Hello, everybody. This is doctor Bob Hoffman from the Master Circle Global. And welcome to the Practice Upgrade Summit. We have another amazing interview today.

And our topic is how not to Diet. Our guest is the author is Doctor Michael Greger. He's a founding member and a fellow of the American College of Lifestyle Medicine.

He's a physician and New York Times bestselling author and an internationally recognized speaker on nutrition. He has videos on more than 2000 health topics that are freely available at Nutrition facts.org, with new videos and articles uploaded almost every single day that Dr.

Greger has lectured at the Conference on World Affairs, testified before Congress, and was invited as an expert witness in the defense of Oprah Winfrey in the infamous meat defamation trial.

He's a graduate of Cornell University School of Agriculture and Tufts University School of Medicine. Three of his recent books, How Not to Die and How Not to Die Cookbook and How Not to Die it all became instant New York Times bestsellers.

His latest book, How to Survive a Pandemic, was just released in May. All proceeds he received from the sale of his books go to a charity. Welcome, doctor Greger, it's an honor to have you on our call.

So glad to be here. So glad to have you. And so thrilled to see you exercising. Well, while we're trying to exercise the minds and the thought process of the people watching.

That's good. So let me dig right in. I know you're a big research guy, and and I think that's so important. So how valuable is research for doctors to get their patients to be more compliant?

Well, I mean, the question is compliant with what? I mean, who cares if patients are compliant? If you're asking to do something that doesn't make any sense or doesn't won't help them at all, or could even harm them.

And so that's where research comes in. Research. You know, we look at the best available balance of evidence to suggest that the benefits outweigh the risks of any particular intervention, in any particular case.

And then we can ask for compliance. And the way we do that is just laying out the facts and letting our patients make up their own minds, their body, their choice.

You know, they want to go, you know, smoke cigarets or go bungee jumping. Do whatever. What you know, that's their choice. You know, we as physicians can do is share with them our knowledge, our experience or training several, you know, people in your circumstances that do X, Y, and Z, you know, the predictable consequences of those actions are loss.

And then, you know, it's up to you. But I'm sure if a physician or any doctor or any health care provider knew the research, they would have more certainty and more confident.

And in order to present to that patient and recommend properly, which I think by and large, would just help the patient be more compliant on their recommendations.

You would agree, wouldn't you? Well, well not necessarily. So, for example, studies show that, when present with, drugs like, high blood pressure medications or cholesterol lowering, medications, people expect in order to take a drug every day for the rest of their lives, they expect, a certain amount of benefit, in terms of, you know, reducing risk of a heart attack, for example.

And when actually presented with the actual reduction in absolute risk, that these drugs can give, assuming there's no change in lifestyle, most patients would not take those drugs.

Right. So the only way we can get our patients to take those drugs, which we want them to, because on a population scale, we can save millions of lives, even though the, the, the, the advantage for that particular patient.

Yeah, maybe vanishingly small. The only way we can do that is actually not fully inform the patient. And that's the only way we can get them to take these drugs.

And so actually giving them all the data may actually make them less compliant, which would be in their worst interest. Because even if there's, you know, one inch 50 chance of, you know, of, of of, you know, of them benefiting, which is typically what you see, you see about a 2%, a reduction, absolute risk reduction.

So for example, secondary prevention, someone has already had a heart attack, put people on a high dose and drug over the next five years. But a one inch 50 chance.

So 49 out of 50 people won't benefit from one out of 50. We may be able to prevent an event. And so for that person, I mean, so I mean, that's our on a population scale, millions of lives could be saved.

Fantastic. Amazing drugs. But that individual, you know, like one in a 50 chance. I don't want to take a drug that may give me muscle aches or may increase my risk of diabetes.

There's just a 150 chance it's going to benefit me. So in that case, actually fully informing a patient about the risks and benefits may ironically, make them do the opposite of what we actually want them to do for their health.

Well said, well said. Thank you. I appreciate your perspective. So with all of your research, knowledge and experience provided, we wanted to help someone get healthier just in general to live a better life, maybe even extend life.

