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You’re listening to Insights at the Edge. Today, my guest is Dr. Joel Kahn. Dr. Joel Kahn is a plant-based cardiologist whose approach combines the best of Western and complementary therapies for total healing. He’s known as America’s Holistic Heart Doc, and graduated summa cum laude from the University of Michigan—Ann Arbor. Dr. Joel Kahn has been practicing invasive, interventional, and preventive cardiology, along with offering integrative and nutritional-based approaches, in Detroit since 1990. He’s a clinical professor of medicine at Wayne State University School of Medicine, and associate professor of medicine at Oakland University Beaumont School of Medicine. He’s the author of the top-selling book The Whole Heart Solution and the bestselling book Dead Execs Don’t Get Bonuses.
With Sounds True, he’s the author of the new book The Plant-Based Solution: America’s Healthy Heart Doc’s Plan to Power Your Health. In this episode of Insights at the Edge, Dr. Joel Kahn and I spoke about how a plant-based diet both prevents and reverses heart disease. We talked about why no decision you can make, according to Dr. Joel Kahn, is as important as deciding to eat a whole-foods, plant-based diet.
We talked about the relationship between being vegan and healthy sex, diabetes prevention, and longevity. We also addressed questions about eating healthy fats, paleo and keto diets and how they compare to a vegan diet, how to address the deficiencies in a plant-based diet, and finally, why Dr. Joel Kahn believes that we are soon at a tipping point in which the plant-based diet will become the new normal. Here’s my conversation with Dr. Joel Kahn.
Joel, to begin, if you can share with our listeners a bit about your background, how you became a leading cardiologist focused on plant-based solutions to health.
Joel Kahn: There’s a few bullet points in my life that are the big milestones. One was, I was 10 years old and I met a cute girl in fifth grade. She’s been my wife for 36 years, but she ties back in the story in just a few seconds. Two, I decided about age 17 with no doctors in the family that I really wanted to be a cardiologist, not just a doctor.
I actually had a murmur as a child, was visiting a pediatric cardiologist once a year. Actually had a heart procedure at age one called a catheterization, which found me to be fine and I outgrew the murmur, but that whole influence led me to say, “This is a cool field.” He was a good doctor, and so that formulated my teenage years, and I got accepted into a special program at age 18 in Ann Arbor at the University of Michigan, where you do undergraduate and medical school combined. Amazing program, and it was just a great honor and privilege to be accepted. That was a milestone.
Then, pretty much two more. I walked into the cafeteria at my dormitory [in] September 1977. I’d been raised keeping kosher. I wasn’t going to eat pork. I wasn’t going to eat cheeseburgers. I walked in with my girlfriend—now my wife of 36 years—I looked around, and I said, “Salad bar. That’s going to work,” I actually became a vegetarian that day 40 years ago, and that very quickly morphed into a completely plant-based—I call it, now, more of a plant diet because plant-based leaves a little wiggle room for the other parts. I eat only plants.
The last piece is, [in] 1990, I finished a long period of cardiology training, stent training, heart attack training, and I began my job July 1, 1990. I actually circled back to Ann Arbor, Michigan. I’d been out of state for four years training. Three weeks after starting my job where I had been literally working 24 hours a day in the cath lab, innovating new programs, pushing the window and envelope, an article came out—July 21, 1990, in a British journal called The Lancet—that reported you could reverse heart disease using the diet I had been eating by that point for 20-plus years. A plant diet including walking, meditation, not smoking. That was called The Lifestyle Heart Trial.
Literally, I had about three weeks where the only therapy I had to really offer our patients was medicine and balloon stent, balloon stent. Three weeks later, I’d circled back to what I had decided in 1977 was now a proven therapy. That really gets you there. I, from 1990 on, said, “I’m going to teach people everything I know. Medicine, stents, balloons, but I feel obligated to teach them about nutrition.” So I’ve always focused on nutrition as a therapy since that day, quite a long time ago.
TS: The idea that a plant diet can reverse heart disease—I don’t know if that’s widely known. Can you tell me what the evidence is for that?
JK: It actually—and I try and be quick and concise, but it’s one of my topics. I go through it in the book. It’s fascinating. Maybe not the first bullet point, but one of them is during World War II, the country of Norway, which had the best records, was invaded by the Nazi regime. During the two years that the Nazis occupied Norway—roughly two years—they would routinely move all the animal livestock out of the country back to Germany to feed troops, and military people, and government people, leaving the people of Norway virtually plant-based in the garden, in the forest, whatever they could forage.
During those two years—surprise, surprise, because this data was published shortly after World War II—heart attack rates fell tremendously in Norway. When that was published, the reason was already implied, “Maybe a diet without animal products reduces heart attack rates, and actually death from heart disease rates.” That was noticed by some people. One was an internist in Los Angeles in the late ’40s—we’re talking long ago.
Dr. Lester Morrison. He had a very large cardiology practice. What was the therapy in the late ’40s? Essentially none. You’re going to die of your heart disease, and there was already a rise in heart disease in the 1940s. He said, “I’m going to feed half my patients a Norway-during-World-War-II diet.” He didn’t call it that, but it was, essentially. “I’m going to take away their liver. I’m going to take away their red beef. I’m going to take away their cheese, their cream, and such, and I’m going to encourage them to eat—” what we would now call the whole-food, plant-based diet.
