Maintenance Phase - March 28, 2023


＂Forks Over Knives＂： Is a Vegetarian Diet Better For You？

Topics
Vitamin A and vegetarian health studies
The Instagram Fiber Feud The Trouble with Sugar

Episode Stats


Length

1 hour and 2 minutes

Words per minute

170.07

Word count

10,705

Sentence count

437

Harmful content

Toxicity

75

sentences flagged

Hate speech

20

sentences flagged


Transcript

Transcript generated with Whisper (turbo).
Toxicity classifications generated with s-nlp/roberta_toxicity_classifier .
Hate speech classifications generated with facebook/roberta-hate-speech-dynabench-r4-target .
Topics generated with Qwen2.5-3B-Instruct.
00:00:00.000 tag us in what is your meat based meat based protein high protein tagline you're already
00:00:15.880 hinting at what my tagline was gonna be oh hi everybody and welcome to maintenance phase the
00:00:21.300 podcast that just wants to know where you're getting your protein where are you getting your
00:00:24.260 protein. Aminos? Are you set for aminos? Are you getting enough aminos? You are a woman who lives
00:00:30.860 in Portland and has a lot of vegans and vegetarians in your life. Correct. I'm Michael Hobbs. I'm 0.90
00:00:35.760 Aubrey Gordon. If you would like to support the show, you can do that at patreon.com slash
00:00:40.040 maintenance phase. You can buy t-shirts, mugs, tote bags, all manner of things at TeePublic.
00:00:45.080 TeePublic. And you can subscribe through Apple Podcasts. It's the same audio content as Patreon.
00:00:51.620 content patreon my quiet little repeating machine i know i keep i keep trying to throw you off and
00:00:57.720 it never works uh today we're getting a little time machine and we're going back to 2011 yes
00:01:05.300 apparently this is a listener request this is since we did our supersize me episode this is
00:01:14.580 by far the most requested like movie debunking for us to do yes today we are talking about forks
00:01:22.680 over knives which came out in 2011 and i think it was one of the first like streaming documentaries
00:01:28.900 i think it was like when everybody was getting netflix a huge number of people watch this movie
00:01:34.420 the book based on the movie was the number one new york times bestseller yeah this comes from
00:01:39.340 an era where there was a lot of media about cord cutters yeah you wouldn't have cable anymore
00:01:45.160 imagine so what do you know about forks over knives aubrey what i remember its hypothesis
00:01:51.200 as being is that a vegan diet was healthier and that it would lead to a longer life and that it
00:01:56.720 would like yes prevent chronic diseases and like it was like about sort of the origins of disease
00:02:04.120 being with eating meat and dairy yes am i getting that right am i in the right neighborhood if
00:02:10.440 anything you're underselling it oh wow this movie explicitly says that a vegan diet will prevent
00:02:17.380 and reverse all forms of like chronic disease okay good heart disease diabetes at one point
00:02:25.000 they mentioned dandruff halitosis yeah flatulence that's one thing i know that it won't solve
00:02:31.840 but then okay because this is a left-wing podcast i feel like we have to start with a series of
00:02:37.960 tedious disclaimers and like meta conversation about like what we're gonna do in this episode
00:02:42.400 let's roll so i i really did go into this fresh i have never seen this movie i have never been
00:02:51.380 like a a sort of pro vegetarian person but i've also never been like an anti-vegetarian person
00:02:59.240 I have a lot of vegetarians and vegans in my life.
00:03:02.460 I've always felt a spiritual kinship with vegetarians and vegans because the stereotype
00:03:09.240 of them is that they're constantly like lecturing you and they're announcing like, I'm a vegan
00:03:14.080 and you're not.
00:03:15.060 I am sure those people exist.
00:03:16.540 I have never come across anyone like that.
00:03:19.460 Yeah.
00:03:20.060 I have known one preachy vegan and it was just a preachy guy who is vegan.
00:03:26.400 Yeah, some people tediously promote their own lifestyle. And like some of those people are
00:03:30.100 vegans and some of those people are not. It's not it's not clear to me. That's a more common
00:03:35.260 trait among vegans than among non vegans. I will say this, I have experienced infinitely more
00:03:41.820 proselytizing from like keto and intermittent fasting people. Although you're not a representative
00:03:47.700 sample because you do have a podcast where you do say that those things are trash. Yes. Yes. No, 0.96
00:03:52.160 totally agree i'm not your starting point yeah for these conversations no no it is worth noting 0.95
00:03:57.900 that like the animal rights and climate change arguments for vegetarianism are just fucking 0.65
00:04:02.860 true there's nothing to debunk it's like yeah the way that america treats animals is atrocious 0.83
00:04:08.880 sure i'm not a vegetarian but like it's totally indefensible the way that we treat animals and
00:04:14.940 also the climate and water impacts of a meat eating diet are are worse than a vegetarian
00:04:21.580 and vegan diet. They just are. This also seems like a good place for our standard issue sort
00:04:27.320 of reminder. You should eat however you want to eat. We don't care. Yeah. Do what's right for you.
00:04:32.420 We're going to talk about a movie and how this movie sells this particular way of being and sort
00:04:38.420 of way of eating. But we're not talking about the individuals who eat in that way, nor are we
00:04:43.420 passing judgment on what anyone else chooses or chooses not to eat. Yeah, it's it's a very weird
00:04:49.420 movie because it is like just a straightforwardly a propaganda film and like most of the factual
00:04:55.460 claims in the movie do not hold up to like even the most cursory scrutiny but it's propaganda
00:05:01.620 in service of something that i think is good yeah like i think vegetarian diets are fine yeah and
00:05:07.100 if you want to be a vegetarian for literally any reason then like you should do that yeah that's
00:05:11.560 right i actually really appreciated this movie because first of all it does a lot of things
00:05:16.140 that I think are illustrative of like the nature of like how propaganda works and like how you can
00:05:21.840 convince people of things without technically lying, but just through like selective omission
00:05:28.000 of important context. And also I learned a lot watching this and debunking this. Like I went
00:05:34.360 down some really interesting rabbit holes. So mostly like we're just going to go through the
00:05:38.000 movie and I'm just going to tell you what I learned. It feels really interesting to me because
00:05:42.140 it's rare that you and I both go into a topic pretty fresh, like aware of the cultural
00:05:48.380 conversations around it. But like neither one of us had seen this film. Neither one of us had done
00:05:54.040 the deep dive into sort of like health claims around veganism and vegetarianism. Yeah, I am
00:06:00.300 like, like you, I am not a vegetarian, not a vegan, not plant based. I like eat meat, but not very
00:06:06.680 much yeah that's kind of where i am too wherever this lands cool yeah you know so let's kick
00:06:12.860 ourselves off by watching the first couple minutes of this movie the the opening montage i love this
00:06:19.540 clearly the western diet is taking a toll this should serve as a wake-up call we have a growing
00:06:26.600 problem and the ones who are growing are us food it's central to our lives and traditions
00:06:35.200 every special occasion seems to involve food and feasting but could some of these same foods
00:06:42.040 including several that we think are good for our health also be causing many of our most serious
00:06:47.200 health problems indeed we're facing a massive health crisis no less than 40 percent of americans
00:06:54.880 today are obese and about half of us are taking some form of prescription drug this could be
00:07:02.080 the first generation of children in the united states that lives less than its parents we spend
00:07:07.760 2.2 trillion dollars a year on health care over five times more than the defense budget
00:07:13.840 yet we're sicker than ever but could there be a single solution to all of these problems
00:07:21.460 A solution so comprehensive, yet so straightforward, that it's mind-boggling that more of us haven't taken it seriously?
00:07:29.940 Someone has to stand up and say that the answer isn't another pill. The answer is spinach.