What's the healthiest diet? The healthiest diet is one that's centered around whole plant foods. So, minimizes the intake of meat, eggs, dairy, and junk.

Maximize the intake of fruits, vegetables, legumes, which are being staple foods. Chickpeas and lentils. Whole grains, nuts, seeds, mushrooms, herbs and spices.

Basically, real food that grows out of the ground. These are our healthiest choices. You know, from fields, not factories. That's what we should be getting most of our nutrition from.

I love it, and I love the concept fields, not factories. I'm assuming you're also a big fan of. We're trying to get someone healthier to recommend fasting.

So what are some of the benefits of fasting and how would one go about it? Well, there's all sorts of different types of fasting. That's why in my book, How Not to Diet is actually the largest chapter.

There's so many different types, particularly the intermittent fasting. Now there's also in the day, eating five two, fasting 25 five, fasting, mimicking diets, time restricted, feeding on and on and on.

They all have various benefits and risks. And this and to more traditional, concepts of fasting such as water only fasting or modified fasting. And they all have various risks and benefits.

For various conditions. Probably the best documented in the literature would be kind of kickstarting, and alleviation of high blood pressure, which could then be locked in by, transitioning to a healthy diet after the fast.

Beautiful. And you touched on it with intermittent fasting, which I think is becoming more and more popular by the day. How would you recommend somebody properly intermittent?

Fast? Well, so I would not recommend alternate day fasting, which has been shown to actually increase cholesterol compared to the same amount of caloric restriction on a chronic day to day basis.

And when I was actually sure what the mechanism behind that is. But, that was the result of the largest, longest study done to date. So if you are going to do it, even though it hasn't been shown to improve compliance or improve, which was kind of the hope, I would make sure that you, had your cholesterol monitored to make sure it doesn't, doesn't go up.

And so in terms of what would actually be the best, the, I think early time restricted feeding, really has, the best evidence to date. And so that's, restricting your eating window to 12 hours or less.

But then, critically, that eating window is shifted towards the morning rather than evening. We're going to skip any breakfast, any, any meal, or you're skipping supper, not breakfast.

And we're trying to shift our calories towards earlier in the day. So someone would be consuming food for 6 or 8 hours and not consuming for for 18 or 14 hours.

Something like that. Right. But critically, when that a window would be. So if you actually look at that time restricted feeding literature, it's all over the place with some showing benefit, some showing harm and say, wait a second, how could restricting people to the same eight hours a day sit in the similar population of people?

Be good sometimes and bad other times, and then you look a little deeper. You realize, it's the timing. So when people, you know, that was a typical way to restrict is skipping breakfast so you don't eat until like 11 or so.

And so then you can, you know, and then you finish eating by seven. And so okay, so there's your eight hours. Right. That may be more convenient terms of social outings in terms of family.

But the problem is then your by, by shifting caloric intake later in the day, you have these negative metabolic consequences. So the better would be early time restricted feeding those same eight hours.

But earlier in the day, and so you're having a very early supper. Then you get benefits of both, the kind of biological benefits of eating earlier. Plus the term restrictive feeding benefits.

At the same time, I had never heard of it like that. That makes a ton of sense. You know, a lot of the people watching this, a lot of the doctors watching this are very much into brain health and brain fitness and, improving cognitive outcomes.

What are some of the most important foods for brain health from your perspective? Based on the research? You know, it's really, heart health is brain health.

And in fact, I mean, and the reason why, these chronic diseases seem to kind of come together is because they have, similar underlying cause. So, for example, inflammation, plays a role in so many different chronic diseases.

And so an entire laboratory diet, that's how an anti-inflammatory diet can have beneficial effects not only on, you know, overtly inflammatory conditions like rheumatoid arthritis, but also diabetes, and, and cognitive decline, other things where you don't typically think of it as inflammatory, another kind of under, underlying, physiological, effect is the, it's, it's blood flow.

So, you know, we think of improving blood flow to our heart, improves, our arterial function, opening up arteries without joints, without surgery, with a, with a with a artery, healthy diet.

