Dr. Danielle Belardo is the Director of Cardiology, and Co-Director of Research and Education, at IOPBM in Newport Beach ...

vegan-doctor-attacked-by-vegans-ft-danielle-belardo-md

Vegan Doctor ATTACKED By Vegans ft. Danielle Belardo MD

- You've been sometimes
labeled, 'a bad vegan.' (Danielle laughing)
What does this mean? This is Dr. Danielle
Belardo, she's a vegan and a cardiologist, but oddly enough she's gotten a lot of flack
from the vegan community. Let's find out why. Why is this happening considering that you're an expert in this
field, as well as a vegan? - I'm very honest and
transparent about the data which is, the truth is, is you don't have to go 100% vegan to have
health benefits by any means. Our American College of
Cardiology guidelines I think really are the most robust and best data in this space. They essentially say
that eating more plants is better than less, eating
a plant-predominant diet or a plant-based diet are both great. - I am glad that you aren't
backing down from that message. You are sticking by
evidence-based medicine. - Yeah.
- Saying what you know, what we don't know because
there's a lot of that, especially with how really lackluster the research has been this
far in the nutrition space. - Right.
- But I think we sort of hyper-focused
there right at the outset of being all about health
when it comes to being vegan. What does it truly mean to be vegan? 'Cause it's more than
just health aspects of it, am I correct? - Totally, so actually veganism
in itself is not a diet. It's more of an ethical decision, it's just abstaining from animal products and from essentially adding
harm to animals in any way, practical and possible. So things like, for example, medications that have been
tested on animals, vaccines, these are things I do support. - We've all seen the documentaries that preach doom and gloom that say, &amp;quot;if you eat one egg a day that's equivalent to some
horrendous habit like smoking.&amp;quot; What's your reaction when
you hear something like that? - I think that we could do a
lot more as vegan physicians and there's a small growing
amount of us that are doing this, but we could
do a lot more in general if we kept our messaging
about nutrition science really honest, right? I don't need to convince
people to go vegan by cherry-picking data, or
really extrapolating things from nutrition science that aren't there. Nowadays you want to
get your LDL cholesterol as low as possible for
cardiovascular risk prevention. So, primary prevention versus
also secondary prevention. So, how do we do that? Well, we want to reduce
saturated fat and a lot of that is in animal products and
in a whole egg, there is saturated fats. If you have high cholesterol,
eating multiple eggs a day adding more saturated fat
into your diet, probably not beneficial, but
you know, we just wanna lower the overall saturated fat that a patient's eating to
help reduce their cholesterol. - Now the research that we
have from Elevated LDL Scores, then matching to outcomes, meaning patients actually
getting a heart attack as a first time, getting
a secondary heart attack, even losing their lives. Do we feel that those end
results are correlated to the LDL scores of people who are eating
those saturated food products and living a very unhealthy
lifestyle with that? - So, starting with what we know, even on these metabolic ward studies. The link between saturated fat and raising LDL cholesterol
is so well demonstrated. It's been demonstrated
in metabolic ward studies for years and years. Like hundreds of studies have shown us that raising your LDL cholesterol by eating saturated fat is, it's predictable in a linear fashion. You would also help to
lower your LDL cholesterol be eating fiber. And the only thing that
fiber is in is plants. One of the things that we also
have the most robust research in cardiology history
is the predictability of LDL cholesterol being
causative in atherosclerosis. So atherosclerosis is
when essentially you start to have, your vessels start to harden because you have plaque buildup. And actually, all of us start
to develop atherosclerosis even when we're young. It's just how bad it builds
up while you get older. When people have other risk factors, so things like they're a
smoker, or they have diabetes or they have high blood
pressure that makes them actually more at risk for
cardiovascular disease because the endothelial lining, so the lining of the arteries ends up becoming weaker and more damaged. And so that LDL cholesterol
can really get in there and cause worse plaque. - I see a difference in that if someone can have an LDL of 90, versus if they raise
their LDL by introducing let's say one egg a day or
chicken into their lifestyle and now it goes up to 110, have we seen the difference
between a 90 and a 110 in the form of primary prevention? Or is it solely if they
go extreme and introduce a lot of saturated fats, go full keto that you start
seeing the 190s, 200s figures. - For anyone listening that doesn't know, understand the difference. So primary prevention is
preventing heart disease before you have a cardiac event, so a heart attack or something like that. Secondary prevention is
preventing a heart attack when someone has already
had a heart event. So whether it's a stroke or they already have underlying
cardiovascular disease. For LDL targets in primary prevention, the more and more data that's coming out, we really want your
lifetime exposure of LDL to be as low as possible. So, I would say, yes you want, you're, and someone without heart disease and without other risk factors, keep your LDL below 100. And if it's, the difference
between a 100 or 110 or 90, it's not quite significant. And then where it really matters is also in secondary prevention. You know, now the ESC guidelines of the European Society of Cardiology, they're a little ahead of us with ACC. Now for secondary prevention, we want our patients' LDL less than 55. - The conversation that