Radical idea. He published the data in a major journal in 1951, and he followed his patients even longer. At 12 years, none of his patients that ate a typical Los Angeles diet were alive. Half of his patients that ate the “Norway-World-War-II” diet were alive. Radical data.
From that, a whole series of people like the engineer Nathan Pritikin, who although he passed away in the ’80s, he still lives on for sure in several ways. There’s a food line called the Pritikin Food Line. There’s a center of health in South Beach, Miami, called the Pritikin Longevity Center that’s very active and beautiful. There’s actually even an insurance-reimbursed cardiac rehabilitation program called Pritikin Intensive Cardiac Rehab. This engineer latched onto the Morrison data and the Norway data and started advising people that they should do this, even though he’s an engineer. It’s a crazy story. I won’t go into it.
He published real data in real journals, and he changed the world. Then, Dr. Dean Ornish, who is still a very active researcher-scientist in the San Francisco area, he did a study and published that paper I read July 21, 1990. He continues to contribute whole-food, plant-based diets—in Dr. Ornish’s world: plus meditation, stress management, plus walking—can stop and reverse advanced plaque and heart arteries, can shrink prostate cancer, can lengthen markers of antiaging in their cells called telomeres, and he’s embarking on an Alzheimer’s study right now.
Then, finally, probably bring up Dr. Caldwell Esselstyn, a pioneer at the Cleveland Clinic in glandular surgery. [He] got very interested in heart disease 30 years ago and has his own program at the Cleveland Clinic. [He] published data, massively compelling, that if you will just change one thing, your diet, to a healthful, heart-friendly diet—the only diet ever described to stop and reverse heart disease, which is no animal products and every plant on the planet—you can actually stop and reverse the disease that may have been going on for decades.
Now, in my world, as an integrative but also plant-based cardiologist, I do all that with diet, stress management, walking or other forms of exercise, and there’s a plus. I do that plus, because the science says there may be some other ways to add to this awesome and really quite powerful dietary therapy. There is no other dietary regimen that has ever been shown to shrink prostate cancer, to reverse established cardiovascular disease, and to affect our aging, our telomeres, the way that what I write about and what I have practiced for about 30 years has been shown to do.
TS: When you say, “I do all of that, plus . . .” I didn’t follow you. What’s the plus part?
JK: I had the opportunity about five [or] six years ago, knowing I was getting restless as a conventional cardiologist. Happy, but restless. I was getting restless in the cath lab putting in balloons and stents, and I knew that I had this long-term interest in nutrition, but I didn’t know the rest of the story. So I found a university program, an authentic and certified university program, that taught integrative cardiology.
For example, just the first one that comes to mind, in Japan, if you have advanced heart disease and you’re having chest discomfort we call angina, they’re going to tell you, along with every other thing they may recommend—medication, diet, lifestyle—they’re going to tell you, “Use an infrared sauna two to three times a week.” Because we have proven, published data in Japan about the health benefits of infrared sauna.
Now, how many cardiology patients in the United States have ever heard that? How many cardiologists have ever heard that? Everybody can go online and check the National Library of Medicine and read the dozens of studies. In fact, now, there are studies coming out in Northern Europe that the number of minutes and the number of times a week you’re in a sauna, basically, is an equation for your lifespan, so the data’s progressing on and on in other parts of the world. That’s one example. I was not aware of that. I have an infrared sauna in my house. A good number of my patients either use facilities in the area where they rent by the hour or have decided to purchase themselves a pretty nice lifestyle option.
Supplements. Proven supplements. Is it just expensive urine, or is it therapy? One I point to all the time, an antioxidant many people have heard of: Coenzyme Q10, or CoQ10. Our bodies make it. Every cell in our body needs it. As we get over age 40, we make less of it. Darn it. If you’re taking a group of drugs called statins, a cholesterol-lowering drug, which can have a role in patient care—I’m not a zealot that says, “Never!” It can also cause side effects, of course. I’m acutely aware of that.
However, if you’re on a statin, you make far less Coenzyme Q10 than you would otherwise at your age. There are two studies that motivate me once I learn these through my advanced training, and I’ve used them now in thousands of patients. There’s a study from Northern Europe again. If you’re over age 70 and a healthy, free-living Northern European and you get put on 300 mg a day of Coenzyme Q10 versus placebo, you live longer. I think cardiologists ought to be teaching that to patients. “You look great, Mrs. Jones, Mr. Smith, but you’re 72 years old. You can go to your local vitamin shop, you can go to your big box store, you can go online, you could maybe add some Coenzyme Q10 based on these studies.”
If you have a serious cardiovascular condition called congestive heart failure, a large and funded 10-year study shows you live longer if you take Coenzyme Q10. Unfortunately, all supplements—and I could go on with many other examples of where supplements can replace prescription drugs—sometimes that’s reasonable, sometimes that’s not, where supplements can be added to prescription drugs to get even a better benefit, or maybe use a lower dose of the prescription drug.
There clearly, clearly are examples like the ones I just mentioned, where either quality of life or quantity of life have been absolutely proven, yet it kind of all falls into one “expensive urine, don’t bother taking them.” There are some concerns about taking large doses of low-quality, single vitamins. There have been some failed studies, but there’s another one for prostate cancer that’s compelling and published. I don’t tell my patients any recommendation if there’s not some scientific literature that I know where it is and I know the data. But if there is, I’m going to tell them that it’s one of the menu options.