And that same diet, not only, reverses heart disease, but has been shown to reverse progression prostate cancer and improve liver function. Kidney function is a wasting.

I hope one day I do all that well. All tissues in the body require oxygen required nutrients. We need to get rid of waste products. So no wonder that a blood flow healthy diet can have benefits to all organ systems and the brain is no exception.

You can do, you know, autopsy studies, and you can tightly correlate the amount of atherosclerosis in the cerebral arteries. These are the arteries tunneling through the brain, and cognitive decline.

In fact, the the tributaries that go directly to the memory centers of the brain, do not have, atherosclerosis in them, tightly correlated to, to Alzheimer's.

And, and memory loss in general. And, and, and so you can see this with back pain, you see this with a variety of conditions. And so cleaning out the arteries, you know, you know, atherosclerosis is not a, it's not limited to the heart, but to your entire arterial tree.

And, so no wonder why starving, the brain of oxygen, one of the most metabolically active, tissues in the body, would have detrimental effects. So heart healthy diet is a brain healthy diet.

And both heart and brain healthy diet. Arterial healthy diet is the same diet you talked about earlier, right? So it's a diet centered around plant foods, low and trans fat, saturated fats and dietary cholesterol.

The three things that increase our cholesterol levels, which is what gets stuck in the, arterial line and causes inflammation that starts clogging off, our arteries.

Right. So, so that that's the reason why we encourage people to, to plant based. They're the only diet ever proven to, reverse the progression of heart disease in majority of patients.

That is the number one killer for both men and women around most of the Western world. Beautiful, beautiful. Now, with the soil all over being so depleted of nutrients, even with this plant based diet, do you normally recommend taking, supplements of any kind?

And if so, which ones? Yeah. So I mean, that whole trope, is largely, a, kind of a disinformation campaign by supplement manufacturers who have this, you know, our, our soils are getting depleted.

You're not going to get enough minerals. And so here, take our mineral supplements. But, you know, this is actually studied by I mean, so the USDA does crop surveys every five years.

So you actually go back and see actually the nutrients, in the same crops grown over the last 50 years and the kernel of truth. Yes, there has been crop depletion, but we're talking over the last half century on the order of 15%.

So, yeah. You know, six florets of broccoli, you know, five florets of broccoli in the 1950s has the same nutrition as six florets of broccoli now. But the answer is not to take a pill trace mineral pill, but to just eat an extra Florette of broccoli.

Fine. Need some more good food? That's great. But there's this sense that that somehow that our soils completely stripped. That's impossible. These nutrients are in the plant.

Not by chance. They're actually used by the plant to grow their physiological functions in the plant. If you really had that little in the soil, you would have no plan.

The fact that there actually is a plant means that there's enough nutrition to support that plant. So for example, Chlorophyl, the you know, what makes you, you know, green leaves, green, the center, every chlorophyl a molecule is a magnesium atom.

That's the you want to look where magnesium is found, to look for things that are green. Right. And so there's only a certain you need a certain amount of magnesium.

If the plant is green it's got magnesium. And it would not grow, would not be able to grow if it didn't have that. So that's why, it's really an overstatement.

And we don't need to go to the supplement aisle to get our nutrition. We can stick to the produce aisle. We just have to made, have to eat a few extra bites these days.

Very good, very good. I love your your angle on looking at all this in your perspective. It really does make a ton of sense. And it's it's so contrary to what we normally hear or read in the media.

So thank you for that. You know, obviously right now we're we're still hopefully at the tail end, but still in the midst of the Covid pandemic. Is the same plant based diet good for everything, even including boosting our immunity?

Well, I mean, the, the the wave diet will help us the most in terms of the pandemic is the underlying risk factors for disability and death. So think about them.

It is time to diabetes, high blood pressure, obesity and heart disease. Those are the four leading, modifiable risk factors for Covid 19 severity and death.

And guess what? Every single one of them, four out of four is not just preventable arrestable, but reversible with a healthy enough plant based diet. And in fact, look, you don't even have to be obese.

