Evidence-Based Nutrition: An Interview with Dr. Michael Greger

What follows is a transcript for the podcast Take Control of Your Health: An Exploration of Evidence Based Nutrition.

Sub-section topics within the interview include the following:

1. What are the Core Tenements of Healthy Eating?
2. Are Lectins Bad for You?
3. What’s the Difference Between Conventional and Organic Produce?
4. Is Taking Supplements Advisable?
5. How does Nutrition Relate to Longevity?
6. About  NutritionFacts.org: Non-Profit Science-Based Public Service
7. Is Cooking Your Own Meals Essential to a Healthy Diet?
8. The Food Industry
9. What has NutritionFacts.org Achieved so Far?
10. Intermittent Fasting Types
11. About Dr. Michael Greger
12. How Does Exercise Relate to Longevity and Health Span? 

What are the Core Tenements of Healthy Eating?

Michael Greger, MD: Let's do it.

Heather Sandison, ND: Welcome to Collective Insights. I'm your host today, Dr. Heather Sandison. I am joined by Michael Greger, expert in nutrition. So Michael, I have some burning questions for you. You have written lots and lots of books about nutrition, and you have the website, NutritionFacts.org. And I'm curious, why is there so much contradictory information about nutrition out there?

Michael Greger, MD: Oh, because there's a multitrillion dollar industry that has a tremendous stake in muddying the waters in hopes that people just kind of throw up their hands and eat whatever's put in front of them. This is a tactic that was first traced back to the tobacco industry. They realized the only way that they could... Given the scientific consensus that smoking was linked to lung cancer, all they can do was try to introduce doubt. There's a famous memo by a tobacco industry PR company, "Doubt is our product." They didn't have to convince people smoking was good for you. All they had to do was [inaudible 00:01:06]...

Some scientists say it's bad. Sometimes scientists say it's not so bad. And we just have to introduce enough doubt that people will continue with their bad habits. And so that's what we see today. And with so many trillions of dollars at stake, the most profitable industry on the planet, bigger than petroleum, bigger than the pharmaceutical industry, it's the food industry. No wonder you can't get a straight answer. But in contrast, the peer reviewed medical literature, which is the gold standard in where to find the truth in health and nutrition, there is a consensus going back decades as to the core tenements of healthy eating.

Heather Sandison, ND: Would you go through those core tenements with us?

Michael Greger, MD: Absolutely. And so if you go to TrueHealthInitiative.org, this is something put together by Dr. David Katz at the Yale Prevention Research Center, where, like the IPCC, you want to know the truth about climate change, why don't we ask the climate change experts, the climate change scientists? So they come together for a consensus statement in the IPCC. Well, let's do... because you can't just listen to anybody because we have ExxonMobil trying to muddy the waters, just like we have Coca-Cola trying to muddy the waters and the egg industry, trying to muddy the waters. So you can't just listen to the news as to what's happening with climate change. You have to ask the expert so that's where the IPCC...

So let's do the same thing with nutrition. True Health Initiative brought together hundreds of the top nutrition scientists in the world like [what will it 00:02:40] at Harvard, to agree as to what's a healthy diet and healthy diet is one centered around whole plant foods. That means fruits, vegetables, legumes, which are beans, sweet peas, chick peas, and lentils, whole grains, nuts and seeds, mushrooms, herbs and spices, basically real food that grows out of the ground. These are our healthiest choices.

Are Lectins Bad for You?

Heather Sandison, ND: What do you say to doctors like Gundry who has written about lectins being an issue or other people who suggest that the vegetables like tomatoes and potatoes and eggplants in that family are potentially harmful?

