Transcription
There was all this hype that the human genome project was going to, you know, within a decade we were going to cure all all human disease. Our genes haven't changed, right? Uh uh and and so it's not our genes, but the microbiome has changed. And the human the a human has about 25,000 unique genes. Our microbiome has 50 million unique genes, right?
Why can't we just go back to what we ate as homo sapiens in the savannah and around the world which is you would think that our system and and our physiology adapted to to that type of nutrition. But what's interesting is agriculture was introduced into different regions of the world at different times um depending on you know when it sort of became really a big part of the diet. And in every case, at the same time agriculture was introduced, if you look at the fossil records, teeth and other fossil records, people got much much sicker.
What is one really productive food to add to your diet to boost and augment your uh your your natural gut microbiome to the state that it should be in? A key bacteria called um B infantis, which is in, you know, more traditional communities, 90% of infants have be infantis. It's fed by breast milk. it it it absolutely blooms and becomes the dominant uh bacteria in the gut. It helps you know normalize the immune system, improve metabolic development. Um in in the United States, 80 to 90% of infants don't even have bin infantis. It's missing. It's gone. It's been wiped out. And so even if they're breastfed, they don't have bin infantis. And so there and that's very likely related to the rise of allergies and poor metabolic health and these other things.
So maybe as an adjunct to the food pyramid that we've all seen, it's continued to change. When do supplements make sense? When should we pick them up or when is it time to put them down? Yeah. All right. So, we're ready to go. Welcome to the Pulp Dental podcast where we talk about all things dentistry and non dentistry from a generational perspective. I'm Ali Nasseh and I'm joined today with my co-hosts, Dr. Parsa Shahidi and Dr. Roene Nasr. And Dr. Koch is not in the studio today, but we have a very very special guest today. Parsa, we're transitioning from all these dentistry topics and questions to something that's universal, health, nutrition, and diet. So, can you introduce our guests? It's my honor. nobody would question the level of expertise of our guest today. He is really really a definitionally a world expert in cardiology, public health, food medicine, science, all the above. He's a Thompson Reuters most influential scientific mind. Dr. Mozaffarian received his bachelors in science from Sanford, his MD from Colombia and his doctor in public health from Harvard. He is actually a Taek Won Do fourth degree black belt. He is a distinguished professor dean emeritus and uh gene mayor professor at the Friedman school of nutrition science and uh policy. He's a professor of medicine at tough school of medicine and he's an attending physician in the division of cardiology at Tufts medical center. He has authored more than 600 scientific publications on nutrition and other cardiometabolic health related topics and he serves on numerous advisory councils and in fact the president's council on sports fitness and nutrition. We're extremely excited Dr. Mozaffarian to welcome you into the studio today to talk about all the amazing work you've done in food science and medicine. Welcome in.
Yeah, it's great to be here and great to be with you. You know, one of the striking things is in the medical field, um, dentists for a long time have recognized the links between nutrition and health because of the links to oral health and and and and gum health and and tooth health. And so the rest of the medical field is slowly catching up. Of course, it is. I mean we we've talked about this here that the oral cavity is the gateway to to to the health and to the rest of the body and you know nutrition obviously is what bridges the gap here that's what the oral cavity is for for the most part now you have Dr. Mozaffarian authored this recent JAMA article on the perspective of the dietary guidelines that have been released and this dietary guidelines have created a lot of buzz in the media primarily because of the fact that it has not just like in the past been telling people what to eat but this time there is a question of what kind of things to avoid and not eat. Why don't you tell us a little bit about overall what the impetus was for the idea behind the guidelines since you had a a big hand in developing them and then we can talk some specifics about the role of saturated fats and carbohydrates and so on and so forth.
Yeah. Well, I think first, you know, we should just step back and say why is a cardiologist talking about nutrition at all? Like how did I get here? And I think it's worth emphasizing that if we care about health, food and nutrition has to be the single top thing that we care about. Not top three, not top five, not top 10, literally the top one priority for for the healthare system. And of course, it's missing in the health care system. And that explains so much of our problems. Uh, poor nutrition causes about 45% of all cardiovascular disease. It causes 70% of new cases of diabetes. It kills more than 500,000 Americans a year and it causes 16,000 new cases of diabetes a week. So, you know, this is this is the dominant cause of poor health, disability, suffering and death in this country. And yet it's largely ignored by the healthcare system and that's kind of what got me into this field in the first place. And that's changing that's rapidly changing with food as medicine as we'll talk about. I think the dietary guidelines which come out every 5 years, I didn't have a hand in them. uh you know these these come come from the government but I certainly followed them closely and uh whenever I was asked for advice about the directions I I gave I I gave advice to whoever whoever asked to whoever asked but I had no formal role at all in the guidelines. Uh but I think they're they're quite important and and most people actually don't even know about the guidelines. So there's going to be people who are going to be listening who are like oh they came out I didn't even know that you know which which is fine but they're influential in a couple couple of ways. First they come out every five years. There's an independent scientific committee that provides a guidance report and then USDA and HHS the agriculture and health departments together put out the guidelines. They have two major roles. You know, one is to inform the public and their success at that uh entirely depends on the budget and resources put toward that which is usually zero. Uh and so most people don't hear much about them. The average person doesn't hear hear much about them. And then the second role which is actually potentially even more important than than the public communication is they're supposed to guide many federal programs. And so school meals are supposed to follow the guidelines which is you know 30 million uh school lunches and and 15 million school breakfast a year. Military nutrition is supposed to follow the dietary guidelines. Federal cafeterias are supposed to buy food consistent with the guidelines. VA hospitals are supposed to serve food consistent with the guidelines. uh and yet like the like the communication of the public it doesn't happen automatically and so agencies have to take the guidelines and turn them into rules and rulemaking so that that actually happens and that sometimes takes years or never happens and so for example you know the dietary guidelines have recommended lower salt for decades and school meals still today don't meet the salt sodium guidelines and so so those are what they're supposed to be for and we we we'll talk hopefully at the end about about imple implementation this year. Um, you know, this this cycle, this 5-year cycle, the guidelines are quite interesting because they happen every 5 years. It's not exactly with any administration. And it just so happened that the scientific advisory committee part of the guidelines was happened under the the Biden administration and the scientific committee that the Biden administration appointed gave their report to the Trump administration and then the USDA and HHS for the Trump administration had to then put out the guidelines. And so that was a little bit of a interesting, you know, handoff, a little bit of a bipartisan attempt in a world that doesn't exist. Yeah.
