Joel Fuhrman, MD on the Nutritarian Diet For Longevity

Content By: Ari Whitten & Joel Fuhrman, MD

In this episode, I am speaking with Dr. Joel Fuhrman – who is a board-certified family physician, seven times best-selling author, and nutritional researcher who specializes in preventing and reversing disease through prioritizing essential nutrients from plant-based sources and minimizing reliance on animal products.

Table of Contents

In this podcast, Dr. Fuhrman and I discuss:

  • The Nutritarian diet (a diet in which optimal micronutrient intake to effectively combat cancer, heart disease, and aging is prioritized)
  • How and why the Nutritarian approach inherently corrects the modern tendency to overconsume food and gain weight
  • GBOMBS – What are they and why should you eat these six types of food every day?
  • Should we be concerned with “harmful” plant toxins?
  • Practical strategies for getting adequate protein without depending on meat, fish, eggs, and dairy
  • Dr. Fuhrman’s approach to addressing missing nutrients in vegan diets (including B12, zinc, and omega-3) and why he recommends supplements instead of meat or seafood consumption

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Ari: Dr. Fuhrman, welcome to the show. Such a pleasure to have you.

Dr. Fuhrman: Great to be here.

The Nutritarian diet

Ari: You have coined the term nutritarian. Can you tell people what that means and why you coined that term?

Dr. Fuhrman: It means to eat a diet that’s optimally designed to be an excellent health and promote lifespan slow aging. I coined the term because there was no term that adequately described a diet that was based on the right nutritional portfolio of healthy foods. You can be on a vegan diet or a plant-based diet, but you can eat unhealthy plant foods that are based from plants. You could be– and whether you’re a strict vegan or eating some animal products, it doesn’t really reflect the quality of what you’re eating. Are you eating organic? Are you eating mostly eating processed foods?

Even whole foods, certainly a macrobiotic diet. We’re just eating mostly brown rice, is not to be designed for human longevity. There’s a lot of variance of even of whole food, plant-based diets that don’t take into the full spectrum of scientific research that utilize the foods that have the most anti-cancer and anti-aging potential. I coined that term nutritarian for us health nuts that are striving to eat a diet that’s as healthy as possible. That’s based on science and clinical evidence and performance.

Ari: What are the specific foods that comprise the nutritarian approach?

Dr. Fuhrman: The foundational principle, I would like people to write down these five words. The foundational principle is moderate caloric restriction in the context of micronutrient excellence. Those five words are moderate caloric restriction with micronutrient excellence. Now I’m also saying that when you achieve comprehensive micronutrient adequacy and you have a good level of nutrients, of antioxidants, phytochemicals and all the substances humans need, it naturally puts you in touch, instinctually the right amount of calories. You desire the right amount of calories. You’re not becoming an over consumer of calories that everybody has to do because they’re deficient in nutrients and they produce too much metabolic waste in their tissues which drive overeating behavior.

I’m saying that people are out of control the amount of calories they desire because they’re not eating a sufficient level of micronutrients and fiber in their diet. A nutritarian diet is certainly predominantly a diet of natural foods, natural plant foods, and there are certain plants that have powerful effects that support human immunity and thicken the microbiome, create a healthy biofilm, allow the body’s DNA to effectively heal and silence DNA defects. Those plants, I use that acronym G-BOMBS, which stands for greens, beans, onions, mushrooms, berries and seeds, to represent those six foods that I want people to include in their diet every day. It’s not that they’re only eating G-BOMBS, they can eat other foods too. Papaya and spaghetti squash and their– We’re not talking everything. Quinoa. Things you can eat that are not in G-BOMBS, but we recognize that green vegetables are necessity for normal human immune function. You have to eat a diet that’s essentially rich in green vegetables.

We’re talking about raw green vegetables like salads that includes both lettuce and cruciferous greens like bok choy and kale and collards and arugula and also cooked vegetables too. Also we’re cooking vegetables like broccoli and brussels sprouts and string beans and asparagus and zucchini. It’s a combination of cooked and raw, both, a white assortment of vegetables. It’s a vegetable-based diet. It’s not a grain-based, plant-based diet. It’s not a potato-based, not a fruit-based. It’s vegetable based. I want people to eat a variety of foods. I want them to eat fruits and nuts and beans and whole grains, but I don’t want them to be predominant on nuts and fruit or grains as the major source of calories. The major source of calories should be vegetables and the other things should be a little lesser amounts.

I recognize that a nutritarian diet is unique because Americans and people in the Western world get most of their fat in their diet from animal fats and oils, plant oils and animal fats is where they get their fat in their diet. A nutritarian diet is completely different. We get our fat from whole nuts and seeds in avocado, not from the oil extracted from the nuts and seeds. We don’t use sesame seed oil, we use the whole sesame seed. We don’t use the avocado oil, we use the whole avocado. There’s a huge amount of scientific literature. I’m talking about more than probably 50 different studies showing the longevity potential when people switch their fat sources from animal fats and oils into whole foods sources of fat.

There’s also a new extremely corroborative amount of scientific evidence that when people try to eliminate all fat from their diet and cut back on all fat and don’t eat any fat in their diet, they also don’t do as well, don’t live as long, have higher rates of heart attack and cancer. It is beneficial to include some fat in your diet regularly, but the best source of fat, walnuts, flax seeds, chia seeds, pistachio nuts, almonds, sesame seeds, things that are real food that we can blend in to make dressing sauces. We can make Thai curry sauce and almond and cashew dressing. We can make it all types of Russian dressings and Caesar dressings and sauces and flavorings and desserts using nuts and seeds and blending them in there instead of using oil as the fat source.

Can you eat animal products on the Nutritarian diet?

Ari: Got it. Where do animal foods fit into this nutrition plan, if at all?

