Why the Vegan Twin Study Got it Wrong

Coming up on this week's episode of the Doctor's Pharmacy.

If you put people on a vegan diet, take them off a standard American ultra processed diet and put them on a whole foods vegan diet, they're going to do better for sure in the short run. The devil is in the details. Will going plant based solve our health and climate problems? Or is the real problem how we're farming, how we're raising animals, how we're doing agriculture, and is it industrialized agriculture.

Including factory farming of animals and monocrops is the problem?

Yes. Hey everyone, it's Dr. Mark.

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Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman, and this is a place for conversations that matter. And today we're going to talk about the vegan twin study that got so much attention, so much news, and was so messy in so many ways that we're going to break down and help you understand what the science says, what it doesn't, and what the take homes are and what they aren't. And it's not what you read in the headlines. This is one of our Help Fight series where we dive deep into topics of science and help you understand what's really going on underneath the headlines and reading between the lines. So today we're zooming in on this groundbreaking study that comes from Stanford University and was recently published in JAMA Open, which is a major medical journal. So Stanford, JAMA sounds great. Okay, it's got to be real and right. Not so fast, right? The researchers basically put a vegan diet head to head with an omnivore diet, for 22 pairs of identical twins to see which one comes out on top as the best diet, vegan or omnivore. But as we'll soon see, the whole study and the conclusions were not as straightforward as they seemed. Now, the buzz around the study was huge, right? It sparked immense conversations anywhere from social media to professional circles. And, in adding to all this excitement, the research forms the basis of this new documentary called you are what you eat, a twin experiment. Wow, okay, so I've never seen before a study that was done and at the same time a documentary was filmed about the study as it was being done, which I think was really interesting and makes you wonder about the whole thing. We'll get into what the messy details of that all are, so stay tuned for this. Who knows, maybe you've watched the documentary already, maybe you are convinced that the vegan diet is better and let's talk about what that science shows and what it doesn't. I mean, it's kind of absurd to do a documentary while doing a study, unless you know the conclusions in advance, right? Study design is everything, and you can manipulate science by stacking the deck in favor of the outcome you want. Now, today our journey takes us through the intricate details of the study. We'll dissect exactly what the twins ate on their diet plans, the effects on their cholesterol levels and other blood biomarkers, and other important body composition markers, which were not actually reported in the study, which I think are some of the most important findings of the study that somehow the authors didn't seem inclined to want to publish because they contradicted the views that the vegan diet was better. We're going to get into that. I think that's one of the most important findings of the study. What is the implication for cardiovascular health? How do they cherry pick the data? We're going to get into all of this. This is just the tip of the iceberg here. We're going to dive deep into overlooked aspects of the study. We're going to contrast those findings with previous data because One study doesn't tell you everything. You need to understand any study in the context of all the previous research of observational data, basic science studies, can randomize controlled trials, and really look at what the data show as a whole and not just grab on any new study as the headline. And, you know, we're gonna also look at research gaps and alternative, more sustainable solutions for eating that you might not be aware of that are better for your health and the climate. than a vegan diet. Make sure you stay on the podcast all the way through because we're also investigating lots of conflicts of interest, funding sources, hidden agendas that were not fully disclosed but have had a major hand in clouding the study's conclusions and the implications for applying this globally to the world's population, which they seem to want to do and make everybody a vegan. We also get into the Netflix docu-series, what it got right, what it got wrong, and they got a few things right. as well as the confusing and very convoluted information they presented. We're going to clear it all up for you. To top it off, we're going to explore a functional medicine approach to diet and how we can feed our bodies to create health and also take care of the planet in a healthy and sustainable and ethical way. It's not a binary choice. Be a vegan for your health and the planet or eat meat and you're destroying your health and the planet. It's not so simple. My goal for this episode is to equip you with the knowledge, the skills, and the confidence to cut through what is clearly a vegan sales pitch and find the right diet that works for you to achieve peak nutrition, longevity and optimal well-being. So let's jump into this touchy topic and unravel the latest in nutrition science. Let's dive into the study. The study was called CardioMetabolic Effects of Omnivorous Versus Vegan Diets in Identical Twins or Randomized Controlled Trials. So that's a good thing, right? A randomized controlled trial is the gold standard of proving causation. That's good. It's not just a population study where you look at correlation. Now, why does this study matter so much? The study and the resulting Netflix documentary are a byproduct of an ongoing quest to figure out what's the best diet for us humans and what's the best diet for the planet. Now, nutrition research as a whole, starting at a high level, is pretty confusing. There's all kinds of studies and we've covered this in other podcasts, but essentially there's two major kinds of nutritional studies. One are population studies where they follow people for many years, they track their habits, their behaviors, their diet, and then they see if there's any correlations with bad outcomes, heart attacks, strokes, cancer, diabetes, whatever. It doesn't prove anything, it just shows an association, not causation. So if I did a study of menopausal women who were over 55 years old and I followed them for many years who had sex, I would conclude that having sex never leads to pregnancy. It's not true, but the study proves it, even though it's not actually factually correct. I mean, yes, 55 year old women who have sex are not likely to be pregnant, but it doesn't mean that having sex never leads to pregnancy. See what I mean here? So that's part of the problem. So what we want to do is more deeper randomized control trials, which this was. Now, when you see these observational data, you get confused because there's a lot of what we call confounding variables, there's factors in people's lifestyle that can't be accounted for. So let's say you're eating meat and that shows that you have a high risk of heart disease, cancer, stroke, and death. But what are your other habits? Are you a smoker? Do you drink a lot? Do you not eat fruits and vegetables? Are you overweight? Do you eat more starch and sugar? Do you not take your vitamins? Well, that'll impact the results. That's what we call confounding variables. And it's very hard to control for these. So they can't really prove anything. Now, we really need to look at more long-term randomized controlled trials. Short-term trials can be helpful, and this one was an eight week trial, but that's a very short time. For example, if you put people on a vegan diet, take them off a standard American ultra processed diet and put them on a whole foods vegan diet, they're going to do better for sure in the short run. But what happens when you put people on a nutritionally efficient vegan diet, which by definition is nutrition efficient, it doesn't have a lot of the key nutrients we need for human health, which we'll get into those, and you put those people on vegan diets for years or decades, what happens then? and I've seen these people, I've seen them in my practice as a doctor. Every day I see patients who are nutritionally deficient, who are vegans, and it's concerning to me, even people who are healthy vegans, who you think would be healthy, they're deficient in iron and vitamin D and omega-3 fats and many, many other nutrients. So we really have to look at, you know, how hard it is to do a feeding study in nutrition, because, you know, nobody wants to be locked up for years in a metabolic lab. and fed a certain diet and given a certain lifestyle and be monitored like a lab rat. That's just not going to happen. So we have to kind of rely on short trials like this one or maybe a bit longer that can be done. And there have been some that are done that are quite good. So the other thing we have to look at is bias. There's a lot of bias in nutrition studies. One study that was done by David Ludwig reviewed all the science around various nutrition topics and they found that If industry funded this study, in other words, the Dairy Council funded a study on milk or dairy and its health effects, it was five to eight times more likely, 500 to 800% more likely, to show a positive benefit for the food that was studied. So if you're Coca-Cola studying whether soda causes obesity, guess what? It's not likely to show that it does, right? So when another study was published in PLOS ONE, we have all, by the way, all the references, everything I'm talking about is in the show notes. You can go ahead and click on the research, find out for yourself. Don't take my word for it. But the food industry funding is a big issue. The nutrition industry funds 12 times as much research as the NIH. They spend about $12 billion a year funding nutrition research. The NIH maybe spends a billion, but as a whole, that's probably even a lot, 'cause a lot of it's not real true nutrition research. Now, 13% of research articles published in the topmost cited nutritional journals in 2018 were backed by the food industry. So about 13% were funded by the food industry. Of those studies, 56 of those studies reported findings that were favorable to industry interests. And the Journal of Nutrition has the highest number of incidents of industry involvement, 28% of studies were funded by the food