Doctor Explains NEW SCIENCE Of Using FOOD AS MEDICINE | Dr. William Li

Science is giving us the answer to those questions that patients want to have, food and medicine, not food versus medicine. There are foods that actually can lower inflammation.

Tell us, what are your top recommendations for people who want to get started to kind of activate their biology through food as medicine?

You know, there's three things that I always tell people that are super easy to do. And again, it has to do with the biology and understanding your body. First, you want to kind of unburden your body's biology, let your health defenses work for you. So you want to cut down the things that actually kind of sit on or kind of squelch your body's defenses. Like let's start with a clear, clean playing field. So, you know, start to cut off things like sodas and ultra processed foods and lots of processed meats, things like that. It unloads your body and allows your body, it's kind of like taking all the dirty laundry off the floor. Yeah. And let's start with a clean room, number one. Number two, what I think is that, you know, find foods that you love that are healthy for your health defenses. And that's one of the things that I did in my book is to create lots of tables and charts. I tell people, you know, if you have my book and you flip open to the tables, take out a Sharpie, okay? And literally start circling foods that you already love. This is not hard to do. It's super easy. It could be a tomato, it could be bok choy, it could be a mushroom, it could be whatever it is. Start circling it. And I tell people, take a picture of it with your cell phone because the thing is make it easy for you to remember what you love that's already good for you. You know, like that's the key thing. Start with things that are easy that you already love. And then the third thing that's really important is to be physically active because no matter what you eat, if you're sitting around like a lump, your body is going to be very unhappy about that. So physical activity eating things that you love, and then just taking a laundry off the floor, unburden your body, unpack that body, have a clean start. Those are three really simple things to start with.

We don't think of the diversity in all these, I always say eat weird food. The more weird it is probably the better it is for you. And many cultures incorporate all sorts of foods, but 60% of our diet comes from three crops and the rest comes from 12. And we used to eat 800 species of plants. and, and, you know, there's, there's, it's ridiculous. Like, we need to need to be actually having a way more diverse diets, way more strange vegetables, things that we're not used to eating.

And we also need to think about foods that are sometimes regarded as snacks, as important main components to our diet. So we're kind of, we can sort of deconstruct this idea. You have to have three square meals a day, breakfast, lunch and dinner, and they have to be a particular way. You need an entree, you need an appetizer, like, I think that, you know, let's appreciate food for what it does for our body. We feel like we can feel the benefits. You know, I always talk about this incredible study that was done by mainstream oncologists, about 14 medical center cancer centers, where they were looking at 826 people with stage three colorectal cancer. This is very advanced cancer, getting surgery and chemotherapy. and they followed these people out and they just wanted to see how well they did. That's a very reasonable thing for oncologists to do, just to look at their own tracker to see who did better. Now, every oncologist will tell you that, you know, some patients do better than others, you know, and when you ask them why, they don't always know. Well, so in this particular research study, which was presented at the American Society of Clinical Oncology, they actually did one thing that most oncologists don't do, which is to ask what did they eat and then use statistics to figure out if they ate what they ate. I mean, look, I always ask my patients what they eat because, you know, it's when you do a history in a physical like that matters, right? So anyway, they found- well, it not.

Only matters, it's probably the most in question, important question we have to ask as doctors that we never ask.

Exactly. I mean, and that's where I think that we're at an inflection point in the whole training of doctors, the next young generation of people going to medical school, they themselves are beginning to have a more they're more in touch with healthy eating themselves. And I think that's actually the only hope we have of being able to change the system from the inside out. But so in this study of 826 patients, they actually found the people who did best were those who ate two one ounce servings of tree nuts a week. And they wound up having a 57% improvement in survival when they followed them over six years. Wow. And so this is a meaningful improvement.

Basically two handfuls of nuts a week, basically.

And like one ounce of tree nuts. So one of these servings is like seven whole walnuts, right? So it's 14 half pieces. Or it could be macadamias, or it could be almonds, or it could be cons. Diversity matters. But now we actually can understand what it's actually doing because you've got healthy oils and healthy fats and the nuts. You've got some bioactives, for example, walnuts have a natural chemical that is in there that actually kills colon cancer stem cells, which is important for colon cancer patients for long-term outcomes. And, that's just got a huge amount of dietary fiber. And, we know the fiber that we eat, it goes all the way down to feed our gut microbiome, our gut bacteria when we feed them. It's like putting flakes in a goldfish for your goldfish. Our gut microbiome thanks us for feeding them properly by producing short-chain fatty acids. This is another metabolite within our body that our bacteria make. And, those short-chain fatty acids lower inflammation, they boost our immune system, they help us heal all those things that cancer patients need.

And, they turn off cancer genes. The P53 oncogene, butyrate actually shuts that off.

All these things are so at the scientific level, They make sense. And if you disguise the fact it was a tree nut that was doing this, and you gave it an experimental drug name, investors would go after it. And here it is, Mother Nature's already given us the greatest return on investment we can imagine, which is that something that is, these are medicines that are hidden in plain sight in our pantry.

I think the real challenge is that people don't really get what food is. Most people understand they need to eat to live and they need to actually have the ability to choose foods that are nourishing and have not too many calories. But people don't understand the power locked in the kingdom of plants and even animals that are medicinal. True, true drugs in the sense of pharmacologic activity. And, and as I began to think about this science years ago when I was, when I was studying functional medicine, learning about food is medicine. I'm like, what does that mean? And I began to look at the biochemistry and biology and the pathways and how these plant compounds somehow know to bind to specific receptors in our body. It doesn't even make sense. Like, it makes sense that you have, you know, testosterone binding to a testosterone receptor, insulin binding to an insulin receptor in the body. But why in the heck would we have a broccoli receptor or a seaweed receptor. And yet the body has co-evolved with these compounds that we don't think of as essential, but I think of them as conditionally essential. You're not necessarily going to get a deficiency disease, but you're going to get a chronic disease if you don't eat them. And there's massively protective foods. And we were chatting earlier before the podcast that right now in science, and it's advancing so fast that we are understanding the mechanisms by which food actually has its action and how we can use it in a pharmacological way. It's not like, oh, just eat healthy. There are, just like there are thousands of drugs, there are thousands of molecules in food, and we can use those in very specific targeted ways to do different things in the body to create health or if we eat the wrong things to create disease. So you're this extraordinary scientist. You've been published in all the major medical journals at Harvard, Dartmouth, and Tufts. and somehow you come back to this simple notion that Hippocrates said 5,000 or 6,000 years ago, let food be thy medicine and medicine be thy food. What made you take that left turn, or maybe it was a straight ahead and every elbow else is going left? And how do you sort of begin to sort of unpack this notion that was so critical for you to understand that you could eat to beat disease?