Dr. Fuhrman: People have the option of doing a strictly vegan version, just a plant-based diet, or to use animal products as a condiment in small amounts. It certainly recommends people move towards and try to eliminate as much animal product consumption as they possibly can. The question is how much is going to be more dangerous and how much is safe? I’m saying that most of the evidence, we can go through some studies showing from 2018, 2019, 2020, all the last four years repeated studies show that as animal protein goes up in the diet, you have more cancer deaths and more overall mortality. As plant protein goes up in the diet, you have longer lifespan. The parameters of how that works, we could talk about, but we’re trying to reduce animal protein and increase plant protein foods.

All whole plants have– You could say protein adequacy except for fruit. You’d be putting oil on your food or white flour. You’re diluting the protein content of your diet because oil doesn’t have any protein. If you ate the whole nut that had the oil in it, then you’re getting protein from the nut. If you’re eating if you took the whole wheat berry and not just the white flour portion, the point is, when you use whole foods, you get sufficient protein almost any combination unless your diet is too high in fruit because fruits particularly low in protein and our ability to assimilate protein and to utilize it for good health and good immune function deteriorates as we age, especially past the age of 80. 75, 80 people’s ability to absorb protein might diminish.

That’s where we’re saying that the biological value of protein is sufficient from plants. When you’re eating a whole food and when you’re eating whole foods like beans and nuts and green vegetables. Beans, nuts and green vegetables have the highest protein as a whole food and a nutritarian diet. They’re also low glycemic foods. They don’t raise blood sugar. We’re eating or diet with sufficient beans is our number one preferred carbohydrate source because they’re higher in protein and they have more slowly digestible lower glycemic carbohydrates. Then the question is then, how much animal products is okay or not going to be, not damaging? The answer is probably somewhere in that 5 to 10% range for most people.

Most of us follow the nutritarian diet, rarely if ever have animal products. We don’t need them. It’s probably not damaging if you had them in very small amounts. As you people use them above 10%, you definitely see then genetic weaknesses start to express themselves. You see heart disease start to occur in populations, cancer start to occur in populations. What I’m saying right now is that via various mechanisms we’re protecting our longevity and have this unprecedented opportunity in human history to really push that envelope of human longevity without any risk of cancer and heart disease by beating natural plants and keeping animal products to a minimum in our diet if we’re eating them.

Tradeoffs in dietary approaches

Ari: What do you think of the arguments that have been made by some around mortality tradeoffs, disease tradeoffs and it’s– forgive me because it’s been a few years since I looked at the literature on this topic, but if I remember correctly, there are only very few studies that have looked at the quality of the diet that have considered that as a confounding variable in the studies that compare more plant-based diets or vegan diets or vegetarian diets to meat containing diets, omnivorous diets.

I think it was the UK’s shoppers study, if I remember correctly which was one of the studies where they specifically examined more ethical omnivores, people who are making choices to eat things like grass-fed beef or pasture-raised dairy and free range chicken and so on. I’ve seen people make the argument that when you look at those kinds of evidence, what you see is really very little difference in overall all because mortality and lifespan between vegans and vegetarians versus omnivores.

What you do see is more of a difference in specific diseases. Vegan diets tend to have very strong evidence that they lower heart disease risk and cancer risk, but the risk of sarcopenia and diseases associated with that generally go up and basically, the argument is that vegan diets lower your risk of these specific diseases, but they might increase risk of other things like muscle wasting and sarcopenia over here and therefore, don’t really have a net benefit. What do you think of those kinds of arguments?

Dr. Fuhrman: I think that they’re inadequate and then they’re not looking at the full amount of evidence we have. They’re just trying to use an argument, trying to collect some data to support those arguments based on some British studies where there was a study on British vegans that you’re talking about where they had more osteoporosis, but when you analyze the diets that were being used. They’re doing tremendous amounts of white flour products and processed foods. Their diet was overly burdened with carbohydrates, did not have nuts and seeds and beans in it.

I analyzed the diet you that most people following in that study, they had half the calcium compared to the– I compared it on a blog, compared to a nutritarian diet, compared to the [unintelligible 00:11:13] diet being followed in the UK study you’re referring to, and half the calcium, half the protein compared to the diet, a nutritarian diet which uses the regular use of beans and nuts and greens and the vegetables in the diet each day. I was critical of that diet, that type of vegan diet by my standards of nutritional excellence and think that they’re not examples of healthy eating and the data comparing grass-fed or healthier versions of animal products has full flopped on its face.

Because all these recent studies, and I can show, I can pull up on my screen, I can pull some studies up to show people if you’d like. Let’s do that now. Let’s see if I can get them. Tha look at this, and most of the negative effects of animal products and the shorten of lifespan that occurred in studies where they used in Australia or South America or around the world where they use grass-fed and more naturally not commercial race animal products. There was no difference between longevity reduction from animal products used from commercial sources of the United States, or used that were more wild or grass-fed from other countries.

The same corroborating data when anybody did the study. The studies on looking at reduction of red meat and longevity don’t show a reduction of longevity from red meat because what foods are the people eating when they reduce the red meat? Invariably, they’re eating more chicken and pasta and so olive oil, so they reduce red meat and they don’t eat more natural plants in place of red meat like beans are nuts or greens. That’s why these studies have so much more value because most of the studies where people say, “Look, not much difference in meat reduction,” is because the people ate more white meat. They just ate more chicken.

They just reduced red meat for chicken. They’re saying, “Look, meat’s not so bad.” They just ate more chicken. Well, the problem is, chicken doesn’t contain phytochemicals and anti-antioxidants. It’s also not as nutrient. It’s just a source of macronutrients of protein and fat, but it has no significant micronutrient load. Fiber, phytochemicals, sterol, stanols, all the things that extend human lifespan are in the beans and the nuts and the greens. It’s not about just putting in chicken and eating more pasta in olive oil. It’s cutting back on meat and eating more beans and nuts and green vegetables.