industry. Now, that leads to all kinds of problems, conflicting studies, headlines, confusion from the public. It's hard to separate fact from fiction. And so, based on this, let's talk about this particular study, which was industry-backed, and we'll talk about what that is later. But I think there's a lot of conflicts of interest that really you should know about as part of this study. Stanford study, and it's resulting Netflix documentary, was a randomized controlled trial, which is a good thing, and it was in twins, which would seem to be good, but it sounds too good to be true. It showed clearly that vegan diet was better. Is it true? Is it not? Let's see. Let's go into the study design. The authors tried to compare the effects of a healthy vegan diet with a healthy omnivorous diet on various markers of heart health or cardiometabolic markers during eight weeks. By the way, just so you know at a high level, everybody knows, we've found this forever and ever, that vegan diets lower LDL cholesterol. Now, whether it's a good thing or bad thing, it's really important to understand because LDL is not the most predictive biomarker for heart disease. In fact, it's a crappy one. There's much more effective markers such as ApoB, lipoprotein fractionation. I've talked a lot about this in a health bite on cardiovascular disease. We'll talk about that more in a minute. it shows the quality of your cholesterol. It also didn't look at insulin resistance in a meaningful way that I would like to see him done. And so we really kind of don't have, you know, the gold standard for cardiovascular disease. We just talked about LDL and in people's mind, LDL is bad, you lower LDL, that must be good. End of story. Well, it's not so simple. And I talked about this a lot in my books. You know, most people who enter the hospital with a heart attack have normal LDL cholesterol, but they have high triglycerides, they have low HDL, which is a sign of poor metabolic health. So I don't think that lowering LDL in and of itself is an important biomarker to assess cardiovascular risk. And yet that's the thing they looked at because they know from all the other data we know that vegan diets lower LDL cholesterol. It doesn't mean that that's a good thing. You could produce more damaging heart disease, causing cholesterol particles that are more particles, smaller particles, whereas if you ate saturated fat, you'd have the opposite. So really it's important to look at a much more nuanced view of cardiovascular risk. I encourage you to listen to my Health Bite on cardiovascular risk, because I go into all this in great detail. So this study was done as a single center RCT. It was at one facility, one location, which minimizes the generalizability of this. If it was done in 10 centers with 10 different populations, it could be a more reliable study. So they used 22 pairs of identical twins. they were 18 and older and basically in good health. The average BMI was 25.9. So right there, I don't think they're in good health. Your BMI should be like 21, 22, 25 is considered overweight. So basically the average BMI was overweight to start with. And they used twins to control for genetic variation, which can be confounding variables. And that can be useful, but again, it's not a perfect study design. Now, one twin went on one diet and one twin went on another diet. One twin got a vegan diet and one twin got an omnivore diet. and it was eight weeks and the primary outcome measure was LDL cholesterol. And that's really what they used to see whether the study was going to prove the hypothesis that a vegan diet improved your cardiovascular risk. Now the study was in two phases. The first phase was four weeks and the second phase was four weeks. The first phase, which is week one to four, they were three meals a day that were provided at no cost by a food delivery service and health coaching. It helps them understand what their diet should be and they Focussed on fruits and vegetables, whole grains, limited sugar, limited added refined grains, which is all a good thing. And they were then encouraged to purchase and consume snacks to meet their calorie requirements. So they gave them some food and then they got some snacks, but they were guiding them what to get. The second phase, five to eight weeks, five to eight, they were told to buy, cook, and prepare food on their own, but adhere to the diet guidelines. And they were expected to understand the type and the amount of food to eat after phase one. so it kind of gave them an idea of what they should eat. And they were basically told to choose minimally processed foods, to build balanced plates with vegetables, starch, protein, healthy fats, to choose a variety of foods within each group, and to personalize the diet to meet their preferences and their needs. And they were not told to restrict calories. So they said, eat as much as you want, and they were not restricting calories. So what was the healthy vegan diet? Well, it was lots of vegetables, which was awesome. It should be. We probably should have, you know, 5 to 9 servings of fruits and vegetables. It probably should be more like 9 to 18, actually. Three servings of fruit a day. five servings of beans, nuts, seeds, or vegan meat per day, so fake meat, highly processed meat, six servings of grains or starchy veggies a day, which is a lot. And then the vegan group, they were instructed to avoid all animal products. Now, on the healthy omnivore diet, they were told to eat six to eight ounces of meat, fish, or poultry a day, one egg per day, one half servings of dairy per day, three servings of veggies, which is really low. Why would they be telling them to eat less fruits and veggies than is the minimum guideline recommended in our dietary guidelines, which is five to nine servings of fruits and vegetables. Now, a serving is half a cup. So let's say a cup and a half of fruits and vegetables a day, which is extremely low. When you add in this fruit, it was two servings of fruit. So let's say five, but it's really at the low end as opposed to the vegan group was told to eat nine plus servings a day as opposed to, you know, just you know, five. So, and they also were told to eat six servings of grains or starchy vegetables each day. Now, this is a problem. When you eat a diet that's high in starch and sugar, which we'll talk about, the omnivore diet had more sugar, it is a driver of poor metabolic health. And it's something that may offset some of the benefits if you followed a low starch and sugar diet, as well as being an omnivore. So they didn't actually design the study to really test a healthy, low starch sugar diet in an omnivore population versus a typically higher starch and carbohydrate diet for a vegan diet. So it wasn't even the right study design, right? So in my view, it was just not looking at the right parameters to understand what's really going on. Because we know that if you eat, for example, starch and sugar with saturated fat, it's a bad thing for your health and it makes everything worse. So what they did to figure out what's going on, well, they basically gave them 24 recalls over the phone to collect data baseline week four and eight. So they basically just called them up, say, Hey, what did you eat in the last 24 hours? Okay, maybe they remember. Blood samples were drawn, you know, basically baseline, four and eight weeks, and stool samples were collected to see what happened in the microbiome, but they haven't really reported on that yet or done anything with it. So let's talk about what happened when they did this study. Well, how did the dietary interventions affect their overall calorie intake? So both vegan omnivore twins had changes in their macronutrient intake, meaning protein, fat, and carbs. the dietary fat, they have both had an increase in good fats like monounsaturated fats from olive oil, which are heart healthy and anti-inflammatory. They both had a decrease in saturated fat. Now, saturated fat gets a bad rap and I've written a whole book called Eat Fat, Get Thin. You can go look at that. There's more even data since that book was published, but it's not as bad as we're led to believe. It depends on the individual, their diet, their lifestyle, genetics, and actually in many, many studies, that's hindsight fat can be beneficial. whether keto, low carb diets. If you're eating low starch and sugar, saturated fat generally isn't an issue. If you're a metabolic disease, which 93% of Americans do, saturated fat actually may be helpful with your lipids, increasing HDL, LDL particle size, which is a good thing, reducing triglycerides if you don't eat it with starch and sugar. So the worst thing is bread and butter, right? Saturated fat and carbs. Good thing would be butter on your vegetables, right? That's fine. so it's really what you eat it with. And I, I think if we understand our standard American diet, if we eat a lot of saturated fat with carbohydrates, starch and sugar, that's bad news. So I agree with that, but not that saturated fat in and of itself is bad. And, and, and again, there's many men analyses, randomized control trials, lots of data on this. But I think the saturated fat as a boogeyman is, is really being overstated and it really genetically variable depending on the population, but for most of us it's okay. Both increased carbohydrate intake. That's interesting. They were both told to eat a lot more grains. They reduced refined grains, although in phase two when people were eating what they wanted, the refined grains went up. They both had a little bit less added sugar, but the vegans ate 17% less added sugar than the omnivores. Now added sugar we know It causes all kinds of issues with your health. So we don't, we don't know if the results are because of less added, more added sugar or what's going on. Um, vegetable intake increased for both. That's a good thing. Fiber intake increased for both groups. Although the vegans had a little bit more, about 30% more than the omnivores in phase two. And that's a good thing. I think omnivores should eat a lot of, of fiber. So it's important what you eat with. It's not what you're eating, it's what you're eating it with. If you're eating, you know, beans and grains and a vegan diet, but you're also drinking soda, that's a bad thing. If you're having an omnivore diet, but you're eating tons of fruits and vegetables and lots of fibrous foods and overall healthy diet, it's not necessarily a problem. Just the vegan twins, they ate a lot more meat alternatives, right? Tofu, tempeh, soy nuts, veggie burgers, not necessarily bad. It was about sevenfold increase from baseline. Their total carb