00:07:37.400 A growing number of researchers claim that if we eliminate or greatly reduce refined, processed, and animal-based foods,
00:07:44.620 we can prevent, and in certain cases even reverse, several of our worst diseases.
00:07:50.480 They say all we need to do is adopt a whole foods plant-based diet.
00:07:55.440 It sounds almost too simple to be true.
00:08:02.380 This is like the example. 0.96
00:08:05.320 This is like the template for fat people are killing us all. 0.99
00:08:10.500 Right. 0.84
00:08:10.800 You can't tell from the audio, but this includes a lot of footage of like headless fat people
00:08:14.860 walking around.
00:08:15.620 I mean, it just, it really did feel like, oh, here we are in 2011.
00:08:19.500 yeah like it just it felt like the really kind of shouty coverage that we got about this stuff
00:08:26.180 for a long time also a lot of maintenance phase cameos in there we get richard carmona the
00:08:33.260 attorney general who started the like terrorism is the threat from without and obesity is the 0.98
00:08:39.260 threat from within the greatest threat to our national security we got bill maher bill fucking
00:08:44.580 an authority on diet and lifestyle the answer is spinach take the stairs uh we also got two
00:08:51.780 of the zombie statistics that we debunked in that episode this is the first generation that
00:08:56.920 won't live as long as its parents playing the hits and then we also got at the end sort of like
00:09:02.300 the thesis statement of the movie which is basically what if a plant-based diet could
00:09:08.660 solve and reverse all of these issues so like i am not reading between the lines or unfairly
00:09:14.900 paraphrasing when i say this like this is this is the overt thesis of this documentary the other
00:09:20.680 thing that i was going to say about that intro there is this assumption that if you are taking
00:09:26.280 a drug you should not be taking a drug yeah i really don't like this stuff there are absolutely
00:09:32.480 people who are taking drugs that make their heart keep going and make their lungs take in air and
00:09:38.120 like really basic biological functions and i mean like listen there are drugs i take absolutely
00:09:44.140 every day that have absolutely helped me stay alive at different points in my life yeah i don't
00:09:49.140 think that that's like a moral failing of mine that my brain chemistry looks different than other
00:09:55.180 people's brain chemistry it's also it's in keeping with a weird tendency of this movie to like gild
00:10:00.640 the lily fruits and vegetables are really good for you like people should eat fruits and vegetables
00:10:05.140 that's totally fine but like you don't need to say that eating fruits and vegetables will reverse
00:10:12.200 your like multiple sclerosis right we then get a little like the history of food section where
00:10:18.440 it's like you know the same kind of stock footage and we learn about like betty crocker and frozen
00:10:22.200 foods and all this kind of stuff this is familiar from like every other food documentary that came
00:10:26.900 out around the same time where it's just like the rise of processed foods and like people are eating
00:10:32.240 outside the home and, you know, people are joining the workforce, blah, blah, blah. And then we get
00:10:36.780 to this section where we learn about the links between animal proteins and cancer. I'm going to
00:10:46.660 send this to you. Send this to me. In the mid-1960s, Dr. Campbell was in the Philippines
00:10:58.500 trying to get more protein to millions of malnourished children.
00:11:02.860 To keep costs down, he and his colleagues decided not to use animal-based protein.
00:11:08.100 The program was beginning to show success.
00:11:11.380 But then Dr. Campbell stumbled onto a piece of information that was extremely important.
00:11:16.480 It centered on the more affluent families in the Philippines,
00:11:19.960 who were eating relatively high amounts of animal-based foods.
00:11:23.480 But at the same time, they were the ones most likely to have the children
00:11:28.140 who were susceptible to getting liver cancer.
00:11:30.880 This was very unusual,
00:11:32.440 since liver cancers are mainly found in adults.
00:11:35.560 But just the mere fact that it occurred in children said,
00:11:38.200 you know, there's something here.
00:11:39.140 This is pretty significant.
00:11:41.360 Shortly afterward, Dr. Campbell came across a scientific paper
00:11:45.360 published in a little-known Indian medical journal.
00:11:48.300 It detailed work that had been done on a population of experimental rats
00:11:52.140 that were first exposed to a carcinogen called aflatoxin,
00:11:55.720 then fed a diet of casein, the main protein found in milk.
00:12:00.720 They were testing the effect of protein on the development of liver cancer.
00:12:04.520 They used two different levels of protein.
00:12:06.920 They used 20% of total calories, and then they used a much lower level, 5%.
00:12:12.300 20% turned on cancer, 5% turned it off.
00:12:18.300 They love getting the shot of that Arby's sign.
00:12:21.640 I know.
00:12:22.340 I've been to that Arby's.
00:12:23.440 i mean i haven't been to it but like i've been by that arby's yeah you can tell they're going
00:12:27.060 back to the history of food stuff boy they really are americans discovered arby's okay
00:12:31.640 so i will say on the face of this i'm sure that you're going to be like this never happened and
00:12:37.260 this paper was never written or something like that but what i will say is just like on the face
00:12:43.180 of it i find it really fascinating that the presumption that because this particular health
00:12:51.660 phenomenon existed within children of affluent people that like the first place that they went
00:12:58.020 to was diet to explain it it's really odd to just be like it has to be their diet and it's gotta be
00:13:06.040 the meat like what one thing this documentary does and a lot of documentaries do is they bombard you
00:13:11.840 with a lot of information very quickly and at the end of it you're left with this impression
00:13:17.300 right of like okay wealthy kids in the philippines were getting liver cancer
00:13:21.120 we looked into it apparently it was the animal proteins giving them cancer right this is the 0.96
00:13:26.160 same kind of science communications that's in like the fucking zoloft bubble commercials 0.95
00:13:30.880 where they're like one side of your brain produces the happy chemicals and then the 0.93
00:13:36.000 other side with the brownie face can't accept them yeah yeah right this is uh science communications 0.88
00:13:44.280 that assumes you don't really need to know what's actually happening here. 0.98
00:13:48.360 The best science communications invites you to consider the complexity of the world,
00:13:54.020 and the worst invites you to ignore the complexity. So the paper that he's talking about,
00:14:00.700 it's a study on rats' susceptibility to this toxin, aflatoxin. It's a mold that grows on corn
00:14:08.980 and peanuts. And so this was a real problem in a lot of countries for a long time. In humid
00:14:14.780 environments, this mold grows. When you harvest the crops, you also harvest the mold and kids end
00:14:21.280 up eating this toxin. And yes, kids get liver cancer. Kids get all kinds of really awful
00:14:26.380 effects of this toxin from eating mostly peanuts, but also corn, especially in the developing world.
00:14:31.740 What they're doing is they're not looking at whether milk protein causes cancer in rats.
00:14:38.980 they're exposing rats to this carcinogen to huge doses of this carcinogen and then some of them
00:14:47.640 are like little vegan rats some of them are not vegan rats and you're like oh the non-vegan rats
00:14:53.160 got tumors which is true but it's like this is a specific effect of the toxin they're being given
00:15:00.620 this isn't just like rats existing in the world and the little vegan rats don't get cancer it's
00:15:06.220 not the same thing as a human child and it's not the same thing as eating corn once a week right
00:15:11.960 if you want even if you wanted to do this study in rats the rat answer would be hey man feed him
00:15:17.340 some of that corn right every once in a while so okay let's do you still have the clip up let's go
00:15:22.440 to 1637 together there we go 37 bing bang boom so this is the text that they show on screen
00:15:31.060 when they're describing this study.
00:15:33.840 Yeah.
00:15:34.180 So toward the bottom,
