I have 25 million subscribers of people who listen to every word I say and correct every mistake I make and I could tell you how your information very confidently lands with them and it doesn't land in the way you intended to and I just urge that in your upcoming books and the speeches that you make just take that into consideration because when you make statements like apples are horrible the the worst thing you could do for your mitochondria is a fruit smoothie it's not just taking a little bit of Liberty with information it's truly misleading people to make bad decisions for their health that's all I'll say Dr Steven gundry is a cardiothoracic surgeon who found success leaving the operating room and shifting his Focus to prevention along with writing several best-selling books including the plant Paradox and his upcoming book titled gut check you may have seen his content across social media highlighting his very controversial claim that certain healthy foods are actually bad for you his most popular claim is that foods like beans tomatoes whole grains and bell peppers are actually unhealthy because they contain proteins called lectins and therefore are destroying your gut this has drawn sharp criticism from the medical and nutrition community at large given the great amount of evidence showing that those who eat those foods are significantly healthier have lower risk factors and do not require the removal of such Foods being fully honest here I was one of those critics so when Dr gundry's team reached out for him to come on the checkup I made sure that we stay sted early and openly that if he were to come on it would likely be a critical conversation to his credit he welcomed the debate I also mentioned given that he is a cardiac specialist and I am a family medicine doc I would like to bring in Dr Danielle Bardo who is a cardiologist heavily focused on Research surrounding disease prevention in fact she's on the committee that puts forth new guidelines aiming to decrease the number one killer of all of us heart disease Dr gundry again agreed so here we go the checkup podcast well we're talking about heart disease prevention and it's great to have two people who are passionate about heart disease prevention because for myself as a primary care provider so many of my patients come in too late already with heart disease and then we're focusing on trying to reverse that and reverse that not just through medication methods but also giving them some lifestyle modifications and that takes a lot of work because currently the American Standard diet is an absolute disaster the the things my patients are consuming High Ultra processed foods very very problematic but Dr Gund I'd like to start with you because part of uh I would say your success on social media and with your books the plant Paradox has been that the advice doctors the medical system gives to patients when it comes to diets including what we call healthy foods are actually unhealthy tell us about that yeah I think that's uh certainly my observation over the last 50 odd years that I've been doing this um as a heart surgeon we knew that if we put a stent in someone or did a bypass we'd probably see them uh for their next procedure in five to seven years uh in general and we were taught that this was inevitable and there's not much we could do to slow down the process Statin blood pressure medications lifestyle modifications exercise more uh but in fact those were really piddly little things in the scheme of things so when I 28 years ago watched a gentleman from Miami Florida Big Ed in all my books reverse 50% of the blockages in his coronary arteries which were basically totally included in six months time with a diet and taking a bunch of supplements willy-nilly from my health food store MH I knew uh that he was on to something and spent the last 28 years figuring out how he did it that's interesting to me because you know in medicine we always look at anecdotal situations as perhaps not the strongest level of evidence so why did this one case because I have patients that come to me follow all sorts of unique diets I have patients who have been smoking for 45 years and they're living a healthy life and they say it's cuz I smoke and obvious obviously we laugh about it because we all agree that it's not true so why did this one case move you so actually let me stop you right there probably it's because he smoked that he's doing so well okay we need to back up how how do we get there uh well I have a whole chapter in gut check looking at the healthiest longest living people and one of the unique features of most of the blue zones is that particularly in the men are heavy smokers and the smoking actually the nicotine in cigarettes is one of the best mitochondrial uncouplers that's ever been discovered and we've looked at this through the wrong wrong lens we said wow what other healthy lifestyle things are these guys doing that's preventing smoking from harming them in fact we should have looked at it the other way what is it about these people who are smokers that allows them to live to 105 110 years old and when you do that then you say okay smoking was good for them why don't we see the oxidative stress that smoking we all know occurs why don't we see the cancers in these people and it's because the rest of their diet facilitates the absorption of the oxidative stress in these guys so your state is that if you smoke but eat in this specific way you can negate the effects of smoking the negative effects of smoking yeah what's fascinating as a heart surgeon uh way back in the good old days is most of our patients were smokers and they had specific proximal lesions in their coronary arteries the rest of their blood vessels were absolutely gorgeous and they were skinny for the most part so how did you gauge that did you what do you mean we operate on but you operate on what other vessels that you saw like you would do Peripheral arterial disease screenings on those patients and you would find I used to operate on because one of the number one RIS factors for per arterial disease is smoking correct because the smoking the oxidative stress isn't facil isn't stopped by our current diet let me give you an example okay um we're one of the few animals that don't make vitamin C MH and vitamin C and I've written about this so normally unfortunately collagen breaks as blood vessels flex and contract and it breaks Prim primarily it bends and when that collagen breaks vitamin C normally rebuilds that rebuilds that collagen in smokers they don't have vitamin C because the vitamin C has been used up in handling the oxidative stress so they have basically raw collagen that sits out and then we start the process of an inflammatory attack and cholesterol is basically a spackling compound and just keep spackling that area the great news about smoking is that it always happens at these bends where flexion occurs if like these people in the blue zones who live a very long time as smokers if you have huge amounts of vitamin C containing foods in your diet and incidentally olive oil doubles our own vitamin C production which is kind of cool then you mitigate those effects and you don't see the negative effects of smoking you actually see the positive effects of nicotine is there research that backs up where if you change someone's diet to have high vitamin C content that there negates their risk of smoking because I've never seen that yeah that's all been done in the blue zones well that blue zones are not research studies in fact you've been quite critical of blue zones even in your book yeah the for instance um let's take Sardinia for example one of the blue zones only the people who live up in the mountains actually have longevity the people who live down by the water don't what's different about those people is that they are sheep herders and goat herders and what they eat is a large amount of fermented sheep cheese sheep yogurt and what makes them have longevity is the men 95% of the men smoke and only 25% of the women don't what's unique is as we all know women live about seven years longer than men the men in Sardinia have seven year longer lifespan than the women because they're smokers that's what BRS that's an incredible conclusion to come to same it with the kavans I'm saying like there's so many variables that influence one's life how are you isolating the one we have trouble isolating anything in research look at the kavans Stephan lindenberg spent his lifetime studying the k provin in Pape Nini they smoke like fiends they've never had a documented case of a stroke or coronary artery disease never had a documented case of lung cancer I'm confused how in this scenario we're using blue zones as an example for this but then in your book you point out that in okanawa you feel that the Blue zone is untrue because they may be trying to collect pensions and their family members are not reporting their deaths appropriately so how on one hand are you using blue zones as a form of backing up what you're saying versus other times saying it's actually the whole thing I'm talking about coronary artery disease and Longevity right so these people don't have coronary artery disease despite the fact that they're smoking so I'm saying we should actually look at this backwards and say wait a minute all these people are smokers is there a benefit to smoking to nicotine I'm not saying don't get me wrong I'm and never had a cigarette in my life but we negate the fact that maybe we're missing a positive benefit for instance the reason I poo poo the blue zones is because Dan Butner would like to convince us the grains and beans are the secret of longevity of the blue zones and since you brought up okan they don't eat grains and beans they don't eat rice 85% of their diet is a purple sweet potato they don't eat soy unless it's fermented they don't eat tofu they eat miso and natto which are fermented soy and they get the benefits of the fermentation so give you another example in another Blue Zone the ngoya peninsula in Costa Rica this is like a gerrymander district everybody in Costa Rica eats beans and corn that's their staple but in the ngoan peninsula and only in that part of the country they're sheep herders and they eat sheep cheese sheep yogurts which actually contain large amounts of medium chain triglycerides which are great mitochondrial en couplers and the ngoan peninsula people say that grains and beans are the negative aspect of their diet that's compensated for by their other lifestyle I think I have to back up do you think that the Blue Zone project is a valuable thing for us to look at as a form of evidence uh no so why are you using it to describe all these things to me that because there are interesting factors that influence these people but it's not the factors that a certain individual would want us to believe interesting Paul Simon said a man hears what he wants to hear and disregards the rest and if you're and that's not what you're doing no I'm saying what is it that makes these areas unique and look I'm the only nutritionist who's spent most of his career living in a Blue Zone Lolinda California so I ought to have some idea or they eat ton of beans in LOL actually they don't eat a ton of beans in lolina they eat a ton of nuts and lots of nuts y lots of nuts and 50% of their diet is fat primarily from milk products what's your take um on the Blue Zone project as a whole so I think blue zones are interesting as a um as an idea to talk about but when we form dietary recommendations I'm a Believer in evidence-based nutrition which is synthesizing multiple levels of evidence to be able to come to a conclusion for what will be a healthy dietary pattern um you know nutrition is complex because there's no Placebo in uh nutrition studies so we essentially can't look at one study one anecdote to form our recommendations for what's healthiest you have to at multiple levels of evidence so we have pre-clinical studies a lot of what Dr gundry talks about things with mitochondria that are very interesting but they're hypotheses they mechanisms we look at those in rats we look at them in vitro but then we have to look at well what happens in actual human studies so then we look at outcome trials so we want to look at randomized control trials