The dietary guidelines great debate | Dr Christoper Gardner and Dr Ty Beal

The new US Diadry Guidelines have just been released and it's safe to say that they've created an enormous amount of debate. Two separate groups of scientists were charged with providing research to the government administration to inform these final guidelines. So I thought why not invite one scientist from each group onto the show and let's get to the bottom of this. Today I have Dr. Christopher Gardner from Stanford who sat on the Diadry Guidelines Advisory Committee and Dr. Tybil from the Global Alliance for Improved Nutrition who is one of nine authors on the Scientific Foundation review. In this episode we get into protein. Our Americans really not getting enough. Should there have been greater emphasis on the source of protein in the guidelines saturated fat. Do the maths in the guidelines even add up? Ultra-process foods does the evidence justify action? Conflicts of interest on both sides and whether these guidelines will ultimately help the person trying to feed their family well. Will Christopher and Ty disagree on everything? Will they find common ground? Let's find out. This my friends is the great Diadry Guidelines debate. Please enjoy. Both of you have been involved in in some capacity in shaping the the current US dietary guidelines. No I haven't but okay. Well to an outsider I think most people who understand your role in the Diadry Guidelines Advisory Committee and your role in the foundation would assume that you've had a lot to say in shaping the the dietary guidelines and there's obviously been a lot of debates since the guidelines came out. So I wanted to get both of you in to talk about the new guidelines, the process, the science, the reviews that went into shaping them and what's good about the new guidelines, maybe what's not so good and what are the most important takeaways for our listeners. Ty, your first time on the show. Appreciate you being here. I really enjoyed your conversation. You had with Marion Nessel on this topic recently. Can you just help people familiarize themselves with your role in nutrition science and what you're doing with Gain? Yeah so I'm a global nutrition scientist at Gain and we're an organization that really tries to help people get access to healthy nutritious foods, especially people who don't have access who can't afford it or they can't access it in the market. It's not available. And so we deal with a lot of populations that have under nutrition and this comes in many forms. You can be stunted, you can have anemia, you can have nutrient deficiencies. So a lot of my work specifically looks at understanding what are people eating around the world. How does that affect their nutrient status, their nutritional status and really what can be done to increase it through interventions and policies. So a lot of my work has centered around looking at nutrition across a life course particularly vulnerable life stages like early childhood, maternal, maternal and child nutrition, adolescents. And what we often see is that there's a lot of there's a role for nutrient dense foods, especially in the lower income context because their diets are dominated by these starchy staple foods. They don't have access to like the diversity of foods that we have in the US and in other industrialized countries. And so our work really has focused on how do we increase access and consumption of these nutrient dense foods. And so would you say broadly speaking, the nutritional advice for low income countries would be different to a country like the United States. I think when you look at where you're coming from, yes, because you have to try to get a population from where they are to where you want them to be. I don't think where we want people to be is very different. I mean, there's some genetic differences probably there's some environmental factors that may influence nutritional status. But overall, I think a healthy diet in Africa and Asia is going to be healthy in the US, in the UK, in Australia. And Christopher, remind folks about your work at Stanford and the things that you're interested in as a nutrition scientist. Sure, thanks. Yep, so I've been there since 1993 as a postdoc and now I'm a professor of medicine there, but my PhD was in nutrition science. So over those last 30 plus years, I've done 25 randomized human nutrition intervention trials, Mediterranean, keto, vegan, omnivore, a lot of weight loss studies actually our our group sort of named a fame came about when we did the eight to Z weight loss study and the diet fits weight loss study. Those are the biggest most expensive longest studies we ever did. But since then, Stanford has opened up a new school of sustainability. Somebody donated the door family donated a billion dollars to open a new school. And so that school has adopted food and nutrition as a pillar of the new school. There's eight different pillars and there's another group on campus called bio X that originated as a group of bioengineers and the Clark family donated the Clark Center to be the intersection of bioengineering medicine and the humanities and a new leader just took over after 20 years. And she decided to make food the central theme of the whole building and now she wants all seven schools to participate in this. So I'm a little giddy at this particular moment because food is a super hot topic across all the different schools. At Stanford, there's a running joke that we might rename the school stand food instead of stand. Third. On sustainability, the current diet to regardless in America don't really mention sustainability. I don't think they do at all. And you just you just mentioned there that it's some it's part of your research interest. Tide, do you feel like sustainability and the impact of the human diet on the environment should be something that we're speaking about when educating the public about what a healthy diet looks like? I think that's a very tricky question. I think ideally you want people to care about the environment. We know the food system has a big impact on the environment from land use, from biodiversity, from greenhouse gas emissions, etc. Right. And the trick is that we often don't understand people's preferences or desires for why they make their choices. And we can't necessarily force people to care about certain things. We know in general the biggest driver of diet is more around what people prefer preferences, what they're used to and the cost of foods. So while I think it's important, we have to be realistic about what we can expect individuals to make choices on to impact the environment. I do think there's there's it's important to make a distinction between what is the nutritional role of the diet solely on a nutritional basis and then distinguish that from what does the evidence say on the environment impact because then you can kind of have a distinction and understand well if my values are mostly about nutrition I'm going to make choices primarily about that. When I care about the environment I'm going to also incorporate that into my so I think that information is useful and important and you actually see dietary guidelines in certain parts of the world that have started to introduce this. I think it's a little bit of a sticky issue because not everybody's values and preferences are the same. And I think that what I would like to see is a bit more of presenting information and incorporate that as part of the approach not necessarily as saying sneaking it in where you say we got to have this type of diet because it's good for the environment and it may mask some of the challenges for example with nutritional adequacy. I'm going to throw that back to you and just say if I'm hearing that correctly. So essentially what you're saying is it's not a perfect overlap between what you would say is the most optimal diet for human health and what would be the most optimal way of eating for the environment and you feel like the the public should understand the differences between those two. And what I like to see is the biggest lever on the food system side is how do we produce our food? How do we transport it? How do we raise and produce all of these different crops and animal source foods in the most sustainable way possible? I do think there's a role for the amount and the proportions but overall if you're to go to a grocery store as a consumer it's very challenging to know what is the animal welfare of this right? If you if you have enough money to go to Whole Foods you can see the animal welfare rating which is great. What about the environmental impact? We see a lot of products now showing sort of regeneratively raised. What does that mean? It's not even a question right? Right. Yeah. And so I think there's there has to be some realistic I think coming to terms with how do we actually understand this at the level of where the food the actual product that somebody's choosing at a grocery store versus is that some coming from the environmental impact analysis for some global analysis. And so I think I would not like to see a lot of the burden placed on the consumer for that. I would like to see it on the system. Consumers only have so much role especially if you don't have the money. I mean for people who are just trying to make ends meet and you're going to be purchasing food the last on their mind if you're a poor person in any part of the world is going to be well, is this going to be good for the environment? You're trying to just get enough food and you're trying to get the right diversity of foods, right? So we should make it easy for people. The food available in the market should be sustainable. And I know there's a role of not eating too much of certain types of foods like potentially animal-sourced foods in that discussion. But I'd like to see that focus away from the consumer and more on, you know, there's a little bit of a role for the consumer, but mostly on the system itself. Is there anything you'd add to that? Well, this is such a great opportunity to get into the politics and the DJC versus the DJA. So I agree with most of what Ty says. But be a great way to introduce the confusion here and whose responsibility it is if you want to let me go there. Let's do that. So 2015 was a big year. And to bring that up brings up the other issue that the dietary guidelines for Americans, which got started in 1980 by law, we're supposed to be updated every five years. And they have. And so two years before the new five year report comes out, a panel of scientists is selected and a sign to look at this. And so let's go with abbreviations here, the dietary guidelines for Americans are often called DGA's and who they pick for this. To review the sciences called the DGA seats, the dietary guidelines advisory committee. And I want to really emphasize that advisory part. So after getting two years to do this and I would love to talk about that process later, I want to jump ahead and tell you what happened in 2015 is that advisory committee handed off their report as is always expected to the Secretary of Health and Human Services and the Secretary of Agriculture and the two of them come up with the dietary guidelines for Americans together every five years for that update and actually swap off who has the first role. So once a decade, each one is the lead of the every five year update. In 2015, I'm going to give you two examples. The committee advised that three to five cups of coffee a day was consistent with a healthy diet. It was sort of a quirky thing that not many people even know has been in there for a decade already. And it really had to do it looking mostly at the impact of caffeine and the amount of caffeine in coffee and what that would do. And when they handed over that advice, the Secretary has accepted it and said, yeah, we this is an advisory document. We can take the advice we want, but we don't have to take it if we don't want. And that same year, they advised linking food to the environment. And Tomville sat Keter the USDA at that point said absolutely not coloring outside the lines completely dismissing that topic, not even relevant to the dietary guidelines. Now the irony there was pretty stunning because almost every year since the dietary guidelines have come out, there's been a recommendation to be physically active. So it seems to be a little bit hyperbolic or just hypocrisy here that say, oh, the environment is off the table. That's not food. The dietary guidelines are about food. But one of the reasons many of us recognized the physical activity is there is from industry pressure as they were pressuring creating too many calories and too much food and too much food addiction for people who are getting overweight as they get slammed for providing too many nutrient poor calories. They could say, well, it's not the food that we're making. It's that people aren't being physically active enough and it's their personal choice. They shift the blame. That's the problem. So no joke or no surprise politics are always a part of the dietary guidelines update. I've been using Woop for over six years and I can confidently say it keeps me on track when it comes to my sleep and exercise routines. The next generation of Woop isn't just tracking your workouts. It's monitoring your sleep quality, your recovery state and even giving you insights into your biological age. No screen, no distractions, just continuous data on what your body actually needs. And here's what matters. Daily Woop where is linked to increased physical activity to better sleep and improved heart rate variability. I have no doubt that my Woop is helping me train smarter, recover faster and make decisions that support my long term health. Head to join.woop.com/simon. That's join.woop.com/simon to get one month off your first subscription. Is this something that you feel Canada and I love both of your views on this has done a better job off because it seems to me that they've they have provided dietary guidelines for their population that would improve public health as well as the health of the environment. Do you do agree with that or disagree or yeah I think in general the Canadian guidelines are held up as a good example. I think Brazil as well. You know one thing I think that people have commented on is in the plate they show the actual foods. You know the previous my plate I think one of the criticisms was you don't actually see what foods are in there right. Totally. So not only do they show you kind of proportions, they show you which foods are there and I think what a lot of people like about those which I can tend to agree with is the protein foods they show the meat with the legumes and the nuts and seeds in the same category right. So it kind of shows you here's the category of foods you can choose from it's not necessarily saying you need to eat the meat and you need to eat the right and it's not necessarily I don't think there's a separate category for dairy is there yes there is. There is separate category. So dairy work is way into that too. So yeah I think in general I think they're a good guideline. So can I have a quick rebuttal to that. So one of the issues not not for you in particular but interestingly as R.F.K. Jr. was considering these one of the talking points was how confusing and abstract that concept was of the plate and the the dietary guidelines were too long and they needed to be shorter and simpler but the reality is once those get generated all kinds of public marketing tools are created I have a plate full of foods so there is one my plate.gov with four quadrants and a little circle that's supposed to be dairy but there's many representations covered with foods as they're suggests so I don't think it's just the Canadian that does this the US has always had that just the simple one that they show I mean it's like the old issue of should we eat less saturated fat or should we eat less fat well fat simpler to say so we'll do that in a backfire so to say that the plate doesn't have pictures of food doesn't quite appreciate that there is a lot of public facing material that goes that next step in the US as well to be fair but Canada is is nice and some of the other countries also there's a Asian pagoda and there's another country with a rainbow and there's there's some real fun representations I want to come back to the Canadian guidelines later on when we get to protein but before we actually get into the guidelines and the process behind them at a high level here when you look at the chronic disease burden in America and how the average diet relates to that is affecting the risk of those diseases I'm interested in how each of you would kind of summarize what are the main problems with the American diet yeah I mean I can go first I think the main obvious problems with the diet is that it's predominantly ultra processed or highly processed foods I don't think all ultra processed foods are harmful but in general the highly refined extracted foods that do not contain a lot of the nutritional value that can increase the risk for chronic diseases so think donuts chips right so does the sugar sweeten beverages I think in general are one of the most probably the least controversial food out there in terms of being a health risk and having no nutritional value and then I think these refined carbohydrates are also a problem especially the refined flowers and when you combine those the refined ingredients like refined flowers refined oils with the right amount of salt sweet texture right like the crispiness of it if you notice the types of foods that are kind of often overeat in they're really quick to eat they you can eat a lot of calories in a short amount of time without really feeling satiated so I think the general like at a high level it has to do with the quality of the foods that we're eating that's the biggest issue with the diet in the US and those foods would you say the the main way that they're driving affecting risk of chronic disease is through the overconsumption of calories I think so I think there are many different ways that they do this so without overconsumption of calories there's risk for cancer from certain types of foods right process meat ultra-process foods even sugar sweeten beverages you have risk for cardiovascular diseases you have risk for diabetes that could be independent of the pathway of excess consumption of calories but I think by far the largest contributor is through that pathway of excess calorie consumption and weight gain and we see that in the data three-fourths of adults in in the US are over. overweight or obese. So that is the primary issue. I think that if we were to focus on one thing, it would be that excess calorie excess weight gain. And I'll come to you in a second. But on that chunk of the diet, I think you said, did you say 50% of calories or maybe even more? I think 60% of the US diet is ultra-processed. So it's a lot. And in adolescence, it's closer to two thirds of the diet. If we think about the opportunity cost, what that's displacing from the diet. If people were eating less of that, what in your view would they be best eating more of? I think this comes down to a lot of personal choice. So for example, lagoons, like beans, nuts, seeds, those are very under-consumed in the US. I think that most people would benefit from increasing consumption of those foods. At the same time, I think even just replacing these ultra-processed foods with any minimally processed whole food, whether that's fruits, vegetables, whole grains, nuts, seeds, meat, fish, dairy, eggs is going to have an impact and it's going to be positive impact. Some people do better on more animal-sourced foods, eggs, dairy, meat, fish, and other people do better on less animal-sourced foods. I have personally, I'm friends with people, I'm colleagues with people who are fully vegan or omnivore, or on kind of the low-carb animal-based diet. And so I would like to see sort of this allowing there to be this diversity of preferences because I do think the biggest issue is the over-consumption. So if people can sustain the diet long term, that is the key. And some people can sustain the diet long term on a really high plant-based diet and others on more animal-based diet. So I'd like to see that flexibility in there. My favorite paper and I hope you'll show it on the show and have it flashed across the screen is the paper from Shan at all. It's National Health and Nutrition Examination Survey data across 20 years. It's like 1999 to 2020, something like that. And they were trying to show trends across total carb, total fat, total protein. And then they did a separate graphic for animal versus plant protein, saturated versus mono, poly, saturated fat, and good quality carbs and bad quality carbs. And it is my favorite graphic. I show it almost every talk these days. It's going to completely back up what Ty just said. So if you look, you'll see that saturated mono and poly just use some rounding errors here. Each contribute 10% of calories. Animal protein, 10% of calories, plant a little less than that, but in the ballpark of 10. Good quality carbs, whole grains, whole beans, legumes, nut seeds, 10%, 10%, 10%, 10%, 10%, 10%, what's left? 40%. So 40% is crappy carbs. 