And so and so that that actually led to some interesting controversy about how much these guidelines actually listen to that scientific committee report. But what's always happened in the past um every every 5 years is that the science committees usually are pretty good. They'll look at the evidence, say, you know, it's not perfect, but they look at the evidence and they say, "Here's things Americans should eat more of. Here's Americans should eat less of." So prior guideline committees have said Americans should have less soda, they should have less processed meats, they should have less refined grains and other things and they should have more, you know, fruits and vegetables and seafood and and beans and and nuts, for example. What's happened every time when those guidelines have reached the agencies is the agencies have said, "Great, Americans should eat more of something. Let's recommend that. More fruits, more vegetables, that's great. It supports agriculture. It supports farmers. Oh, the scientists told us Americans should eat less of something. Let's not talk about that." And so they basically have ignored those recommendations and no prior guidelines have really emphasized what not to eat. Um, and they've not ignored it completely, but they've hidden it. They've hidden it behind nutrient targets. And so instead of saying don't drink soda or don't have candy, they say, you know, keep your added sugar to less than 10% of calories, right? Instead of saying don't have processed meats, they say keep your saturated fat below 10% of calories and so on. And so that really has led to this, you know, decadesl long approach which which is has been sort of the the clinical approach to nutrition is that there are no bad foods. Everything's okay. Eat everything in moderation. As long as you're within your nutrient targets, everything's fine. And obviously everything's not fine. We're we're really really really sick. And so and so, you know, to to get to the the crux of your question, what's really new in this guidelines has never ever been before before done is that the US government in their official guidance is telling Americans not to eat very specific food groups that if you put them together, it's almost 60 or 70% of calories in the food supply.
You've talked about for a while, Dr. Mosafar, and this idea that we're in a metabolic train wreck, right? You I think I think that's an important wakeup call. And we talked about the number of deaths per week. I'm just going to quote a few things. 10,000 deaths from poor nutrition on a weekly basis. 1500 new cancer cases. 16,000 new diabetes cases per week. All tied to poor nutrition. And then you know we have and those aren't the total numbers. Those are just tied to poor nutrition, right? And and I think the question is here and obviously the economic impact we'll get into. You know the that there's been a shift in what's been put out in terms of saturated fat. We're talking briefly protein processed foods. What are some of the highlights you'd want to share about what's come out and that you're really, you know, in support of actually?
Yeah. So, so the guidelines have some things that are unchanged and we should just talk about those because because people usually don't talk about what's the same. And so they continue to recommend, you know, fruits and vegetables. Very important to eat fruits and vegetables. They continue to recommend whole grains. They continue to recommend low salt and and keeping keeping salt low. That's all consistent. Um, they actually fudge a little bit around alcohol. they they recommend low alcohol, but they took out sort of any numerical limits. And so that's a little weird. We can talk about that, but there really other than that, there's um kind of four, you know, big big changes to to the guidelines. The the first is what I mentioned before is that there's many many categories of foods that the government says avoid or or limit. And and words matter in federal, you know, policy. And avoid or limit are the strongest words. You know, you could say reduce or or you know, but they say avoid or limit. Avoid is very strong. And so the first, you know, category of foods to avoid uh is, you know, they say highly processed foods, packaged foods, ready to eat foods or foods high in uh added salt or sugar. They say to avoid specifically sugar sweetened beverages. Um they say to avoid foods that have more than 2.5 or to five grams of sugar per serving, which is most sweetened foods. Um they say kids less intention of zero added sugar. Uh and they say to avoid um uh artificial sweeteners, artificial colors, artificial preservatives, artificial flavorings, which has never ever been said before. And so if you put all that together, highly processed foods, packaged foods, ready to eat foods, foods with sugar, foods high in salt, foods with artificial sweeteners, additives, like I said, it's it's about 70% of the food supply. It's all the ultrarocessed foods that are making us sick. It's all the most of the grocery store, right? That's right. Uh and that's not never been emphasized before. And so that's one of the the the biggest changes and it's because of the scientific evidence that's become clear that there's heterogeneity in that category, right? Like ultrarocessed yogurt is probably still better for you than ultrarocessed white bread. But on average, those foods are making us sick. And so I think that's the biggest single change. And then the other three changes which I'll just quickly mention but we can go into each of them is to embrace healthy fats to increase protein and to really uh eliminate or avoid refined grains.
Wow. I mean, the I just want to pinpoint one thing on the fats because I think it's a whole discussion in itself and you talk about that that one of the biggest shifts was from you know talking about fats as being kind of a a demon right you know no fats in salad dressings no fats in in in yogurts no no non- sugar options but now it seems like the the guidelines recommend that uh you know it's really about the ratio of saturated to unsaturated fats is what what you talk about being important. Can you dive deeper on the fats part because I think a lot of people are focused now on that. You know, see the trend of keto diets, etc. What do you think about that?
