0:00

Taggosyn, what is your meat base?

0:11

Meat

0:13

base? Protein, high protein tagline. You're already

0:16

hinting at what my tagline

0:18

was going to be. Oh. Hi everybody

0:20

and welcome to maintenance phase, the podcast that just wants to know

0:22

where you're getting your protein. Where are you getting your protein?

0:24

Aminos? Are you set for aminos? Are

0:27

you getting enough aminos? You

0:30

are a woman who lives in Portland and has a lot of vegans

0:32

and vegetarians in your life. Correct.

0:35

I'm Michael Hobbs. I'm Aubrey Gordon. If you

0:37

would like to support the show, you can do that at Patreon.com

0:39

slash

0:40

maintenance phase. You can buy t-shirts,

0:42

mugs, tote bags, all manner of things

0:44

at Tea Public. Tea Public. And you can

0:46

subscribe through Apple Podcasts.

0:48

It's the same audio content

0:51

as Patreon. Some content. Patreon. My

0:53

quiet little repeating machine. I know. I

0:56

gotta keep, I keep trying to throw you off and it never works.

0:59

Uh,

1:00

today we're getting a little

1:02

time machine and we're going back to 2011. Yes.

1:05

Apparently. This is a

1:08

listener request. This is since

1:10

we did our

1:11

Super Size Me episode, this

1:14

is by far the most

1:16

requested like movie debunking

1:19

for us to do. Yes. Today we

1:21

are talking about Forks Over Knives,

1:24

which came out in 2011. And I think it was one one

1:26

of the first like streaming documentaries.

1:29

I think it was like when everybody was getting Netflix.

1:32

A huge number

1:33

of people watch this movie. The book based

1:36

on the movie was the number one New York Times bestseller.

1:38

Yeah, this comes from an era where there was a lot

1:40

of media about cord cutters.

1:42

Yeah, yeah, yeah, yeah. You wouldn't have cable anymore?

1:45

Imagine. So what do you know

1:47

about forks over knives, Aubrey?

1:49

What I remember its hypothesis as being

1:52

is that a vegan diet was healthier

1:54

and that it would lead to a longer life and that

1:56

it would prevent chronic

1:59

diseases.

2:00

and it was about

2:02

the origins of disease being

2:04

with eating meat and dairy. Yes.

2:08

Am I getting that right? Am I in the right neighborhood?

2:10

If anything, you're underselling it. Oh, wow.

2:12

This movie explicitly

2:14

says that a vegan diet will

2:17

prevent and reverse all

2:19

forms of chronic disease. Okay,

2:21

good. Heart disease, diabetes.

2:24

At one point, they mentioned dandruff. Halitosis.

2:28

Yeah. flatulence.

2:30

That's one thing I know that it won't solve. But

2:33

then okay, because this is a left-wing podcast,

2:35

I feel like we have to start with a series

2:37

of tedious disclaimers and meta

2:40

conversation about what we're going to do in this episode.

2:42

Let's do

2:42

it. Let's roll. I

2:45

really did go into this fresh. I

2:48

have never seen this movie. I have never

2:50

been a pro-vegetarian person,

2:55

but I've also never been like an anti-vegetarian

2:58

person. I have a lot of vegetarians and

3:01

vegans in my life. I've always

3:03

felt a spiritual kinship

3:06

with

3:06

vegetarians and vegans because the

3:08

stereotype of them is that they're constantly

3:11

lecturing you and they're announcing like, I'm

3:13

a vegan and you're not. I am sure

3:15

those people exist. I have never

3:17

come across anyone like that. Yeah,

3:20

I have known one preachy vegan

3:22

and it was just a preachy

3:24

guy who is vegan. Yeah, some people

3:27

tediously promote their own lifestyle and

3:29

some of those people are vegans and some of those people are not. It's

3:31

not clear to me that

3:33

that's a more common

3:35

trait among vegans than among non-vegans.

3:38

I will say this, I have experienced

3:40

infinitely more proselytizing

3:43

from keto and intermittent

3:45

fasting people. Although you're not a representative

3:47

sample because you do have a podcast where

3:49

you do say that those things are trash. Yes. Yes.

3:52

No, totally agreed. I'm not your starting

3:54

point for these conversations.

3:56

No, no, no, no. It is worth noting that like the animal

3:58

rights and climate.

4:00

change arguments for vegetarianism

4:02

are just fucking true. There's nothing to debunk.

4:05

It's like, yeah, the way that America treats animals

4:07

is atrocious. I'm not a vegetarian,

4:10

but it's totally indefensible,

4:12

the way that we treat animals. And also,

4:15

the climate and water

4:17

impacts of a meat-eating diet

4:20

are worse than a vegetarian vegan diet.

4:22

They just are. This also seems

4:24

like a good place for our standard

4:26

issue sort of reminder.

4:28

You should eat however you want to eat. We don't care.

4:31

Do what's right for you. We're gonna talk about a movie

4:34

and how this movie sells this

4:36

particular way of being and sort

4:38

of way of eating. But we're not talking

4:40

about the individuals who eat in that way,

4:42

nor are we

4:43

passing judgment on what anyone

4:45

else chooses or chooses not to

4:47

eat. Yeah, it's a very weird movie

4:49

because it is just a straightforwardly

4:52

a propaganda film. And most of

4:55

the factual claims in the movie do not hold up

4:57

to even the most cursory scrutiny,

4:59

but it's propaganda

5:01

in service of something that I think is good. Yeah,

5:04

yeah, yeah. Like I think vegetarian diets are fine.

5:07

And if you wanna be a vegetarian for literally any reason,

5:09

then you should do that. Yeah, that's right.

5:12

I actually really

5:12

appreciated this movie because first

5:14

of all, it does a lot of things that

5:16

I think are illustrative of the nature

5:19

of

5:19

how propaganda works and how

5:21

you can convince people of things without

5:24

technically lying, but just through

5:26

like selective

5:27

omission of important

5:29

context. And also, I

5:31

learned a lot watching this and debunking

5:33

this. Like I went down some really interesting rabbit

5:35

holes.

5:36

So mostly like we're just going to go through the movie and

5:38

I'm just going to tell you what I learned. It

5:41

feels really interesting to me because it's rare that you

5:43

and I both go into a topic pretty

5:46

fresh, like aware of the cultural

5:48

conversations around it. But like neither

5:50

one of us had seen this film. neither

5:53

one of us had done the deep dive into

5:55

sort of like health claims around

5:58

veganism and vegetarianism. Yeah.

6:00

I am like like you. I am not

6:02

a vegetarian, not a vegan, not plant based.

6:04

I like eat meat, but not very much.

6:07

Yeah, that's kind of where I am to. Wherever this lands.

6:09

Cool. Yeah. You know. So

6:12

let's kick ourselves

6:13

off by watching the first couple of minutes

6:16

of this movie, the opening montage.

6:18

I love this.

6:21

Clearly, the Western diet is taking a toll.

6:24

This should serve as a wake up call. We have a growing

6:26

problem. and the ones who are growing

6:28

are us.

6:31

Food. It's central to our

6:33

lives and traditions. Every

6:36

special occasion seems to involve food

6:39

and feasting. But could some of these

6:41

same foods, including several

6:43

that we think are good for our health, also

6:45

be causing many of our most serious health problems?

6:49

Indeed, we're facing a massive health

6:51

crisis. No

6:52

less than 40% of Americans today

6:55

are obese, and about half

6:57

of us are taking some form of prescription

6:59

drug.

7:01

This could be the

7:02

first generation of children in the United States

7:04

that lives less than its parents. We

7:07

spend 2.2 trillion dollars a

7:09

year on health care, over five

7:12

times more than the defense budget.

7:15

Yet we're sicker than ever. But

7:18

could there be a single solution to all of these

7:21

problems? A solution

7:23

so comprehensive, yet so straightforward,

7:26

that it's mind-boggling that more of us haven't

7:28

taken it seriously? Someone

7:30

has to stand up and say that the answer

7:33

isn't another pill. The answer

7:35

is spinach. A growing number

7:38

of researchers claim that if we eliminate or

7:40

greatly reduce refined, processed

7:43

and animal-based foods, we can prevent

7:45

and in certain cases even reverse

7:48

several of our worst diseases.