where you're actually randomizing people to a certain dietary intervention and then evaluating them based on a placebo control then we have long-term epidemiological studies because you can't randomize someone to something for 15 years but then we have large cohort data for nutrition Epi where we look at the effects of the intakes at certain doses of foods over time with outcomes evaluating it based on outcomes like cardiovascular disease autoimmune disease GI disease things like that and so you have to synthesize all multiple levels of evidence to be able to come to a picture and a conclusion of what the recommendations for a diet are um last year we published um I was fortunate to be the lead author of our latest cardiovascular disease and nutrition guidelines for the American Society of preventive Cardiology and you know we had to evaluate and synthesize multiple levels of evidence looking at you know various different kinds of studies and so although the blue zones are really interesting I think they tell us that you know you can have a wide variety of diets because if you look at Greece for example in the blue zones versus you look at okaba Japan they have different amounts of fat that they intake they have different amounts of um carbohydrate intake and they have multiple you know success and Longevity um across various different um intake ratios of carbohydrates fat protein but I think that why the blue zones are interesting yet not super scientific is because we have to look at more controlled studies to be able to kind of really synthesize all those levels of evidence to come up with the recommendation when you were making those guidelines was there ever talk in between the Physicians doing this as to whether or not recommend smoking along with vitamin C so um I will stand on the uh fact that uh you know I think that it's pretty well established in the scientific literature that smoking is incredibly harmful it's probably uh smoking sensation is probably one of the most important if not the most important um advice we can give and help patients thankfully we' have lots of tools in modern medicine now to help our patients with smoking sensation because it's certainly not easy um but I think that uh we don't even have randomized control trials for smoking because the data is so robust um just evaluating how patients um do eventually whether it's Peripheral arterial disease coronary disease um or cancer outcomes obviously with smoking so that I believe in the scientific Community um is not really arguable at this point and so yes so smoking sensation huge recommendation for both cardiovascular disease prevention but also probably one of the best things people can do to prevent cancers dementia you know a variety of different um diseases and have you seen evidence of vitamin C negating the risks of smoking no but what I do think that Dr gundry may be um pointing to is that in you know uh smoking is one variable a very very important variable but of course if someone's smoking but they're also eating an incredibly healthful diet living in the blue zones where you know they have great relationships because that's also a portion of it people have great um interpersonal relationships great community um lower stress levels uh great satisfaction with life exercise they're active smoking doesn't help them but maybe all of these other factors are contributive to their longevity um whereas if you're smoking and eating you know a highly processed uh um hyperpalatable foods and um not exercising it would have more of a negative impact but we know all things considered um smoking sensation makes a huge impact in health that's fair a lot of times there's so many biases when it comes to to an individual's lifespan uh if they're a vegetarian they tend to practice more healthful habits if someone is smoking their odds are they're also drinking they're staying out late at night so it's contributory in that way so the takeaway here is that just because you have one bad habit it doesn't mean that you have all bad habits as exhibited in the blue zones right um what's your takeaway from the fact that some people in the Blue Zone do smoke is it to say we should be smoking should be taking nicotine what's your take away from that so what I take away from it is um if you look at nicotine as a drug first first of all as addictive as any tobacco executive knows so even I don't recommend like Dave asprey does taking nicotine drops and putting it under your tongue or wearing a nicotine patch but I do think we actually have to look at whether or not nicotinic acid is a useful longevity drug and you don't have to go very far to look at the literature looking at the various forms of nicotinic acid that are now available like nnm or NR nucle sorry nicotinamide riboside that these have clinical published studies on their effects on uncoupling mitochondria so uh give you a long interesting story I use nasin to treat my patients who make LP little A lipoprotein little a It's very effective at lowering LP little a and I and others think that LP little a is one of the most important effect factors of cardiovascular disease certainly in family history what does nin have to do with the nin lowers LP little a no how does that connect to the nicotine component nicotinic acid isn't nice interesting I have to jump in on this because that's is a very passionate topic of mine I just actually moderated the um major uh LPA session at one of our um biggest Cardiology conferences this year and what's really fascinating from the experts I've learned um from lipoprot a we no longer recommend nasin for lipoprotein a reason being is that the three biggest randomized control trials that looked at nin with hard outcomes so you know there's lots of things that can be great from a mechanistic theory we have lots of ideas as to why in preclinical research you think something would be a good idea you have to test it in actual human outcome trial to see and when I talk about outcomes we talk about the things that are most important heart attack stroke major adverse cardiovascular events so the three major trials that looked at lowering lipoprotein a um with that looked at lowering um any cardiovascular disease risk with niin all showed all three showed there's absolutely no benefici benefit in cardiovascular risk reduction with nasin so we no longer in cardiology recommend niin to um for cardiovascular disease risk for lipoprotein a because despite the fact that it lowers lipoprotein a it actually doesn't improve outcomes and what's interesting is that there's things that are really bad for you that actually also lower lipoprotein a which is why lipoprotein a is complex so the European Society of Cardiology released the latest lipoprotein a um guidelines and the uh recommendations are to just lower apob lipoproteins as much as possible through diet lifestyle if they need a a Statin therapy um and for anyone listening that's like what is lipoprotein a what are you guys getting into it's a arthrogenic lipoprotein that I would agree with Dr gundry it's incredibly important it's um now the recommendations are to have everyone screened for their um it's LP little at least once in their lifetime but we no longer recommend nasin because the hard outcomes in the trials shows does not reduce cardiovascular risk and actually things that can really um lower your LPA that are harmful so things like thyroid disease untreated thyroid disease can actually lower your lipoprot liver disease can actually lower your lipoprot these do not reduce cardiovascular risk a high saturated fat High animal-based diet can actually artificially lower your lipoprotein a and we know that raises your apob and can also increase cardiovascular risk so that's why it's so important that um as we're uh looking at different biomarkers and evaluating cardiovascular risk that we keep in mind the actual heart outcome trials and we actually keep in mind what actually matters to our patients which is heart attack stroke and all cause mortality and so now with lipoprotein a in the pipeline are specific drugs that are not out yet but um that are going to be uh lipoprotein a targeted specifically Snips and um various different other um modalities but at this time all of our cardiac evidence shows nias and doesn't improve it so even though you can lower the number it doesn't necessarily improve outcomes so that's actually a perfect example I think you Illustrated at least in you know in cardiovascular disease prevention why something may in theory and in mechanism be really interesting and useful and we may and it's worth testing right so when you do preclinical research in a rat or in a uh inv vitro model you know you may find a really interesting Theory a really interesting mechanism that's worth exploring that's when you translate it to human studies and you see does this improve outcomes in humans and we found it hasn't well that's because you didn't compensate for what was going to happen with nasin in raising homosysteine and also in raising lpa2 levels and if you treat the lpa2 increase and the home assistin with supplements which I published at the American Heart Association then you negate those effects of Ni well I looked up your Publications Dr Gunder I couldn't find anything published at aha um I saw that you had one abstract that was at presented at the conference but it was never a published paper peer reviewed well abstracts are peer reviewed so well it wasn't it wasn't a study but it's just that I have to be honest it's just that that's a little leading I mean it goes against our Cardiology guidelines our card our Cardiology guidelines don't recommend for Lio protein I realize that but the guidelines for instance and you I'm sure understand that Statin increase LP littlea levels to a stin um increase LP littlea in a very um clinically insignificant way and the reason why our guidelines recommend that for people with elevated lipoprotein a that they should be on statins if they have an elevated APO B is because because the target of therapy now for lipoprotein a uh is to keep apop as low as possible Right but the target of therapy of getting apob as L as possible is oxidized phospholipid epob measurements and that is the only measurement that correlates with LPA levels that's a well that's a really good theory about oxidized um it's not a theory it's published by multiple researchers it's a theory because we don't have actual assays that can really disain that we know the the research for lowering apob and we know for cardiovascular mortality is incredibly sound there's no cardiovascular organization across the board whether it's ESC aha ACC ASPC that even recommend checking oxidized levels of anything because we know that lowering apop is the gold standard for reducing cardiovascular risk for patients with li elevated lipopro so why wouldn't you want to measure oxidized fossil liid app will be because we oh because I mean you could but truth it doesn't alter uh management CU management going be the lower CU it's going to the Management's going to be the lower ifob be as low as possible well Dr Gund I think what's interesting for me here as a primary care doctor who follows guidelines like these is how do you decide because some of the things you're proposing have really strong mechanism background right like you can explain how it works you can explain the theory of how you can get from point A to point B right but in so many times in medicine when we start with mechanisms once we bring it to human data we find the complete opposite I mean like the simple example that my viewers probably think about is like Viagra initially we started to treat pulmonary hypertension and then now we found out it's a great erectile medication so it started mechanistically to treat one thing and then it ends up going in a different direction so well we still use Viagra to treat pH but true we we call it just sanhil yeah it's the um chocolate chip cookie mistake where we thought the the chocolate chips would melt and they didn't um and then we've also seen the same with beta blockers and cardiomyopathy initially we thought that it would be something that would be problematic and now we see that it actually reduces uh mortality so how do you make the decision of when to go from a