Yeah. So, um, as I hope we can talk about more, I have a book coming out in October called Food is Medicine. And the first section of the book is is the history of how we got here. And you need to know how we got here to know where where to go. And so, it's worth stepping back and say, how did we even get into this low-fat focus? And and really what the the book goes into is the first you know twothirds of the 20th century nutrition science and policy focused on the science of the time which was the discovery of vitamins which were discovered in the 1920s and 1930s very recent and the fear of global famine from not enough calories. And so the focus of the most of the 20th century was was food production and vitamins. Uh and so that was the focus really until 1980 of the dietary guidelines was get your vitamins, get your calories. That led to what's called the green revolution kind of industrial, you know, industrial monocropping. It uh and so on. And so when you go down the cereal aisle and you see boxes and boxes of starchy staples, cheap, fortified with vitamins, that wasn't an accident. That was the very specific goal and direction of most of the 20th century. And so it wasn't really until around 1980 that that um uh you know policy makers and scientists started really thinking about other diseases besides vitamin deficiency diseases. And and we know when we talk about vitamin deficiency diseases we're talking about things like pelagra or nasin deficiency or or night blindness from vitamin A deficiency or ricketetts from vitamin D deficiency. These were prevalent diseases. These were common in the United States in in in the 20th century. And so those policies to address those were wildly successful. We eliminated famine and sort of true caloric hunger in the United States and much of the world. We dramatically reduced vitamin deficiency diseases. And so people said, "Well, what do we turn to next?" And and they said they started noticing that people are dying of heart attacks. And the Framingham Heart Study was starting to publish in the 1960s. Then for the first time people said, "Hey, maybe blood pressure and cholesterol levels, you know, are contribute and maybe we can address these." And that was all relatively new science. And so the focus shifted from vitamin deficiency diseases to chronic diseases, particularly heart disease. And the mistake that was made, the the sort of, you know, intuitive uh error that was made was well, we we dealt with vitamin deficiencies by finding the nutrient, right? there's a nutrient that causes, you know, scurvy. There's a nutrient that causes um pelagra. What's the nutrient that causes heart disease? There must be a nutrient. Let's find it and let's deal with it. And so, the mistake that was made was that very simplistic kind of what we call reductionist approach to food was extended to to heart disease. And so, saturated fat and fat and cholesterol became the nutrients that were the problem. And we've fast forward now, you know, 45 years later, and we've learned that that was a mistake, right? A single nutrient deficiency disease can be cured or caused by a single nutrient by definition. But complex chronic diseases, obesity, oral health, cancer, cardiovascular disease, uh diabetes, brain health, autism, allergies, they're not caused by a single nutrient. They're caused by a much much more complex constellation of food factors. So, so when that happened, um in 1977, there was a Senate committee that tapped Dr. Mark Hexath from Harvard to kind of come up with a report about this. And so in 1977 he put out a report uh uh which recommended for the first time that Americans have low fat, low saturated fat and low dietary cholesterol. And that was based on what we call ecologic studies um which is comparing across countries. And so the seven countries study was a famous ecologic study. People saw that countries that had higher fat had tended to have higher rates of heart disease and countries that had lower fat tended to have lower rates of heart disease. And the exception was France, which led to this idea of the French paradox that people pinned on red wine, but it wasn't really red wine. Um, something a lot of red wine don't have. Yeah. That red red wine makers loved love that story, but that really wasn't wasn't the case. And so that was the best science they had was sort of these cross-country studies and then some very simple animal experiments and some simple human trials. And so Hegathth put out these recommendations and then he was tapped to go into USDA and lead the 1980 guidelines. And so the same guy then put out the 1980 guidelines and and you know he he he was doing his best he could with the science he had. I don't want to he's he's an amazing scientist and contributed a lot but he made a mistake. He recommended lowfat lows saturated fat low dietary cholesterol diets. And what's interesting is while um people still think of those three things together or I do at least um two of those things the dogma has fallen away and we've accepted it but saturated fat remains and so total fat was dropped in 2015 as as a target. the the 2015 dietary guidelines said Americans no longer need to limit total fat. Although it was very quiet and most Americans don't know that dietary cholesterol was dropped as a nutrient of concern in 2015 because the science showed it just wasn't that important because dietary cholesterol doesn't affect blood cholesterol that much. Uh and again that was pretty quiet although there was there were some stories about like eggs are back and shrimp is back but saturated fat has continued and persisted as this kind of dogma orthodoxy from from 1980 and and you know the the the basic point is all of them were wrong. all, you know, saturated fat, cholesterol, and and and and total fat. None of them are really related to heart disease. You can have a healthy diet or a terrible diet that's high in fat or low in fat, or high in saturated fat or low in saturated fat, it it depends on the foods you pick and and and how you put them together. So, so I think that that's what's really interesting about these guidelines is that while prior guidelines have slowly moved away from low-fat diets, very, very slowly and gradually, it's been like, you know, baby steps. And so they'll say, "Okay, go ahead and have nuts. Nuts are good for you, but you know, they're energy dense, so don't have too many and be careful." They never say that about strawberries or apples. Like, why do you say that about walnuts? Or they say, you know, use extra virgin olive oil, but be careful. Do it within your caloric needs. There's still this, you know, collective fear of fat. And these guidelines for the first time actually say embrace, they use the word embrace, embrace healthy fats. So, they're really encouraging people to eat more fats. And that's probably one of the if you had to pick one simple, you know, instruction for eating a healthy diet, it would be eat lots of healthy fats. Um, and so I think that's very positive and and a, you know, a positive outcome of these dietary guidelines.
Yeah. What's interesting is all of us here have some kind of a science background and to me it's like if you look back historically and from an evolutionary biology point of view, right, you have to look and see how our species evolved, right? For millions of years, we've been having a diet. And then all of a sudden, the past hundred years, as you said, as we move from trying to address the problems of scarcity and we've moved into the problems of abundance, now what we've chosen to create is just car, you know, mostly carbohydrates and calories. But why can't we just go back to what we ate as homo sapiens in the savannah and around the world, which is you would think that our system and and our physiology is adapted to to that type of nutrition. Doesn't that make sense to you?
