Nutrition Chat with Gianna Simone

Hello and welcome to the Nutrition Facts podcast, I’m your host Dr. Michael Greger. 

Now, I know I’ve made a name for myself in explaining how not to do certain things – just look at my books – How NOT to Die – and my upcoming book, How NOT to Diet.  But what I want to share with you is actually quite positive: what’s the best way to live a healthy life? Here are some answers.

A few months ago I met up with the amazing actress, and producer Gianna Simone, for an interview. In this 30-minute conversation, Gianna and I discuss healthy pregnancies, the science of soy, supplements and more.  Enjoy.

Gianna:          Hello, and welcome back to Love, Gianna. Today I’m here with the incredible Dr. Greger.

Dr. Greger:    Happy to be here.

Gianna:          Please tell us a little bit about yourself and how you became a leader in the field, NutritionFacts.org, and any books that you’ve written that you’d like to talk about.

Dr. Greger:    Wow! I am a physician, specializing in lifestyle medicine using diet and exercise to not only prevent disease, but to treat and reverse it as well. And it all really goes back to my grandma. I think the spark for many kids to want to be a doctor when they grow up is watching a grandparent get sick or even die, but for me was watching my grandma get better.

She was diagnosed with end stage heart disease. Already had so many bypass surgeries, nothing more the doctors could do. She was sent home in a wheelchair to die. Crushing chest pain. But then she heard about this guy, Nathan Pritikin, one of our early lifestyle medicine pioneers, and what happened next is actually detailed in Pritikin’s biography, to talk about Frances Greger, my grandma. She was one of his early patients, featured in his biography as one of his early success stories. They wheeled her in, and she walked out a few weeks later. She was walking 10 miles a day, and though she was given her medical death sentence at age 65, thanks to a healthy diet was able to enjoy another 31 years on this planet to age 96, to continue to enjoy her six grandkids including me. So that’s why I went into medicine. That’s why I practice the type of medicine I do, lifestyle medicine. That’s why I started NutritionFacts.org. That’s why I wrote the book, “How Not to Die.” That’s why all the proceeds from all my books all go to charity. I just want to do for your family what Pritikin did for my family.

Gianna:          That’s amazing. First question: how much fat and protein do we need daily? What are the best sources? And how much should athletes be eating?

Dr. Greger:    Well, you know, we don’t eat macronutrients; we don’t eat micro nutrients. We eat food, and I think that’s one of the ways in which the food industry is able to become a trillion dollar—the processed food industry has become a trillion-dollar industry because if you just care about carbs or fat or protein or magnesium, vitamin C, whatever, they can give you, you know, junk food to match. You want Paleo junk food, we’ll give you vegan junk food, we’ll give you fat free junk food, we’ll give you… I mean any kind of junk food you want because it’s all about macro nutrients or it’s all about whatever particular thing, right? On Fruit Loops, they can say, “with fiber, vitamin D” with all this stuff, and that gives us this kind of health halo, when in fact it should all be about food.

And the reason people don’t talk about food is there’s no money to be made in food. In fact, produce goes bad; it’s like the worst possible investment. There’s no markup value. Can’t sit on the shelf like a Twinkie for a couple weeks. And look, even a broccoli grower is not going to put an ad on TV for broccoli because, you know, they’ll just buy a competitor’s broccoli. There’s just no money to be made. You’re never going to see an ad on TV for sweet potatoes because there’s just no money to be made. That’s not where the profit is. The system is set up to reward just the unhealthiest but most profitable behavior.

And so, I mean, so that’s just kind of falling into the food industry’s trap to speak of kind of this reductionist view of nutrients as opposed to food. Like what’s the best food, right? So like are carbs good or bad for you? Well, carbs are jelly beans or kidney beans, lentils or lollipops. They’re both carbs, right? I mean so fat, fat’s walnuts or lard, right? So that’s why you can’t talk about it. That’s why the industry wants you to talk like that, but it really has to come down to is what are the healthiest foods?

So like, look, the dairy industry can say “the calcium in dairy.” Yeah, you know what else is in dairy? It’s the number one source of saturated fat in this country. People think like steak or something. No, the number one source of saturated fat is dairy, yes, the number one source of calcium, but yes, there’s protein in pork, yes, there’s iron in beef, right? But what about the baggage that comes along with all those nutrients? I mean as much as Burger King says you can “have it your way,” you can’t be like, “Yeah, can I get the protein but hold the saturated fat, hold the hormones, hold the cholesterol.” I know, it’s a package— food is a package deal.

So the thing about that, so if you get your calcium from, you know, dark green leafy vegetables instead, then it’s like, well, the baggage is actually a bonus. You get the fiber and the folate and the iron and the antioxidants—all these things missing from kind of, the dairy source. So that’s how we think in terms of food.