mechanistic model where you say look this oxidative measurement works I can explain to you why it works but then if we're lacking the actual end points of people having less Strokes by following your model how do we prove that that what you're saying is actually true well again that's going to take a very long time but I see patients six days a week I even see them on Saturdays and Sundays and I don't need to at this point in my career I draw blood on them every 3 months from multiple Labs looking at among other things oxidize phospholipid ampop as a marker of therapy and a lot of my patients see other Physicians as well Family Practice other cardiologists and we watch a manipulation say let's say somebody decides to increase a Statin drug to drive down Appo that's one idea but when I see then the oxidized phospholipid Appo go up even as the Appo goes down and then I intervene can I ask you a question on that because that's so important what you just pointed out if their Appo goes down but their oxidized level goes up and they have less heart attacks do you care they don't have less heart attacks but we do we have the harded data to tons of of data that they they don't have more less heart for instance you brought up beta blockers the most recent recommendations are we should not be using beta blockers as a treatment for coronary arteries no for hypertension yeah so so as first line for hypertension yeah and so for and exactly and um for coronary artery disease we no longer uh put people standardly on beta blockers if they haven't had an MI within you know exact and yet that was standard of care right right but the reason it changed was because human models showed it to that's exactly right but the human models initially made beta blocker therapy after an MI or after a stand or after a coronary bypass standard of care and then it change why I could I couldn't send anyone out of the hospital and get dinged from Medicare if I didn't put them on a beta block but similarly human trials is are why you know initially we didn't recommend beta blockers and heart failure right it was Bull beli to be the mechanisms were believed to be this is going to be so dangerous for heart failure Etc and now it's the standard of guideline directive medical therapy for systolic heart failure with the um quadruple therapy for gdmt and so it's so important this is why you know the multiple levels of evidence why preclinical data is important to generate ideas but then testing in human outcomes and so I'm not saying that people shouldn't be um researching oxidized lipoprotein so I am a huge fan of lipids I I very much am a very lipid focused physician and lipid science and Thomas dpring who's like a world renown lipidologist is one of my mentors and I have huge respect for the research going on in that space But the thing is is that we already know with regards to you know across the cardiovascular disease field and across every major medical organization um worldwide that reducing apob lowers your risk of cardiovascular disease and so although these other biomarkers are interesting you know we don't have the correlation the the hard outcome data that we have with lowering apob also the assays vary depending on which Labs you're looking at which we could really get into the weeds of it but there's plenty of people who believe that the assays that are even evaluating those markers aren't even correct so there's not even a lot of validity in a lot of the advanced lipid testing um you know that that is exciting to talk about in theory but for clinical utility you know I believe with evidence-based medicine we have to use use the best available of evidence to date and that includes looking at a variety level of evidence especially most importantly randomized control trials with hard outcomes to give our patients the option to do things that are best for them that we have the best outcome data for to summarize your positions for people watching it seems like the the reason you make the decision to treat in the way that you're treating your patients is you're seeing good outcomes in your patients you are finding this mechanistic approach uh that makes very logical sense and you could follow it along a pathway track it and you could track it with your patience and um Dr Bardo is using um sort of hard end points of heart disease stroke for lowering apob my question is I have plenty of doctors that I've ended up having to treat patients after they' fallen out of their care that have made you know wild recommendations that you would firmly disagree with say you should only eat beef or some very hard hard carnivore stance type diet and they claim the same improvements with their patients so how do I distinguish as a family medicine doctor between your recommendations that are lacking this hard endpoint data versus the carnivore diets so I can have a patient on a carnivore diet and I have a number of patients who choose to do a carnivore diet I'll have patients that will do an Elimination Diet um to treat their leaky guts and at the end of the day at three months 6 months we begin to see their inflammatory markers go up we see their pla2 markers go up we see their hscrp markers go up we see their il6 go up and so and tnf Alpha go up and so we'll say hey guys you know look you may feel really good and here's here's what's happening you know underneath the surface it's like you know the girl in Jo swimming at the top of the ocean doesn't realize a great white's underneath when they see that they go o um okay you got my attention now they don't feel it yet in fact a lot of them feel really good so there's also you know there's this entire group of a sect of the dietary tribes there's a whole food plant-based no oil group right and um I personally I happen to be vegan I believe that you don't have to be vegan um I you only should be vegan for ethical reason she's actually been cancelled by vegans so yes because I um the the whole food plant-based no oil individuals vegans um don't necessarily like my viewpoint because I believe olive oil is incredibly healthy why because of a lot of our hard outcome evidence um anyway but the the the low-fat Whole Food plant-based vegans actually who believe olive oil is toxic they have the exact same claims as you identical they reverse autoimmune disease they claim to reverse heart disease which I've gone up against quite a lot of them in debates they claim to um reverse every sort of disease um inflammation they lower um highr CRP on these incredibly high lectin no olive oil diets and they claim that olive oil is incredibly toxic and they can cite a thousand endothelial studies that will tell you olive oil is toxic and my argument against that is that when you look at the multiple levels of evidence and you look at the randomized control trials we know that olive oil is not harmful it's actually beneficial and it's healthful but I think that one of the points Mike and I discussed as well is that for you know when you are a consumer of this information and our patients who are listening well do I follow these low-fat plant-based people or do I follow you know because they have just as many anecdotes as as you have and so how do we sort out and differentiate the evidence and this is where my belief is the evidence is looking at evidence-based medicine looking at the hierarchy of evidence looking at analysis and then looking at systematic reviews and then looking at randomized control trials and then being able to synthesize that into our dietary recommendations which are eating a diet filled with fruits vegetables whole grains legumes lean protein fatty fish olive oils great you know um higher in poly and saturate fat because otherwise if we're just going anecdote to anecdote then we really have a lot of different dietary tribes making the exact same claims and everyone has really believable stories and it's really I totally understand and it's moving I've seen patients improve even though I'm vegan I've seen patients improve drastically on a carnivore diet you know um because in many ways it's a Elimination Diet of course carnivore diet I highly recommend against because it can raise your risk for coloral cancer and heart disease and raises apob and they're missing out on lots of vitamins minerals and important things but that being said you know we can see the the carnivore group has tons of anecdotes where they can reverse X Y or Z disease and so I think that Where It's Tricky for the general consumer of the dietary information is how do they sort out whose anecdotes are best and which is why you know anecdotes are the lowest form of evidence and we have to kind of go by the looking at all the levels from long ranging epidemiology to randomized control trials and Free Living studies that are over two years like the Leon Hart study or like studies that are looking at two weeks metabolic Bo highly controlled by my friend Kevin Hall at the NIH so we have multiple levels of evidence to synthesize that that come to our guidelines otherwise it's it's confusing for the consumer do you agree with that that we need multiple layers of evidence and not anecdotal mechanism oh absolutely so what uh what's your takeaway about the evidence that Dr Bardo uses for her guidelines do you think the evidence is wrong do you think it's incorrect do you think it's incomplete I think it's incomplete let's put it that way for instance um and I've talked about this in the plant Paradox the potential reason why a lowfat diet is effective in those Believers is that you no longer have a mechanism for lipopolysaccharides to ride on kyom microns through the wall of the gut and create inflammation and I love the lipopolysaccharide theory of inflammation and if you do not have fat carrying fat across the wall of the gut unless you have leaky gut from other causes leus uh then you're not going to have LPS's get into circulation but those lowfat plant-based no oil Group which I don't endorse I love olive oil nor do I but right of course that's why I'm saying because I know you're huge we agree on olive oil we think olive oil is great and so what I'm saying is that they believe you know they they're on high high high lectin diets with the exact same results as you so I think what we're we're saying is that how do you differentiate that which is why I think the levels well and I treat a lot of ornish failures esselon fa failur uh who have Progressive coronary AR disease on those programs and I'm sure they have gundry failures that they see exactly so how do I then decide what I should do what should I teach my residents to do so for instance I don't have I think the best controlled trial of a lowfat diet versus a high-fat diet was the Leon Heart Diet I think it was very welld designed it's my favorite study I'm glad you said that the Leon heart study has a statistically significant increase in so the Leon Heart Diet for your listeners who aren't familiar one of the best randomized control trials we cited in all of our guidelines where they looked at people they randomized them to they were on a a baseline diet and then they um randomize them to a diet that increase legumes statistically significant increase drastic increase in legumes increase in whole grains a decrease in saturated fat increase in polyunsaturated fat so pretty much everything we recommend in our latest Cardiology recommendations in our nutrition um statement for the ASPC is in the Leon heart study so you increase beans you increase whole grains what did they find in Leon heart's study within a year of the study and I believe it was a four year St it was five year study they stopped it three years W because they had uh 50 to 70% reduction in cardiovascular disease risk and so that was actually one yeah everything in events in heart outcomes of events heart attack stroke major and so I was going to ask you with them you know quadrupling their lectin intake what is your counter to how some study like that oh that's easy it turns out the only what she's not mentioning is that the study group they were compared to a lowfat American Heart Association lowfat diet it wasn't a lowfat diet the the the original it was the so they actually just replaced they replaced the saturated fat with poly it wasn't they replaced it with basically rape seed oil which