Michael Greger, MD: I would tell them to go to NutritionFacts.org and watch my video entitled "I believe Dr. Gundry is wrong." I can't get more obvious than that. And just so I show you the science, "Okay. Here's what he said. Here's what the science showed." And how else can we make decisions as life and death important as to what to feed ourselves and our families, but by the best available balance of evidence? So you don't listen to people. Don't listen to me. You listen to what the science says. And so anyone who tells you anything about something as life and death important for yourself and your family as what to eat, the first question out of your mouth has to be, "Where'd you get that? You weren't born with that information. Tell me where you got it so I could see what kind of veracity. Put it in context with every other data point that's ever been published on that particular fact."

And so you should challenge people, say, "Well, wait a second. Yeah. Who says this is good for you, this is bad for you?" Okay. Well, they should be able to not only show you the source, they should share the source with you so you can see, read the PDF yourself, make sure they're not skewing it, they're not spinning it. We're not talking about toaster reviews on Amazon where, yeah, some opinion of some complete stranger may actually be useful to you. We're talking about life and death. And for that, you don't want to just see what the checkout aisle magazine has to say about what to eat or what your buddy at the gym says. You want to rely on the science.

What’s the Difference Between Conventional and Organic Produce?

Heather Sandison, ND: And do you think there are different diets that are right for different people?

Michael Greger, MD: There are small little exist so for example, people have peanut allergies, "Ah, peanut's not for them, because they could close their throat up and die." Okay. But in general, peanuts are healthy for people. Some people are lactose intolerant. Some people are not. Some people metabolize caffeine a little differently than other people, fine. But in general, there's one healthy diet. Some people, certain foods are more or less healthy, but it's not like there's anybody on the planet that could benefit from eating more hot dogs other than people perhaps starving to death but you know what I mean.

Heather Sandison, ND: Organic versus conventional.

Michael Greger, MD: So in my book, How Not to Die, I talk about this modeling study, which suggested that if half of Americans ate a single more serving of fruits or vegetables, we would prevent 20,000 cases of cancer every year. That's how powerful produce is. But since they were talking about conventional produce, pesticide-laden produce, the additional pesticide burden on the American public would cause 10 cancer deaths. It would cause 10 cases of cancer. So all in all, we would just prevent 19,990 cases of cancer, right? That gives you a sense of the tremendous benefit of fruits and vegetables versus the tiny bumping risk. Now you say, "Wait a second. Why accept any risk at all and choose organic?Then you get all benefit, no risk." Great, but you should not prevent the concern over pesticides. You should not let that prevent you from stuffing your face with as many fruits and vegetables as possible.

Is Taking Supplements Advisable?

Heather Sandison, ND: Supplements, is that advisable?

Michael Greger, MD: Well, it depends who you are, if you're an alcoholic or you're pregnant or you're a burn victim, but in general, we should try to get our nutrients from the produce aisle, not the supplement aisle. There are, however, two exceptions. There are two vitamins not made by plants. One is vitamin D, which is the sunshine vitamin, which is made by animals such as yourself when you walk outside. But those getting inadequate sun exposure need to, I recommend 2000 international units of vitamin D3 a day. That's what I take since I'm inside my laptop all day and the sun's glare screws up my screen and so I'm working all the time and not getting... I had the vitamin D levels of an institutionalized elder, so that's why I supplement with vitamin D.

And the only other vitamin not made by plants is vitamin B12, which isn't made by animals either. It's made by little microbes that blanket the earth. You used to be able to get B12 from a drink out of a mountain stream or well water. But now we chlorinate the water supply to kill off any bacteria so you don't get a lot of B12 in our water anymore. Don't get a lot of cholera either. That's a good thing that we live in such a nice sanitary world. Our fellow great apes get all the B12 they need from eating bugs, dirt and feces. I prefer supplements. 2000 micrograms of cyanocobalamin, most shelf-stable form once a week is all the B12 you need, cost less than five bucks a year, critically important for anyone eating a healthy diet.

How Does Nutrition Relate to Longevity?

Heather Sandison, ND: How is nutrition related to longevity?