intake increased more than the omnivores. Their protein increased 20% from baseline. their vitamin B12, which is a critical nutrient, we're going to talk about that more in a minute, went down by 65% from the baseline. Then in the short term, it may not cause effects, but imagine if you're doing this over years, what's going to happen? Their iron intake increased from baseline, but this was a non-heme iron from fortified grains that doesn't necessarily benefit you. They also had higher levels of polyunsaturated fats, that's a whole other conversation, but not necessarily bad. their cholesterol intake went down, obviously, because they're not eating animal foods. And it was replaced with something called plant sterols, which compete with cholesterol that's made by the human body and lowers serum cholesterol. So soybeans, for example, has this. But the research is really mixed on whether or not replacing animal cholesterol with plant cholesterol is beneficial. We don't know if it reduces heart disease risk or just lowers cholesterol. Right. So just so you understand, LDL cholesterol is not an indicator of heart disease. It's a risk factor that may actually drive an increased risk, but it may not depending on the quality of the cholesterol, the type of cholesterol, your other biomarkers, whether there's inflammation. For example, I had a patient yesterday who had extremely high cholesterol LDL of 180, really high total particle number. He has no inflammation. He has totally normal metabolic health. His A1C is 4.8, his blood sugar is perfect, his insulin is perfect. So he has no inflammation, no metabolic disease. and he was a 64-year-old guy, and you'd think this guy would be full of plaque, but we did a heart scan, very sophisticated heart scan called the Clear-Lee scan, which looks at AI interpreted CT angiograms, and we found he had zero plaque. He also had zero calcium score. So here's a guy with extremely high cholesterol that has no heart disease. So again, it's an indicator that she should look at other factors, but LDL in itself is not the LDL end-all of your cardiovascular risk. So to say that lowering LDL cholesterol by a small percent in the study would a vegan diet is the holy grail that tells us that vegan diets protect us against cardiometabolic disease is just nonsense. Now, the omnivore twins, they did increase protein from baseline and their cholesterol and their dietary cholesterol did increase a little bit as well. So that's fine. So but minimally, right? So if you just so you understand like cholesterol is not according to the dietary guidelines not a concern anymore. and it's nearly debunked as a cause of heart disease. And just to sort of explain the math to you, if you have 200 milligrams per deciliter of cholesterol, which is your number, let's say your cholesterol is 200, you have about five liters of blood. That's five liters. So every liter, you've got about 2000 milligrams, five times, so you've got about 10,000 milligrams of cholesterol in your blood. Adding two or 300 milligrams is not going to move the needle very much. Most of it's produced in your liver or reabsorbed from your gut. so what happened? What was the effect of these dietary interventions on cardiometabolic risk factors? Well, at eight weeks, the twins on the vegan diet had a lower amount of cholesterol. So their cholesterol dropped by 13.9 milligrams per deciliter, which is not really that significant, but it's something, right? Although it's statistically significant, their insulin dropped a little bit, which is a good thing. They also add added less sugar and less calories, which does affect your insulin production. So let me explain it. And it seems like a good thing, but they lost 1.9 kilograms more than the omnivore group. Now that's fascinating to me. So you say, okay, weight loss, cholesterol comes down, that's all good, insulin comes down. But what was the weight loss? And let's, we're going to talk about why the decrease in body weight was not a good thing, but a bad thing. in this group and we'll talk about that in a minute. But what I'm talking about is actually just to give you a heads up is body composition. And they didn't report on body composition in the study, but they did report it in the movie, which was so interesting to me. And in the study, it kind of would debunk the whole study if you looked at it. But I don't even know why they focused on in the movie because it kind of undermines their argument.

Hey everyone, it's Dr. Mark here.

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So look for the yellow carton at your local grocery store or visit happyegg.com slash Pharmacy. That's H-A-P-P-Y-E-G-G.com forward slash Pharmacy. And now let's get back to this week's episode of the Doctor's Pharmacy. The other things that happened where these are non-significant reductions that weren't scientifically, statistically significant, but HDL went down a little bit, which is the good cholesterol and it's protected. Their blood sugar went down. The TMA went down because they didn't eat meat and that can be produced from gut microbes that are processing meat and that may be linked to heart disease or may not. We don't know yet. their triglycerides went down a little bit, okay, that's because they probably eat less sugar. But here's an interesting fact, the satisfaction with the diet was quite different. The omnivores actually were satisfied and had an increased satisfaction or stayed the same. For the vegans, they all had a reduction in their diet satisfaction, so they didn't like it. They like the healthy lifestyle part, but not the vegan diet. Now let's talk about the issues with this study. First, focus exclusively on LDL as the primary endpoint. I just explained why that doesn't matter as much as we think. You can't determine your cardiovascular risk by just looking at one biomarker. Now, I've co-founded a company called Function Health and for $499 you can get 110 biomarkers. Normally the cost would be about $15,000. It's a membership model for twice a year testing and you get a full cardiometabolic panel, not just one marker you get. lipoprotein fractionation, which is what we should be looking at, not just LDL cholesterol, which is mostly meaningless in my view, given the data we have now. We're looking at particle number, particle size, we're looking at for that, for both HDL, triglycerides, LDL, looking at inflammatory markers, we're looking at insulin levels, glucose, and a much more detailed look at what's going on that'll give you a better sense. We're looking at ApoB, lipoprotein A, and if you really want to know what's going on with your cardiovascular health and cardiometabolic health, it's important to get the full panel, and you probably won't get this with your doctor. like less than 1% of cholesterol tests are the right one. Less than 1% are the newer version, which is called lipoprotein fractionation. Essentially it means looking at the particle number and size, not just the total number of cholesterol you get, like the regular test, but actually the quality of your cholesterol, not just the quantity. And that's really much more important looking at your risk. I encourage you to listen to my podcast on assessing cardiovascular risk. It's another one of my health bites. We're gonna put the link in the show notes so you can read the transcripts, you can listen to the podcast, but it goes into this in great detail. And you'll understand why I think just looking at LDL itself is pretty meaningless. Second, they didn't control for things that could also account for the lower LDL, like weight loss or lower calorie intake. So the vegan group had weight loss, more weight loss, and ate less food because they didn't like it. So their LDL went down, could have gone down because of that. what's interesting is weight and fasting insulin were not included as endpoints in the study design and they were added after the study was completed. So normally you do a study, you have to declare, like you're declaring your major in college, you have to declare what you're looking to see an impact on, which was LDL. But then they, they saw benefits from other things and so they added those after, which is, you know, I guess, okay, but it's, it's, you know, they, it just because it was made the study look better for them. And they didn't actually include the fact that HDL was included. reduce in the abstract. And it kind of reflects this cherry picking where they emphasize the things that went well, but de-emphasize the things that didn't go well. So they de-emphasize the lower HDL, they de-emphasize the change in body composition, which were much worse in the vegans. And this is important. We're going to talk about why that's important. Also, the study was short term. Like I said, it only lasted eight weeks and you really can't assess long-term risks. You can't assess the risk of nutritional deficiencies. on your muscle mass or sarcopenia, energy levels, the risk to iron levels and anemia, gut issues, immune function, you just can't look at all that in eight weeks. So you need much longer studies and they're harder to do, right? They only gave the people four weeks of prepared food and four weeks they had to figure it out and they kind of deviated after the four weeks. And there was no follow-up period really. So they didn't really look at what happens over the long term with these patients, what was their sustainability of the diet, so they like it, what are the nutrient deficiencies, did they adhere to it? were they satisfied with it? None of that was looked at. Also, we only did three 24-hour diet recalls to look at their macronutrients. Now, do we really know what you ate by just looking at one day? I mean, maybe, but again, food frequency questionnaires are highly unreliable, and I talked about that in other podcasts. Also, this didn't really represent the normal population of the country, right? You can't just generalize a study. That's the thing about randomized controlled trials. They're good, but they only are good for looking at the patients they're looking at. If you're only studying 70 kilogram white males from Kansas, it doesn't apply to someone who's African-American or Asian or from India or from Africa somewhere. So, it doesn't really look at that. 70% sorry, 77% of the group were female, 72% were white, only 11% were Asian, 5% were black, 2% were Pacific Islander. So, it really can't generalize this study. also there was a lack of diversity of socioeconomic and education status. So, you know, what about people who are less privileged who live in food deserts who can't really access a healthy vegan diet, which