7:50

They say all we need to do is adopt

7:53

a whole foods plant-based diet. It

7:55

sounds almost too simple to be true.

8:02

This

8:02

is like the er example.

8:05

This is like the template for

8:08

fat people are killing us all. Right. You

8:11

can't tell from the audio, but this includes a lot

8:13

of footage of like headless fat people walking

8:15

around. I mean, it just, it really did feel

8:17

like, Oh, here we are in 2011. Yeah.

8:21

Like it just, it felt like the really

8:23

kind of shouty coverage that we

8:25

got about this stuff for a long time. Also,

8:28

a lot of maintenance phase cameos

8:31

in there. We get Richard Carmona, the

8:33

attorney general who started the

8:35

like terrorism is the threat from without

8:37

and obesity is the threat from within

8:40

the greatest

8:40

threat to our national security. We got Bill

8:42

Maher. Bill fucking Maher.

8:45

An authority on a diet

8:46

and lifestyle. The answer is spinach.

8:49

Take the stairs. We also got

8:51

two of these zombie statistics

8:53

that we debunked in that episode.

8:55

This is the first generation that won't live as

8:57

long as its parents playing the hits. And

8:59

then we also got at the end sort

9:02

of like the thesis statement of the movie, which

9:04

is basically what if a

9:06

plant based diet could

9:08

solve and reverse all of these issues?

9:11

So like I am not reading between the

9:13

lines or unfairly paraphrasing

9:16

when I say this, like this is this is the overt

9:18

thesis of this documentary. The other thing that

9:21

I was going to say about that intro, There

9:23

is this assumption that if you are

9:25

taking a drug,

9:27

you should not be taking a drug.

9:29

Yeah, I really don't like this stuff. There

9:31

are absolutely people who are taking drugs that

9:34

make their heart keep going, and

9:36

make their lungs take in air, and like

9:38

really basic biological functions.

9:41

And I mean, like, listen, there are drugs I take absolutely

9:44

every day that have absolutely helped me

9:46

stay alive at different points in my life. Yeah.

9:49

I don't think that that's like a moral failing

9:51

of mine,

9:52

that my brain chemistry looks

9:54

different than other people's brain chemistry. It's

9:56

also, it's in keeping with a weird

9:59

tendency Let's move it.

10:00

to like guild the lily, fruits

10:02

and vegetables are really good for you. People

10:04

should eat fruits and vegetables. That's totally fine.

10:06

But you don't need to say that eating

10:09

fruits and vegetables will reverse

10:12

your multiple sclerosis. We

10:14

then get a little like the history of food

10:17

section where it's like the same kind of stock footage

10:20

and we learn about like Betty Crocker and frozen

10:22

foods and all this kind of stuff. This

10:24

is familiar from like every other food documentary that

10:26

came out

10:27

around the same time where it's just like the rise of

10:29

processed foods and like people are

10:32

eating outside the home and people are joining the

10:34

workforce, blah, blah, blah. And then we

10:36

get to this

10:37

section where we

10:40

learn about the links between

10:43

animal proteins and cancer.

10:45

I'm going to send this to you. Send

10:48

this to me.

10:55

In the mid 1960s, Dr.

10:57

Campbell was in the Philippines trying to get

10:59

more protein to millions of malnourished

11:01

children. To keep costs

11:03

down, he and his colleagues decided

11:05

not to use animal-based protein. The

11:08

program was beginning to show success. But

11:11

then Dr. Campbell stumbled onto a piece of

11:13

information that was extremely important. It

11:16

centered on the more affluent families in the Philippines

11:20

who were eating relatively high amounts of animal-based

11:22

foods.

11:23

But at the same time, they

11:26

were the ones most likely to have the children

11:28

who were susceptible to getting liver cancer.

11:31

This was very unusual since liver cancers

11:33

are mainly found in adults. But

11:35

just the mere fact that they occurred in children

11:37

said, you know, there's something here. This

11:40

is pretty significant.

11:41

Shortly afterward, Dr. Campbell

11:43

came across a scientific paper published

11:45

in a little-known Indian Medical Journal. It

11:48

detailed work that had been done on a population

11:50

of experimental rats that were first

11:53

exposed to a carcinogen called Aflo-toxin,

11:56

then fed a diet of casein, the

11:58

main protein found in

12:00

They were testing the effect of protein

12:02

on the development of liver cancer. They used

12:04

two different levels of protein.

12:07

They used 20% of total calories

12:10

and then they used a much lower level, 5%. 20% turned

12:13

on cancer, 5% turned it off.

12:18

They love getting the shot of that Arby's

12:21

sign. I know. I've been to that Arby's.

12:23

I mean, I haven't been to it, but I've been by

12:25

that Arby's. You can tell they're going back to the history

12:28

of food stuff.

12:28

Boy, they really are. Americans discovered Arby's.

12:31

Okay, so I will say on

12:33

the face of this, I'm sure that you're gonna be like, this

12:36

never happened and this paper was never

12:38

written or something like that. But

12:41

what I will say is just like on the face

12:43

of it, I find it really fascinating

12:45

that the presumption that

12:48

because this particular

12:51

health phenomenon existed within

12:53

children of affluent people, that

12:56

like the first place that they went to

12:58

was diet to explain it. It's

13:01

really odd to just be like, it

13:03

has to be their diet and it's got to

13:05

be the meat. Like what? One thing this documentary

13:08

does and a lot of documentaries do is

13:10

they bombard you with a lot

13:12

of information very quickly. And at

13:14

the end of it, you're left with this impression,

13:17

right, of like, OK, wealthy kids in the

13:19

Philippines getting liver cancer. We looked

13:22

into it. Apparently it was the animal proteins

13:24

giving them cancer. Right. This is the same kind

13:26

of science communications that's in like the

13:28

fucking Zoloft bubble commercials

13:31

where they're like one side of your brain produces

13:34

the happy chemicals and then the other side

13:36

with the brownie face can't accept them.

13:38

Right. This

13:41

is a science communications

13:44

that assumes you don't really

13:45

need to know what's actually happening

13:48

here. Right. The best science communications

13:50

invites you to consider the complexity

13:53

of the world and the worst invites

13:55

you to ignore the complexity.

13:57

Mm-hmm. So the paper

13:59

that he's talking about. It's a study on

14:02

rats' susceptibility to

14:04

this toxin, aflatoxin.

14:06

It's a mold that grows on corn

14:09

and peanuts. And so this was a

14:11

real problem in a lot of countries

14:13

for a long time. In humid environments, this

14:16

mold grows. When you harvest

14:18

the crops, you also harvest the mold,

14:20

and kids end up eating this toxin.

14:23

And yes, kids get liver cancer. Kids get

14:25

all kinds of really awful effects of

14:27

this toxin from eating mostly peanuts

14:29

but also corn especially in the developing world. What

14:32

they're doing is they're not looking

14:34

at whether milk

14:36

protein causes cancer in

14:38

rats. They're exposing

14:41

rats to this carcinogen, to huge

14:44

doses of this carcinogen. And

14:47

then some of them are like little vegan rats. Some

14:49

of them are not vegan rats. you're

14:51

like, oh, the non-vegan rats got

14:53

tumors, which is true. But

14:56

it's like this is a specific

14:58

effect of the toxin they're being given.

15:00

This isn't just like rats existing in the world

15:03

and the little vegan rats don't get cancer.

15:06

It's not the same thing as a human child.

15:08

And it's not the same thing as eating corn

15:11

once a week. Right. If you want, even if you wanted

15:13

to do this study in rats, the rat answer

15:15

would be, Hey man, feed him some

15:17

of that corn every once in a while. So,

15:19

okay. let's do still have the clip up. Let's

15:22

go to 1637 together. There we go. 37. Bing, bang,

15:26

boom.

15:27

So this is the text

15:29

that they show on screen when

15:31

they're describing this study. So

15:34

toward the bottom, read

15:36

the sentence that starts with in all. In

15:39

all, 30 rats on the high protein

15:41

diet and 12 on the low protein

15:43

diet survived for more than a year.

15:45

Low protein here means

15:46

vegan, basically. Or like this is the

15:49

analog that they're inviting us to consider.