Yeah, well, so Mark, like yourself, you know, as an MD, we're trained to identify diseases, diagnose diseases, and write prescriptions and send patients to specialists to take care of the disease. But we all know that the ways that we have been trained in medicine fall short of what it is that patients really seek. And if you've ever been a patient yourself, you certainly know what we want is really to be healthy and to be well. It's okay to get sick once in a while, but if you are, you wanna kind of bounce back. And so that led me as an internal medicine doctor to ask the question that nobody in medical school ever taught me, which is, what is health? Health is not just the absence of disease. That's an extremely unsatisfying definition. The absence of something, like, what's a good day? It's the absence of rain. That doesn't make any sense, you know? So you want to actually have a definition. And the working definition that I came to emerged out of 25 years that I had involved with drug development. I'm still doing it, but the idea with drug development is that we have to understand the body inside and out. We have to identify those molecular pathways, those receptors, the Achilles heel of disease. Well, turn that inside up, up in that idea. You still need to know what the mechanisms are and the receptors are, but rather than looking at the Achilles heel of disease, Let's take a look at the struts that support the infrastructure that support health. And if you take a look at everything that is unpharmaceutical with a pH, you wind up actually with pharmaceutical with an F, which is why I love being on the doctor's pharmacy.

Right, right.

So look, I mean, like you and I have had many of these conversations before. And for me, I've been involved with developing treatments that help to control the blood supply of cancers and blindness in the eye. I've been involved with diabetes treatments for complications like chronic wounds and cell therapies and gene therapies to treat these really ambitious diseases that we don't have successful cures for yet. Along the way, what I realized is by looking at the going back and walking that path that I was on, that these same pathways, same receptors that, you know, drugs have a very tall reach for and most of them haven't actually climbed up the ladder yet. Mother Nature beat us to the punch. There are foods that already hit these receptors and usually not one at a time like we do with pharmaceuticals. Mother Nature actually basically puts a Gatling gun of these natural biochemicals that activate our health. So treating disease, you send a heat-seeking missile in. But activating health, you basically take this, you know, this cluster of incredibly, you know, wonderful blooming, health blooming molecules to be able to make our bodies do what they want to do.

It's sort of like a shotgun versus a sniper's rifle kind of. Right. But it actually, you know, what you said was so profound, I want to highlight it because most people might have missed it. What you said is that these pharmacological targets are actually embedded in our biology. They weren't designed for drugs. They were designed for our internal metabolic processes, but also to work in this coevolutionary way with plants. And then with animals that eat the plants. This is a whole another conversation, which is kind of fascinating about how we now know their activated metabolites and biochemical compounds in meat and milk from animals that eat a wide diversity of forage. So we're now learning that there are actually phytochemical compounds in animal foods. So it's not just plants where you can get it. And they may be even better for you. And I think that the concept of these compounds as acting on key aspects of our biology that are designed to create health is a really radical idea. And often people don't understand that these molecules were not created by the plants for us. They're their own defense mechanisms. They're their communication systems. They're there to attract pollinators. They're there to attract seed collector. I mean, there's a reason nature does this. They're there to communicate messages to the neighboring plants, to ward our predators. I mean, plants have 20 different senses, which is just remarkable to me. And these plant compounds, we're really using them because our biology is lazy and is only doing what it absolutely has to do. And so we're gonna borrow, like we get vitamin C from food, we borrow these phytochemicals to regulate key processes in our body from the immune function to the microbiome's health, the detoxification, the hormonal regulation, to our brain chemistry. And what you're talking about, and this is so important, William, you're talking about is taking food in a different context to create health. That most medicine is about trying to push down or shut down or block or interfere with some pathway to mitigate disease, not to cure it usually, right? Unless we have an antibiotic, but even that doesn't always work. And so we really have a whole different framework now about how to use food as medicine. It's not some theoretical concept. It's actually a scientific proven model of what to do to actually activate healing systems in the body.

Yeah. And, you know, honestly, this is actually how medicine was practiced back in the days of these ancient food cultures. I mean, I know that you have, like me, a great affinity for the Mediterranean and Asia. Both of us share, you know, lots of travels in that area. And you go back to 3, 000 years ago, and you go back to Hippocrates, or you go back to Confucius. and the people who actually wrote the first kind of tomes relating to health and medicine. Look, people cared about health going way back, but they didn't have pharmaceuticals. A lot of people don't understand how recently pharmaceuticals actually were. Before, all we had was the material around us, and everybody knew inherently stuff that you eat, that there are stuff that you eat that your body doesn't agree with. It's going to make you sick, right? A great example is just like poisonous mushroom in the woods. People learned how to actually avoid those. Well, somehow we've lost the defensive mechanism to avoid the poisonous things on the grocery shelves, yet we could recognize that, you know, deadly ring mushroom, blue mushroom in the woods. And I think what we're trying to do now is regain our own natural instincts. So they've always been with us. We're just kind of bringing it to the forefront. And the one thing that I think is new is we are bringing some really deep science, which is where I come from. I'm a vascular biologist. You know, the science is actually helping to illuminate a new depth of understanding. It's not just a what, but it's the whys. Yeah.

So tell us down, go down the rabbit hole a little bit of, of what some of the biggest discoveries have been of how food modulates our healing systems and how it actually helps us create health.

