would love to see those in randomized controlled trials. Would love to see breast cancer reversal studies. We've we were able to reverse the progression of prostate cancer, leading cancer specific to men with a hopeful plant based diet. You know, wouldn't it be great to see if we could do with breast cancer, too? Never been done. Although, you know, Ornish is doing now, he conquered our killer number one heart disease, moved on to kill a number two cancer, was able to show reversal of the progression of prostate cancer now. He moved on to kill a number for all Harmers disease, randomizing Äls Harmers patients to a whole food plant based diet in an attempt to reverse the progression of Alzheimer's disease. That takes some hits. But the trial is going on now. Can't wait to see what the results are right now.

What do you want me to tackle? Number three, medical error.

Oh, well, well, three people are so healthy they won't need the drugs that caused a terrorist. They want to the hospital acquired infections and they won't get the wrong surgeries, etc..

All right. Last question. Is there another book in your mind?

Absolutely. How not to die. Excuse me. We already did that. How Not to Age, 2023. December 2023. Yeah. I'm so excited. And good talking to you. And keep up the good work.

Thank you. You too, Dr. Greger. A pleasure.