Ep. 140: Who’s Really Telling the Truth About Nutrition? with Joel Kahn, M.D.

This transcript has been edited for clarity.

Robyn: Hey there, and welcome back. I’m Robyn Openshaw, and I’m your host on the Vibe Show.

If you’ve been following me for a long time you’ve probably been wondering why I’m leaving one guy out when it comes to interviewing, and digging deep with, the clinicians and researchers that have come to the conclusion that eating a mostly or all plant-based diet is the superior lifestyle. And if you have been wondering that, here’s the guy’s name: his name is Dr. Joel Kahn.

[Dr. Joel Kahn] is a medical doctor. He’s lived pretty much his whole life in Detroit, Michigan, and he goes by “America’s Holistic Heart Doc.” He’s a preventative cardiologist and a clinical professor of medicine at Wayne State University School of Medicine. He graduated summa cum laude. I think that’s the highest one. Yeah, it is. Then there’s magna cum laude and cum laude. I never hit summa cum laude, I was always in the second tier.

Really, really smart guy. You’ll pick up on that. I’ve known him for years and I’ve heard him on a lot of shows. If he’s on it, I always want to listen to it because I don’t know very many people with more recall of the clinical evidence when it comes to nutrition and health and specifically cardiovascular health.

He’s a diplomate of the board of internal medicine, and he maintains a sub-specialty in cardiovascular medicine and interventional cardiology.

He was the first doctor worldwide to complete the metabolic cardiology curriculum in conjunction with a4m, [the American Academy of Anti-Aging Medicine], at the University of South Florida.

He’s authored scores of papers that have been published in the medical journals, but he’s also written several books. [Dead Execs Don’t Get Bonuses: The Ultimate Guide to Survive Your Career With A Healthy Heart.] There’s a sex one, I can’t remember what that’s called, but his latest book that everyone should get is called The Plant-Based Solution.

He’s been on Dr Phil, The Doctors; he’s been on Joe Rogan, the Larry King show. He’s been awarded a Health Hero award from Detroit’s Crain business and he owns three vegan businesses.

Welcome to the Vibe Show, Dr. Joel Kahn.

Dr. Kahn: Oh, thank you very much, good friend and great leader Robyn. I’m excited to share this conversation with you and your wonderful, vibrant, and enormous community.

Robyn: I have been asking myself lately, why have I not had Joel on the show?

Dr. Kahn: I’ve been asking my therapist the same thing.

Robyn: Well that’s all settled today. You can go back to the important issues with your therapist.

I’ve been really enjoying listening to you on other shows, where you are a walking encyclopedia of the scientific literature published on the plant-based diet. I really want to dive into what I really want to ask you, but I’m going to back up and ask you about your personal story first.

Then we’re going to go to, why are there over 10,000 published studies and yet everybody’s arguing, and pretending like there’s no evidence for the plant-based diet?

We’re going to go there next, but how’d you even get to be the Vegan Cardiologist? Decades now, I think, you’ve been eating entirely plant-based. You have the labs to prove it, that it’s a great way to eat.

Tell me more about when you did that, and why you did that, and now you put everybody in your practice on a plant-based diet.

Dr. Kahn: It’s a very emotional story. I ask everybody to grab a tissue because you’re going to have a tear in your eye.

I grew up in suburban Detroit, which is where I am right now. I have been here most of my life, and I grew up in a home where we honored the Jewish dietary laws called Kosher; I didn’t do cheeseburgers and I didn’t do pork. [We weren’t] a real observant family, but that was the part we were pretty good with.

And when I went up to university, I just didn’t want to ditch it. It was really the first day — it was 1977, before you were born Robyn — and it was University of Michigan in Ann Arbor.

I walked into the cafeteria in the dormitory, east quadrangle dormitory, and they had truly a gorgeous salad bar. They had food like I’d never seen because my mother was a very good cook and it wouldn’t have met my religious requirements anyways.

It certainly didn’t meet my visual requirements, and I just started grazing the salad bar. I had a cute little thing next to me, my girlfriend, who’s been my wife for 38 years — so that kind of worked — and she felt immediately better, giving up her mother’s home cooking, which wasn’t the world’s most famous home cooking. But she was a wonderful mother-in-law, now unfortunately gone for a long time.

And we felt good. Ann Arbor was very pro-vegetarian. There wasn’t the word “Vegan” that I knew, but pro-plant, pro-salad bar. I actually called it the salad bar Rotarian diet.

That is a boring story, but that is the story. And then I was handed the book A Diet for New America by John Robbins a few years later, but I had pretty much committed to eating this way all the time. I read that book, it was a wow moment. John and Ocean Robbins, The Food Revolution.

Fast forward 13 years later, I’m a really committed plant-based eater. It made life easier everywhere generally, even though it was hard back then compared to nowadays. I opened my mailbox and there was the medical journal — before the Internet — called the Lancet, and there was Dr. Dean Ornish’s study called “The Lifestyle Heart Trial,” indicating, at the highest level of science, that he had observed and achieved major improvement in heart patients with an almost exclusively plant-based diet, meditation, exercise and social support. “The Lifestyle Heart Trial.”

I had just been in practice for three weeks as a heart attack stint specialist back in Ann Arbor — I had circled the country and come back — and at any rate, I said, “This is absolutely phenomenal.”

So truly since July 21, 1990, I’ve been teaching heart patients that there was another path; a Dr. Ornish came out with a book that year. I told them to read that.

Fast forward to about 2010, and Forks Over Knives came out. I told them to watch that. And now, you know, there’s such a wealth of great information.

That’s it in a nutshell. And everybody I know is just bawling that that’s an emotional story of ill health and recovery. No, it actually turns out for 42 years… I mean, I’m medication free. I just turned 60. I have no medical problems, thank you Lord. I wake up every morning with more energy than the Tasmanian Devil, and I’m pretty darn sure this has helped me maintain that kind of insane and active life that I enjoy, but requires to be on 24… seven minus seven hours and 15 minutes of deep sleep, measured by MET Oura Ring.

Robyn: But where do you get your protein?

[Laughter]

We only started laughing because we’ve been asked that 17,000 times each. Right?

Dr. Kahn: Of course, of course. That famous meme: everybody becomes a nutrition scientist the minute they understand you’re eating only plants.

I like to get my nutrition science from people like Valter Longo, maybe David Katz, of course Dr. Ornish, Dr. Esselstyn, Dr. Fuhrmen, Dr. McDougall, Dr. Neal Barnard, Walter Willett… people that are really in the research game, who really have research grants, because there’s so much noise everywhere else and it’s often not very well-suited, educated, or unbiased noise.

Robyn: I have my own take on this, and my audience has heard plenty from me, on why most of public attention is captured by whatever fad is going on, and whatever the marketers are selling, and what all the social media posts are, and they seem to have gone so wildly astray of what we actually know about nutrition.

What’s your answer for why most people talking about nutrition these days are talking about keto or whatever, and it has absolutely nothing to do with what we know about nutrition. Why is that?

Dr. Kahn: A couple of reasons come to mind. One is, I don’t think optimal health is so simple. I don’t know that it ever was, but I think it’s more complicated, let’s say that, because we do literally have to pay attention to air quality, air pollution. There is unbelievably massive, serious science going on about air quality and inflammation, diabetes, cancer, heart disease, dementia.

This isn’t a subtle association. This is serious. If you go jogging near a highway, if you live closer to a highway versus living a mile from a highway, if you measure the parts per million of various factors, it’s serious.