Yeah, well, look, when, you know, when I set out to study food as medicine, the things that I reached for was what I knew was proven in the pharmaceutical world. We know that your blood supply is important. Think about what cardiologists spend all this time doing, trying to get better blood flow, or in oncology for cancer treatments, they're trying to cut off the blood supply. to cancers. And so with like, so that was one of the things that I thought, well, maybe let's see what food does. So throwing food and food extracts and food bioactives into the same systems used to develop medicines used by cardiologists and oncologists yielded really like a whole new playbook of how to actually use foods to help improve our circulation, which happens to be one of our body's health defenses, which is what I write about in Eat to Beat Disease. What I actually say is that when it comes to food and health, it's not just about the food. food. It's about how our body responds to what you put it in. That goes to stem cells, that goes to our microbiome, it goes to our DNA repair mechanisms, and it also goes to our immune system, which is both, it's a double-edged sword. You've got the inflammatory side, you've got the, you know, defense fighting the defensive side as well. And, and so when I think about how Foods benefit us, I try to insert that lens into the thinking process to say, all right, so which of our health defenses does any particular food activate?

And give us some examples of how a particular food will activate a particular defense system and what those defense systems are. 'Cause I think it's important, you're one of the few doctors out there. I mean, I just had a conversation with Andy Weil yesterday. He talked about the body's own healing systems in a very kind of high level. But you go really granular and you're one of the food doctors to talk about how the body has its own healing mechanisms and that we're not doing enough to activate those healing mechanisms. We all know that we have that if we cut our skin, it heals, right? How does that happen? It's not a miracle, it's biology. And that doesn't happen only on the outside, it happens on the inside. So how do we activate our healing systems? What are those healing systems and how do specific foods activate different healing systems?

Yeah, well, okay, so let's follow a piece of food that we're going to put in our mouth, right? So we're chewing it up. Guess what? Our food actually interacts with the healthy gut bacteria that lives in part on our tongue. So our tongue has healthy gut bacteria as well. The gut starts in the mouth and it goes all the way to the anus. And so when we eat foods like a beet, for example, or a piece of spinach, and we're chewing and enjoying the beet, It turns out that the nitrogen that the plant naturally absorbed in the soil gets converted by our gut microbiome that live in the little recesses of our tongue. So think about it. You get up in the morning and you're brushing your tongue. Okay, now it'll grow back.

Okay. I don't do that.

I think it's supposed to who brushes their tongue? I don't know. But people actually use this like dentist gives you a brush. And they actually kill all the bacteria in your mouth. with the intent of actually preventing cavities. Well, look, if you have good healthy gut bacteria in your mouth, which is one of the body's health defense systems, it actually works for you. It doesn't work against you and it actually suppresses cavities by itself. So, eat a piece of spinach or beet, chew it up, the bacteria actually change the nitrogen into a form that when you swallow it gets absorbed in your stomach. We're still following the food along as of a chemical form that is nitric oxide. Now, nitric oxide suddenly is absorbed in the stomach in your blood vessels, carried by the circulation, which causes vasodilation. Now, your blood pressure falls. And why is that important? Because for every, I mean, hypertension, one of the big causes of stroke, for example, and for every single point, we can lower that top number in the blood pressure, you know, 140 over 90, We decrease our risk of stroke by 5%. Wow. So, it's meaningful. So, you know, a nitric oxide also has other benefits for our body as well. It actually calls another defense system, stem cells, to help us heal. So, the stem cells live in a bone marrow, have nitric oxide. Now they fly into the bloodstream like bees in a hive looking for organs to actually repair. So just eating a spinach or a beet, for example, will immediately help our cardiovascular system, help us our regeneration system, and also can help grow blood vessels that we need to heal. That's just one example of how we can track kind of like the, you know, it's like being a like a like a going on safari in Africa. You know, you're you're in a jeep with a camera and trying to follow follow on what's going on. And we're beginning to understand there's this, you know, incredible journey that happens in our body with foods that we eat and they activate our health defenses.

Yeah. One of the favorite things I love to talk about is how we've sort of lost our nutritional wisdom and historically we were attracted to the right foods. Now we're not because our brain chemistry hormones and our microbiome all been hijacked and are sending chaotic signals to our brain about what to eat. But historically, we crave the right things. And when you eat in a certain way, you don't actually look at food the same way. I mean, when you see, when I, I see processed food or I go buy a Starbucks and I see all the muffins, it doesn't look like food to me. I'm like, well, why would I eat that? It's like, I'm eating a rock. Like, it just, like, doesn't even interest me. And it's not because I'm depriving myself. It's because I've changed my nutritional wisdom in my innate biology to crave the right things. And, and what happens is when you, when you look at this phytochemical story, the flavors in our food come from these molecules. So actually the more flavorful a thing is naturally, not when you put all kinds of stuff on it, but naturally, actually the better it is for you and the more medicine is in the food.

Well, and you know, when you treat the food with medicines, like putting pesticides on foods, for example, you might make it look a little bit nicer. But in fact, you know, I always like to talk about this example. I used to be a skeptic about organic foods. And the reason is because there was so much marketing on there and I, you know, like telling me to have less something bad doesn't attract me. I want to know, like, I want a different reason. And so I started talking to horticulturalists and they told me something really important. They said, you know, that a plant like a strawberry or a coffee bean, when they're existing in the wild and the pests, the little bugs, insect nibble at their leaves and stems. Yeah, they produce more chemicals.

They produce more chemicals because they view.

The little nibbles as an injury. So in response, as a wound healing response, they create more ellagic acid in a strawberry or more chlorogenic acid in the coffee bean. And sure enough, When you actually put pesticides on a strawberry or a coffee, which is conventionally grown, you wind up, they don't need to make more of those chemicals. And so what you wind up having is something that looks like a coffee bean and something that looks like a strawberry, but it's actually relatively deficient in what Mother Nature would have otherwise served up that's actually good for our body. And so, you know, I started to change my mind more good as opposed to less bad.

Yeah, that's true.

Now that actually attracts me.

It's true. I think the other point to make on the back of that is that when we put these chemicals on the soil, it kills all the life in the soil. So when you till the soil, when you put fertilizer on it, when you pesticides, herbicides, it literally kills the microbiome of the soil. And the plants are in an intimate relationship with the microbiome of the soil. They're feeding the microbiome by bringing in carbon dioxide, turning that into metabolizable starch. And then in turn, those bacteria are helping the plant extract nutrients from the soil, minerals, vitamins, all kinds of stuff that the soil has that benefits the plant. So it's this mutualism that occurs that if, when we break that cycle, we end up, as we see now, with many of our fruits and vegetables having dramatically lower levels of nutrients than they did even 50 years ago. And that terrifies me because we're, these nutrients are not just kind of window dressing on our food. They're critical molecules that, that are, they call 'em vitamins. vital for life. That's what they have vitamins at the home. And that was the whole point of these things that you get sick and die if you didn't eat them. So, we're kind of a pandemic of that.