When I talk to a patient, I say, “For heart disease, there’s three doors. Door one is the lifestyle issue, door two is a stent, and door three is bypass.” There’s so much in that door one the patients never hear about, and you can call that lifestyle or integrative cardiology, but it’s so much fun to have the toolbox that goes to that level. Now, if you’re in the emergency room and you’re having a heart attack, I’m not going to talk to you about garlic or your heart arteries. I’m going to talk to you about getting you in a cath lab as quick as we can, because we need it.
TS: Sure. Joel, there’s so much to talk about here, but I just have a quick question about the infrared sauna, because I’ve never heard that there were heart-health benefits to being in an infrared sauna. Can you explain that to me? How does that work?
JK: It’s not completely clear, but if you go to the Japanese literature again, they’ve done both basic science and clinical trials, real clinical trials, and it appears that infrared sauna may have multiple benefits. It may be a detoxifying strategy. There’s data that if you go to the gym and sweat and collect your sweat in a little vial and analyze it, you may be actually excreting some of the toxins we build up—let’s say BPA, let’s say mercury. If you go in an infrared sauna for the same amount of time and collect the sweat, there’s actually more of the toxins excreted. So, they’re both great activities, but infrared sauna is truly scientifically known to be detoxifying.
Then there’s a concept, inside every artery in our body—50,000 miles of arteries in our body, that’s twice around the planet Earth—every artery is lined with a wallpaper called the endothelium. We’ll call it the wallpaper. It needs to be healthy and functioning for heart attack/stroke-resistant life, and it turns out, it looks like infrared sauna helps the endothelium stay healthy, or heal and become healthy.
In Japan, they’ve done studies, again going to congestive heart failure, that if you’re suffering from that very common and very serious disorder and you add infrared sauna, there’s actually one study that has suggested you live longer. There’s other studies that suggest at a minimum, you feel better, you walk further, because if your arteries are responding better, the whole system works better. It does lower blood pressure, and blood pressure is the single biggest cause of death in the world. It’s actually blood pressure, according to a study called the Global Burden of Disease Study Group, so anything we can throw at the global population to lower blood pressure is a great benefit.
TS: In your book, The Plant Based Solution: America’s Healthy Heart Doc’s Plan to Power Your Health, you make an incredibly compelling case for people to change to a plant-based diet, even if they don’t have any diagnosed heart problems or challenges.
Here’s a quote from the book. You write, “There’s no decision you can make that is as powerful for your health and as supported by medical research as giving up animal foods and learning to replace them with enjoyable and healthy plant-based substitutes.” No decision you can make. That’s a really strong statement.
JK: I think it’s actually—I wouldn’t have put it in there if I didn’t feel strongly it was supported by science. What don’t we know? I’m not a type of physician or author that won’t recognize the deficiencies.
Do we absolutely know that there’s one diet that fits every human being? We don’t know that. I believe there is. I believe every human being could eat a well-constructed, easily-constructed, inexpensive, whole-food, plant-based diet. Most of the world eats beans and rice as the mainstay of their calories, and they have a much lower rate of the chronic diseases, including cancer, than we have in the Western world. That would do it for most. That actually provides complete proteins as well as naturally low in fat, low in sugar, and such.
We don’t know for sure if there are some people that couldn’t tolerate a whole-food, plant-based diet. We know that there’s reports and bloggers, “I had to add back fish, chicken, meat, because I felt tired.” These are anecdotal reports. I don’t know if their diet was top-notch or not. But with all that said, there’s three legs upon which the movement—we can call it the plant movement, the vegan movement, whichever you want to call it—sit upon.
One is animal rights, and I always bring that up because although there are wonderfully ethical farmers, more than 95 percent of Americans who are eating eggs, chicken, fish, beef, pork, turkey, ham, whatever you want to pick—the cruelty with which animals are born, live, and die in factory farms, which is more than 95 percent of all that food that’s graded. Which is the second leg, the environmental price we are paying for that is inexcusable, but it’s been protected by laws that don’t allow full disclosure of what’s going on. Of course all these little videos sneak out. Now drones are revealing the massive environmental destruction.
That’s one. The second is the environment. Don’t take it from the cardiologist Joel Kahn. How about the United Nations? How about Oxford University? How about our own United States Food and Drug Administration with the USDA guidelines, Department of Agriculture? All have said if we don’t move from beef to beans, we don’t have, as it’s called, Planet B, instead of Plan B. Where are we going to live in 2050 when there are no forests, no rivers, no oceans that are sustaining what we expect and hope to have for our children and grandchildren?
There’s no doubt that that’s a benefit. It’s not perfect. You still have to raise plants to feed 8, 9, 10 billion people. There’s going to be some contamination of the planet, but greenhouse gases are growing at a rate of contamination faster than they have ever in the history of humankind. That’s data that just came out from the World Meteorological Organization. We got an issue, but everybody wants to enjoy their steak and not think about 20 years down the road. But it’s happening right now with the crazy weather we’re having.
The third is the health issue, and that’s where I got to. I can’t prove, I just know the science is if you took a scale and put all the science that says, “You can exist without animal products on a well-balanced, rainbow, whole-food, plant-based diet of fruits, vegetables, legumes, and whole grains,” versus those that say, “Meat and other products are essential or health-promoting,” the scale falls so heavily in favor of the plant diets. So heavily. Whether we’re talking multiple sclerosis, something called the Swank Diet, whether we’re talking about preventing and even reversing type 2 diabetes, work by Dr. Neal Barnard, Dr. Gabriel Cousens, and others. Then my main focus, cardiovascular disease, where studies done with the Adventist Health System and the Seventh-Day Adventists, the actual prospective scientific studies by Dr. Dean Ornish, Dr. Caldwell Esselstyn, Dr. Joel Fuhrman.