40% is added sugar and refined grain. That is the big problem. And interestingly, the Mahat report very much focuses on that. And they take a lot of pride in saying, never before has anybody radicalized this and focused so much on this. And I would like to get back to that. But let me finish that thought just for this immediate conversation. I've for years ever since doing our A to Z and our diet fits weight loss studies have been stunned that most people do pretty well on any diet as long as it's a good quality diet and you get rid of the crap. So I would love to see that 40% of added sugar and refined grain go away. And if it was all carbs, it could be healthy. It's hard. Not many people can replace 40% with more beans and whole grains and nuts and seeds. And I know there's a community that wants to be all replaced with fat. And so I'm seeing there's another group that wants to be avocados and all of and meat and whole fat dairy. And I suspect for most people, if you replaced all that 40, with some combination of the whole foods in both of those categories, you would do so much better than the average American does. And I actually love the flexibility that comes with that. So it does suggest that if you got rid of the huge proportion of our diet that's all to process food and mostly nutrient poor carbs, you'd have a lot of flexibility in what you replaced it with. I'll end on the note that will be fun to come back to if you want to put it in the parking lot. Stunningly, the protein doesn't change much. I've had a fun insight from all the studies that we've done in looking at some others. That is, people have radical changes in fat and carbohydrate. I'll cite some studies for you later. It's amazing how protein stays at 20% almost every time. On that, I think you just mentioned there that that protein sort of half that's animal and half's plant. I had thought that almost three quarters was animal protein and a quarter was plant protein. Well, okay. So most people get about 18%. If I were to look across a lot of different databases, I say it usually ends up being 15 to 20. Actually, if you look across the entire world, almost every culture that I've ever seen is between 15 and 20. And so the high protein eaters, the high animal source food protein eaters are at 20 and the low animal source are at 15. But there is protein and everything up, as hopefully I've said on this show before. So could be 10 and 5, or it could be 12 and 6, or it could be 13 and 7. So I don't know if it's three quarters, but it's much more than plant protein currently for the average population. But there's still a fair contribution. And Ty, just coming back to you. So I think you said that some people do better eating a little bit more animal-based and others do better, more plant-based. And I would tend to agree with you that you definitely, there are, I have people in my life that would say the same thing. And you can read all sorts of stories online. My question to you is, is that always representative of long-term health outcomes? How someone feels today? I don't think so. I don't think we know the answer to that question. I think that's very important. The time that people are on a diet has certainly a big impact on their overall health. I think the, from my understanding of the evidence, when you look at the trials, look at what people eat, there's this big distribution of what people tend to eat. And there's often distribution of their, you know, amount of animal source foods and whatnot and the relationship to their biomarkers or their health markers. So I, without the data because we can't randomize people to these studies, we're left with sort of looking at the cohort studies. I think most of the observational studies that look at people over time, many years or decades, they tend to show the correlation with more animal protein, or sorry, plant protein foods, right? I think that those observations are sort of seen. I don't think we know we don't have really strong high quality evidence to know. But in general, I think when you get into older age, you want to see quite a bit more protein, I think, from both plant and animal sources or whatever people prefer. The bigger challenge there is more about what are people going to be able to consume and energy needs decrease, muscle mass is being lost at a higher rate. And so I think there's a, in general, more protein foods would be beneficial regardless of what source they're coming from. I don't think my main response is, I don't think we know. But I think it's important, it's an important question for sure. Given that we don't know for sure, let me tell you what we just decided recently. So I think you know we had a real fun, identical twin vegan versus omnivore study ended up being a Netflix show that got an Emmy Awards. So we're pretty happy about that. And we have a follow-up to that. We just are finishing this week, 120 firefighters are getting randomly assigned to plant-based versus omnivore. And so they aren't identical twins, but they're all firefighters. And they're all big and they're all really active. And we didn't have any aspirations of making them all vegan. And so one group is getting a very plant-oriented plant-rich diet. I now actually prefer plant-rich to plant-based. So plant-rich diet, because that includes other things. And they all got to eat fish and eggs and yogurt. So even within the plant world, and I've seen this in some of your writing tie, you know, constrian animal feeding operation beef is not the same as regeneratively farmed beef, is not the same as chicken is not the same as fish is not the same as yogurt within the dairy category. So even as we get to that animal part of the protein, there are a lot of options to choose from there. Didn't you guys write a paper on animal protein together? Yes, we did. And it was really fun. I was invited and it was really quick. I can go ahead. I can tell you about that, okay, because I was working as a co-author on a paper. I was just a contributor of a paper that was around animal source foods and livestock and the health and ethical and environmental impacts, okay. It was led by a colleague, Frederick Leroy, a controversial colleague. I love you, Frederick. Really? Yeah, so anyways, we got a review back, okay. Very, very detailed review. And it was by, signed by Christopher Gardner. And I'm reading this review. And it's amazing. I don't know if you remember this. I didn't know I reviewed it. Go ahead. Keep going. Very, very detailed, very thorough. And it was like very constructive feedback, right? And I knew because I know your work, I knew sort of where you're coming from. And I thought this person gave like, a very thoughtful review. And so I specifically sought out Dr. Gardner to co-author this manuscript because you probably know some of my work and I try to be balanced, but I tend towards kind of emphasizing the nutrient density of animal source foods partly because of the work that I do. My research focus. So I can have this bias of like animal source foods are great, we need them. - When you say probably because of your work, just to point this out to the listener because you have a lot of focus on low income. - Yes. - Country, slow income countries and sort of, and then that's merged into the nutrient density of the foods, right? And so I know I have these biases, we all have biases. If you go through a PhD, one of the things they teach you is that we all have bias, the best thing you can do is be aware of it. Reflect, it's called reflexivity, really no understand it, be able to communicate that. So I invited Dr. Christopher Gardner and it was interesting when I reached out, I said, you know, you don't have to commit to it. I'd love to just get your thoughts and this have a discussion and you can decide after the paper has been written, right? And I also invited on the environmental side, I invited somebody, Mario Herrera, who was one of the key modelers on the environmental impact of diets in the Eat Lancet Commission. And so my goal was to be like, let's get some people on different sides of this debate. I wanna try to get it as close as we can to sort of an objective reality. So that was what led me to ask, I don't know if you remember writing that review, but it was signed, Christopher Gardner, maybe it was another person, but it was a very good review. And I was very impressed and I have to say, the paper is stronger for it. Like the, I think of some of the biases that I had, you know, and inherently in the work that I do and maybe my slant, I think they were a bit countered. And there was some challenges, we had some discussions of, okay, how do we phrase this? What does evidence say here? And I think overall it made for a much more balanced, final paper. - Yeah, I commend you on reaching across the aisle to do that. I mean, that's really what science should be about, right? Healthy debate and having our ideas tested and going through that process to come to the best conclusions and reducing uncertainty as best as we can. What was your experience of writing that paper? - Yeah, I was so pleased to be invited, I have to tell you. So I've really spent the last at least 10 years being frustrated at all the built up controversies that would be more consensual if we just talk to one another and said, "What are we really talking about "which papers are here?" So when I got the invitation, I kind of forget the review part. But I will say to that end, I sign all my reviews. So I don't know how much you know about the review process. It's usually blind and some people are quite cruel and unconstructive and it really doesn't help the science. So I was like, "I'll own this if you want to know who said this." I said it and I'm trying to be constructive and I agree with this part and I disagree. So it was really reaffirming to get a call and said, "Hey, you look like a reasonable plant-based person." Okay, I think I want to have a reasonable constructive one on my side and I do very specifically remember that offer which was really enticing that said, "If you do this and you join and at the end, "you feel compromised and you don't want to be on it. "You can take yourself off." That was such a great approach. So hats off to you including me and giving me an out. And I stuck with it. I'm a co-author on the paper and I had many comments which you said, "Yeah, you're right." That one goes. And I learned a lot from the paper as well 'cause it's not the side of the argument that I often present. I said, "Oh yeah, loan middle income countries, absolutely." Oh, I hadn't really thought about that angle even in the US. So it was a great collegial process there. Thanks for including me. What was some of the main takeaways from that paper? I think that the high level takeaway was sort of, there are benefits of animal source foods and risks of animal source foods, both on the health side and the environment side. And on the health side, the benefits really come from the populations that have very low consumption and have higher burdens of under-nutrition. And so in certain countries in Africa and South Asia, consumption's very, very low to the point where you can increase animal source food consumption. It's gonna reduce anemia, reduce stunting potentially and reduce nutrient deficiencies. And then at the same time, there was these risks of excess to try to kind of simplify it. We took off a lot of the, you could go down rabbit holes but we looked at like the saturated fat issue, the processed meat and the red meat. And I mean, my general takeaway from it was, saturated fat, there is some increased risk there. The processed meat, very clearly there's increased risk, you need to limit. And then the red meat was sort of, the unprocessed red meat was sort of, you want to moderate. There's some sort of amount where you have too much and it's harmful potentially. And it depends on the population. I think when I looked at the data, which I think is surprising, if you look at data in the US, by some markers, iron deficiency and women of reproductive age of 15 to 49 years, is around a third of women. And so I think for that population, the unprocessed red meat can play more of a role, right? But for a lot of people, it's going to potentially increase risk, especially if it's that fatty meat. So it comes down to what that person's priority is. Priority in their baseline and their needs. Yeah. And the context, so you have a great graphic in that paper. So we had the water domain and the land domain and all the other domains. And in branching off of each one was, here's a pro and here's a con. Here's a pro and here's a con. And so if you looked at it in this country for that person, it was a pro. And in this country for that person, it was a con. And it's really, that's actually the way nutrition works. In the same environment too, it's sort of how do you produce these foods? To your point about how is it raised? Is it generally if you're raised, is it done in a more sustainable way? There's these impacts around, I think we looked at soil, health, water, quality and quantity, greenhouse gas emissions, biodiversity, all of these things, right? And in general, there's a big impact of all foods produced. But we were looking specifically animal source foods and there's a lot of harmful potential environmental risk and harms. But there's a lot of options that you can do to improve them, right? So it's sort of looking at it constructively. Have how do you balance that and how do you understand what needs to be done to make sure that the foods we do produce are more sustainable produced. (dramatic music) Today's episode is brought to you by Prolon. Prolon is a patented program developed by Dr. Valtelongo based on more than 25 years of research into fasting, metabolism and longevity. The idea behind the FMD is to keep the body in a fasting-like state while still allowing you to eat carefully designed foods. The FMD has been used now in over 40 clinical trials showing improvements in metabolic markers, reductions in visceral fat and reductions in biological age under controlled conditions. 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This deal is exclusive for listeners of this show. So head to carawayhome.com, forward slash proof, or use the code proof at checkout. - Do you know Dr. Hannah Richie? - Yes, yeah. - That's great. - Yeah, I've had her on my show, and not to digress too much, because we could probably speak with three hours about the environment. - Her view tended to be similar to what you just explained in that we, the animal protein that we do consume, there could be improvements to the way that it's farmed, that benefit the planet. But generally, it seems that her sentiment is that, As you shift to those more sustainable kind of regenerative systems, they're more extensive. They require a lot more space than the kind of KFO factory farms, which most people agree are not so good. The downstream consequence of that is that there is less kind of protein-meat consumption for a unit of land and that shift to that kind of better, more sustainable meat production system would inevitably mean less meat consumption at an individual level. Yeah, I think this gets down into the weeds. So if you want my view on this, it's so short-take. We can leave room for another one. There's this debate if you're in the geography world, which I was in in my graduate program. It's sort of the land sharing versus land sparing. Sort of like, do you try to use as little land as you can and go super industrial and intensive production high yield? Or do you try to share the land? It's extensive, but the biodiversity and the ecosystem services can be better. And I think we need a bit of both. Like if you look at the evidence all around, we need to produce food more efficiently, but it depends on the context. And many contexts where you have, maybe like I'll give an example of an Africa. Many contexts in Africa, there are pastoralist cultures that essentially have been using livestock on the land in a way that is relatively sustainable. It's extensive, so it's not going to be doing the high yield production that we have in the US and other industrialized countries. But there are a lot of ecosystem benefits from that process because if they're kind of managed in a way that is improving the biodiversity and they're not overgrazing, they're not necessarily making things worse. There can be some potential benefits. You can take advantage of land that's not suitable for crop production, for example. And then of course, all sorts of technologies. There are veterinary care services, there's potential things with medication, with vaccines, different ways, feed added is that can reduce the emissions. I just think that it's overly simplistic to think we should just go for really efficient production to reduce the emissions because if you look at more of the regenerative holistic perspective, circularity, there's a lot of opportunities to take advantage of crop residues, stuff that's distiller grains, things that are not for human consumption, that would otherwise potentially be a problem, even the manure issue. That can be a big problem with if you don't process it in the right way, it can be an environmental risk. But you can also use manure and naturally in systems to fertilize. I think there's just a lot of nuance around what part of the world are you in? What does the ecosystem look like? How can you produce foods and which types of foods can you produce there? So if the ecosystem is a natural range land, it's going to be more suitable to have some livestock grazing. If it's a rainforest, it's going to be hard to have remnants that are evolved with grass lands there. It's going to be very destructive. Obviously, no one thinks it's a good idea to clear rainforest for grass land production of cattle. So I think it just depends where you're at. If you're in the US, I would totally agree with your point there. So a simple way to move this forward in the US would be eliminate concentrated animal feeding operations, move the cattle to grass land, and graze them regeneratively. The amount of meat that could be produced would be a fraction of what it is today. And US Americans would eat less meat and a better quality meat. I'm in. But Mark Heimann has pushed back multiple times and said, "No, I've done the math. Mark, I don't know if you're listening, but I hope you are." We'll see what Ty says here. Yes, you can take all the cattle off the concentrated animal feeding operation. There's enough land for them all to graze. Every environmentalist I have ever talked to has said in the US, not remotely possible. There are too many million heads of cattle to graze them. Would you agree with that? I think the answer is probably yes. It's not going to be able to produce the same as the same as that. I think that's been modeled out in a few papers. Yeah. Even when you take all of the factory farms plus there's a lot of crop land that's used to feed them. Yes. When you take all of that and you shift to a regenerative system, I don't think it can supply as much meat. I don't think so. I think that at the same time you have to look at the amount of natural range lands in the US is quite vast. When you look at bison numbers, this is often stated like we had 50 million, I mean 30 million, 70 million, I don't know exactly, but tens of millions of bison in the Great Plains. The sort of issue is, yes, they were naturally there, but could we at scale do the same type of thing in our current industrialized society? I don't think we could. I don't think that's