happens online the most is usually surrounding the
primary prevention aspect in that, like I'm a healthy person, I eat some protein,
chicken, fish, et cetera. Am I increasing my risk? And when I think about this, I am not a cardiologist, you are. So, not that I'm saying you
don't think holistically, to me, I have to balance so
many risks for this patient in their everyday life. That I have to sort of pick my battles as to which risk is
gonna be the biggest risk because I can give someone 10
things to change in their life and really be honestly expecting for all these things to happen. Especially when it comes to food. Food holds such an
important part in culture, in society and in manners. So, I have to tread
lightly when I'm giving this type of advice. And that's why I'm trying to figure out, how much of a battle should I make it and where should it fall
on the priority scheme. - So, one important point you've just made which is that I emphasize always is that we have to meet patients where they're at. There is no all or nothing. Patients don't have to go 100% plant-based or 100% Mediterranean,
literally small changes count. And the reason why that's
not popular in social media is because everyone wants to
sell a diet as a cure-all, and as the only way, 'cause they want their diet book to sell, when in reality, the truth is
somewhere in between, right? The philosophy I live by is
I just present my patients with the options in the data and then I'm there to support
them in any way I can help. - Do you think there
are any health benefits to consuming meat or fish? - Red meat, I absolutely think
there's no health benefits. We actually have an American College of
Cardiology recommendation that's officially, official recommendation to limit or eliminate red meat. Lean meats are actually recommended
with our ACC guidelines. So, what's my opinion on lean meat? Do I think that you need them or that they add benefit to your health? Personally no. I think that anyone who's interested in the literature in this,
if you look at Ron Krauss did a study, he did a
phenomenal study actually. He did a randomized control trial, that was a crossover study,
and people were randomized to either red meat, white
meat or plant protein. And he actually controlled
for saturated fat. And he looked at LDL cholesterol and then he actually crossed them over to each of the other arms,
and what did he find? That actually red meat and white meat, when he controlled for saturated fat actually raised cholesterol,
the LDL cholesterol equally. And the only thing that
didn't was the plant protein. Now fish is a different story. So we have consistent
epidemiological research that shows us that fish is beneficial. Fatty fish is beneficial
with cardiovascular disease, some studies showing us it's neutral. So to me, it could go either way. And the truth is, is that
with all of these foods you can eat, you can eat all of them. Like you never need to feel that you can eat nothing ever again. It's just trying to modify
your overall dietary pattern to a helpful one. - Would you say that we have complete data to say that elimination
of all animal products is undoubtedly safe and ideal for all. - I'll start with safe. Is eliminating 100% animal
products safe for all? a 100%, yes. So, there is absolutely, we need absolutely nothing from animals, despite what people will tell
you, we can supplement B12. The American Academy of
Nutrition and Dietetics even has an official formal statement, that it's actually healthy to be vegan. Well, it's gotta be a
well-planned plant-based diet, is helpful at all stages of life. We're talking infancy through adulthood. We have randomized control trial data showing that plant-based diets are helpful but also, we also have
epidemiological data. Even if you look at the
Seven-day Adventists, right. They are some of the longest
living people in the world, if you look at the Blue Zones and they eat a 100% plant-based diet. Now, your second question
was, is that ideal? And this is where I get some
people give me a hard time. You do not have to go
on 100% plant-based diet to be in ideal health and be healthful. We don't have data that shows that eating 100% plant-based diet is better than eating
a really plant-centered or plant-predominant diet with some amount of animal products. - There are certain Blue Zones
that do eat animal products, certain ones that don't.
- Exactly. - It's important to know that
individuals cross-culturally have developed different abilities to extract energies from food, different reactions to certain foods. Their gut microbiome is totally different which is a whole new thing
that we're exploring. For me I like to be introspective and think about how we
need to be very humble when it comes to even looking
at evidence and medicine. And, you know, you've talked
a lot about of great data of, outcomes for primary prevention,
secondary prevention, increasing LDL scores when
you eat animal products. We've also seen, this is
historically speaking, very historically speaking humans started eating animal products at some point in our prehistoric nature. There has been some data
showing and speculating perhaps at times that the
reason we've gotten taller, the reasons our minds evolved, because we started eating animal products. - I do think people extrapolate
way too much from historic things in general,
people were really truly more of hunter, more gathers
than they were hunters and eating lots of plants. Of course, there are certain
populations like the Niue who eat a high fat diet
and they do fine with it. So, from the evolutionary standpoint, I just think it's, I do not think we need or require animal products to be healthy. - Do you feel like there is
a heavy user bias that exists with, like, you have people
who follow a vegan lifestyle are generally healthier. They're less likely to smoke, less likely to engage in bad habits, getting a poor amounts of sleep, mental health struggles, et cetera, than compared to someone who is eating the American Standard Diet? There was one study where they compared vegetarians to their friends who ate meat, but followed similar lifestyle habits. And then people who shopped