When you ask the question, “What diets have been proven to halt and reverse our number one killer?” It’s proven for a plant diet. It’s absolutely conjecture for every other attempt, because it’s never been shown, and that’s always my question. Yes, I was a CrossFit gym person myself, and the paleo diet is so much better than going to Wendy’s®, Hardee’s®, McDonald’s, and KFC, but don’t tell me it reverses heart disease because it’s never been studied. Short studies suggest a low-carb, high-fat diet may help you lose weight and control type 2 diabetes short-term, but show me what it’s doing to arteries long-term.
If you don’t have science, don’t promote it. You’re putting butter in your coffee? I know it’s a trend out west, but you’re telling me that’s good for your health and you’ve never studied arteries and the impact on cholesterol and arteries? Don’t promote that for health, because it’s never been shown. But I can show you how eating fruits and vegetables do it. We can go on and on, but chronic conditions—psoriasis, eczema, autoimmune diseases like lupus, like rheumatoid arthritis, like colitis, hypertension, cholesterol, type 2 diabetes, stroke, heart attack, cancers, certainly prostate cancer, just recently shown colorectal cancer—after you recover, you should be on a plant-based diet rich in fiber, on and on.
A whole-food, plant-based diet—we’re not talking about eating soy hot dogs. You want to have one once in a while, that’s fine. There’s much better products out there, although soy is a good food. We can come back to that, but a well-constructed, whole-food, plant-based diet—the rainbow diet—is associated with more prevention and reversal studies than any other choice out there. Plus the side effect that it benefits the environment, and it’s a kind way to live.
We live in a cruel world. At least the internet, there’s this “Constantly Negative News,” that’s what I sometimes call that channel. Just to know that peace begins on your plate, your choosing to eat a kind diet is a nice thing to do, and mindful. Whether it’s once a week as Paul McCartney just put out a YouTube, “Eat plants once a week as a baby step,” or whether you want to do it 21 meals a week as I’ve done for 40 years.
TS: You brought up some really, I think, important points about why some people say, “Plant-based diet, I’m not really sure.” You mentioned a paleo diet, and I know right now, a fad at least here in Boulder, is the keto diet, and this whole idea that we need good fats. Fats are good. I’m going to put the butter in my coffee, as you talk about.
I think people are confused. One of the reasons it’s not so obvious—yes, whole-food, plant-based diet, no butter, no healthy fats—is that there’s a lot of confusing information out there. How can you help people sort through that without just being, “Oh, that’s Dr. Joel Kahn’s bias, or his fundamentalism,” or whatever?
JK: I think you’re right. Some people say the confusion’s on purpose, that the playbook of the cigarette industry was to—for about 20 years—to confuse the public, “Well, yes, smoking’s associated with lung cancer. It’s not proven, and it could be other factors. Maybe smokers just don’t eat healthy. It’s the diet.” For about 20 years, they were able to hold off the government and regulation, and hospitals allowed smoking for way too long because of that. Some people say the food industry’s doing an awesome job of that playbook: confuse the public, and we can let people basically eat and buy whatever they want because they’ll be so confused they can’t commit when we have two doctors giving polar opposite recommendations. I’m sensitive to that.
The keto diet—a couple comments since you brought it up, and then I’ll bring up the last point you brought up. Ketogenic diet, the idea that either a low-calorie diet, which induces a primitive response to change the fuel in your body from primarily glucose—which most of our cells are used to getting—to ketone bodies, which I’m used to seeing diabetics in coma and we try and reverse their ketone bodies and ketosis. Maybe most of us can tolerate a little bit of ketosis by lowering our calories or eating what you said: a low-carb, high-fat diet, never eating anything white, but packing in hopefully some fruits and veggies.
There are guys and gals out there on social media eating, literally, an all-meat diet, 21 meals a week, week after week, after week, after week, claiming unbelievable strength, power, and all the rest. There are at least two studies suggesting that long-term mortality goes up. That’s called death. That’s called permanent. There are no studies that show low-carb, high-fat diets, long-term ketogenic diets, reduce mortality. That should be a goal, [to] reduce mortality. Whereas there certainly is some favorable data for plant-rich diets.
The smartest people are eating low carb, high fat, but tons of leafy greens, brightly colored fruits and veggies. That’s some mix in there of paleo or pegan, or even close to a Mediterranean diet, but a Mediterranean diet usually discourages red meat, of course. There are vegan versions of ketogenic diets that Dr. Jenkins at the University of Toronto, one of the most esteemed nutritional researchers for decades, has published 10 [to] 15 years ago. It’s called the Eco, E-C-O, Atkins diet. It’s a plant-based ketonic diet. He showed some good data.
Right now, there is a lot of interest in fasting, and there’s a vegan version or a plant-based version of a ketogenic diet. It’s only five days a month, and you eat healthy the other 25 of your choice. It’s out of the University of Southern California, it’s called a Fasting Mimicking Diet™. You can do plant-based versions—which, plant protein is healthier than animal protein—and if anybody wanted to play with ketosis, play with plant-based ketosis.