The most pointed example was in the 2008 Olympics in Beijing. They actually turned the factories off around Beijing’s rather industrial areas for about four weeks before the Olympics. They turned them back on one week after the Olympics; [there was] a major drop in heart attack rates during those five weeks.

That [rate] went right back up. Like the curve in Norway in World War II, due to dietary pressures in that country with a drop in death rates overall.

Water quality. I’m in Michigan. We are suffering, not only lead in Flint, we’re suffering p-phos and PFAS, these new alphabet soups that are coming from things like Scotchgard and military bases. We’ve got this year — it’s so sad — lakes and rivers in Michigan have all kinds of warnings not to eat fish, children not to play with foam… it’s all toxic. The only reason Michigan’s the center is we’re actively testing for it. And your state isn’t yet actively testing for.

It’s everywhere. It’s crazy. Plastic bottles and endocrine disruptors. That’s part of it. Sleep disruption, Wifi, EMF. And then you get to food and processed food and hyper-processed food and whether it’s plant-based/non-plant-based; the 65% of calories most Americans are eating that isn’t food. It’s factory slop.

We had an elegant study by NIH researcher this week, Kevin Hall, that if you happen to fill your plate with quote “hyper-processed” [food] — vending machine, cafeteria, hospital cafeteria, middle-of-the-grocery-store frozen food, the hyper-processed food that tastes so good by chemical scientists — it not only doesn’t provide you nutrition, you end up eating 500 calories a day more as you’re just striving to find micronutrients. It was elegant, randomized, what’s called “Metabolic Ward Studies.”

With that complexity (let alone we’re sitting more, we’re just stressed more, and such), the quick fix is going to sound so attractive. The good-looking six-pack or bikini, the “I got there quicker than you’ll get there,” it’s the rabbit and the tortoise again. The tortoise is going to win, just like in the fable, but it’s not as sexy. It’s not as attractive.

Until the day comes that we just rip open a packet, and that’s our perfectly designed factory “organic” food, and we just forget about farming, forget about animals and all the rest, which could be one day — it’d be a sad day — but could be one day.

We have to parse through all this, but you and I know there is a core body of science. You mentioned 10,000 studies that it’s unsexy. David Katz, again — I don’t mean to quote him twice — from Yale, David Katz, MD has told me seven years ago “You’re going to say over and over, exercise, sleep, stress reduction and Broccoli, and you’re going to be the most boring person when you get interviewed on local TV. But that really is the message and it is the right message. So just stick with it.” You know, it is the truth.

Robyn: I think that that is a big part of it, that the fitness industry is all about maximizing protein and it has had a long, slow effect on people obsessing about not getting enough protein, which is maybe the last thing we need to worry about.

You also touched on fish, and I wanted to mention that when I’ve interviewed almost every single one of your favorite clinicians, and practitioners that you mentioned, who are all decades long plant-based advocates, I asked John Robbins, “So you’re 70-something now, do you eat meat?” And he said, “I do eat fish twice a week.”

I have no dog in this fight, I’m pretty much 100% plant based. I don’t ever seek out any animal products because I think I need them. If I ever do, it’s because there wasn’t anything to eat where I was, or wasn’t enough to eat. But he said (and I’ve seen this movement in functional medicine more, and more practitioners saying), “I don’t know if it’s true, but over 60, 65, you may need to be eating more perfect proteins, like animal proteins.”

Are you planning to go all the way to 110 with no animal proteins? Or do you think you’ll need to supplement a bit when you get over 60?

Dr. Kahn: Yeah, I’m going to cut back to four days a week at 110 and then keep on grooving through. That’s the plan. I got my eulogy written for the year 2150, but I’ll be just a bionic brain in a box by then like we all will according to into Ray Kurzweil.

Just to touch on the protein story, which you accurately quoted, it comes from some research by a woman, Morgan Levine PhD, who is now at Harvard and was, I believe I’m correct in saying this, working in Dr. Longos’ lab for a while — Valter Longo at University of Southern California, The Longevity Diet book and the Fasting Mimicking Diet ProLon program — and they’ve published two papers together. 2014, 2016, looking at about 6,500 people, looking at dietary detailed questionnaires and disease and survival.

And younger than 65, less protein — now these were not plant-based people so the majority of their protein was coming from animal protein and they parse it out actually — but under age 65, less protein in the diet is associated with better health and better survival.

And after age 65 to 70, there was a flip in the data (it was observational data, it wasn’t a randomized trial) and there actually seemed to be some benefit to upping the protein closer to the American recommendation, or the nutritional society recommendation, of 0.8 grams per kilogram body weight. And you know, fish could be a way to get that.

Now in those same publications, 2014, 2016, they did parse out people that ate more plant-based protein and there was never a risk in higher amounts of plant-based protein. It wasn’t really a need to up your plant-based protein after the age 65.

I think we’re in a real good place to rely on peas, beans, lentils, perhaps some organic soy products in their natural form like edamame, algae – I’m a big fan of chlorella, organic, which is a food but we don’t consider it a food in this country very often — green leafies. You know, the highest protein in any plant in the world, actually I think in any food source, is algae at about 65% [protein].

You’re right, the protein idea is overplayed. The data suggest less is better at your age and my age. What I’ll do at age 75, I’m not sure, but I think it’s going to be chlorella. It’s not going to be cod.

Fish has a few clear drawbacks. One is, it’s what’s called a bio-accumulator. Again, unfortunately 2019, 2020 is not 1910. There is mercury, there are PCBs, DDTs. We have this terrible chemical called p-phos. Fish flesh, fish fat is called a bio-accumulate more than any other animal species on the planet.

Fish will accumulate these toxins, both heavy metals like mercury and these other POPs, persistent organic pollutants. And they can have very high levels. Some do, some don’t. But you never know. It’s not taste, it’s not appearance.

Bigger fish are more likely to have mercury so big tuna, big shark, big mackerel as opposed to maybe a little perch. But the other pollutants is why there’s signs on many lakes in many states, including my state of Michigan, about pregnant women not eating the fish out of the lake because it’s just horrible.

There is one mouse research study that actually shows accelerated atherosclerosis, meaning hardening of the arteries, with fish. The meat world doesn’t like to talk about it because there isn’t any real solid data that fish reverses atherosclerosis. So that is the only unique observation.

And the last little bit on fish, but it is interesting: some of your listeners may have heard of a molecule, a metabolite, you could measure it in the blood now, clinically. I measured thousands and thousands of levels of something called TMAO, trimethylamine oxide.

In Cleveland Clinic in 2011, Dr. Stanley Hazen, MD, and Dr. Wang sat down and said, “There has to be other things that are causing hardening of the arteries, strokes, heart attacks, erectile dysfunction, periferovascular disease, more than just blood sugar, blood pressure, cholesterol, smoking.” Because there is that rare patient that has advanced disease and all those measurements that seem reasonably okay, like protein A, my favorite, and homocysteine.

They identified a molecule trimethylamine and oxide, TMAO; they developed a way to measure it. They tested it in humans, they tested it in mouse; bottom line, high blood levels, which are now available through Quest Labs — and I’m not an owner of Quest Labs, I just use them — trimethylamine oxide is associated with higher risk of atherosclerosis, hardening the aggregates.