Well, and I totally agree because I think you and I were at a meeting once where we both heard there was like only 60 harvests left in topsoil in America. Just think about that. You can count that off with a family member on hands and fingers and toes. that is truly scary. And so I think that, you know, the greater, the more we're alert to the fact that if we want to take good care of ourselves, we don't want to get more complicated. We want to get more simple. We want to actually follow our body's instincts to eat those things that are more natural, that are less processed, that are plant-based and, you know, ultimately, you know, you were talking earlier about, you know, animals eating plants, you know, even these delicious seafoods, oily fish that people actually eat. At the end of the day, it's big fish eating smaller fish, eating smaller fish, eating plants. And, that's where the Omega-3s come from. Exactly.

It's algae, right? Exactly. Yeah, it's so true. I think, you know, the interesting thing that I'm learning about is that the animals left to their own devices, they'll eat three or four main crops or foods. but if they're free to eat and forage for a wide variety of plants, they might eat up to 50 or 100 different plants and they'll sample little bits of each one, kind of like taking their vitamins or their daily pharmaceutical drugs. And those animals, so if you take a feedlot cow, it takes an enormous amount of investment to keep it healthy. Antibiotics, hormones, all kinds of very aggressive measures because they're not eating their natural diet. and, and the molecules in there that we want aren't there. And there may be inflammatory molecules when you take a grass-fed cow better. But if it's only eating one or two kinds of grasses, that's not great. And, and, and they need extra support. Whereas regeneratively raised cows foraging on maybe a hundred different plants actually don't need medicines, donate antibiotics, don't get sick. If the plants are the right plants, they actually grow to their ideal weight as fast as feedlot cows and don't release as much methane. I mean, it's really fascinating when you get into the science of the biology of how much the interrelation between soil, plants, animals, and humans exists.

And, the concept of diversity, which you're talking about, is so important, right? Because we do want to protect the species and the diversity of species in our planet. But actually, this is how we're hardwired as well. we, our human body, loves diversity. Our gut microbiome wants to eat lots of different things. Our health defense systems, our five health defense systems, all crave different types of stimuli to activate them, to keep them kind of agile and active and in shape and working on our behalf. And here's, I think, the really good news for people that are watching this is that ancient cultures, ancient food cultures that revere treasured tasty foods, mostly plant-based foods actually understood this. And that's why so many of the foods from the Mediterranean or from Asia, if you go back and look at traditional foods, like, I mean, you and I talked about this before, this idea of Mediterranean cuisine, like there's a lot of unhealthy eating that goes on in modern Mediterranean countries today. We're talking about traditional eating patterns. Same thing in Asia. We're talking about going back to basics. And so, you know, we're, we're entering this era where we're, In a way, I think that we're all kind of shedding the artificial skin that we've grown over the last five decades. That what we are sold in media or in the supermarket is actually better for us. And when you shed your skin, you kind of get back to basics. The more authentic instincts that we have about what we should eat happen to also taste better as well.

It's so true. You know, I went to a Chinese doctor the other day and I had just to check up. I just wanted to get my pulse checked and get a tune up. And afterwards she sent me a prescription, which was after filling my pulse and seeing where I was out of balance, she said, oh, you need to build up your blood for this or that, the other thing. So she said, I should eat bison and beets and duck and liver and cuttlefish, avocados and black sesame seeds. And then she said, I should eat walnuts and almonds and woodier mushrooms and all mushrooms, olives, natto and seaweed. And of course, she said cherries, goji berries, mulberries, persimmon and then all this other Asian food like daikon, lotus root, burdock, mountain yam, sweet potatoes, soba noodles, oily fishes and so forth. And I was like, yeah, she's giving me a drug prescription because each one of these foods, and you probably could talk about each one of these foods for an hour in terms of what's in them. in terms of the, the way that foods and drugs work together, I think you, you, you, you're sort of bringing up a very interesting point here. I, I think there's a lot of conversation about, you know, drug interactions and how you shouldn't take certain things with certain, like people say, oh, don't have fish oil if you're on a blood thinner. And it's more negative, but it turns out that there's a lot of kind of power in combining food with medicines to activate the power of the medicines, but also to mitigate some of the effects and side effects of the medicine because they contain compounds that help to benefit.

Yeah, well, you know, so what is the first thing that doctors learn when they enter the clinical phase of medicine is that old adage, first do no harm. Well, I actually think that's the wrong priority. I think the first thing we should do is to deliver benefit. you know, and if you flip that around to first deliver benefit, all right, why are we thinking about the bad stuff when we can actually focus our minds on the good stuff? If you're going to first deliver benefit, you have to think about food. And this is where, you know, the reliance on the prescription pad that so many people encounter when they see their, you know, their average, their primary care doctor, I think every patient knows that there's something that's not being discussed. There's something that, you that is so important that isn't being part of the dialogue. Well, you know, I can tell you that my mind opened on food and medicine, not food versus medicine.

Yes.

Right. So you got these kind of extremists who are, you know, the guy that quit clinical medicine, they stand up on a soapbox, they wave a frond of kale, and they basically say, you know, eat this and everything will be cured. And I think that that is as wrong as somebody who only writes prescriptions.

Absolutely.

We all need to bring to do first do good, first deliver benefit. What we need to do is to think about all the tools in our toolbox we can give them. And so, you know, one of the studies that I thought was really interesting was performed done by the University of North Carolina, where they were taking young, healthy people who were just getting a flu vaccine, you know, winter time flu vaccine. And, and they wanted to see if if they gave them some food on top of that, it would make a difference in terms of how well their immune systems responded to the vaccine. So they actually took broccoli sprouts, baby three to four day old broccoli plants, which contained lots of sulforaphane. These are the natural biochemicals. A hundred sprout, broccoli sprouts contain a hundred times more sulforaphane than the grown up broccoli. And so you turn them into a shake. and they just gave them two cups of shake, two shakes to drink every day. Plus, they got the flu vaccine and they gave half of the people a placebo shake with no broccoli sprouts, right? Probably didn't taste very good. And then they measured that they swabbed their nose to measure the number of bacteria or viruses that were present, flu viruses. And then they did a blood test. So, this is just like you would do in a pharmaceutical trial. They took out blood and they measured their Natural Killer T cells, which is what your vaccines was doing. And then here's what they found. They found the people who had the flu vaccine plus the shake had 22 times more of the natural killer T cells. Wow.