Now, in those studies, we do have available today and we see market benefits in longevity. We’re talking about 40% reduction in cancer– 40% reduction in heart attack rates, 30% reduction in cancer rates and no cause of sarcopenia or muscle wasting. The only thing that these paleo and carnivore people also do to confuse people is they talk about studies on strokes. Because there’s a relationship between higher cholesterol levels and hemorrhagic stroke in Asian countries because they eat so much salt in those Asian countries. They’ll eat like between 3,000 and 5,000 milligrams of sodium a day and they’ll be on diets that are mostly plant-based.

The sodium causes microvascular hemorrhaging and weakening of the endothelial lining over time and it weakens the blood vessels in the brain, and those Asian populations have a much higher risk of hemorrhagic stroke than embolic or ischemic stroke in this country. When we’re looking at reduction in stroke, you’re looking at the reduction of hemorrhagic or ischemic stroke, not the reduction of embolic stroke. In other words, I’m saying now is, they have 10 times the amount of hemorrhagic stroke in those Asian countries that consume a lot of salt. We have 10 times the amount in the United States of ischemic or embolic stroke caused by clots caused by eating high-cholesterol foods and saturated fat.

The different type of fat strokes, one’s caused by a clot, the other’s caused by a bleed, which is the opposite of a clot, completely opposite. Eating a diet with more bacon and cheese and cholesterol in it or whatever you’re eating to produce more atherosclerosis, thickens the blood vessels in the brain and makes them more resilient or resistant to cracking open and bleeding into them when you are having a high salt diet, but it’s still the salt that caused the stroke on a diet that was more plant-based. If you didn’t have the salt, you wouldn’t have had a hemorrhagic stroke.

What I’m saying is that cholesterol levels affect risk of ischemic stroke because if the cholesterol’s higher, you have higher risk of ischemic stroke and cholesterol levels affect the risk of hemorrhagic stroke because as the cholesterol goes lower, you have higher risk of hemorrhagic stroke. They can look at low-cholesterol countries that aren’t eating a lot of animal products and see, “Look, when you give them more animal products and more meat, they have lower rates of hemorrhagic stroke. When you raise their cholesterol, they have lower rates of stroke in Asian countries.”

Okay, that’s true, but our goal isn’t to switch is that’s still not– our goal is to have neither type of stroke. I think a nutritarian diet is just a step above. It’s a lot of confusion and as you know, the confusion is because people have agendas they want to push and they’re not looking at nutritional research in an unbiased manner and trying to ascertain what’s best. They always have some preference they want to–

Ari: I want to ask you about that. You’re almost answering the question I’d like to ask you already, but I suspect you have a lot more to say on it. I listened to, for example, a conversation that you had with Paul Saladino, who is an advocate of carnivore diets. To be honest, it was kind of painful to listen to because you guys were just really speaking languages–

Dr. Fuhrman: It was painful to do it. He just refuses to accept the 20,000 studies that indicate he’s wrong. It’s like saying, you know, “I’ll only accept this type of study. I’m not going to accept any or all those other studies that show I’m wrong. I just refuse to accept those.” It’s just an unreasonable, and now there’s always radical extremists in politics and nutrition and everything as you know.

It’s just extreme viewpoint that– We have the American College of Lifestyle Medicine with more than 10,000 physicians and nutritional advocates. Were pretty much trying to think and putting into people’s and to advising people to better their health through lifestyle changes, sleep and exercise and emotional poise and eating healthfully. There’s nobody that would recommend a diet based on meat. It’s completely irresponsible and radical and wrong. I shouldn’t have even agreed to be interviewed by him.

What science tells us about diet

Ari: We’re in an interesting time period in history where we now have every conceivable type of food that has been demonized somewhere by someone. The spectrum now spans from the extremes of hardcore veganism to the extremes of people saying you should eat really only meat or only animal foods. People are literally making the argument, some of these carnivore dive advocates, they’re saying plants are trying to kill you because they’re full of phytochemicals or which are essentially a form of plant toxin.

They argue based on this sort of logic, that if the plant evolved these chemicals in order to dissuade predators, whether herbivores or insects from eating it, or to make them feel unpleasant side effects if they consume too much of that plant, therefore that chemical is toxic and you don’t want to eat a toxic compound because toxins are bad for you and therefore plants are bad for you because they’re full of these toxins.

I’ve seen that a number of these carnivore diet advocates who have put forth that line of argumentation have been quite successful in convincing many, I assume probably hundreds of thousands of people at this point, that that’s true, that these plants are full of toxins which are harming them. I’m curious if you have any thoughts on that specific claim.

Dr. Fuhrman: Well, it’s so utterly ridiculous to even have to– We know that the American diet and modern– the standard American diet leads to 40% of Americans dying of heart attacks and strokes. It’s leading cause of death in adults. We know that as people eat more vegetables, that lowers the risk of heart attacks and strokes, and if they eat more animal products, it increases the risk. This stuff well established and I have 20,000 studies to demonstrate that. There’s radical people in every field as we talked about.

You can always find some followers of people who believe that– That attacked the Capitol, that believed Trump won the election and they were saving — There are people that think that climate change doesn’t exist. There are people that think that there’s all types of– There’s millions, there’s much more millions of people that are like, let’s say, Trump supporters and there are people who will think that you could better eat all meat into your diet. We have all kinds of radical people with unreasonable way of thinking. Could you enable me to share my screen? Then I could show you some studies to review some studies quickly.

Ari: You should be good to go now.

Dr. Fuhrman: That worked. Let’s just take a look, can you see that now?

Ari: Yes.

Dr. Fuhrman: You can see that, so here’s four studies. 2016, 2018, 2019, 2020, that just didn’t look at people reducing meat, and these are studies that put together meta-analysis, different researchers around the world. Put together looking at people’s not just reduction of meat, but actually what about when they ate more plants? What about when they ate more plant protein or high protein plant foods like beans and nuts and whole grains and didn’t just cut back on meat and ate more chicken, but actually ate more plants.