If you’re a diabetic, if you have kidney disease, congestive heart failure or heart disease, high levels are very adverse. And they’ve actually shown that probably actually causes atherosclerosis and causes our HDL not to work. It causes our cholesterol to enter arteries more rapidly. It’s a bad, bad thing and right now we don’t have a specific treatment.

We get [TMAO] in our blood from really three sources, I’ll say four sources. If you eat red meat, there’s an amino acid called carnitine, not in white meat, only red meat. It will raise your TMAO levels if you microbiome is an unfriendly microbiome. We don’t know how to test that. You can test the blood though. If you eat egg yolk, it’s rich in choline and some choline is good. Lots of choline may not be so good if your microbiome is an [unintelligible] microbiome.

If you feed a vegan vegan food, they won’t make TMAO. Usually if you feed a vegan a steak, they won’t make TMAO because their microbiome isn’t adept at converting the stake. This was a research study. The carnitine may be in the food, but the microbiome doesn’t know what to do and it doesn’t make TMAO.

Fish: a few fish, this is the most important, are rich in TMAO. You don’t have to make it in your body, it’s in their body. It helps with their balance in deep, deep, deep water. So there are a few fish that are very rich in TMAO.

The argument from the pro-fish diet is, TMAO is just a red herring. That’s a bit of a joke; but it’s a red herring if fish are so healthy. And some fish, (they don’t distinguish, they just say all fish but it’s not true, most of the fish people are eating do not have pre-formed TMAO), you know, fish must be healthy and TMAO is a non-issue. It’s just a marker of insulin resistance and it’s all about carb-high diets. That gets back to the keto, paleo argument.

But it’s pretty clear from the Cleveland Clinic, even in an article published week, that that’s smoke, and the real science says — you know, this idea you just brought up that at age 65, 70, we need to pack down more protein — that it might be just fine if you’re wanting to up your beans, peas, lentils, algae, green leafies, a humble white potatoes is 11% protein by calories.

But for most of us, we’d still be far better off into our late age. Like the famous [Ellsworth Wareham] the cardiac surgeon in Loma Linda, who just passed away over the age a hundred but did heart surgery until age 95. We can pretty much count on that it’s a good program for the long run.

Robyn: I totally agree with you. That was a great amount of detail I would sum up as, if I ever need to eat more protein, I will do that. And it will probably not be fish. I can get organic plant foods, the ones you’ve listed a couple of times, so hopefully you wrote those down if you weren’t clear on what plant products, or what plant foods, are high in protein. Those are the ones to get more of.

I would do that versus maybe five years ago; I thought that if I was going to eat meat it would be fish. Maybe I said that five years ago. I don’t say that anymore. Not with all the data that’s coming out. Even in the cleaner waters and the waters that we’ve been told, “Oh, well these are where we want to get the wild-caught fish.” Well, when the wild-caught fish have cocaine in significant amounts in their tissues, we have a problem.

Can you give your thoughts [on the fish oil industry?] My audience may have heard me give my thoughts before about the fish oil industry because — you don’t know this Joel — but a year ago, a colleague of yours and mine that we both know well called me up to say, “I’m not going to support you anymore if you continue to diss the fish oil industry. We need to get behind the supplement industry.”

And I said, “I’m really sorry that you feel that way, but I’m just going to keep telling the truth as I see it. I’m not going to get behind the supplement industry if I think that they’re killing lots of plant life and feeding people billions of dollars of products that don’t work.”

What do you think the research says about eating fish oil tablets for heart disease, et cetera?

Dr. Kahn: Yeah. I’m going to backtrack; just clarify one thing I said and dive right into your question.

Although it’s hard for you and I and your listeners to know what their persistent organic gluten, DDT, PCB level are — let’s just say you’re eating fish and you’re now concerned — there are ways to do it with advanced labs called Doctor’s Data and Cyrex. You can find out if you’re rich and full of, again, glyphosate, even roundup; you can do testing and find out if your body is riddled with this chemical, which I guarantee you you have some in your body.

Robyn: Okay. Cyrex. Let me get that from you again. What labs would they get from Cyrex, and what’s the other lab?

Dr. Kahn: Cyrex, which I have no connection [with]. C-Y-R-E-X, Great Plains Labs, and Doctor’s Data are the three companies that might offer urinary organophosphate PCB, DDT levels, they might offer urinary glyphosate, the component of roundup that seems to destroy our gut and is a major cause of leaky gut or maybe leading to — without being too woo-woo — autism, and inflammation, atherosclerosis.

But the one that’s really easy to measure is blood, mercury, lead, cadmium, arsenic levels; you can do it in the hair, it’s not so hard. You can do it in the urine. It’s a little more difficult to do it the way that functional medicine practitioners do it, because you do it twice — baseline provoke — but a blood heavy metal screen is available in every hospital in America, mainly for factory toxicity. And I measure that in my patients. It’s not the best. It only shows what their exposure was maybe in the last few days.

I can tell you, if I get a patient that tells me, “I’m a sushi lover and I eat lot of raw tuna,” I can predict to you that mercury levels going to be 10 times the appropriate level. In fact, I get the State of Michigan, Lansing, sending me emails: “We got a report that one of your patients has a toxic mercury level. Do you think he’s being attacked by cyber or Russian sources?” But it’s the sushi, or it’s the salmon.

If you want to get a good omega 3 levels from fish and eat salmon four or five times a week (not always, but I frequently see so much elevated heavy metal, mercury particularly) that’s easy [to check]. And if you’re eating a lot of fish and you just want to put your mind at ease, at least ask your doctor at your local hospital for a heavy metal screen in the blood because that’s inexpensive; that’ll be covered by insurance for a standard diagnosis like high blood pressure, high cholesterol.

If you get those metals out of the body very often, cholesterol falls. That’s a natural approach from functional medicine to treating high cholesterol without a stent.

Then to move to your question on fish oil, in some sense I’m a little bit peaceful about fish oil. I’ll tell you why.

When Dr. Dean Ornish — I mentioned the name — constructed the Lifestyle Heart Trial, the first randomized high-tech study, the whole “Can we stop and reverse the number one killer of men and women in America: coronary artery disease causing angina, causing heart attacks, requiring stents or bypass” and doing it in a way that he was examining people with angiography (a very high level study published in 1990, important in my life) he was very concerned that if he put people in the 1980s on a plant-based diet they would not get enough omega 3.

He was trained at Harvard. Harvard was the hotbed of Omega 3 research back then and he was advised by his mentor, peer, Chairman Department Dr Alexander Leaf, “Put those people on four grams a day of fish oil.” Not a lot of people know that Dr. Ornish’s research was done with people on four grams a day of fish oil. It was plant-based. It wasn’t strictly vegan from an ethical viewpoint. And it showed the results, it showed.

So when people ask me, “Is my omega 3 fatty acid fish oil going to destroy my goal to reverse my atherosclerosis or prevent atherosclerosis?” I bring that up and say, “I don’t know that it helps, but it appears that it didn’t hurt the process when published in 1990.” But that was 1980s, and 1990.

If you’re going to buy fish oil, please, please, please really read about third-party testing on heavy metals and such.

I still don’t know if they are testing for PCBs, DDT, organophosphates, these persistent organic pollutants. So I have jumped more and more into the algae-based Omega 3 we started seeing about four or five years ago. Dr. Fuhrman and others, they were very low dose. Now they’re getting better. I’ve seen five to 600 milligram capsules, vegan, algae-based EPA, DHA.