is quote can oil it's incredibly high of in alphal linolenic acid which is a short chain omega-3 fat what's fascinating is when the researchers broke down every possible change what the factor was that made the difference the only one was the blood level of alpha linolenic acid predicted the outcome and I write a lot about that in my previous books I go back into it and gut check it's the alpha linol IC acid that is actually making the difference so I would highly disagree oh publish data go ahead look it up because they also it's similar there was multiple variables that that's the only one that impacted it no because but how can you decide that because that was the only difference between the two groups is that true no because they also had they had the the leonart the leonart group The the intervention group also had higher antioxidant intake because they had higher fruits and ve vegetable int true but those were all compensated for in the final analysis and it was only it surprised me it was only alphal linolenic acid so I I had a feeling you were going to say that the um the poly and saturated fat intake which I'm a huge fan biggest fan of poly and Sater fat I and I love that I love canol oil big fan of canol oil as well organic canol oil but but um but there were a multitude of factors that improved the outcomes and so you're so you're your theory is then that the polyunsaturated fat intake makes up for the lectins that yeah absolutely CU polyunsaturated fats alphal linolenic acid actually prevents lowers LPS levels okay so let's work off that theory because I think that's very valuable there's a whole list of your in your books of foods that you say Don't eat high in lectin some of them are common foods that doctors even label as healthy why not instead of saying stop eating these foods that are rich in antioxidants vitamins minerals Etc and instead tell them to consume these fatty acids that are healthy well I do tell them that but what I do when most of my patients who I see about 80% of my patients now are autoimmune patients who are not getting any better despite why do you think that is uh well because for whatever reason my program if you follow it your autoimmune disease 90% of the time will be gone will be in remission in 9 months to a year so you so people end up in my office specifically for autoimmune corre what about people who are looking to lose weight people who have cardiac disease are those people in your practice as well oh absolutely but why is it so skewed towards the autoimmune because well we have I like I treat a diverse population and I can't get to an 80% we have an epidemic of bom immune disease in this country and I among others think that all diseases coronary AR disease is in fact an autoimmune disease and so if you fix the underlying problem of autoimmune disease which I and others happen to think is intestinal permeability leaky gut then that autoimmune disease resolves that's very powerful that you say that because when you say it's a it's the leaky gut that causes is the autoimmune disease and you say I think this I as a skeptic because I try not be a cynic I want to be a healthy skeptic hear that you think this and I think it's wonderful I think we need to research it more well leio Fano from Harvard not only thinks this but has done pretty good job proving this that all disease comes from a leaky gutoc said it 2500 years ago yeah but 2500 years ago we would balance the humors and make people vomit and bleed them out there's a lot of things we did in the past it doesn't mean we should look at that as a guide so the question is how do we go from individuals saying this as Theory versus to Modern practice because we can measure these things but measurement doesn't yield outcomes in every scenario sure it does it doesn't because I have patients who have abnormal thyroid levels and yet feel perfectly fine and the second that I try and change them with medication they develop symptoms did I help or hurt this patient why would I try to change somebody who's feeling fine because their levels are off as you said levels are more important no no no I'm talking about we can measure the degree of intestinal permeability with good blood tests and we can watch intestinal permeability change and we can watch it heal you do that with your patients exactly how do you measure intestinal permeability with your patients so we use vibrant Wellness we use anti zonulin IG anti-act and IG and anti-lps IG these the food sensitivity tests that that measure IGG is this what food sensitivity does but this looks at intestinal permeability and this is actually what alesio Fano worked out as the way to measure intestinal permeability uh I didn't avise the test yeah I'm just confused because when I work with gastroenterologists gastroenterologists teach me I go to some of their meetings this is not that the only time the concept of leaky gut and it's not leaky gut syndrome comes up is in autoimmune diseases like celiac disease where there's actual damage blunting a Villi immune complex damage how do we get from there that's the tip of the iceberg right so the tip of the iceberg has data behind it data that we can act upon yeah there's good data behind leaky gut and reversing leaky gut for instance I mean what's shocked me when I started looking at this is every one of my patients with coronary artery disease had leaky gut when they walked through the door every one of my patients with an autoimmune disease let's take Hashimoto had leaky gut every one of my patients with rheumatoid arthritis and you know these are blood markers that we can measure had leaky gut so when we put them on a program and remeasure their leaky gut every 3 months we can watch it go away and it will resolve and what's interesting is that the markers will resolve they will go away but that's not the interesting part the interesting part would treat their leaky gut that's what we do so for example in gut check you know I'm really excited about the microbiome right there there holds a lot of untapped potential that we still have a lot of work to do to figure out and then I seen on certain podcast there's statements that you've mentioned about you know if you take the microbiome of a depress Mouse and you implant that into a happy Mouse the mouse gets depressed or you mentioned a study where um I couldn't quite find the study where there was an individ back in the day when people were institutionalized for their depression they would give them a colonic and then give them a feal enema and 66% of them would improve that was a statement that that I've seen you make does like what do I do with that information because put put yourself in my shoes for a second I have a patient that comes into my office who's depressed they heard you say that they wonder why I'm not giving them the fecal enema I wouldn't give them a FAL why not you just said you have evidence of 66% cure rate that's the last thing I would give them but how if you said a study did this back in the 1930s for one thing believe it or not when I went to medical school back in the Dark Ages we were actually the first people at the Medical College of Georgia to use fecal Animas from medical students to treat cicil we didn't even know it was CI back then it was pseudo memus entercolitis and my professor Arley mansurger said you know and this was when broadspectrum antibiotics first came out in the mid 70s he says you know I think there's something going on in the gut and we've got to reconstitute the gut so once a week medical students took a crap in what we called the Honey Bucket went into Arley mansburg lab put it in a wearing blender homogenize it and shoved it up the rear ends of people with pseudo memoris en colitis and it cured it cured it and we went son of a g this is nuts and we do that now we do not to that degree but obviously we do use transplants but we don't need to do that we can reconstitute the microbiome for one thing we're we've killed off our microbiome because of all the antibiotics we take that's why we put it in all the antibiotics we give are animals and the best most potent antibiotic there is is glyphosate Roundup it was patented as an antibiotic by Monsanto and so if you wanted to do a number on your microbiome we've created The Perfect Storm for killing off our microbiome and what's really interesting is glyphosate in particular kills off the tryptophan pathway making but drugs that make serotonin so if you wanted to make someone anxious and depressed you would kill off that tryptophan pathway of the microbiome so what you do is you eat organically and you stop taking antibiotics unless there's a lifethreatening problem and the good news is if you stop eating animals you'll lose those antibiotics the bad news is that most of our grains are contaminated with glyphosate my question I don't think we got the answer here yet CU I think it's important when we found that FAL transplants work specifically in the case of ciff but not in the case of depression right I'm advocating that correct yeah it just in fact I don't know if maybe over in Europe it's being used for that but certainly not in the United States because the FDA would not allow it yeah I just don't know what's the use of them stating that study because there there's chapter after chapter in gut check showing the correlation between a diverse microbiome and lack of depression lack of anxiety and we're getting closer and closer to understanding which bugs do what but we're not there yet we're getting close we're close but we're not I just want to put that on the record we're not there yet we know A diversity is good yeah but we don't know which ones we don't know exactly which ones there's still room to be explored here yeah I mean for instance um there are now bugs that make oxytocin the love hormone and you can actually swallow some of these uh and make more oxytocin that may be a good thing maybe so I would like to counter that with the fact that so I think the gut microbiome is fascinating and I think we're at the you know beginning of I think if you talk to the world's renowned gut microbiome researchers they will humbly tell you that we are at the very very beginning of the of elucidating the answers to the questions of how important I don't think anyone doubts that the gut microbiome is an important facet of Health but we don't really have those answers yet and and I think that that can be the the most you know world-renown microbiome researchers will tell you that you know we're not even sure the exact population of and what percentage of what colonies of which bacteria are more beneficial so we can't even prescribe right now exactly what is most beneficial for the gut microbiome at this time because we don't even know that's why probiotics that's why the American College of gastroenterology which you'll know this because as a family provider I'm sure you are asked all the time about probiotics and this is why the ACG does not recommend probiotic use for people um generally outside of very few clinical conditions that require it because we don't even know what strains at what doses in which scenario um are going to be beneficial and we know that with lots of the probiotic research that it doesn't have benefits and it can have harms and risks which is why the ACG um uh is U looks at it that way and so I think that we're at the infancy of gut microbiome research and I do agree that it's important but we don't have enough of that hard outcome data yet to give us you should be you know eating this exact kind of food to improve your gut microbiome I think that in enal you know most of the things with a healthy dietary eating a a diverse you know plant predominant diet of course we believe can help gut health in general with eating fiber and short chain fatty acids and all of the things that happen in the gut microbiome but I do think we're at the infancy of that research and not knowing it's not as quite as prescriptive yet which is why the probiotic trials have failed um and why we don't we recommend probiotics only in very certain small clinical scenarios because we don't fully understand um and there's tons of research to be done in that space and I also just wanted to counter on glyphosate quickly um uh organic when we look at organic versus um