Leading Edge Nutrition - with Dr. Mark Hyman | The Empowering Neurologist EP. 14

Hello, I'm Dr. David Perlmutter, and welcome to The Empowering Neurologist. Today my guest is Dr. Mark Hyman. Many of you know Dr. Hyman. Many of you are familiar with his work. I've known Mark for many, many years, and it's really going to be a great honor to interview him today. He believes that we all deserve a life of vitality and that we have the potential to make this happen. He's dedicated himself to tackling the root causes of chronic disease by harnessing the power of what is called functional medicine. He's doing that to virtually transform healthcare. Mark is a practicing family physician, and he's also a 9-time number 1 New York Times bestselling author. Dr. Hyman is internationally recognized. He's a leader, he's a speaker, an educator, an advocate in the field of functional medicine. He is the director of the Cleveland Clinic Center for Functional Medicine. He's also the founder and medical director of the UltraWellness Center. He's chairman of the board of the Institute for Functional Medicine, and he is the medical editor for the Huffington Post. And Mark has been a regular contributor on many television shows, including CBS This Morning, the Today Show, CNN, The View, the Katie Couric Show, and of course you've seen him many times on the Dr. Oz program as well. This is his new book. What a title, Eat Thin— rather, Eat Fat and Get Thin. And it's a terrific book. It's a science-based book, but it's very, very understandable. It stems from his clinical experience dealing with patients, and beyond that, it is very, very actionable. He gives us a terrific plan throughout the book and really focused at the end of the book on how we put this into play. What makes for a good fat versus a bad fat? Really terrific information. So I'm really looking forward to this interview today. Hope you stay tuned. So hello, Mark. Dr. Hyman, how are you doing? I'm good, David. How are you? I'm great. I am super, super thrilled about your new book. And I'll you know it's it's what a lot of us have been saying, but you've done an amazing job in making it really understandable and leveraging the science and. An action plan. I'm really thrilled that this is coming out. Fantastic.

Well, truth be told, I used Grain Brain as a lot of background material as I'm reading about fat and the brain, because it's like it's— you just hit it right on the nail on the head with it.

Fathead, who knew? But, you know, we've all said that, and you make a great point, that fat has been demonized in our society. Everything— we are fat-phobic left, right, and center.

A 4-letter word.

How did it all get started?

It's a 4-letter word. And, you know, we had a perfect storm, David. We had a perfect storm of a very enthusiastic and charismatic scientist, Ancel Keys, coming up with an idea that fat caused heart disease. We had the American Heart Association, and it was based on pretty skimpy epidemiologic evidence that wouldn't stand the light of day today, but was sort of relied on to come up with this conclusion. We then, the American Heart Association, marrying him, essentially, and promoting his hypothesis. Then we had the government saying, you know, I guess these guys are right, so let's create a low-fat recommendation for America in 1980. The McGovern Report in 1977, then in 1980, the Dietary Guidelines came out and said, eat less fat. And then, of course, guess what? The food industry decided to jump on board, and they created every which way of low-fat products— low-fat yogurt, low-fat cookies, low-fat everything, low-fat salad dressing. And we got into this low-fat era where there's 600,000 products that have added sugar and low fat. That's really driven this epidemic of obesity and diabetes. We now see a 7-fold increase in diabetes since 1980. We see dramatic increases. David, when you and I were in medical school, we never saw a kid with type 2 or adult-onset diabetes. They had to change the name to type 2 from adult-onset, right? Now we have 3.5-year-olds, because they're eating too much soda, getting type 2 diabetes.

Even to this day, I think I'm jumping the gun a little bit getting into saturated fat, but even to this day, I was reading a news report earlier today. And you can hardly ever find the word saturated fat without the word artery clogging, words artery clogging in front of it. That's true. No pun intended, but it really seems to stick.

Yeah, we should get some Pam, you know.

So, you know, moving from fat, you know, the message obviously, we'll talk about it at some point, is the type of fat. Yeah, but moving from, from total fat consumption to The still voiced concerns over consumption of saturated fat. Yeah. And you make it very clear that that's not valid either.