is really much harder to do. And there's also genetic variability they didn't look at. So we tend to look at, you know, things as if everybody's the same, but there's a lot of variability from person to person. for example, some people have genetics that make them extremely susceptible to B12 deficiency effects. So, for example, MTHFR, which is a methylation SNP, requires methylfolate and B12 folate supplements. And if you don't have this, you increase your risk of heart disease, mental illness, and B12 deficiency is almost universal unless you supplement with B12. The diet did not supplement or address the potential for these nutrient deficiencies, right? There are many nutrients beyond B12 that are low or absent on a vegan diet. B12 wasn't supplemented in this study. The dietary intake for the vegans was much lower. B12 stored in the liver, so it stayed more or less the same in the range, not the same, but it stayed in the range, but it probably was coming down over time. Also, iron, vitamin A, and calcium all had reductions in their intake in the vegan population. uh, and, you know, really didn't seem to be a concern in the study because it takes a while for the effects of these dietary deficiencies to show up. And maybe that's why they only did eight weeks instead of six months. So maybe it was the cost, but they didn't really have to address this fact, which is a really big issue. Now, what are the kinds of things that we see? And because deficiencies really don't show up for months to years on a vegan diet, the things we see typically are omega-3s being low because these come from fatty fish. low vitamin A, certain B vitamins low, low vitamin K2, low calcium, vitamin D, iron, zinc, iodine, which is often from fish, selenium and choline. Now you can get some of these from plants, but they're less bioavailable, right? For example, iron intake is increased for vegans, but it was heme iron, which isn't well absorbed. Also, certain things in your diet, like oxalates and phytates, which are in spinach, collard greens, really affect absorption. so it takes months or years for nutritional deficiencies to show up in vegans. And there's a lot of nutrients we should be concerned about. Omega-3s vitamin A, particularly retinol, certain B vitamins like B12, vitamin K2, calcium, vitamin D, iron, zinc, iodine, which is something from fish, selenium, which is also a fish choline, which comes from fatty fish and other animal foods like eggs. So we're often seeing these deficiencies in patients who are vegans, even quote healthy vegans, if they're not taking supplements. Now, you can get some of these nutrients from plants, but often they're less bioavailable. For example, the iron intake was increased for the vegans in the study, but it was non-heme iron, which doesn't really get absorbed as well or is as good to raise your blood count. Also, calcium can be inhibited in its absorption because oxalates and phytates found in beans and certain plants, spinach, collard greens, can hinder the absorption. I'm gonna talk about that more in a bit. Also, a proper vegan diet where you stay healthy requires lifelong planning and it requires supplementation and even requires supplementation with highly processed plant proteins. And I'll explain why this is important later, but it's almost impossible to get the required amount of protein for what we call muscle protein synthesis. Now you can get a protein for your basic kind of life functions. But what really matters as we age is the amount of muscle and the quality of muscle and building muscle. And vegan diets are clearly inferior to doing this. And often we'll see a lot of issues with sarcopenia as people get older and vegans. And this is a big concern of mine, particularly in terms of longevity. Now, you know, even with supplements, it's hard to make up for the differences. You can't actually compare, you know, getting supplements just from a vitamin pill compared to eating a complex food which has a deep nutrient matrix and a synergy of all the ingredients. And by the way, not everybody can afford supplementation, particularly the amount you need if you're vegan. Also, it doesn't address the best and worst candidates for a vegan diet because not everybody should be doing this. Are we recommending this for everyone? Well, Gardner, who is the study author from Stanford, said in the press release, Our study used a generalizable diet, meaning for everyone, that is accessible to anyone because 21 out of the 22 vegans followed through with the diet. Well, I don't know about this. I'm guessing most study participants are enthusiastic about participating study, want to do it right. It doesn't mean that because they did it for eight weeks that they're going to continue to do it. And remember, this was done in generally healthy twins and it doesn't account for genetics, their underlying health conditions, autoimmunity, thyroid issues, lots of other things. what about pregnant women and kids? Well, there's a lot of data that this is a concern. And when you have vegan mothers, they're deficient in omega-3 fats, which is critical for developing the brain, B12 for iodine for thyroid function, selenium important for thyroid function as well, vitamin D, I mean, the list goes on. And vegan diets in mothers have been linked to neurodevelopmental issues to lower IQ, weaker bone mineral density, and even failure to thrive. so some countries actually outlaw vegan diets in children, which I think is a little extreme, but I think really it speaks to the challenges of actually growing a healthy kid on a vegan diet. Now, it can be beneficial, vegan diets can be beneficial for weight loss or cardio metabolic health if you have comorbidities, chronic disease like type 2 diabetes, obesity, heart disease, but only when coming from a standard American diet. So, you know, like my sister always told me this stupid joke, she said, you know, when the Vermont farmer was asked, how's your wife? He's like, compared to what? Compared to what matters. If you're comparing a extremely healthy omnivore diet with lots of nutrient dense foods, whole foods, or generally raised meat, sustainably or generally raised fish, lots of nuts and seeds, lots of fruits and vegetables, low starch and sugar, compared to a healthy vegan diet. Now, this is not what they did in the study. They actually had a fairly high carb diet and more sugar in the omnivore diet in the study. So it wasn't really studying the right diets. It should have been studying what I said first with a healthy vegan diet, because I don't think what the omnivore diet was that very healthy. But when you're coming from a standard American diet, if you just switch to a healthier diet, whatever it is, if it's vegan or omnivore or keto, whatever, you're going to get better. But the question is how long does that last? and what other problems accrue over time, including nutritional deficiencies, muscle loss, which I think is my biggest concern. All right, so now let's talk about the conflicts of interest, because that is a big problem with this study. Now, this whole thing is just kind of unbelievable if you actually asked me about it. The head of the study, Christopher Gardner, he's a great man, good guy, he's the director of nutrition studies at Stanford Prevention Research Center. And he's also, by the way, director of the Stanford Plant Based Diet Initiative. Now, this seems to me to be a very biased title because, you know, if the assumption is that plant-based diets are better as an a priori hypothesis, how do you do independent research? Right? It's just like, okay, we know plant-based diets are better, so let's just study that and prove that they work. That's kind of what's going on. He's been vegan for over 40 years, and that does introduce bias. He admitted that his research is primarily driven by his personal values, animal rights and welfare, the environment, climate change, versus a strict focus on nutrition health. So there are, I would say between, you know, the meat story is complicated. There's really three big issues that people debate about, and they're all conflated. One is health, one is animal welfare, and one is the environment and climate. So they're not all the same. and it depends on what you're eating. And we'll talk about that in a minute and how it affects overall these factors. And I wrote a book about a lot of these things called Food Fix, in which I talk a lot about these issues. I also wrote a book called the Pegan Diet, where I do talk about a lot of these issues and help you understand them. But his personal bias towards a vegan diet could favor vegan diets in his reporting. Now, in the Complexes of Interest Disclosures, he admits to receiving funding from a company called Beyond Meat. which is a vegan plant-based highly processed meat. So that's where a lot of the funding came from. He also serves on the Dietary Guidelines Advisory Committee, which, you know, makes me concerned a little bit about the committee's report. If he's already biased toward a vegan diet, scientists should be impartial, should look at the evidence, and should not be focused on one outcome or another based on their own personal views. Now, the funding, this is interesting, the funding of the Stanford Plant-Based Diet Initiative of which she's the director is funded by Beyond Meat, which is a processed meat, fake meat company. And it probably does influence the direction and the conclusions from all the work they do. It's sort of advocacy disguised as science, right? It's like Coca-Cola funding a department at a medical school and studying soda. well, how does that make sense, right? Just because it's plant-based or vegan doesn't mean it's impartial. Now, the Stanford plant-based diet initiative has a stance that plant-based diets are superior. So how can they do neutral scientific research? And that kind of raises a lot of questions about the integrity of the research itself. There's also selective disclosures. So all conflicts should be disclosed, but they weren't. In the twin study, they did disclose some of it. They disclosed that some of the funding of the study was from the Voight Foundation, but it does not disclose the advocacy nature of this particular foundation. This foundation is a vegan philanthropy group run by Kyle Voight. They donated $850,000 to vegan promoting films like Game Changers, and he markets himself as a vegan athlete. They also donated $600,000 to the Oceanic Preservation Society, which is a production company with the mission to create media for environmental advocacy. And they filmed the Vegan Twin Study. So the Voight Foundation helped fund the Twin