The healthy fats issue—very few diets don’t include or encourage olives, nuts, avocados, whole foods. However, when you get to the strictest of heart-reversal diets, they still are debating olives and avocados because go back to Lester Morrison in 1948, ’49, 1950. He set the standard by excluding those foods from his diet and showed amazing results. Then Dr. Ornish excluded them, showed amazing results. Dr. Esselstyn. So there’s that.
Where do people go? We can go to the USDA food guidelines. One of the three patterns of healthy eating they recommended: one was Mediterranean, one was something called healthy Western diet, but the third was vegetarian/vegan diets. Believe your USDA if you ever believe anything the government does. Go to the American Association of Nutrition and Dietetics—the largest dietician group in the world, 100,000-strong—where in the end of 2016, they put out a paper on vegetarian diets. At every phase of life: preconception, pregnancy, infants, teenagers, middle-aged, and elderly, a vegan/vegetarian diet is an awesome and healthy option. We can talk in a second about the few deficiencies, but every diet has deficiencies.
Lastly, there’s an organization called True Health Initiative. They have a beautiful website. It’s over 300 nutrition and health experts, physicians, PhD scientists. I’m a member of it. I’m on their advisory board. It’s people with very diverse opinion[s] who’ve come up with a central recommendation that every healthy diet at its core has: an abundance of fruits and vegetables and whole grains and legumes, prepared in traditional ways based on the culture and the location. True Health Initiative is the place to go to.
Anybody that says, “Don’t eat legumes. Don’t eat fruit. Don’t eat . . .” That all-plant diets are unhealthy, they’re rogue, they’re fad. Their obligation is to come up with science. Is there a study that show s putting butter in your coffee promotes health? No. It promotes sales of butter and coffee and such, but I’m highly critical of that because it harms people without a doubt. Long-winded answer. I’m pretty passionate about this stuff.
TS: You’re making such a strong case that it brings up, I think, a very, very, very important question, and I’m sure you’ve thought about this a lot, which is: Given the compelling scientific evidence, why is such a small percentage of the population, at least in the United States, choosing a vegetarian—and in your case, your recommendation, vegan—diet? Why? Why is it so small?
JK: There really is a tipping point, without a question. Maybe I’m the crazy guy that actually scans the internet, which I do, looking for new medical data, new nutrition data, but the word “vegan athlete,” “vegan racecar driver,” “vegan Formula One World Champion,” “vegan politician in England and Australia,” and “[vegan] actor.” These are just people, but they get the headlines.
Oh, my God, the food industry. Campbell’s food buying plant-based companies. Tyson® chicken investing in plant-based burgers. Leonardo DiCaprio putting tens of millions of dollars along with Bill Gates and Richard Branson, and on and on. There’s no doubt the hospital industry [is] slow as molasses. Slap them in the rear with shame, shame, shame. They should be leading the charge to healthier diets, but the food industry is leading the charge because they know what the public is seeing.
There’s estimates that in 20 years, protein—and I don’t even like the word “protein,” because a chickpea has protein—protein will be pea protein, plant protein, and very rarely animal-farmed protein or it’ll be in a lab animal protein. We can’t afford the CAFOs, the factory-farmed meats, any longer. They’re inefficient, they’re expensive, and they’re litigious in what they’re doing to the environment.
It’s the time. It’s the place. The public’s seeing—White Castle, Taco Bell, even McDonald’s in Europe and soon the United States, and Burger King®—they’re seeing that it’s on the menu. I don’t think they’re choosing it as much as they should, but it’s getting more available, and certainly at the grocery stores. There’s whole sections, and farmer’s markets have come back, because really the best food is out of the garden and you prepare your own, or simple combinations. There’s so much accessibility to people. But 10 years from now, it’s going to be in your vending machine at the gas station, and at the convenience store, you’re going to be able to pick up a tempeh burger as opposed to a ham-and-cheese sandwich.
TS: Maybe so. You mentioned this thing, the person who perhaps cares about animal rights, and even appreciates the other benefits you’re talking about, they care about the environment, and they care about their health, but at the end of the day, it’s something like, “But I like my steak.” Or, “I get it. I could have split-pea soup, or I could have split-pea soup with ham, and I like it better with ham.” How do you help people with this sense of, “I just don’t want to be deprived of this thing I like”?
JK: At what pace do you need to adopt any of this? For the average person who believes they’re in good health, and I will say, believing you’re in good health is not proof. I run an advanced cardiac clinic where every day I see people who believe they’re in good health and I deconstruct them, put them back together, and either congratulate them and celebrate, or identify silent heart disease or other problems, because heart disease tends to be silent.
For the general public: find the food you like to eat and start to play with substitutions. You can make a chili with beans, not beef. There’s hundreds of kinds of beans. You can make a soup with putting in beans rather than chicken. You can actually make an omelet out of chickpea flower. That gets a little bit more in the skilled department. If you want, you can buy plant-based turkey roll, plant-based hot dogs, plant-based bologna, plant-based packaged meats. I warn people [that] they’re not an apple, but you can make that substitution and realize there’s plant-based ham to put in that soup. It’s better to the environment. It’s better to the animals. It’s probably somewhat better to your health. It’s not moving fully down the road, but these are baby steps.
You can do that. Find those simple recipes. You can make a taco out of—jackfruit is very popular. It’s actually a fruit from Asia that looks like pulled pork, tastes like pulled pork. You can do amazing things with crumbled beef that’s actually out of pea protein. What they’re doing out of peas and hemp nowadays is crazy, and tasty, and radical.