Right. So, so, David, I spent a lot of time researching this book. I looked at over 1,000 papers. 500 of them are quoted in the book. And I think there are great areas of agreement around fat and there's great areas of controversy. So the areas of controversy are, one, are all calories created equal? And I think the basic consensus is, yeah, they are. Where in fact the science shows they're not. Fat calories don't make you fat. Carb and sugar calories do because they produce insulin in your body, which is a fat storage hormone. And in the absence of eating a lot of refined carbs and sugar, fat doesn't actually cause weight gain. The second thing is that fat causes heart disease, and then it's refined to be saturated fat. So everybody agrees now that trans fats are bad. Those are like hydrogenated shortening, margarine, And that omega-3 fats are good. Everybody agrees on that. And most people agree that olive oil and monounsaturated fats in avocados are good. So that leaves 2 categories left of fat where there's controversy, saturated fat and omega-6 polyunsaturated fatty acids. So I really dug into the research on this to try to figure out what does the science say, 'cause there's so many different opinions. And you were part of the fat summit we did, which was really fun, and thank you for being on it.

Mm-hmm.

We had about 150,000 people listening to 33 experts experts on fat. I interviewed some of the most amazing scientists, you included, Dr. Walter Willett from Harvard and Dr. Ronald Krauss from Oakland, who was the discoverer of lipid particle size, all the different sizes of particles that we have in cholesterol. He's the guy who figured that out 40 years ago. They had completely opposite opinions. One was omega-6 fats, not that great, and saturated fats, not bad. Dr. Walter Willett's like, saturated fats, terrible, and omega-6 fats are great. We should be drinking corn oil all day. And soybean oil. And I'm like, how do these smart guys come up with such opposite opinions? So I started just digging and digging. And, you know, there's so many different kinds of evidence. There's evidence that's experimental, there's population studies where they ask food frequency questionnaires. So the quality of nutrition research is pretty crummy, which is why there's so much confusion. But my conclusion after looking at all of it was that in the absence of refined carbs and sugar, and in the presence of enough omega-3 fats, Saturated fat is not a problem. It doesn't cause heart disease. I don't think it causes inflammation in the absence of refined carbs and sugar and the presence of omega-3 fats. And I think there's a large heterogeneity in the population, variations in our different responses to fat. So I think the genetics of diet are getting more and more refined so that we're going to be able to ultimately take a finger stick and say, gee, you know, maybe you shouldn't be eating that much saturated fat. You, you could stick a Eat a stick of butter in your coffee in the morning, not a problem. I think we have to be careful. I think as far as omega-6 fats, just from an evolutionary point of view, we never had refined oils before. We had olive oil, but we never had soybean oil, which is 20% of our calories. Linoleic acid's 10% of our calories. That's inflammatory fat. We need it. It's an essential omega-6 fat, but the volume we have is just extraordinary. I mean, the 2 biggest sources of calories are soybean oil and high fructose corn syrup, which are subsidized by the government, which is why they're so cheap.

And both are genetically modified seeds, I might add.

And there's that, and there's that, right? And then on top of that, you've got glyphosate issues and gut microbiome issues, and it just goes on and on. So I think we have to be smart about what we're doing, and I think we always ate saturated fats in our diet, in butter and animal fat, and that's something we've eaten. We've eaten omega-6 fats in nuts and seeds, but we haven't eaten the volume of refined oils like corn and soybean and canola and safflower oil. And, you know, one of the studies— just to finish up— one of the studies that really convinced me about omega-6s— there are a couple, but there's a couple of scientists, Ramsden and Hibbeln, who I talk about in the book, who really look at omega-6s. And they found that when they really included all the studies that looked at omega-6 and omega-3 together or just omega-6 alone, the ones that had omega-6 and 3 together, they did okay. Okay. 6 alone, they did worse. They had a higher risk of heart attack. And I think, um, I think that's actually what I think the, the sort of truth is about these oils, that they, they— we need them, but not in the quantities, and we need them, you know, with enough omega-3s.

Well, you said something that I— and I really want to make sure that we don't pass by it because it's actually really fundamentally important. You mentioned that people can— eating a high-fat diet, but they get into trouble when that diet is not low-carb at the same time.