Study and the documentary that resulted from it. So that suggests a bigger agenda to influence public opinion through the media. Now, there's a lot of ethical considerations, too, that I think were not considered. And also, I want to dive into the documentary a little bit because it's just like, if you want to convince people and produce a documentary. And I think they can be impartial documentaries. They can be very scientific. They can be well done, or they can be just pure propaganda. And a lot of the vegan documentaries, I think, like what the Health or Game Changers, are primarily propaganda and not real science when you dissect them. They're really powerful because they work to captivate people's minds and and persuade an audience. The twins added really little scientific value to this study. In the normal randomized controlled trials, they can control for genetics. And the world is sort of fascinated by twins. And Gardner even said that in his press release. He said, not only did the study provide a groundbreaking way to assert that a vegan diet is healthier than the conventional omnivore diet, but the twins were a ride to work with. Well, who cares? Why does it matter? Well, it maybe creates a sexy documentary. maybe creates more attention, media headlines, but, you know, it's kind of weird. In addition to the sort of chronic disease focus, this paper was heavily focused and influenced by this whole idea about climate change and how we need to go plant-based in order to lower the environmental impact and to reduce climate change and so forth. But that requires a lot of unpacking. And this is what they said in the introduction of the paper. The most significant global health crises affecting our generation are non-communicable diseases like diabetes, heart disease, cancer and so forth, and climate change, which are both inextricably linked to diet. And dietary patterns high in plants and low in animals can maximize health benefits and environmental benefits. Wow. Okay. Well, again, I wrote a whole book on this called the Food Fix, how to save our health, our economy, our communities, our planet one bite at a time. And this is not true. It's just, it's not true. Now, the devil is in the details. Will going plant-based solve our health and climate problems? Or is the real problem how we're farming, how we're raising animals, how we're doing agriculture? And is it industrial agriculture, including factory farming of animals and monocrops is the problem? Yes. I 100% agree that we should not be factory farming animals, that we should not be doing monocrops, that we should not be doing industrial agriculture. 100% agree, and I 100% agree that those are damaging the environment. It's bad for our health with the products they produce, and it's bad for the animals. So no argument there, and 100% we should get rid of all that stuff. No question. And I wrote again, I wrote a lot about this, but we're gonna dive deeper into this. But I first wanna talk about, before we get into the whole environment, climate thing, I wanna talk about what other studies have found and whether vegan diets work. Now, In the short term, like I said, if you switch from a standard American ultra-processed diet to a whole foods vegan diet, you're going to do better. And, this was what they found in obesity reviews. There was a systematic review and meta-analysis looking at the effect of vegan diets for 12 to 26 weeks on cardiometabolic risk factors in people who are overweight or have type 2 diabetes. And, what they found was that vegan diets help reduce body weight, BMI, blood sugar, cholesterol, LDL, no effects were seen on blood pressure, HDL triglycerides. in these studies, they were really highly supported with tons of coaching and nutrition support. And, you know, it was a benefit. But again, compared to what? Right? Compared to what diet? Like I said before, you know, they studied vegan diets versus omnivore diets and people who shop at health food stores. They reduce the death risk in half for both groups. So it's not necessarily the meat, it's what you're eating. with the meat. And again, most of the studies on this are showing that meat's a problem in observational studies when people are doing a lot of other bad things. And I talked about this in my red meat type diabetes health bite. But essentially, you know, if you look at the data on this, the people who ate red meat in these studies were typically unhealthy and people who didn't eat meat were more healthy because we were told that meat is bad for you. But you look at this, for example, the data, the red meat consumption has dramatically dropped over the last 30 or 40 years and diabetes has dramatically increased. so how is red meat linked to that? I don't know. Again, correlation, not causation. So why does a vegan diet seem to have this effect? Well, you eat less saturated fat, so you reduce LDL, which may or may not be a good thing. May also lead to weight loss. You decrease calories because you're potentially eating less caloric foods. You're increasing fiber, which is a good thing, and fiber lowers cholesterol. It makes you feel full. It balances blood sugar. it may help your gut microbiome with increasing prebiotics in your diet. That's all great. Plant-based diets also have more phytochemicals, anti-inflammatory, cardioprotective, all great if you're eating a healthy vegan diet, which is not processed food, not processed fake meats, not chips and soda vegans, but really nutrient-dense vegan food. It also can reduce your intake of ultra-processed food, but not always. and here's the key, the quality of the vegan diet matters. You know, chips and soda and french fries are vegan in the diet, right? Doesn't mean that they're healthy. Now, if you're eating an ultra processed vegan diet, it actually increases your risk of disease. So if you avoid animal foods with higher consumption of ultra processed foods, which many vegans do, and by the way, in this study, energy intake from ultra processed food was higher in the vegetarians about 37% of their total energy intake, and especially vegans. So 40% of vegan's diet is ultra processed food. So industrial plant-based meat and dairy substitutes, which are kind of fake processed foods, accounted for 42% of total energy intake for the vegans, but only 3.4% for meat eaters. And by the way, the plant-based meat intake in the twin study increased by sevenfold. So It is an ultra processed food and we don't really want to be eating that stuff. A higher intake of processed food in vegans and vegetarians was also associated with higher weight and BMI. Another study in the Journal of the American College of Cardiology examined the effects of healthy plant-based diets, namely whole foods, to an unhealthy plant-based diet like juice, refined grains, sugar, sweet beverages, sweets, desserts, over 5 million years of follow-up. They looked at the Nurse Health Study, Health Professional Study, and they found that the healthy plant-based diet was associated with a 25% reduced risk of heart attacks, and heart disease and an unhealthy plant-based diet was associated with a 30% increased risk of heart disease. So the quality of the diet matters. Now, here's an interesting thing called the Vegan Paradox, which is both LDL goes down, but so does the good cholesterol, HDL. Now, good and bad are not really the way we should be talking about them. It's really the quality of them and what they do. And it's more complicated. I encourage you to listen to my health bite on cardiovascular disease and assessing and reducing your risk of heart disease. but I go into way more detail there. But there was a review of over 30 observational and 19 clinical trials, randomized controlled trials, looking at the relationship between plant-based diets and the effects on cholesterol. Now compared to omnivores, vegetarian diets do reduce total and LDL cholesterol, but they also reduce HDL, no seemingly effect on triglycerides and this is vegetarians. In the twin study, we saw the same thing, lower HDL but also lower LDL. and lower triglycerides, but it wasn't significant. Now, another study in the American College of Cardiology was a meta-analysis of 30 randomized controlled trials looked at the impact of vegetarian and vegan diets versus omnivore diets on blood lipids. And again, lower LDL and total cholesterol. But that doesn't necessarily mean your risk is reduced because if the quality of the cholesterol is worse, if you have lower levels of HDL, if you have more small particles, more LDL particles, you can still have a lower total cholesterol or LDL cholesterol, but actually the quality gets worse and that increases your risk. So it's complicated, I know, but LDL in and of itself is not enough. And as I mentioned, you need to look at all the biomarkers, particularly around cardiometabolic health, which is insulin resistance and inflammation. Those are the things that drive heart disease. Now, long term, what else should we see with vegan diets? We see B12 deficiency. Now, it's a really important nutrient found only in animal foods. involved in red cell formation, neurotransmitter production, synthesis of DNA, cell division, energy metabolism, your heart health, your mood, bone health, pregnancy, pretty much everything, and strict vegetarians or vegans who don't supplement or at high risk of problems. There's another study in the European Journal of Clinical Nutrition, by the way, all these are in the show notes. There was analysis of 700 men, 52% of the vegans were B12 deficient versus 7% of vegetarians and 0% of omnivores. Only 19% of vegans actually took a B12 supplement. Now, certain subgroups are at risk, like pregnant, vegan, or vegetarian women. There's high risk of birth defects like neural tube defects, like spina bifida, poor cognitive function, stillbirth, preterm delivery, low birth weight. It's not a joke. So, if you're pregnant, you have to supplement with methylfolate and methylcobalamin, which is an active form of B12, not the typical kinds that are multivitamin like folic acid or cyanocobalamin. And by the way, this won't be in your typical prenatal vitamin and it won't be what your doctor tells you. But if you're vegan and you insist on this during pregnancy, which I don't think is a good idea, you have to make sure you're taking all the right nutrients including iodine, choline, omega-3s, right B12, folate, et cetera. If you're older and you're vegan, it's a problem because a lot of people have what we call atherosclerotic arteritis. They may not absorb B12 as well. they get B12 deficiency, they are often taking acid blockers which reduce stomach acid and you