So if you ask me what are the best foods that happen to have fat in them, well, it would be nuts, seeds, avocados, because then it’s just—you just get the bonus instead of the baggage. In terms of protein sources, anyone who doesn’t know how to get protein on a plant-based diet doesn’t know beans, right? Beans, split peas, chickpeas, lentils, legumes—the protein superstars of the plant kingdom. And then also some of the whole grains, nuts and seeds and all sorts of things. So whole plant foods are the healthiest way to get almost all your nutrients, and that’s really, I think, how we should think about those macronutrients.

Gianna:           Question number two: what are your thoughts on alkaline and distilled water, and which is best for athletes?

Dr. Greger:    Most of the kind of alkaline water nonsense is just bogus, scam kind of stuff. I have a video on NutritionFacts.org that goes into the science around that. Distilled water just kind of seems a waste of energy to me. I mean it’s the same thing with like, you know, kind of reverse osmosis distillation; it’s just a very kind of wasteful process. But you can get rid of a few little trace minerals, but that’s not really the issue. I mean tap water is typically the cheapest, safest source of drinking water.

Gianna:          What about fluoride in it?

Dr. Greger:    Fluoride is the reason why we don’t grow old and lose all our teeth.

Gianna:          Should we be consuming fluoride though?

Dr. Greger:    It’s not necessary, but from a public health standpoint—rich people can go to the dentist and afford all sorts of gizmos, ultrasonic gizmos for their teeth—but from a public health scale, I mean that’s how you reach impoverished populations which may not have the dental care that you have, and so if you have a dental problem, no big deal, go to the dentist, right? But if they have a dental problem, they could lose their teeth, which means losing a lot of their nutrition or being in chronic pain. And certainly from a public health standpoint fluoridated water is—in fact, according to the Center for Disease Control, one of the greatest public health innovations over the last century.

Gianna:          Question number three: are there any guidelines or special tips for women who choose to eat a plant-based diet while pregnant, and who also choose to raise children plant based after the breast milk stage if over?

Dr. Greger:    When you’re eating for two it’s just that much more critical to get all the nutrition you need, and so it’s basically all the same advice you’d give to anyone consuming a healthy diet, consuming a plant-based diet.

Critically important: vitamin B12. So there’s two vitamins that aren’t made by plants. One’s vitamin D, which is made by animals such as yourself when you walk outside; it’s the sunshine vitamin. And the other one’s vitamin B12. Not made by plants, not made by animals either; made by little microbes that blanket the earth. So, you know, we could get all the B12 we needed drinking well water or out of a mountain or something a long time ago, but now we chlorinate our water supply to kill off any bacteria, so we don’t have a lot of B12 in our water any more. Don’t get a lot of cholera either. It’s a good thing that we live in a nice sanitary world, but because of that we need to get a regular reliable source of B12. Critically important, particularly for pregnant women, but for everybody.

During pregnancy iodine’s critical, a mineral often missing from prenatal vitamins, so it’s important, if you’re getting a prenatal, to make sure it has iodine. Recommended daily allowance is 150 micrograms a day.

Gianna:          And for children being raised vegan, do you recommend any books or any videos to watch? Is that something that you would recommend to raise children whole food, plant based?

Dr. Greger:    Should we raise our kids healthy? I say yes, indeed, and so does the most esteemed pediatrician in human history, Dr. Benjamin Spock, in the 7th edition of Child and Baby Care, which is like one of the best-selling books ever, second only to the Bible perhaps in this country. Where in his last edition he wrote, in his 90s before he died, recommended all children be raised with zero exposure to meat and dairy, and he did that because he could see what the grandparents were dying from and see this burgeoning childhood obesity epidemic.

So absolutely we should raise our children in the healthiest possible way. That means not having them smoke cigarettes. That means having them put on seat belts, smoke alarms in the home, and a whole food, plant-based diet—really basic, simple. And even the ADA, well, what’s now the Academy of Nutrition and Dietetics, in their official position paper says strictly plant-based diets are appropriate for all stages of the lifestyle, including pregnancy and infancy and on through old age. So absolutely, we should all be raising healthy kids, and in fact, Dr. Scott Stoll is currently writing a book on raising vegan kids; he’s got six, so he knows one or two things about it.

Gianna:          OK, number four: please help explain soy and hormones, and why both men and women need not fear it.

Dr. Greger:    Soy is a misunderstood bean. All sorts of nuttiness out on the internet. If you look at the science, though, it’s really just kind of a remarkable scientific consensus in terms of humans. I mean, the laboratory animal studies, it depends if you’re a hamster or a rat, or different strains of mice have different effects. When we finally had human data, so for example breast cancer, you can see concerns on the internet about, look, soy has phytoestrogens. When you think of estrogen receptor positive breast cancer, should women with breast cancer be eating soy?