Like just for people listening, that's 22,000% more. Like that's an insane result. Because, you know, we get excited in medicine when we see a 20% improvement or a 30% improvement. We're talking about a 22,000% improvement. There's no drugs that do that.

Right, and we think about how to make the medicine do its job better. Well, look, here's the difference between foods and medicines, and we're talking about making them work together. Medicines don't give you joy. They give you some effect that you hope to have. Foods can give you that effect and the joy as well. And then when you put them together, you're getting more effect, and you also get a little bit of the joy of life as well. And so that's one of the studies that I always refer to to say, you know, like we can't ignore food as medicine. And the other thing that I think that is, you know, I'm a cancer researcher. I've done a lot of cancer research over my career. And, you know, I've had cancer in my family. I talk about my mother who actually, you know, had all of her cancer successfully eliminated by immunotherapy, using her own immune system to get rid of it. And we had given her pomegranate juice, we'd given her other foods that actually help to grow good bacteria. Well, the latest study that I think is a jaw dropper was published in Nature Medicine. It was done by the MD Anderson Cancer Center, one of the top cancer centers in the world. Jim Ellison, who actually Ellison, who's actually one of the researchers, won the Nobel Prize for his work in immunotherapy. Yeah, that group is studying immune immune system, the microbiome, what you eat and cancer. It's sort of like the holy quadrinity of what we want to actually start to do in cancer research. So, here's what they found. They took 200 patients who had malignant melanoma, a deadly form of skin cancer. And, these patients were getting immunotherapy, a kind of infused immunotherapy that actually works when it works, it works great. The problem, only about 20% of people respond to this type of immunotherapy. So they wanted to find out what the difference between responders and non-responders were. And this is starting to be the pattern of the kind of research done in this field. They found that responders who benefited from an immune therapy that jack up your own immune system to go after the cancer. And therefore you do better, you, the cancer starts to go away and you live.

Yep.

Had one bacteria. that the ones who didn't respond didn't have. And that bacteria is Ruminococcus. Now, on a past podcast, I talked about Akkermansia. Well, Ruminococcus is starting to pop up as another significant player in the microbiome space. Now, I started to take note of Ruminococcus about a year and a half ago during the pandemic. People were studying, why did some people have more antiviral cytokines in their bloodstream if they weren't getting COVID. And it turned out that those people had more rhinococcus in their stool as well.

Wow. So here you are. Not only cancer, but also COVID.

Yeah. And so what was interesting is that in the study in China that found this during early days of COVID also asked what were these people eating? And in China, the study for the COVID study showed that the people with more rhinococcus and more interferon gamma, the natural virus killer, They were drinking more green and black tea, not just green tea but black tea. And they were having more omega-3 fatty acids, both from plant-based foods as well as seafood. Now, flip back over to the Japanese.

Food with sushi and green tea is a good thing.

Exactly, that's the carryout. The cancer study is much more sober because now we're talking about a different kind of life or death. and the surprise with this rumenococcus bacteria, now what they did is they actually asked the people what they were eating. And because the microbiome of course is strongly influenced by the food we eat, turns out that these people were eating many different, mostly plant-based foods with tons of dietary fiber if they were getting rumenococcus, if they were responding. And so then they began to calculate how much dietary fiber you would need to get in effect. And what they found, is that for every five grams per day of dietary fiber you ate, how much is five grams of dietary fiber? That's the average amount you'd get in a medium-sized pear. A pear a day would give you five grams. Lower.

By the way, the average American eats about eight grams a day, which is terrible.

But even five grams in this setting would actually lower the risk of tumor progression and lower mortality by 30%. So, now they calculated out if you actually had 20 grams, up to 20 grams of fiber, you really maxed out your ability to actually respond to a medicine, a cancer medicine. And so, every cancer patient always asks their oncologist, Hey, Doc, what should I eat? And oftentimes they say, just eat anything, go to Mickey D's or whatever.

Or they say, eat ice cream and.

Milkshakes and it's like terrible. We, you know, this is where science is. science is giving us the answer to those questions that patients want to have. And I think that this is what responsible doctors who are on, you know, who are current and who are forward going. This is where our society has to go. It's beginning to get those answers to be able to tell patients how they can help themselves.

Well, it's interesting. Well, you know, we talk about dietary fiber, but that's a very big bucket. there's soluble fiber, insoluble fiber, prebiotic fibers. Did it matter? And how did they figure that out?

You know, they were looking at mostly fruits and vegetables, and, and they think these are mostly insoluble fibers or, sorry, insoluble fibers that were in this study. And so this is now the next layer. So real, real scientific research doesn't deliver all the answers in one fell swoop. You kind of go back and you, you know, you get back into the batter's box and you hit another one out. in terms of research. And so that's really, I think, a place to watch MD Anderson looking at this work that they're doing on the microbiome and diet and looking at the response to cancer therapy. So, I mean, look, these kinds of efforts are going on all around the world, but they underscore this idea that the food that we eat does matter. And it can matter a lot to help the medicines that have been the product of all this research to help get the result that we want to patients. So first, deliver benefit. And I think that that's something that is really important for doctors to hear.

So I think if this is true, and I clearly believe it is, and you believe it is, and I don't even know what's a belief, 'cause it's scientifically proven, and I can believe in God or not, but that's hard to prove scientifically, or how many angels dance on the head of a pin, we can argue that all day, but this is science. And given that science, then, if food is medicine, how should doctors prescribe medicine? What's the dose, the amount, the frequency, and for what disease is? I mean, it's a whole new field of inquiry and it really requires a whole new curriculum for medical school that we haven't even come close to formulating. And your book was probably the closest curriculum there is to actually laying that out. So how do we get from here to there? Because right now we're here and in 10 years, where are we gonna be and how are we gonna get there?