If you got a health condition—if you’ve got type 2 adult diabetes, and you’re really struggling and nobody’s ever told you it might be reversible, or heart disease, or obesity, or even eczema, psoriasis, asthma—and you want to bust loose out of the sick mode into health mode, you probably want to jump right in and find some [things]. That’s why my book is full of resources, and recommendations, and an eating plan.
You want to eat clean. It’s just food. Your health is more valuable. You’re going to have to break some habits. There’s a well-known anthropologist, Margaret Meade—I think now a blessed memory—who said it’s easier to change a person’s religion than it is to change their diet, and that is clearly true. People resist. People fight. That’s why the public’s confused. They turn on TV and there might be a doctor’s show and people are arguing. But the reality is you can trust eating from the garden as your mainstay or only source is by far the decision to move.
TS: You made this interesting point quoting Margaret Meade, easier to change someone’s religion than their diet. I ask this question again, because here you are, you’re saying as a physician, you decided to dedicate yourself not just to healing people through interventions but as an educator—being an educator. Why is it so hard for people to change their diet?
JK: Part of it is—it’s always going to be somewhat education. What’s the benefits? What’s the downside? There’s a statement out there in the wellness world, “When you make the right thing to do the easy thing to do, you’re more likely to move down a health path.” When you build in sidewalks in neighborhoods and work sites, people are going to move, more likely. Or you give them pedometers or standing desks.
When we have cafeterias at hospitals—hello, hospitals—at work sites will only have fast-casual and vending machine, easy options that are price-competitive, or maybe you’re paying a little bit more. In the United States, we spend the least amount of money per capita on food as any Western country because [of] so many government subsidies. That’s also part of the problem. When meat, dairy, egg, and cheese are subsidized so they’re inexpensive, when a salad costs more than a beef burger, we’ve got a problem. All we can hope is the food industry keeping on . . .
That’s why I get excited when Tyson invests in a plant-based burger company, because that kind of efficiency and reach will keep the price down, and they’re not going to sneak beef into these burgers. They know the future is plant-based proteins, but they’re going to keep the price down. When the right thing to do is the easy and cost-competitive thing to do, people will be on board.
We need legislation, too, just like some of these sugar taxes have been out there. We need to figure out: How do you break the subsidies? Think about how stupid it is. We pay taxes, our government subsidizes food industries that clearly create disease, that then we have to use more of our taxes to pay for people’s health care through government-subsidized health care—which is so much of health care in America. It’s a cycle. Breaking the bank, and breaking our own tax structure, and causing people to suffer. If you had to do it all over again tomorrow, you’d take those subsidies away, but it’s politics. It’s not happening tomorrow.
TS: You mentioned that we could talk about the deficiencies of a full, plant-based diet, and you said that every diet has deficiencies. I can imagine someone saying, “Really? The reason the plant-based diet isn’t so great is because I have to take this supplement and that supplement. I wouldn’t have to do that if I was just eating a little bit of animal protein or some fish and eggs.”
JK: The current recommendation—you can go beyond this, but if you’re eating a 100 percent plant-based diet, you’re never having an animal product, what I’ve done for 40 years—B12, most people know about. Cows don’t make B12. B12 is produced by bacteria in the ground, but cows graze on the dirt and their tissues accumulate B12, whereas plants don’t do that.
Vitamin D. My hemp milk, my oat milk, my almond milk is vitamin D-fortified, but you might not be getting enough. Mushrooms are very rich in vitamin D. The last one is algae-based omega-3. Omega-3 we’ve all heard of, we think fish oil. It is very rich in flax seed, very rich in chia seeds, walnuts, green leafies. But actually, it’s pretty common to be low in omega-3. In my cardiac clinic, I measure blood levels of omega-3, and my plant-based eaters tend to be low, but so do my general omnivores patients. They’re low, too, unless they’re concentrating on salmon regularly, or flax seed in their oatmeal, or chia seeds in their pudding and such.
Those are the big three, and if you will adhere—even if you just adhere to Vitamin B12 as your only supplement, you’re in good shape. There’s a junk food version of a vegan diet you don’t want to do. You don’t want to do those chips, and that fake bologna, and fake cheeses, and soy pizzas as your mainstay. They’re a nice little treat now and then, and I’ve mentioned soy a couple of times. I’m actually a pro-soy eater. Eat organic soy beans. Eat organic edamame. Eat organic tofu cut up into a stir fry. Some of the junkier foods emphasize that.
What are the deficiencies of a meat-rich Western diet? We know them. It’s 40 percent obesity in adults, 20 percent obesity in kids. It’s the highest heart disease rate in the Western world, highest cancer rate in the Western world. Horrible diabetic rates. The deficiencies are lack of fiber, lack of nutrients, lack of vitamins, lack of minerals like magnesium. Food is the most powerful decision we can make, as we started a number of minutes before.
I’d rather trade off taking three vitamins a day. In fact, more and more, you can find these that all three are in a single capsule or a single spray. It’s really convenient. I’d rather do that than trade off taking drugs for blood pressure, or erectile dysfunction, diabetes, heart disease, or developing cancer.
These are bold statements. The development of disease is multifactorial. Diet is the biggest part. It’s not the only part. Vegans get cancer. Vegans get heart disease. Vegans can have a stroke. They’re setting it up to be less likely to do it, but genetics matter. I don’t oversell the program. I sell it, I don’t oversell it. You still got to get your checkups.