realistic. I think that at the same time there are a lot of ways to go towards more regenerative production. I think that there are a lot of producers that are doing that. I visited ranches where the diversity on the land is really extensive. There's this whole issue of what happens to the land. There's a lot of efforts by environmental scientists and conservationists who say, can we remove the livestock from the land and potentially rewild or create that for other purposes? I think the reality is to what extent that can happen, that can be a good option, but what often happens is the economics drive what happens to that land. If there's fragile ecosystems, there's actually world wildlife is working in the prairies. They have a whole program that they're actually working with ranches as conservationists, because they know if they remove the cattle from the land, there's actually potentially worse consequences, but if it can be managed in a way that is beneficial, they can preserve the ecosystems, the natural ecosystems. Again, it's a bit of nuance. At scale that we would like to in that way. There's usually there's some trade-offs. There's like synergies and trade-offs, and that's one of the trade-offs. I think this is probably a conversation for a whole another episode. Let's pocket and come back to that. We're here to talk about the guidelines. Oh, yeah. Let's go down. I think we're trying to avoid that. Yeah, I'm not. Bring it. Let's do this in chronological order. Your advisory committee brought out a report first and then tie you were involved in the scientific foundation. Let's start with you, Christopher. What is the dietary guideline advisory committee? How was that formed and what was the intent behind that? Okay, and feel free to rein me in, because again, given multiple talks on this, although I had hundreds of slides in it. I have no slides today, so I'll try to keep it shorter. This happens every five years. I've been nominated twice in 2015 and 2020, and I wasn't picked. I was picked for 2025. It's an enormous honor, but I didn't actually know what I was getting myself into. To be picked, you have to be nominated by multiple different organizations, and then they take these nominations into account. They vet you to see if you have too many conflicts of interest. And to be honest, there are 20 of us, and by the time you get picked, many of them are senior nutrition scientists, and none of them are clean. I think maybe one of our 20 members had no conflicts, whatever. We all had some. Mine was beyond meat. I had taken some money from beyond meat to do a study that I've talked about in your show before. Anyway, when they get you, they say, "Are you sure you want to do this?" Because just so you know, it's a two-year commitment. It's free. It's voluntary. There'll be two Zoom calls a week for two years. You'll have to come to Washington, DC six times for a full day public meeting to show everyone that you're doing. And as the committee got started and met each other, I said, "Okay, Senate, before you go anywhere, we're going to give you a list of 80 potential questions that we pre-selected for you that we want you to answer." And having done this before, we don't think you can do it in two years. So rank them as high, medium, and low. And we'll try to get to the highest priority first and then go from there. And now you're not done. Now you all have to establish the PICO guidelines for the search. So PICO means the population, the intervention or exposure, the comparison to that intervention or exposure, the outcome of interest, which could be a blood pressure, it could be mortality. And the time, if it was blood pressure, it could be 48 weeks, and if it was mortality, it would have to be decades maybe. And so we had to do this because we had a staff of 30 people helping the 20 scientists, 30 federal employees, prepared to do the searches for this. And it's called the E NESR, I'm going to blank on this. Anyway, it's a search committee that helps us. And they're like professional librarian search PhDs. And so what would happen is you'd say, "This is who I think the PICO guidelines suggest the search should be for." And they would come back to us and say, "Well, that set of guidelines, we have a thousand papers. You won't have time to read them all." And they'd say, "Oh, okay, we need to narrow the guidelines." So it's more realistic to answer 60ish questions. And sometimes it came back with nothing. And they said your search criteria are too strict. You won't be able to answer the question. Are you willing to loosen them at all? So we spent months just defining the search criteria for these. Before we ever looked at a single paper, it was to be honest, it got super annoying. It's like, when do we get to do the work? And so it was months and months later, when we first started this and of the 20 individuals involved, pairs of us were assigned to be the lead for each question. And then two are sort of the backup leads and the whole rest of the committee had to approve everything before it got written up in the report. So we would take these. and we would, the leaders had to read all the papers and the federal staff. It is amazing job extracting, finding the papers and extracting the data, putting it in an Excel sheet. We could sort by year, we could sort by country, we could sort by race ethnicity, we could sort by socioeconomic status, we could sort by blood pressure versus cholesterol. So we had all this time to read it, play with it, come up with something, and once in public we had to explain what the criteria were for the search and the next time in public we had to say, this is what we found, this is what our conclusion is going to be and if there were enough papers for a conclusion, we had to use another set of criteria to say, was it generalizable, was it precise, was there a risk of bias, was it generalizable, was it direct, and so we had to rank everything as strong, moderate or low, and so we would have a conclusion, yes or no or neutral, with this much strength, and I'll just give you one example, I was in charge of food sources of saturated fat with Deanna Holescher, that was one question, food sources of saturated fat. In our two or three months of working on that one question, there were 31 subquestions, if you can imagine a different population, a different exposure, a different comparator, a different outcome, and a different time that meant there were all kinds of permutations. And what kind of saturated fat? Yes, so yeah, we actually didn't get to carbon length to be perfectly honest, but we did do meat versus dairy versus tropical oils, that was, so again this was food sources, this is actually something I was really excited to tackle, because what you just brought up is maybe a 12 carbon, 14 carbon, 16, no, that was something that we considered, but the way we were tasked this particular round of the DGAC was to look at, oh the food sources are meat, dairy and tropical oils, and the comparators could be a high fat meat versus a low fat meat, or it could be a high fat meat versus legumes, and the dairy could be high fat dairy versus skim milk, or it could be milk versus soda. And so all those were the things that we put together, and then we'd say it, and then we'd announce it, and we'd talk about it in public, and we wrote it up into a 400-page report with a thousand-page supplement, and we handed it off to the secretaries of health and human services and agriculture in December of 2024, as the administration in the US was turning over, and despite having a different sanctuary of health and human services and acts throughout the entire two-year process, at the very end we handed it off to other people. And just to be clear, this is just a piece of advice, it's not something that the government has to use to formulate the dietary guidelines. And as I was trying to point out earlier, the 2015 classic was they took the caffeine in the coffee as advice, and they did not accept the link to the environment. So no one was under the illusion that all of our advice would be taken. It was advisory, and we did, in the final report, have a 10-page summary, and even a two-page conclusion to the 10-page summary. If you're going to fix anything, we suggest you fix this. These are the biggest things. So that was really mind-boggling consumption of time. It was really an honor to be part of this. And if you could put ultra-process foods in the background that we could cycle back to, it was a really interesting difference to how we addressed ultra-process foods, which is a huge priority of this administration currently, to how we address some of the other things. So I think we'll illuminate a couple other issues. I think that gets us to health equity, which we'll get to. Just quickly though, you mentioned 19 of the 20 committee members had some type of conflict of interest. I think Nina Ticolts was pretty critical of that. So for the listeners, if they have heard that this committee had a ton of conflicts of interests, there's a lot of ideology in those recommendations. How did you as a group put your ideology, preconceived beliefs about food, and nutrition to the side in creating that report? This really merits going into a little more detail. So we were asked to say, did you ever receive any funding for research? Did you ever get an honorarium for going to a conference? Did anybody ever cover your travel, your flight to the place? Did anybody ever cover a hotel for when you went to this? It was really a huge category of possible conflicts of interest. None of them were, did you ever take the money to go to Hawaii and have a vacation with your family? They were all very research-oriented, and some of them were quite benign, and we were asked to list every single one of them. This has been a critique of every dietary guidelines advisory committee since the beginning of time. If you can imagine finding 20 scientists who are willing to talk about these things, who have the improportor to talk about these issues, and I just said that word, whatever that word is, you're going to get people with conflict. This is the first year they decide to do a process a little differently, which is, I think, to their discredit. I made a huge list of everybody's conflicts. In past years, they showed which members had which conflicts. You could see some had 10, some had five, some had two, some had one, and one person had none. When you looked at the whole list, it was really long, and they said, "No, the point is, we all know there's conflicts of interest, and collectively, these are all the conflicts they have, and so we are being transparent about this." I think the lack of linking them to specific committee members hurt them in the long run, because I think people were blown away by the length of the list, which was many they paid for my hotel. They paid for my flight. This very inconsequential thing five years ago that I did that I'm required to list. That was part of the process, was opening up to all the potential conflicts of interest you had. So some of them were quite benign, and I'll just finish that by saying, "I was totally impressed with these people." They left all their biases at the door. For every single thing that we looked at, all 20 members had to agree on the final conclusion. There was no way for somebody to walk in and be very charismatic and outspoken. I know you all think this other thing, but I think this way, and by the way, I have a few conflicts. It was very transparent and very objective, and I was really proud to be part of the whole group. Here's the truth. Most of us are drowning in pills. We open the cabinet each morning, we grab a fistful of capsules, and think there has to be a better way here. We're spending hundreds every month, and honestly, it doesn't feel like how a healthy human should approach supplementation. 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And tie the scientific foundation for the dietary guidelines for Americans. So that's the group that you were a part of, which came after the advisory committee's piece that Chris Vigius explained there. When were you invited to be a part of that group and what was the kind of mission that that group was given? Yeah, well, I have to start off by saying if I was Christopher and I spent two years on the committee and then it was just not taken up, I would be pissed. So I have to say, I totally validated that feeling. Like actually when I was approached in the back of my mind, I was thinking, what is Christopher trying to get a thing about me doing this new group? So anyways, I was obviously there was only a year worth of time from when the new administration, the new secretary came and when the guidelines came out in January. And so I was approached, and I don't remember the month, but I was approached at some point several months ago and was just asked, I wasn't given a lot of information, but just asked, like, we're recruiting some scientists to do the guidelines. And we want you to write this specific section on V, and a vegetarian diets. And how do you make sure that they're nutritionally adequate and whatnot? And I said, oh, you know, I think I could do that. I have written a bit about that. I know about that. So let me do that. And so I was honored and I know When you're involved in something like this, you don't really have a lot of control over what's done with it. You don't have control over how the conflicts were communicated, right? And so you're signing yourself up for some credit. I knew I was going to have some criticism or some, there's going to be some controversy, but I thought I can, I think this will be something I want to contribute to. So I was honored and I thought I want to be able to speak about this specific thing that I have, you know, expertise in. Okay, so your involvement in me in that, the foundation piece we try to have here was just on the vegetarian and vegan section of that paper. And then one other section, I also wrote on the life stages, which is very short. So yeah, that was my role. So as in the appendices of the scientific foundation, you can see all of our, all of the author's specific reports. So those are just as we wrote them, right, without any additional authorship. Now, I will say that we had two kind of double blind NIH reviewers for each of the reviews that we went through. So they had a round of reviewer that I give comments and we had to respond point by point, kind of like in a peer reviewed publication for a scientific journal. And just to be clear, we kind of alluded to this earlier. This is something I learned in your conversation with Marion, who, as I also mentioned earlier, off-air is just sharp as attack at 89 years old. Yeah. Yeah, sure. Yeah. Yeah. Sure, for the nine years. Wow. Goals. I was interested to learn that the scientific foundation piece that your group created was sort of then handed over and the dietary guidelines were created from there, but your group didn't actually create the final dietary guidelines. And this is something I think is very fascinating. Marion Nessel told me on the interview with her that she, I think it was 1998 if I'm not mistaken. She said that all the scientists actually drafted the actual guidelines. Now I think since then, it has always been the case that there's a scientific group that kind of writes these advises, does all these background reviews and they hand it off. And you sort of, you're, you're a bit powerless in that, in the instance that you, you do all this work and you spend a lot of effort and time and then you don't have control over what's exactly phrase and what's taken up. Like you mentioned, the coffee thing was taken, but the environmental issue was not. And so that was, you know, I, I did not have any control over what's in the pyramid, what is right in the actual guidelines themselves. But what you can read is that the scientific foundations, the background document is sort of a synthesis of those appendices of the individual authors. And that document is about 40 to 50 pages kind of goes through the justification and the quite research questions and what was looked at, right? And then from that, I think the intent from the outset was really to make this five to 10 page document that was just listing at a high level some of the key guidelines. And when you first saw the, the new dietary guidelines that that document with the, the pyramid and the, the kind of subtext that goes with the pyramid, what was your first reaction when you please, were they representative of the scientific foundations, advice and review? So I was reading them as the rest of the country was reading them, who was, those who are early interest, you know, adopters or whatever. And so I was kind of fascinated to see the graphics I went to the website. I think I was, I was generally pleased with the whole food message, the calling out specifically the highly processed foods, the refined carbs. And I think I was in the graphic, I saw the steak and I thought that's, that's going to be a topic that people are talking about for a lot of reasons, of course, the price of it and the size of it. And then I, I looked through, I kind of read through and I was actually on my way to DC that day to sort of release these, these guidelines. So I was looking at this thing and kind of reading them in real time as they came out. I think I saw the, the mention of the, the butter and the talo and I was like, okay, interesting that they're like, it's going to be spicy. And then I looked at the wording of the oil. One thing I noticed was that there was no mention of seed oils. I know. Wasn't that interesting. Yeah. It did say to consume more central fatty acid oil, but all of oil was listed. Right. So it's not for daily, inadvertently, inadvertently by recommending more central fatty acids. It kind of is recommending seed oils. So wait, I have to jump in here. So, so this is so frustrating. So there, I will start out and say most of the guidelines were fine. And I want to get back to how radical this is because it's not really radical. Eat more veggies and fruits. Don't eat so much junk food. Two to four servings a day of whole grains. That whole idea of the line that says, choose healthy fats and the subtext that you read. So you hit the nail on the head there. It said, including essential fatty acids. The one example they gave was olive oil and two alternates were butter and beef tala. So the essential fatty acids for anybody who goes to be a dietician or goes to school in nutrition knows it's linoleic and linoleic acid. That is those the 18 carbon double bond or triple bond fatty acids. None of those are in olive oil or butter or beef tala. So it was just sloppy. So that the intent was okay and you right, it made it make confusing because most of the quote unquote, healthy fats slash essential oils are some of the seed oils and they didn't say seed oil. They said healthy and they just kind of have this sloppy line where they got essential fats wrong in the central wording of the document. Just to push back a tiny bit on that. Because I read this and I was like, okay, this is wrong. But then I reread it and then I kind of looked at foods like olive oil does contain some essential fatty acids. It's not a false statement. Even butter and beef tala do contain some essential fatty acids. It's not to the letter a wrong statement. It's just that there are other foods like you say that are way richer in essential fatty acids. Okay. I also have to say to the credit of the guidance, which I generally, of course, I contributed to these. I'm biased. But I think that generally there's a good message here. The statement does say food sources of fat. So it does emphasize food and I think that that I think that sometimes is under emphasized in the in the communications. For example, you have the butter. It's a big stick of butter, right? If you look at the serving sizes, there actually is a line in the footnote of the table. It's the two page document and it says small amounts of added fats like butter can be okay, right? And so there is a little bit of that nuance, but it's not in the messaging. And so what I would have liked to see is messaging that that sort of distinguish that sort of like added fats and oils. And I think what you're seeing is probably the political process of trying to say the background reviews on saturated fat. If you look at the document, it doesn't really