00:15:35.900 read the sentence that starts with in all.
00:15:38.380 In all, 30 rats on the high-protein diet
00:15:41.420 and 12 on the low-protein diet
00:15:43.640 survived for more than a year.
00:15:45.720 Low-protein here means vegan, basically.
00:15:48.160 Or like, this is the analog
00:15:49.300 that they're inviting us to consider. 0.99
00:15:51.360 So wait, what the fuck? 0.99
00:15:52.580 Yeah, yeah. 1.00
00:15:53.500 More of the high-protein diet rats survived?
00:15:56.380 So the vegan rats were twice as likely to die.
00:16:01.380 They had to stop the study because the little vegan rats kept dying.
00:16:06.600 So it's not useful for understanding humans.
00:16:09.520 And also it says the opposite of what it was going to say. 0.99
00:16:14.580 I feel like this is my new way of documentaries is just pause on every block of text and be like, hang the fuck on. 0.99
00:16:23.340 We're reading this entire thing. 0.98
00:16:24.680 So when they talk about this obscure study published in an Indian journal, the study is part of a two-part study.
00:16:31.620 One of the studies, which is what they're referring to here, is about the growth of tumors in the rats. 0.92
00:16:37.360 The other study is about why the rats kept fucking dying and the vegan rats were much more likely to die.
00:16:44.960 So I'm not going to say that like this invalidates vegan diets. 0.89
00:16:49.800 Like that would also be just as superficial as saying this proves vegan diets.
00:16:53.380 But like, okay, if it's turning off cancer, but you're more likely to die, then the cancer thing's kind of irrelevant, right?
00:16:59.820 Like we only care about cancer to the extent that it's killing people.
00:17:03.760 I love that a documentary would have this level of a self-own in it, that if you pause it, it undoes its own work.
00:17:11.160 It undermines itself if you read all of the text on screen.
00:17:15.780 Okay, so then we get to the other protagonist of this documentary.
00:17:20.580 So this documentary basically follows these two doctors.
00:17:24.540 One is T. Colin Campbell.
00:17:26.080 That was the guy who we just met in the Philippines.
00:17:28.620 And the other one is named Caldwell Esselstyn.
00:17:31.300 And he is telling us about his work as a surgeon and how that led him to do his own research.
00:17:39.520 So Dr. Esselstyn started investigating the global statistics on breast cancer.
00:17:45.120 One of the facts he discovered was that the incidence of breast cancer in Kenya
00:17:48.680 was far lower than it was in the United States.
00:17:52.680 In fact, in 1978, the chances of a woman getting breast cancer in Kenya
00:17:57.640 were 82 times lower than in the U.S.
00:18:02.640 Dr. Esselstyn was even more surprised by the numbers he discovered
00:18:06.000 for some other types of cancer.
00:18:08.100 In the entire nation of Japan in 1958,
00:18:12.040 How many autopsy-proven deaths were there from cancer of the prostate?
00:18:18.260 18.
00:18:20.060 In the same year, the U.S. population was only about twice the size of Japan's.
00:18:25.820 Yet the number of prostate cancer deaths exceeded 14,000.
00:18:30.940 Dr. Esselstyn also discovered that in the early 1970s,
00:18:35.200 the risk for heart disease in rural China was 12 times lower than it was in the U.S.
00:18:40.760 And in the highlands of Papau, New Guinea, heart disease was rarely encountered.
00:18:45.860 Even more compelling to Esselstyn was some historical data that had long been overlooked.
00:18:50.380 In World War II, the Germans occupied Norway.
00:18:54.520 Among the first things they did was confiscate all the livestock and farm animals
00:18:58.680 to provide supplies for their own troops.
00:19:01.420 So the Norwegians were forced to eat mainly plant-based foods.
00:19:06.260 Now we look at the deaths in Norway.
00:19:09.800 just antecedent to this period from heart attack and stroke.
00:19:12.680 Look at right up here, right at the very top, 1939.
00:19:16.360 Bingo! In come the Germans. 1.00
00:19:18.600 Well, hang on. 0.92
00:19:19.380 Immediately, 1940. Wow.
00:19:21.760 41, 42, 43, 44, 45.
00:19:25.020 Have we ever seen a population have their cardiovascular disease
00:19:28.720 plummet like this from statins?
00:19:30.980 What? I know.
00:19:32.620 But look what immediately happened with the cessation of hostilities in 1945.
00:19:37.580 back comes the meat back comes the dairy back comes the strokes and heart attacks
00:19:43.320 okay okay describe describe the visual feast that we just had in the last like 30 seconds 0.97
00:19:52.240 holy shit michael but first i will say while we were watching this clip i was like oh we are in 0.92
00:19:59.900 peak michael hobbs territory yeah why are people dying of this thing in this country but not in 0.99
00:20:06.060 this country is like prime grade oh i'm using meat metaphors yes spurious correlations are the
00:20:13.340 fillet of this documentary then we get a graphic that is one of the wildest things i have ever
00:20:20.620 fucking seen in my life uh you go to 2050 holy and see the chart in all of its glory
00:20:27.040 i know this is this is like monty python yeah the title of the graph is mortality from circulatory 0.99
00:20:37.680 diseases norway 1927 to 1948 and what it shows is more people dying of heart disease
00:20:47.760 that peaks at about 1940 and they have superimposed a little teeny tiny nazi flag
00:20:55.520 And it pops in like pop-up video. It's like, bloop. Nazis.
00:21:01.360 It goes like, great, good. And then mortality from circulatory diseases plummets.
00:21:10.820 You got to hand it to them.
00:21:11.820 Listen, if you were just looking at this graphic without the narrative that is offered by the
00:21:18.740 documentary it really looks like it's trying to credit nazis with like the heart health of norway
00:21:27.020 i posted this on twitter and people were like this seems unfair that you're posting this out
00:21:31.180 of context and i was like it is not better in context this is like yet another reason that
00:21:37.020 it's good that i'm not on twitter very often people were yelling at me and i was like i cannot
00:21:41.120 debunk this for you because aubrey might see it so just open your podcast app in like two weeks
00:21:47.140 Chill out. We'll be back in a minute.
00:21:49.440 So obviously, all of these country comparisons are extremely facile.
00:21:54.020 So the first thing he points out is that Kenya had a much lower rate of breast cancer than America in the 1970s.
00:22:02.320 Jesus Christ.
00:22:03.280 Obviously, the reason why you have less breast cancer in Kenya at the time is because Kenya does not have a health care system that is set up to do breast cancer screenings.
00:22:12.280 And also the rates of infectious diseases are significantly higher in Kenya.
00:22:16.460 So people are not dying of non-communicable diseases because they have like more urgent
00:22:21.760 issues that they're dealing with.
00:22:23.400 We then go to the extremely low rate of prostate cancer deaths in Japan, where I looked this
00:22:31.080 up.
00:22:31.280 It appears to be the case that prostate cancer rates are lower in Japan.
00:22:36.300 It's genuinely like kind of a mystery.
00:22:38.480 And like what frustrates me about this documentary is that like it's actually kind of interesting.
00:22:42.300 It seems to be more related to the fact that a lot more Americans get a surgical procedure
00:22:48.540 called a TERP, which is where they go up through your urethra and cut a little chunk out of your
00:22:55.280 prostate. And as part of this procedure, they usually do a biopsy on your prostate tissue.
00:23:00.620 Oh, so we're just checking way the fuck more often? 0.98
00:23:04.060 Yeah, basically, like that is the most obvious explanation. There's just a lot more screening 0.93
00:23:09.500 for prostate cancer, especially in 1958, which is the year that he refers to here.
00:23:14.520 Right. This feels reminiscent to me of that 60 Minutes clip about red wine.
00:23:19.480 Yeah, yeah, yeah.
00:23:19.860 I'm like, well, hang on, guys. There might be a story here, but you got to adjust for all this
00:23:24.840 other stuff first.
00:23:26.280 Right. He then takes us to rural China and Papua New Guinea and says that like their rates of heart
00:23:33.100 disease are much lower than the US. And again, this is true. They also at this time have 12 1.00
00:23:38.700 year shorter life expectancies jesus hell mao dies in 1976 uh china is coming out of like one
00:23:45.080 of the most brutal like decades-long repressive periods of like any country in history it's just