can't even absorb B12. You're taking drugs for insulin resistance like metformin, all those things affect your nutrient needs. And you can get a lot of problems with that. You can get fatigue, memory loss, brain fog, depression, you can be irritable, anemic, and neurologic symptoms if you're B12 deficient. So it's no joke and it's really common. Another thing we often see is high levels of homocysteine, which is a sign of B12 or folate our B6 deficiency. And it's really important that we get the right amount of methylating B vitamins, B12, folate, and B6, because if you don't, you get increased risk of stroke and heart attack. And then you get more oxidative stress, more blood clots, heart attacks, and maybe that over time will have a negative effect on the vegan vegetarian diet, even if your LDL is lower. Now, what about omega-3 deficiency? Well, plant-based omega-3s like ALA from flax seeds, walnuts, things like that, they don't convert very well to the active omega-3s, EPA and DHA. There's only about a 15% conversion of that and some even less, depends on the enzymes and genetics. And omega-3 deficiencies are so important, 90% of Americans are omega-3 deficient, not because they're vegan, because they don't eat wild food anymore, and it leads to more depression, anxiety, mood changes, inflammation, dry skin, dry hair. I mean, the whole list of Omega-3 deficiency problems. And it's important to supplement. Now, there are plant-based Omega-3s but often I don't think they work as well. And I've seen some studies where, you know, this doesn't work. And in my patients, if they're often taking plant-based Omega-3s, they're just not getting enough. Vitamin A, another big one. Vitamin A is the actual final product that you get from the carotenoids, which is orange. vegetables, leafy greens, they actually have beta-carotene or the carotenoids. Those get converted to A, but it has to get converted. Now, if you don't have a good conversion rate, if you're not doing that well, you can end up with vitamin A deficiency. But you need the proper form, you need dietary fat, all this stuff. Your digestive health is important. The conversion to beta-carotene to vitamin A is low, it's about a 12 to 1. ratio. In other words, you need 12 times as much the beta carotene to get one microgram of retinol. It's really important, right? Why do you need vitamin A? It's important for your gut and the barrier for all your mucosal surfaces, your immunity, the gut associated lymphoid tissue. And if you have low levels, it's associated with all kinds of stuff like inflammatory bowel disease and decreased immune function and poor skin health and blindness. I mean, when it gets really bad, what about calcium? We only need calcium and we should get it from our food, but when you take calcium, a lot of certain plants like beans or certain oxalate vegetables like spinach and beets, it can actually bind to the minerals and it can cause problems. Then you get worse gut issues, autoimmune stuff. So you have to cook these things to reduce the anti-nutrients. We call them anti-nutrients. So you need to pressure cook greens, pressure cook beans, well-cooked leafy greens. And plant-based diets seem to be lower, especially with lower bone mineral density. So that's concerning. So you get more osteoporosis. And this was from a national health examination survey, which is NHANES study. And they found it was like, you know, people who had a plant-based diet had an increase with some bone loss, decreased bone mineral density and increased risk of fracture potentially. So it's a bit, a bit of a concern. I encourage people to get bone density tests, index of bone density and a body comp as well to see what's really going on. And the body comp is key because you could be thin. and you can look thin on a vegan diet, but if you do your body comp, you'll see you're mostly fat. So you can be what we call a skinny fat person. You can get basically muscle loss and fat deposition, so you look thin, but actually you're fat on the inside. We call that skinny fat. Protein, let's talk about protein. That's a big one. Now vegans and vegetarians usually consume less protein than meat eaters, although they seem to still meet the RDI if you classify that as the right amount, which is point eight grams per kilo, but that's the minimum amount to prevent deficiency disease, not the optimum amount for health. So plants contain different amino acids than animals. It doesn't contain all the amino acids that we need, the essential amino acids. So it's an incomplete protein. If you combine beans and grains, you can get more complete protein. But it's not just having all the amino acids, it's the amount of different amino acids that are important for regulating different body functions. For example, lysine is lower in grains, sulfur containing amino acids are lower in legumes, and sulfur is really important for making a lot of phytoene and is a really critical component of our biology. So you have to, you know, eat different plant proteins to meet the requirements and you require a lot of planning. But you also need, to be honest with you, if you want to build muscle, you need actually processed plant proteins, which I'm not a big fan of. for a lot of reasons. So it's more difficult, and the science is really clear on this. I've written about this in my book, Young Forever. I've done podcasts about this. I've had Gabrielle Lyon on the podcast, on Lehman, protein experts talking about this. And it's really more difficult to build muscle with plant protein. Plant protein is far less bioavailable. There's tannins, phytic acid, they bind proteins. Meat increases the essential amino acids much more than plants after eating. And leucine, and this is really important, leucine is much, much higher in animal protein and low in plant protein. Now, why should we care about leucine? It's the rate limiting step for building muscle. There's something called muscle protein synthesis. That means building muscle. If you don't have two and a half grams of this amino acid, in a protein meal, you won't turn on the switch to build muscle. Now, this is really important to understand because if you don't actually supplement with leucine as a vegan or have jacked up plant proteins that are full of extra amino acids that are added to it, you're not going to be able to get enough. Now, a lot of research is needed, but if you look at older adults given isochloric meals, the same amount of calories, the same amount of protein, right? Same amount of grams of protein, one from plants, one from animals. The animal protein resulted in a 47% higher rate of muscle protein synthesis than the plant protein. This was published in the journal of nutrition. So the study, this is one study, but there's study after study that confirms this. It's also hard to consume enough calories to hit the protein goals on a plant-based diet, right? If you have, for example, a four ounce piece of chicken or meat, that's the same as protein as 30 grams of brown rice or two cups of beans. Who can eat that? So it's just a lot of stuff you have to eat. And then on top of that, you're not only getting, you know, only a couple hundred calories with the protein from meat or chicken, you're getting hundreds or a thousand plus calories from the amount of rice you would need to get or beans you would need to get. and that's a problem. So you really need to look at what's going on if you actually get the plant proteins, you need a lot more of them and you need to probably eat these processed plant proteins like isolated soy protein, which may cause cancer or pea proteins or lots of other things. So when you start to eat more protein and more calories as a plant-based person, you're going to be eating a lot more calories from carbs, you're going to eat lots of glucose and insulin produced. And, and, and, you know, if you don't have enriched proteins, you're going to be in trouble. So if you have ultra processed plant meats, too, what are those like, you know, impossible foods or Beyond meat? You know, those are made with GMO soy, with wheat, now pesticides, environmental impact, monocrops. I mean, nobody talks about that. And to me, protein requirements, you know, people often have to eat these ultra processed foods, these plant mm, meat or plant based proteins that are, are often highly processed. Um, and in this, in one study of 774 adults on a vegan diet for over six months, the minimally processed foods basically constituted about 66% of their diet, whereas ultra processed foods made up 3% 13%. But to meet the protein requirements, the vegans had to have these ultra processed foods like soy protein isolate. which leads to higher calorie intake and also may cause cancer. So I'm really concerned about the need to use these jacked up, ultra processed vegan foods for protein, which may affect long-term health, and they have other processed ingredients. And it was a study we're going to link to here, which shows that they have a lot of other things, flavors, colors, emulsifies gums, lots of starch. So it's not just so straightforward. Okay, let's talk about the Netflix documentary a little more. I think this is a big concern of mine and how this manipulates people's public opinion and actually doesn't give people a clear view of what the science is. So here's what they got right. They addressed how problematic our food culture is, ultra-processed food and its link to chronic disease. No argument there. They talked about how we should not be doing factory farming of animals and we should be focused on farming that improves climate and soil health and all that 100% agree. They highlighted the importance of body composition, which is really important. And their, their documentary actually showed how bad the vegan diet was for body composition, but they, they did mention it was important. And I think it's really important that you need to build or maintain muscle mass while losing body fat. And they also talked about the role of food on epigenetics, which I think is important. And we have to understand that food is medicine. It can regulate our gene expression. I'm down with that. I've been talking about that for years. But what are the problems with the study? Well, we highlighted some of them, but it was presented as a Stanford-led study, a twin study, that was what the show was about. But they didn't even talk about the study until much later in the episodes. I think the first three episodes were basically a vegan sales pitch promoting plant-based meats, cheese, and egg alternatives. Many of the claims were not based on scientific evidence. the Stanford alternative