Michael Greger, MD: Well, hey, it is the season. Have you looked around outside? There's a disease called COVID-19 and the risk factors for disease. Forget chronic disease. Forget dying from heart disease in a decade. Right now, having heart disease, hypertension, obesity, type 2 diabetes dramatically increases your risk of a severe course of COVID-19. And guess what? Every single one of those can be prevented, arrested and even reversed with a healthy enough plant-based diet and lifestyle. So this is the time. If there was ever a time to clean up your diet, this is the time to eat healthy.

Heather Sandison, ND: And what would be the first step you'd recommend someone taking if they have diabetes, obesity, heart disease, any of these comorbidities that increase their risk of dying from COVID-19?

Michael Greger, MD: I got a book recommendation, so How Not to Die. The first half of How Not to Die's 15 chapters, [you should have 00:09:12] 15 leading causes of death, talking about the role diet may play in preventing, arresting, reversing each of our top 15 killers. All proceeds are received from the sale of the book go to charity. I just want everyone to have access to this life-changing, life-saving information. Let us take a step back for a moment. There's only one diet ever proven to reverse heart disease in the majority of patients, a plant-based diet.

So anytime someone tries to tell you about some new diet they heard about, do me a favor, ask them one simple question, "Wait a second. Is this diet been proven to arrest heart disease, the number one reason me and all my loved ones will die?" The answer is no. Why would you even consider? If that's all a plant-based diet could do, reverse the number one killer of men and women, shouldn't that kind of be the default diet until proven otherwise? And the fact that it can also be so effective in preventing, arresting, reversing other leading killers like type 2 diabetes and high blood pressure would seem to make the case for-plant based eating simply overwhelming.

Heather Sandison, ND: What do you have for breakfast this morning?

Michael Greger, MD: Oh, what'd I have for breakfast morning? I had groats. So I had a combination. This prebiotic mix of oat groats, ripe berries, purple barley groats and these beluga lentils, these little caviar-looking round black lentils and did that with some... it is cherry season, at least where I live, so a whole bunch of pitted cherry, some pitted not as well as the others, my teeth will tell you, but with some cocoa powder, with some pumpkin seeds, walnuts, ground flax seeds, ground chia seeds. What else I put in there? And some apricot vinegar and oh yeah, that's it. So I had this kind of chocolate cherry kind of oat groat kind of thing going on. It was delicious.

Heather Sandison, ND: Coffee, no coffee?

Michael Greger, MD: A tea. I had chai tea.

Heather Sandison, ND: So tell us...

Michael Greger, MD: With unsweetened cinnamon.

About NutritionFacts.org: Non-Profit Science-Based Public Service

Heather Sandison, ND: Oh. Yum. Tell us about the non-profit and where the proceeds go to for that.

Michael Greger, MD: So NutritionFacts.org is a free non-profit science-based public service providing daily updates and the latest in nutrition research. We have bite sized videos. There are more than a thousand videos on nearly every aspect of healthy eating with new videos and articles uploaded nearly every day and the latest in evidence-based nutrition, what a concept, NutritionFacts.org. It's a 501(c)3 so you can make a tax deductible donations. It's a non-profit charity and the money going to Nutrition Facts goes to our 14 staff, including me. I'm on staff as kind of the content creator. And it will help get this life-changing, life-saving information out into the world in terms of the proceeds I get from the books.

The money that I don't give to Nutrition Facts, give to other non-profits depending on the book so for example, my latest book, How to Survive a Pandemic was just came out on Tuesday. So that's... what is it? I don't know, four days ago now. Is donating to a number of pandemic prevention and preparedness groups like The Good Food Institute or the Plant Based Food Association, Well-Fed World, the Center for Infectious Disease Research and Policy at the University of Minnesota got the money from this book but every book's a little different.

Is Cooking Your Own Meals Essential to a Healthy Diet?

Heather Sandison, ND: And what are your thoughts about cooking? Is it essential to learn to cook if you're going to eat a healthy diet?