Yeah. I mean, we are evolved to be hunter gatherers, right? We evolved to have minimally processed, structurally intact foods, whole foods, nuts and grains and beans, a little bit of game, a little bit of meats, you know, kind of fish, all all mixed together. Um, the challenge is there's now 9 billion of us, right? Not 200 million of us. And so for for millennia there were 100 200 million humans. There was enough food. uh and and when agriculture developed and about 10,000 years ago really took off agrarian society um humans got much sicker and that's been a relatively recent discovery and we I sort of you know talk about this in in the book as well people used to think oh the discovery of agriculture was a boon for for humanity right and we all of a sudden didn't have to like scrge for food and we had had stable food supply but what's interesting is agriculture was introduced into different regions of the world at different times um depending on you know when it sort of became really a big part of the diet and in every case at the same time agriculture was introduced if you look at the fossil records teeth and other fossil records people got much much sicker um more fractures you know lower height um more more uh uh dentition disease um other evidence of of illness everything you can glean from from from the from the record and so we actually got much sicker with um basically the production of starchy calories and crops than we did as hunter gather. So the problem now is we can't go back to that hunter gather lifestyle because there's 9 billion people. And so so we're not going to solve the problems of today and we're certainly not going to solve the problems of tomorrow with the with the solutions of yesterday, right? And so we have to understand how we got here. We have to understand where we are today, but we actually have to understand the solutions for the future. And that's the the part three of my part two of my book is where we are today. And part three is where we need to go. What are the solutions? And and and we can talk about about those things. But you're right. Ultimately, the recipe for a healthy diet is minimally processed foods, right? Um nuts and seeds and and fruits and vegetables and beans and legumes. Dairy is a are healthy, particularly fermented dairy. We can, you know, we can talk about fermented dairy. Um poultry, eggs are okay. They're not necessary. You don't we don't need them, but they're they're fine. Red meats in moderation are fine. There's some pro-inflammatory effects of red meats. We probably don't want to have too too many red meats. Uh, and then and then processed meats like salami and bacon and low-fat deli meats are actually kind of like ultrarocessed foods. And so we shouldn't be be eating too many of those. And I think of all the families that sent their kids to school with bologn or or buy bought turkey sausage because it was low fat. They thought it was a better choice than beef sausage, right? And actually did did did harm, you know.
Yeah, that's kind of something I'm interested about actually. I feel like we've talked a bit about misinformation or misunderstood themes and notions that have generally evolved as we enter the age of influence and kind of leave the age of information. Are there any core truths that you found that you kind of have thought to debunk some of these thoughts of eat everything in moderation or anything that parents, kids or anyone else has thought to be the truth but you've actually found not the case?
Well, you're right about, you know, the kind of social media um explosion, right? People get their in information not only from social media, but in camps. Yeah. Where there's algorithms that reinforce their their own views, uh making it very hard to break out and get get accurate information. I think the the challenge with nutrition is people are so busy and there's so much going on, people are looking for not only a simple rule, but a simple rule that's no more than one or two words to remember. And you know, when it comes, yeah, when it comes to smoking, okay, don't smoke. When it comes to activity, just move, do anything. But nutrition is complicated. You can't break it down to simple rules. And so, lowfat, low carb, even natural or organic, um, you know, even local, those simple rules get you toward the path of of where you want to go, but they're not accurate. And so, I think that's what's what's challenging. And in social media, uh, on top of this, there's actually a lot of money to be made. and and so people make money from clicks and likes. And while there are, you know, media programs like this one that are doing their best to get, you know, valid information out to people and really talk about the issues at length, the people that are really getting the millions and millions of clicks and likes and and the money, um, they get more clicks for conspiracy theories and outrageous claims than sort of nuance and subtlety. And so there's a lot of misinformation out there, you know, that that seed oils are toxic, right? seed oil. Seeds are the seeds and nuts are the healthiest foods on the planet. And so the oils extracted from seeds are incredibly healthy. So soybean oil, canola oil, safflower oil, sunflower oil, these are great healthy oils. And so there this is like a big myth that's out there about feel like it dominates every you know health reel or YouTube video.
I mean as you as you speak Dr. was I feel like a million questions come to our mind and it's I mean every one of these could be an atlength conversation in terms of the crux of the you know the some of the shifts that have happened we talked about a little bit about uh at length of fats and then the processed foods and I think one of the things that you know we'd want to hear your perspective on that I think for the most part is pretty much universally you know uh the messaging that's been consistent across you know the health the health thought leaders is protein Right. And I think um you know, correct me if I'm wrong and what I'm wrong. It's it was8 g per kilogram uh previously and now we're talking about 1.2 to 1.6 g per kilogram uh as a recommended daily dosage of protein. And you know talk you know tell us about the importance of that and and and let us know if you think that you know that's probably the most important uh piece of advice you can give to someone trying to optimize their health in terms of the macronutrients they're getting is protein. the absolute number one uh piece of all of it.