non-organic and I have no dog in this fight personally because sometimes I buy organic if it's convenient for me sometimes I buy conventional um but I do think it's really important to make this clear to your audience that when we're looking at research with hard outcomes um meaning you're looking at cancer risk you're looking at heart disease risk the reason why no guidelines that make recommendations for diet including the American Cancer Society um that recommend eating organic is because all the research with hard outcomes there's two main studies that looked at it Bradbury and I forget the other one um they show no difference with organic versus conventional produce so although the mechanisms and the ideas of glyphosate may be interesting um it hasn't borne out to being any difference in outcomes with regards to cancer risk cardiovascular disease risk or other heart outcomes that have been evaluated in the cohorts all that is interesting here's my takeaway for me as a primary care doctor the reason why America is sick the world is sick we have an obesity epidemic we have people consuming ultr processed foods at rates unheard of um my patients overeat ultr processed foods they eat tons of unnecessary added sugars and as a result they're very sick cardiovascular disease Strokes diabetes Etc none of my patients are overeating fruits and yet within your book and your podcast you make fruits almost an enemy they're not an enemy they should be our friend when they would have been available no great ape eats fruit all year round they eat in season and great apes actually only gain weight during fruit season and we don't we'll take trip to the Central Park Zoo why do we need to go to the Central Park Zoo none of my patients overeat fruits why are we talking about that there's no juicers in the Central Park Zoo but do you feel like generally across the United States fruit consumption is an issue no fruit products are an issue totally different what's a fruit product like apple juice like orange juice AG we're not we agree with that we're not talking about juice but that's not what we're talking about we're you're saying an apple is not ideal to eat you said grapes are sugar bombs that are sugar bombs there's as much sugar in a cup of grapes as in a Hershey's candy bar yeah but that requires new on because I would never tell a a child to eat Hershey bar over a grape that will never happen in my practice would you recomend you might allow the mother to give them apple juices they're that's not we're not talking about apple juice saying grapes it just it's it's a child hears a mother hears grapes are sugar bomb might as well give them Hershey's they will give them Hershey's might as well and your example why might as well don't you think grapes have more nutrients than Hershey's well believe it or not extra dark chocolate has some of the highest polyphenol content but we're talking about milk chocolate yeah I wouldn't give anyone milk chocolate exactly so why even bring the comparison you have great animated examples Dr gundry I it's they're quite I I I appreciate you there's textbooks written about great apes I believe you but what's interesting is that because in this modern day and age we don't actually need to the guidelines how much did you guys take into consideration grade AP diet we zero considered great apes because the the good news is is that we have multiple EV levels of evidence that look at fruit intake in humans like in actual human species so we don't need to look at great apes for to help us indicate how much fruit is healthy and if you look at the epidemiological data over time I mean it is without question that um individuals who are in the higher tertiles of fruit consumption are always always always associated with lower risks of cardiovascular disease autoimmune disease cancers um in human beings so you know although the great ape theory is is great but there's we're not Apes you know so as you think fructose is good for us I think that's what I'm hearing well I I'm saying that I don't recommend apple juice and I actually think that all major medical organizations do not actually in in cardiology guidelines we do not recommend sugar sweetened Beverages and apple juice is not beneficial neither is orange juice um but fruit in its whole form thank goodness yeah fruit in its whole form you know comes with a lot of other things besides just glucose fructose fructose it comes with you know um polyphenols vitamins minerals fiber things that are really healthy for us and so um you know the comparison of fruit to um you know a candy bar is just a little disingenuous and I do think that the ape example while it's interesting we have so much human data we can look at that shows us how beneficial and healthful fruit can be and I'm not saying everyone needs to eat a ton of fruit I'm not here recommending a fruitarian diet by any means but you know we do know that uh like as Mike mentioned that you know the vast majority of our patients who are having difficulty with diet it's it's not from a banana overdose it's not from eating too many grapes you know I think that we can all agree at least all three of us I think can be on the same page here that the major problems with diet in our current time a lot of it has to do with these hyper palatable processed foods that are super convenient and you know ubiquitous in society yeah Dr gundra I think what we're pointing out is we're on the same page with being anti-press Foods we're pro Olive Oil Pro mediterranian diet we're all on the same page here the issue is that folks are overeating these uh overprocessed Foods they're not consuming enough fruits and vegetables the leonart study showed that if you increase legumes and whole grains and your your major stance in your books is remove whole grains limit legumes fruits are your enemy how so well I eat beans multiple times per week as long as they're pressure cooked I think ancient societies always fermented their legumes when you when you put beans in a pot you soak them for 24 hours you ever notice the scum coming to the top but who's advocating teed raw beans here well nobody but regular cooked beans you have not destroyed the lectin that's well proven fermentation will destroy them and yet when these people in the own heart study ate those nonfermented beans they did great if you they were fermented you're not hearing me no know if you cook beans appropriately like even in a pot you can remove like 95 plus percent of the lectins and I I I agree none of us are advocating for raw beans but cooked beans and also by the way canned beans huge fan for anyone listening that wants something convenient canned beans as long as there's no sodium wash them they're already pre-cooked and the lectins are minimized and only two companies that pressure cook their canned beans Eden brand and joil now I'm not consultant to either of them so but so easy the the problem in our society is people aren't eating Whole Foods and here we are making a list of Whole Foods they should avoid I'm not telling them to avoid them whole grains if you have Millet and sorghum which do not have a hall they're perfectly safe but you can even eat these in excess and let's get back you eat anything in excess carrots you let get back to a fruit for a second I can watch my patients you know go to Costco and load up on the grapes or the blueberries and I can watch their triglycerides go up and you might agree with me that the triglyceride HDL ratio might be very useful actually so in cardiology we no longer uh focus on triglycerides htl ratio now um we know that the most important prognostic factor is apob so the cheat sheet way for that is looking at your non-hdl cholesterol triglycerides incredibly important but triglycerides are only a temporary um measure and and exactly and so the we actually don't look at your triglyceride HDL ratio anymore as a u as a but as triglycerides go up in general your Appo will go up but well yes for sure but you're the HL ratio not not a super huge part but fruit actually you you will know this Dr gundry all the research shows us that people who eat High amounts of fruit actually have a significantly lower hypo um apob in all randomized control trials across the board due to dietary fiber and low saturated fat content so actually eating tons of fruit um especially not in the form of fruit juice fruit in terms of whole fruits can actually reduce apob significantly and cardiovascular subsequently all of this is valuable but why are we arguing about fruit when it's not the enemy the enemy is people thinking that fruit it we should not have 365 days of Endless Summer but who is overeating fruit uh Americans are overeating Ultra processed foods Americans are overa Burgers hot dog totally agree with that I can't get my patients to eat fruit what research shows us that people shouldn't be eating fruit when I when I just mentioned that every um like if you look at en hanan's data if you look at say Don't eat fruit I'm saying eat fruit in season right but I'm trying I'm trying to ask you I'm trying ask you there's no is not available year there's no research that shows us that fruit has to be eaten in season for it to be healthful all the research shows us that in a dose dependent manner people who eat more fruit in the highest fertiles of consumption of fruit um people who eat a VAR diet of fruits and vegetables and whole grains and all these things have every Mar marker of lower disease risk whether it's cardiovascular disease risk obesity we control diabetes and so my question to you is is besides the seasonality discussing with regards to Apes which we are not when we have all this human outcome data showing us that there is no seasonality to fruit consumption it's just eating a varied plant predominant diet that's most helpful how do you make that leap from animals to when we have all this human data showing the opposite of what you're saying so in the Mediterranean people do eat fruit seasonally in the Mediterranean as well do you not respect the research that Dr Bardo is pointing out saying that people who eat fruits in in the highest amounts have lower risk factors and better outcomes because they're following people primarily in the Mediterranean and they do true no the enhan I'm talking about the major cohort datas in the United States that's the nurses health study we're talking about the um Physicians study like all of these cohorts are in the United States so and even in the Mediterranean I mean we live in a modern society now where fruit is accessible most people in modern society year round and a lot of people are not eating seasonally so you know the seasonal the seasonal idea I think you know based on the animal studies and thing although an interesting thought it doesn't bear out in human outcome data which shows us that you can eat fruit healthfully year round without with not only without there being no Adverse Events in any at least cardiovascular disease or all cause mortality or cancer research you know but there's m a multitude of benefits of a higher amount of fruit consumption and I'm not telling anyone to eat all fruit all day every day but um there is no reason for it to be limited seasonality and then the reason why also I think is really important too is there's a reason why the um American Cancer Society guidelines the American College of Cardiology guidelines are um um ASPC guidelines are all for nutrition they are very similar as well as the endocrine Society guidelines all the guidelines to prevent cancer to prevent diabetes to prevent cardiovascular disease all the recommendations for nutrition are similar because the science is similar so eating a diet with varied fruits vegetables whole grains legumes lean proteins fish things like that have proven to reduce the risk of the variety of diseases which is why we have so much Synergy across the various Specialties as a spectator of listening to to experts speak Dr gundry your reason for not recommending fruit year round you reference Apes she references longitudinal studies here in the United States how can I possibly side with you uh come to my clinic and watch what happens when every a lot of people can do that I have nothing against fruit maybe you don't hear me I need to read some of your statements fruit in