Look at the title of these studies associated with animal and plant protein intake will all cause and cause specific mortality. We’re talking about 30% reductions of all cause mortality. There’s tremendous reduction of mortality when people increase more plants. Here’s the other one, patterns of plant and animal protein intake strongly associated with the cardiovascular mortality. Another year, different researchers also publishing associated with animal plant protein intake, we’re talking about all these studies show the same thing.

Dramatic enhancements in lifespan when people eat more vegetables and beans and nuts in their diet. We’re talking about instead of eating animal products or just– if you cut out processed foods and eat more plant protein. In other words, if you cut out pasta and white bread and oil and eat more nuts and beans and whole grains and green vegetables, you get longer lifespan.

Anytime you take any food of the diet– because the average American diet is 60% processed foods, which is just empty calories. Then 33% animal products, which don’t contain phytochemicals or antioxidants. These people saying, it’s not good to consume phytochemicals or antioxidants in colorful plants. The opposite is true, our immune system and all legitimate scientists recognize that the intraepithelial lymphocytes that line [unintelligible 00:22:31] the digestive tract are the defenders of the gates of the castle build up with exposure to flavonoids and phytochemicals, particularly the aero hydrocarbon receptor is dependent on green vegetables derived substances to have normal immune system.

We can’t even have a normal immune system tp defend us against viruses and infections if we don’t eat green vegetables, all the studies demonstrate this. There’s no studies that demonstrate better immune functional longer life with a carnivore diet. Show me one study that showed when people ate more meat and less vegetables, they live longer, or less beans, they live longer. Nothing exists in the world and we have thousands of studies that show otherwise. In my most recent book, Eat For Life, I have 2,000 medical references in there documenting that. I’ve reviewed maybe 20,000, 30,000 to get those 2,000, but we can go through a few more slides here. Let’s look at here–

Ari: Let me ask you this before you go on, two questions. Number one would be there are anecdotes, and this is really the reverse of the same question I asked Paul Saladino when I spoke to him, which I would say was probably the most frustrating podcast I’ve ever done because it’s very difficult to speak the same language and agree on the terms of how we’re going to play the game. What I asked him was if plants are so toxic and full of these chemicals that are so damaging. How do you explain not only so many studies can exist showing just as long or longer lifespan or protection against various diseases or so many obviously tens or hundreds of thousands of anecdotes of people who have adopted vegan diets, who have gotten healthier.

What I’m seeing now is a trend where a lot of people have been swayed by some of the pro meat arguments. That includes not only the carnivore camp, which I consider the extreme of it, but some of the more paleo type diet proponents who are generally in favor of higher intake of animal protein. Let me ask you the reverse of this, admittedly we don’t have nearly anywhere close to any comparable amount of evidence to show benefits from carnivore diets. What we do have are several thousand testimonials that now exist of people saying that their health has been improved by a carnivore diet. How would you rebut that? How would you explain how that’s possible?

Dr. Fuhrman: It’s almost irrelevant because we’re talking about soft endpoints versus hard endpoints. Let me explain that for a minute. I can take overweight people and have them all start smoking cigarettes and these overweight people will lose weight and their triglycerides will improve because the smoking will curtail their appetite and they may even feel better or have better diabetic control because they’re losing weight from smoking cigarettes. That’s a soft endpoint, the soft endpoint means your triglycerides went down, you lost weight. You’re not craving food as much, craving overeating as much, there’s some benefits to smoking cigarettes. To know for sure if that’s a safe way to lose weight, we have to follow groups of people for decades who smoke and then see what the hard endpoints show. Are they really living longer or is this a dangerous way to facilitate a soft endpoint? The statin drug is the same thing. We give people a statin drug to lower their cholesterol.

Their cholesterol’s better, but that’s a soft endpoint. How do we know that just lowering the cholesterol with statin drug is actually going to make a person live longer? Maybe it’s going to increase risk of more cancers than the number of heart attacks it prevents. Until we follow those people for decades,and we have to follow large numbers to see effects, we can’t follow a hundred people. We have to follow hundreds of thousands of people for probably more than 10 years, preferably 20 years like two decades. We have enough people dying and get the ages they died at. We have to have enough people that died using this program, enough people died using that program to look at a heart endpoint. A study has higher credence value if– let’s list those three criteria for high credence. Number one, looking at heart endpoints like heart attack, cancer, age of death, cause of death.

Number two, we followed them for decades not from six months to see benefits because it could be short-term benefits and soft endpoints. Number three, there was a large enough number of people to see a significant effect on the data. You have to have 5,000 deaths in there to see how long people live, this is going to be a really accurate study. Then once we have a high credence study with 5,000 deaths, are there other researchers, different parts of the world with another study that went for 25 years with hundreds of thousands of people showing the same corroborating evidence? Is this a one and out of a– or is this something of a needle in a haystack study where the other studies don’t all agree with it?

All those things show consistency. It’s not that one study contradicts another. All the largest most high credence studies all corroborate each other and show the same thing and they also show a dose dependent relationship between animal product intake. The long-term study, one study I’m referring to, I could bring that one up too, goes on for 25 years of more than a 100,000 people and giving people a 0 to 20 score based on how much animal protein they’re consuming. 20 would be like a carnivore diet, zero would be a vegan diet. It showed as the animal product intake score went from 1 to 2, to 3, to 4, to 5, to 15 to 16, as it went up, heart attack deaths went up in a dose dependent matter. Is the data all over the place or is it dose dependent?

Is it consistent with as you eat more you see more disease or is there some other confounding variables? We’re saying that the studies are done very well, they corroborate each other. They’ve got hard endpoints. True, some people get short term benefits from cutting out all carbohydrates, getting better glucose control. Some people are gluten sensitive or have allergies and things to certain components of beans that they might get some benefits from cutting out beans and grains from their diet, for example. There are some people who could benefit from that, but you could do though. You can adjust the diet for people who have food sensitivities on a plant-based diet too but the problem is any of those benefits on a diet rich in animal products are going to result in shorter lifespan.