TS: A question about soy. You said, “Here I am.” It’s controversial. Can you tell me what the case against soy is? Then I also just have a question: What about soy milk?
JK: There has been a case made that soy has estrogens in it and therefore might promote cancer, breast cancer, prostate cancer. Actually, soy has very low levels of plant-based estrogens. It’s a fancy word called phyto, P-H-Y-T-O, estrogens. Meat typically has real estrogens in it because it might be a female cow that was producing estrogens. Of course, during a dairy cow’s life, it’s always pregnant or always lactating, so there’s real estrogen in that cow. Plus they often add synthetic estrogen, which is a really bad idea. There’s real estrogen. The minor activity of the plant-based estrogens are not only far less damaging than meat and dairy in its animal form, but the plant-based estrogens may actually be therapeutic because they can block the animal-based—our own estrogen, if you’re a woman—or the food-based estrogens.
In general, the real science is, including organic—I say organic now because so much of soy has been transitioned to genetically modified soy, and I advise people not to do that. But almost all of the products you’re going to buy at the grocery store—soy milk, tofu, such—say “Non-GMO” on it. The genetically modified soy beans are being fed to cows that people are then eating as a steak, so that’s where they ought to be worried.
There actually is data. You can prevent breast cancer with some organic soy-based foods in your diet, and if you’ve had breast cancer, the scientific data is [that] you lower your risk of a recurrence. These are huge databases from major medical centers, and up-to-date studies in 2017, 2016. There will be more in 2018. Soy milk, organic soy milk, is the naturally highest protein of the non-cow milks—almond milk, hemp milk, and such. Although there’s now protein-fortified almond milk, the industry knows that the public is hyper-focused on the word “protein.” They don’t need to be.
So, yes, I drink soy milk. I think it’s delicious. It’s always going to have the USDA organic label on it, but I vary. I like my oat milk, I like my hemp milk. I tend to make these milks at home now. It’s a simple and a fun little project.
Do not fear soy. Why do we have the reputation? Some people point to, there’s an organization out there called the Weston A. Price Foundation that promotes based on science I believe a dentist in the 1930s identified—I think that’s the area he was doing some studies around the world in—that certain diets promote health and disease. There’s a lot of funding and dollars, and the dairy industry’s very powerful. There’s a number of forces out there that benefit when you knock soy and knock soy milk, but soy is a joy.
TS: Just a couple more questions—
JK: It’s tasty.
TS: I like soy milk. That’s part of the reason why I asked. OK, Joel, just a couple more questions. You make a case in The Plant-Based Solution that a vegan diet will help our sex life. Tell me about that.
JK: Woo-hoo! I was hoping you’d get there. My god.
TS: Keeping our listeners on the hook.
JK: It’s getting hot in here all of a sudden. Why would a vegan diet improve sex life? Couple of answers. To have good sex, you need healthy arteries and pipes, and if meat, cheese, and butter, in the vast majority of the scientific literature, promote clogging of your arteries—atherosclerosis, which we typically think of heart attack and stroke—but if the arteries to your groin are getting clogged, a man particularly will develop erectile dysfunction a few years before a heart attack. Very typical, scientifically founded observation. In fact, the teaching point is if a man is developing erectile dysfunction, go get your heart checked. Go get your blood checked. Find out what’s going on and change your diet.
One, if your arteries don’t get clogged, you’ll have better sex and more effective. Number two: I mention the lining of your arteries called endothelium, the wallpaper. If you feed that lining of your arteries leafy greens—arugula, kale, collard greens, bok choy, or beets, beet roots, beet powders, pomegranates—you actually make more healthy chemicals that make that whole sexual process work. Number three, please laugh, there is some data that plant-based eaters smell better and taste better. OK, let’s move to the next topic, but there actually is a little science on it. There is, actually.
Four: this gets into the philosophy. If you’re mindful and your plate is purposely avoiding harming animals, maybe you’re just a kinder, more attractive person. Maybe not. I’m not saying there aren’t meat eaters that have amazing sex, and aren’t good people, and aren’t kind. I never said that. But the sensitivity and the mindfulness of choosing a diet that in part you’ve chosen to demonstrate that you’re a person that believes animals shouldn’t be abused at all, hopefully spills over into your human life and your human friends.
TS: OK. Dr. Joel, the connection between longevity and a plant-based diet, and if there’s actual evidence for this?
JK: A couple of the best pieces of data, one is: I mentioned before the Seventh-Day Adventist Church got funding from our government back in 1958 and started a series of studies that are still ongoing 60 years later called the Adventist Health Study. It’s part of the Adventist religious philosophy to eat vegetarian, and it turns out half of them don’t, and half of them do, and some of them that eat vegetarian eat completely vegan. These have all been analyzed in 100,000-plus study subjects. Every question that can be asked has been asked.
Disease rates like obesity, hypertension, cholesterol, diabetes, and it appears longevity are all better in those that respond, “I’ve chosen the vegan path,” the middle road are those who say, “I’ve chosen the vegetarian options,” and the worst are those that say, “I ignore the church rules and I’m an omnivore.”
Then, there’s that beautiful series of studies in the last 15 years called the Blue Zones. Where do people live the longest and healthiest in the world without chronic diseases? Okinawa; Nicoya Peninsula in Costa Rica; Ikaria, Greece; Sardinia, Italy; and then Loma Linda, California. They are not completely vegan societies. But in general, the data is less than 5 percent of their calories in some instances, like Okinawa, are animal products, and 90 to 95 percent diets are plant-based. It can be sweet potato, it can be corn, it can be fruits and veggies, depending on the location, and that longevity is enhanced.