A lot of them have carrageenan; I’m not a fan of that red algae product that in some people causes inflammation, but I’ve been finding some brands now that don’t have Carrageenan. And I liked them, but you’re going to take twice as much because the standard good quality omega 3 fish oil from fish is going to be about a thousand milligrams or more. The best capsules out there are about 500 milligrams. But I have hundreds and hundreds of patients supplementing with algae Omega 3.

I’ll say one last thing. There are a couple of cool vitamins on the market. Now, if some of your audience are strictly completely plant based eaters, hundred-percent vegan diet, whole food, there’s a couple of multivitamins out there that, in one capsule, have the amount of vitamin D you might be missing it, many Americans in general. The amount of B12 you should be supplementing, the amount of algae Omega 3, even a little iodine, vitamin K2 — kind of recognize, what may be indeed a completely plant-based diet, has a couple of holes in the fence, but we can plug it with technology.

I favor that because I am not just about the argument, “This is the best item for everybody!” And blindly recommending that. I want people to be optimally healthy. And if it is these whole foods, –many organic, great green smoothies — and they have to take a vitamin, that has become easier and easier, just one stop shopping. All the better.

Robyn: What vitamins do you like?

Dr. Kahn: Well there are a few:

Dr. Joel Fuhrman makes a men’s and women’s multi that’s designed for the whole-food plant-based 100% eater. But there is no algae Omega 3; you’ll have to either eat a boatload of Chia, flax, hemp, or add in a separate algae Omega 3.

There is a vitamin out there called Future Kind from Australia, brand new, two capsules a day does the job.

And the one I was referring to is called Compliment Plus. Matt Frazier, the no-meat athlete designed it, and it has the D3, the B12, the algae Omega 3, but it goes beyond that too. A little bit of iodine, a little bit of vitamin K2. And I think it’s really a breakthrough to saying “Hey, I want to do this and I want to be healthy.”

But let me just say the standard American would benefit from taking some of those, because my meat eaters — and I checked their D, their B12, their Omega 3, and other things — were very often very low [in these nutrients]. It’s been in the news since the 1930s that the majority of Americans have nutritional deficiencies like magnesium because they’re not eating any fruits and veggies and nuts and seeds. So by all means it’s not only a whole-food plant-based diet problem; it’s a western world diet problem when we divorced ourselves from gardens in the backyard, farmers markets and all that.

Robyn: I don’t know why this is, but I used to be anemic and B12 deficient when I used to be a burger-eating girl. And I’m not now. I don’t have a low hematocrit now even though I don’t eat any animals and haven’t for a couple of decades.

Dr. Kahn: “Just Beet It.” That’s B-E-E-T. As you know (your listeners may not know this), cows don’t make B12, bacteria make B12. We make B12 in our colon. We absorb it up in our small intestine, which is very inefficient actually. That’s why we need B12 from some food source or a supplement source.

The bacteria make B12. We don’t usually eat dirt. If we started eating dirt, we wouldn’t need a supplement. And we wash our carrots so we don’t get B12 on the little dirt bombs on a carrot. But cows generally don’t have those rules if they’re out in the meadows. Those cows that are being raised in those factory farms, which is steel floors, it’s not natural dirt, do have B12 problems.

So, what do they do? 90% of the B12 made in the United States is injected into factory-farmed animals to jack up their B12 level to satisfy the American public expectation that plants like B12, animals have to B12, but it’s another artificial construct really. You’re filtering through a cow the nutrition you can get by eating dirty vegetables or taking a supplement.

Robyn: I think you may have just accidentally told me why that, even though I eat entirely plant-based now, I’m not deficient in either of those. B12 is very obvious. You were just talking about beets and then carrots and anyone who would like my hot pink breakfast smoothie I’ve been having every single morning unless I’m traveling of the last 20 years it has, guess what, wait for it… Unwashed beet and carrot in it. I buy the organic carrots. In fact, lately I’ve been buying the heirloom ones, so my carrot might be yellow or sort of purple or whatever and I don’t wash it. I don’t need to. It’s organic. So I cut the tops and bottoms off, throw it in there, and a chunk of a beet. Maybe that’s why I’m not B12 deficient anymore, even though I haven’t eaten animals in 20 years.

Dr. Kahn: That’s right. You know, they say, “Live clean, play dirty,” or some such statement. You’re eating dirty, which is keeping your microbiome happy. Good for you.

Robyn: Yes. I have to go back and mop up some of the things that you’ve said that I’m sure I’m not the only one that’s going, “I got to hear more about that.”

Green smoothies. I have, for years, been addressing this question. Why does Dr. Esselstyn say that we shouldn’t have green smoothies? I also have to address Bryan Clement’s arguments, and neither one are actually very hard. But I’m curious about your take on it because I know that you are a fan of people getting lots of greens in their blender.

Dr. Kahn: I’m more familiar with Dr. Esselstyn and his son Rip’s viewpoint, and it’s a viewpoint geared — I’m a cardiologist –to a lot of heart patients specifically. It’s really viewed for the sickest heart patient. And the theory goes like this:

You want your arteries to be healthy, 15,000 miles of arteries in your body. You want the lining of your arteries to be working perfect. That’s called your endothelium. There’s about seven tennis courts of wallpaper lining in your arteries, the biggest arteries, the smallest arteries, and inside your heart. And the magic that your endothelium does is ,it makes nitric oxide. This magical gas won the Nobel Prize in medicine in 1998.

When you’re making a lot of nitric oxide, it could be because your diet’s great: arugula, beets, watermelon, pine nuts and such.

Blood pressure’s better. Sexual performance is better. Gut health better, brain health better, lung health better, it goes on and on. And if your lifestyle, or diet, or even some genetic snips and such hamper the ability to make nitric oxide, blood pressure comes up and male sexual function goes down and other organ systems don’t function as well.

The Nobel prize in medicine identified that there’s amino acids called arginine and citrulline that help us produce more nitric oxide. That’s why watermelon, particularly yellow watermelon, particularly the rind of watermelon, are very rich in citrulline. And can help you make more nitric oxide. So putting watermelon in your smoothie is another little tip for cardiovascular health, sexual health, and such.

But there’s a second system that was found after the Nobel prize was awarded, which is the dietary nitrate system. You’ve got a bowl of arugula, you’ve got a bowl of spinach, you’ve got a bowl of baby kale.

If you slowly chew them in your mouth — you’re very mindful, you’re into conscious eating — and if you don’t use Listerine and scope-type mouth washes, because they are antibacterial, you will have certain… they’re called facultative anaerobic bacteria. There’s a mouthful.

In the grooves of your tongue (this is the weirdest system) while you’re chewing these greens, there will be dietary nitrates, much different than you’ll find in bacon of course, dietary nitrates. They interact with the bacteria. They will be converted from the nitrates to nitrites. They will circulate down your intestines, they’ll will be absorbed in the blood and converted to nitric oxide.

So if you slowly chew and allow nature’s amazing system and don’t impede it with these antibiotic mouth washes, you have another way to make more nitric oxide. Better blood pressure, better health. There’s lots of studies. That’s where the beet juice, beet powder comes in. That’s where greens and such come in.

The argument is that, you make a beautiful smoothie in the morning and you’re in a rush and it’s down. There may not be enough time for this chemical reaction in the grooves, on your tongue, to happen.

I’ve heard people talk about chewing your smoothie, chewing your juices; I call mine a chewy. I actually don’t run my blender very long. I’d like it to have a little bit more of a texture. So I do slow down a bit. It’s not juice-like it’s more particulate-like.