Yeah. Great. So, so yeah, so that's a perfect ne next phase to talk about. So, we talked about the big change in the guidelines to recommend less processed foods. The the other big change to embrace healthy fats. Uh and then, you know, the third really big change was an increase in the in the protein guidance. And so, uh for decades, it's been 0.8, you know, grams per kilogram of of body weight per day. Uh and now it's 1.2 to 1.6 is the new new guidelines. It's very hard to to turn into, you know, numbers. And by the way, it's supposed to be your your lean body mass. Okay? So, if you have obesity, you should kind of adjust for that. It's supposed to be kind of your your healthy body mass, not your whatever your your weight is. But if you it's easier, I think, to turn it into percentage of calories, and if you turn those numbers into percentage of calories, it's a little bit easier to think about. So, originally, it was about 10 to 12% of calories. That's kind of where the guidance was before. And now, it's around roughly, you know, 15 to 20% of calories. um roughly um so it's a higher amount recommended. So so a few thoughts about this new recommendation which which in some ways has been the most controversial part of the new guidelines and what the media have focused on because um secretary Kennedy and others have said you know steak is back and go ahead and you know eat eat what you want and and there's been all these articles that they're recommending meat and steak and protein because they didn't actually say eat more more steak or red meat. They doesn't say that anywhere in the guidelines. Just says protein. Um it says protein. And so when people think of protein, they think of of red meat, but the guidelines actually say eat more protein from a range of of sources. And they say eat more protein from real food. They make that very strong point. And so they say eat it from red meat, but p poultry, eggs, dairy, uh plant sources, you know, eat your protein from a mix of plant and animal sources. So first like let's get to the science of protein. So I guess the first point is that change from a purely technical perspective doesn't make that big of a difference because Americans are already there. Americans are on average eat 16 to 17% of calories from protein right now. So they were already above the previous guideline and they're already in the current recommendation. And so if you're out there eating food, you're already meeting the guidelines. You don't need to need to change your protein intake. That's the first key point. I think the second key point is that um like the low-fat guidance of the 1980s that was oversimplified and we sort of had this gave this health halo to low-fat foods. Um uh and we should talk about snackwells and low-fat frozen yogurt and all these foods that that that chicken McNuggets were invented. I can't believe it's not butter. Jel Jell-O became like a big dessert, you know. Um lowfat foods really had a health halo. Now, high protein foods have a health halo because of this guidance and and and and because of the last few years of kind of influencers. That's a mistake. That's a mistake. And so, let's let's, you know, talk about protein. Um, you know, to answer your question directly and then get into the science, absolutely not. You should not be focusing on protein as a as a way to a healthy diet. You should be focus you should be focusing on on the quality of the overall diet. And and here's why. So, um, if you're strength training and you're actively in a regular program of strength training, there are many many randomized trials showing that you build more muscle mass. Um, interestingly, um, uh, and that and you build more strength and you build more function. So, so that's clearly the case. And so, if you are in an active strength training program, um, you need to have more more protein. And that level of protein, six 15 to 20% of calories is the right target. And again, most people are already there. Um, that's that's fine. But if you're not strength training the which most people aren't um the evidence for higher protein intake being helpful is pretty limited and one way to think about it is well if you get you know amino acids into your bloodstream and you haven't been strength training in the last week what's going to happen to them where are they going to go right and and they don't they don't build muscle. If we could eat more protein and build muscle we we'd you know all do that right? So where do they go? They get turned by the liver into fat. Uh, and so just like starch and sugar, extra starch and sugar get converted by the liver to fat for energy storage if you don't need them, extra protein gets converted by the liver to energy storage. And so, uh, you know, you can actually increase fat by eating too much protein if if you're not strength training. So, so I think that that and and you know, people talk about, well, post-menopausal women have, you know, declining muscle mass, older adults have declining mus muscle mass or sarcopenia. um uh people who have who are sick and have heart failure and and so we should be eating more protein but without strength training you're not going to do any good. So, so I guess the bottom line is, you know, I would say kind of big principles. Um, first you you should maintain your muscle mass and so you should strength train, right? That's really important. And and roughly the proportion of your activity that should be aerobic versus strength training is roughly your age. And so when you're 25, 25% of your activity should be uh strength training and 75% should be aerobic. And when you're 75, 75% should be strength training and 25% should be aerobic. keep up your muscle mass. You should you should do more strength training as you age. Keep up the muscle mass. And then if you're strength training, make sure you're getting enough protein. It could be plant protein, animal protein. Um and and it's not that hard to do. You're probably already getting it without even trying. And that and that third, um I I guess four points. Third, um that if you're not strength training and you eat more protein, right, you're you're not going to probably get be getting much benefit and you may be even hurting yourself. And then lastly, um what whether you're strength training or not, it's not just the protein that matters. And so you have to think about what else is coming along with it. What are the what's coming along with it? And so are you going to have a protein source that also has fermentable fibers for the gut that also has bioactive polyphenols that also has lots of other positive things that has pro probiotics, prebiotics, or are you going to be eating a protein source that has tons of salts, tons of sugar, highly processed, and is going to be hurting you. So the amino acids are the same, right? But you have to think about what it's coming with. And and so what I'm really worried about is already leading up to the dietary guidelines, the country has been starting to obsess about protein um because of kind of the online, you know, man bros, you know, that are that are like carnivores and eating protein. But now with the dietary guidelines, it's getting supercharged. And so you have high protein Pop-Tarts. It's it's actually a real thing. High that's protein Pop-Tarts. You have Dunkin Donuts super sugary drinks that are, you know, add add protein. You have protein cheese puffs. You have protein cake batter. Protein ice cream. Yes. I mean, ice cream already had protein in it. So So I that's what I'm really worried about. And and to the credit of the dietary guidelines, they say do not have highly processed foods. And so nobody should be trying to get their protein from processed foods.
That's interesting. So that that kind of is also along the same lines of these big jars of GNC amino acids that a lot of bodybuilders use as protein shakes, right? Because I mean that may give you a lot of protein, but it's also processed. Would you say that?
Yeah. I mean, again, if you're working out and especially if you're a bodybuilder and you're trying to gain muscle super fast, it's going to help. It's going to help. I I it'd be better to get the protein from a real healthy food, but it's going to help. It's going to add muscle mass. I mean, there's not's But if you're But most it is processed, but you're you're burning it off, right? You're taking in the protein and you're using it, right? You're using those amino acids. But if you're not really rigorously strength training and you're doing that, and a lot of people are, they're adding that little protein boost to their coffee order or their or their breakfast shake and then they're just going to work and sitting on their office chair. That's not going to be helping you and it could be hurting.
I guess the the confusion for me because the messaging is really interesting, Dr. was around the you made a point which is I I think really unique is it well if you are actually not expending that energy and using that protein you know efficiently it can actually do more harm for you is that associated with just the extra calorie intake because of the protein or is it because you're now misdirecting those calories to protein when you should be getting healthy fats you should be getting you know uh antioxidant rich foods it what is the reason that it can be negative for you you mentioned fats storage. But yeah, you know, if calories aren't a concern, somebody with lean body mass or or low BMI, what what is the problem?