that similar health food stores who ate animal products
and those who didn't. And they found actually their
end points were quite similar. Do you feel like there's
something to be made of this? - So healthy user bias is a real thing. It could be, you look at
the Seven-Day Adventists, but this is what's interesting, is that we actually have
data with heart outcomes that totally eliminates that. So, if you actually look
at what I mentioned again, randomized controlled trial, right? Leonhard, they decrease
butter, decrease saturated fat, decreased red meat,
increased fruits, vegetables, whole grains, legumes, and the experimental
group had more smokers. And they still had
improved cardiac outcomes just from what they ate, just from eating more plants
and less animal products. And it was not a vegan diet. It was just a Mediterranean
style plant fully diet. Another randomized controlled
trial was PREDIMED. And if you looked at
the post-talk analysis, the PREDIMED data, the post,
the vegetarian subgroup actually had the most reduction in cardiovascular mortality as well. - I think there is such an
important distinction to be made between population evidence
and an individual guidance. - Yes.
- Because it just, it's incredible how many patients I have come through my door, that if I even give the
best knowledge of all these references that you've mentioned, to think that they're
gonna adapt it right away is not realistic. So, when I don't, I can
see how the vegan community can come after me and say, in one of my videos, I recommended, I said like, we should
eliminate as much as we can, processed foods. - I totally agree.
- Including, you know, like hotdogs out of our diet. - Yeah, I totally agree.
- But if you go to a ballgame and you eat a hot dog to celebrate that you're at a ballgame. - I totally agree, I totally agree. - But I got destroyed on that, like... - But I totally agree with you. Like no one food in one dose
is going to cause disease. If you go, if you eat birthday cake, if you eat a steak, you
know, once in a while, like no one food in one dose
is gonna cause a problem. - Do you think for a patient
who's diagnosed with obesity or morbid obesity. Do you think it's more
important for this patient to look at their caloric intakes, or more important to look
at the types of foods they're consuming? - I think it depends. So at my practice, we
have registered dieticians and we have obesity medicine specialties. So we do a multidisciplinary approach. Some patients who are obese
or have morbid obesity, some patients benefit from
gastric bypass surgery. Like the best data we have is actually no specific dietary pattern is actually gastric bypass surgery, the results are remarkable. And so I think a multi-pronged
approach is important. When it comes to the
dietary portion of it, you know, if you look at the data of what people can sustain,
we have research showing that people can stay
on keto for two years. We have research showing you can stay on plant-based for two years, we have research showing
that you could do whatever. I think it's most important to work with a registered dietician and find something that works for you. If that's small changes
and sometimes people, I'm sure you see this
in your practice too. Sometimes patients can
do unbelievably well, just cutting out soda. - Last point here, it's
something that you've mentioned before you struggled with. There's an unfortunate
tie-in that has developed in the &amp;quot;natural foods community&amp;quot; and has now reached into
the vegan community as well, surrounding being anti-vaccine. Talk me through how that's come about and how do you speak to that subject? - The one thing that has unified
Nutrition Twitter this year is that there's a huge
presence of anti-vax. And I think that all of
us who are physicians in this space who are
not anti-vax like me, have kind of all bonded over this fact. And I think it all comes
down to the same thing. There's this inaccurate belief that health is just a pull yourself up by your bootstraps method and
that everyone should be able to just fix their health immediately with their own willpower,
not respecting the fact that each individual has certain circumstances that maybe make it more
difficult for them to lose weight or follow a certain
dietary pattern, et cetera. And so part of this whole idea that people in some of these diet groups have is that, this pull yourself up by
your bootstraps mentality is that well, COVID isn't a big deal and that we don't need vaccines. And then also in the
natural health community, there's obviously a ton of misinformation about what vaccines are, what they do to you, that
they change your DNA. And so to me, the most
important thing to emphasize to my patients, and I
do this with everything from vaccines to statins
to diabetes medication, is that this binary idea
that it has to be lifestyle or medicine to me is
where we got it wrong. - As the expert I'd like to leave you with the final word here. Take us through what you
find to be the optimal diet for us to follow, and
how should we be thinking about nutrition and
health into the future? - There is no perfect diet. Chasing the perfect diets is a fallacy. I think that just focusing
on the overall context of your dietary pattern,
meaning eating more plants, so more fruits, vegetables,
whole grains, legumes, nuts and seeds, you
know, limiting red meat, processed foods, these
things can be beneficial. And just looking at the overall context of your dietary pattern, I think, that's the best that we can say from the data we have
overall is most important. - I actually went vegan for 30 days, and a whole bunch of other diets, click here to check it out and as always stay happy and healthy. (soft upbeat music)

Dr.

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