season is great fruit contains polyphenols they're one of the best ways to get polyphenols in the diet in fact what I recommend is reverse juicing go buy all your organic fruit put it in a juicer throw the juice away take the pulp and put it in plain coconut y I love fiber I'll great polyphenol house podcast this is a quot from yes apples are horrible for you yeah they are I mean why because an apple is not an apple anymore and in fact on Instagram true it's not an apple anymore it's been hybridized for sugar yes but it has high fiber content it has polyphenols all the things you just said are Health nutrients it doesn't anymore but it does it does no it's been totally changed it's it has less vitamin C than but it still has vitamin C it has a little bit small apple but how can you say apples are horrible from you from that deduction from that big grapefruit size Apple correct and then when we look at research of people who consume apples they live great lives my patients who are unhealthy don't eat apples when they eat an apple that's the right size and guess what apples are not available year round normally again all those statements you can stand behind that apples are different that apples are not the same size that they're not shouldn't be available year round how does that bring you to the deduction of apples are horrible for you apples in this size are you said a fruit smoothie is the worst possible thing you can do for your mitochondria I think that's true you don't think cyanide is worse for your mitochondria that blocks oxygen and kills it well you're not going to eat cyanide unless you eat the apple exactly so how can fruit smoothie fruit smoothie is a pure fructose bomb and if you want it's not pure fructose all you on that because when glucose so when you smoothie by the way when you make a smoothie the reason why I think smoothies can be beneficial not for weight management because you know often drinking your calories can be not super helpful but um in general why smoothies are helpful is that when you blend this is why I'm anti-icing Pro smoothie when you actually blend a fruit vegetable Etc to put it in a smoothie you actually preserve the fiber Matrix and so the fiber remains in the Smoothie so when you're blending a Blackberry raspberry apple smoothie you're getting tons of fiber tons of phytonutrients tons of amazing healthful benefits um the only uh downfall I would say in my opinion is that for weight management maybe you're not going to get as much satiety as you would chewing it but that's a entirely different discussion but um I did have to you know step in with the Smoothie defend give smoothies a little defense because you do maintain the research shows you do maintain the fiber Matrix when you do a smoothing now juicing on the other hand not beneficial because you're removing the important parts of the fiber in the P we all agree on that yeah I want to read you a statement and you tell me if you agree Dr gundry States my research along with the research of others has shown that yearound fruit consumption is associated with kidney damage and diabetes among other diseases so not only is this um not does not bore out at all in human data it doesn't even um we have multiple level levels of evidence of research that uh disagree with this drastically so you could start with the EP research as I mentioned so perspective cohort research is where you're observing someone over years and years in time you're looking 20 30 years you're evaluating someone's dietary intake and you know that is only one level of evidence right you can't make every decision off of nutrition epidemiology in that one area and level of evidence we see as I mentioned in the higher tertiles of consumption of fruits people have less diabetes this is very well known less heart disease less cancer risk Etc then you look at the randomized control trials there's numerous randomized control trials that when you replace um a standard American diet for a diet that's higher in fruits vegetables and fruit included in that variety of fruits we know we can reduce diabetes risk heart disease risk cancer risk Etc in shorter term randomized control trials even my friend Kevin Hall at the NIH did a you want to go to even more meticulously controlled trial you look at Kevin Hall's study at the NIH where people went to live in the metabolic w at the NIH in two weeks and he did a really lowfat plant-base and I'm not even a huge proponent for lowfat by any means um I think there's multiple different um dietary compositions that can work for people but he looked at a lowfat 100% plant-based diet high tons of fruits tons of lectin versus a um a high fat anic diet ketogenic diet I know this stud and you know and he found that when he tightly controlled over two weeks they lived at the NIH every molecule that they ate was measured you know evaluated and you know everything improved in the lowfat arm drastically compared to the keto arm um and it was because they were eating more fruits vegetables and whole grains and you know foods like that so I think that we have multiple levels of evidence that show us fruit is healthy and I think that I think the point you're trying to make is that you know we have bigger fish to fry in the world of unhealthy eating than fruit being the issue and I think that unfortunately I think that discouraging people against eating fruit can give people people the mixed message that they're you know that a food that's healthful for them may not be as beneficial and then they may even find something that's even less healthy to stick with do you think that that could be a reasonable thing a person can deduct uh first of all if I have somebody with kidney failure and they have an elevated uric acid the first thing I do is modulate their fruit intake why not meat intake given that modulate their meat intake you you forget I'm I'm kind of anti- meat um well I'm I'm not I'm not necessarily anti well you're not anti- meat either you I am very much so but you said small amounts of meat is small amounts but that's why I'm saying you guys aree am I'm I've been going after new 5gc now for a very long time and there's more evidence that scares me to death about new 5gc but back to Fruit so uric acid I think we would agree fructose is a Big Driver of uric acid fructose uh animal proteins particularly fish and shellfish will drive uric acid anyhow in my patient population and I'm talking about my patients that I do their blood work every three months when I reduce their fruit intake look for other sources of fructose in their diet high fructose corn syrup Etc we see their uric acid fall and we see their cystatin seed and egfr based on cattin C rise there and that to me and then if we change and allow their uric acid to come back they'll go the exact opposite way how do we generalize what you are doing with the select population of said did the same thing he even wrote a book about it you know drop acid um I'm not a strong a proponent of cute cute name only Boomer get the joke it's called drop aing but like all of these things are individual cases versus generalized advice this is generalized advice I give to a patient who I see with renal failure wanting to stay off when you write your book your book is not targeted to people with renal failure well even people with renal failure by the way I just step in jump in so even with people with renal F very much can eat fruit there's actually no limitation I mean people with fa failure may have specific dietary potassium or protein restrictions um at hand but in general we know that all the cohort data and the RCT data shows that people are less likely to develop renal failure if they eat a diet with a variety of fruits and vegetables and whole grains and legumes so I think the issue is is that Dr gundra going back to kind of like the other dietary group like the low-fat plant-based no olive oil group I mean they will say that they can reverse kidney disease on their exact cohort I mean if you had Dr estelon sitting here you know he'd be saying that he rever every single disease you say you reverse with your dietary plan he will say he does on a high lectin zero olive oil diet and I'm here in the middle saying that there's a variety of different dietary paradigms that can be Health healthful but where we have to get that evidence can't be from an individual cohort it has to be from a variety of uh levels of evidence in order to inform our decisions because your you know anecdotes are um you know of course are going to be meaningful to you and his anecdotes are meaningful to him and we've all seen patients that have improved on a variety of different dietary paradigms but how we inform our patients in the general public has to be based on good sound scientific evidence yeah um I I think it's just it becomes more confusing when we start picking certain biomarkers to look at and nitpicking certain problems and then we create this very confusing picture where patients come into my office and say I no longer eat fruits because I heard this in this on Lewis House's podcast and that scares the life out of me because I every patient why don't you see what happens to their blood work when they do that which is what I do they don't they because what they do is they switch off fruits to Milky Ways per your statement I didn't never tell anybody eat a Milky Way you say if you're going to eat grapes you might as well eat a Milky Way it was actually a Hershey's candy bar so if people who eat fruit and all the research how do you explain that if people who eat more amounts of fruit and all research have lower apob lower weight lower risk of diabetes lower um highr CRP like in multitude of evidence then then how do you explain way it being so dangerous with wait wait wait wait fruit is one of the best sources for polyphenols and if you want to feed your gut microbiome it turns out that polyphenols are the best Prebiotic there is but not year round not year round look at the hodas but why the hanas I'll give you a perfect example we want to change our gut microbiome on a seasonal basis based on the food that's being eaten during the wet season when the hodas just eat fruit and every Liv they have a really interesting diverse gut microbiome in the uh dry season when all they're eating is meat their microbiome changes 180° and I think and other people think that that change preseasonal was built in perfect you think it it's a theory but how can we generalize this that everyone should follow it from this Theory because it's a theory because that's how we came about well that's how they came about but there's people that live they're one of the last hun gatherers if you talk to Herman poner you know who Herman is he's studied the Hoda probably more than any individual he's a good friend of mine I just texted him before our debate today to to ask him a few questions you know if you talk to Herman about it you know he would never advocate for seasonal only for eating because you know the evidence doesn't support that and he studies the hza in great detail because you know the hza eat the way they do because they are a hunter Gathering right population they're stuck and they we have so much to learn from them um but we live in the United States where things are youit good as and available we we have data that looks at people who eat for year round and shows positive outcomes for every cardio I mean for diabetes for hypertension for weight for inflammation for cancer risk so that's because of the polyphenols right so I feel like we are circling a bit because so it sounds like you agree that fruit good because of polyphenols right there's whole lot easier ways to get polyphenols than eating fruit which is my point I think what's the whole lot easier way I think fructose is a mitochondrial poison do you think it's more beneficial to take your polyphenol um supplements than it is to eat whole fruit uh depends on the season for instance I had a cute little apple a couple days ago that I got at the Santa B far Farmers Market four bites and the Apple was gone do you think our disease epidemic our chronic disease epidemic our our disease our cardiovascular disease our diabetes epidemic the cancer risk the autoimmune disease do you think fruit is an issue there or do you think that it