plant protein project, which are students working in a lab to develop plant-based meat alternatives. In fact, one of the students said in an interview that plant-based meats are truly a better cut of meat. And Mikio's plant-based cheese was an amazing vegan cheese. But what is it? It's like tapioca starch, cashew milk, it's got a lot of carbs, very little protein. It's not really meat, right? It's, it's, it sort of may look like it, tastes like it in some way, although I it does. But a lot of these plant-based alternatives, these weren't even consumed by the vegans in the study, but they were promoted in the film, right? Vegans consume no egg substitutes, but they focus on that in the movie, even though in the study they didn't eat that. Other claims were crazy that have no scientific evidence, which is meat was not a part of our diets before 150 years ago. Well, right there you just stop. Wait a minute. What about our hunter-gatherer past? All our societies, we're not agrarian. We weren't growing grains and beans and vegetables. We were hunting and gathering. And I just visited a tribe in Africa. There are a hundred gatherers around for 50,000 years and they were killing animals. Of course they ate meat. I don't know where they would come up with that. And then the other thing I say is every time you eat a steak, a little puff of smoke goes up in the Amazon. Well, that's true if you're eating industrial factory-based meat, not if you're eating regeneratively raised meat. that's actually restoring the soil, reducing climate change, storing carbon, preserving our freshwater resources, limiting the use of chemicals, you know, just not using fertilizer. I mean, there are just so many benefits from regenerative agriculture that are actually a positive net benefit for climate and the environment versus traditional farming and factory farming is what they're talking about. So you can't just talk about the things that you want to talk about. You have to talk about the whole story. Now, they also focus on animal welfare, factory farming, climate change, and that was main focus on saturated fat as their main focus rather than nutrition quality or anything else. They didn't mention really nutrition at all. They don't mention sugar at all, which is crazy as a root cause of chronic disease and obesity. They focus on saturated fat instead. And again, there's so many studies that show that saturated fat is not the boogeyman we once thought. They focus on the dangers of foodborne illness. Oh my God, you're gonna get salmonella from eating chicken. Well, no, not if you cook it, right? If you eat raw chicken for sure. But foodborne illness kills 2,400 people a year. It's an issue, but it's not that big of an issue if you're smart about what you're doing. You don't eat stuff that's rotting or raw this and raw that. It also doesn't really mention the dangers of industrialized agriculture, which is something that you know, is a big deal. And, and the way we grow beans and grains and a lot of vegetables in this country is not regenerative. It's industrial and uses heavy amounts of killing herbicides, pesticides. For example, there's 1.2 billion pounds of pesticides used annually in the US. Glyphosate used on wheat and corn and many other crops on 70 of all crops is herbicide that also kills of the microbiome of the soil and your microbiome, by the way. There's 280 million pounds of this glyphosate Monsanto Roundup stuff. It's sprayed on crops every year, mostly wheat, corn and soy, which is the backbone of ultra processed food and also a lot of what vegans will eat. They'll eat a lot of soy foods, a lot of wheat, corn-based products, and it sticks on the plants and it's in our diet. I know this because I've tested my patients. I even tested myself. because I don't eat at home all the time, I'm eating out and I'm getting glyphosate too. In fact, Monsanto was awarded a patent for glyphosate as an antibiotic in 2010 and it destroys our microbiome, which is really concerning to me in very low amounts. Now in the movie they do acknowledge that regenerative agriculture is important, but they say it's not scalable. And again, this is not true and I wrote about this in my book Food Fix. In fact, we can produce more cows by far using all the unused land that the Bureau of Land Management has, or the land we're using to grow row crops like soy and corn for factory farming animals, and we converted that to regenerative farms, we could produce more cows than we do now given our industrial factory farming system. This is Alan Williams' data. And again, I write about this in my book Food Fix. Now, they didn't really break down the data and the results of the study until the third episode. So this whole thing was supposed to be up to the study, but it really wasn't. Out of the four episodes, only a really small portion of the series was dedicated to the study to the design and the results. And the rest was really promoting plant-based meats like Beyond Meat. Now, the data was really underwhelming in this study. I mean, it focused on LDL, which was just slightly decreased in the vegan group. TMAO, another marker potentially for cardiac risk based on your microbiome, there was really no difference in the primary analysis, but they did claim a difference in the study. The only difference was after the outliers were excluded from the data set, which means oh, we're going to get rid of all the people who have high, extremely high, extremely low levels, what they're eating, and we're going to only pick the people we want to pick, not looking at all the data. This is what we call cherry picking. The weight changes were interesting. They looked at weight in a study, but not body composition, which is way more important than weight or body mass index. But what was interesting to me, and I don't know why they did this, was they did focus on body composition, in the study. Now, the results did not favor the vegans and I think this is one of the most important findings of the study. For example, the twins Michael and Charlie, Charlie was a vegan, he lost 3.5 pounds, but he lost 2.6 pounds of fat and about a half a pound of lean muscle mass. Michael only lost 0.1 pound, but he lost 3.8 pounds of fat, more than the vegan, and he gained 3.6 pounds of muscle, meaning when you ate meat you lost more fat and gained more muscle, which is the name of the game protecting your health long term and for having good metabolic health. So they lost more weight in the vegan study and they lost less body fat and also lost muscle. So that's really concerning to me. The omnivore twin lost less weight but they lost more body fat and gained more muscle. This is really, really important. And I think we should not ignore this. And I think it sort of almost negates the entire study because over time this phenomenon will lead to poor metabolic health because your muscles turn to fat. That leads to insulin resistance and inflammation, lots of other things. Now, the vegans who lost weight and body mass, lean mass, were blamed because they didn't eat enough. Well, maybe because they didn't like the. So the whole thing is ridiculous. I mean, to do a documentary that's propaganda while conducting a study is just kind of nuts. So to conclude, I just want to talk about a more comprehensive approach to addressing your health and in the environment. Health rather than just saying vegan is good for your health and the planet. How about we Nuance that a little bit and talk about the real data? Here's where we discuss, like, a healthy balance that looks like how to eat for health in the environment. and what the power of regenerative agriculture is for healing the planet and addressing climate change and how to appropriately follow a plant-based diet, if that's what you choose. First is eat real food, right? If it has a label, don't eat it, right? It's probably bad for you. So, I mean, some things are fine. If it's a can of sardines or can of tomatoes or something you recognize ingredients, it's fine. But focus on whole foods, no matter what diet you're following. You have to personalize the diet. Some people do well. better on vegan diets, that'll be worse. I'm going to do better on omnivore or high fat or low carb diets or higher carb diets. You just have to understand what your dietary individual needs are. And this is personalization. Now, I wrote a book called the Pegan Diet where I talk about basic principles to deal with nutrition in a very confusing world. And the Pegan Diet just generally was talking about it was a joke between, you know, Pegan was a sort of a pun on paleo and vegan. They're basically more or less the same in every aspect except where you get protein, right? So they both eat whole foods, get rid of dairy, no processed foods, lots of whole foods and so forth. You should have a plant rich diet. I'm a hundred percent in favor of a plant rich diet, but not a solely plant based diet. The 70% of your diet should be non-starchy veggies. it should be plant-based by volume but not by calories because broccoli isn't a lot of calories. I think you need 35 cups of broccoli to equal one big gulp drink because it's just sugar. It has a lot of benefits to eating plant-rich foods, polyphenols or phytochemicals, fiber, prebiotic foods. It's gut healthy, it promotes microbial diversity. You should eat nuts and seeds. Some whole grains and beans can be okay depending on what you're eating. should be in the whole food form. People eat wheat, but they eat wheat as wheat flour. They don't eat wheat berries. So I would say flour is a problem in general. Gluten free, ideally for most people would be helpful. Not for everybody, but if you're eating gluten, it should be, you know, actually from more heirloom grains. Avoid American wheat. Sometimes European wheat can be better. They don't spray with GMO there, but most wheat is full of GMO. Healthy fats, really important. staple of the diet, omega-3s from small cold water fish, monounsaturated fats from olive oil, avocados, nuts and seeds, saturated fat and cholesterol, not all the same. There isn't one such thing as saturated fat. There are many saturated fats. There's ones from dairy, there's ones from meat, there's ones from butter, there's ones from coconut. And they're all different, have different effects. And I wrote a lot about that in my book, Eat Fat, Get Thin. And they have different properties. For example, stearic acid is in meat, but it doesn't really raise cholesterol. Palmitic acid, is a different fat that may have a different effect. So you have to look at what's going on. Some people have dramatic improvements of their cholesterol on saturated