That is the argument from Dr. Esselstyn’s standpoint. “I’m treating advanced sick cardiovascular patients, to the brain, to the heart, to the legs, the sexual organs. And I’m bypassing one of nature’s gifts.” He of course advises people to eat green sautéed balsamic about six times a day.

I advise many of my patients to do that if they’re very sick. But most of us are not very sick heart patients, or at least we don’t think we are in terms of symptoms. There is this magical second system that if you do just down that green smoothie, dietary nitrates, they can still — it’s amazing — they can be absorbed, but they’re not going to create nitric oxide. They get circulated back through your parotid gland, your salivary gland. Whomever designed this thing should win an award for an elegant design.

Through your saliva duct, the dietary nitrate shows up on your tongue again. It’s a recirculating system. This time they’re just being trickled on your tongue. What’s on your tongue? The same bacteria. So there is this second chance to create the same chemical reaction. Nitrates, nitrites: swallow them, absorb nitric oxide. Maybe it’s not 100% as efficient as the slow chewing of the whole food, but it’s still going to happen and it still benefits.

When I’m concerned is that if it’s not that smoothie, they’re getting a breakfast sandwich or they’re getting a bagel with cream cheese, they’re doing some other options. I’m a practical guy. You want to make a smoothie, chew it a little, make it rough if you want, but be confident you’re still going to benefit in terms of this nitric oxide production. Which is kind of a tangential topic.

There are ways to actually test it. My patients, my clinic, has a blood test and another test for their adequacy of nitric oxide production. There’s even a little test strip. It’s very cool actually. Maybe I’ll talk to you about it after, Robyn. There’s a test for it made by a company and within about 10 seconds you can tell if you’re making enough nitric oxide. Does a smoothie girl make lots of nitric oxide? By your glowing healthy look, I would bet yes.

Robyn: Interesting. And especially interesting because, as you’re talking about Dr Esselstyn, it reminds me of how the damage to the epithelial lining and producing nitrous oxide is a big thing that he talks about a lot as a mechanism for why we shouldn’t eat any animal products.

Also, and this goes to your point, it’s the same point I often make when people are saying, “Wait a minute, Dr. Esselstyn and Dr. Fuhrman two pounds of vegetables [daily].” I agree with that. I bet you and I both eat two pounds of vegetables on an average day, vegetables and greens if we can lump those together.

But he also talks about how eating any kind of oil damages epithelial and decreases your nitrous oxide. I’m really glad [you said something] because I do occasionally sauté something in oil, and I have people who are really anxious about that once they’ve read that from Dr Esselstyn. But that’s my answer too Doctor Kahn, my answer is, “Well, he’s dealing with people nearing death if they don’t turn around major cardiovascular problem.”

For you and I, maybe a little more Mediterranean approach. I mean, millions and millions of Mediterraneans outlive the millions and millions of others of us who don’t eat their diet ,and they seem to have oil in their diet. What do you think about that?

Dr. Kahn: Since you bring that up — and man, that’s a sticky topic — I had a mentor at University of Michigan Medical School, Dr. Robert Vogel, MD. He’s cardiologist and he’s in Denver now. He moved to Baltimore and he did a study, a very famous study, it’s called the Sausage Egg McMuffin study. He had a mechanism to take healthy people, volunteers, put a device in their arm, measured the health of their endothelium, and then he fed them a bowl of oatmeal. And it didn’t come impact in a negative way their endothelium. Then he fed them a sausage egg McMuffin on another day and within an hour, and then persisting for seven hours, it damaged their endothelium.

He made the point, “Well that’s his breakfast. What are you eating for lunch, KFC? What are you doing at dinner? Hardy’s? You’re probably walking around more than half the day with damaged endothelium, year after year after year.” That’s hypertension, atherosclerosis, and western illness. It’s food as a poison.

Then he went on to do the Mediterranean diet study and the general perception that, compared to a bad American diet, [the Mediterranean diet is healthier]. Whatever the exact Mediterranean diet is. Probably less red meat, maybe fish, olive oil, lots of whole grains, fruits and vegetables and whole grains; I don’t know whether it’s pasta or Farro and such. He said, “I’m going to isolate them. I’m going to feed people fruits and see what happens to their endothelial function.”

Fruits, all good. Feed them vegetables, all good. Feed them grains, all good. He actually fed them fish; I hate to say it, they didn’t have a deterioration in their endothelial function, it was part of the study. And then he fed them two kinds of oils and man, you’re going to get upset with me. He fed them canola oil as a control, didn’t damage. It didn’t cause temporary damage to their endothelial function. And then he gave them extra virgin olive oil and it did cause their endothelium to drop in function, like the sausage egg McMuffin.

That is probably the seminal study, elegant study, published in a good journal that Dr. Esselstyn points too. But there’s probably 40 olive oils studies. And if you were to put them all together, I’m going to tell you it’s confusing. My classic study is, olive oil dropped endothelial function, somebody confirmed it. But if you have olive oil with a glass of red wine and you measure endothelial function, it was neutral. Maybe the polyphenols, the antioxidants, the vitamin C in red wine to some degree neutralizes it.

I have heart patients like Dr. Esselstyn; I totally respect and love Dr. Esselstyn, and I absolutely counsel them on a no-oil diet and it becomes difficult in restaurants, but they just tell people, “I’m allergic to oil and I need an oil-free menu.” As you know, Robyn, I own three restaurants and we have extensive oil-free options because I just have a lot of people that come and see me from my clinic into the restaurant and we want to provide that for them. But it has created a tremendous sense of being anxiety for many others.

I love, probably a little bit more, the approach that Dr. Dean Ornish has, which is, he called a book “The Spectrum.” Here you have the horrible American Diet. Here you have a whole-food, plant-based, maybe even organic, diet with little to no oil. I mean, where are you, in terms of your health? The very sick heart patient needs to gravitate to the very end of that spectrum.

The number one book that I give patients to read in my clinic is Dr. Esselstyn’s book. And if they’re very sick, I say, “This is exactly what you need to do.” And if they’re not sick like that I say, “This is the extreme, which is absolutely ideal for certain people in my practice, I just want you to know that that’s there and we’ll talk about where on this spectrum you’re comfortable with.” I’m not going to judge you unless you’re very sick. I have hundreds of patients that are oil-free patients and do very well.

The example is always Okinawa. In Okinawa, Japan — one of the blue zones, exceptional longevity in the forties and fifties — their percentage of calories from fat in their diet was under 10% their oil use in general is almost absent and they had exceptional health as part of their program.

They had activity, they had fresh air, they had fresh water, they had fresh food. They weren’t smokers to any degree when they were at their prime longevity. So it is possible. They have a very well-constructed, very low fat, no added oil diet, and did exceptionally well. The Okinawans are not the only example, but the easiest example.

Does the general public have to have anxiety? I will say, some of your listeners have autoimmune disease. I’m a big fan of Dr. Brooke Goldner, MD, VeganMedicalDoctor.Com, a book called [Goodbye] Lupus.

It was a much better story than me because she actually had very severe lupus at age 15. And by age 26 every biomarker in the blood was gone. And it has very simple rules. Eliminate processed oils, eliminate processed food, add in fruits, vegetables and tons of Omega 3 rich, flax seed-type foods. Drink lots of water, get lots of rest. It’s a very simple book, Goodbye Lupus, and I encourage people to look at it.