It’s sad for the people adopting it and for the people promoting it because they’re believing in something that’s not going to be in their own best interest to eat that way. The probabilities are highly against them when we have so much corroborating evidence from thousands of studies showing otherwise. I think if you feel better eating a little bit of animal products, my suggestion would be you still should keep it a little better. You should still keep that to a very small amount and eat mostly natural whole plants to get the full levels of phytochemicals and antioxidants you need because you can’t have normal immune function and protection against cancer or protection against the inflammatory effects of animal protein, which makes the gut bacteria produce more pro-inflammatory compounds like TMAO, trimethylamine oxide.

You raise IGF-1 to cancer promoting levels, you create other oxidative damage to the body which produces more reactive oxygen species in the body and advanced glycation end products, lipofuscin and other ammonia and urea and other factors at ages. It’s just almost to the point of being silly, and it’s ridiculous viewpoints that are not supported by science, but you still have people having all types of belief systems.

Ari: I think the central argument that facilitates this shift in how they can argue in favor of this, is basically to say that, at the whole field of epidemiology, that type of research is nonsense, and that it doesn’t mean anything. Therefore, the only things that mean anything are randomized, controlled studies, and that’s the only true science, that’s the only way we can actually know something is real, versus all this epidemiological stuff is just garbage, it’s trash pile type research.

Therefore we can take these tens of thousands of studies that have been accumulated over 50 years of nutritional research, looking at the hard endpoints that you’re talking about, actual mortality outcomes and disease outcomes and death at certain ages. We just immediately throw it all in the garbage pile-

Dr. Fuhrman: Throw it all in the garbage, right.

Ari: -and then we get to select what specific randomized, controlled studies we’re going to pull from, and then extrapolate based on that what diet is best for health. What do you think of that argument?

Dr. Fuhrman: It’s not only hysterical, it’s just totally ridiculous. First of all, randomized, controlled studies are short-term studies looking at soft endpoints. They don’t show anybody living longer, reducing rate of cancer, have any benefits, it’s just looking if your cholesterol went down, your triglycerides went down, a person lost weight. Those studies generate a hypothesis, they don’t generate conclusion, you have to have agreement with long-term part high credence studies with randomized control trials.

They’re saying, I’m going to disregard all randomized controlled, all large scale epidemiologic studies, representing hundreds of thousands of people who are devoted scientific researchers. That’s their career and lifestyle, will control for variables and are excellent at what they done. You can believe anything, you could say, I don’t care about all the courts of law that said that there was no evidence that Trump didn’t win, and I don’t care about this, and I don’t care about that. I only care about this. There’s one guy who told me that, it’s just ridiculous thinking, if they could pick their own criteria, they’re going to pick just one type of study that they want to show benefit.

Plus the fact that, even among those studies, you don’t see a benefit of cholesterol lowering, you don’t see better short-term weight loss, diabetic reversal, because both diets that are healthy vegan diets, also show in short-term randomized studies those benefits as well. Here I put on the screen two of my studies that I was involved with, one is called nuts and seeds for heart disease prevention and reversal published in 2020, with over 50 references.

The next study is improved cardiovascular parameters, I think there were more than 450 people there whose average blood pressure drops 26 points within six months, as their medications were taking away, and they lost weight, with people who reversed advanced heart disease, in other words, people with heart failure and heart attacks and blockages that reversed, got their health back by this nutrient dense plant rich eating style, that I call a nutritarian diet. Here’s just a resolution of high blood pressure reversal, and that’s certainly illustrative cases in six months of benefits, but then the question is, is that way of eating safe?

Are there any long-term studies that show it’s safe to eat a diet like this and what would happen if people ate that diet for 30 years or 50 years? We have so much evidence on this, which I’m demonstrating already. You have to put all the evidence together, and when you put all the evidence together, it points clearly, with the preponderance of evidence, towards the fact that we know the healthiest way to advise people. The Seventh Day Adventist Health Study 2, which I have on the screen here, is such an important study. The reason it’s such an important study is because the Seventh Day Adventists don’t smoke and they don’t drink generally.

Generally they’re healthier, their religious, you could say advisors, advise them to take good care of their health. Many of them are plant based eaters or vegans, near vegans, flexitarians, pescatarians. Those of them that eat animal products are eating less processed animal products and lower amounts of animal products. In this study of healthy, in these studies, we’re looking at people who generally are eating and living much healthier, exercising, thinner, living healthier, some including more animal products and some not. There’s difference in individual cohorts, and there’s not as many confounding variables.

We can look at a vegan and seeing, does the vegan do better when they don’t eat nuts or when they do eat nuts? What the studies show, these studies showed that groups with the highest meat intake had a 60%, you could say higher cardiovascular death, those with the highest nut intake had lower than 40% cardiovascular death. We’re talking about, we modulate cardiovascular death, a major cause of death by modulating meat and nuts, and more nuts or less more meat. We have more meat, more death, more nuts, less death, and tremendously differences in death, not a little bit of difference in death, we’re talking about 40% to 60% difference of premature deaths.

Actually, what’s interesting here is that the vegans who weren’t eating any animal products, who ate no nuts and seeds, did not live as long as the people who ate a little bit of animal products who ate nuts and seeds regularly. The vegans who ate nuts and seeds live the longest, but the vegans who ate no nuts and seeds didn’t live as long as the people who ate some animal products, small amounts, but also ate nuts and seeds, demonstrating how valuable it is to use nuts and seeds as your source of fat in the diet.

Obviously, clear studies that I don’t know how people could look to, bash or disregard or to say– you could say, that’s one study, but you have other studies from different parts of the world who show similar benefits or similar effects, and the answer is, yes. We have 20 studies that document the same thing that occur in those populations, too. There are so many mistaken studies that are all wrong, how can they can’t find one that shows the long-term lifespan benefit looking to a meat based or heavy meat diet? The whole argument is ridiculous.