Yeah. So, so complexity is the is the name of the game for modern nutrition, it's extremely complicated, right? Um but but you know, kind of breaking it down to some of the the basic principles. If it even saying you're eating calories for your needs varies depending on how processed the food is. And and so um because if you eat a minimally processed food with intact natural cell structure or an intact natural physical structure uh like a nut or a bean or a legume or even you know a piece of poultry, some of that protein and calories actually gets to your large intestine and is digested by your bacteria. So you're eating 2,000 calories, but your bacteria is digesting 300 of those calories. Whereas if you have a, you know, a Dunkin Donuts with with, we're in Boston, so you know, you have a Dunkin Donuts with a little extra protein or you have a protein thing in your in in your shake or or a protein pop-tart, that is going to be rapidly digested in the stomach and small intestine and nothing gets your large uh gut microbiome. And so that same 2,000 calories that you ate is all digested by your tissues. So even just saying oh if you have like calorie balance depends on the food because your microbiome can digest some of that. Secondly the the foods and nutrients you eat can turn on or off heat generation thermogenesis and so humans have brown fat which is we discovered in hibernating bears. It keeps them warm in in the winter. We thought adults don't have brown fat. We knew infants do but they do. Um white fat which is energy storage can turn into beige fat which is calorie burning. And so literally the food we eat can turn on or off thermogenesis. A lot of that's mediated through the microbiome. And so what you eat can change your resting energy expenditure. And so and so secondly, kind of the food choices you have and what kinds of foods you're eating can change your resting energy expenditure. How many calories you're burning without doing anything. And that difference also in studies can be two or 300 calories per day. And so we're talking about two or 30 hundred calories per day of a delta of the microbiome digesting calories versus your tissues and another two or 30 hund calories from thermogenesis versus lack of thermogenesis. What you eat has incredibly powerful effects. And you can't just say, well, I'm eating calories that's okay for my energy needs. But all that aside, you know, let's go go back go back to your question. if if you actually are, you know, expending the number of calories you're you're taking in, the protein is going to get converted to energy and you're not going to gain fat and it's probably not going to be bad for you. Um, but but again, most people because of high if most people who eat highly processed foods, which is most of Americans, they're starving their gut microbiome. They're not getting all the beneficial metabolites from that microbiome digestion. More calories are being shunted to their own tissues and away from the the microbiome. their thermogenesis is blunted because they're lacking all the polyphenols and bioactives that are in that are that are in natural foods and so they are in in excess calorie intake and that's why we have a obesity epidemic and so processed proteins are going to be harmful in them and so on average processed proteins I think are are a bad thing if you're eating kind of a Mediterranean style or or okanowan style or you know pick pick a traditional culture um uh a banto bantto hunter gatherer style um healthy diet and you're exercising, you can eat almost anything you want and you're going to be healthy. So a pound and a half of you know fresh salmon you know while you don't need a pound and a half will not necessarily be a net negative for your body depending on your you know that's right interesting.
And on the the note of overconumption or under consumption where do supplements and vitamins kind of come into the mix? when are they relevant, when are you overdoing it, and stuff like that. So, can we can we continue the conversation about obesity since you mentioned overconumption and then come back to the vitamins? I think that's really important.
So, so um you know, again, I I I I want to, you know, talk about my book, Food is Medicine, and hopefully you can put the link ready to um pre-order. It can it can be pre-ordered. It's coming out from from McMillan. Um just because I I want to really have people read and understand these things. The the second half of the book is about where we are today. And so I have a chapter on heart disease, a chapter on obesity, chapter on the microbiome, and then kind of a chapter on what to eat. And so let's let's talk about obesity a little bit. I started to touch on these these questions with uh microbiome versus host partitioning of calories, uh thermogenesis, but but what's fascinating about obesity and and overconumption is there is this uh concept that we're all over eating. There's this concept that that has is widely discussed that um you know food industry has hooked us on addictive foods and marketing and we're we're all overeating and we're not exercising enough. So the question is is do the empiric data actually support the fact that we're overeating, right? Are there data on that? And you would assume there are, but are there? And so I I've looked at this and we've published on this on this recently. There are not. And this is kind of just mind-blowing. And so I wanted to to touch on this a little bit before we got to supplement. So from the obesity epidemic started uh in the in the 80s uh you know when I graduated college in '91 um there was no obesity epidemic like nobody we there just wasn't a thing. It didn't exist. And so
The obesity epidemic really took off after 1990. So the question is, what changed in the 80s? Um, the 1950s, 1960s, and 1970s wasn't this golden age of lifestyle, right? What, what, what changed? And so, really, the processing of food is really, really what changed. The green revolution, the loss of biodiversity is what changed. And over the 1980s and 1990s, our calorie intake crept up as our body mass index crept up and our obesity crept up. It all kind of made sense. We were eating more processed foods, all the stuff you think about, you know, sugar-sweetened beverages were going up. You know, refined grains were the biggest thing that went up, actually, processed grains. So all that kind of made sense till around 2000.
And, and if that was the end of the story, I could, we could go to the next question. But, but, but around 2000, a really interesting thing happened as we really started paying attention to the obesity epidemic, which was really around 2000. And people started paying attention to it. Soda consumption went down. Uh, people started paying attention to their calories. People, people really started thinking about this. Calorie intake went flat. And so from 2000 to now, over 25 years nationally, the average calorie intake in the United States has gone down. Right. Wow. And we've gotten more obese. Wow. And so there's a huge paradox there. There's, there's a double paradox there. The first paradox is we're getting more obese while our calorie intake has been flat or declining. And the second paradox is even, even just the increased tissue mass requires more calories to maintain. If you have somebody who weighs 200 pounds or somebody who weighs 180 pounds, all else being equal, they need more calories to just maintain the mass. So even if we weren't eating more to cause obesity, the fact that we're bigger, we should be eating more calories. And so calorie intake has been flat in this country. What about physical activity? Physical activity has gone up in this country. We, it's gone up by all measures. Um, including objectively measured, doubly labeled water studies. Physical activity energy expenditure has gone up. Gym memberships have gone up. Memberships and running teams, people are exercising more, not much more, but more. So, our calorie intake is flat or declining and our, and our physical activity has gone up. Why are we getting more obese? Yeah. Right.