Yeah, I know. I'm glad you brought up this whole issue of food dosing because if food is medicine, medicine always has a dose, right? So like as doctors, we're taught to write prescriptions. What is the name of the medicine? How much do you give? How often do you give it? And then what are we actually looking for? And so to do this, you know, for a drug, you design a clinical trial and you test different doses. There's a completely different way to come at this when it comes to food. and that is to look at the research studies that have been done. And we talked about a couple of them. And then to look at the result and then to calculate based on the result, you kind of work backwards to figure out where did we start from. So I like to talk about a study of 36,000 people. It was a health professional follow-up study that looked at men who were ultimately who are all men at risk for developing prostate cancer. And they wanted to find out for the people who didn't develop prostate cancer, what were they eating? And they had a hypothesis that lycopene in tomatoes might affect prostate cancer because it's antioxidant, it kills cancer cells, and it cuts off the blood supply feeding cancers. And so when they did the study, they found that men who ate two to three servings of cooked tomato. Now, what's in a serving? You can calculate this when you look at the study, it's a half cup serving size. So 2 to 3 half cups of cooked tomatoes. Now you even have a way of preparing the food over the course of a week. That's not asking a lot. 2 to 3 cups of half a cup of half cups of serving the tomatoes lowered the risk of prostate cancer by 29%. And so now we have an outcome. And again, I don't think it's reasonable for to ask people, patients, healthy people to go into that medical research to dive into it. But for those of us who are doctors and trained to do this, we have that ability. And so I think that, you know, you're absolutely right. What we need to do is to train up the ability for healthcare providers that patients are supposed to trust, to give them the tools to be able to actually go in and wade into that complicated stuff to make it simple for patients. So when somebody asked me about tomatoes and prostate cancer, I just say, look, you wanna have something with tomato sauce in it two to three times a week, and it only needs to be a half cup.

That's not a lot. Yeah, yeah. I had a patient once who did not wanna take any supplements. And she came to see me and she said, look, I know I need this much zinc and I need this much magnesium and I need this much bulgur gas and I need this much magnesium. And she said basically showed me, she's like, I need 17 pumpkin seeds and I need like 12 almonds and I need, I was like, wow. that's impressive because she literally did the research to find out what nutrients are in the food. Now, hopefully she was getting it from sources where actually the food she was buying had the nutrients that they're supposed to be in there, but it's really quite amazing. And I think, you know, William, I think that most doctors don't understand the power of food. And because, you know, if I, if I, if I said, oh, do I, do you have a headache, William? Okay, well, I'm a doctor. I'm gonna prescribe aspirin for you and you need to take 650 milligrams of aspirin. that will help your headache. But if I just gave you a milligram of aspirin, I would conclude that aspirin doesn't have anything to do with headaches. But we're not prescribing the right drug in the right dosage. And I think we don't see the outcomes that we can see us, such as reversing heart failure, cancer, diabetes, autoimmune diseases, chronic digestive problems, skin diseases, mood disorders. I mean, you just go on and on down the list. and it's like, wow, you know, we're, we're missing this entire pharmacology that is so critical. Years ago, I wrote an article called food is pharmacology, eating your medicine, basically based on this Chinese meal I had in a restaurant in Hong Kong that was like ginkgo nuts and Chinese wood ear mushrooms and this thing and that thing. And everything had its, like, medicinal properties. And Chinese folks have known this forever. In fact, the word for take your medicine is chrysalis, which means eat your medicine. Right. Which was the name of my PBS show that did really well. So I think they're onto something. I feel like it's so critical.

You know, I think, I think you're right. And, and, and here's something in real time I can tell you that I'm in the process of working on. And, and you're going to like this because this kind comes from one of your home-based institutions out of Ohio. So there was a study that did computational analysis, artificial intelligence to take a look at what medicines might be associated with lowering the risk of some serious disease like Alzheimer's disease. And so here is the Cleveland Clinic. They were taking a look at 7 million people's medical records and putting a computer program into mine and see like 1600 different kind of medicines that people are taking, all these different disease states that people are having and trying to figure out what was there any connection interconnection to the pattern at the genetic level. And what they found was truly amazing because at the end of the day and here's the punchline for the study, they found surprisingly that men who were taking Viagra sildenafil had a 69% decrease in the risk of developing Alzheimer's disease. Wow. Okay.

So more sex means less dementia or is it something else?

Clears your mind.

Well, actually, I read a study once that men live longer if they have more sex. The same is true for women, but they have to like it.

Well, so here's the thing. How is it that that Viagra, sildenafil, could actually be helpful for Alzheimer's disease. So, these researchers went back into the lab. So, sometimes we can take an observation, whether it's through dietary studies or through medicine studies, and go back into the lab and check it out. So, what they found actually with the Viagra, which produces nitric oxide, the same thing that spinach and beets actually help our body produce, actually stimulates regeneration and nerves will actually start to sprout new nerves. Okay. And it actually down regulates the gene that creates a protein called tau that builds up and clogs up your brain in Alzheimer's disease. And so now we have a going backwards to try to find an explanation for something that a computer helped us figure out now. And this is kind of like the wait for it moment. So, what I'm trying to do now is to figure out on the basis of the doses of Viagra that create nitric oxide. Can we then jump to a different silo to say, well, by aggregating this much nitric oxide, how much can spinach and beets create? Because then we can actually kind of do that, take out the pH for pharmacology and put the S, because they.

Have natural nitrates that get converted to nitric oxide in the body.

Exactly. And so now what we can actually do is to try to figure that out. And this is, I think, you know, the, the, those of us who are working at an advanced area of food as medicine are really trying to break open new frontiers by doing this kind of research. And what I would say is that it's kind of like mixed martial arts. You don't want to just use one style of fighting, one set of moves. You want to use every tool at your disposal in order to be able to get that match win that match.

Yeah, so true. And I think the exciting thing is we are starting to understand how to use medicine from foods in a more precise, deliberate way. And you mentioned the, you know, the 22,000 full percent increase in the benefit of eating certain foods and the flu effectiveness.

Broccoli sprouts.