Even having a, BMI of 28, puts you at nearly six times your odds of suffering, severe Covid 19 course. The average BMI in the United States 29. So being skinnier than the average American could still put you at so much excess body fat that you're six times as likely, to suffer a severe course, you know?

But look at who would you know how many months into this thing are we right if people started to clean up their diet? And, you know, getting an exercise program, doing, starting, taking better care of themselves, you know, by now there's no excuse why you wouldn't be able to fortify yourself, against this disease.

Beautiful. In the plant based diet, doctor Gregor, are there certain key herbs or spices people should be utilizing and consuming as well? Oh, I'm so glad you bring that up.

Yeah, I mean, the I mean there's there are plant foods and then there are plant foods. Right. And there are some that are healthier than others. Right.

So iceberg lettuce, definitely a plant. But there are healthier options for your salad out there. So that's where, my Daily dozen, concept came from. The daily doesn't checklist of all the healthiest of healthy foods.

I encourage people to try to fit into their daily routine. And so, for example, fruit is great, but berries are better with berries are the healthiest foods to encourage people to be berries every day.

All vegetables are great, but dark green, leafy vegetables are the best of the best, so I encourage people to eat them every day. And a quarter teaspoon of turmeric, a tablespoon of ground flax seeds every day. The best beverage is best.

We know how much exercise to get every day. Again, just trying to inspire people, to move towards some of these healthier options. And it's available free as a, as an app on iPhone Android, doctor Gregor's daily does and you can, you know, graph your progress and go through the checklist every day.

And just kind of a fun way to try to encourage people to eat some of the healthiest foods. Beautiful. Would you mind sharing most or some of the Daily Dozen with us?

Sure. Oh my God, can I do it all from. That's why I have an app. I have to I don't have to memorize any of this. Oh, yeah. So, greens. Healthiest, vegetables. Berries. Healthiest.

Fruits, legumes, chickpeas and lentils. I did the quarter teaspoon turmeric. The test went to ground foxes. Recommended, 90 minutes of moderate exercise every day.

That's what the, the literature suggests is best for longevity. Oh. The healthiest beverages would be, green tea, hibiscus tea and herbal tea called a biscuits.

Tea or water. How am I doing? I think we're up to seven. Well, there's five more. Check out the. Yeah, I don't mean to put you on the spot. Did you did great. You did great.

And and let's even drill down deeper if we can. Even in the world of berries, there's so many different types of berries. Are are raspberries better than blackberries or blueberries the best of the bunch?

Where should we be focused? Blackberries. When? The day. So blackberries are the most antioxidant packed common berry. There are some exotic berries with, Doctor Susi and names like Wardle berries and things like that.

But, in terms of where you can buy your local store, you know, blackberries really do, seem to be best, but, but actually most of the research on the benefits of berries, we think it's these anthocyanin compounds, these pigment compounds, antioxidant pigment compounds concentrated in berries.

And, give them those bright colors like reds and purples and blacks, that are so beneficial. But the studies was done on, like the Harvard Nurses Health Study in terms of, significant improvement in brain health was, blueberries and strawberries, kind of the most mundane of berries.

But because we think it's these aren't the sign and compounds, but the most concentrated sources of those are the kind of the darker the better. And that's why these blackberries and black raspberries really rise to the top.

Beautiful. And how about something like pomegranate? Oh, fantastic. Exactly. Has those same anthocyanin pigments. You can see it right in the, in the pigment. Right.

So it's like a whole. Yeah, a whole bowl full of berries. And you have all sorts of fat soluble nutrients actually found in the seeds, when you chew them up, so. Oh, yeah.

Pomegranates are fantastic. Beautiful. And even if we take a slight detour, how about the value of drinking like, good red wine? Well, eating good red grapes.

How about that? Better. Better. So, Well, so if you are going to drink alcohol, the best choice would be, red wine. I mean, that's the only alcoholic beverages that has not been tied.

And this is in the large Harvard cohorts to increase risk of breast cancer, even light drinking, defined as 0 to 1 drinks per day in women, significantly increases breast cancer risk, with the exception of red wine.