find a lot of strong, it doesn't, it doesn't say there's a lot of strong evidence for the 10% threshold, but then the threshold is maintained. Then you have this statement that says consume essential fatty acids and oils. And it says like olive oil. I think that they're picking an oil that is the least controversial. Yeah. And I think that it's phrased a certain way intentionally, right? And I mean, for better or for worse, I think that that was the intent was to sort of get around some of those controversies, you know? I want to come to some of the specifics here and talk about fats and protein and the way that they're treated in the guidelines, but just broadly speaking, in terms of the two reviews that your groups did, because you did come to slightly different conclusions. Was there a difference in the way you were treating evidence? Because the evidence base is the same. The studies are the same that you guys had access to. But in terms of weighing evidence as weak or strong, was there a difference in that process? I'm going to push back on that statement. They've never been compared head to head. So the report that you released, I don't think has gone up head to head with the dietary guidelines advisory committee's report. The politicians took your report and made all these conclusions out of it. They didn't have to use just like they didn't have to use our advice. Sure, but I think they didn't have to use your advice. They didn't have to use your advice. I think somebody did. Those are the dietary guidelines advisory committee. I don't think anyone on your nine person committee ever saw that. In this foundation document that I read, which Ty is saying is from a collection of people. In that document, it does go through the 59 recommendations and they're either rejected excepted or something in the middle. I have to say honestly that I don't know who reviewed those. Yeah. So, it was not me. I can say, okay, let's talk about the differences at a high level. First of all, I think there's a lot of the controversies from communication. Yes, okay. Can I read out a quote in this, which I think will act as the perfect segue? This is a quote that's at the beginning of this scientific foundation paper. It says, "The committee consistent." When they refer to committee, they're referring to your report. The committee consistently advocated plant-based dietary patterns, de-prioritized animal source proteins, and favored high-linearlyic acid vegetable oils. For example, the DGAC proposed reorganizing protein-food subgroups to prioritize beans, peas, and lentils, while listing meats, poultry, and eggs last, a symbolic, re-ordering, lacking scientific justification. The report recommended that fat replacements focus on plant-based sources encourage dietary patterns that increase plant-based and decrease animal-based protein foods and continue longstanding recommendations for low-fat dairy and butter replacement, despite emerging evidence that calls these positions into question. When I read this, it does very much challenge the advisory report that your group put together. That's true, but TIE didn't write that. I know, and I'm not positioning this as a tie, but it's. Let me go think there. The Christopher thing, where I'm getting at is that this scientific foundation report that was then used to create the dietary guidelines, it does reject a lot of the things that your group put forward in your advisory report. Yes, but I really want to dig a little deeper here. I read that, and I was thinking of you and Michael Goren and some of the others who are on the committee, and I can imagine if they had read that line and said, "That line is going to be attributed to you," they would have been upset. Because I don't think they were. I think that you put all your material together. Here's my section. Here's my chapter. Here's another one. They weren't ever shown this document that compiled everything that they did am I correct? I did not have any input into that. This is, I think, largely political the way, and part of what they were framing was what a radical change this was, and they really picked some hotter button things. Let's look at the difference. Let's try to comment on that. That statement that I just read out in there is that overall, pretty reflective of your position, semi-reflective or not reflective, even though your name's on that report. I'm going to read the full DGSE report. I don't have enough awareness of all of the differences in there. What I want to say is that when you look at the findings, I actually went and looked at the report and some keyword searches because I think a lot of this has been political, intentionally trying to make a contrast with the previous. If you look at the word nutrient density, it's in there like hundreds of times. Probably over 100 times the word nutrient density is in the DGSE report and in the previous one from five years ago and the previous one from 10 years ago. There has been a focus on nutrient density. That is not necessarily new. The other thing that I think is very common is the focus on minimally processed whole foods. You see that in there. Fresh foods produce all of that. I think one of the main differences that we see is the specific verbiage of calling out highly processed foods. You can correct me if I'm wrong, but in my understanding, one of the big differences is that the new guideline report, the scientific foundations and the guidance themselves, they don't say ultra processed foods, but they say highly processed foods should be limited in some language. I think that was the criticism of one of the, even Mary and Nestle said this, of the previous committee. They said the evidence wasn't there right now. We're going to, this is a future research thing. The other difference I think that I like about the newer version is that the emphasis on cutting refined grains is stronger. Now, previous, the committee, the previous guidelines from five years ago as well, they always say emphasize whole grains. They say try to make at least half of those whole grains. I think something like that. I think that what the criticism, and I sort of share this is yes, but it also allows half of these to be refined grains. So maybe you can respond to this, but my read of even the DGAC report is that it is still allowing three servings of refined grains and three servings of whole grains. It's not saying you should consume three servings of refined grains, but these actually say limit as much as possible to refined grains. And the added sugar limits are a little bit lower. So if I'm going to call it what the differences are, those are the main differences. Now with the plant and animal source foods, the messaging on these guidelines is meat, meat, meat, protein, animal source protein. But the guidelines themselves do not say prioritize animal source protein over plant protein. The bullet, you can read it verbatim if you have it there. It does not say that. And I think the intention, it's my understanding of this, is that it's not trying to distinguish. And even in the serving sizes, it lists options of plant sources and animal sources. And it doesn't say to prioritize. I think that the order was probably intentional, just like in the DGAC, the order of the foods, right. And so I think there was more emphasis on plant proteins in the DGAC. And I think in this one, there is not an emphasis. But again, it's like a, it's a, it's a bit of a small difference because it's not trying to say prioritize animal proteins. It's just saying overall kind of inadvertently, sort of here by the order and the size. The size. The size of the foods and then and also just the order in the list. I know there's serving size sections, but how many people actually get there. And the other thing is I just want to add one other, I'll say another criticism of the current guidance. So the other thing I think that I would like to see was the listing of healthy fats from foods. I'm glad they said foods, but they put the order. They did not put fish. They did not put seafood and nuts and seeds and I'm a kind of first, right. So I think that that would have been aligned with the evidence and that would have been a positive thing to be able to put those first. You don't even have to get into necessarily the animal and plant source food to be because you're listing seafood and you're listing nuts and seeds and avocados. And then it would have made it much more likely and easier for people to meet the 10% of the total daily calories from saturated fat recommendation when you put those fat, those foods containing fat in that order. Yeah. You've got some things to say. Nice. Maybe I went gargoyle and just went below the stick there. That's going to be on the highlight reel. If you got your committee of nine together with our committee of 20, I bet we would agree on almost everything including the wording, but we never had that opportunity to share. I think they got your advice and they used it to make new guidelines and they made the point that the old group didn't do it. Well, we found a new group that did it better and that's why this is so science-based. I don't know. I push back a little bit. I know some of the views of like Don Laman and some of those. True, true, yeah. And I think that some of the views in that group are that saturated fats coming from hope it's not a problem that linoleic acid and seed oils could be a problem pointing to like rams and studies and whatnot. So I still think there is some debate in there. Wait, but if you got us all in the same room, which I'm always anxious is why I'm super glad you did this with Ty and I right now. And we looked at the papers together. We would come to more of an agreement. But this half refined grain thing drives me absolutely berserk because so if you look at the amount of grains people eat that are whole versus refined, it is almost all refined. It's 84% or something, 87%. So this is one of these issues of communicating. So if the federal government says you really have to get rid of all the refined carbs you're getting and only eat whole grains, that is something that people can't achieve. And I have some excellent parallels here. You will know these more than anyone. Dietary cholesterol, that original number of a cut point of 300 milligrams was a made-up number. If you go back historically, there was a group that said, "Wow, there's a lot of heart disease and there's cholesterol in the plaque and people eat dietary cholesterol and it's probably too much." They ate like 500 milligrams a day. Let's recommend a cut point of 300. We all know that 10 years ago they abandoned the cut point. Part of the reason was there was no rationale. There was no scientific evidence for that number, which leads you back to the point was they were just trying to give people something reasonable to make a substantive change. So for the refined grain, for many, many years, all public health people have been saying, eat more whole grains preferably, all whole grains. But when the messaging comes out, the messaging is at least half of them. It's almost like a plea. You eat so much friggin refined grain right now. Could at least half? But should the guidelines be meeting people where they're at or should the guidelines be showing the healthiest way of eating? So this is a great point. So where are the guidelines used the most? American public has never followed the dietary guidelines. The places where they have the most impact are food safety net programs of the government like school lunch. So if you make that 100% whole grain and no refined grain, that means going into every school in America and getting rid of pizza crusts and hamburger buns and burritos and other things. Is that a problem? If you have the replacement food and accessibility. So there's no money in schools to work with. pay for the replacements and those products are not available. So you could say that and you could say the science is it should be all whole grains. And as the federal government at some level, you should have that responsibility and that capacity to provide the schools with the money and incentivize the food industry to make those. But everybody in the government knows that that would require an insane amount of regulation. And investment. That's an investment that you could not hold the food industry to right now. So there's one group that's saying I'm pleading with you to try to get at least half and there's another group that's saying stand on the science and make it zero. Can I add one more point to this? And it should be a fun graphic for you to show on your podcast. So there's always been a graphic. Well, I know there was in 2020 and now there's in 2025 and they show all the food groups in the US and they show the percent below the dietary guidelines of 2020. I'll say no. And above. And it's all actually in two colors. It's sort of blue and gray, something like that. The 2025 added two colors. And one of the colors was orange and it was showing it's above the recommendation in the wrong way. The reason they made it orange was to show that it's all bad. I don't know. Does that mean you're looking at it right now? Okay. So if you looked at it, you would say, okay, so some people are getting more than enough protein and some are getting less. But they're not calling more than enough protein adverse. They are calling the entire category of refined grain over the recommendation. Bad. So I actually thought that was a clever, really visual communication strategy to suggest, you'd really rather you have no refined grain. And right now we recommend a certain number of grains. And we wish they were all whole grains. But right now that whole bar is below the recommendation. So people are striving for a way to communicate across preferences, biases, possibilities, regulation. And they're, it's really hard. It's really hard to, especially if you're trying to communicate with a school food service director who has to follow this advice under really challenging conditions. So that's why I went Gaga because none of us have ever said that could include three servings a day of crappy carbs that, but that's been flipped. That narrative has been flipped on my group. And it pisses me off that no one has ever said that in my field. What they have said is please can it be least half? And to flip that and say, so you support half being refined. No, we don't. I agree, Christopher. Most people and probably on the committee do not, they would like to see as low as possible the refined grains. The only, the only statement I think that's in there that does suggest that for fine grains play a role is there's a statement in the previous DGAC and the previous guidelines that say to me nutrient needs refined grains fortified refined grains help contribute to that process without them. We can't, there is a statement that says without them you can't meet nutrient needs. And I'll just finish real quick. I, no, I work in fortification. I, it's not my main thing, but gain does fortification work. I'm very supportive of fortification. It's a safety net. There's iodized salt has made a huge impact. There's a lot of other nutrients. And at the same time, if we, if we stick with this paradigm that you have to consume unhealthy foods, refined grains, just to get the added nutrients, I don't think that's a valid long-term argument. I think that what we should be doing is modeling, okay, if whatever the dietary pattern is, if you can get everyone to consume whole grains and you still need nutrients fortify the whole grains, tech, it's technically feasible. Rockefeller Foundation is doing a lot of efforts to fortify whole grains. There's a process, obviously, that you have to go from where we are to where we want to be. But I still would, I would not like to see the justification of consume refined grains fortified nutrients. And I'm not sure that that was the intent, but I remember reading a statement in there that said something to that effect. And a lot of that is actually folic acid and neural tube defects. It actually goes way back to 1996, this decision to fortify refined grain with folic acid prevent neural tube defects. And it's worked. It's been a public health sector. Let me just say how much it's worked, okay, because we did a study in 2022. We looked around the world at a bunch of nutrients, but folic was one of them. In the UK, folic deficiency in women for reproductive age was around 20%. Not very good fortification folic acid in the UK. In the US, can you guess the prevalence of folic deficiency? 20%. Zero. Sorry, now zero. Zero. Okay, because it's highly effective. Yes. And so I think I want to make that point is that I think there's a lot of commentary of you should never fortify an unhealthy food group because you're encouraging that food group. And I say no, that's not true. It's stealth fortification. The reason that we fortify salt is not to say we need to promote more salt consumption is to say salt is something people universally put in relatively stable amounts that we can fortify without having excess. And so I really do push back against the people who say don't fortify unhealthy things because I think that if you can get them, if you can slip it in and you keep the public health messaging to the consumer, moderate salt consumption, right? Whatever it is, reduce refined grain consumption. And then you adjust the fortification amounts correspondingly to what the consumption is. I think it's a big misconception in the nutrition's kind of health influencer space of the whole foods approach. And this is what it's so good that you've got us both here, right? Because it's not just heart disease, it's not just cancer, it's neural two defects and other things. Guatemala at one point had an iron deficiency problem and you know what they fortified sugar. So one of the issues is take a food staple that's inexpensive that every family has in their kitchen. And that was white flour for folic acid and it was iodine for salt and it was sugar for Guatemalan's for iron. And it has that role. It's sad that it has that role, but it has a place. And I just want to say, I totally agree. We have a new study, in press at Lancet Global Health right now, quantifying the impact of fortification on nutrient inadequacies. Seven billion nutrient inadequacies are currently estimated to be prevented from fortification alone around the world, right? When you look at like several nutrients, okay? So it's having a huge impact. And I think we all like Christopher and I and probably all most of the nutritionists out there would all agree we want mentally processed whole foods for most of the diet try to get most of your nutrients through whole foods. And at the same time, we have a lot of nutrient inadequacies. We need to address them. We need a safety net. And I think that those are those don't have to be in conflict, right? You can say reduce consumption of sugar, reduce consumption of salt, reduce consumption of refined flowers. And you can adjust fortification and still try to fill gaps so that people don't have neural tube defects. And you know, child development issues from lack of iodine or whatnot, right? Did affordability and health equity also come into consideration when in your report when you were talking about ultra processed foods? No, not for all. Well, it came into consideration for everything. But so this is a different rabbit hole. Or can I go there? Because ultra processed foods is separate. And I wouldn't mind going back there. So this I may cry. I may actually tear up at this point. So let me clarify the health equity issue. And I'd be curious to know what your impression of the health equity issue in the health equity lens was. So every dietary about dietary guidelines advisory committee for the last however many decades sort of got an extra topic. And in 2015, it was the environment. In 2020, it was infants. Prior to that, the dietary guidelines had only been for two years older, two years and older. And he was like, what's the matter with infants? Don't they count? I was like, Oh, well, we've handled so much. The US diet is fairly safe and nutritious. Yes, let's do infants. And so for my group, it was suggested and I don't know by who that we take extra care to include health equity. And two of the 20 members were selected for their expertise in health equity. And what that meant was we got divided into four committees, four sub