Yes, yes.

You know, so many people, uh, go on, they think, well, you know, have at it with the coconut oil and all the fat, olive oil that they want. But if you're not cutting the sugars and the carbs, you're setting the stage for disaster. It won't work, nor will you lose weight, I might add, as you talked about.

Yeah.

Unless you also are very strict about the carbs. And, you know, what happens there is with the carbs being elevated, you're glycating your proteins, including LDL. And then you're setting yourself up to make the fats that you're consuming that would have been helpful otherwise damaging. So you make a comment.

So David, I call that sweet fat. Sweet fat, right? You know, fat fat is good. Like sweet fat is like a donut or bagel and butter. Like that's not good.

Yeah. And you had a nice discussion in the book about meat. And certainly there's there are arguments on both sides of that story. Tell us more.

Yeah. Okay, so listen, you know, like you, I want to live a long time, and I want to do the right thing for me. So I have a selfish motivation to figure this out. And as a doctor and scientist, I want to know, you know, what's the right thing to do for my patients. So there's so much controversy about meat. You know, you've got the people who say if you look at meat, basically even look at a cow, you're gonna get, you know, cancer and heart disease. And others are saying, you know, we should be eating tons of meat because our Paleolithic ancestors ate all this meat. So I really spent a lot of time researching the literature. I wrote 18 Yeah. I spent about 80,000 words in the book on meat, and there are really 3 issues, as I could tell. One was a moral issue, and I can't really argue. If you're a Buddhist and you don't eat meat, I have no argument with that. And I have patients who are monks, so I'm good with that, and I think that's a way to eat well. The second is environmental, and I think factory farming and industrial farming practices of animals is detrimental to the environment. It contaminates our water supply, it contributes to climate change, it depletes our soils, and just for so many reasons. It throws pesticides and herbicides and toxins in the environment we're all exposed to. So I think from that point of view, I have no argument with the ending of factory farming and meat, the antibiotics in feed, all that. Then there's the health issue. So you remove the moral and the environmental issues, which are real, you have to deal with the health issue. Is meat good or bad for your health? And I think people conflate them too often. So I found, from looking at the research, that there was a lot of epidemiologic evidence, or population studies, that showed that meat seemed to cause increased risk of heart disease, cancer, premature death, etc., and I was like, diabetes. So I began to look at this, I was like, this doesn't make sense to me exactly. Like, it doesn't pass the sniff test, as Jeff Bland would say. And like, how is the mechanism for this? I mean, I understand the mechanism of sugar. So then I began to look at these studies, and if you look at the populations that actually ate meat, They were eating factory-farmed meat. The meat eaters ate 800 calories more a day per person. They ate far less vegetables and fruit. They ate more refined foods and sugar and processed foods and fried foods. They exercised less. They drank more. They smoked more, and they didn't take vitamins. Of course, they were sicker and had more heart disease. And then I looked at studies where they compared vegetarians and meat eaters who shopped at health food stores, right? So, they're going to be more health-conscious meat eaters who are not eating all the crap and eating vegetables. And there was no difference in health outcomes in 11,000 people who were studied in this large study. And then I looked at interventional trials. What happens when you take out the crap and the sugar and the refined processed food and you eat meat more like a paleo diet? People reversed diabetes, their inflammation got better, their lipids got better, their blood sugars and blood pressure got better. They had tremendous improvements across all the biomarkers that you would think would be causing heart disease, diabetes, and cancer. So I think that's real. The meat issue around TMAO I address, which is trimethylamine oxide, which is basically a compound that's produced from meat in your gut. And this seems to be increasing the risk of heart attacks. And right here at Cleveland Clinic is where the research is being done. That's where I'm right now, at Cleveland Clinic. And Stan Hazen's a great researcher, and he found that, you know, if you were a meat eater, you had high levels of this compound and you would get heart disease. But if you were a vegan, you didn't have these. And if you fed a vegan a steak, They wouldn't make the TMAO.

What does that tell you, though?