00:23:50.280 very weird to make this comparison right and talk about china as some sort of like utopia of like
00:23:55.240 better dietary choices all of this also plays into some narratives that are culturally really
00:24:01.560 tempting to a lot of americans right one of them is one that we've talked about before it's in a
00:24:07.720 book called diet and the disease of civilization which is sort of this belief that our diet is
00:24:14.080 evidence that we are part of a fallen society right when these narratives go in a direction
00:24:20.120 that your brain was already headed when they tell you things that you were already kind of thinking
00:24:25.480 those are points that are more likely to land for you right right that takes us to norway and the
00:24:31.940 nazis tell me about norway and the nazis jesus christ i thought this was like super interesting
00:24:36.940 it is true that the nazis occupied norway and like confiscated everybody's livestock and
00:24:43.460 immediately imposed like really strict rationing regimes people were so desperate for food that
00:24:48.920 they were like growing food in their backyards a lot more people started fishing just like get
00:24:53.420 food from the wild people like eating moss and shit like it is true that the dietary patterns
00:24:58.120 of norwegians changed very significantly and like very rapidly during this period
00:25:02.240 What the documentary doesn't mention, though, is what the war did to infectious disease.
00:25:09.140 So there is a researcher named Broda Barnes who wrote a book called Solved, The Riddle of Heart Attacks.
00:25:14.880 And he is looking at this period after World War II.
00:25:18.740 All over Europe, you have like rapidly rising living standards, right?
00:25:22.580 People are getting back to normal and they're rebuilding infrastructure.
00:25:26.640 Employment is really high.
00:25:27.760 They're setting up these health care systems, setting up welfare systems for the first time.
00:25:32.240 At the same time, you have an explosion of heart attacks.
00:25:35.700 And so it's like, well, people are doing everything you're sort of supposed to do, right?
00:25:39.400 They have like healthy diets, much better living standards, and yet heart attacks are
00:25:43.800 going up.
00:25:44.620 He starts looking at autopsy data from people in Graz, Austria, and he finds the same pattern
00:25:51.360 that they found in Norway, where there's this huge reduction in heart attacks and then
00:25:55.240 a massive increase.
00:25:56.400 This isn't all of the explanation, but the primary explanation for this effect is tuberculosis.
00:26:03.440 Having blocked arteries makes you susceptible to tuberculosis and it makes you susceptible
00:26:08.240 to heart attacks. It increases your risk of both of them. Before the war, most people would just
00:26:14.380 die of tuberculosis. If you had blocked arteries, you get tuberculosis, you end up dying of
00:26:19.580 tuberculosis. You don't live long enough to have a heart attack. After the war, you get treatments
00:26:24.760 for tuberculosis. So when you get tuberculosis, you get antibiotics and then your tuberculosis
00:26:29.440 goes away. You live a couple more years and then you die of a heart attack because you have all
00:26:32.800 these risk factors. Well, this is also something that has come up on the show before that you
00:26:37.540 have mentioned, which is essentially like how technologies and treatments are changing around
00:26:43.520 these conditions, right? So like we are still talking about heart disease in sort of the way
00:26:50.260 we did in the like 80s and 90s and treatments for heart disease and mortality rates and all of that
00:26:56.960 kind of stuff look really different now than they did 30 or 40 years ago well what i'm so fascinated 0.79
00:27:03.280 by is without any context you look at europe after world war ii and you're like holy shit the heart
00:27:09.380 attacks are going crazy like this is this is really worrying but actually it's good news right
00:27:14.840 because almost every single one of those people would have died of tuberculosis what that's
00:27:19.640 actually reflecting is a precipitous drop in tuberculosis deaths. But what it looks like from
00:27:25.660 the outside, or if you only look at this one metric, you're like, oh my God, we're getting
00:27:29.600 so much less healthier. You know, it's interesting as we're talking about this, I'm realizing how
00:27:33.540 many mortality numbers are just completely and totally decontextualized. Totally. I know that
00:27:38.760 this like fucked with my brain too. Yeah. The main way that I feel like I encounter mortality 0.99
00:27:44.360 numbers in the wild is not unlike this documentary where it's just like big block letters of a big
00:27:51.000 scary number in red but it's not stacked up next to here are some other you know similar levels of
00:27:58.500 mortality causers right like they're not giving you anything to relate it to they're just yeah
00:28:03.400 saying big numbers at you and the big numbers sound scary this takes us back to Norway so what
00:28:10.220 we find when you look into the actual specifics of Norway and you're not just trying to like make
00:28:14.040 a point with a graphic or whatever, is that tuberculosis and other infectious diseases
00:28:19.200 exploded in Norway during World War II. So this is from a paper about this. It says,
00:28:24.820 the incidence of infectious diseases increased substantially during World War II in Norway,
00:28:29.360 probably due to the introduction of infectious agents from the large contingent of German
00:28:33.740 soldiers and civilians, up to 450,000, and in addition, 100,000 prisoners of war from Eastern
00:28:40.140 Europe. So basically, a huge influx of people into Norway, some of those people are carrying
00:28:46.120 tuberculosis and other infectious diseases. And so heart attacks go down because people are dying
00:28:52.640 of other things first. You know, they're getting pneumonia, they're getting various other things.
00:28:56.740 Tuberculosis is one of the main causes. And there is actually a big outbreak of tuberculosis in
00:29:01.020 Oslo during World War II. But just kind of overall, people are just dying of other stuff.
00:29:07.020 Huh. So just like a rise in heart attacks isn't necessarily bad news. A drop in heart attacks
00:29:13.420 isn't necessarily good news. I think, again, particularly after having done a couple of
00:29:17.480 years of this show, I now feel so suspect when I see this kind of decontextualized reporting.
00:29:24.500 Oh, yeah. This one weird trick and then the graph goes down and you're like, what?
00:29:29.380 Yeah, this I'm I'm way too like mortality pilled to watch documentaries like this.
00:29:35.180 I was like watching it. I was like, it just has the structure of something that's wrong, right?
00:29:40.620 Like anytime you're like World War Two, and then the heart attacks fell. I'm like,
00:29:44.280 I don't think I think someone's probably written a PhD about this. And it's probably
00:29:48.000 significantly more complex. Yeah, this is the reaction that I started to have early on when
00:29:52.720 we were doing the show to headlines with a question mark in it. Yeah, I'm on to you.
00:29:58.020 We're not doing this. So to return to the film, we then go from Nazis to protein,
00:30:03.380 Yeah, the classic progression.
00:30:05.460 There's a whole thing.
00:30:06.400 They do more stuff about how like animal proteins cause cancer, but like it's all this aflatoxin 0.99
00:30:11.100 shit. 0.94
00:30:11.920 They do mention very briefly, and I don't know why they don't linger on this more, that 0.99
00:30:17.340 vegetarian diets do not mean that you're going to get a protein deficiency.
00:30:21.100 The whole thing of like you need all this protein to survive is basically just like
00:30:25.280 a decades long propaganda campaign by like the meat industry.
00:30:29.880 It feels a little bit similar to the fiber stuff.
00:30:32.220 it's similar to vitamin C stuff where we're like really bad at knowing what things have protein in
00:30:37.860 them. Yeah, yeah, yeah, yeah. Plenty of vegetables, plenty of beans, plenty of like, generally
00:30:44.540 speaking, Americans eat much more protein than any sort of nutritional guidelines suggest that
00:30:50.720 we might need. Also, there's dozens of studies on this. One of the ones that I found non vegetarians
00:30:56.540 are getting roughly double the amount of like daily recommended protein. And vegans are getting