has to do with everything else I because I don't I don't think that it's it's our highly processed food among other things age but a lot of our highly processed food is loaded with fructose but that's different than fruit I'm just saying fructose is a problem and please correct me if you think fructose is good for you it's not about thinking a fru I don't want to take it apart an ingredient and villainize the ingredient because that's not helpful in real life if I start villainizing individual ingredients I can't give my patients good guidance that is universally valuable it's the same way that any restrictive diet if you restrict patients to eating toilet paper they'll lose weight but it doesn't mean they have a nutritious diet so when I tell someone fructose is bad for you they can get fructose from a Hershey's candy bar or a grape I'd much rather they get it from a grape and fructose can be turned into glucose and the brain works off glucose and yet too much glucose is a problem inflammation can be a very big problem in the intestine area causing permeability we know this you say this quite often but inflammation could also be a wonderful thing when we exercise we have spikes in blood sugar we have spikes and inflammation so to generalize saying fructose is terrible is not a valuable thing to the general public do you see what I'm saying with that yeah but the problem is fructose is now ubiquitous in our diet and the more we can identify where it's hiding then the better off we all are and you're proposed statement is that it's in hiding in all these fruits people are consuming all these large fruits out of season yeah but no one's eating fruits none of my patients you can't possi I live in California we eat fruit in California sorry but in America we talk about how much fruit is in the American Standard diet it depends on where you live no I'm asking about the American Standard diet when we very little so then why are we talking about it because and even give you another example Joseph marolo recently has gone a kind of on a high fruit kick and which is hilarious because he was one of the original high fat guys and he says man I feel so much better all I do is eat fruit all day long I mean I don't care what someone says then he says hey but wait a minute I notice that when I'm really going crazy on fruit my triglycerides start going through the roof and my insulin starts going through the roof and uh you got to be careful well that's also so listen that's also not a randomized control trial where you're controlling calories right I just don't know what to do with that because it's not generalizable what Dr mola does or doesn't do with his insul it's not a controlled feeding study where you're looking at of course if you're increasing calories and you're increasing you're going to make shifts in lipoproteins and you're going to see a variety of shifts but overall on balance when we look at all the data we know that people who eat I just don't want your listeners to be confused that when we look at all the research the totality of evidence people who eat more higher amounts of fruit consumption on balance have a much lower risk of obesity diabetes hypertension and then you know I don't think you can honestly sit here and think that fruit is the major problem of our obesity epidemic or our disease epidemic you know it's it it's just it's Dr gundry I'll simplify it to a metaphor it's like we're sitting here and we're saying evidence shows eating carrots is healthy and carrots are a health food and you sit here and you say but if you eat enough of them will turn orange no one's debating that yeah cars are cars are really good for you yeah I know but you see how I'm saying that we say that in general this food is healthy fruits are healthy year round and you say but in some instances fruits can be bad yeah great but what why say that because if fruits are picked out of season they're picked uh unripe and they are actually loaded with lectin and then we ripen them when they arrive here are there any times lectin are good for you oh yeah there's couple nice really good lectin so why are we generalizing lectin to be terrible uh because most of them are part of the plant defense system against being eaten but there's many of them that are being researched for good things we used to have a great defense system against lectin in our microbiome there are bugs that enjoy eating gluten most people they're gone unfortunately there are bugs that eat oxalate and interestingly enough people who have oxalate kidney stones or who are oxalate sensitive they don't have those oxalate bacteria eating bacteria in their gut microbiome if you ref Foster those guys the oxalates don't become a problem anymore so again I guess we're circling back around the gut microbiome which has been def decimated by everything we've done is part and parcel of all this and getting back to the hanzas I think the idea that maybe we should have shifts in our microbiome on a seasonal basis is built into our evolutionary fiber that's a fair Theory okay but we have to be humble enough to say it's a theory yeah didn't say didn't say it's proven that that's that's great then would you say that you in general villainize lectin in general Yeah in our American diet so do you see that problem with simplifying something as all good or all bad in healthcare how it could become a problem I started doing this because I asked patients to eliminate certain foods out of their diet and let me see what happens to their blood work let me see what happens to their intestinal permeability did that did when you were a hard surgeon or practicing as a heart surgeon because you still are a heart surgeon did you make those recom recommendations to eat fruits vegetables all those things yeah and what do you think the reason for the failure of those patients diets leading to them coming back every few years was was it a the fact that they couldn't stick to it or they didn't stick to her they couldn't afford it or the fact that they ate fruits and vegetables and still got sick um well there's a new paper out just this past week looking at a u basically a vegan diet versus a u well proportioned Chris gardeners I just read it and it turns out the vegan diet did wonderful things in terms of cholesterol markers inflammatory markers the other diet did well but not anything as good as a vegan diet right M what's interesting if you actually if you read the paper is they go yeah this is all true but the compliance with the vegan diet is so difficult that it's unsustainable and the compliance behind your yes and no list is easier it's actually much easier 90% of my patients follow that L but that doesn't there's a little select selection bias well they're they're interest that's like saying my followers watch 90% of my videos well they're my followers because if they see if they're autoimmune disease goes away they're really interested or they support what you do and what do you mean they're your patients my followers watch my videos because they've selected to subscribe to they wouldn't be my patients if they didn't see a change in their autoimmune disease there's I'm not saying your the recommendations you make about eliminating processed foods is all bad that's not where our debate comes from in fact I there's so many things you do very well for your patients that lead them to have good outcomes the danger comes in when we start generalizing as Foods as being evil or bad apples are horrible for you those statements mislead patients into making bad decisions because when you say apples are terrible for you you're making this statement from a very knowledgeable position of the the polyphenol change this change and you wish that they were a little bit smaller the patient hears I might as well eat a Hershey's Kiss do you get how that happens yes and that's a big problem because your books are best sellers but and then patients go I don't want to eat apples anymore great because the Apple they're eating is the wrong Apple that's so hard to that makes me very happy that's so hard to say what's your takeaway my takeaway is that um you know there's many different dietary patterns that patients can be healthy on um although there's much research that um informs our our recommendations and guidelines patients have to find what works best for them and that eating a plant predominant diet filled with fruits vegetables legumes whole grains lean protein you know there's a reason why I believe there Synergy across all of our Major Medical Society guidelines for Cardiology cancer endocrine Society uh Etc and um in reality there is no one perfect diet no one food in one dose is going to um cause disease and that it's really patients finding something that's sustainable and works for them long term I'm going to say something borderline controversial when we talk about leaky gut syndrome not the concept of leaky gut leaky gut syndrome I feel like patients who have gastrointestinal conditions a lot of times have non-specific vague symptoms and our Health Care system is trash at helping those people true for many reasons one our system is flawed so doctors don't have enough time to spend with their patients to properly hear them out two we don't have enough research to figure out exactly what's going on so that we don't have every diagnosed disease already on the icd10 classification and then three so many of these patients then fall into the bucket of seeking an answer elsewhere usually in the form of supplements that are being for sale to them diets that promise them solutions to their things that are largely unproven and as a result those patients and why I suspect 80% of your patients are autoimmune patients because they've been hurt by our system but that's not because there's some kind of definitive proof in the solution for all autoimmune conditions it's simply because you're offering them a solution that our health care System doesn't have oh that's absolutely true most of my patients in the autoimmune Spectrum have been to six 8 10 different centers different Physicians looking for an answer and not getting it and that's actually how they end up in my office do you like zooming out do you find it strange that patients that have a GI disorder an autoimmune condition a rheumatologic condition go to many GI centers Rheumatology centers don't get helped but then a cardiothoracic surgeon is helping them uh not anymore because I actually what do you know that the rheumatologists don't know uh quite a bit what so for instance all of this comes from intestinal permeability how do I know that because when the intestinal permeability stops by whatever mechanism you want to do it and there are multiple ways I Happ to like my way because it works when that stops the the autoimmune condition goes away and the rheumatologists don't want to help their patients and follow your mod they want to believe in the system of using a biologic to treat what is treatable with food so you're saying a rheumatologist who's went through 15 years of higher education yeah has such strong faith in other methods of treatments that they refuse to see the very simple solution that you have laid out uh example from the plant Paradox a young lady with crohn's disease who was taken care of by the head of GI at the Mayo Clinic who believes the Crohn's is as a genetic component has some but not much went on my program resolved her Crohn's disease called her gastroenterologist said I cured by following this diet and he says that's just a bunch of bull uh this is all in your head he's a charlatan she got off the phone her mother was baking Christmas cookies she had a couple Christmas cookies two hours later she was in the bathroom severe GI distress I talked her on the phone she said why won't my doctor you know learn from this I said look you can't see unless your eyes were open when I met Big Ed 28 years ago luckily for some reason my eyes were open and for instance Dale bris from the end of Alzheimer's and David prid grain brain and drop acid we joke that people from you know the neurology community and the people from Cardiology and cardiac surgery all we talk about is the gut because everything comes from the gut just like hypocrates said and I'm learning that remember sickness is good for business