15:51

So wait, what the fuck? Yeah, yeah.

15:53

More of the high protein diet rats

15:55

survived? So the vegan rats

15:59

were twice as l-

16:00

likely to die. They had to stop

16:02

the study because the little vegan

16:05

rats kept dying. So it's

16:07

not useful for understanding humans

16:09

and also it says the opposite

16:11

of what they said was going to say.

16:14

Exactly. I feel like this is my new way of documentaries

16:16

is just pause on

16:19

every block of text

16:21

and be like, hang the fuck on, we're reading

16:23

this entire thing. So when they

16:25

talk about this

16:26

obscure study published in Indian

16:28

Journal, the study is part of a two-part

16:30

study. One of the studies, which is what

16:32

they're referring to here, is about the growth

16:35

of tumors in

16:36

the rats. The other study is

16:38

about why the rats kept fucking dying

16:40

and the vegan rats were

16:43

much more likely to die. So

16:46

I'm not going to say that this invalidates

16:48

vegan diets. That would also

16:50

be just as superficial as saying this proves

16:52

vegan diets. But like, okay, if

16:54

it's turning off cancer but you're more likely to

16:57

die, then the cancer thing's kind of

16:59

irrelevant, right? Like we only care about cancer

17:01

to the extent that it's killing people. I

17:04

love that a documentary would have this

17:06

level of a self-own in it that if

17:08

you pause

17:08

it, it undoes its own work.

17:11

It undermines itself if you

17:14

read all of the text on screen. Okay,

17:16

so then we get to the

17:19

other protagonist of this documentary. So this

17:21

documentary basically follows these two

17:23

doctors. One is T. Colin Campbell.

17:26

That was the guy who we just met in the Philippines.

17:28

And the other one is named Caldwell Esselstyn.

17:31

And he is telling us

17:33

about his work as a surgeon

17:35

and how that led him to

17:37

do his own research. So

17:40

Dr. Esselstyn started investigating the global

17:42

statistics on breast cancer.

17:45

One of the facts he discovered was that the incidence

17:47

of breast cancer in Kenya was far lower

17:49

than than it was in the United States.

17:52

In fact,

17:53

in 1978, the chances

17:55

of a woman getting breast cancer in Kenya were 82

17:58

times lower than in the U.S.

18:02

Dr.

18:02

Esselstyn was even more surprised by

18:05

the numbers he discovered for some other types of

18:07

cancer. In the entire nation

18:10

of Japan in 1958, how

18:12

many autopsy proven deaths were

18:15

there from cancer of the prostate?

18:20

In the same year, the U.S. population

18:22

was only about twice the size of Japan's,

18:25

yet that the number of prostate cancer

18:27

deaths exceeded 14,000. Dr.

18:31

Esselstyn also discovered that in the early

18:33

1970s, the risk

18:35

for heart disease in rural China was 12

18:38

times lower than it was in the US. And

18:41

in the highlands of Papau, New Guinea, heart

18:43

disease was rarely encountered. Even

18:46

more compelling to Esselstyn was some historical

18:48

data that had long been overlooked.

18:50

In World War II, the Germans occupied

18:52

Norway. Among the

18:55

first things they did was confiscate all

18:57

the livestock and farm animals to provide

18:59

supplies for their own troops. So

19:02

the Norwegians were forced to eat mainly plant-based

19:04

foods. Now

19:06

we look at the deaths in

19:09

Norway. Just antecedent to this period

19:11

from heart attack and stroke. Look right up here,

19:13

right at the very top, 1939.

19:16

Bingo! In come

19:18

the Germans. Well hang on. Really? 1940s.

19:22

Wow. Have

19:25

we ever seen a population have their

19:27

cardiovascular disease plummet like this from

19:30

statins? I know. But

19:32

look what immediately happened

19:34

with the cessation of hostilities in 1945.

19:38

Back comes the meat, back comes the dairy,

19:41

back comes the strokes and heart attacks.

19:44

Uh-uh. Okay. Okay.

19:47

Holy shit. Describe the visual

19:49

feast that we just had in the last like 30 seconds

19:52

of it.

19:53

Holy shit, Michael. But

19:56

first I will say, while we were watching this clip,

19:58

I was like, oh, we're in peace.

20:00

Michael Hobbs territory. Yeah.

20:02

Why are people dying of this thing

20:04

in this country, but not in this country is

20:07

like prime grade. Oh,

20:10

I'm using meat metaphors. Yes. Spurious

20:12

correlations are the filet of this documentary.

20:15

Then we get a graphic

20:17

that is one of the wildest

20:19

things I have ever fucking seen

20:21

in my life. You go to 2050. Holy.

20:25

See the chart in all of its glory. I

20:29

know. This

20:31

is like Monty Python. Yeah.

20:34

Yeah. So the title of the graph is Mortality

20:36

from Circulatory Diseases, Norway,

20:40

1927 to 1948. And

20:44

what it shows is more

20:46

people dying of heart disease.

20:47

That peaks

20:49

at about 1940, and they have

20:51

superimposed a little

20:54

teeny, tiny Nazi flag. And it pops

20:56

in like pop

20:57

up video. It's like, boop.

21:00

That's it. It goes. Yeah,

21:03

great. Good. And

21:06

then mortality from circulatory

21:08

diseases, plummets. You

21:10

got to hand it to them. Listen, if you were

21:13

just looking at this

21:14

graphic without the narrative

21:17

that is offered by the documentary,

21:20

it really looks like it's trying

21:22

to credit Nazis with

21:24

like the heart health of Norway.

21:27

I posted this on Twitter and people were like, this seems unfair

21:29

that you're posting this out of context. And

21:32

I was like, it is not better in context. This

21:34

is like yet another reason

21:36

that it's good that I'm not on Twitter very often.

21:39

People were yelling at me and I was like, I cannot debunk

21:41

this for you because Aubrey might see

21:44

it. So just open your podcast app

21:46

in like two weeks. Chill out. We'll

21:48

be back in a minute. So obviously all

21:50

of these country comparisons are extremely

21:53

facile. So the first thing he points

21:55

out is that Kenya had a much lower

21:57

rate of breast cancer. than

22:00

America in the 1970s. Jesus

22:02

Christ. Obviously, the reason why you have

22:04

less breast cancer in Kenya at the time is because Kenya

22:07

does not have a healthcare

22:09

system that is set up to do breast cancer screenings.

22:12

And also, the rates of infectious diseases are

22:14

significantly higher in Kenya. So

22:17

people are not dying

22:18

of non-communicable diseases because they

22:20

have more urgent issues that they're dealing with.

22:23

We then go to the extremely

22:25

low rate of prostate cancer deaths

22:27

in Japan, where

22:29

I look this up. It

22:32

appears to be the case that prostate cancer

22:34

rates are lower in Japan. It's

22:36

genuinely like kind of a mystery. What

22:39

frustrates me about this documentary is that it's actually kind

22:41

of interesting. It seems to be more

22:43

related to the fact that a lot more

22:46

Americans get a surgical procedure

22:48

called a TURP. What? where

22:50

they go up through your urethra

22:53

and

22:53

cut a little chunk out of your prostate.

22:56

And as part of this procedure, they usually do a biopsy

22:59

on your prostate tissue. Oh, so we're just

23:01

checking way the fuck more often?

23:04

Yeah, basically, like that is

23:06

the most obvious explanation. There's

23:08

just a lot more screening for prostate

23:10

cancer, especially in 1958, which is the year that

23:13

he refers to here. Right. This

23:15

feels reminiscent to me of that 60 Minutes clip

23:18

about red wine. Yeah, yeah, yeah. Well,

23:20

hang on guys, there might be a story

23:22

here, but you got to adjust for all this other

23:25

stuff first. Right.

23:26

He then takes us to rural

23:29

China and Papua New Guinea and

23:32

says that their rates of heart disease are much lower

23:34

than the US. And again, this is true.

23:36

They also at this time have 12 year

23:39

shorter life expectancies. Jesus hell.

23:41

Mao dies in 1976. China is coming out of one of the

23:44

the most brutal, decades-long,

23:47

repressive periods of any country in history.