Michael Greger, MD: It can certainly make things easier. Cooking, you have control. All right. So even so-called healthy restaurants, they need to stay in business. How do you stay in business? You add salt, fat, and sugar. That's how you stay in business. So you can go get Italian salt, fat, and sugar. You can go get Thai, salt, fat, and sugar. You can get Chinese. You can get Mexican salt, fat and sugar. You name it. They'll give it to you. And so you think you're eating healthy, but it's funny. Somebody in my patients will tell me, "Oh my God, I eat so healthy and I can't lose weight, whatever." Then all of a sudden they're locked down. They just have to cook for themselves. Oh, all of a sudden you're losing weight. All of a sudden you're in this. Oh really? It's because restaurant food is crap in general.

You cannot saying you can't get healthy options, but at home you have control. You have control. You can add salt. You cannot add salt, right? You're going to add sugar. You cannot add sugar. And so then, you have some modicum of control over what's going into your body, which is the most important decision we make for our health. According to Global Burden of Disease Study, the largest study of risk factors for disease in history funded by the Bill and Melinda Gates Foundation, the number one cause of death in these United States is our diet, bumping tobacco smoking to number two. Cigarettes only killed about a half million Americans every year whereas, our diet kills thousands more, also leading cause of disability. So the most important decision we make for our health is what is at the end of our fork.

Heather Sandison, ND: What would you suggest would be the first step into making these ideas more commonplace?

Michael Greger, MD: Well, it's taste, cost, convenience. That's how people make their choices. And so we need to make it convenient for them. And it's getting increasingly easy. But look, if we're going to subsidize as a country, if we're going to subsidize the food industry, why are we giving taxpayer dollars to the sugar industry? Why are we going... why are our taxpayer dollars making high fructose corn syrup cheaper or making feed crops cheaper to make dollar value menu burgers? If we cared about public health, rather than the lobbyists in the Washington Beltway, we'd be subsidizing fruits and vegetables. We should be making apples cheap. If you're going to put taxpayer dollars in, then let's make apples cheaper. Let's make cabbage cheaper. So yeah, unfortunately, if you look at the consumer price index, junk foods gotten cheaper, particularly just as the obesity epidemic was launching off in the late 70s, early 80s whereas fruits and vegetables compared to the consumer price index actually went up, got more expensive. No wonder fruit and vegetable consumption was declining and junk food intake was increasing.

The Food Industry

Heather Sandison, ND: So do these produce industries need lobbyists in Washington?

Michael Greger, MD:  Well, there are. There's a Watermelon Promotion Board. They are there, but they're outgunned. They say, "Well, wait a second. Why are they outgunned? Don't they make a lot of money?" No they're selling produce. They're selling something that goes bad, that rots on the shelf, that can't be patented, that can't be branded. Even a broccoli grower isn't going to go on TV, making an ad for broccoli because you'll just buy their competitor's broccoli. It makes no sense. You never going to see an ad on the Super Bowl for sweet potatoes. There's no markup. There's no money.

What you want is a snack cake that sits on the shelf for a couple of weeks. That you can make money off of. You can make money selling brown sugar water, right? That's how you make money. That's how you satisfy your shareholders in the next quarterly returns. You don't do it by selling healthy food. That's why the system is set up to make people sick. It's not some conspiracy. It's just the way the system works. And we need to take responsibility for our own health, for our family's health and we can't wait until society catches up to the science because it's a matter of life and death.

Heather Sandison, ND: So really it's the responsibility of government to be making good decisions for public health.

Michael Greger, MD: And if they're not going to, if they're failing because of the role of special interests in corrupting the political process, then we have to take our own responsibility for our own community.

Heather Sandison, ND: And then there's also the doubt, the seeding of doubt that you mentioned that is very, it's distracting and confusing.