Well, that tells you what the gut microbiome of a vegan— and how do you get that? You eat a lot of vegetables and fiber. So clearly— and then he found in further studies, if you add olive oil with the meat, or red wine, or balsamic vinegar, which sounds like a great salad, bottle of wine, and steak to me, then it didn't seem to actually create problems with TMAO. So

I think you made some really good points, and it's again getting back to the fact that meat is looked upon as Protein and fat, basically. Again, we have to control the carbohydrate and sugar consumption, but beyond that, meat is like fat. You have to be very discerning in your epidemiological studies, in your food questionnaires, in terms of what people are eating that qualifies to be called meat. Sure. Like you said about eating food from a factory farm, high in omega-6, that's sprayed with glyphosate. food, etc. And I always liked that statistic about it takes 17 pounds of grain to make 1 pound of beef. Well, you know, beef normally don't eat grain. So maybe we should start at the beginning there. And how much water does it take to make the grain? Well, if the cattle are outside grazing on grass, you don't have to make grain in the first place.

Right.

So let's talk a little bit about the much maligned eggs.

Yes. So just one more thing on meat. You know, I think that also the meat In terms of volume is a concern for me. I think it's okay to eat meat. I say eat clean meat. There was a study came out just in the last couple of days about grass-fed meat being healthier than feedlot meat because of higher omega-3s, etc. But, you know, I think there are— there are a lot of pressure on the earth in terms of animal production. Even if we all wanted grass-fed meat, I don't think there is enough. And I also think from a health point of view, having, you know, a palm— like a palm's worth of meat a day is probably okay, but having huge, you know, 72-ounce steaks is probably not a good thing for your health or for the environment. So I think I call it condiment, you know, as opposed to like condiment, uh, condiment, because it's like a smaller amount as part of your meal. It's how they do it in China too, and I lived there for a while, and they— it's not like this huge slab of meat, it's mostly a side dish on my plate.

The garnish, you know. Yeah, when I'm criticizing Grain Brain, people saying, oh, it's a meat-heavy diet, you're eating meat like Atkins said, and all that. And it's not. The plate is filled with colorful, above-ground, nutrient-dense vegetables that have lots of fiber, and maybe the size of a deck of cards if you're going to have meat.

Exactly. So it's like your plate is mostly— I always say your plate is mostly vegetables, and, you know, maybe sort of animal protein as a condiment. And then by calories ends up being mostly fat because you're putting olive oil and other fats in your food. So that's really what I say I have a fat shake for breakfast, and I have a fat salad. Fat shake is almonds and walnuts, chia seeds, hemp seeds, coconut butter, almond butter, coconut milk, berries. That's my fat shake. Then I have a fat salad. I have arugula, but then I put a can of wild salmon with omega-3s, pumpkin seeds with fat, avocados with fat, and then more olive oil. I have fat on fat on fat on fat. That's my lunch. The same thing for dinner. I have olive oil on my vegetables.

Those cans of— of wild salmon travel very well, along with avocados and hard-boiled eggs.

There you go.

You should know. Eggs, you're pretty much in favor of eggs as well?

Yeah, I think, you know, there's just a lot of research that shows that they're not an issue. In fact, I just read a study that was done, a longitudinal study from Finland, where they looked at egg consumption over, I think, 21 years and 1,000 people, and there was no risk of people who ate 1 egg a day in heart disease. One, eggs don't really increase your cholesterol, even though it has cholesterol. So we had 25 or 35 years of eggs being the demon, and everybody's suffering from egg white omelets. And now, like, even the U.S. Dietary Guidelines says, oops, we got it wrong. And every other major country's guidelines do not have a limit on cholesterol in the diet. So I think that's an issue. I think eggs also are a great source. It's probably Nature's perfect food, not milk, because it's full of protein, it's full of the good fats, it's full of choline for your brain that you know, it's full of B vitamins, it's full of vitamin A. It has so many nutrients in it because it's really a source of a whole new life, and especially if it's a farm egg and not this factory-farmed egg where you can break the shell just by touching it and it's a pale yellow yolk. You want something that's really a hearty egg.