Here’s meat intake and mortality, a prospective study over half a million people, following, talking about 47,000 male deaths and 23,000 female deaths. Of course, all these studies are wrong, they’re saying, red meat and processed meat increased risk of total mortality and cancer mortality. Just disregard every study done by all the top researchers in the world, and just believe this one guy who’s telling you you need a carnivore diet, and telling you not to believe any study except one study that’s whatever.

It’s just ridiculous. We shouldn’t even be having a talk about this, we should be motivating people, to let them know that they have this incredible opportunity not to have a heart attack if they eat a healthy diet, and not to be confused by nonsense.

Ari: Are there any other studies you want to show before I shut down screen share for now?

Dr. Fuhrman: No, that’s enough.

Xenohormesis – healthful or harmful?

Ari: Let me ask you this, and I suspect this is a question you’ve never been asked before. I’m curious if you’ve thought about it. There’s no a whole lot of research that exists to be able to answer it, but I’m curious what your thoughts are. The field of research, and this is actually what I told Paul Saladino when I spoke to him in person, when I met him for the first time when he argued to me that these compounds in plants were toxins that are harmful to health. I said, you know that there’s a whole field of research that has existed for decades on this topic where scientists all over the world have been studying the effects of these chemicals in plants on human physiology, and it’s called xenohormesis.

We have thousands of studies on xenohormesis, on many hundreds of different phytochemicals and their health effects. While you can certainly cherry pick examples of actual plant toxins that are genuinely harmful to health, the overall body of literature on things like curcumin and quercetin and anthocyanins and sulforaphane and many, many dozens of others-

Dr. Fuhrman: [unintelligible 00:39:30]

Ari: -it is very clear that they have a positive effect, not only in nutritional, epidemiological research, but in randomized controlled studies, in many thousands of randomized controlled studies that show clear beneficial effects and reductions of mechanisms of neurological disease or cancer or things like that. I’m curious though, as a form of hormetic stress as something that acts through hormetic pathways, which is, this is a big area of passion of mine, it’s a subject of my next book. One of the principles that’s important in that area is, I’d say two. One, there’s generally always a biphasic dose response in terms of hormetic stressors, which for listeners that means that a little or moderate amounts are very good and associated with benefits, but if you have way too much, it can create harm. This is even true with things like exercise, for example. If you are doing massive amounts of exercise, running ultra marathons every week or something like that, you’re–

Dr. Fuhrman: Or vitamin D or iron, anything you take too much of it. Exactly what you said. A biphasic too little is bad and too much is bad.

Ari: Right. Even sun exposure, we get too much of it. It can be harmful, create DNA damage. If we drink two gallons of water in the next 10 minutes, we can cause permanent brain damage, put ourself in a coma. Everything’s toxic in too large amounts. Even that’s true of water, I’m curious if you have any thoughts on if there’s a threshold at which too much phytochemicals might start to turn into a net negative instead of a net beneficial effect.

Dr. Fuhrman: No, we’re a primate. We’re only a fraction of a chromosome different from gorillas and chimps. We’re designed to be plant-based eaters, our digestive tract and such. The evidence on what your biphasic response has shown that when you’re getting, let’s say beta-carotene from food, you’re getting it in a spectrum of a hundred other carotenoids too in the right amount. You can’t get levels that are toxic unless you took beta-carotene in a pill without the other carotenoids because it competes with absorption with the other 100 carotenoids.

You can’t over-absorb one when you’re taking in food that has a hundred different types. It’s the same thing with phytochemicals. There’s only about a hundred different glucosinolates and isothiocyanates in cruciferous vegetables that you can’t get a concentration of one to cause damage like that unless you concentrated in a pill without the other isothiocyanates and glucosinolates that were in the food.

Food prevents us from that happening and our bodies are designed to accept these phytochemicals from food, but when we think we’re going to isolate them because sulforaphane from broccoli is so powerfully against cancer, we’re going to concentrate that sulforaphane in a pill and take it in a higher dose you couldn’t achieve from a food, that’s when we see these problems developed. That’s when see the potential for what you’re talking about, which now the body’s being irritated by this chemical to a degree without having compensatory ability to build back stronger in response to it because the chronic exposure is too high and too often. Yes, it’s not possible to do that with real food only when you concentrate them in supplemental form.

Ari: This is an argument in the direction of too much use of herbal extracts or plant food extracts could potentially create some negative effect in that way and an argument in favor of deriving most of these phytochemicals from whole foods.

Dr. Fuhrman: Correct. That’s right. We derive most of our chemicals from whole foods. We could say, what about just extracting those anti-cancer nutrients and adding them to the diet in a pill? Not going to be as effective or as safe as taking them in a food form which our bodies and our prehistoric ancestors’ bodies have been eating these chemicals for thousands and hundreds of thousands of years, mushrooms or organic sulfite compounds in mushrooms. In onions and the different compounds and green vegetables, we’ve developed a dependency on these such as ergothioneine found in mushrooms and other foods that we have a receptor on the cell walls that ergothioneine attaches and stabilizes DNA from aging and why would we even have an ergothioneine receptor stabilizes the aging of the cell if we weren’t have some ergothioneine exposure in our environment eating mushrooms.

It’s the body of the human body or the primate body wouldn’t even have that in there. The point is we have all these receptors and we have the antioxidant response element that’s fueled by flavonoids and isothiocyanates. In other words, it turns on the antioxidant response element. It’s called the Nrf2 transcription protein is activated by these phytochemicals we’re talking about that turns on the antioxidant response settlement that enables the cell to repair broken DNA cross-links, remove toxins and otherwise heal and reconstitute healthy tissue in cells that are damaged. Why would that mechanism be fueled by phytochemicals if we didn’t have them exposure to them in our diet? The whole idea is just utterly anti-science.