Michael Greger, MD: That is completely on purpose. That's what I'm trying to get across to people that it is no coincidence. That's exactly... That's what they want. They coffee on one day to be good for you, coffee, to be bad for you the other day. It's all about muddying the water so people just kind of throw their hands up in the air and eat whatever's put in front of them. It's good for a business. It's not good for the health and well-being of our families.

What has NutritionFacts.org Achieved so Far?

Heather Sandison, ND: If NutritionFacts.org did everything you hoped it would do in the next 10 years, what would that look like?

Michael Greger, MD: It would just giving people the tools to make the right decisions. I'm not telling people to eat anyway. You want to eat bacon, eat bacon. You want to smoke cigarettes, smoke cigarettes. You want to go bungee jumping and go bungee jumping. All I can as a physician do is share with you the predictable consequences of your actions. If you continue to do X, Y, and Z, well, the science suggests that you're at increased risk of X, Y, and Z.

And so then I just want people to be informed. It's your body, your choice. Do whatever you want, but you shouldn't be eating your sausage link thinking that you're doing your body any favors. No. In fact, you're reading a category 1 carcinogen determined by the IARC, the official World Health Organization, by the terms what is and is not cancer-causing. You are eating something known to cause cancer in human beings. We try not to smoke around our kids. Why would we send them to school with a bologna sandwich? It's outrageous and there should be warning labels. Who knows that they're increasing the risk of cancer for their children by giving them lunch meats? And look, as long as you do know, then stuff your face with whatever you want, but know that you're not necessarily making the best choice for your health.

Heather Sandison, ND: Is there any amount of meat or animal product that is okay, or is health promoting?

Michael Greger, MD: It's all about quantity. It doesn't matter what you eat on your birthday, holiday, special occasions. It's the day-to-day stuff that adds up. Your body has a remarkable capacity to bounce back from entry. It's like, you see social smokers, people that can sit, that can... at a party a few times a year, pick up a cigarette, never become addicted. It's amazing. Right? You're going to tell me there's no data in the world that is finely grained enough to say that it's going to be harmful to anybody. The reason we tell people don't smoke at all is because they're afraid one cigarette's going to lead to one pack a day and eventually then you're dramatically increasing your risk of things like emphysema and lung cancer and the same thing with overly rich foods.

The reason that the ideal intake of candy is zero, it's not that one piece of candy is going to really hurt anybody in the long-term, it's that by maintaining this hyperstimulated palate, this hyperpalatable foods, the hypersalty, hypersweet, hyperfatty foods, we are doling our palette. The industry is going out of its way to get these tastes engineers to get that bliss point such that regular food tastes like crap. People going on low salt diets, everything tastes like cardboard for a few weeks until your taste buds can alter. The ripest peach in the world's going to taste sour after a bowl of Fruit Loops. That's exactly what they want. So the only way to kind of recalibrate your taste buds is to avoid those foods completely.

If you had candy every day, you'd never pull away from that. But then the reason that you want to do that is because after a few weeks, you get that reset. Your taste buds only last about 21 days before being replaced. Then all of a sudden, normal, healthy, natural food tastes delicious. Corn on the cob, no butter, no salt, delicious. Just a sweet potato, a little sprinkle of cinnamon, delicious. Not because you're some aesthetic monk white knuckling it with willpower. No, you get the best of both worlds. It actually tastes delicious and it's good for you too. That's only possible if you get rid of the junk.

Intermittent Fasting Types

Heather Sandison, ND: Any opinion on fasting?

Michael Greger, MD: I've got tons of opinions on fasting, but who cares what opinion? I can tell you about the science and facts, that's all that matters.

Heather Sandison, ND: Even more importantly.