Now, we all know the 103-year-old woman that smoked, and ate bacon, and made it in the newspaper because, “The secret to my longevity is I eat bacon every morning,” but you got to go with trends. You can’t go with a single case study. The trends are there.
I know that, again, these plant diets are an extremely healthful choice. Is it 100 percent that’s required for that optimal health? Is it 90 percent-plus? Remembering that 5 to 10 percent of animal products a person might eat still have environmental issues of how they were raised, and ethics, and cruelty. That hasn’t been resolved, whether you actually could study that benefit.
Get to 90 percent, and then you’ll probably feel so good you’ll just fill in the blank. For example, President Bill Clinton is reported to eat 20 meals a week that are completely whole-food, plant-based, but he likes a piece of fish on Friday. OK, is that worth condemning? If I was a fish, I wouldn’t be happy about it, and if I was an environmental expert I’d say that’s still a little harm to the oceans. But from a health standpoint, I don’t know that I can distinguish that from 21 meals a week in terms of his heart and his heart health. I’m being honest.
TS: I like it. I appreciate that. I just have—
JK: I can’t BS the public.
TS: I just have two final questions for you. I’m curious, for that person who’s listening who feels inspired but says, “I’m going to have to approach this gradually.” You mentioned Paul McCartney, and one day a week I can eat a vegan diet. What do you think about someone who says, “I’m inspired, but I’m going to have to take a gradual approach”?
JK: “Inch-by-inch it’s a cinch, yard by yard it’s hard,” said the great Detroit spokesman Les Brown, once married to Gladys Knight. Anyways, I’m a very patient person, so there’s a couple different ways. You could do a meatless Monday. It’s a small step. It’s an easy step, and many companies and schools—actually, there’s now 15 schools in Brooklyn that are doing meatless Mondays, recently announced by Mayor de Blasio. That’s a great step. If you get kids at a young age mindful, that’s good stuff.
You can do just breakfast. “I’m just going to do breakfast without bacon, eggs, and cheese. I can do oatmeal and chia pudding, I can do whole-wheat pancakes, I can do hemp-coconut-almond yogurts with fruits and veggies. Or do what I do: I skip breakfast because I do some intermittent fasting. Anyways, that’s a step.
Then you can do, “I’ll do it for three weeks and see if I feel better,” and there’s many resources on the web. There’s something called 21DayKickstart.org. Totally free online programs to eat easy, simple, inexpensive plant-based for three weeks. You might feel so good you don’t want to stop. You might have lost some weight, more energy, sleep better, acne’s better. Then there’s a 28-day program like that called The Engine 2 Diet. There’s a 22-day program called 22DaysNutrition.com. All on the web, all available, by credible either physicians or nutritional experts.
TS: Just one final question. As part of this conversation, you mentioned this idea of a tipping point, and that in your own sense of our future, you see it. You see a point in time where a whole-food, plant-based diet will be the diet of choice. I noticed that when you said that I thought, “Huh? Really?” I haven’t seen that as something that would come, certainly not in my lifetime, which I hope from all the plant-based foods I’m eating will be many, many, many decades to come. What gives you that confidence that there will be this tipping point?
JK: I think the best barometer, again—dollars speak—is the food industry. When you see, as I said, Campbell’s food bought a Detroit company called Garden Fresh Salsa and Hummus for over $200 million. This year they bought Pacific Foods, an organic, plant-based food company for $700 million. When Tyson invested in Beyond Meat, when somebody bought Silk milk, WhiteWave, and spent about $400 million, and examples like that. These are not decisions taken lightly. These are huge dollars. They’re based on marketing and industry trends.
I think there’s a huge portion of the public that if you can present to them in their grocery store—or more and more, people are buying food sources online that we have either pre-made, or easy-to-assemble, or the components. The buzzwords people are looking for: clean foods, maybe they’re non-GMO, plant-based, maybe organic. I think the public understands they’re healthier than barbecuing kielbasa wrapped in bacon. It’s happening, and the food industry’s making it accessible.
Then it never hurts when the Formula One winner this year, Lewis Hamilton, announces his victory was because of his enhanced performance being plant-based. Or the world’s strongest man, Patrik Baboumian, [who] lifted 1,200 pounds last year and set a world record, is plant-based. Dispelling these myths—14 NBA players this year have announced they’ve adopted a completely vegan diet because their performance is better. The public sees that and they’re opening their minds somewhat.
For a lot of rank-and-file people, you walk into the liquor store or the grocery store or the vending machine, the work food truck, it’s still eons away, I agree.
TS: Dr. Joel Kahn, I have to say, you’ve really inspired me. I love the fact that you’re a physician educator, and your emphasis on really helping share the scientific data with people. I want to thank you so much.
JK: Thank you. Actually, the next thing I’m going to do here is call a patient and go over some patient data. I am a real doctor. Thank you. You asked great questions, and I hope my enthusiasm and authenticity came through, because I really do care.
TS: I can feel it. I’ve been speaking with Dr. Joel Kahn. He’s the author of the new book, The Plant-Based Solution: America’s Healthy Heart Doc’s Plan to Power Your Health. Thanks, everyone, for listening.
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