Ari: Do you think it’s within the realm of possibility that, all things being equal within the nutritarian approach, let’s say you compared purely vegan diet versus one that contained, let’s say, 5% or 10% of calories from whatever the animal foods are that you would say are the most benign. Let’s take red meat and processed meat certainly out of this and let’s say maybe seafood and I don’t know what you feel about dairy or eggs, but something like that. Five or 10% from animal foods where you’re getting some of these proteins, which some people argue are more bioavailable, give you a little bit higher protein intake than plant proteins do, would you be surprised if that diet performed better in all cause mortality than the purely vegan diet?

Dr. Fuhrman: No, I wouldn’t be surprised because we’re talking about a vegan diet is lacking in certain nutrients that have to be supplemented appropriately to maximize human health and longevity. Zinc, B12, EPA and DHA, iodine, vitamin D and maybe K2. There’s certain nutrients you more readily absorbed from animal products, particularly zinc and DHA and EPA, which people call fish oil, but you have them in salamanders and snakes and frogs and other foods besides fish.

The problem is that with modern agriculture, we have so much nitrogen runoff that we’ve caused so much algae bloom with the cyanobacteria that feed off the algae and now the bivalves, clams, oysters, scallops and mussels, have so much BMAA in microplastic compounds and other shellfish like lobster and crab that have so much BMAA and plastics. The point is that if we’re probably supplementing a vegan diet with a small amount of omega-3 and BH12 and zinc-containing seafood would enhance longevity in a primitive population.

In a modern population where we’ve polluted the shores and the coastlines to where the average American now has a credit card amount of plastic in their body, and we have clusters of Parkinson’s dementia syndrome and ALS near lakes and coastal waterways where people are eating more seafood, because of the pollution and the runoff of agricultural chemicals. Now we’re thinking, meaning me and my cohorts who think like me, that it’s better to use a supplemental omega-3 fatty acid because we know that brain shrinkage on a vegan diet, if you have no exposure to seafood or EPA or DHA, we could have increased risk of dementia or cognitive impairment or even Parkinson’s disease from low omega-3 index.

We’re talking about supplementing a vegan diet with those nutrients that you would be beneficially getting more of if you ate some animal products, which are mostly B12, zinc, and DHA and EPA. Because the phytates from plant foods do bind zinc absorption. I’d rather take my chances with using a vegan diet, and we’ve seen, and obviously been in practice more than three decades, in all my patients who came to me in their 50s and 60s and 70s with heart disease and early cancers and all types of problems and psoriasis, got well and are living between 97 and a 100, they’re living long lives.

They’re remarkably living long lives. We’re seeing tremendously ability to live a long life. So I advise people in my, and I practice myself, I take a supplement of EPA and DHA and I actually sell the supplement because I have it– there’s a monopoly on who makes the companies that manufacture it, make it for all the vitamin companies. All the vitamin companies that sell algae-based DHA and EPA, which is a vegan form of fish oil, it’s all made by the same company that they just bottle it and market it differently.

What we do differently is we– I started packing it in glass and keeping it refrigerated in our warehouse before we ship it out so it stays fresher, cleaner and fresher source. It’s the same stuff, we’re just making sure because over six months out at room temperature, you have more rancidity in it. There’s some idea of rotten fish oil or rotten oils or oils that are at room temperature for too long.

Even when you buy oil it sits, so we’re trying to take those oil arguments and say, “Should I try to eat a little more animal products to get B12 and zinc or EPA and DHA?” To do that, you’d have to eat enough animal product to assure adequacy in those nutrients that may then give you a higher risk of toxicity. That’s why we’re limiting that to a small amount and using supplements to make up the difference, which I think is more conservative, is safer than– because we know that the other things are more likely when you’re exposed to more of these, we’re seeing these toxins play a role in human health.

Ari: Let me ask you this. You made the argument earlier about phytochemicals and ergothioneine that we have this receptor that ergothioneine has these benefits as far as protecting DNA from aging and that these flavonoids and other phytochemicals act on the Nrf2 pathway, the xenohormetic pathway that have all these translate into all these benefits.

Dr. Fuhrman: Correct.

Ari: That therefore based on an evolutionary biology lens that humans have evolved to have those benefits because those things are good for us. Couldn’t the same logic be used to using B12 and Zinc and EPA and DHA? Couldn’t the same logic be applied to say we have also evolved a need for animal foods?

Dr. Fuhrman: Yes, and I think that that’s– I’m using that argent actually. I’m saying that most of human evolution there even gorillas and early men ate some small amounts of animal products in their diet, and ate more of insect residue on their food, so they’ve got more B12 exposure. A vegan diet is not the natural diet for humans over the millenniums. The argument is we have to take more care to make sure that what could be potentially missing, and are you getting adequate levels of these substances if you completely avoid of animal product in your diet?

We know that we are not, we know that there’s a potential risk of B12 deficiency. Now, the vegan community doesn’t really necessarily all agree with this idea of zinc supplementation by vegans, because because plant foods have adequate zinc, but it’s true that the absorption of zinc is not as bioavailability. You don’t absorb zinc as readily from plant foods as you do from animal products. It’s much more conservative and safe based on the fact that humans did probably eat small amounts of animal products.

It’s best to eat to sub to look at what could be missing, and then when you’re taking the zinc, the B12, the DHA-EPA, because some people can convert enough and their Omega-3 index could be adequate with just all plants. Genetically we’re a little different from each other. Some of us don’t have the conversion enzyme ability to take just eat flaxseeds and green vegetables and make enough long chain omega-3 fatty acids. Others of us do. Most people don’t, most people on vegan diets don’t because I’ve measured hundreds and hundreds of people. Most of them don’t have ideal levels.