It’s not the only organ system, being heart disease, but if you’re battling Lupus, rheumatoid arthritis, Sjogren’s disease, and other autoimmune thyroiditis and such, you might want to adopt the spectrum all the way over there.

There’s other examples, even now, like advanced kidney disease, there’s your spectrum. Because you’re sick! When you’re sick, you need to adopt perhaps the most religious and observant of diet. So Dr. Esselstyn’s right for the population that comes to Cleveland to see him. But is he right for everybody listening? I think that’s a difficult program when you’re healthy and just looking for an optimal and somewhat enjoyable lifestyle.

Robyn: Lots of great information there and we’ll make sure to link you to Dr. Brooke Goldner’s book, Goodbye Lupus. That’s a new one to me. I’m going to get it and read it. I don’t have Lupus, but —

Dr. Kahn: Amazing. And she loooves smoothies.

Robyn: Does she? Awesome.

Let’s have a light question here. I’m going to tell you what’s in my smoothie; you tell me what’s in yours today.

I had made my own sprouts out of Alfalfa, radicchio seeds, fenugreek, something else.. Four seed mix. I dumped about a cup of those in with about a cup of organic Aloe Vera and a little knuckle of fresh ginger. And then just all kinds of Costco Greens and some purple cabbage and then a banana and some organic berries. What do you put in your smoothie?

Dr. Kahn: I’d say about half the days a week I do a smoothie, half the days a week I skip breakfast. Either because of the schedule or I like to skip breakfast despite some concern that breakfast is an important meal for heart health. That’s been in the news the last four weeks.

Nonetheless, I’m not as elegant as you. There may actually be black beans in my smoothie, I do that. And I say, “Dr. Gundry, take that!” And I just put them in my blender, and often a Michigan brand called Eden foods, which even Dr. Steven Gundry endorses. They’re pressure cooked and organic and the can is not lined with BPA. So I like that. It’s a Michigan brand. I like that it’s gotten a lot of attention.

A lot of flax seed or Chia seeds, usually arugula. I don’t know why, I just love arugula. I like bitter foods. And then a lot of blueberries to counter that. And then spices and I’m done. I like nutmeg, cinnamon, all spice. Sometimes a little turmeric. Some milk; Oatly’s my favorite lately, the oat milk Oatly.

Whatever I’ve got in the fridge, sometimes just water, a couple ice cubes, done. I mean, I really try and move it. I don’t often put protein powder; I have a range of them. My wife reminds me how many canisters I have in the cabinet. Pea protein and Sacha Inchi seed protein and the rest, pumpkin seed proteins, and they’re lovely. But I don’t often take the time to do that.

Robyn: You mentioned Dr. Gundry, and one of my favorite things about you is that you just go head-to-head with all these people that I think that we disagree with. We disagree with based on the evidence, and Gundry has had two New York Times bestsellers the last few years, telling people things that I believe are almost categorically false or taking a very small truth and making it this global truth.

I’m going to go through a few different things and have you just comment briefly on Dr. Gundry and the idea that lectins in beans and all the different kinds of legumes there are are going to kill us. Also in nuts and seeds. So I’m going to go start with Dr. Gundry and the plant paradox.

Then I’m going to have you hit quickly on Keto and carnivore, and maybe we’ll finish up with you talking about how much Dr. Longo’s work has impacted you.

We’re also coming out with a modified fast 600 to 800 calories a day of organic, plant-based stuff. I love his work, I would just want to provide a much cheaper package that’s also organic. So we’re coming out with the flash fast in the next couple of months.

We’ll kind of go in that order. But backup, you mentioned Gundry; you’ve gone into many public debates with guys like this, whereas most of the plant-based folks I think would refuse to do that. And you two have had a very civil, respectful dialogue. What do you think about Gundry’s work?

Dr. Kahn: We did until I bumped into him three weeks ago in Austin at PaleoFX, vegan attended. Actually I’ve spoken at PaleoFX because I do have a lot of friends across the aisle.

Robyn: I heard you were there. Somebody said, “There’s a Vegan here!” I was chit chatting with someone because they were like, “Are you coming to PaleoFX?” And I’m like, “Think about that for a minute. You know what I do right? Like Paleo, really?” And she’s like, “Well there’s a Vegan cardiologist here.” I’m like, “It has to be Joel Kahn.”

Dr. Kahn: I was on a panel with a person we both love, Dr. Kellyann Petrucci, most famous for bone broth, and Dr. Sean Baker, who was a carnivore, and Dr. Gabrielle Lyon in New York City who’s quite the meat advocate for protein. But it was actually very civil, a very good conversation and took down some of the heat. In fact a whole lot of people that blocked me on Twitter unblocked me because they realized I wasn’t a giant anus.

But getting back to your question. Very quickly, if the audience has lived under a rock the last two years and hasn’t opened social media anywhere to see ads everywhere, Dr. Steven Gundry was a very well-trained heart surgeon. I’m a heart doctor, he’s a heart surgeon. I do stents, he does bypass. He had an amazing career in Loma Linda of all places, the blue zone that favors plant based eating.

And then he went to palm springs, became a celebrity doc at a place called We Care Spa and other places. And he wrote a book a few years ago about Dr. Gundry’s diet. but then two years ago, the story goes, a patient named Big Ed, having all kinds of problems nobody could fix, came to Dr. Gundry, overweight and inflamed. And when he removed the “killer” lectins, these chemical products that are not just in plants but they’re in meats, they’re in nature, there’s hundreds of different kinds of lectins, “anti-nutrients killer, if you had five red kidney beans you will die because they’re so bad for you.” And it is true that legumes are higher in lectins in their raw state than any other food groups.

He designed a diet that the biggest focus of the plant paradox was a lectin-free diet. Of course there was a lectin blocker vitamin for $90 you could buy, and it just captured the public. It was actually, I think, in the New York Times bestseller list for 38 weeks. It’s been translated into 34 different languages.

I got wind; I read the book actually with interest. I didn’t know that much about Dr. Gundry. I read the book with interest, and I started looking at the references because he quoted a really interesting study to support his bizarre viewpoint. I go to the back of the book, pull up the reference, and it didn’t match. And right at that time, a very famous researcher, Dr. Colin Campbell from Cornell with the China Study, he published a paper where he had looked at about 20 or 30 references in the book and they were fraudulent. [Gundry’s] an MD with the public trust, but it was fraudulent. I think that’s actually fair to say.

More recently, about six weeks ago, a PhD named Stephen Guyenet actually analyzed the entire book in incredible detail and said the accuracy of the science and the plant paradox book was 26%. If you go through the references, you go through the science, 74% of the book I think can authentically be called fraudulent. Okay. Sue me Dr. Gundry, it’s just the science and the analysis.

Then I debated him on The Doctors Show, and we went at this hard, and I talked to him about the references (this was a year and a half, two years ago, it’s on YouTube, you want to look it up, it’s well worth watching, five minutes). And he just got all flustered. “A Harvard medical student did my references, I can’t believe they’re all that bad, but I’ve been hearing that, I’m going to do better.”

The book was a killer success. And the vitamin line does hundreds of millions of dollars a year and he’s everywhere. He did come out with a book recently called The Longevity Paradox with a couple figs on the cover. And I eagerly — I didn’t want to buy it, but I bought it — read it hoping that he actually had improved the quality of his research.