fat diets. Others get a lot worse. For example, the lean mass hyper responders, which I've talked about before, I'm one of those. If you're an athlete, thin and fit, you often have a problem. So you have to look at your own numbers. So test, don't guess. Look at lipoprotein fractionation, look at the quality of your cholesterol, do a diet transformation, and recheck your numbers. don't rely on some large study that may not have anything to do with your biology. And I've written a lot about this in my book, the Effect Ketone. But I also encourage you to check out Function Health. I'm a co-founder and chief medical officer. We've created an access for testing for people at a very low cost, $4.99, and you get all the relevant biomarkers, including all lipid fractionation, all metabolic markers, inflammatory markers, hormonal markers, and we can see what's going on. And that's the best thing you should do. to know what's really going on with your health. Now, what about protein and animal versus plant protein? Well, meat actually is one of the most nutrient dense foods on the planet, but you have to look at other factors, right? Ethical and moral considerations. And, you know, I think, you know, it's an issue. How are animals raised? Were they humanely raised or not? You know, and I can, I can talk about different, different aspects of this, but. what's the environment impact? What's the impact on our health? So these are the three things that we need to think about and we can't conflate them. So factory farm meat, 100% no, right? It has bad consequences for the environment, for the climate. The diets of the animals are super unnatural. Candy, soy, corn. It has negative effects on farmers, climate, the environment, our health, animals, farm workers. The list goes on and on. I've written a lot about this in my book, Food Fix. and also the destruction is caused by industrial farming including increased fertilizers, pesticides, herbicides, it's destroying our waterways, overuse of irrigation, the dead zones from all the fertilizer that's put on our farms that drains into the rivers and causes massive dead zones around the world, killing all the fish and animal life in the water. Even plant agriculture can be destructive, right? If you're not having regenerative animals, regenerative raised vegetables and fruit, it's a problem, right? So, you know, industrial farming techniques are used for organic food even, for most crops that are grown and fed to people at least soil erosion from excess tillage. There's lots of pesticides and herbicides. I mean, we use 400 billion pounds of nitrogen based fertilizers annually. It causes greenhouse gases. Nitric oxide destroys the carbon in the soil. Rivers likes and streams, it leads to all these dead zones. It's just disaster. Also, animals are killed in plant agriculture. You're basically destroying their habitat. There's 7.3 billion wild animals killed in crop production. So our way of growing often vegetable crops has had this massive destruction in our bird population. Over the last 50 years, we've lost 50% of our bird species. So if you're a vegan for ethical reasons, then you need to be advocating for regenerative farming. You should not be eating any vegetables or plant foods in aren't regeneratively farmed or farm in a way that doesn't destroy the environment. Because I think people aren't realizing this. But even if you do, you're still killing a lot of animals, whether you like it or not. It's just the way it is. Now, regenerative agriculture is a science-based approach to producing really high quality food while restoring ecosystems. You have to integrate animals into farming. You don't have to eat them, but you have to integrate them into farming because they are the ones that build the soil. For example, we had 168 roommates. that were roaming around America building huge amounts of topsoil, 80 to 50 feet of topsoil in some areas. Now, we've destroyed a lot of that, but that was because of the ruminants. They were pooping, peeing, digging, their hosts were aerating the soil, and that led to the massive amounts of topsoil growth. And we see this on farms. And I've been to these farms, one in Rome Ranch in Texas, where they use bison and reintroduced them and they increased the water absorption of the soil, they increased wild animals coming, they increase the soil carbon by six fold. It was just amazing to see what happened in just a few years by doing the right type of animal husbandry. You have to build the soil and animals are doing that. Also helps with carbon sequestration and water retention. I mean, there were rivers and streams coming back in this ranch in Texas that hadn't been gone for 100 years. It was amazing. Regenerative agriculture, according to some estimates may be able to sequester 100% of our annual carbon emissions. So talking about carbon capture, one of the best ways it can reduce net greenhouse gas emissions by 86%. Regenerative livestock production is 74% lower in greenhouse gas emissions than commodity crops. They use feedlots or beyond meats, soy burgers or impossible burgers. There was a large study done by Qantas looking at the climate impact of regeneratively raised meat versus an Impossible Burger. And they found that while the Impossible Burger was better than factory farmed meat, it still added about three and a half kilos of carbon in the environment. Whereas the regeneratively raised meat actually removed three and a half kilos of carbon. So you basically have to, you know, eat two regeneratively raised burgers to offset the carbon emissions of a, of an Impossible Burger. So swallow that one. and again, I've written about this in my book. The data is there. The references are here in the show notes as well. And when you, when you actually do regenerative agriculture, you restore the environment, restore biodiversity, pollinators, insects, Wildlife, you reduce the amount of fertilizers, pesticides, herbicides, water use, and it really important for food security, for climate change, for biodiversity, for our health. So the debate really shouldn't be about plants versus animals. It should be about regenerative agriculture versus industrial cultural. As one regenerative farmer said, it's not the cow, it's the how. It's not the cow, it's the how it's how we raise them that matters. And of course, regeneratively raised meat is way better for health and the planet than, and then these plant-based meats. Ruminants again, as I mentioned, forage on diverse plants and the phytochemicals reduce methane production. There are lots more phytochemicals in plant-based, I mean, in sorry, there are a lot more phytochemicals in Regenerus meats, they're anti-inflammatory. There's conjugated linoleic acid, which is great for your metabolic health and cancer. There's less fats, less calories in them. There's less toxins in them. And you can buy them. You can buy Regenerus meat at forceofnature.com and thrivemarket.com and you can find these also butcherbox.com has grass-fed meats as well. So if you're going vegan, you want to do it the right way. Eat real food, not Frankenfood. replace all the starch you're eating bread, pasta, rice, and sugar with vegan proteins like tempeh, tofu, lentils, low starch beans, nutrient dense whole grains like quinoa, black rice, buckwheat, prioritize protein. You know, two cups of beans equals six ounces of chicken, 46 ounces of chicken. So you, you might have to supplement with amino acids. I would say if you're really committed to being vegan, and there are branched chain amino acids you can get, you can you can get certain protein powders aren't so bad. With two and a half grams of leucine with other branched amino acids, you can supplement with them as a supplement branched amino acids or something I use called the amino acid complex, which is really great for building muscle. And you can supplement also with a multi-vitamin and mineral with the right B12 and omega-3s from algae-based supplements. You might need retinol in your vitamin, which is a preformed vitamin A. You reduce starch and sugar. and end up with protein and quality fat, and you can do okay, but it's not that easy. So I hope you've enjoyed this very complicated discussion of the vegan twin study, and now understand that it's not so simple that you need to read between the lines, not just at the headlines. There are lots of conflicts of interest and that, you know, it's a much more nuanced conversation than plant versus animal, and we're really having the wrong conversation, unfortunately. Now, the Stanford study really throws a spotlight on just how tricky nutritional science can be. It's a field where the one size fits all guidelines is just tough. You got to consider a whole bunch of variables like biases, our genetic makeup, our personal goals and our health, our lifestyle, how we want to live. All that really is important to consider. Any nutrition study that claims they got the answer should always be taken with a grain of salt. And look at this study in particular points out how hard it is to apply findings broadly or really understand what's happening and they just fuel the debate about what diets are best for us on the planet. But you have to think about funding sources and ethical challenges and study design and it's a lot of complicated stuff, but you can't ignore that and you can't just read the headlines. We need to question our beliefs about our diet. We need to go on a personal journey to figure out what's good for us. Let's tailor to our individual health needs and the environmental impact. It's all about the balance, but you've got to figure out what's good for you and look at science critically, and that's what we've done, and that's what we're going to continue to do on our Health Bites. So again, thank you for joining this Health Bites episode on the Doctor's Pharmacy podcast. If you are enjoying the Doctor's Pharmacy podcast and learning from it, please subscribe to our YouTube channel. It's a great zero cost way to learn more and support us. In addition, please subscribe to my podcast. You can leave up to a five star review, which I'd love. 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So thanks you for joining us today on this deep of the vegan twin study and all things vegan and carnivore or omnivore. And thanks for your interest in all things health. And we'll see you next time on the Doctor's Pharmacy. Hey everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I wanna tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff, from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. 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