committees and everybody in the whole group of 20 was on two. And so each of these two people were on two of the committees. So there's always someone represented. And the whole idea there was that as we reviewed the papers that we did, they looked to see if the papers had reported race ethnicity if they had reported socioeconomic status so that there might be an opportunity to do a subanalysis. My best example here is going to be going back to dairy and the whole fat dairy recommendation. Put the whole fat aside for a minute. Three quarters of the world's population is lactose intolerant. How insensitive is that to put among the dietary guidelines that three servings of dairy is an optimal diet without a qualifier. All it would need is a simple qualifier if you can tolerate dairy. I have read it multiple times and I have never seen that statement. That is a health equity issue. You can't be telling somebody that this is an important issue. I'm sorry you can't tolerate it, but you need to drink it anyway because the federal government has deemed that an important source of nutrients. So likewise for every every single question that we looked at, we had one of these representatives in the room, and we looked through the extracted Excel sheets we had to see if those data had been collected. In almost every case, the data, either those participants were not recruited for the study in a meaningful way, or the data were extracted or extracted a bull so that we could consider very few of any of our conclusions were impacted in a substantive way. And so when the foundations report came out and the very first line, sorry, I'm really going to cry here. It was so hurtful that that first line says, "Our central concern is that you are scientifically inappropriate, and you're used to health equity lens to look at everything. You should have just looked at the science and later gone back to look at health equity. I'm sorry, that is racist." These are the dietary guidelines for everyone, for all Americans, and to say that the health equity lens was inappropriate is crushing. It crushes my soul and makes me embarrassed for the country that leads my federal government. What did you think when you heard that they were upset with the health equity lens? I'm curious what your perspective would be. I share your concern for everyone in the US, and there is a huge issue with equity, and so I, of course, first of all, I had nothing to do with that statement. I agree 100%. Health equity is part of health, and not just that, but social science about health equity is science still. There is a science of health equity. So I think that that is a, I think that's a big problem. I didn't read it the same. I think when I understand how you took it, I read it as we want to take this in steps, but I don't think there's going to be, I don't see there being investment to make sure that people equally have access to all of this. I don't see that, and I also have the concerns around the schools. So the school meal thing, I think you raised this earlier too, which is a huge point. It would be great if all schools could just go to perfectly healthy diets, like healthy meals, right? My kids, I have two kids in public schools. They've been in public schools in California, in DC, in Arizona, and a lot of schools don't have kitchen. Our current school does not have a operating kitchen. They get their food from a neighboring school. And so there's a huge issue with health equity of implementing something even, and not to mention the distribution of health burden as well. So there's a huge need to invest in and help make sure that everyone can get the improvement that needs to happen. Because if you put out a policy, let's just stay sticking to the school meal thing. Put out a policy, which my state did, Arizona, which I'm in favor of restricting the ultra-process foods with support. Okay. There's not support in Arizona for this. So the schools that can do it, they can afford it, they have the staff, they have the infrastructure, they have the ability to do it, and the parents can choose which schools they go to. That's great. But there's a whole batch of schools. They don't have kitchens, they don't have staff, they don't have the training, they don't have the money. Not to mention the whole, I think you mentioned the food industry component of it. You got to have the foods available to do that, right? I get jealous of my colleagues in France and Italy and Switzerland where they tell me they have the private chefs preparing all this stuff. And I don't see the investment. So I actually wrote a proposal to do this. We didn't get funded, but to provide that support within Arizona to make that happen. And one of the new things that I was a part of that I have not been in the last year or two is that I've sat in on state legislative conversations. I presented to one state legislator on ultra-process foods. And I think every state's different. And California probably does a great job with this. I don't know. But one of the states I listened to was different than Arizona. They said the whole conversation was around. How do we make sure that the schools, all schools can get this, all schools, everyone can access this. And they had grants that had specific grants they were looking at that they were looking to support. And they actually had a discussion around how they could make that happen. I think that when I read that, I think it's a huge, it's a shame, it's a missed opportunity. I didn't have the same reaction right away because my interpretation was we're just trying to focus on the health impacts. And later afterwards the next step is of course, I think there was mention of we want to make sure that people can afford everything. And there's access to these foods. But I understand fully your your take on that because it's not. I mean, I don't it's not necessary. It's kind of like a lot of this stuff. If there was an intent to make things different, you could make it different. I don't think you had to make this kind of false. Yeah. I mean, that extra, the example of dairy and a extra line. Well, it's just pretty simple. Let me just say for me. Okay, I eat, I am a proponent of dairy. I think the health benefits can be good. I'm lactose intolerant. I don't drink milk. I drink soy milk. I have, I can have yogurt. So I have yogurt. So I think that you're absolutely right about that. Like you should not be making a statement about, and I'd say Mark Heimann would agree with you on the dairy thing, right? Mark Heimann was one of his main things was why did the dairy, why was it everybody has to consume dairy sort of thing, right? But the key was in that leading that whole document was that was the central concern. Look at the language. The central concern was that we included that perspective. I don't know a single scientist that you could ask would say, this would undermine science to include them at the same time. It's not like it displaced the other science. So it's baffling and really all I can think was, sorry, I'm going to be a little cynical here. Our process was so systematic, so methodical and so defensible that in order to dismiss it, they had to have a reason like that. They had to say, oh, so much conflict of interest, which is hypocritical because of some of the meat and dairy conflicts that your group had, and they did this health equity thing, which is just not the right way to do science. And for anybody who saw how we were doing that science, there is no possible way that that undermined the science that we were doing. It only enhanced it. And I have to say to to that point, I'm on, I just had a two-hour phone call for a WHO meeting on the optimal intake of animal source foods that we're looking at the evidence. And it's probably similar but less intensive in terms of the amount of frequency of time. But I'm on that group, it's a guidelines development group. It's two to three years, and it's very extensive and it goes into all of that stuff. And I like, I fully support the process and everything that went through. I think that, to me, it's like a huge shame that there was a, I think I would call it an artificial pitting of the new guidelines against the old, right? It's not constructive, it's not bipartisan and it's not going to be getting us to come together. What will get us to come together is conversations in person like this. The conversations that are happening in Congress, I think you have Cory Booker who's a Democrat who's saying, look, he's been saying this for a long time. Ultraprocess foods are wreaking havoc on our health, right? Bernie Sanders even recently said, you know, Casey Means, the surgeon general nominee, you, I agree with you on ultraprocess foods, right? And in the diet. So I think that like, there's an approach that could bring people together that is not being done that needs to happen. And I have to say on both sides, I have experienced it from all sides. This has been, and that's why I had Mary Nessel on, right? She's pretty critical of the guidelines, but there's a lot to agree on. And when you actually have a conversation, you said this a lot of times, we'd probably agree on 80 to 90% of things. And it's not the margins where we disagree, but it's like the media is polarizing, social media is polarizing. And there is, I think, an intentional effort to politicize at times that is just completely destructive and it doesn't move us forward in our health. I had David Katz on as well and he echoed that. And, and even though you can kind of pick little parts that you might like to say a little bit differently, he strongly stated that if the average American was to shift from what the average diet is today to what's being recommended. Yeah. Health would improve. Absolutely. And yes, you can debate like little little things like we're doing, but I think it's important not to lose sight of that big picture. And so for me, this is part of undermining science right now. This is this is actually what's more hurtful than the impact of the dairy on the people who are lactose intolerant. I think that sucks, but I can get through that. However, we want to define ultra processed foods. We all want to get rid of junk food. If one person wants to get rid of it more vehemently than the other, we have to figure out how to implement it. But this idea that the committee's report could be dismissed, replaced. There's a line in that foundation report about how radically transparent it was. It was not radically transparent. All of us on the guidelines who knew our committee report was being dismissed. Look for a year, called people, wrote people, asked who is doing this? No one knew until January 8th when they were released and then said, oh my god, Tybil is on this. Oh my god, Michael Gornazon. Oh my god, Don Laman is on this. Oh my god, Heidi. Wait, what's your last name? Heather Lighty. Heather Lighty. Sorry. That's who did it, but it was not transparent. It was not public. And then it was just released. And I can't help but think that that is just undermining trust and science. Say, oh, sorry, you 20 people who worked a thousand hours on this after being selected in a very transparent way. We don't have to use yours. We're gonna get another committee. And I fear that leads, feel like that leads to slandering your committee completely inappropriate. You guys all volunteered to do this. So it's like science is taking a hit. - So your committee, it wasn't like your committee sat down and we're kind of as a group coming together and saying, hey, this health equity lens that they've looked through has to go. Let's go over there. - I didn't have one conversation about health equity on that. - If these guidelines were more equitable, other than then dairy, which you've mentioned, like what would the other main things you would have liked to have seen written in the guidelines? - Oh, there really wasn't. There was not, to be honest, most of our conclusions were, if you wanna address this in the future, you're gonna have to do a better job of collecting data on race ethnicity and socioeconomic status. One is the data collection part and part is the recruitment. So quite often our conclusion was, maybe we should tie federal funding to the requirement that you show that you've recruited a diverse population so that you are representing all Americans. Nine times out of 10, that was our conclusion that we don't have the data to do this, but it is a future goal that we be more representative. - And that's true, the data we've collected is usually on white men for most conditions, right? We don't have good data and this is, I think, hard to see too when you look around the world, like we have now the demographic and health survey now is no longer running, right? And so there's this lack of data and I think that does nobody good, especially the people who are underrepresented and we don't know what are their health differences. And I think one example of this is in diet quality. So I've done a project for many years with the Gallup World poll on what do people eat around the world? And when you look at diets, you realize we have almost no data on what people eat around the world, right? And the data we do have is actually, well this is something that's a bit different. It's mostly just for women of reproductive age because the way the surveys have been designed. So we have no idea what men are eating. And so for the first time, we looked at those differences and you know what we found? Men tend to eat much less healthy diets than women in many ways, right? More sugar, sweet, and beverages, more junk foods. The one food that I think women have, that are not as, they don't consume as much as the animal source foods in many low income context where they need to consume more sometimes. So I think that there's that issue too. It's like we don't have the data, we can't even answer the questions of that we want to answer without the data. - I read something actually that you told CSPI, you mentioned the meat and dairy industry. - Yes. - Just then. And I'm gonna read out this quote, not to embarrass you, I just wanna get ties. - Could you argue embarrassed? - Take on this. So the quote is, disregarding the DGA C's conclusions and instead relying on a new process with significant conflicts of interest with the meat and dairy industries is harmful to the scientific integrity of the DGA and to public health. So Ty, I just wanted to give you an opportunity to respond to that. I know you've probably come up across many people who said the Scientific Foundation report that you guys put together was bought by the meat and dairy industries and a number of the contributors had ties to those industries. How would you respond to that? - I think Chris pointed this out before earlier on is that it's very hard to find a big group of scientists that have no potential conflicts of interest. So while I would love to see funding be sufficient to where there's just no industry involvement, everything's perfectly balanced and public funded the potential conflicts with public funding as well. I don't think that's the reality. I think we saw that in these guidelines. What I think is a shame is that there was a message of we're gonna get rid of conflicts of interest and we're gonna just, it's sort of this counterate, like we're gonna do it totally different, right? And then you see conflicts in there. You know, I think that you can just say you can be transparent about it and say we're gonna have conflicts, we're gonna disclose them, right? What they are. And I think at least what we did of being able to list all the conflicts and who has what particular conflicts, I think was transparent. Now that you can criticize, of course, the process about going through that. And again, this was not, I think this is a distinction is that it wasn't official committee. And I think the committee has a process for how they handle conflicts that go through and it's over a period of two years. So they have a whole process for that. I will say, I was called out by the Physicians Committee for Responsible Medicine for having conflicts with industry and I have don't have conflicts with industry, like they listed a, I served as a scientific advisor on a Food and Agriculture Organization report. I currently serve on a WHO committee on Optimal and Take of Animal Source Foods. They served on a UNICEF committee on diets. And so they listed me as somebody who's conflicted. So I think it went a little bit extreme, but I think it's totally a fair criticism that there are conflicts with meat and dairy industry, right? I will say with all of that, I don't think Christopher Gardner is conflicted about your research because you had beyond meat. Like I specifically wanted to work with you. I don't think that that's a fair thing. And the same thing, I don't think just because Donald Laman had maybe a flight covered by the meat industry means that he has that conflict, okay? - He had more than meat, more than a flight covered, but keep going, sorry. - But the point, but again, you had research covered, right? I think the point is that can we focus on the evidence? - Yes. - And the individuals, like I have more bias probably from my own preferences and values than from the funding that I take. - Interesting. I don't know, like that's what I would view. - Do you think there's a misconception about you and your work in that you, as you've spoken to already here in this conversation, you have a lot of interest in nutrient density and animal protein kind of feeds into that with particularly when you're looking at low income countries. Do you think a lot of people see the things that you're publishing on and there's an assumption that some sort of animal industry is funding all of that research? - Yeah, I mean, I think there is that assumption. I think also I have biases. So there are the studies I have and the types of thing I look at, I think I sometimes do advocate for the role of animal source food. So I think that's something I've done on social media and I take responsibility for that. I try to be balanced. I think that what happens is we all get caught up in the context and the algorithm in terms of when you post something and you have a graphic or something, right? And I think that what I love about the in-person conversation or even just like a video conversation is, it cuts through a lot of that noise and it gets that the person in what they really think a bit more. And the online debates and the environment and the polarization, I don't think it's particularly productive a lot of the time. - Do you find people may kind of inappropriately use some of your research from low income countries and apply that to a country like America? - Yeah, okay, so I think that's a fair criticism and that is done. - And that's on a criticism view. I'm saying just like the community in general says, oh, look at this research in low income country. It's recommending more animal, protein, great, let's share it. - Yeah, I think that that's done quite a bit. And I think also I am responsible for communicating about the role of animal source foods or nutrient deficiencies even in high income countries. So I think it's not just people taking stuff out of context, but some of my work specifically does look at what people, their nutritional status in the US. And so I think I have that concern, but like if I was to say what is the biggest problem in the US, it's definitely not nutrient deficiencies. Like by far it's chronic disease risk. It's just that I don't want to miss, I don't want to gloss over it. And I think like one in three women having iron deficiency is an issue and that's something that can very easily be exacerbated if we don't pay attention to the nutrient density. - And we should be able to talk about, okay, these nutrient deficiencies exist. They're real, they're important. How do we go about correcting for them and reducing the number of people with them whilst also still optimizing for chronic disease to the best of our ability? - Both are important. - Right, yeah. - You said something there that I think is really important. You said, you know, these conflicts of interest they exist on all sides, but we should focus on the evidence. And this kind of gets me back to something I said earlier that not all evidence is equal, there's different, there's randomized control trials, there's epidemiology. And I just wanted to understand from