23:50

It's just very weird to make this comparison

23:51

and talk about China as some

23:53

sort of utopia of better dietary

23:56

choices. All of this also plays

23:58

into some narratives. that

24:00

are culturally really tempting

24:02

to a lot of Americans, right? One of them

24:04

is one that we've talked about before. It's in

24:07

a book called Diet and the Disease

24:09

of Civilization. Which is sort

24:11

of this belief that our diet

24:13

is evidence that we are part of a fallen

24:16

society. Right. When these

24:18

narratives go in a direction that your

24:20

brain was already headed, when they

24:22

tell you things that you were already kind

24:24

of thinking, those are points that are

24:26

more likely to land for you. Right. Right.

24:29

That takes

24:30

us to Norway and the Nazis.

24:32

Tell me about Norway and the Nazis, Jesus Christ.

24:35

I thought this was like super interesting. It

24:38

is true that the Nazis occupied

24:40

Norway and like confiscated everybody's

24:42

livestock and immediately imposed

24:45

like really strict rationing regimes.

24:47

People were so desperate for food that they were like growing

24:49

food in their backyards. A lot more people started

24:51

fishing, just like get food

24:54

from the wild. People were like eating moss and shit.

24:56

It is true that the dietary patterns

24:58

of Norwegians change very significantly

25:00

and very rapidly during this period. What

25:03

the documentary doesn't mention though is

25:05

what the war did to infectious

25:08

disease. There is a researcher

25:10

named Broda Barnes who wrote a book

25:11

called Solved, The Riddle of Heart

25:14

Attacks. He is looking

25:16

at this period after World War II, all

25:19

over Europe, you have rapidly rising

25:21

living standards. are getting back

25:24

to normal and they're rebuilding infrastructure,

25:26

employment is really high, they're setting up

25:28

these healthcare systems, setting up welfare systems

25:30

for the first time. At the same time,

25:33

you have an explosion

25:33

of heart attacks. Right.

25:36

And so it's like, well, people are doing everything you're supposed

25:38

to do. They have healthy diets,

25:41

much better living standards, and yet heart

25:43

attacks are going up. He starts looking

25:45

at autopsy data from people

25:47

in Graz, Austria, and

25:50

he finds the same pattern they found in Norway where

25:52

there's this huge reduction in heart attacks and

25:55

then a massive increase. This isn't

25:57

all of the explanation, but the primary

25:59

explanation for this effect is tuberculosis.

26:02

What? Having blocked arteries makes you

26:05

susceptible to tuberculosis, and

26:07

it makes you susceptible to heart attacks. It

26:09

increases your risk of both of them. Before

26:12

the war, most people would

26:14

just die of tuberculosis. If

26:16

you had blocked arteries, you get tuberculosis,

26:18

you end up dying of tuberculosis, you don't live

26:20

long enough to have a heart attack. After

26:23

the war, you get treatments for tuberculosis.

26:25

So when you get tuberculosis, you get antibiotics,

26:28

and then your tuberculosis goes away, you live a couple more

26:30

years, and then you die of a heart attack because you have all these

26:32

risk factors. Well, this is also something

26:35

that has come up on the show before that

26:37

you have mentioned, which is essentially like

26:40

how technologies and treatments

26:42

are changing around these conditions, right?

26:45

So like, we are still talking

26:47

about heart disease in sort

26:49

of the way we did in the like 80s and

26:52

90s, and treatments for heart disease

26:55

and mortality rates and all of that kind

26:57

of stuff look really different now

26:59

than they did 30 or 40 years ago.

27:02

Well, what I'm so fascinated by is without

27:04

any

27:04

context, you look at

27:07

Europe after World War II and you're like, holy shit, the heart

27:09

attacks are going crazy. Like this

27:11

is really worrying, but actually it's good

27:14

news, right? Because almost every single one

27:16

of those people would have died of tuberculosis.

27:19

What that's actually reflecting

27:21

is a precipitous drop in tuberculosis

27:23

deaths. or what it looks like from the outside,

27:26

or if you only look at this one metric, you're

27:28

like, oh my God, we're getting so much less healthier. You know, it's

27:31

interesting as we're talking about this, I'm realizing how

27:33

many mortality numbers are just completely

27:36

and totally decontextualized. Totally, I

27:38

know, this like fucked with my brain too, yeah. The

27:40

main way that I feel

27:42

like I encounter mortality numbers

27:45

in the wild is not unlike this

27:47

documentary where it's just like big

27:49

block letters of a big scary number

27:51

in the web, but it's not

27:54

stacked up next to. Here are some other

27:57

similar levels of mortality

27:58

causers. Like, they're

28:00

not giving you anything to relate it to, they're

28:02

just saying big numbers

28:05

at you and the big numbers sound scary. This

28:07

takes us back

28:08

to Norway. So what we

28:10

find when you look into the actual specifics of

28:12

Norway and you're not just trying to make a point with

28:14

a graphic or whatever, is that tuberculosis

28:17

and other infectious diseases exploded

28:20

in Norway during World War II. So

28:22

this is from a paper about this. It says, the

28:25

incidence of infectious diseases increased substantially

28:27

during World War II Norway probably

28:29

due to the introduction of infectious agents

28:32

from the large contingent of German soldiers

28:34

and civilians up to 450,000 and in addition 100,000

28:35

prisoners of war from Eastern

28:40

Europe. So basically, a

28:42

huge influx of people into Norway.

28:45

Some of those people are carrying tuberculosis and

28:47

other infectious diseases.

28:49

And so heart attacks go down because

28:51

people are dying of other things first.

28:54

You know, they're getting pneumonia, they're getting various other things.

28:57

is one of the main causes. And there is

28:59

actually a big outbreak of tuberculosis in Oslo

29:01

during World War II. But just kind of overall,

29:04

people are just dying of other stuff.

29:07

So just like a rise in

29:09

heart attacks isn't necessarily bad

29:11

news. A drop in heart attacks isn't necessarily

29:14

good news. I think, again, particularly after

29:16

having done a couple of years of this show,

29:18

I now feel so

29:21

suspect when I see this kind of decontextualized

29:23

reporting. one weird

29:26

trick and then the graph goes down

29:28

and you're like, what? Yeah, this I'm,

29:30

I'm way

29:31

too like mortality pilled

29:33

to watch documentaries like this. I

29:35

was like watching it and I was like, it just has the

29:37

structure of something that's wrong.

29:40

Right. Like anytime you're like World

29:42

War Two and then the heart attacks fell. I'm like, I

29:44

don't think I think someone's probably written a PhD

29:47

about this and it's probably significantly more

29:49

complex. Yeah, this is the reaction

29:51

that I started to have early on when we were doing the

29:53

show to headlines with a question

29:55

mark in it. Yeah, yeah, yeah. I'm onto you. We're

29:58

not doing this. So church.

30:00

When we turn to the film, we then go from

30:02

Nazis to protein. Yeah, the classic

30:04

progression. There's a whole thing, they do more

30:07

stuff about how animal proteins cause cancer,

30:09

but it's all this aflatoxin shit. They

30:12

do mention very briefly, and I don't

30:14

know why they don't linger on this more,

30:17

that vegetarian diets do not mean that you're going

30:19

to get a protein deficiency. The whole thing

30:21

of you need

30:22

all this protein to survive is basically

30:24

just a decades-long propaganda campaign

30:27

by the meat industry.

30:30

feels a little bit similar to the fiber stuff.

30:32

It's similar to vitamin C stuff where we're

30:34

like really bad at knowing what things

30:36

have protein in them. Yeah. Yeah. Yeah. Yeah. Plenty

30:39

of vegetables, plenty of

30:41

beans, plenty of like, generally

30:44

speaking, Americans eat much more protein

30:47

than any sort of nutritional guidelines

30:49

suggest that we might

30:51

need. Also, there's dozens of studies on this. One

30:53

of the ones that I found non vegetarians

30:56

are getting roughly double the amount of

30:58

daily recommended protein and vegans

31:01

are getting one and a half times the

31:03

recommended amount of protein.

31:05

For non-vegans,

31:08

we're getting 15 to 17% of

31:11

our calories from protein

31:12

and vegans are getting It's

31:14

not that big of a difference.