You know, I'm wondering why we don't eat the eggshells. We should start looking at recipes and actually Incorporate the eggshell. Why not? Especially, you know, it's covered with good bacteria. That's why it doesn't have to be refrigerated.

Don't wash it. Don't wash it, right? That's gone a little far for me, you know.

We have to have this disclaimer for that one.

Can I clean the chicken shit off the egg? Is that okay?

Mark, you call olive oil liquid gold. Why do you do that?

I mean, olive oil is an amazing substance that is not just monounsaturated fat, which is apparently good for us. It also has, by the way, 20% saturated fat. People think, oh, olive oil is healthy. It's omega-9 monounsaturated fat, but it's actually 20% saturated fat. If saturated fat is so bad, why isn't olive oil bad? They've done some amazing studies. The recent one, which is one of the most important studies in nutrition, which was a large randomized controlled trial, which are hard to do, looking at heart disease and fat, and the group that had the more fat, olive oil, a liter of olive oil a week— I mean, they gave you a liter of olive oil. They're like, I want you to have a liter of olive oil every week. And a handful, or a handful of nuts, 30 grams of nuts, they had far greater reductions in heart disease than the other group that didn't have the oil.

And dementia risk and breast cancer risk.

Yeah, and weight and diabetes, everything got better. So that was impressive to me. And then— excuse me— that was really impressive to me. And then what was even more impressive is that olive oil is not just oil, it's also full of phytochemicals. Polyphenols and squalenes and all sorts of things that are incredibly effective. I mentioned the effect, for example, on reversing the damage from meat and TMAO by putting olive oil with your meat because it changes the structure of the chemical in a way that protects you. So I think it's such a powerful substance and it tastes so great, right? It's just— and you want the dark extra virgin olive oil. There's a lot of imposter oils out there.

That's for sure. I mean, there is, you know, there's a statement that up to 70% of the extra virgin olive oil imported from Italy is nothing of the sort. It's basically chlorophyll added to either safflower oil or other type of oil or sunflower oil, and people don't know the difference. But you can taste that little bite of fresh olive oil.

Yeah, it's got that little bitter tang to it. It's good. I love olive oil. I use it liberally. I use it in my cooking, and I pour it over everything. I don't worry about it. I think that's where I get a lot of my calories, from olive oil, avocados, nuts, and seeds. That's probably where I get the bulk of my fat calories.

Well, I will say, as you're saying, this is the type of diet that you and I maintain. Truth be known, I had a cardiac stress test today at age 61, and I got my heart rate up. I was at 167 on the incline treadmill, and the cardiologist came in.

Amazing.

How are you feeling? I said, I'm feeling great. Let's push this thing.

I know. I have one of those heart rate monitors when I ride my bike, and I get up to like 178, riding right up the hills. It's great.

I'm with you. Listen, thanks for the interview today, and all the best with respect to the new book. We'll show that as we close this. Good to see you, Mark, and I hope you come down and visit.

I think I will. Anybody can check out the book at eatfatgetthin.com. I have a 45-minute Q&A that people can listen to. You get a free sneak preview of the book, and it's just a great resource for people to understand what to do.

Another thing I'll say about the book is there's so many little clinical vignettes in there that are really helpful, and a lot of comments from, obviously, your patients that are really helpful to read. That was really nice.

Yeah, it's true. There's a plan in there. It's not just a bunch of science. It's a 21-day plan that I put 1,000 people through, and they lost weight. They had improvements in all their numbers, but what was really impressive to me was that there was a 68% reduction In all symptoms from all diseases. We used to use in our practice called the MSQ, which is the symptom score. I mean, that's just an amazing change in how people feel. So it's not just about weight loss or heart disease, it's really about changing everything.

Well, fantastic. Okay, Mark, all the best, and I hope to see you soon.

Thanks, David. I'll see you soon.

Bye-bye. Well, that was a terrific interview. Mark really sets us straight in terms of all of the issues going on surrounding fat About what we were told over the years about fat being bad for us. Terrific book, Eat Fat, Get Thin. Sounds like a paradox, but it is not. It's a terrific book, and I hope you'll check it out. Hope you enjoyed the program. I'm Dr. David Perlmutter. Thank you.