Michael Greger, MD: Exactly. Actually the biggest chapter in my... I was going to say latest book, but now that I have a new book out this week, it's my second to latest book. In How Not to Diet, I talk about all forms of intermittent fasting, including water only fasting, modified fasting, but also alternate day fasting, 5:2 fasting, 25:5 fasting, fasting mimicking diets, on down the list, time- restricted feeding, bottom line, and so I talked about the pros and cons of all of them. Bottom line, early time-restricted feeding is beneficial, meaning restricting your feeding window to 12 hours or less, but critically important, that's an early 12 hours, not a late. If you're going to skip any meal, you skip supper, not breakfast. We want to weigh our calories towards the beginning of the day. We shouldn't be eating after the sun goes down, encourage people to fast after 7:00 PM.

About Dr. Michael Greger

Heather Sandison, ND: So you're a physician, you mentioned you have patients. If people wanted to schedule with you or someone on your team for more information about what they could do to incorporate the science into their diet, how could they reach out?

Michael Greger, MD: The best thing they can do is go to NutritionFacts.org. I have all my contact information there. Firstly, I'm not taking any new patients, but there is tons of free information, thousands of videos waiting for them to binge watch themselves to health.

Heather Sandison, ND: Fantastic. Dr. Greger, it's been an absolute pleasure having you here with us today. I know that you're a very busy man, so we won't keep you. The one last question I have is, or actually I would just want to let all of our listeners know that you are actively exercising right now. You are walking on... You're not only at a standing desk, but you are taking steps probably 10,000 as we've just talked over the last 30 minutes.

Michael Greger, MD: Indeed, indeed. I walk about 17 miles a day.

How Does Exercise Relate to Longevity and Health Span?

Heather Sandison, ND: What is the role of exercise in longevity and health span?

Michael Greger, MD: Critically important. In fact, it's part of my daily dozen. So I talked about the first half of my book, How Not to Die. The second half centered my recommendations around this daily diet, a daily dozen, a checklist of all the healthiest of healthy foods I encourage people to fit into their daily routine like greens everyday, the healthiest vegetables, berries every day, the healthiest fruits, a tablespoon of ground flaxseeds, a quarter teaspoon of turmeric, the best beverage is best sweeteners and how much exercise to get every day. I recommend 90 minutes a day, a moderate intensity exercise, four to five minutes of vigorous, seven days a week, every single day. That's what the science suggests is the best as a minimum. And so we shouldn't patronize the public and give them these ridiculous recommendations like you see the USDA and the dietary guidelines has cut down on candy. No, they should say these are dietary guidelines. Don't eat. Ideally, we shouldn't be eating candy. Similarly, instead of saying, "Oh good, 30 minutes, three times a week of exercise." That's not what the science says is best. Tell people the truth. Let people make their own decisions.

Heather Sandison, ND: I thought Framingham was 200 minutes a week.

Michael Greger, MD: Well, but if you look at... If you do a med analysis of all these... So this is all based on walking studies, this was mostly walking studies. Walking 15 minutes a day is not as good as walking 30 minutes a day. It's not as good as walking 45 minutes a day. Not as good as walking 60 minutes a day. not as good as walking 90 minutes a day. And that's all the data we have because they couldn't find enough people walking regularly more than 90 minutes a day. So maybe walking two hours a day is even better. We have no idea. The science hasn't been done. But what we can say is the best available balance of evidence says that the lowest all cause mortality, meaning the greater likelihood that you live the longest is at 90 minutes a day.

Heather Sandison, ND: And you're the end of one for at least two hours a day.

Michael Greger, MD: Oh my God. I'm walking at 1.8 miles an hour...

Heather Sandison, ND: I love it.

Michael Greger, MD: So all day long, I'm just at my desk. I encourage people, "Look you don't have to get some fancy thing. You go to your thrift store. They got tons of old treadmills. You stick one on it some cheap plastic shelving, little duct tape. You are good to go."

Heather Sandison, ND: I love it. On that note, thank you so much for your time, Doc. It was a pleasure having you today.

Michael Greger, MD: I'm so glad to be here. Keep up the good work.

Heather Sandison, ND: You as well. Take care.