31:17

I should say that those surveys are based

31:20

on the same dumb food frequency

31:22

questionnaires that we're always criticizing in other diet

31:25

studies. I don't believe

31:27

biblically in these numbers, but also one

31:30

of the main problems with these food frequency

31:32

questionnaires

31:32

is that people underestimate how much

31:34

they're eating. If people are saying

31:37

that this is how much protein they're getting, they're

31:40

probably getting even more. Even

31:43

if you

31:43

throw out the food frequency questionnaire stuff,

31:45

which is totally legitimate, protein

31:48

deficiencies are just not

31:50

a problem in the United States. People are not going

31:53

to the hospital with protein deficiencies.

31:55

I'm guessing there are a problem in as much as

31:57

hunger overall is a problem. This

32:00

is what you find in the study. So I found a study

32:02

that is finally just like laying it out

32:04

like brass tacks. It says, there

32:07

is a widespread myth that we have to

32:09

be careful about what we eat so that

32:10

we don't cause protein deficiency. We

32:13

know today that it's virtually impossible

32:15

to design a calorie-sufficient diet

32:17

which is lacking in protein and any of

32:19

the amino acids. So basically, when

32:22

you look at actual protein deficiency cases,

32:24

it's

32:24

almost always people with very

32:26

rough eating disorders who just are

32:28

not getting enough food overall. You

32:31

would legitimately have to try

32:33

to design a diet that has enough

32:35

calories but doesn't have enough protein.

32:38

So unless you're doing this for a fucking YouTube challenge

32:40

or something, you're probably fine.

32:43

My understanding is that this is the case on a

32:45

number of nutrients. You don't need

32:47

to worry about how much riboflavin

32:49

you're getting. The only

32:51

exception I found was that if you're an elite athlete,

32:54

it turns out you can need more protein or

32:56

whatever, but you know that if you're an elite

32:59

athlete. It's not like you're

33:01

learning this from an internet listicle

33:03

for the first time, and the vast

33:04

majority of the population is not

33:07

an elite athlete with very specific

33:09

macronutrient needs.

33:10

Michael Phelps isn't listening to this episode

33:13

going like, oh, interesting, more protein. All

33:15

right. First time I heard this. Good

33:17

to know.

33:18

get a clip

33:21

about the ability of a vegan

33:23

diet to reverse heart

33:25

disease. Okay,

33:28

let's go. I'm going to send you

33:30

a clip.

33:33

Dr. Esselstyn was getting some powerful data

33:35

from the research he'd started in 1985. He

33:39

began with 24 patients,

33:42

but six had dropped out in the first year,

33:44

leaving him with a total of 18. The

33:47

end of five years we had to follow

33:49

up angiograms and 11 of the group unhauled

33:52

their disease. There was no progression

33:54

and there were four where we had

33:56

rather exciting evidence of regression

33:59

of disease.

34:00

These results were astonishing. The

34:03

diet produced something that medication and

34:05

surgery never had before. Actual

34:08

reversals of heart disease.

34:11

They're again making some like very

34:14

bold claims. The underlying

34:17

logic is like you're basically immortal. Right.

34:20

You will die of old age at, you

34:22

know, 90 something or 100 and something

34:25

because nothing's taken you down. He's

34:27

also papering over some

34:30

fairly weird number stuff. Yeah,

34:32

four cases. Yeah. This study

34:35

that he's talking about, he does eventually publish

34:37

it. I'm getting a lot of this

34:38

from a woman named Denise Minger, who is

34:41

one of the only people to take this movie

34:43

seriously and try to debunk it. So

34:46

she points out that

34:47

there's no control group. It's

34:50

self-selected. People are going to

34:52

this guy who's at this point a very prominent

34:54

vegan advocate. This is basically just

34:56

an anecdote,

34:57

ultimately. Even though it's published, it's

34:59

basically published as like a case study. It's not

35:01

like a randomized control trial or anything. I

35:03

can't really debunk that, but it's not clear

35:05

that this really says anything about vegan

35:07

diets overall.

35:08

But what's

35:10

really interesting is that there are actually studies

35:13

where these kinds of interventions have reversed

35:16

heart disease. So one

35:18

of the

35:18

most famous ones is, do you know Dean

35:21

Ornish? Sure, the Ornish diet

35:23

for sure. The Ornish diet. My mom was

35:24

on that for years. This was like a huge presence

35:26

in our house growing up. Very big, very popular in

35:29

the 80s. Yes. He's basically like the

35:31

patron saint of low-fat diets.

35:34

This was the guy telling you to eat carrot

35:36

sticks. This is why your parents were doing that in the

35:38

80s. He has a study that

35:41

shows people actually

35:43

reversing symptoms of heart disease.

35:45

And so this is touted as evidence that

35:49

a low-fat vegetarian diet

35:50

reverses heart disease. However, if

35:53

you read the actual study, It's not

35:55

just a low-fat vegetarian diet.

35:58

This is a program where people are also

36:00

quitting smoking. They're also getting

36:03

stress management training and

36:05

they're also increasing their exercise, getting

36:07

daily exercise. Oh, so it's like

36:09

a full overhaul on how you were

36:11

being in the world is now very

36:14

different than how it was before. That's a

36:16

lot more than just eating less fat in

36:18

your diet. Also, after you have

36:21

a heart attack or a stroke scare,

36:24

usually you're extremely

36:25

motivated to change your lifestyle.

36:28

So a lot of these things work for like a year

36:30

or two, because people are like, holy shit, I'm going to die.

36:32

And then they do like all this stuff at once. So

36:35

that doesn't mean that like a low fat vegetarian

36:37

diet doesn't reverse heart disease, but

36:40

it's like,

36:40

we're doing 10 things at the same time. I

36:42

would also say like, in that year

36:45

or two, after,

36:47

you know, a cardiac event, or after

36:50

a new diagnosis, or whatever, you

36:52

are extremely motivated to make a bunch of lifestyle

36:54

changes, but you were also

36:57

on a more intensive schedule

36:59

of health care. Oh yeah.

37:00

There's like numerous scenes in this

37:03

documentary where they talk about how these like these vegan

37:05

doctors are like, we're not like other doctors. And there's

37:07

a scene where a doctor goes with

37:09

one of his patients to the grocery store

37:11

and like helps him shop for stuff and

37:13

is like giving him recipes and like having him over

37:16

for dinner, it appears. So it

37:18

might not be the veganism. It might be that

37:20

like your

37:20

doctor really gives a shit about you. I would

37:22

say also on this this reversal stuff is like just

37:24

because it's possible for some

37:27

people doesn't mean

37:29

that it is likely for

37:32

everyone or possible for everyone

37:34

or guaranteed for everyone. But

37:37

like the way that this kind of stuff

37:39

comes across and the way that it is pitched

37:42

is this is a sure shot. All

37:44

of those caveats, which are all

37:47

context, are all missing,

37:49

right? I also think it's important to note that like

37:52

it may be the case that vegan diets can help

37:54

people reverse heart disease, but that's not the only

37:57

diet that has been shown to do that. So

37:59

there's studies. the Mediterranean diet that have shown

38:01

that. There are studies of low-fat diets. There are studies

38:03

of low-carb diets. There's a

38:06

study of a high-fiber diet. One

38:08

of the most interesting things I found was one of the studies

38:11

showed that people tend

38:14

to stick with a vegetarian diet

38:16

longer when they're doing these programs because obviously

38:18

the initial burst tends

38:20

to go away after a year or two. One

38:23

of the reasons why vegetarian diets might

38:26

be good for managing things like diabetes

38:28

and heart disease could just be that people

38:30

find it much easier to stick to over the long

38:32

term because like vegetarian

38:34

diets are like fairly entrenched in

38:37

our lives. Like you can go to a restaurant and be like,

38:39

Oh, Hey, what do you have on the menu? That's vegetarian. Yeah.

38:42

Whereas if you're on like the Mediterranean diet

38:45

or I'm low carb, there's just

38:47

a bit more friction. I will

38:49

say I think the it's easier

38:51

to be vegetarian. Take is

38:53

a very coastal city dweller take

38:57

in part because this is

38:59

one of my favorites. A good friend

39:02

of mine is vegetarian and works in

39:04

politics in Montana and ends up at

39:06

a bunch of fundraising dinners. She

39:08

will ask for the vegetarian

39:10

option at said fundraising dinner and will

39:12

be given chicken.