sickness will exist whether or not we follow the Dr gundry diet do you agree uh depends you're saying you could eliminate all disease bres believed it I see it every day I'm not asking hypocrates no I yeah I think I mean that just think about the statement you make you saying you can eliminate all disease yeah I mean then we're in the midst of a prophet why do you think I keep working six days a week at my age when I don't have to because I get to see these things happen and the more I see of it the more I firmly believe that hypocrates was right just like Fano you see why I see a lack of humility in a statement where this is not I get to watch Miracles every day why I show up for work but so do I when I start my patient I'm at foreman and their hemoglobin 81c drops I see a miracle too yeah but you're trying you're trying to patch up the underlying cause sure but my patients don't always follow the lifestyle guidance but your but do you know why your patients follow your guidance versus mine don't always follow mine because usually they're at their Wits End yes and because you've pre-selected the patients who want to follow your guidance I don't call them up no they call you they've pre-selected you okay so if I took your model yeah and then started doing it on my patients it would not have the same effect because it's not a pre-selected but we have tried it we've tried it with all the research that Dr Bardo has proven that if you eat high fruit concentrations you live longer Leon study you eat grains you live longer and these are all the things have you get Al linolic acid in your body but you also live longer um no one's arguing about the Ala what we're saying is that you live longer by consuming a high grain diet in the Leon heart study and you're arguing against those things and you live longer if you smoke in some of these areas but that's not it's not because if you smoke it's in spite of smoking no you're wrong but how you are wrong you know smoking is Pro pro-inflammatory acid is one of the best mitochondrial in Dr we have to this conversation British doctor study not good we need to at least British smoker British doctors who smoke have a 30% less incidence of Parkinson's and diens they die of 10 other diseases beforehand so I had I have one thing one anecdote to share with you I had a patient in residency who reversed their I actually don't like using the word reverse sorry put their diabetes into remission improve their hemoglobin any1 see this was not on the advice of myself this is just something I observed that the patient told me this patient went from eating just a ton of processed foods whatever and went on a cocaine binge for a few months okay literally a cocaine binge and um eating Twinkies candy bars but low calor and their hemoglobin A1c and their high-risk CRP totally normalized yeah from that anecdote would we be universally recommending cocaine and Twinkies as a diet of course not right we can't extrapolate from anecdote that individual lost a substantial amount of weight which is why that happened in a really negative way right they lost weight because they weren't eating because they were using cocaine that is something I would ever recommend to patients so a lot of the anecdotes we can all have anecdotes that we see I mean I have patients that are fully plant-based that go on these really extremely restrictive diets that improve all of their biomarkers and the reason why I don't recommend someone follows a no olive oil Whole Food plant-based diet even though it's been recommended by tons of people with tons of anecdotal evidence is because when you look at multiple levels of evidence we know that eating olive oil can be healthy we know that eating fruit can be healthy we know that you know all fat is not necessarily bad by any means polyunsaturated fat incredibly healthy and so this is why I believe anecdotes while they're interesting we have to base our recommendations off of the most robust outcome data with evaluating various levels of evidence yeah I I was lost when we're saying lectins are pro-inflammatory so we should stop eating them and smoking is pro-inflammatory but it extends life in some conditions no the the pro-inflammatory of smoking can be countered by a high polyphenol diet they can't period I can't well then how do these guys make it so long how does my grandpa who eats the most unhealthy low Vitamin C diet lived to 95 when he smoked yeah that's what I'm asking you yeah I this is the I this is in medicine we have to have the humility to say I don't know and my answer to you is I don't know and I could state that but let's find that out we should well that's why I do what I do let's find out there's a difference between saying let's find out verse I'm the prophet with the answer not a prophet but when you say you can end all disease that's prophetic no all disease comes from the gut and all disease can end from the gut that's all I'm saying how does AIDS happen from the gut well actually there's some interesting evidence that the microbiome in AIDS patients is totally different well yeah because they have Auto they have immune dise and you can change their microbiome how does herpes h on the lip happen from the gut I mean some of these how does a blocked gland in my eye haveen like we have to be humble here believe it or not there's now really cool evidence that hearing loss is because of disbiosis in the gut period when you say really great evidence I'm curious what goes through your mind uh what goes through my mind is in the next book believe it or not there's really strong correlation between mitochondrial disbiosis and hearing line there's a really good correlation between ice cream cells and shark attacks as well uh and I found that to be not very valuable so why not manipulate the microbiome and find out I would if there was if there was quality evidence I would you don't look I can I have a channel here with 12 million subscribers I can sell them probiotics and make a ton of money I could sell them your probiotics in fact you'd probably sell me your probiotics I could sell it to my audience and make millions of dollars and help people I'd much rather you sell prebiotics and postbiotics how's that I would sell those to my audience you think I'm withholding making money you think I'm withholding help patients be out of principle no then why do you think I'm not selling those things uh because maybe you don't believe the evidence that they work like like I do how's that but the evidence that you believe they do is not based on human outcomes that's the problem there actually you you just said that you found some correlational data and it leads you to make this sweeping recommendation selling yes not just you but you're the person in the room that we're discussing you read alesio FIS professor at Harvard if you don't believe it's called Authority bias yeah I mean no I just I don't want to talk to those people because I'm talking to you and we're seeing correlations and we're seeing mechanisms and we're seeing your theories which you admitted are unproven that was your statement from earlier they are theories and if they're theories just like the cholesterol hypothesis of coronary artery disease is a hypothesis there are multiple other hypothesis but oh no no no it is hyp we know that elevated LDL cholesterol is causitive without a doubt in AOS cardiovascular disease we know that why yeah we do know why why are you asking like from like a god sense why no I mean in other words what is it about having a high LDL cholesterol that's so bad for you because I have patients quite frankly who have LDL cholesterols of 400 and have an absolutely normal CD coronary engine and that is not typical and that is a very that is you were talking about a unicorn that is very rare we know from all the research of people with actual with familial hyper cholesterolemia we know that regardless of uh some we know that there's factors of metabolic Health that lead to increased ascvd we know that diabetes increases risk we know hypertension increases risk but all of that completely controlled for irrespective isolated elevated APO B in and of itself causes asvd which is why our our all of all of our um are not measuring lpp2 levels because it's clinically insignificant well it is clinically significant and the assays are not not validated it's funny the Cleveland Clinic uses it it's a Cleveland Clinic does a lot of things that um are not I would think they'd be very interested in heart disease well I they I mean I'm not I'm not aware of Cleveland Clinic Physicians personally that recommend that because it's not in our guidelines because those assays aren't inv validated and don't have outcomes but anyway asvd we do have an answer to at least um and we at least agree apot B is positive we don't have answers for everything and in medicine you're aware of this as more evidence comes out we update our our changes practice like you used to poop in a bucket as a med student and now we actually have in Harvard they freeze dried capsules in order to deliver these FAL trans so we we we literally will take what we learned and we update our guidance and from there we need to have a strong layer of skepticism before we accept something as a changing of the way we do things I ex I completely agree with you and I do not feel the caliber of the evidence that you use to make certain statements reach the level that we should make generalized claims that apples are horrible that smoking isn't bad as long as you have high antioxidant levels because those are dangerous statements to make because they mislead people into thinking that smoking is safe that apples are bad and that might as well eat a Milky Way and ultimately I know that's not what you want I know you genuinely want to help people you want to help people off of ultra-processed foods you want to help people get to a healthy weight higher muscle mass lower fat those are the things you want it's the mechanism by which we're talking about mechanisms the mechanism by which you chose to get here is very dangerous and I'm telling you this because while you're an expertise with your patients I'm an expertise at mass communication I have 25 million subscribers of people who listen to every word I say and correct every mistake I make and I could tell you how your information very confidently lands with them and it doesn't land in the way you intend it to and I just urge that in your upcoming books and the speeches that you make just take that into consideration because when you make statements like apples are horrible the the worst thing you could do for your mitochondria is a fruit smoothie it's not just taking a little bit of Liberty with information it's truly misleading people to make bad decisions for their health that's all I'll say in every one of my books I tell people if you do not smoke smoking is bad for you but we should learn what is it in cigarettes we should learn that is a factor in these people who are long lived we should Lear okay that's what I'm saying no one's against and if you want to raise triglycerides one of the best ways to do it is fructose and I happen to think triglycerides are a real problem in cardiovascular disease and we might agree about that triglycerides are a problem but fruit does not fruit in and of itself does not in the whole food form doesn't raise triglycerides by itself and I say reverse juice get all the fruit you want put it in a juicer throw the juice away and eat the pulp well I agree we all we all oh I love the pul we all agree that juicing is a bad idea so again just that's that's my only word of caution yeah I think there's a lot we agree upon I think it's the mechanism by which we disagree and I hope the audience got something out of it I appreciate you taking the time to have a critical debate because a lot of people wouldn't take that conversation so I'm first and foremost very grateful that you're willing to have this debate and thank you Dr Bardo for uh the feedback and all the work that you do with the Cardiology associations across the globe um gut check we're looking forward to January 9th gut check all right thank you Dr gundry Dr Bardo another popular offender in this class is goop click here to check out my takedown and as always stay happy and healthy