00:31:01.740 one and a half times the recommended amount of protein. And so for non-vegans, we're getting
00:31:09.100 like 15 to 17% of our calories from protein and vegans are getting 13%. So it's not that big of
00:31:16.340 a difference. And I should say that those surveys are based on the same dumb food frequency 0.92
00:31:22.600 questionnaires that we're always criticizing in other diet studies. I don't believe biblically 0.78
00:31:28.200 in these numbers, but also one of the main problems with these food frequency questionnaires
00:31:33.140 is that people underestimate how much they're eating. So if people are saying that this is
00:31:38.260 how much protein they're getting, they're probably getting even more. And then even if you throw out
00:31:44.160 the food frequency questionnaire stuff, which is like totally legitimate, protein deficiencies
00:31:49.140 are just not a problem in the United States. Like people are not going to the hospital
00:31:53.660 with protein deficiencies. I'm guessing they're a problem in as much as hunger overall is a
00:31:59.120 problem. Yeah, this is what you find in the study. So I found a study that is finally just like
00:32:04.100 laying it out like brass tacks. It says, there is a widespread myth that we have to be careful
00:32:09.760 about what we eat so that we don't cause protein deficiency. We know today that it's virtually
00:32:14.540 impossible to design a calorie sufficient diet, which is lacking in protein and any of the amino
00:32:20.080 acids so basically when you look at actual protein deficiency cases it's almost always people with
00:32:25.740 like very rough eating disorders who just are not getting enough food overall right you would
00:32:31.620 legitimately have to try to design a diet that has enough calories but doesn't have enough protein 0.94
00:32:38.140 so unless you're doing this for like a fucking youtube challenge or something you're probably 0.63
00:32:42.040 fine my understanding is that this is the case on like a number of nutrients right like you don't 0.91
00:32:47.360 need to worry about how much riboflavin you're getting you know yeah the only exception i found
00:32:52.500 was that like if you're an elite athlete it turns out you do need more protein or whatever but like
00:32:57.060 you know that if you're an elite athlete like it's not it's not like you're learning this
00:33:01.900 from like an internet listicle for the first time and like the vast majority of the population
00:33:05.760 is not an elite athlete with like very specific macronutrient needs michael phelps isn't listening
00:33:12.240 to this episode going like oh interesting more protein all right good to know we then get a clip
00:33:20.960 about the ability of a vegan diet to reverse heart disease okay let's go send you a clip
00:33:31.320 dr esselston was getting some powerful data from the research he'd started in 1985
00:33:38.240 He began with 24 patients, but six had dropped out in the first year, leaving him with a total of 18.
00:33:47.080 At the end of five years, we had follow-up angiograms, and 11 of the group had halted their disease.
00:33:52.720 There was no progression, and there were four where we had rather exciting evidence of regression of disease.
00:34:00.340 These results were astonishing.
00:34:02.800 The diet produced something that medication and surgery never had before.
00:34:07.540 Actual reversals of heart disease.
00:34:11.420 They're again making some like very bold claims.
00:34:15.940 The underlying logic is like, you're basically immortal.
00:34:19.340 Right.
00:34:19.520 You will die of old age at, you know, 90 something or 100 and something because nothing's taking you down.
00:34:27.120 He's also papering over some like fairly weird number stuff.
00:34:32.120 Yeah, four cases.
00:34:34.240 Yeah.
00:34:34.420 This study that he's talking about, he does eventually publish it.
00:34:37.940 I'm getting a lot of this from a woman named Denise Minger, who is one of the only people
00:34:42.040 to, like, take this movie seriously and, like, try to debunk it.
00:34:45.440 So she points out that there's no control group.
00:34:49.500 It's self-selected.
00:34:50.940 People are going to this guy who's, like, at this point, a very prominent, like, vegan
00:34:55.020 advocate.
00:34:55.800 This is basically just an anecdote, ultimately.
00:34:58.300 Even though it's published, it's basically published as, like, a case study.
00:35:00.980 It's not, like, a randomized control trial or anything.
00:35:03.020 I can't really debunk that, but it's not clear that this really says anything about vegan diets
00:35:08.180 overall. But what's really interesting is that there are actually studies where these kinds
00:35:14.300 of interventions have reversed heart disease. So one of the most famous ones is, do you know
00:35:20.540 Dean Ornish? Sure. The Ornish diet. For sure. The Ornish diet. My mom was on that for years.
00:35:25.580 This was like a huge presence in our house growing up. Very big, very popular in the 80s.
00:35:29.580 Yes. He's basically like the patron saint of like low-fat diets. This was the guy telling you to like
00:35:35.420 eat carrot sticks. Like this is why your parents were doing that in the 80s.
00:35:39.140 He has a study that shows people like actually reversing symptoms of heart disease. And so this
00:35:46.240 is touted as like evidence that a low-fat vegetarian diet reverses heart disease.
00:35:52.020 However, if you read the actual study, it's not just a low-fat vegetarian diet. This is a program
00:35:59.340 where people are also quitting smoking they're also getting stress management training and they're
00:36:05.400 also increasing their exercise getting daily exercise oh so it's like a it's a full overhaul
00:36:10.680 on like how you were being in the world is now very different than how it was before that's a
00:36:16.860 lot more than just eating less fat in your diet and also you know after you have like a heart
00:36:22.040 attack or a stroke scare usually you're like extremely motivated to change your lifestyle 0.96
00:36:27.660 so a lot of these things work for like a year or two because people like holy shit i'm gonna die
00:36:32.520 and then they do like all this stuff at once so that doesn't mean that like a low-fat vegetarian
00:36:37.780 diet doesn't reverse heart disease but it's like we're doing 10 things at the same time i would
00:36:43.080 also say like in that year or two after you know a cardiac event or after a new diagnosis or whatever
00:36:52.140 you were extremely motivated to make a bunch of lifestyle changes. But you were also on a more
00:36:57.780 intensive schedule of health care. Yeah. Oh, yeah. There's like numerous scenes in this
00:37:03.080 documentary where they talk about how these like these vegan doctors are like, we're not like other
00:37:06.940 doctors. And there's a scene where a doctor goes with one of his patients to the grocery store
00:37:11.640 and like helps him shop for stuff and is like giving him recipes and like having him over for
00:37:16.180 dinner, it appears. So it might not be the veganism. It might be that like your doctor
00:37:20.780 really gives a shit about you. I would say also on this reversal stuff is like, just because it's 0.99
00:37:25.580 possible for some people doesn't mean that it is likely for everyone or possible for everyone
00:37:34.580 or guaranteed for everyone. But like the way that this kind of stuff comes across and the way that
00:37:40.860 it is pitched is this is a sure shot. Yeah. All of those caveats, which are all context are all
00:37:48.840 missing, right? I also think it's important to note that, like, it may be the case that vegan
00:37:54.140 diets can help people reverse heart disease, but that's not the only diet that has been shown to
00:37:58.580 do that. Sure. So there's studies of the Mediterranean diet that have shown that.
00:38:01.880 There's studies of low-fat diets. There's studies of low-carb diets. There's a study of a high-fiber
00:38:07.420 diet. And one of the most interesting things I found was one of the studies showed that people
00:38:12.820 tend to stick with a vegetarian diet longer when they're doing these programs, because obviously,
00:38:18.480 like the initial burst tends to go away after a year or two and one of the reasons why vegetarian
00:38:25.040 diets might be good for managing things like diabetes and heart disease could just be that
00:38:30.020 people find it much easier to stick to over the long term because like vegetarian diets are like