39:13

Oh, yeah, that's vegetarian for Montana.

39:16

Yeah, it's a bird. You're

39:18

welcome. Yeah, this used to happen when I lived in Germany

39:21

a lot, too, that my American friends would be like, what are

39:23

your vegetarian options? And they'd be like veal.

39:26

It's like,

39:27

no, I think the baby animals are still animals.

39:30

And then, okay, so after this,

39:33

we then get one of the weirdest

39:35

clips of the entire movie. So

39:38

they're catching up with people who

39:40

were in this heart disease

39:42

study. And so we're doing like a follow-up

39:45

with one of the patients and the benefits in their lives.

39:48

Anthony and the other male patients also

39:50

noted another change. When you're young,

39:53

when you're a teenager, you see a

39:56

female and so on. It gets kind

39:58

of exciting. And

40:00

the first reaction physically, you

40:02

know, it gives attention,

40:05

you know, raise the flag, I call it.

40:07

This happened to us. All the other

40:11

Dr. Enserson's, I call him

40:13

all the guinea pigs.

40:15

The flag still rises.

40:17

What? So

40:21

now we're just talking about dicks. So

40:23

this dude gets boners. We're talking

40:26

about this dude and his boner. God damn

40:28

it. He's talking about raising his

40:30

flag. Very patriotic. I

40:33

was all ready to debunk this.

40:36

The thing about a vegan

40:38

diet reversing your erectile dysfunction

40:40

is obviously not supported by the

40:42

data. However, erectile

40:44

dysfunction is a precursor

40:47

of heart disease. And so it's now

40:49

becoming a thing that

40:51

they actually tell patients that if you're middle aged

40:54

and you start getting erectile dysfunction and there's no kind

40:56

of obvious reason for it, then

40:59

you should go get your heart checked out because

41:01

it's like your artery's closing and it's something. Right, it's

41:03

like a blood flow issue. Yeah. Yeah. This

41:05

is a thing to look out for. If you're not raising flags.

41:08

Don't. Raise more flags. So

41:11

that's basically the end of the documentary. We're

41:14

only two thirds of the way into the documentary

41:16

at this point, but the rest of the documentary is

41:18

just a bunch of stuff that

41:20

is true, but kind of irrelevant. So,

41:24

there's a long sequence with like an

41:27

MMA fighter and he's like, it's possible

41:29

to be an athlete and a vegan. And like, yeah, yes,

41:32

it is. Okay. There's

41:34

a whole section about how school lunches suck. Like

41:37

yeah, that's true. There's

41:39

a very baffling part where he talks

41:41

about like milk being bad for you

41:43

and like milk is poison. And

41:45

then

41:46

there's a really funny chart where they

41:49

point out that the countries with the highest

41:51

milk consumption in the world have

41:53

the highest rates of hip fractures, which

41:56

is a sign of osteoporosis. What? So

41:59

it turns out milk...

42:00

doesn't actually make your bones stronger. This

42:02

is some fucking Pete Evans shit. Yeah.

42:05

Dairy leeches calcium from your bones

42:07

was his thing, I believe. I

42:09

love this as like a

42:10

spurious correlation because all

42:12

of the countries that have the highest milk

42:14

consumption, they're all Scandinavian countries.

42:16

And most of the countries with the lowest

42:19

milk consumption are like tropical countries

42:21

in like Southeast Asia. In debunking this

42:23

movie, people point out that all

42:25

of the countries with high milk consumption

42:28

have very cold winters.

42:30

And one of the main reasons why people fracture

42:32

their hips is falling on the ice.

42:35

So you just in Thailand

42:37

have a lot fewer hip fractures than you

42:39

do in Norway, which has nothing

42:42

to do with milk consumption. It's just like there's

42:44

a reason people fall down in

42:46

Scandinavia. So then

42:49

the worst,

42:50

by far the worst section of

42:53

this movie is there's a lady who's a marathon

42:55

runner, and then she's diagnosed with breast

42:57

cancer. They're like, oh, she was

42:59

told to get radiation and chemotherapy, but instead

43:02

she went on a vegan diet.

43:05

And now she's like running Iron Mans. Right.

43:07

We're back in sort of Gerson therapy

43:10

adjacent territory. Yeah. Like

43:12

this was where, I mean, not that I had a lot of

43:14

confidence in this documentary, but I was like, this is

43:17

really irresponsible. Yeah. Vegan diets

43:19

are fine, but don't tell people that they fucking

43:21

cure cancer. What the fuck is wrong with you? I mean,

43:23

I feel, I would say I feel sort of shades

43:26

of gray that way about

43:28

most dietary interventions

43:30

into most health conditions, right?

43:33

If someone is telling you

43:35

and is not presenting pretty hard

43:38

and fast data that like X,

43:40

Y, or Z dietary change means

43:42

that you cease to have a chronic

43:45

health condition. All of this

43:47

shit just needs

43:47

to be tempered and presented in context

43:51

in order for us to understand it properly. But

43:53

then this gets

43:54

us to what I want to spend the rest of the episode

43:56

on, which is the years long

43:59

debate. about whether a vegetarian

44:01

diet is good for you. Oh, just full

44:04

stop. Just like, is it healthy? Period.

44:07

Are you healthier eating a vegetarian

44:09

diet than not eating a vegetarian

44:11

diet? This is the core claim of this movie.

44:13

Let's do it. So to talk about this,

44:16

we have to talk about vitamin E. Okay.

44:19

Vitamin E is a now notorious

44:22

antioxidant. In the sixties

44:24

and seventies, there were a bunch of mouse studies show

44:27

that this helped oxidate

44:29

the bloodstream and could reduce

44:31

plaque in their little mouse hearts. After

44:35

this very

44:36

preliminary hypothesis

44:39

generating stuff on animals, people

44:41

start doing these observational studies on humans.

44:44

Vitamin E is found in like sunflower

44:47

oil and almonds and peanut butter and all kinds

44:49

of stuff and so they start doing these big

44:51

cohort studies where they ask people

44:54

what their diet is and what kind of health markers

44:56

they have, how early they're dying, et cetera.

44:58

And so again and again, studies

45:00

are finding that people who consume more

45:02

vitamin E like live way longer.

45:05

This is starting to look pretty strong in

45:07

the 1990s, right? It's like, well, it's

45:09

happening in animals, it's happening in people,

45:12

so we should probably start giving people supplements

45:14

for vitamin E, right? So in the 1990s

45:17

and 2000s, doctors start

45:19

giving vitamin E supplements to patients, especially patients

45:22

who have had some sort of cardiac event. So people

45:24

who are recovering from heart attacks start getting vitamin

45:26

E supplements. So the daily

45:29

recommended amount of vitamin E

45:31

is 22 international units. And

45:34

doctors start giving patients either 400

45:36

or 800 international units. Holy

45:40

shit! 20 to 40 times

45:43

the daily amount. Jesus. And

45:45

so after this wave of animal studies,

45:48

after this wave of observational studies, we start getting

45:51

randomized controlled trials of people who are

45:53

taking vitamin E and people who aren't taking vitamin E.

45:56

And it turns out that vitamin

45:58

E has no effect on vitamin

46:00

And for some people, vitamin E

46:02

actually increases the risk of heart

46:04

attacks. These are not large effects,

46:06

but people who take large doses

46:09

of vitamin E are 13% more likely

46:11

to have heart failure in one study. Oh, wow.

46:13

So there's now been this huge

46:15

turnaround on vitamin E, and the

46:17

entire field is like, oh, fuck, we

46:20

really got this one wrong. We're basically giving people

46:22

large doses of this thing

46:25

that there really is no evidence for

46:27

at this point. Yeah.