Broccoli sprouts. I want to take a kind of a little bit of left turn, but not really because it relates to food and the immune system. And we, and some of the sort of discoveries you've made around COVID and long COVID, Right now, we know, for example, our friend Darshana Mazzafarian published an article from Tufts research that showed that 63% of cases of hospitalizations and deaths from COVID were because of poor diet, lack of protective foods, too much bad food. And so the question is, with our understanding now of COVID and now this post-COVID phenomena, what are we learning and what are you learning that may combine both nutrition and also pharmacology to help us reimagine our approach to preventing COVID, treating COVID, and actually dealing with what we call long COVID.

Yeah, I mean, it seems like we've been mired in COVID, in this pandemic, for a long time. And yet, when you really look at it, it's only been about three years or so that we've been kind of wrestling, arm wrestling with this thing. And in three years, we've learned a lot.

It's only two years, but it feels like three years.

Yeah, well, the thing is that we started with zero knowledge. And I think that's what's amazing. And to speak to your point about food is medicine, I remember distinctly staring out the window at the very beginning of the pandemic in March 2020, realizing that, you know, as a medical doctor, as a highly trained medical doctor that actually develops medicines, that here was a moment in human history where we have all this technology, all these drugs, all this knowledge, but we were confronted with a new disease for which we had nothing. Hospitals couldn't offer anything, doctors couldn't offer anything, pharmaceutical companies couldn't offer anything, and it was just us. And the only thing that we all had to do as humans was to go out and get our food and bring it back home and to prepare it. And so this was that moment that I started to realize, like, okay, there is a real important mission for what it is that you do, Mark, and what I do, and which is to get that message out. People need to understand in when, you know, we could be confronted with something new around the next corner. And at the end of the day, we have the agency as individuals to make better choices on our own body's behalf for immunity. And so I will tell you the things that I started to look at. Now, you know, I've also been involved with sort of like the vaccines and antivirals and all that fancy stuff that is in the realm of pharma for COVID. But here's some basic things that everyone should know. What does this coronavirus do when you have COVID? It causes massive inflammation in your body. Yeah. There are foods that actually can lower inflammation. I mean, simple foods containing vitamin C, lower inflammation, you know? strawberries, guava, tomatoes, red bell peppers. These are the kind of colorful foods that actually can begin addressing some of those things. We also know that, you know, people who had vitamin D deficiencies actually were more vulnerable to actually developing COVID or becoming infected with COVID and getting sick. Well, you know, mushrooms are a good source of vitamin D. And if you actually take a mushroom and slice it and expose it to sunlight, in the window sill before you eat it, it'll act, the mushroom will actually make more.

Vitamin D. So, give your mushroom a suntan.

Not in a suntanning salon, but, and don't rub any olive oil until you're.

Ready to cook it. I love that. No sunblock.

No sunblock.

But, you know, the porcini mushrooms are the most potent sources of vitamin D. They're hard to find. I, I only had fresh porcini mushrooms.

When I go to Italy. well, the dried ones actually also have, are also still good because not only do they taste great, they have a lot of dietary fiber. And if you take a look at dried porcini mushrooms, that, you know, there's some caps of the mushrooms which are good, but the stems actually have more of that soluble fiber than the caps do. So, you, you know, you're getting, again, go back to ancient food cultures, you know, porcini mushrooms, why should you eat them? Because they taste great. And then let's talk about the, let's talk about the other reasons that are equally important. But, you know, so you can actually supplement, you know, get use food to get your vitamin D levels up. You can actually have citrus and other foods to lower your inflammation. And then the other thing we're beginning to realize too, that what this virus does to your body is it actually does two things that need to be addressed. And this is relevant to long COVID. Yeah. You know, because so many, most people actually recover from COVID There's millions of people that have recovered from COVID But they're walking around, I believe, and the research actually shows potentially as time bombs because even when the virus has left the body, it may not have left, it may have actually stayed hidden inside your body. We believe that people who continue to suffer from long COVID, which is this odd syndrome, more than a hundred symptoms that can't be easily explained, They can arise, you know, they stick around for and they can even appear a month after you recover from COVID They can last for months or years. They can be mild or crippling. We don't understand too much about it, but there are some common themes. Number one, it seems like there's chronic inflammation that's going on in the body. We think the chronic inflammation is due to autoantibodies that the virus stimulates. So this is like COVID kind of like tries to give you lupus by triggering autoantibodies. And then the third thing we do know that COVID does is it's very sneaky. It gets into your blood vessels and damages, scrapes up your blood vessels cells, the endothelial cells, and damages them. Now, foods can heal endothelium. The Mediterranean diet has been studied with the cardioprev study to improve endothelial health. Dark chocolate can improve endothelial health. these are some of the foods that we need to think about. Oh, spinach and beets with natural nitrates and bok choy can improve endothelial health. These are important things to think about.

That's what I'm having for dinner, beets and bok choy.

There you go. Hydroxytyrosol, which is actually one of the highest level polyphenols that are found in olives and in olive oil, actually has been shown to interfere with the binding of the SARS-CoV-2 coronavirus with human cells. And so, you know, again, when you stop thinking first about the food and start thinking about the mechanisms, those bio, the biology of health and disease, it allows us to kind of step back and look at them, look at what's going on and say, all right, if that's what's going on, how do we start to choose the foods to be able to put into play? And I think this is where we are in 2022. We have an opportunity now to take a look at all the science that's been done, all the research has been done, and to realize that at the end of the day, the answers really are still, there's a lot of answers that are still in the hands of people and they involve food. Yes, amazing. So, I know you've been involved with.

Thinking beyond food because you sort of have an inquisitive mind. You're the doctor that everybody goes to when no one else can figure out what's wrong with them and you come up with the solutions. You're kind of a medical detective, Sherlock Holmes, Dr. House kind of guy. and you're in that process of looking at what is our current pharmacology and what within that can help us to address this whole phenomenon of post-COVID? And we talked about things a little earlier before the podcast. Could you share what you're discovering, what you're finding, what you're advising your patients to do?