I’m here to tell you I didn’t check everything, but you can’t, as a doctor, make a major statement and quote a book without quoting the page numbers. So there’s no way to ever track it down. If it’s a 400 page book, where can we look to verify? Huge sections of his platform have no references. He thinks fruit is evil. He eating apples are evil in this book. Actually, beans got rehabilitated. He’s now okay with beans as long as you’re eating food beans, where’d all that go?

“Our enemy are fruits particularly,” it just goes on and on and on and he does dislike meat in the new book. So, at the end of the day, if somebody eats his program, they’re not going to be at Wendy’s, Harvey’s, Burger King, and KFC. Hooray. Nobody should be there anyways. Nobody’s going to be drinking coca cola and Pepsi if they follow this program. But you know, it’s not a science based program.

The last thing just to say, he says over and over in both books, “I’ve published data on my program. I have published public data.” It sounds great to the public, but go try and find it. And if you find it, it’s a little square paragraph called an abstract and has all kinds of mistakes in it. So bottom line is, he’s an emperor in my view that wears no clothes. But he’s handsome, he’s articulate, he can tell a story like Father Time or Santa Claus, like no one other, he’s traveled the world…

And, for reasons I don’t get, people like Tony Robbins (who is sort of in the news right now, and not so positively), Dr. David Perlmutter, Dr. Dale Bredesen, these people all endorse him. They’re all part of the same “We can sell 3 million copies of a book and retire” club. And unfortunately the latest book has an endorsement by Doctor Valter Longo in the back. It grieves me.

I can tell you that Dr. Longo never read the book. I’ve asked him about it. I said that was a mistake because to be honest, he sort of copied the fasting mimicking diet into his book without paying appropriate attention and royalties because Dr. Longo has it all patented. Whatever, you know, the world will go on and one day there’ll be another Gundry that rises.

I think that kind of answered the topic.

Then you said, “What’s so special about Dr. Longo?”

I have no real connection with him. I’ve met the man and spent some time with them, but this is a man that’s been in a research lab doing basic biochemistry in yeast, mice, earthworms and now some human clinical data funded by the NIH, our National Institution of Health.

$46 million [dollars] of research had gone into Dr. Longo’s extensive labs in the United States. It’s got other research labs in Milan, Italy. Now I’m doing work on fasting and nutrition and cancer and brain disease and diabetes type II, and the next few years you’re going to see so much high-quality science.

His science is so high quality. It’s not little paragraphs that have mistakes in them. The ends of the spectrum between the doctor Gundry and doctor Valter Longo are as polar as they get in terms of quality. And he has this big picture.

Last thing I’ll say is that nutrition is a tough field. We all recognize that. The Paleo, Keto world, we’ll say all of these epidemiologic studies are worthless. Well they’re not worthless, you’ve got to have basic biochemistry. Is meat good for aging, is meat bad for aging? He’s done most of that research out there. It’s not very anti-aging to eat lots of red meat. Is, in randomized study, of which there is only a few, things like meat pro-health? Anti-health? And in a large randomized studies there you see inflammation, and insulin release, and cholesterol rising and other factors.

How about epidemiology? Are we’re going to throw out thousands of studies on millions of people? Let’s take a look at it. Let’s look at what centenarians, what the hundred-plus crowd eats. Not the carnivore diet, it’s a whole lot of whole-food plant-based variety of diets that are not the same, but they have a common thread being very plant-strong.

And lastly, he talks about like a big picture view. What’s it doing for the environment at all? And we know that plant-strong diets are certainly better for the environment and the planet we live on. So that’s why I just admire Dr. Logo. It’s a scientist, versus a physician with a very strong sales viewpoint.

Robyn: We did interview Dr. Longo probably early last year. I wish I could recall the exact episode number, but make sure you go back and listen to that because what Dr. Khan is referring to is his five pillars of nutrition science. He doesn’t take this myopic view, he takes all the views and puts them together in a framework. And it sounds like you feel pretty strongly that it’s a good framework to look at. Am I right?

Dr. Kahn: It’s a great framework used by many other very high-level scientists, Nobel prize-winning scientists. They don’t even know they all use the same structure, but I just happened to notice in a variety of lectures, “Oh, Dr. Michael Brown, who won the Nobel prize for cholesterol in 1985, he talks exactly the same framework that Dr. Longo does.”

In fact, I introduced them to share the fact that they have come across a very similar approach. Dr. Longo will go like this, “The Keto diet? That’s half a pillar. There’s a few people say they feel better, but there’s nothing else to support it.”

Robyn: In other words, what you’re saying is that it holds up to half of one of the five pillars, and what he wants to do is, if you’re going to really invest in a diet and you’re going to make a lifestyle change and you’re to commit to a specific way of eating, you want it to hold up to five different pillars. Is that what you’re saying?

Dr. Kahn: It would make sense to look from a very high level at all the data, and not a throw out a whole lot and isolate a whole lot. Right, absolutely.

Robyn: Okay, so Longo would say, we already have his quote about Keto. We have a quote you gave, even though I hadn’t interviewed you yet, but just from talking to you and being friends with you, I got a quote from you. It’s actually, I believe in the tens of millions of words that we’ve published on GreenSmoothieGirl the last 13 years, I think it’s the longest blog post I’ve ever published, on “22 Health Experts Debunk the Ketogenic Diet.”

It’s not that I have an ax to grind, it’s not like I’m selling a fad diet and I want to compete with their fad diet. It’s that I think it’s actually downright dangerous. Do you feel that strongly about it?

What are the most salient facts you would want to share with someone who’s considering doing the high-meat or high-animal-fat diet?

Dr. Kahn: I would introduce them to Dr. Longo’s five pillars, Dr. Michael Brown M.D.’s four foundational aspects of nutritional science. But I would actually tell them to go a bit deeper.

My greatest concern right now, as a doctor advising patients, is the Keto Diet. Honestly, the Paleo Diet, which was very hot the last few years, it’s not out of the picture, but for some reason it hasn’t remained as sexy as it was, we can eat like our ancestors 50, 100 thousand years ago. You can give up dairy and give up grains or give up legumes and our health will flourish. There’s really a strange thing going on because some of the Paleo people have added back some dairy, have added back some legumes.

The very founder of the modern Paleo movement is a guy named Boyd Easton, MD, from Atlanta. He’s a radiologist, but he wrote a paper 34 years ago announcing that it might make sense to follow this ancient diet that our ancestors ate for optimal health in a modern world.

He announced three years ago, “Stop doing the Paleo Diet. We’re ruining the world,” he actually said this in Boston in November, 2015, “and I’ll let you guys know when you can resume the Paleo diet when we figure out how to do it without destroying the environment.”

It was an insanely important turnaround that, of course, you’re never going to see on a blog post by Dr. David Perlmutter or somebody like that, the Brain Grain guy.

The Keto diet worries me. The Keto diet was developed for a variety of medical indications, and children [were affected] and there were medical reports, and there were side effects, there were warnings, and somewhere in the last 10 years, with Halle Berry and Lebron James and Hugh Jackman and Kim Kardashians and then a whole lot of docs and all, it’s on the hottest food trend out there.

We know — Dr. Atkins showed us and this is a reformulated Atkins — you can lose weight quickly if you drop your carbs and up your fats and eat a lot of animal products. You’ll deplete your glycogen; you’ll get some water out of your body.