We think it's because of these aromatase inhibitor compounds found in the, skins of grapes, which are, included in the use of red wine but not other alcoholic beverages, which may, impair, the, tumors ability to create its own estrogen to kind of fuel its own growth.

And, but, there's also this compounds found of white mushrooms, for example. Or you can eat the grapes themselves. And so then you just have and then you just have the benefits.

And so in red wine the alcohol is increasing your cancer risk. But the, you know, grape skin compounds are decreasing. And so you get a negative, neutral effect. Okay.

But why not just go to all the benefits without the red grapes? I, you know, even some even some table grapes. Beautiful, beautiful. My last question for you, but quite frankly, because we're in the practice upgrade summit might be my most important for our listeners, even though everything you shared has just been awesome and spot on and very inspiring and thought provoking.

Doc, what's the best way for a doctor to upgrade his or her practice with nutrition? Based on all the work you've done? Well, you know, it's, depending on one's practice, I, may encourage, people to bring on, auxiliary staff.

Doesn't have to be dietitian. You may health coach. But, you know, I mean, there's there's a there's a lot there. In terms of, not just informing people about the best side, but actually, you know, how to fit it into their lifestyle.

I mean, there are some practices that have people that actually go to people's houses, go through their pantry, go help them shop, really to get them all set up.

I mean, that's the really kind of it's the practical how to tips that often as medical practitioners, we just don't have the time, to go kind of, to, to, to fully inform and so we can be like, you know, we can be the ones that lay down the law and say, look, based on the bloodwork we just got back or whatever testing you really need to eat this way.

And to help you do that, I want you to make an appointment. You know, with this person, and they can help you achieve this, and then let's see you back, return and repeat that blood work.

And so, if you're able to do that, then, I mean, I think that's really the best of both worlds. Unfortunately, too often we just tell people kind of what to eat, but not exactly how to do it.

Or even worse, we just be like, you got to eat better, you know, some ridiculous, vague, you know, that's not going to help anybody. But even if you're very specific.

Look, I want you to, you know, cut out the soda, and I want you to, you know, people are like, well, what am I going to do instead? They can be like, oh, do you know about these seltzer machines?

You know about all these other way things you can drink to kind of wean yourself off? And, you know, there's a lot of practical day to day grocery store type tips that can help people make a transition more effortlessly.

Make the default options healthier options. You know, get some good healthy snacking options to replace some of the junk that they're eating. But, you know, you know, that's not the best use of our time and expertise, but certainly, you know, bring on coaches, can, can help actually get the results.

You know, the, you know, kale that what the healthiest food in the world. Dark green leafy vegetables are useless if it's just going to rot in your crisper.

It only helps when you actually eat it. So we got to make it delicious for people. And it's hard to do that in a, you know, a 15 minute appointment. Beautiful.

Thank you so much for that. So listen, if this if this conversation with Doctor Michael Greger got you thinking, please go to nutrition facts.org. Check out his 2000 plus and growing videos.

His research, his material. Go out and buy his books. You know How Not to die, How Not to Die cookbook and how not to diet. They're they're all just terrific.

Before we conclude, Doctor Gregor, any parting comments for for the doctors watching us? Any words of wisdom, pearls of wisdom you want to leave them with?

Well, I have a new cookbook coming out, How Not to Diet Cookbook in December. And I just want to leave everyone with the good news. So we have tremendous power over our health, destiny, and longevity.

The vast majority of premature death and disability is preventable with a plant based diet and other healthy lifestyle behaviors. You are a, a rock star and a gem.

And thank you so much. I know how crazy busy you are. You actually had a fit in this interview during part of your 90 minutes of exercise, and I appreciated the fact that you were able to remain so focused and so calm and so.

So why is while you're you're working out on your treadmill is, is a gift? You are a gift. So thank you so much for contributing to our summit and for helping our doctors help their patients even more, which is what it's all about, isn't it fantastic?

Any time. Keep up the good work. Same to you and you have yourself an awesome day. Thank you.

Michael Greger, MD

Never Diet Again: How to Quit Dieting for Good & Finally Reach Peak Physical Health