46:28

So, people have now gone back and

46:30

have done this sort of like, what

46:32

happened? Like, how did this whole

46:34

catastrophe take place with

46:36

vitamin E? And what they've

46:38

identified is something called healthy

46:40

user bias. In all of those

46:43

observational studies,

46:44

the people who were getting more vitamin E, or

46:47

people who were eating more almonds, eating more

46:49

vegetables, they're getting more

46:52

fiber, they're basically eating like a

46:54

better diet and those foods happen

46:56

to have vitamin E,

46:58

but it wasn't the vitamin E that was making those

47:00

people healthier. It was all of the other

47:02

shit that they were doing. Yeah, which also probably

47:05

correlates to higher

47:07

socioeconomic

47:08

status. It also probably

47:10

correlates to not

47:12

having other disabilities is my

47:14

guess. Yes. I mean, I think about this often

47:17

with celery juice too, right? Like if

47:19

you're a person who can afford a juicer

47:22

and has the time in the

47:24

morning

47:24

to juice 16

47:27

ounces of celery and

47:29

drink it and then wait a half an hour before

47:31

you eat anything else. There's

47:34

all this other stuff that's sort of loaded into

47:36

that. It's not just a matter of

47:38

like, oh, any person who

47:41

drinks the celery juice will have this effect

47:43

or whatever. This form of

47:45

bias is a huge

47:47

existential problem in these kinds of

47:49

studies. One of the large

47:52

effects that I found in other

47:54

various meta-analyses is that people

47:56

who brush their teeth regularly, have 30%

47:58

lower more. than

48:00

people who don't brush their teeth. What that's covering

48:03

is not necessarily that brushing your teeth extends

48:06

your lifespan. People who brush their teeth

48:08

are more likely to engage in all kinds

48:10

of other healthy behaviors. This

48:12

turns out to be the central problem with

48:15

comparing the health of vegetarians to

48:18

the health of non-vegetarians.

48:19

If you just look at the raw

48:21

data, vegetarians and vegans have like

48:24

way lower rates of everything. everything,

48:26

diabetes, strokes, cancer,

48:29

they live longer. Basically

48:31

any health thing that you can name,

48:33

vegetarians do better and vegans

48:35

do even better. But that

48:37

doesn't necessarily mean that

48:40

it's the diet that is doing it. Because

48:43

only around 5% of the population

48:45

is vegetarian or vegan, and the non-vegetarians

48:48

is like everybody else. So you're basically

48:50

taking a very small subset

48:53

of the population who are like way

48:55

more health conscious

48:56

in a million ways.

48:59

Vegetarians get more physical activity than

49:02

non-vegetarians. Vegetarians

49:04

are less likely to smoke. They are less

49:06

likely to drink. They're more educated.

49:09

They tend to be from like more affluent

49:12

backgrounds. Although they actually have lower

49:14

incomes than the population at large,

49:17

but that's mostly of just the fact that they're

49:19

younger. And then one of

49:21

the things that this documentary does that I think

49:23

is a very interesting bait and switch

49:26

is throughout the documentary, they talk about like

49:28

the

49:28

benefits of a plant-based diet, but they always

49:31

add this little modifier. They say

49:33

a whole foods plant-based diet.

49:35

Yeah. Well, that's a big fucking difference. But

49:38

then they don't define what the fuck whole

49:40

foods means. And like in

49:42

these awful little montages they

49:45

have this b-roll of

49:47

like a family at McDonald's

49:49

and they're sitting there eating french fries and

49:51

it's like very clearly designed to be stigmatizing

49:54

but also french fries are

49:56

vegan French fries are like pretty

49:59

close to a whole food, right? You chop

50:01

up the potato and you cook it. What they're

50:03

basically doing is like very clearly

50:06

promoting a vegan diet. Like the

50:08

whole movie is like, you know, milk is

50:10

poison meat is poison, et cetera. But they're

50:13

also giving themselves this like little asterisk

50:16

of like, well, if you're a vegan and you still

50:18

get cancer, like the foods

50:20

you ate weren't whole enough.

50:23

Yeah. That's the difference between like

50:25

the kind of veganism that eats

50:28

at like vegan restaurants and

50:30

drinks a bunch of green juice and all that sort of stuff. And

50:32

then like your vegan roommate in college

50:35

who kept yelling about how Oreos are vegan.

50:38

Yeah. Where you're like, yeah, yeah, yeah, yeah, yeah.

50:40

There's

50:40

a way to

50:43

eat in a way that people sort of like associate

50:45

with a lack of health for

50:48

kind of any way of eating. Yeah, exactly.

50:50

So like, if you look at surveys of

50:52

like the food behavior

50:55

of vegans and vegetarians, it's like they eat

50:57

less fat, They eat less sugar, they

50:59

eat more fiber, they eat fewer

51:01

calories overall, they eat

51:03

foods with higher nutrient density. I'm

51:06

not married to the idea that

51:09

any of these other things are necessarily explaining

51:11

the differences. I don't think there's

51:13

a diet that is best for everybody, but

51:16

it's like there's

51:16

almost no one who

51:19

has the same patterns as

51:21

the average American but doesn't

51:23

eat animal products. The fact that vegetarians

51:26

and vegans live longer and have all these better health

51:28

markers, maybe that means that

51:30

vegetarian diets are healthier? We can't rule that

51:33

out, but we can't say it with any confidence

51:35

either because there's like 15 or 20

51:38

differences between vegetarians

51:40

and non-vegetarians. Sure. I mean, it would also

51:42

be interesting to look at people who

51:44

are vegetarian for religious reasons. I'm

51:47

thinking of Hindus, right? Yeah. Okay.

51:50

Does that play out differently or the same? Yeah, it's very

51:52

weird to me that the vast

51:53

majority of studies on this only

51:55

look at UK or US

51:58

vegetarians when like 40% of

52:01

the population of India is vegetarian.

52:03

Oh, interesting. Although it's also an interesting

52:06

demonstration of how difficult this is because

52:09

in rich countries, being

52:12

a vegetarian is a sign of high socioeconomic

52:14

status, right? It's like

52:16

Reese Witherspoon in like big little liars.

52:19

But in poor countries, vegetarianism

52:22

is associated with low socioeconomic status

52:24

because when When you're super poor, you're

52:26

eating basically just like rice or

52:29

potatoes or like some other like super

52:31

basic starch because you can't afford anything

52:34

with higher protein or higher fat. And

52:36

so as people move up the income

52:38

ladder in poor countries, what tends to happen is they

52:40

don't actually eat more calories, but they eat

52:42

more higher end food, things

52:45

like

52:45

meat and eggs and dairy. So

52:48

it also speaks to how this

52:50

is always couched as like a biological

52:52

thing and how this affects the body, but like it's

52:54

extremely social. Right.

52:57

The idea that we could just cleanly say

52:59

this is straightforwardly because

53:01

of vegetarianism or because

53:04

of a fully plant based diet feels

53:06

like, again, I'm not sure that we've eliminated

53:09

everything else just yet. Well, one thing I will

53:11

say, so I called up

53:13

Catherine Fleagle to help me with this episode,

53:15

because we've kind of become pals

53:18

since we did an episode on her like a year and a half

53:20

ago. I love everything about

53:22

this. I know I, she's like an actual

53:25

methodology queen. I'm like joking

53:27

about my methodology queen status, but she

53:29

like actually knows what she's talking about. So like I

53:31

check in with her when I have like a technical question.

53:33

We're like the fantasy football.

53:36

Yeah.

53:39

A lot of the studies

53:40

on vegetarians versus non-vegetarians

53:42

do use statistical controls. So

53:44

like we've controlled for income, we've controlled for age,

53:46

we've controlled for gender, etc. So

53:49

statistical controls allow you to compare

53:51

like for like. So vegetarians on average

53:54

are much younger than non-vegetarians. So if

53:56

you're going to do a study, you have to control

53:58

for age because otherwise it's gonna be like

54:00

there were no heart attacks because young people

54:02

don't really have heart attacks. So, controlling

54:04

for age allows you to compare like 60-year-old

54:06

vegans

54:07

and 60-year-old non-vegans, right?

54:10

And like rich vegans and rich

54:12

non-vegans. You can hold everything else constant

54:15

so you're comparing like for like, which is great.

54:18

However, you can only control

54:21

in that way for the variables

54:23

that you gather.