both of you, mostly how you see nutritional epidemiology because I think it's very polarizing. And there are people that certainly think you should probably throw most of it out, that it's not that great. And then there are others who are career epidemiologists and like Dr. Walter Willett and that's kind of all of his research. So how do you see nutritional epidemiology and its utility in kind of helping us shape the things that we're talking about? - I think we need both randomized controlled trials with very controlled diets and making sure we understand what people eat and we can control exactly what quantities. We can keep them in a metabolic ward. We can't do that long term and you can't usually do that with hard endpoints or obviously you can't do that. It's not ethical to do that with hard endpoints. And so I think we need both. I tell you. different things. And I really, I think I'd get frustrated when there's a, when people throw out epidemiology as it's just not useful. It's how do you ever know if there's a cause and effect? It's just correlation. You can never learn anything from that because it tells you something that you can't get from the short term randomized trials. You know, a lot of conditions take a long time to develop over time. There's a big difference between what people eat in a controlled environment versus what they eat in the real world. And so I think you need these data. What I like to look at is the, you know, the overall evidence and the convergence, when you see things align from the randomized trials from the observational data, I think you have much stronger evidence than when you see maybe the observational evidence suggests one thing and the randomized controlled trials don't agree with it. Then I would be more skeptical of the observational data. So I would look at it as both are important, but they tell you different things. Yeah, same thing. Everything he said, super frustrating for me to see somebody say, you know, but on this particular area, they did not cite any randomized controlled trials. And I look at what the question was and I say, no one will ever conduct a randomized trial. It's not even possible or ethical or fundable to do this. So if you're going to wait for the randomized control trial, you're screwed. You're going to have how does ultra process student-based cancer multilayered? Any of those meat seed oils, the seed oils really kill you? Well, to really know, you'd have to randomized people and wait till they die. Or you could see what happens to their cholesterol or blood pressure or weight, which is my kind of study. I thrive on that. And every time I write up my paper, I say, and this could be linked to mortality or health or keeping out of the hospital because of these observational epi studies. We really need them. But they're almost all questions in nutrition. They're never complete adequate evidence to prove everything for every dose, every person, every source. Let's circle back to ultra process foods. Okay. That's a great topic for this. Yes. There's an idea out there. And I've had this conversation with numerous people, this is about your guideline report, it was a little soft on ultra process foods. And I tell you, this is particularly personal for me because while that was going on with the DGAC, I was the chair of the nutrition committee for the American Heart and had a scientific advisory underway. Ten people were focused on that one question for six months. And the dietary advisory committee was supposed to look at 60 questions over two years and follow a systematic process. If you remember when we started this, you have to have the pico guidelines. What's the population intervention comparison outcome time? And so when we gave the search committee those criteria, I said, we can't find any randomized control trials. We know Kevin Hall did a really good one, but we're asking the question about weight and a two to four week study on weight doesn't meet our criteria. Mary and Nestle was super mad at us for this in particular that we she was one of the ones who criticized us the most that the DGAC gave ultra process foods guide. Mary and Nestle was also a reviewer for our American Heart Association guideline. Just to bring people up to speed, that's a study where people were randomized to an unprocessed diet or an ultra process diet. They were given food and just told to eat until they're satisfied. And they matched a whole lot of things like fiber and sodium and sugar and all the things between these two diets. The people on the ultra processed went sorry, it's across over. So when they were eating the ultra process diet, they were consuming like 500 more calories a day. So pretty significant increase in calorie intake. It's an elegant design, but it's very controlled and contrived. And so it doesn't really have much generalizability. So you'd want to match that with something else. Interestingly, for our committee, remember I also told you we had degraded on generalizability, risk of bias, impact, directness, precision. We had to come for one conclusion for our CTs and one conclusion for observational studies. And it was quite striking in many cases when there were none, there were no randomized control trials. So the whole thing was based on observational epi because that's all there was. So when it did come to ultra processed foods and we gave the search committee our criteria, they said, all we have is observational epi. Now part of that discussion also was what is the definition and the definition at the time, which is exactly what we came to the conclusion of for American Heart Association was Nova. Carlos Montera is Nova classification. This Brazilian epidemiologist is the one that people are using in the observational epi papers. And if you dig down to that, I know processing sounds like the physical and chemical processing, the extrusion and grinding. But his main criteria are actually cosmetic additives and foods of no or rare culinary use. If you read his work in detail, it's fascinating. And I actually love his intent. And his intent is, I know we have too much junk food. I've been thinking about the purpose of how and why the industry makes this food. If the purpose was to addict you, if the purpose was to use these 10 categories of cosmetic additives or using ingredients that no self-respecting restaurant or homeowner would have, I'm a little upset about the purpose of all the things they added to this. And we looked at that and said, none of the papers that you have shown us have evidence specific to the cosmetic additives. They've all got some proxy measurement. They've taken this old food frequency questionnaire data that never listed red dye number, whatever and blue dye, whatever and high fructose corn syrup. It always had food frequencies of 160 foods of which we could probably pretty fairly assume that these were the biggest contributors. So when we looked at the data source and our search committee, I knew that we had 59 other questions to answer. We said, well, okay, the only thing we're really willing to take a look at is obesity and weight change. And in adults, it looks like there's some evidence that says that would be a problem. But given all the criteria, we have to follow. It's limited evidence. So look pretty lame. There's limited evidence that ultra-process foods lead to obesity and weight gain. And people looked at that and said, that's what you got. There were 20 of you and you had two years. That's all you came up with. And really the rest of that said, I'd really like to see data on the hundreds of cosmetic additives. And I'd like to see randomized trials. And I'd like to see more specific questions answered. And there weren't. So we moved on to the next question. And boy, did we get crap? Well, I think people look around and see the rate of overweight obesity type 2 diabetes. Absolutely. And then think, how can you plausibly not go hard on Oreos and cookies and cakes and biscuits and these category foods? If you are held to a systematic methodical process, it's completely public. And you have to follow these pre-established guidelines for searching for the papers, extracting the data from the papers and reporting on it, that's how. I think people that are not scientists would push back and say, well, that system sounds flawed. It's a pharaoh. It's a heart felt like, oh my God, how can you do that when it's obviously so bad for people? The flip side of that, so this is going to be fun. I'm going to wear this different hat for a minute, maybe. So if you're of the political persuasion that regulations shouldn't be overly harsh and you've got a mom and pop group that put together this food and they have one of these cosmetic additives in it and they've started their own business and they're just kicking off and making headway and making money. And somebody says, your food's going off the table. You've got one of those 150 cosmetic additives in it. And if they were to push back and say, do you actually have data on that one additive that we put in our food, the way we're serving it to the people we're serving? I said, no, we don't have data, but it sure sucks that people are eating so much junk food. And some of those would get swept up in that. And as time mentioned earlier, one of the early problems was there's things like co-eat bread and salad dressings and some yogurt. There's one other category I'm forgetting where they were fairly nutritious and probably more nutritious than some other people could afford for other alternatives. And if you threw all the bath water out with the baby or the baby with the bath water, sorry. It's hard. Yeah. So it's good that you were mentioning our considered ultra processed foods. So you're saying, so actually have a whole set of slides that I use a lot now. I'll have meeting the classification of ultra processed for a whole wheat bread and another one that doesn't. And this one is twice as much money. I have two yogurts, one that meets the category and one that doesn't. The one that doesn't is three times more expensive. And so I have a whole set of slides where I say, I understand where you're coming from. But from a health equity perspective, this would actually get in the way of some people finding, think of my favorite was the tomato sauce, the thing that got the tomato sauce in that category was the presence of high fructose corn syrup. So just as a very specific example, Simon, one of the things that I really think can come out of Carlos Monterra's efforts is a reformulation. And the reformulation is getting some of those cosmetic added as out. I went to my local grocery store and I found eight tomato sauces. None of them had high fructose corn syrup. Several of them had a symbol on the front that says, we have no high fructose corn syrup. And then I looked at the ingredients and they all had sugar. Metabolically sugar is a day. to high fructose corn syrup. High fructose corn syrup is cheaper. And so somebody could sweeten the American palate, putting that in the tomato sauce and enhance sales. That's why it's sort of cosmetic and-- - And just to be clear, refined sugar is not something that classifies foods as a process. - Thank you, yes, that's a key point. - That's the thing that people don't understand. - Refined sugar does not count as a health process. High fructose corn syrup does, and so at that point for some of us, I was like, "Ugh, some of this is a little arbitrary, "and it's a great idea. "We know people are reading too much junk food. "I'm not sure how this helps." So if I could just wrap up and say, when the American Heart Association did our scientific advisory, we said, "This is a really cool idea. "It's a little hard to quantify. "We would feel comfortable pairing it with nutritional quality." So if you also took into account nutritional quality and you found the biggest offenders that were the most processed and the least nutritious, and you also found the ones that are the most nutritious and the least processed, we'd be happy to come together on those. But some other corners of this diagram where they're high in one and low in the other, you have to scratch your head a couple of times as to whether you can really justify getting rid of those right now when some options aren't available. - I thought the guidelines coming back to those, actually did a pretty good job of speaking to highly processed foods and what to look out for. - Yeah, I think one of the things I liked about the background document that, Michael Gorin led the section on the highly processed foods. He let it on the added sugars, refined carbs and sugar-sweetened beverages. And one of the things that he did in the background document shows us an intro chapter is sort of the Nova 4 foods plus the refined flowers and added sugars. So it's sort of like the foods we know are sort of the less healthy foods, grouped them together, called it highly processed foods. And I think there was also this recognition that there is this need to define the unhealthy types of processed foods. And I think that is one of the goals is to have a better understanding of that. And I think until then, we still have a lot we can act on. It's just, I don't wanna get caught up on the margins. Like I think we could say, what about the soy milk, the unsweetened soy milk or the tofu that has something that kind of puts it into the Nova 4 category. Those aren't the foods we were concerned about, right? And so I think we just, we get lost on the, some of the edges on the margins. When I think the big picture is like, it's a pretty obvious food. It's the chips, it's the candy, it's the sodas, the cakes, it's the donuts, right? That those are the obvious ones. - And I ruled my eyes when I saw on the list of cosmetic additives is turmeric. Turmeric, when used as a seasoning, is not an ultra-prostated ingredient. Turmeric used to color something yellow, becomes a cosmetic additive. That is how frustrating that could be to communicate. Wait, doesn't turmeric have curcumin? Isn't this a big health thing? Shouldn't we be seasoning more of our food with turmeric? Not if all you're trying to do is get it to be yellow. It's like, I'm not. I'm trying to season my food, but I saw it on the naughty list. That would be hard. - At your point, Ty, that, that not all, I guess ultra-process foods by definition are, are equal. And that's pretty obvious, which ones? Many people I guess would identify as junk food, and which ones are not. This gets me thinking about plant-based meat alternatives. And you mentioned swap meat, and I like that we have Ty here, who researches animal protein. How important is the compared to what in this question of a plant-based alternative meat? And should we be lumping plant-based meats in the highly processed category of foods to avoid? - Well, I would just say, the swap meat study was great. I also just published a review. It's a long review. This took two years in Lancet Planetary Health, and we have a whole series. So we've looked at alternative animal source foods in comparison to animal source foods and the ones that they would replace across all these domains. So nutrition, we have environment, we have food safety, we have economic, like a price of the food, we have the livelihood impact, and we have the acceptability of it. So we looked across all these domains. Now the livelihood review, and my review on nutrition health is, they're out, they're published now. And what we found was, there's a lot of potential benefits and potential trade-offs. Now, in general, with the plant-based, now we looked at the plant-based meats, but we also looked at the minimally processed legumes, things like tofu, that type of thing. And we find potential benefits for cardiovascular health with blood pressure, with even sometimes the blood sugar regulation, with inflammation. But then there's some shortfalls in nutrients. So we saw some shortfalls in B12. We saw sometimes iron or zinc, and then calcium with a plant-based alternative. I knew you'd talk about meat specifically, but when we look at the milks, it's like the soy milk has a lot of nutrients, doesn't have the same calcium with the B12, but if that's fortified, then it's there. But then a lot of these, like the almond milk, or the rice milk, or the cashew milk, whatever type of milk, not milk, they often lack in a lot of things. So our general finding was like, it really depends, and you have to understand the trade-off that you get. But it was not a blanket, it was not. We did not find that, necessarily the plant-based meats, even the highly processed ones are just not healthy because they're ultra-process. Like there were potential, and the SWAT meat study was one. I think there is an effective processing. When I looked, we looked across all of these studies, and we had 247 studies included, so that are 25,000 studies that we've screened. We found, in general, the minimally processed plant sources were more beneficial than the ultra-process ones, in general. Now we also looked across, we looked at fungi-based foods, and we looked at algae-based foods, and we tried to look at cell-based foods, and we tried to look at some other ones. But there wasn't enough data on those. But we did this very specific criterion of the replacement needs to be the similar quantity, and so everything else needs to be controlled for. Calories, so. Or. - We did a fine, good question. - Yeah, well, I mean, it depends on how the study was set up, but in general of calories. So the big difference is that, most of these studies, they do something different with the diets, and that's so frustrating. It's like they change this, but they also. You have more vegetables, you're consuming more, whatever. And so I went through kind of meticulously as, unless they're really controlled for either by modeling, or by the actual design of the study, and we looked at that across the board. So I mean, the finding is, yes, you can have healthy plant-based meats, but yeah, there's a risk of higher in sodium. There's a risk of some of the additives that are potentially at risk, but I think, how do you know across the long term? I think SWAT me how long was SWAT me? - Oh no, eight weeks. - Eight weeks. It's like, how are you gonna know these outcomes? You know, but you can see some of the, you know, serigate markers, and that tells you something. - Small piece, each study's just a small piece. How you ask the question. - Yep. - Anything you would add? - That's that. - Yeah, I mean, we went at this 'cause it's a benefit for animal rights and welfare, less animals, it's better for the environment as all kinds of land use, and what are you seeing? You can pull on. I just kept seeing these New York Times full page ads slandering them, saying because of the sodium, they're raising blood pressure, because of the coconut fat they're raising lipids, because of Kevin Hall's study, they're gonna raise weight and cause people to gain weight in and our single short-term study with one dose and one comparator group. Their LDL went down, their blood pressure didn't go up, their weight went down, not up, and their trimethylamine oxide went down. We saw no benefit to the meat. The immediate response from some of my followers said, I can't believe you're pushing those plant-based meats over the lentils. I said, that was not the question. I really want you to-- - On the person that's eating the beef burger is probably not gonna go and eat a bowl of lentils. - Right, and I say, I've been trying this for 20 or 30 years, not to eliminate it, but to get 'em to cut back as Americans eat so much meat more than any other country in the world. Couldn't they cut back? And what would incentivize them to cut back? For some people, not everybody, maybe that would be the gateway drug to more lentils is having some of these plant-based meats. Quick follow-up is, even though that study worked, beyond meat reformulated their product multiple times. So now we're sort of getting into the Nova classification. So maybe one of this ideas of the ideas of ultra-processing is you get shamed a little bit for these ingredients. So beyond meat started taking one ingredient out after another, probably-- - State oils out and eating-- - One of the most impactful thing was they replaced the coconut oil with avocado oil. The coconut oil was there for the bat feel in the mouth of the saturated fat, and they were able to do it with avocado oil. And my cardiologist division chief set up, these look okay, but I wouldn't give them to any of my patients 'cause of the coconut oil is saturated. And they said, "Ah, that's a really important comment. "Thank you very much, we'll reformulate." So there is that possibility of responding to ultra-formulation that way. So it's not a finished question. You look at many different products, all those different milks, all those different plant-based burgers. It's pretty hard to say this thing about plant-based meat or this thing about plant. Milk's pretty much all of which add 30% calcium and B12 'cause they know. that people would be missing that. - Well, they don't, they don't add 'em. This is the point. - But it's fairly easy. - It's easy to do it and they should be. And that's kind of a key message. - Could it be a message? - Do you think? - I think you should. I think you need to make B-Trow. Because if people consume these as substitutes, they're not gonna be consuming, they're not necessarily gonna be taking a supplement or something. I think the calcium and the B-Trow, are pretty important because that's the source people would get those from, right? - They definitely not added to many plant-based yoghurt that I've seen. - No, but especially the milk. - The yoghurt's in the cheese, the plant-based yoghurt's in cheese is pretty bad. Like a lot of them are pretty bad. In terms of the nutrient content. They're very nutrient-based. - Well, the first, I mean, it's mostly water and then a small percentage of calories from nuts and not a lot of calories. - There's a lot of starch in there and stuff. It's just, they make good ones. They're like $10 of bottle. And they're delicious, right? Like I have one that's, I don't know, it's a pilling up. Yogurt has like plantain and I'm like, this is amazing, but it's like, if you can afford $10 for a little jar, okay, so your four kind of mandatory fortification of plant-based milks? - I think that is one category that should be at mandatory to fortify. And I don't know this, I would do it probably with B12 and Calisthen at the very least. 