Yeah, well, I mean, you know, some of the basic things that I think very current doctors who are keeping up with the latest research you know, this is where we are at the taping of this podcast and things may change because that's the other thing is that things are things are changing have been changing very quickly over the last two years. But here's what we have that we didn't have two years ago. We have vaccines and then but people still get COVID when they have got vaccines. They just they just don't get they just don't go to the hospital and die. But then when you have it, you don't want to have the autoimmune response. You don't want to actually have the vascular damage. So what can you do to to to get rid of the virus? All these antivirals like Paxlovid, which was just approved and authorized by the FDA not too many months ago, was specifically designed to intercept the coronavirus and knock it out, decrease the ability of the coronavirus. It's literally the Z pack for COVID. And so that's now available. And then the question is, if you really wanted to think as a prescribing doctor, what you would do, what I've been telling people is that we do know that COVID, mild or severe, causes a lot of inflammation in your body. So, in addition to the food and supplements, take the things, the cold medicines that actually make you feel better. Like if you have muscle aches or headaches or fever, the high dose non-steroidal anti-inflammatories can be beneficial. And so, I believe is that if you've got COVID, even if you don't have a lot of symptoms, it's still worth it to take high dose anti-inflammatories to lower body inflammation as much as you can. So, like if you take an ibuprofen, you know, what's a high dose is like 800 milligrams. If you take that at the max that you can actually take it for a few days, that will actually help you, your body recover better.

Yeah.

Secondly, if you take a look going further down the stream and you, after you take five days of your Z-pack for COVID, okay, when at the end of that, what should you be doing? We don't know. who actually develops those autoantibodies, but I'm sure concerned about them. Like in pediatric and kids who have had COVID, there's a twofold incidence of developing type 1 and type 2 diabetes. They found this in people who didn't even get very sick. Autoantibodies are one explanation. So what could you do? And again, sort of as a thinking man's doctor to come up with a MacGyver solution for that, look at low dose prednisone, a short course that won't set down your adrenals. Probably a good way to just kind of stamp out the fire. It's kind of like pouring water at the, at the end of the evening after your campfire before you go into the tent. Go ahead and put a bucket of water on that. So a few days of low dose prednisone. How many days?

How much is a low dose?

You know, at, like, two and a half grams. Like, I can't get medical device on the show, obviously, but you're like, Two and a half milligrams is a baby dose. You don't need to actually kind of titrate off of that. I would say until we think the virus goes away, which is like day 10 or maybe even a little bit beyond that. And then the other thing that I think for people, I've seen such horrible vascular damage from COVID and recently in Nature Medicine was a paper that looked at 11 from a study from the Veterans Administration Medical Center in St. Louis. They looked at 11.5 million People. Okay, that's a monster study. And they found that, and they controlled it for people who didn't have COVID, had COVID historical, and they found that there were elevated risk of heart attack by 75% of stroke by 85%, twofold increase of cardiac arrest one year later, and lots of atrial fibrillation and ventricular fibrillation, lots of rhythm problems that were in the 70s and 80% higher. and 11.5 million people. And so, you know, it's driving cardiologists crazy because, you know, they're suddenly seeing patients that shouldn't have these problems, suddenly come up with these problems post-COVID. And so one explanation, and we're not 100% sure of this, but I'm pretty sure is it's vascular damage, damage to the blood vessels, feeding the heart in the heart, feeding the nerves to the heart and the brain that are causing all these kinds of problems. And so what can you do to repair blood vessels. And, this is where going back into the food research, we knew that dark chocolate cacao actually is endothelial repair. We know the Mediterranean diet can actually do it. We talked a little bit about beets, beets and spinach and bok choy as actually ways of actually inducing nitric oxide. Let's go back to that Cleveland Clinic study. You got sildenafill, Viagra, that can be given at low doses. And, so this is when I went back in my research and I'm still doing it right now. So, this is not medical advice, but it's medical research. and you and I are having a conversation about how researchers who are doctors think about this. Yes. In pediatrics, there are conditions involving high blood pressure and damage to the blood vessels in the lung, pulmonary arterial hypertension in pediatric patients, and they are using Viagra, low dose Viagra to treat kids to heal up their blood vessels. So, an interesting research question that's easy to put into practice is to say, well, can that actually be one of the ways to repair blood vessels as well? Yeah. Again, you know, it's sort of, I think the whole, this whole conversation we've been having is really about how important it is to activate the potential of the body for healing.

Yeah, it's so important, William. And I think the, the era we're going to be emerging into is, is really a deep understanding of health. You and I went to medical school. and learned about disease, we learned about zero when it came to health, and even less when it came to nutrition. And what we're now entering is an era where we're really discovering the underlying biological systems that drive both disease and health and how to work with those systems. And the biggest thing that drives transformation in those systems, something that we do every day if we're lucky, most of us on the planet anyway, is eat. And food is the biggest signal transduction system, cell messenger system that we interact with. Literally, we're eating thousands and thousands of foreign compounds that are all somehow tantalizingly floating around in our blood, doing exactly what they were supposed to do, keeping us alive, optimizing our immune system, fixing our microbiome, helping us detox foods, helping balance our hormones, improve our brain chemistry, help our mitochondria function better, build our tissues and structure. All of it is really derived from the raw materials of food and the quality matters. And just like, you know, the study you talked about, depending on where the food's grown, how it's grown, how it's stored, transport, shipped, all of that, how it's cooked, all that matters. And I think now that we're beginning to understand this from a scientific point of view, it's no longer sort of.

A platitude to say that food is medicine, but it literally is medicine. Right. Well, I mean, and I think that, again, we have just come through this really, really dark tunnel that we're starting to really get back to see the light that again, you know, this medicine, this form of medicine, food is something that doctors are not prescribing for us because they don't need to. It's something that we can actually do for ourselves. This is the power, the agency of actually food. It's something that we can take control of our own lives. And that's, you know, one of the things that happened to me personally is that as I was staring out the window, realizing that pharmaceuticals were not able to play a role at the very beginning of the pandemic, I started realizing that the messages that we deliver, you and I and many other people that work in our field out there is an incredibly important thing for us to be able to share with the community.

If you love that last video, you're gonna love the next one. Check it out here. I would say that the foods that drive these cardiometabolic diseases are foods that.

Disrupt our cells from doing what they need to do to function optimally and that then lead to insulin resistance, the physiologic process.