54:24

So, if you have data on socioeconomic

54:26

status, then you can control for it. If you have data

54:29

on gender, you can control for it. Yeah. Very

54:31

few of the studies that I found

54:32

controlled for health insurance status. That

54:34

seems like a big one, dude. I know. And

54:38

one of the weirdest findings, there's

54:40

all this research showing that vegans and vegetarians

54:43

have higher rates of depression

54:45

and anxiety. But I don't think

54:47

that's the fucking diets. I think they're more

54:49

likely to have health care. Sure. A

54:52

condition of existence at this point is a certain

54:54

percentage of people are just going to be depressed and anxious

54:56

and like the differences who can access

54:59

treatment and who can't. Right. So

55:01

like I don't think that that means anything,

55:02

but then I also don't think that the health stuff

55:05

really means anything either because you

55:07

can't control for all

55:09

of the behaviors

55:10

that distinguish vegetarians from

55:13

non-vegetarians. This is where the vitamin

55:15

E comparison comes in. A lot of those

55:17

studies on people who eat vitamin E

55:19

live longer. They did control for things like socioeconomic

55:22

status

55:22

and gender and age and all this other stuff that you're

55:25

supposed to control for, but there's some residual

55:28

stuff that you can't control for because you

55:30

don't have every single piece of

55:32

data that you would need. To control

55:34

for it. Yeah, yeah, yeah. Yeah. I

55:37

read a really interesting article about

55:38

the problem with observational

55:42

studies. It used to be that

55:44

the threshold for publishing

55:46

these kinds of studies was you

55:49

would need a three to four

55:50

times greater risk to

55:53

publish something. People who eat apples are four

55:55

times more likely to have heart attacks or

55:57

whatever. A lot of the study's coming out.

56:00

about these kinds of risks and a lot of the studies

56:02

on vegetarians and vegans, it's like, oh, you're

56:05

at 10% higher risk of

56:07

a heart attack. Yeah, which your overall

56:09

risk for a heart attack was like 1% and

56:11

now it's 1.1%. Yeah, it's very

56:14

small. And then these small

56:17

gradations are easily

56:18

swamped by like, oh, all the

56:21

shit you couldn't control for. Another one of the

56:23

articles that I looked at pointed out that smokers

56:26

are 20 times more likely

56:28

get lung cancer than non-smokers. You

56:32

can say, okay, smokers also have some

56:34

characteristics that make them different. It's

56:36

a minority of the population. There's other things

56:38

that distinguish them. If we're talking

56:40

about a 20 times difference, it's

56:43

like, oh, well, people who smoke don't get as much

56:45

sleep. It's like, all right, maybe that knocks

56:47

it down to 19 times more likely. Yeah,

56:49

but it's a pretty decisive impact. So

56:52

much of this whole field of

56:54

observational studies, its tiny

56:57

effects, and given everything else

56:59

we know

57:00

about the muddiness of this data and the bad

57:03

track record of these fucking studies, we

57:05

just can't really say anything.

57:08

Well, there's also a bunch of stuff that there

57:10

have been illustrated links between

57:13

these things and heart disease, things

57:15

like experiencing racism

57:19

or experiencing weight Right? Like

57:22

all of these things are linked

57:24

to some kind of heart health conditions,

57:27

right? You're not going to be able to control

57:29

for that stuff necessarily either,

57:32

right? Like, there's just like a bunch

57:34

of stuff that like structurally is going

57:36

to be too difficult to

57:39

build into any one study.

57:41

Right? I mean, I also want to say that like, it

57:43

also is plausible to me that

57:46

like, I don't know, vegetarian vegan diets are better for

57:48

you. Like none of this rules out vegetarian

57:51

or vegan diets and like people,

57:53

Aubrey, people People who go out of their way

57:55

to like dunk on vegetarians online

57:58

are like some of the the baddest fucking

58:00

people I've ever come across. Just

58:02

mind-numbingly boring. So

58:05

boring. I came

58:07

across this first when I was researching our carnivore

58:10

diet episode, where there's these

58:12

weird fucking meat influencers

58:15

who make up these vegans to dunk

58:17

on. They're like, vegans don't want to admit

58:19

me. And it's like, dude, just

58:22

eat meat or don't eat meat, man. But shut the fuck

58:24

up about what other people are doing. It's

58:26

so fucking

58:27

weird. Jesus Christ. There's

58:29

a real strain of this in

58:31

like anti fat activist stuff

58:33

where they'll just like make up shit that

58:35

they're like fat activists say

58:38

it's fat phobic to have a decent

58:40

resting heart rate and you're like, yeah,

58:42

one has ever said that. Do what you want to do,

58:44

man. There's I watched this presentation

58:46

by this academic lady who did like the myth

58:48

of vegetarianism or something and she was like,

58:50

you say you care about animal rights, but what

58:52

about the animals that are killed to grow crops?

58:55

What? I

58:58

don't think that vegans are pretending

59:00

that their actions have no effect on

59:02

any animals whatsoever.

59:04

I think it's just really easy

59:06

to opt out of the worst forms

59:08

of animal torture. And people

59:11

are doing that. And it's such a fucking

59:13

weird thing to do with your time, to criticize

59:16

other people who are trying to

59:19

have less of an impact on living

59:21

creatures and the planet.

59:22

It's like, you're just as bad as me. We're

59:25

all kind of bad, so it just seems like a weird

59:27

thing to be proud of. It's just three

59:30

cattle ranchers in a trench coat. Five

59:33

million Joe Rogan listeners in a trench coat, but yes.

59:35

Jesus Christ. So I want to end with a

59:37

quote from the Annals

59:39

of Internal

59:40

Medicine. This is one of the only

59:42

editorials I found that

59:44

says what I have been thinking for many years

59:47

now. Ooh. It's an issue where

59:49

they go over a lot of these meta-analyses

59:52

of red meat. This is during the fucking red meat wars

59:54

in 2019 when a bunch of studies come out about this.

59:57

This editorial says It

1:00:00

may be time to stop producing

1:00:02

observational research in this area. These

1:00:04

meta-analyses include millions of participants.

1:00:07

Further research involving much smaller cohorts has

1:00:10

limited value. High quality, randomized

1:00:12

controlled trials are welcome, but only

1:00:14

if they're designed to tell us things

1:00:15

we don't already know. I love

1:00:18

to see this, that people

1:00:20

in the field are like, let's not do

1:00:22

this anymore. Every single time one of these

1:00:24

fucking studies comes out, it's like red meat will

1:00:26

kill red meat will save you, whatever it is, coffee,

1:00:29

breakfast, anything. We

1:00:31

know how these things are going to be framed

1:00:33

in the media, and we know how they will

1:00:36

be received by readers. The

1:00:38

only reason you click on

1:00:40

a headline about like, drinking

1:00:42

coffee in the morning causes cancer, drinking coffee

1:00:45

in the morning cures cancer. The only

1:00:47

reason to read those stories is to adjust your

1:00:49

own habits. The general population

1:00:51

is not interested in these studies

1:00:53

for like biological, epidemiological,

1:00:56

population level reasons. Nor are we reading

1:00:58

the original text of the studies. Which

1:01:01

always say we cannot determine

1:01:02

cause, yes. Right, all it's doing

1:01:04

is like fanning the flames of like

1:01:06

the closest sort of diet

1:01:09

world gets to culture wars. Yeah.

1:01:12

But this is a road to nowhere, or it's a road to where

1:01:14

we already are is maybe a better

1:01:16

way to put that. The whole thing is this quest

1:01:18

for like the best diet. I think

1:01:21

that is a pointless quest. Are

1:01:23

vegetarian diets better for you? It

1:01:25

seems like a very simple question,

1:01:27

but it turns out the science that

1:01:29

we have available to us can't really answer it.

1:01:32

And that's basically going to apply for any kind

1:01:35

of dietary pattern. If you are just happier

1:01:37

on a vegetarian diet than not on one,

1:01:40

then that works great for you and you should do it. For

1:01:42

other people it's going to be Mediterranean, for other people it's going to

1:01:44

be low fat, for other people it's going to be nothing. I

1:01:46

don't know

1:01:46

that more of these studies is really doing very

1:01:49

much for us. Okay, so what I'm hearing

1:01:51

is that I should go vegan

1:01:54

and paleo at the same time? Just

1:01:56

hearing you say that made me raise my flag.

1:01:58

Hahaha no much! Oh

1:02:00

no, I'm going to HR. That just happened.

1:02:03

have them...