'Cause I think people, I mean, that's one of the findings. I looked at, there was another study, not just the SWATME. There was another study that did this comparison of, I can't remember the product, but it was a plant-based versus an animal-based SWAT. And it was randomized controlled trial and they had some sort of markers of bone resorption that were concerning on the plant-based thing. And so I think that we've seen, there's been a few other studies I looked at that the bone health side of things can be a problem. And so I think that if you're going to be swapping for the, again, I'm somebody who drinks soy milk. I'm not against plant-based milks. It's just if you can do it in the right way, fill the gaps that milk typically provides, I think that's gonna make it be a big service to people. - What about iodine and vitamin D? - Yeah, I mean, vitamin D is very low. If you look at prevalence, it depends on what you consider an adequacy or a deficiency, but a third to two thirds of people in the US don't really have enough by some standards of vitamin D. And so vitamin D, I think, is a nutrient or concern. We should be adding it to milk, so I don't see it downside. I take a vitamin D3 and K2 supplement when I'm not getting that through sun. And what was the other nutrient? - I mean, iodine. I mean, iodine, so iodine, that is one of the biggest success stories of fortification, we have goiter, cognitive development problems were pretty widespread. And in many places around the world, they're much less of a problem. I think there's also this push to go for sea salt and the natural type of thing. And I'm not opposed to that in like about natural foods, but I do worry if, and this is another thing with plant-based. So the amount of iodine in a food, it depends on the soil content of the where it was produced. Animal source foods, it does too, but it's to a less extent. So I think when you, like you say, when you start going to more plant-based diets, if you don't live in a place or you're not getting a supply where it's high in iodine, I think iodine isn't it? So I would be in favor. I think iodine, one of the things that probably needs to be fortified for the rest of time is probably iodine in salt. Yeah, that's the same with selenium when it comes to soil as well. So I'm not qualified. So I supplement selenium as part of my multi. Let's slide over to the protein recommendations in the guidelines. So on this topic of meat and plant-based meat, the Canadian guidelines say specifically, choose protein foods that come from plants more often. The current new US dietary guidelines, as we've mentioned, they choose different languages. It says prioritize high quality nutrient-dense protein foods and then consume a variety of protein foods from animal sources, including eggs, poultry, seafood, and red meat, as well as a variety of plant-source protein foods, including beans, peas, lentils, legumes, nuts, seeds, and soy. Do you think that the guidelines should have been stronger in their emphasis on plant-based protein? Yes, that was one of our main conclusions. So if you take our 400-page report down to the 12-page supplement, down to the two-page overarching advice to the secretaries, it said more beans, peas, and lentils, and less red and processed meat. That was one of the overarching things that they're working together for two years. It came from saturated fat, that topic that I worked on. It came from dietary patterns and cardiovascular disease. It came from something called food pattern modeling that we did where we took some meat away and replaced it with legumes and looked at the overall profile of vitamins and minerals, and there was a benefit to that shift. The reason that conclusion appeared in those final two pages of the executive summary was because that was a consistent finding we found across multiple domains. It was a slap in the face to see red meat included in that first list of sources. There's different qualities of red meat, not getting into the amount here, but that was certainly very frustrating given that many of our other conclusions, even though they didn't take them, were still adopted. So I disagree strongly with that. Evidence-based, that's what 20 of us worked on for two years, and that was dismissed. What do you think about that? Well, I think that prioritizing protein with every meal is good for satiety and for, in general, the metabolic health issues we have. So I do agree with that for sure. I don't think the source is as important because I think that people have, when you look at trials looking at weight loss and metabolic health studies, you've seen studies by David Ludwig and others that have shown sort of the low carb version that has a lot of benefits for that, for the metabolic health and the weight maintenance. And I think you've seen a lot of observational data, hundreds of studies of observational data, showing that plant proteins are really beneficial, especially for long term. So I agree that given the current diets that we eat in the U.S. at emphasis on plant proteins would have been probably better in a line with evidence. I wouldn't say it's as strongly as Christopher on the need to have really a strong emphasis on consuming more plant-based proteins. In general, I like to see in the graphic, more representation, larger. I think that's one of the things in the communications. It was not emphasized. And I think you read the guidance right there, and I want to point out, I'm not talking about high protein in terms of ultra-process foods or protein shakes. And I think we're already seeing industry, even before these guidelines came out. It's like as much protein as you can possibly fit. That's not what, and I, that's not what these guidelines are intending to do. You don't see any protein pattern here. You don't see any protein bars, right? And I think that that is something industry will probably do with the guidance, even though they're phrased as they are, and say, look, we're going high protein with everything. I've seen that already. I think that at least they say protein-rich foods. And I really like the emphasis on foods. Just on the low carb comment, because I think that's a good one. If I was to push back slightly on that, it would be that, and there was a recent paper that just came out looking at low carb and low fat diets, and long-term cardiovascular outcomes, I think came out like two weeks ago. And they actually modeled like healthy low carb, unhealthy low carb, healthy low fat, unhealthy. And when the low carbohydrate diet was rich in unsaturated fats and fiber, they had really good long-term cardiovascular outcomes. Same as when the high carb diet was rich in unrefined carbohydrates, they had the good long-term outcomes and vice versa. So you could do a low carb diet poorly, and you could do a low fat diet poorly, or you could do them both really well. While I acknowledge that there are trials showing low carb diets can be really good for metabolic health in the short term, with weight loss to certain people, I think it is important to acknowledge that you can construct a low carb diet in a way that is also good for your long-term health outcomes. Yeah, for sure. I fully agree with that. And I think the intention, at least from my perspective, is the high-fiber rich foods and high-protein rich foods together are good for satiety and for metabolic health. But long-term, I agree the plant proteins in general are associated with positive health outcomes. I would just point out also that when I've looked at some of the studies in Japan and other countries, there is a benefit of moderate animal sorcery to intake. Like, lower is not always better for longevity. And I think the thing that I sort of, I think the nuance in there that is sometimes lost in this discussion what you're talking about, which is the cardiovascular health benefits of the long-term is, yeah, and a big risk of aging is when you fall and you break a bone, and muscle mass is a big issue. And in fact, there's an randomized controlled trial that looked at lean-red meat in older adults and found a significant improvement to a bunch of different health outcomes. And so I'm not like, I don't want to dismiss, though, I don't want to dismiss that body of evidence and that's sort of just reasoning by saying, just go all, or mostly plant-based with that. But I do take your point, I contribute to the cardiovascular benefits. Like, absolutely, like the nuts, the seeds, the legumes, um, even the obvious fibers, the whole grains, those are, from my view, those are important. And they're all in here. It's just that the graphic doesn't give them equal space, right? I think frailty, I'm glad you brought that up. I think that's super important. I've had a number of episodes dedicated to that. And something that I've really tried to like try and understand is what's driving South Cappanian frailty in a country like America. And I'm sure you've looked at this. So I'm interested in your view on it. When I look at the risk factors for South Cappanian and what the average Americans diet looks like and how much protein is in the average Americans diet, it seems to me that it could be a little bit more optimal. But the biggest driver is the sedentary lifestyle and the fact that people aren't doing resistance training. Yeah. So, okay. We have a study with, I invited Stufelips to join this. But we look at global protein and adequacy around the world. What is the prevalence of people not getting enough protein? Now, when you look at the target of just like the RDA, when you're using the ear, when you're looking at prevalence, right? Or if you look at the RDA, you're 0.8 grams per kilogram. It's, prevalence is very low. Like worldwide, it's not a huge issue, as long as people get enough calories, right? So in terms of that minimum threshold of making sure you have enough, you don't have like a deficiency. Then I think you get into this question of what's optimal intake. And I think there is evidence that higher than that, that the RDA, you know, for many different reasons can be optimal. But to your point, I think the vast majority very clearly is the lack of resistance training. And if you think about where people start. So if you're having low resistance training your whole life, you go into your older age after 65 with low muscle mass, and you're not doing anything better, and you're under consuming protein, which we did find actually when you look at the older population, they're actually even just at the RDA. It's like 10 to 12 percent globally. So it is an issue globally. So that when you say globally, that's global high income countries or that's all countries. Yeah, but we can look at the US specifically as well. And it is, you can kind of look at the inadequacy curve by age as you get older. That's when you start seeing actually reason of meaningful amounts up more than negligible, like not not just 5 percent the population. And when you look, now we did this as well. We looked at optimal intakes, which I know it's a big debate around what's optimal, but using 1.2 as an optimal. And then you see much higher prevalence actually. And even in some context like in the US, where you actually see, okay, people aren't necessarily getting optimal. There's there's a sizeable portion. Now I think there's a bunch of debates about what's optimal. But to your point, it's the resistance training across the lifespan and then into older adulthood. And then this, I think the lack of protein is marginal, but it makes it makes an impact like a noticeable impact. And then the bone health, I think, is huge too. We have very, we don't have dense bones. We're not working them out through resistance training. We don't often get enough of the calcium and the vitamin D and the synergistic nutrients to make good bone health. And we're eating ultra-process foods in soda, which has a lot of added phosphorus, which is absorbed quickly. And so there's a lot of issues, I think, with the diet that contribute to it. It's just not probably the main issue. And I would agree with your comment on, if there is a a limitation of kind of plant-based dietary patterns, long term that you see consistently in the research, it does tend to be bone-related. So all you see lower risk of heart attack and stroke and type 2 diabetes. If you're not paying attention to protein calcium, vitamin D, in those populations, there is a little bit of a signal there, particularly in women. Is there anything that you would add to older? Yeah, and I think for the bone again, it's like muscle mass. It's weight bearing. That's actually a bigger impact than the protein in my take. So I just love to throw out that the, you know, I think most people get more protein than they need, personally. And half the fiber that's recommended. So the more you recommend animal-based protein, that even lower the fiber goes because there isn't any fiber in animal protein ever. So the American Heart Association guideline also says, get most of your protein from plants, from beans and nuts. So I hope we get to get into the 1.2 and the 1.6 thing. Because there's actually two systematic reviews that were done for the national academies, which is in charge of the DRIs, the dietary reference intakes. Dietary guidelines for Americans are designed to translate grams of nutrient into servings of food. So it's technically not the purview of the DGA to talk about raising the RDA from 0.8 to 1.2 to 1.6. So I have a fear that if anybody has been living under a rock, they wouldn't know this, but you can't go into the grocery store without seeing proteins in cereal, pop-tarts soup, bars, powders, everything. And if they now see this 1.2 to 1.6, they might have said, I've been wondering, why are all those, why are all those foods high protein now? This must have been it. We must have been all dying of protein and they're going to fix it by doubling this recommendation. And I'm going to go out and buy the pop-tarts and the candy bar and the cookies and everything else that's high protein. They said, way, way, way, you didn't understand us. We meant whole foods. They say, oh, I don't actually think they're going to get this, but they might say, oh, you meant whole foods. Well, my understanding is protein is in meat. So I won't have junk food. I'll have meat. And I say, no, actually the health community in the US recognizes that the US already gets more meat than anybody else in the world. It's not that you need more meat. You need more fiber and you could get fiber and protein from lagoon beans nuts and peas, which was our conclusion from the DGAC. There was a mention of fiber, although it was not emphasized to the same degree as protein. It says in gut health as a little breakout section. That was so cool. That was included. Yes. Probably your study contributed to that. High fiber food supported diverse microbiome, which may be beneficial for health. There we go. Right. So it's included, but it's not as if there is a strong call out to prioritize fiber rich foods at every meal. And in the health community, there is for the gut microbiome and for many other things right now. So that's why plant-based proteins for American heart and for our dietary guidelines advisor, could be many others are being recommended. I will add one final comment. You guys can feel free to kind of jump in here. But at the beginning, you mentioned how sometimes in in communicating nutrition science, if you oversimplify things, it could lead to unintended consequences. So 1980, let's eat low fat. Spoke about. Even in, I've gone back and looked at the research back then of time and it was clear that all the type of fat mattered. So quality of fat, and it would have been much more helpful to the community of people who just understood real food swaps. Eat less of this, eat more of that, and it took care of that fat quality of thing. So in this conversation now about protein, what sounds like to me, without the details, if it's just prioritized protein at every meal, that the same thing could happen. Where the unintended consequence is we see increase potentially in saturated fat consumption and a further decrease in fiber. I agree. And having read that report, I want to see if you notice this. So in the small section where they justify or discuss the 1.2 to 1.6, I'm curious if you ever ever had stacey Sims on the show. I have had her and I've had a number of people that disagree with stacey. Okay, so here's an interesting thing for me. So when I read that and it said, for active people and for people trying to lose weight on an energy restricted diet, this higher protein could be important. See if you can find that section. And I tell you why that really stuck out with me. So I think active people would end up getting more protein because they would be working out and they'd be hungrier and they'd eat more food. I don't know how many of your listeners recognize that in the National Health and Nutrition Examination Survey, in the database called what we eat in America. The average protein intake in the US is 1.2 already. So I think this thing, we raised it from point eight to 1.2 to 1.6. I think they're going to misunderstand that to think, wow, they're practically doubling this. I really think I need to get more when they were already there. But when I see that comment, it reminds me of stacey Sims because she's pushing a lot of protein for some women and I asked her to send me the papers because I didn't understand her position and she sent me about 10 papers and almost every single one of them was protein needs on an energy restricted diet. So let me throw that back at you to help clarify for the listeners, I hope, for what I'm getting at. If you were trying to lose weight while you're putting on muscle, so you have an energy restricted diet while you're trying to bulk up on muscle and lose fat, you would need more protein, having not eaten enough calories, to support your energy needs for for the day your body would bar- borrow from skeletal muscle to provide that. So I think this tiny little caveat of in an energy restricted diet is really inappropriate. This should be for people who are going to the gym, they're weight stable, they're eating a normal number of calories and maybe even more 'cause they're trying to put on muscle. So how important is the energy restriction? - Well, I think