00:38:35.780 fairly entrenched in our lives like you can go to a restaurant and be like oh hey what do you have
00:38:40.560 on the menu that's vegetarian yeah whereas if you're on like the mediterranean diet or i'm low
00:38:45.600 carb. There's just a bit more friction. I will say I think the it's easier to be vegetarian
00:38:52.460 take is a very coastal city dweller take. Yeah, in part because this is one of my favorites.
00:39:00.500 A good friend of mine is vegetarian and works in politics in Montana and ends up at a bunch
00:39:06.460 of fundraising dinners. She will ask for the vegetarian option at said fundraising dinner
00:39:12.380 and we'll be given chicken oh yeah that's vegetarian for montana yeah it's a bird
00:39:17.000 you're welcome yeah this used to happen when i lived in germany a lot too that my american
00:39:22.280 friends would be like what are your vegetarian options and they'd be like veal it's like uh
00:39:27.700 no i think the baby animals are still animals and then okay so after this we then get one of
00:39:34.460 the weirdest clips of the entire movie so they're catching up with people who were in
00:39:41.000 this heart disease study and so we're doing like a follow-up with one of the patients and the
00:39:46.020 benefits in their lives anthony and the other male patients also noted another change when you're
00:39:52.700 young when you're a teenager you see a female and so on it gets kind of excited and the first
00:40:01.240 reaction physically you know it gets uh attention you know raise the flag i call it this happened to
00:40:08.300 us. All the other Dr. Esselstyns, I call them all the guinea pigs. The flag still rises.
00:40:18.860 What? So now we're just talking about dicks? So this dude gets boners. We're talking about 0.99
00:40:26.100 this dude and his boner. God damn it. But he's talking about raising his flag. Very patriotic. 1.00
00:40:32.260 I was all ready to like debunk this. The thing about like a vegan diet reversing your erectile
00:40:40.100 dysfunction is obviously not supported by the data. However, erectile dysfunction is a precursor
00:40:46.960 of heart disease. And so it's now becoming a thing that they actually tell patients that if
00:40:52.760 you're middle-aged and you start getting erectile dysfunction and there's no kind of like obvious
00:40:56.900 reason for it, then like you should go get your heart checked out because it's like your arteries
00:41:01.980 closing and it's something right it's like a blood flow issue yeah yeah yeah this is a thing
00:41:06.240 to look out for if you're not raising flags don't so that's basically the end of the documentary
00:41:13.260 we're we're only like two-thirds of the way into the documentary at this point but the rest of the
00:41:17.840 documentary is just a bunch of stuff that is true but like kind of irrelevant so there's a long
00:41:25.440 sequence with like a an mma fighter and he's like it's possible to be an athlete and a vegan and
00:41:30.960 like, yeah, yes, it is. Okay. There's a whole section about how school lunches suck. Like,
00:41:36.980 yeah, that's, that's true. There's a very baffling part where he talks about like milk being bad for
00:41:43.500 you and like milk, milk is poison. And then there's a really funny chart where they point
00:41:49.200 out that the countries with the highest milk consumption in the world have the highest rates
00:41:54.680 of hip fractures which is a sign of osteoporosis what so it turns out milk doesn't actually make 1.00
00:42:01.080 your bones stronger this is some fucking pete evans shit yeah dairy leeches calcium from your bones 0.99
00:42:07.320 was his thing i believe i love this as like a spurious correlation because all of the countries 0.99
00:42:13.040 that have the highest milk consumption they're all scandinavian countries and most of the countries
00:42:18.340 with the lowest milk consumption are like tropical countries in like southeast asia in debunking this
00:42:23.360 movie people point out that all of the countries with high milk consumption have very cold winters
00:42:30.180 and one of the main reasons why people fracture their hips is falling on the ice yeah so you just
00:42:36.280 in thailand have a lot fewer hip fractures than you do in norway which has nothing to do with
00:42:42.800 milk consumption it's just like there's a reason people fall down in scandinavia so then the worst
00:42:50.140 by far the worst section of this movie is there's a lady who's a marathon runner and then she's
00:42:56.580 diagnosed with breast cancer they're like oh she was told to get radiation and chemotherapy but
00:43:01.540 instead she went on a vegan diet and now she's like running iron man's right we're back in sort
00:43:08.600 of gerson therapy adjacent territory yeah i like this was where i mean not that i had a lot of
00:43:14.160 confidence in this documentary but i was like this is really irresponsible yeah vegan diets are fine 0.98
00:43:19.960 but don't tell people that they fucking cure cancer what the fuck is wrong with you i mean i 0.96
00:43:23.880 feel i would say i feel sort of shades of gray that way about most dietary interventions into 0.99
00:43:31.140 most health conditions right if someone is telling you and is not presenting pretty hard and fast
00:43:38.400 data that like x y or z dietary change means that you cease to have a chronic health condition 0.83
00:43:46.060 yeah all of this shit just needs to be tempered and presented in context in order for us to
00:43:52.020 understand it properly but then this gets us to what i want to spend the rest of the episode on 0.98
00:43:56.960 which is the years-long debate about whether a vegetarian diet is good for you oh just full
00:44:04.300 stop just like is it healthy period like are you healthier eating a vegetarian diet than
00:44:10.280 not eating vegetarian diet this is the core claim of this movie let's do it so to talk about this
00:44:16.040 we have to talk about vitamin e okay vitamin e is a now notorious antioxidant in the 60s and 70s
00:44:24.740 there were a bunch of mouse studies that show that this helped oxidate the bloodstream and could
00:44:30.800 reduce plaque in like their little mouse hearts after this kind of very preliminary like hypothesis
00:44:38.800 generating stuff on animals people start doing these observational studies on humans vitamin e
00:44:44.760 is found in like it's in like sunflower oil and almonds and peanut butter and all kinds of stuff
00:44:49.480 and so they start doing these big cohort studies where they ask people what their diet is and what
00:44:55.720 kind of health markers they have how early they're dying etc and so again and again studies are
00:45:00.620 finding that people who consume more vitamin e like live way longer this is starting to look
00:45:06.380 pretty strong in the 1990s right it's like well it's happening in animals it's happening in people
00:45:12.100 So we should probably start giving people supplements for vitamin E, right?
00:45:16.340 So in the 1990s and 2000s, doctors start giving vitamin E supplements to patients,
00:45:21.020 especially patients who have had some sort of cardiac event.
00:45:23.860 So people who are recovering from heart attacks start getting vitamin E supplements.
00:45:27.620 So the daily recommended amount of vitamin E is 22 international units.
00:45:33.680 And doctors start giving patients either 400 or 800 international units. 0.99
00:45:40.400 Holy shit. 0.97
00:45:41.220 20 to 40 times the daily amount jesus and so after this wave of animal studies after this 0.98
00:45:48.620 wave of observational studies we start getting randomized controlled trials of people who are
00:45:53.160 taking vitamin e and people who aren't taking vitamin e and it turns out that vitamin e has
00:45:59.160 no effect and for some people vitamin e actually increases the risk of heart attacks these are not
00:46:05.420 large effects yeah but people who take large doses of vitamin e are 13 more likely to have
00:46:11.340 heart failure in one study oh wow so there's now been this huge turnaround on vitamin e and the
00:46:17.880 entire field is like oh fuck we really got this one wrong we're basically giving people large doses
00:46:23.760 of this thing that there really is no evidence for at this point yeah so people have now gone back 0.83
00:46:30.220 and have done this sort of like, what happened?
00:46:33.260 Like, how did this whole catastrophe take place with vitamin E?
00:46:37.160 And what they've identified is something called healthy user bias.
00:46:41.800 In all of those observational studies,