You’ve got a wedding to go to, and you’re going fit in your Tuxedo, your dress, it works. But what about two months? What about six months? There’s very, very few ketogenic diet studies that go two years or more,

There is a body of data out there and nobody talks about it when they promote Keto. There are 10 studies, they’re epidemiology, we all know that’s not perfect.

We asked 25,000 people in Greece what their diet was. Those that described their diet in a way that the analysis said was a low carb, high fat diet, we followed them for 20 years.

They used to be healthy. There was an increased rate of deaths in Greece by doing the low carb, high fat diet. They didn’t call Keto, but by design it was a similar to what a lot of people are doing by eating the burger and taking the bun off rather than throwing them both away and having a bowl of beans or something. There’s 10 of those studies that involve more than half a million people. Time after time after time, increased death rate increased death rate, increased death.

If you’ve had a heart attack and you adopt a low carb diet, you have an increased rate of heart attack. Recurrent, and death after the initial heart attack. There are cardiologists advising the low carb diet.

I actually think they should get patients to sign a permission slip that says you’re aware that there’s reports of increased death rates. And until we have better data, they’re doing this for some other reason, their waistline, their blood pressure, and they recognize the risk. Just like any therapy that has a known downside.

I’ve written a blog called “The Low Carb High Coffin Diet” or in another blog, called “The Skeleton in the Ketogenic Diet’s Closet.” It’s not my science, but by putting it all together [it’s helpful to see.] And now Walter Willett at Harvard School Public Health talks about it, and others.

[Increased risk of heart attack] is the biggest risk to me, and that’s why the US news and World Report puts the Ketogenic diet in the Whole30 Diet at the lowest recommendation for long term diets and any diets in the United States year after year after year. It’s concerning.

Robyn: I appreciate you speaking up on it because surveys say that the most common answer people will give when asked what is the Paleo diet, or what is the Ketogenic diet, is that they eat more vegetables. And while they may actually eat more vegetables — because pretty much anything is better than the standard American diet — the fact of the matter is we have this Paleo diet, which people for some reason keep calling it a plant-based diet and they’ll call a Keto diet a plant-based diet.

This is how far afield we’ve gone, that the vast majority of us eat so few whole-plant foods that when they go on Keto, where 70% of their calories are fats and most of them animal fats, they are literally eating more vegetables than they were before.

And I think that’s the thing that never gets talked about; are you feeling better because it’s better than the standard American diet you were on before? Or are you feeling better because eating 70% fats is actually good for you? That’s something that we need to be really careful with.

I saw that you shared my blog post the other day. Thank you very much. It’s called “11 Astonishing Claims of the Carnivore Diet.” And I think what you’re saying is the Paleo diet was just the rage for close to a decade. We’re all friends with the fact that it banned processed foods. However, people eating Paleo are often eating twice as much animal protein, or more, as the standard American diet. So we went from the frying pan to the fire.

I feel like with Paleo to Keto, we went from the fire to the fire with gasoline. I’m not even sure what to say about the carnivore diet, but you mentioned Dr. Sean Baker. He’s one of the people I quoted most often in the “11 Astonishing Claims of the Carnivore Diet.” We go on to debunk all 11 of those claims, which is actually like shooting fish in a barrel pun intended. It was so easy to completely dismantle their argument with evidence.

What do you have to say about this new rising fad?

Dr. Kahn: The carnivore diet analyzed, by Dr. Longo’s Five Pillars would be a quarter pillar because it relies on some anecdotal reports of improved health. Dr. Sean Baker is an orthopedic surgeon in Albuquerque, New Mexico. He lost his medical license, I think he has it back at about 52 years old. He served our country in the military.

I don’t hate the guy, but when I started noticing him on social media, we went at it a bit. Then I got on his podcast and we were friendly. Then we went at it a bit. He was on the panel at PaleoFX in Austin recently with me. He’s unfortunately a brute of a guy. I mean he’s six foot five, six foot six 250 pounds. He holds a few world records in rowing. He held all those before he adopted the carnivores diet, at diet that recommends nearly completely meat.

We’re talking prime rib for breakfast, prime rib for lunch, prime rib for dinner. No sources of vitamin C. Some people eat some greens, some eat nothing but meat, they claim.

There was one research study in the 1930s of two scientists that somehow survived a year in reasonably good health, eating only meat. Since then there’s really no science but there are prominent people.

There’s Jordan Peterson, the author of a book, a self-help psychology book, that was a worldwide best seller. His daughter, Mikayla Peterson — Jordan had depression, he claimed, “I got better on an all-meat diet,” — and Kayla has juvenile rheumatoid arthritis, very advanced at age 22, 23, she claims she got a lot better. So you’ve got that kind of report.

I don’t deny that these seem to be credible people. I don’t know if they went to True North and did a water fast followed by a whole-food diet, or did the GreenSmoothieGirl program or something, they wouldn’t have had the same or better.

I do worry. Two, three, four, five, eight, 10. Cancer doesn’t develop in a week, and heart disease doesn’t develop in a week. As they maintain this diet that is clearly horrible for the environment, and I fear may not be optimal for them.

Or maybe we live in such a screwed-up world that they can avoid some biotoxicities, some of those chemicals I talked about at the beginning in meat, but they often don’t eat organic meat. It’s too expensive. They’re talking about just going into your local Albertson’s and buy whatever’s there, which is even scarier for the whole world.

From the science standpoint, it’s not even worth the breath. But from a popularity standpoint, it’s a roller coaster right now. Maybe, just as I say, we’ve screwed up the food chain so much that it’s one more place to hide short term, or whether it’s going to actually be anything we talk about in five years. I sincerely hope not.

Robyn: It’ll be interesting to find out and I hope you and I speaking up about it everywhere we get the chance to. We’ll make a difference just pulling people’s attention back to the known, true principles of what we need to be eating to avoid all this heart disease, your specialty, autoimmune disease, cancer.

Thank you so much. You’ve been an absolute firehose of information. The show notes are going to be very, very rich from this. Our interview with Longo, Dr Valter Longo, number 74. That’ll be in the show notes as well as a number of the other references that Dr. Joel Kahn has made here.

Tell our listeners where they can learn more about you, and tell them about your latest book and some of your favorite books that you’ve written. You’re a multi-time author as well as a three-time restaurant owner.

Dr. Kahn: If you go to DrJoelKahn.com, d-r-j-o-e-l-k-a-h-n.com, there’s a link to my clinic in Detroit, but I see people all over the world. There’s a link to my restaurants, a link to some articles and videos. I’m really active on Twitter, Instagram, Dr. Joel Kahn, America’s Healthy Heart Doc on Facebook, D-r-j-k-a-h-n on Twitter and Instagram.

My last book was called The Plant-Based Solution, it happens to be on my desk, been out about a year. A good book, about three quarters science, one quarter many, many recipes. There will be a new book coming out next year on a cholesterol issue.

GreenSpace Cafe in Ferndale and in Royal Oak, Michigan, and a food truck in Austin, Texas called ATX Food Co. on Barton Springs Road is where you have to eat at least once.

I’m so glad to be introduced to you, I respect so much what you’ve done, the business you built, the message you’ve created, the firm stance for reasonable discussions, and it’s — God knows — refreshing, and helps so many people.

Robyn: Oh, it’s my pleasure and thank you so much for giving me this time today. I’ve learned so much from you. I always do. Dr. Joel Kahn.

Dr. Kahn: Thank you. We’ll see you soon, I hope.