that they maybe were adding that in about energy restriction because of the high number of prescriptions of GOP1, Hageness now. - Well, that's true. - And so many people dieting and consuming less calories and the importance of getting enough protein to preserve muscle mass during that. - And I think that's a different issue. So I think if you were in caloric restriction, sort of that amount of protein makes a difference. Most Americans are not in a state of caloric restriction and most have tried and really struggle with that and that's why they can't lose the weight and that's why GOP1s are so amazing 'cause it's sort of taken away this willpower issue for a long time the food industry has said, it's your fault you haven't had the willpower and they take this drug and all of a sudden they say, well, I'm not hungry, I'm having no problem restricting my energy now but they are in 11 of 12 or off after a year, they can't sustain it. And if you've read diet, David Kessler's, "Diet drugs in dopamine," many of them are malnourished 'cause they're not eating enough calories. They're losing muscle mass, they're losing fat and body weight but they're also long term gonna be malnourished if they eat that few calories coming back to a developing country or a low middle income country where they don't get enough calories where a higher proportion of protein again in that context could be more important but that's not what's happening in the US. - I actually think I have a slightly different view of both of you. - Well, I just wanna share, okay. So I think I have a different view on the protein take because 75% of Americans are overweight and need to lose weight to be healthy. What's the most satiating foods? - No, that's wrong. - So I'm gonna push back for 10 months. - Here's the, what are those most satiating foods? Fiber and protein, I think fiber and protein rich foods are more satiating. Now, I think when you look at weight loss evidence, which if you look at the background review by Donald Layman and Heather Lighty, they're looking at those randomized controlled trials with weight loss. Now, I'm not arguing about the metabolic health or the cardiovascular outcomes but in terms of weight loss, we're coming from, we have a lot of excess weight. We're consuming weight to many calories. We need to consume fewer calories and we all are agreeing that we should be doing resistance exercise. Now, just because people aren't doing resistance exercise doesn't mean that we should recommend lower protein. Like, and if you also, if you think about the 1.2, Matt, okay. Half of the population, you said the average is 1.2. In normal distribution, half of the population is consuming less than that. Now, I'm not saying that everybody needs to consume 1.2. But if the average consumption is 1.2, by definition, in normal distribution, a half of the population is consuming less than 1.2. Half of them are consuming more, okay? That's where 0.8 comes from. Okay, that's not exactly true. The reason the 0.8 comes from is the difference between the estimated average requirement and the RDA. Now, RDA is going-- - It's cool standard deviation time. - Yeah, but the optimal is totally separate from this. We're talking about minimal protein requirements, right? - Nobody has two standard deviations higher than the estimated average requirement to cover 97.5% of the population. But that's not the argument about the optimal intake. They're using a different argument that there's benefits of consuming more than that. Now, I'm not like a protein person. I'm not gonna argue for, we need to have 1.2 or 1.6 to be okay. But I do think that it's consistent with the evidence on when you have a metabolically unhealthy overweight population and you wanna lose weight. I don't see a problem with that as long as you have lots of fiber and you get your cardiovascular health under control. - I wanna hear your different opinion. - Well, my opinion is that, and I think if Stu Phillips was here, he would say that he is your point about Americans needing to eat fewer calories. But he also strongly believes that Americans need to preserve muscle mass as they age. And so an optimal amount of protein will do that better than a suboptimal amount that might be the RDA. And he would point to evidence showing that 1.2 grams per kilogram has been shown to lead to significantly greater hypertrophy and also strength gains compared to the RDA. And then I would say I agree with that. And I think 1.2 grams per kilogram is probably more optimal. A lot of people are probably already there. And then looking at overall chronic disease and current baseline diets and the lack of fiber in the diet, this is where I would just say, hey, protein is important. I think you should prioritize it, but I'd come back to the Canadian guidelines and say you don't have to eliminate animal foods, but prioritize these plant-based foods because you're gonna increase your fiber at the same time. You're gonna achieve enough protein and you're gonna lower your intake of saturated fat. Now we're gonna help you lose weight. We're gonna protect your muscle because you're not consuming a suboptimal amount of protein. And we're gonna look after your arteries, brain health, liver, et cetera, in the long run. - I think I agree with that fully. Like the recommendation to eat more plant proteins is would improve the health of most of Americans. - I'm all in. - Okay, we're in agreement. Because I actually thought this was almost a train wreck. We got three hours in and it felt like all of a sudden we had a big disagreement and we were gonna have to spend another 30 minutes cleaning it up so we got there. - Oh, yeah. - Yeah. - I love how you do that. - That was a great wrap up. - Okay, I have some listener questions, audience questions. And I thought this could be cool 'cause it's a bit of a rapid fire, but a nice practical way to close this out. When we're thinking about food at the grocery level or at home when we're making something, it's usually when we're not just removing something where we're placing it. So I'm gonna throw out this all that style question and I wanna hear from you guys. What the average American, if we just take the average American, what your recommendation for them would be. Okay? So the first one is full fat dairy or low fat dairy? - Both are equally healthy. - Low fat dairy, higher nutrient density, but full fat dairy and studies has been shown to actually not increase excess consumption and actually have generally positive effects on cardiovascular health and especially yogurt and cheese. - Is that Mario Cratz's work? - Some of it is Mario Cratz's, but there's been a whole, I mean, I just looked at the data today on the, oh, I can't talk about what it says exactly but in the WHO reviews and I will just say that, yeah, dairy is, I mean, when you look at most of the evidence and you could look at dairy, mazaffarian and his research and his summaries of the synthesis of the evidence is also-- - I think that surprises me. What surprises me, I would have assumed that consuming full fat dairy would have resulted in a greater calorie intake. - You would think that, and again, this is whole dairy products with the food dairy matrix and it's not talking about butter, right? It's talking about whole dairy products. - Okay, butter or olive oil? - Olive oil. - Olive oil. - Cheese or hummus? - Hummus, cheese. - Do you wanna unpack that? - Yeah. - Oh, just in terms of taste. Or are you going for a just health? Okay. - No, okay. - So look at this stuff. Okay, now again, when you look at from a nutrient profiling perspective, cheese doesn't always perform as well, okay, because it's got the sodium and it's got a lot of calorie density. But when you look at the outcome studies, cheese is very consistently positive. So yeah, okay, it's not better than hummus. Okay, I'm not trying to say it's better. - I guess in the outcome studies also compared to what? - Yeah, I don't know if there's been outcomes, a lot of studies of cheese versus hummus. - I've done 12 studies on cheese versus hummus and 11 at it. (laughing) No, I didn't do any of those. - Nothing against hummus. Okay, especially hummus with olive oil and it. - Okay, cool. Unprocessed red meat or unprocessed white meat. - Depends on who. - Somebody who has, who's anemic, I would say the unprocessed red meat, but for most people who don't have an iron deficiency that the white meat. - What percentage of Americans would be anemic and? - Okay, let me do me a phrase that. Iron deficient. - Yeah, what percentage of Americans would be eye-indefient? - Well, a third of women of reproductive age, men is probably much lower at a less than 30, so I would say on average across the population, it's probably like 10%. So I think for most people, if you're not a woman of reproductive age, an adolescent, particularly 15 to 19 years of age, and trying to think if there's a pregnant and lactating woman, maybe a pregnant woman, I would say probably white meat in terms of the outcomes. - So a question we asked in the DGAC for food sources of saturated fat. It was fast-nating, so most of the red meat versus white meat studies had no findings. But one of the reasons we didn't like it was, a lot of the red meat was Spanish studies with goats, not concentrated animal feeding operation beef in the US. - And goat meat is very lean. - And the white meat they used, in at least one of the studies, they matched the saturated fat to the red meat for the blood cholesterol. I was like, how the F did you match the saturated fat? And you expected an LDL difference? I didn't, so we actually, So we're actually not seeing many differences, but we're not really happy with the studies for being applicable to the US. Mostly cardiovascular, not anemic. Good point on anemic. So what's the recommendation? Does make a difference. Okay. On processed meat could be red or white or fatty fish. Fatty fish. Omelette or oatmeal. I'm going to say omelette and I'm going to tell a quick story. Okay. So I have tested my lipids on this different types of dietary fatty. So my typical breakfast which I had today was Greek yogurt, whole yogurt, plain with some added fruit. I had raspberries this morning and a three egg omelette with some greens on microgreens. Okay. Now that's been what I've sort of consumed because it gives me a lot of protein energy. I can have, I don't get hungry shortly afterwards. It kind of sustains me. But my apobie was a little high. I think you had an episode talking about your apobie. So my apobie is kind of marginally high. And so I was like, okay, let me do this test. It takes about two months, six weeks, six to eight weeks. You can adjust. So I made a swap. And again, this is just me, my own experience. But I did instead of doing the eggs, I cut out the eggs that you don't. Whole oatmeal, right? And fruit. And instead of the whole yogurt, I did nonfat yogurt. And then I even reduced further. So I'm like, I don't have a lot of fat in me. But I reduced sort of the meat and did more of lentil pasta, like just the lentils and the black beans and things like that, nuts and seeds. To already eat, but I just made more of this. Two months later, I got my lipids checked. Can you guess what my apobie was? No. What was it originally? One or two? I think it was low eighties. One or two. Exactly the same, okay? No change. Now my LDL went down nine points. Apobies stayed the same. You know what my triglycerides did? They went up. 50%. On the oatmeal. On the oatmeal and the legumes. Whole grain oatmeal. So again, I eat whole grains, I eat legumes. I think we need to consume them. But I just think for me personally, I did not have a benefit on the apobie. Anyway, so I think that totally depends. Some people, oatmeal is probably better for them. For some people, maybe the eggs are better for them. That's the thing. Probably the eggs. Yeah. This is one of my favorite slide decks. I show eggs and then I show eggs that are cheesy and then I show eggs with bacon and sausage. And then I show steel cut oats and then I show a pop tart. And I say, our eggs good for you. I say, it depends. Are they cheesy eggs? Are they bacon and sausage with them? Or was it steel cut oats? And I end up coming up with them being comparable and I said, which one's better than pop tarts? Yeah. I mean, the question I gave you was a tough one in the scheme of things. I think on average, both of them are much better than pop tarts. You can make both, you can make eggs better ways and you can have quick oats with a lot of brown sugar on them or you can have steel cut oats with fruits, nuts and cacao nibs, which is actually what I had this morning. Okay. So, I'm going to say beans. Okay. I'm going to say beans, but just because of the evidence in terms of what I've seen, okay, but I have to say personally, it's still the sort of tradeoff of how I feel. Like if I have a lot of beans and I don't have, and I, in place of meat, which I still do, I'll have whole meals. It's just like tofu or a lentil pasta. I don't feel as good. Like I just, my own experience of the day, I feel a little more bloated. So personal experience. But in terms of health outcomes, I will have to say beans. I used to be a very big beef eater as well. And I would say that it took me a while to be able to adjust to an increase in fiber intake. I've been doing it for years. I've been doing it for years and it's still in the process of getting a different, somebody has approached me about having a farting study and I'm really looking for the funding. Like can you decrease your farting over time, either by acclimating or preparing them in different ways, like soaking and other things? Right. Or can you at least make them not smell so bad? Yeah. One of those. All right. Maybe we finish on thoughts. Yeah. That's a good place to land the plane. Spark finish, yeah. Is there anything that we didn't get to or something that we covered that you wanted to kind of add to it? We didn't have the buy-summent. No, I know. I wanted to call this the great dietary guidelines debate. Yeah. I think it was. What's the thumbnail going to be? I think it was more friend than fo coming back to your paper. That's the title of his paper. I think I would love to circle back and say if you look at the new 12 dietary guidelines, eat more veggies and fruits, eat two to four servings a day of whole grains, stop eating so much junk food. If you go down that list, they're all pretty good. The ones that bug me are the prioritized protein every day and the healthy fats, just a little bit and the dairy being insensitive to people lactose intolerant. And the bizarre thing should have having two to four, you wrote me about this. Two to four servings a day of whole grains are sure at the bottom. So does that mean everything above has to be more than two to four servings a day? Well, and the protein is three to four servings. It's not a lot of servings in the serving size. But most of the categories are agreeable. There's really more similarity than before. I do have a last point is the administration has said this is a radical shift from what we've done in the past. I think the radical shift has been their really strong stance against ultiprocess foods and against added sugar. And I don't think that's all that radical. The Healthy Hunger Free Kid Act of 2010 by Michelle Obama tried to do that and it's hard to implement that in a school. So I love that their rhetoric is stronger, but I want to see them implement it with funding the schools and regulatory issues for the food system and the food industry to follow up on that. I'm going to be a great end on that. No, ask one more question. I think Jessica New York, do you know her? Yes. I think I had her on my show and I think if she was here, she might say none of this matters because people don't follow the dietary guidelines. And when the industry is funding so much of these political campaigns, at the end of the day, this is very much lip service and without the regulations put into place the policies, the average diet's not going to change. I have a lot of reasons for optimism. Okay. So that states across the country before two years ago, we didn't have any policies really that were really being implemented about snap of restricting sugar sweet and beverages of actually limiting the amount of ultra-process foods or sugar sugar in milks, for example, in schools. Dozens of states now have passed even before the guidelines came out. They had passed legislation, including Arizona, to limit ultra-process foods in schools and to limit sugar-student beverages in snap purchases, supplemental nutrition assistance program. Now, with the new guidelines, there has already been a proposal to restrict soda in snap. There's been proposals to actually provide more funding or require grocery stores that take snap funding to have more fresh produce available. There have been other policies around how much, you know, in schools, the sugar sweet and beverages are actually going to be limited. So my daughters have the choice of chocolate milk versus plain milk. Every kid is going to choose a chocolate milk, right? But these are policies that are actually being implemented. And we're talking about it. So I'd say the big picture that I think I agree, I think we all agree on like probably us three agree on 90% of the nutrition stuff, right? There's a bait on the margins and I think we can have those debates, but I think the, I would like to see some constructive dialogue like this and at the political level of how can we move forward on what we agree about and set aside these differences. There's a lot of I think unnecessary attacking and slandering and it's a, I think it's a shame. And it's kind of embarrassing that that's happening when we have so much to agree about. At least people are talking about. If you ask people, have you seen the new food pyramid? People have some image of what that looks like and how we're talking about it. Yeah. And I think this comes back to health equity. If we really worked on this, who's suffering the most from the ultra process foods, it that people with very limited resources. So if this does lead to more discussion and more action, I think it'll help those in need the most. And I would love to see that. I would love to celebrate our current administration for achieving that. The funding needs to be there though. If it happens. Well, hasn't the funding for community nutrition kind of programs been caught? I think so. I don't know exactly what investments are there, but I think that there needs to be funding. And I think that's what my big concern is. I like the policies of reducing ultra process foods. I like restricting staff. Now there's a theoretical way to have more money is reducing the health burden, the cost of health care. If you get people healthy, you save a ton of money, not just for the individual, but for the country itself. And so I think there is a pathway there, but you have to invest first to get people to, you know, schools. There's what hospital meals, what people feed the military. I think you have invest in this and you can have an economy of scale where you reduce the price of more healthier food and nutritious food. But we need to invest in infrastructure for schools, staff, training facilities to be able to make these, you know, a reality. Because I think we agree about where we need to be. It's just a question of how do we actually get there? So you're point of billion dollars just to get taken away for schools for whole foods. So it's rhetoric so far, like to see that flipped. Well, thank you for hanging out with me today. Okay. Coming to LA. Appreciate you both and all the work you're doing. No blood, there's no bruises. No. Thanks, friend. More than foe. Yeah, I think it's, I mean, I really enjoyed this format. I feel like I understand both of you and your research and your views a lot more. So yeah, this was cool and maybe a format that I'll continue with going forward. Yeah. Thanks for doing such a great job moderating. You're welcome. Thanks for having me. There you have it, friends. I hope you enjoyed this episode. If you did and want to stay up to date with future episodes, be sure to hit that subscribe button on YouTube and follow on Apple or Spotify. Finally, thank you for showing up and the effort that you're making to take control of your health. I look forward to hanging out with you again in the next episode.