00:46:44.780 the people who were getting more vitamin E
00:46:46.900 were people who were eating more almonds, eating more vegetables,
00:46:51.200 they're getting more fiber, they're basically eating like a better diet.
00:46:55.040 And those foods happen to have vitamin E, 0.98
00:46:57.760 but it wasn't the vitamin e that was making those people healthier it was all of the other shit that
00:47:03.180 they were doing yeah which also probably correlates to higher socioeconomic status it also probably 0.96
00:47:10.480 correlates to not having other disabilities is my guess yes i mean i think about this often with
00:47:17.340 celery juice too right like if you're a person who can afford a juicer and has the time in the
00:47:24.220 morning to juice 16 ounces of celery and drink it and then wait a half an hour before you eat
00:47:32.380 anything else oh yeah there's all this other stuff that's sort of loaded into that it's not just a
00:47:38.260 matter of like oh any person who drinks this celery juice will have this effect or whatever
00:47:43.900 this form of bias is like a huge existential problem in these kinds of studies one of the
00:47:51.920 large effects that i found in other various like meta analyses is that people who brush their teeth
00:47:57.800 regularly have 30 lower mortality than people who don't brush their teeth yeah what that's covering
00:48:03.100 is not necessarily that brushing your teeth extends your lifespan people who brush their
00:48:07.980 teeth are more likely to engage in all kinds of other healthy behaviors yeah this turns out to
00:48:13.180 be the central problem with comparing the health of vegetarians to the health of non-vegetarians
00:48:19.260 If you just look at the raw data, vegetarians and vegans have like way lower rates of everything, diabetes, strokes, cancer, they live longer, like basically any health thing that you can name, vegetarians do better and vegans do even better.
00:48:36.580 But that doesn't necessarily mean that it's the diet that is doing it, right? Because only around 5% of the population is vegetarian or vegan. And the non-vegetarians is like everybody else. So you're basically taking a very small subset of the population who are like way more health conscious in a million ways.
00:48:58.960 vegetarians get more physical activity than non-vegetarians vegetarians are less likely to
00:49:05.060 smoke they are less likely to drink they're more educated they tend to be from like more affluent
00:49:12.200 backgrounds although they actually have lower incomes than the population at large but that's
00:49:17.380 mostly of just the fact that they're younger sure and then one of the things that this this
00:49:22.160 documentary does that i think is is a very interesting bait and switch is throughout the
00:49:27.000 documentary they talk about like the benefits of a plant-based diet but they always add this little
00:49:31.940 modifier they say a whole foods plant-based diet yeah well that's a big fucking difference but then 0.96
00:49:38.300 they don't define what the fuck whole foods means and like in these awful little montages 0.97
00:49:44.420 they have this b-roll of like a family at mcdonald's and they're sitting there eating french 0.97
00:49:50.820 fries and it's like very clearly designed to be stigmatizing but also french fries are vegan
00:49:56.940 Yeah. French fries are like pretty close to a whole food, right? You chop up the potato and
00:50:01.940 you cook it. What they're basically doing is like very clearly promoting a vegan diet. Like the
00:50:08.760 whole movie is like, you know, milk is poison, meat is poison, et cetera. But they're also
00:50:13.400 giving themselves this like little asterisk of like, well, if you're a vegan and you still get
00:50:18.600 cancer, like the foods you ate weren't whole enough. Yeah. That's the difference between like
00:50:25.620 the kind of veganism that eats at like vegan restaurants and drinks a bunch of green juice
00:50:31.480 and all that sort of stuff. And then like your vegan roommate in college who kept yelling about
00:50:36.040 how Oreos are vegan. Yeah. Where you're like, yeah, yeah, yeah, yeah. There's a way to eat in
00:50:44.020 a way that people sort of like associate with a lack of health for kind of any way of eating.
00:50:49.640 Yeah, exactly. So like, if you look at surveys of like the food behavior of vegans and vegetarians, it's like they eat less fat, they eat less sugar, they eat more fiber, they eat fewer calories overall, they eat foods with higher nutrient density.
00:51:05.560 And, like, I'm not married to the idea that, like, any of these other things are necessarily explaining the differences.
00:51:12.660 Like, I don't think there's, like, a diet that is best for everybody.
00:51:15.820 But it's, like, there's almost no one who has the same patterns as the average American but doesn't eat animal products.
00:51:24.460 The fact that vegetarians and vegans, like, live longer and have all these, like, better health markers, maybe that means that vegetarian diets are healthier.
00:51:31.980 we can't rule that out, but we can't say it with any confidence either because it's like there's
00:51:36.520 like 15 or 20 differences between vegetarians and non-vegetarians. Sure. I mean, it would also
00:51:42.820 be interesting to look at like people who are vegetarian for religious reasons. Like I'm
00:51:47.000 thinking of Hindus, right? Yeah. Okay. Does that play out differently or the same? Yeah. It's very
00:51:52.240 weird to me that the vast majority of studies on this only look at UK or US vegetarians when like
00:52:00.060 40% of the population of India is a vegetarian. Oh, interesting. Although it's also an interesting
00:52:05.960 demonstration of how difficult this is, because in rich countries, being a vegetarian is a sign
00:52:13.240 of high socioeconomic status, right? It's like Reese Witherspoon in like Big Little Liars.
00:52:19.520 But in poor countries, vegetarianism is associated with low socioeconomic status. Because when you're
00:52:25.260 super poor, you're eating basically just like rice or potatoes or like some other like super
00:52:31.280 basic starch because you can't afford anything with higher protein or higher fat. And so as
00:52:36.560 people move up the income ladder in poor countries, what tends to happen is they don't actually eat
00:52:41.140 more calories, but they eat more higher end food, things like meat and eggs and dairy.
00:52:47.940 So it also speaks to how this is always couched as like a biological thing and how this affects
00:52:53.560 of the body, but like it's extremely social. Right. The idea that we could just cleanly say
00:52:59.280 this is straightforwardly because of vegetarianism or because of a fully plant-based diet
00:53:05.660 feels like, again, I'm not sure that we've eliminated everything else just yet.
00:53:10.240 Well, one thing I will say, so I called up Catherine Flegel to help me with this episode
00:53:15.540 because we've kind of become pals since we did an episode on her like a year and a half ago.
00:53:20.600 i love everything about this i know i i she's like an actual methodology queen i'm like
00:53:26.440 joking about my methodology queen status but she like actually knows what she's talking about so
00:53:31.040 like i check in with her when i have like a technical question we're like the fantasy football
00:53:35.900 yeah a lot of the studies on vegetarians versus non-vegetarians do use statistical controls so
00:53:44.700 like we've controlled for income we've controlled for age we've controlled for gender etc so
00:53:48.900 statistical controls allow you to compare like for like. So vegetarians on average are much younger
00:53:54.980 than non-vegetarians. So if you're going to do a study, you have to control for age because
00:53:59.260 otherwise it's going to be like, there were no heart attacks because young people don't really
00:54:02.360 have heart attacks. So controlling for age allows you to compare 60-year-old vegans and 60-year-old
00:54:08.720 non-vegans, right? And rich vegans and rich non-vegans. You can hold everything else constant
00:54:15.280 so you're comparing like for like, which is great. However, you can only control in that way
00:54:21.960 for the variables that you gather. So if you have data on socioeconomic status,
00:54:27.120 then you can control for it. If you have data on gender, you can control for it.
00:54:30.840 Very few of the studies that I found controlled for health insurance status. 0.77
00:54:34.900 That seems like a big one, dude.