And so, this gets back to the microbiome and physiology and biology. Uh, and I really believe it's again, the, the two things I talked about. There's very good evidence just published in the last couple of years in Nature and Cell and other terrific papers showing that our resting energy expenditure has declined. Uh, and our microbiomes have changed. And so why? And our resting energy expenditures have declined over 20 years by 200 calories per day. And if you want to, you know, look, and there's been lots of metabolic, um, uh, uh, uh, quantification of this, an energy gap of about 20 calories a day will lead to weight gain. Right? If every day you eat about 20 calories too much, you will have a couple pounds of weight gain. And you'll, you'll gain weight and, and then the next year you have to do that again because you'll get in a new steady state. So if you're always like 10 or 20 calories up, so we have a 200 calorie gap in resting energy expenditure that's more than enough to explain the obesity. And I think that's thermogenesis. I think we have become cool. We have become cold humans because of processed foods and changes to our microbiome. And then also separately from, from that, we can't measure this energy partitioning between the calories we're digesting and the calories the microbiome is digesting. And as I mentioned, if you eat, there's been great studies of this, if you eat a minimally processed diet, we might digest 80% of those calories and the microbiome might digest 20%. Um, if we eat a super processed diet, we're going to digest 98% of those calories. And so on a 2500 calorie diet, that's a 15% calorie difference. That's another 200 calories. And so there's roughly 400 calories between thermogenesis and microbiome starvation, um, that we are missing. And that's the missing calorie gap. And so it, it means that we are not actually overeating as a nation. We're all paying attention. Everybody's trying to eat less and, and our biology has been hijacked by ultra-processed foods. Our microbiomes have been hijacked. Our thermogenesis has been hijacked. And so even this idea of overconsumption is false, right? It's not, it's, it's malconsumption. We're eating the wrong things. We're not eating too much. We're eating the wrong things. Yeah.
And it's interesting that our microbiome has changed so much as well. And I mean, you can see that also just historically. We're talking about, you know, our forefathers and the Homo sapiens as a whole. We had a whole different relationship with nature when we had parasites, all kinds of stuff inside us. I mean, you know, eosinophils have been pretty much not busy recently in the recent time. So the hygiene theory, all these things have changed our, our gut biome plus the use of the antibiotics and the feed and so on have killed a lot of that biome, um, in us as well. So to what extent, so I mean, I feel like, so, whole show just talking about the microbiome and its effect on the nutrition and the diet and just the overall, uh, arc of our evolution, but, um, do you think that there could be a time in which a microbiome type of, um, friendly, I mean, you see some of these nutritional things, people, you know, recommending probiotics and things like that, where do you see the effect of that overall in the, is it just hype like many other things, or is there some potential benefits? And, and I want to get back to supplements. So I don't want to forget that. But let's, let's continue. I, I think the microbiome. I think it's, it's quite interesting. So in addition to just highly processed foods, which get rapidly digested in the stomach and small intestine and starve the, the microbiome that way, highly processed foods also lack a lot of fibers. They lack a lot of other prebiotics. Polyphenols are are powerful, uh, prebiotics. And so we're starving the microbiome in a lot of ways, but we've very likely disrupted the microbiome in other ways. And so antibiotics is one really important one. Antibiotic use skyrocketed. I mean, penicillin was, you know, discovered after World War I, right? And then antibiotic use has skyrocketed in the world, and that's likely changed our, our microbiomes. Um, there's a, a key bacteria called, um, B infantis, which is in, you know, more traditional communities. 90% of infants have B infantis. It's fed by breast milk. It, it, it absolutely blooms and becomes the dominant, uh, bacteria in the gut. It helps, you know, normalize the immune system, improve metabolic development. In, in the United States, 85 to 90% of infants don't even have B infantis. It's missing. It's gone. It's been wiped out. And so even if they're breastfed, they don't have B infantis. And so there, and that's very likely related to the rise of allergies and poor metabolic health and these other things. So, so that's, that's changed. Antibiotics have changed. The, the, the hygiene has changed. I always, I always eat food off the floor, you know, like I just, I just, you know, we have, we have immune systems, right? And people are super, drop something, pick it up, eat it, you know, and, um, people are so like caught up in, you know, in, in hygiene, and, and that's changed. And then on top of that, you know, something that I used to dismiss and, and make light of was all the, all the additives, chemical additives and contaminants in our foods. I, I used to say, well, like, it's not a big deal. A peach is a peach, you know, it doesn't matter. It's, it's a big picture. But there's more and more research about, um, artificial sweeteners, POS, um, BPA, um, you know, all these contaminants and additives and emulsifiers, uh, common, common additives that are in most processed foods that they interact with our microbiome, they disturb our microbiome, their endocrine disruptors, their obesogens. And so if you put all that together, the, the, the loss of natural cellular structure, the loss of prebiotics, the additives, the contaminants, the, um, lack of the appropriate bacteria at birth, um, you know, we, I, I think the microbiome is, is everything. And I remember when the Human Genome Project came out, um, I was like, this is hype. I'm, you know, I'm like a public, I'm a doctor. I'm a, I'm a cardiologist, but I've also have a PhD in public health. And just, it's just basic statistics, right? We weren't obese in 1980. It's 2000. We're obese. Like, it's not our genes, right? It's been 20 years. That's true. And, and so there was all this hype that the Human Genome Project was going to, you know, within a decade, we were going to cure all, all human disease. Our genes haven't changed, right? Uh, uh, and, and so it's not our genes, but the microbiome has changed. And the human, the, a human has about 25,000 unique genes. Our microbiome has 50 million unique genes, right? We have about, you know, uh, uh, I might get the numbers a little bit wrong, but we have, I think, roughly 30 trillion organisms in, in our human cells. There's 40 trillion other organisms living with it. So by cell count, we're more bacteria than human. And so I think the microbiome is, is, you know, 80% of the game. And it's why we have so many diseases and not just the physical diseases, mental health, anxiety, depression, anorexia. There's been, there's been case studies, just case studies of women with anorexia nervosa tried on every, every therapy, cognitive therapy, behavioral therapy, forced feeding, and, and failed. They get a fecal transplant, and they gain healthy weight, right? Um, so, so, and, and terrific animal studies to support that. So, I really think it's, it's we've, we've harmed our microbiomes over thousands of years. Um, but we've really, really hit them hard the last 50 years. Yeah, it's amazing.