So much the vegan community is going to argue with me and say that the vegan diet is a natural diet, and you don’t need to supplement anything, and show me that these people are being hurt by not supplementing. I’m saying, well, I can show evidence in my practice of clinical people who got in trouble long-term on a vegan diet, because of a low omega-3 index, but that’s not the basis of coming to a conclusion, that’s just gives you a suspicion. There’s lots of studies that show that, lower omega-3 index throughout life exposes you or puts you at higher risk of neurologic deficit in later life.

Smaller brains, more cognitive impairment in later life, especially if you’re going to live much longer and not die in your 70s or 80s. You’re living to the 90s, you’re going to see more chance of dementia. We all want to live longer, so we really should try to maximize. The question is how many studies, and how are they well done, and how do they corroborate each other at showing that supplemental EPA and DHA is beneficial for people with low levels omega-3 index? Does it work to protect the brain as does eating fish does?

I think we have the answer to those studies, and my bet is that it’s safer and more longevity producing to make sure that you have an adequate omega-3 index on a vegan diet as opposed to trying to eat more seafood, and increase your other risks with potentially toxins or too much animal protein, because you do get a benefit from having reduction to animal protein to very low levels, because then we keep IGF-1 very low in certain other parameters that extend human lifespan.

Yes, I’m advocating a conservatively supplemented vegan diet or one that’s using animal products much more judiciously. As you said probably egg whites and naturally wild animal pools like salamanders and frogs and things that are living in the wild, are probably say wildly beast and antelopes, I’m joking now.

Ari: Salamanders and frogs, I’ve never heard that one before.

Dr. Fuhrman: Salamander– Well, what kind of animal products did humans really eat in their past? They ate worms and insects and frogs and salamanders and snakes and things they could easily catch, maybe some rabbit. They didn’t go after–

Ari: You could look to some modern day hunter-gatherer tribes as an example. Staffan Lindeberg has cataloged a lot of those diets. He was a researcher that traveled the world and very systematically cataloged the diets of a lot of modern day hunter-gatherer tribes, and some that were doing some agriculture but still also doing some hunting and gathering. The most famous of those is the Hadza tribe, and there’s videos online where they show the nutrient composition of the diet. A significant is meat and from various [crosstalk] porcupines and deer and things like that. Whatever they can capture.

Dr. Fuhrman: I’m talking about the millennium of 150,000 years of humans on the planet, and the hundreds of thousands of years of pre-human of the Cro-Magnon, and of our earlier human primates. I’m not talking about one narrow part of history, and one narrow tribe, but those tribes and those studies show that those populations do not have lengthy lifespans, do not have excellent health into the later years, and they’re not taking advantage of the– and they’re not eating a diet even though their diet may comparatively not be as bad as one that eats so much processed foods, fast foods and processed meats, animal products, fried foods. Nothing is as bad.

You can’t make any diet worse than a standard American diet as when you’re eating fast foods, processed foods, fried foods and things out of bags and boxes, and you– Anything people do is going to be better than that. Let’s compare what obviously I’m saying, let’s look at the blue zones where people live the longest, and a nutritarian diet is not a blue zone diet. It takes that to a whole other avenue of scientific integrity, and trying to not just eat what’s locally available, but eating what show what foods show the best effect against cancer.

Right now in the modern world we have about the leading cause of death is heart attacks and strokes in adults, and the next leading cause of death is cancers. By reducing heart attack, by wiping out heart attacks and cancers, and by slowing aging, we can definitely prevent, have this ability to give humans the possibility of a much healthier and longer life.

Ari: I find myself wanting to ask you so many more questions based on what you just said, but it would take us another hour. We have to wrap up unfortunately.

Dr. Fuhrman: I’ll be back again then.

Ari: It would be a pleasure. Dr. Fuhrman, this has been a joy. Thank you so much for coming on the show. Is there any final thought or two that you want to leave people with?

Dr. Fuhrman: I want to leave them with the thought that we’re not just talking about these diet wars and questions. We’re talking about people who already are overweight, have diabetes, have high blood pressure, have psoriasis, have asthma. What I’m saying is that a nutritarian diet designed to maximize human lifespan, enables people to reverse disease, and get rid of them, and get healthy again. My whole career over the last 30 years is treating and helping people that way.

They get rid of their diabetes, they get rid of their excess weight, they get rid of their high blood pressure, they get rid of their asthma, get rid of their psoriasis, they get rid of their headaches. That therapeutically it enables people to reverse disease and get well again. That’s the message I want to leave them with. That don’t be satisfied with being sick, and don’t take drugs for the thinking that that’s the avenue to you’re going to get yourself well again, you have to eat– healthy eating is incredibly protective and effective.

Ari: Agreed 100%. I have to say that I’m someone personally who’s a little bit more in the omnivorous direction than you are, but I really appreciate your work. It’s been a big influence on my own thinking, and I appreciate you, and the way that you think through these issues, and you’re so focused on the evidence, and you really think deeply about how to arrive at the best conclusions. You think through all the different layers. Thank you so much for all of your wisdom. I really appreciate it Dr. Fuhrman. Let people know where they can find you, I know you’ve got an upcoming retreat in my hometown San Diego, but let people know about that.

Dr. Fuhrman: Yes, it’s, My most recent book is Eat for Life and my retreat in San Diego is open 365 days a year. People come here to get healthy, and to stay here for a month two or three, and to get their hope, get their health back, learn how to make healthy food taste great and go home with the tools to be able to apply it and stick to it at home. The Eat to Live retreat is an ongoing business that that I live right next door to it, and I have a staff that helps people all year round.

Ari: Wonderful. Thank you so much, Dr. Fuhrman. I look forward to our next conversation.

Dr. Fuhrman: Take care. Bye.

Show Notes

00:00 – Intro
00:38 – Guest Intro – Dr. Joel Fuhrman
02:00 – The Nutritarian diet
07:38 –  Can you eat animal products on the Nutritarian diet?
10:42 –  Tradeoffs in dietary approaches
19:35 – What science tells us about diet
40:11 – Xenohormesis – healthful or harmful?


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