00:54:36.600 I know. And one of the weirdest findings, there's all this research showing that vegans and
00:54:42.600 vegetarians have higher rates of depression and anxiety but i don't think that's the fucking diets 0.96
00:54:48.620 i think they're more likely to have health care sure a condition of existence at this point is 0.98
00:54:53.780 a certain percentage of people are just going to be depressed and anxious and like the differences
00:54:57.940 who can access treatment and who can't right so like i i don't think that that means anything but
00:55:03.040 then i also don't think that the the health stuff really means anything either because you can't
00:55:07.680 control for all of the behaviors that distinguish vegetarians from non-vegetarians this is where
00:55:14.720 the vitamin e comparison comes in a lot of those studies on people who eat vitamin e live longer
00:55:20.240 they did control for things like socioeconomic status and gender and age and all this other
00:55:24.560 stuff that you're kind of supposed to control for but there's some residual stuff that you can't
00:55:29.620 control for because you don't have every single piece of data that you would need to control for
00:55:34.880 Yeah. So I read a really interesting article about like the problem with observational studies.
00:55:42.920 You know, it used to be that like the threshold for publishing these kinds of studies was like
00:55:48.640 you would need like a three to four times greater risk to publish something. Like people who eat
00:55:54.620 apples are four times more likely to have heart attacks or whatever. A lot of the studies coming
00:55:59.560 out about these kinds of risks and a lot of the studies on vegetarians and vegans, it's like,
00:56:04.540 you're at 10% higher risk of a heart attack. Yeah. Which your overall risk for a heart attack
00:56:10.340 was like 1% and now it's 1.1%. Yeah. It's very small. And then these small gradations are easily
00:56:18.860 swamped by like, Oh, all the shit you couldn't control for. Yeah. Another one of the articles 0.99
00:56:23.580 that I looked at pointed out that smokers are 20 times more likely to get lung cancer than
00:56:29.520 non-smokers sure and like you can say like okay smokers also have some characteristics that make
00:56:35.600 them different like that's you know it's a minority of the population there's other things
00:56:38.780 that distinguish them but like if we're talking about a 20 times difference it's like oh well
00:56:43.660 people who smoke don't get as much sleep it's like all right maybe that knocks it down to like
00:56:47.680 19 times more likely yeah but it's like a pretty decisive impact so much of this like this whole
00:56:54.160 field of observational studies. It's tiny effects. And like given everything else we know about the
00:57:00.660 muddiness of this data and like the bad track record of these fucking studies, like we just 0.98
00:57:05.900 can't really say anything. Well, there's also a bunch of stuff that like there have been 0.95
00:57:11.140 illustrated links between these things and heart disease, things like experiencing racism or
00:57:19.700 experiencing weight stigma right like all of these things are linked to some kind of heart
00:57:26.160 health conditions right you're not going to be able to control for that stuff necessarily either
00:57:32.100 right like right there's just like a bunch of stuff that like structurally is going to be
00:57:37.060 too difficult to build into any one study right i mean i also want to say that like it also is
00:57:44.600 plausible to me that like i don't know vegetarian vegan diets are better for you like none of this
00:57:49.000 rules out vegetarian and vegan diets and like people aubrey people who go out of their way 0.95
00:57:55.580 to like dunk on vegetarians online are like some of the saddest fucking people i've like ever come 0.96
00:58:02.040 across just mind numbingly boring so boring there's i i came across this first when i was 0.99
00:58:08.400 researching our carnivore diet episode where there's these weird fucking meat influencers 0.95
00:58:14.200 who like make up these vegans to dunk on they're like vegans don't want to admit me and it's like 0.99
00:58:21.120 dude just eat meat or don't eat meat man but shut the fuck up about like what it's so fucking weird 0.98
00:58:27.460 jesus christ there's a real strain of this in like anti-fat activist stuff where they'll just 1.00
00:58:34.300 like make up shit that they're like fat activists say it's fat phobic to have a decent resting heart 0.85
00:58:41.380 rate and you're like no one has ever said that do what you want to do man there's i watched this 0.99
00:58:45.800 presentation by this academic lady who did like the myth of vegetarianism or something and she
00:58:50.220 was like you say you care about animal rights but what about the animals that are killed to grow
00:58:54.740 crops what it's like i don't like i don't think that vegans are like pretending that their actions
00:59:01.520 have no effect on any animals whatsoever i think it's just like really easy to opt out of like the
00:59:07.720 worst forms of animal torture yeah and like people are doing that yeah and like it's such a
00:59:12.920 fucking weird thing to do with your time to like criticize other people who are like trying yeah
00:59:18.980 to have like less of an impact on like living creatures and the planet it's like you're just 0.98
00:59:23.440 as bad as me we're all kind of bad so like it just seems like a weird thing to be proud of
00:59:28.980 it's just three cattle ranchers in a trench coat but five million joe rogan listeners in a trench
00:59:34.460 coat but yes jesus christ so i want to end with a quote from the annals of internal medicine this
00:59:41.040 is one of the only editorials i found that says what i have been thinking for like many years now
00:59:47.840 oh it's an issue where they go over a lot of these like meta analyses of like red meat this
00:59:52.600 is during the fucking red meat wars in 2019 when a bunch of studies come out about this 0.62
00:59:56.320 and this editorial says it may be time to stop producing observational research in this area 0.96
01:00:04.100 These meta-analyses include millions of participants. Further research involving
01:00:08.800 much smaller cohorts has limited value. High-quality, randomized controlled trials are
01:00:13.280 welcome, but only if they're designed to tell us things we don't already know.
01:00:17.340 I love to see this, that people in the field are like, let's not do this anymore. Every single
01:00:23.820 time one of these fucking studies comes out, it's like red meat will kill you, red meat will save 1.00
01:00:27.900 you, whatever it is, coffee, breakfast, anything. We know how these things are going to be framed 1.00
01:00:33.700 in the media and we know how they will be received by readers. The only reason you click on a
01:00:40.780 headline about like drinking coffee in the morning causes cancer, drinking coffee in the morning
01:00:45.380 cures cancer. The only reason to read those stories is to adjust your own habits. The general
01:00:50.800 population is not interested in these studies for like biological epidemiological population
01:00:56.980 level reasons. Nor are we reading the original text of the studies, which always say we cannot
01:01:02.420 determined cause. Yes. Right. All it's doing is like fanning the flames of like the closest
01:01:07.740 sort of diet world gets to culture wars. Yeah. But this is a road to nowhere. Or it's a road
01:01:14.080 to where we already are is maybe a better way to put that. The whole thing is this quest for like
01:01:19.140 the best diet. I think that is a pointless quest. Yeah. Are vegetarian diets better for you? Seems
01:01:25.420 like a very simple question. But it turns out the science that we have available to us can't really
01:01:31.380 answer it and that's basically going to apply for any kind of dietary pattern if you are just
01:01:36.920 happier on a vegetarian diet than not on one then like that works great for you and you should do it
01:01:41.840 for other people it's going to be mediterranean for other people it's going to be low fat for
01:01:44.860 other people it's going to be nothing i don't know that more of these studies is really doing
01:01:48.760 very much for us okay so what i'm hearing is that i should go vegan and paleo at the same time just
01:01:56.700 hearing you say that made me raise my flag no michael oh no i'm going to hr that just happened
01:02:26.700 Thank you.