So, what is one thing that, you know, we can do? I mean, as we, you know, we want to put a little emphasis and attention on your upcoming book, and I think if this podcast is any indication, you know, you can sign us up for, uh, right here. Um, but really quickly, Dr. Mafarian, some really quick case questions. You can answer them in one or two sentences. What is one, uh, you know, really productive food to add to your diet to boost and augment your, uh, your, your natural gut microbiome to the state that it should be in? Yeah. Well, I think nuts and seeds are nature's powerhouse, right? So 80, 90% fats, really healthy fats, fiber, polyphenols, bioactives. I, I think of them as foods that give rise to life. You plant them in the ground, they give rise to, rise to a new plant. Nuts and seeds are amazingly powerful. Um, you know, if I had to pick one, have, have nuts and seeds every day. Perfect.
And really quick, two more of these. If someone is a, you know, high BMI, type two diabetic, pre-diabetic, and they have to choose between a, you know, Coke Zero, non-sugar, or a, you know, traditional full, full sugar, added sugar Coca-Cola, uh, despite the artificial sweeteners being as bad as they seem to be, what should they choose? Yeah. So, I don't think artificial sweeteners are innocuous. I don't think we should just be putting them in everything and eating them. But it's, it's clear that at like big massive doses, they're still better than sugar. And so if you're going to, you know, have, if you're drinking 20, 30 ounces of soda a day, yes, switch to, switch the diet. But don't think of that as a destination. Think of it as a bridge. Sure. And then get off that. So, so, and then if you're just doing a packet, if you're just at home and you're putting in four grams of sugar, do the natural stuff, right? You know, I think, so I think it's dose-dependent, right? At, at low doses, go for the natural stuff. At high doses, you know, use the artificial stuff as, as a crutch until you can get, get away from the sweet. Very interesting.
And last one is, uh, somebody, let's say, history of heart disease, now they have to choose between a non-fat salad dressing or butter, or a full-fat, you know, basically non-altered formulation. What do they choose? I love that you brought up fat-free salad dressing. Like I actually had to look that up. I had to go to the grocery store and look at the ingredients list. Fat-free salad dressing should be oil, right? So what in the heck is in fat-free salad dressing? Do you know what, like what are the ingredients? It's, I don't, it's, it's starch, sugar, salt, and chemical emulsifiers, right? And so, absolutely choose the highest fat, you know, dressing you can find because, you know, dress, salad dressings are plant oils and, and definitely there's a hierarchy. Plant oils are healthier than animal fats. Um, and within animal fats, dairy fats are healthier than meat fats. And so, I think if you know, embracing fats, there should be plant fats first and foremost. All plant fats are terrific. And seafood, plants and seafood first. Then I would say dairy, then poultry and eggs, and then red meat at the bottom. Awesome. Yeah. Super interesting.
Well, maybe you'll circle back to my question that I was a little curious about, kind of maybe as an adjunct to the food pyramid that we've all seen. It's continued to change. When do supplements make sense? When should we pick them up or when is it time to put them down? Yeah, I mean, well, of course, there are still a rare individual who's actually vitamin deficient in something. Um, and so they should, of course, get, get treated. Uh, the caveat to that is vitamin D deficiency has been redefined incorrectly over the last 10 years, and there's this concept of insufficiency, and people kind of fudge the numbers, and we're, we're taking way too much vitamin D and, and calcium in, in this country. But generally, of course, clinical deficiency should be treated. But outside that, um, there's really no evidence that that typical traditional conventional vitamins, that taking them in supplements benefits health or taking a multivitamin, taking calcium, you know, vitamin D, all these, all these other things. So generally, we should be trying to get our nutrition from, from, from whole foods. I do think that, um, you know, there are some supplements with more evidence for benefit and probably fish oil is probably the top one. The evidence isn't perfect, but there's at least some studies, um, showing significant reductions in cardiovascular events. And so I think fish oil is a reasonable supplement to, to, to take. And then I think there's this whole new world of, of bioactives that are starting to open up. Things like quercetin or EGCG or turmeric that in randomized trials, turmeric in randomized trials has anti-inflammatory effects. Um, clearly, clearly documented. And so I do think we're going to start to enter this, this future where, you know, again, the conventional basic vitamins, we're, we have enough of, but, but there are probably going to be some of these other, uh, other, uh, uh, supplements that are important, but we don't know enough yet, I think, to, to say that, that, that they're necessary. That's fair. Really interesting stuff.
Dr. Mafarian, I don't think we're going to get tired talking to you. You seem to be an encyclopedia of information about diet and nutrition, but we're cognizant of your time. Um, we would love to have you back as we get closer to the release of your book so we can talk a little bit more detail about your book. I'm going to leave a, um, a link to pre-order for this book, which I can't wait to get my hands on myself. So, we really want to thank you. This was really, really informative for all of us. Really appreciate you making time to spend with us. Yeah, terrific to be with you. Thank you. Absolutely. Hope to see you soon. Thank you so much, folks. We'll see you in the next episode. All right. Wow, that was terrific. That was so root canals and life, culture, and politics, we dare to share on protein and from moments that shape our day. We drill down deep in every way, turning pulp into gold with every word. A show like no other you've ever heard. Health and hearts we craft and mold. Tune into Pulp where stories unfold.