And so we didn’t know until 2004, the first study that actually put it to the test and actually followed breast cancer survivors, some that ate soy and some that didn’t, just to see who lived longer, who had less breast cancer recurrence. And in that study and in all of five studies done to date, every single one found that women with breast cancer, whether estrogen receptor positive or negative, whether they were on Tamoxifen or not—all consistently greater survival; put them all together, greater survival, lower cancer recurrence rate. And so we’ve known that eating soy, particularly during adolescence, can reduce the risk of getting breast cancer in the first place, but now we know it’s associated with improved survival as well.

So wait a second. How is that possible when it has estrogenic effects? Well, no, see you don’t understand. There’s actually two types of estrogen receptor cells—it’s a long story: alpha, beta—so basically your own estrogen, your endogenous estrogen produced by your ovaries attaches preferentially to alpha receptors. Soy attaches to a different type of estrogen receptors. So it matters, the effects of soy on the body matters on the ratio of these different receptors and different organs of the body. And so it actually has pro-estrogen effects where you want it, like in the bones, skeleton. It actually reduces bone loss compared to dairy milk, for example, in studies of soy milk. But it has anti-estrogenic effects where you want it, for example in the breast, reducing breast cancer risk and improving breast cancer survival. So it’s what’s called a selective estrogen receptor modulator, a fancy term for basically the best of all worlds. So it reduces hot flashes, anti-estrogen effect, strengthens the bones, pro-estrogenic effect, reduces breast cancer risk.

And so you don’t have to eat it; all the legumes are healthy, and I encourage people to eat whole soy sources like edamame, immature green soybeans; you can get frozen bags of it, sprinkle it on your salad, a fantastic choice. Tempeh, miso, these are all whole soy foods, as well as some of the more processed stuff. And so you look in the scientific literature, it’s clear. We’ve got tons of videos about it. So yeah, you just don’t believe the craziness you read on the internet.

Gianna:          And just for the males out there that are concerned that they might grow breasts or something like that from soy. Can we help debunk that for men, so they don’t fear it as well?

Dr. Greger:    Sure. So there’s three case reports in literature of gynecomastia with excessive soy consumption. But by excessive soy—they were literally drinking gallons of soy milk a day, so I forget… I think some people, like 40 servings of soy a day, and at that level you can actually get enough alpha receptor activity to actually have pro-estrogenic effects. So the answer is not to avoid soy, but not drink four gallons of soy milk a day.

Gianna:          So men aren’t going to grow breasts if they’re eating soy here and there?

Dr. Greger:    No, and in fact it would be healthy. So soy consumption in men is associated with lower prostate cancer risk, which is the number one cancer killer specific to men.

Gianna:          OK, question number five: Can a whole food, plant-based diet help heal autoimmune diseases like thyroid issues and colitis?

Dr. Greger:    So eating an anti-inflammatory diet, no surprise, can be one of the best dietary treatments for inflammatory diseases in general, including autoimmune disease. So for example, multiple sclerosis, which is an autoimmune disease where your body attacks your own nerves, the single best recorded intervention—medical, surgical, anything, no drugs—have ever beaten out a plant-based diet: Roy Swank’s anti-MS diet, so the most effective. So it’s not just safer, cheaper. No, the most effective treatment ever published in the peer reviewed scientific medical literature, a plant-based diet.

Crohn’s disease, same thing. A study out of Japan using a plant-based diet, some of the best relapse prevention rates ever. Crohn’s disease is an autoimmune inflammatory bowel disease. Rheumatoid arthritis, one of the most powerful interventions for rheumatoid arthritis—whether we’re talking about objective measures such as grip strength and inflammatory markers in the bloodstream or just in terms of quality of life for people suffering from these diseases. Autoimmune disease, we just don’t have a lot of good data for.

We have data, so the Adventist 2 study found that those who eat strictly plant-based diets have the highest rates of what’s called euthyroid thyroid, meaning normal thyroid function, and so it may prevent thyroid problems. But there’s never been any study that actually put plant-based diets to the test in terms of treating thyroid dysfunction, unless we’re talking about something like iodine deficiency. There’s other types of inflammatory diseases that we don’t have data for, but it would make sense if it works for all these other autoimmune diseases, it works for these other inflammatory diseases, an anti-inflammatory diet would have this effect.

And part of that anti-inflammatory power is from the fiber. You say, fiber? Who would think fiber? We think like bowel health or something. It’s just kind of an inert substance. Not at all. We can’t digest fiber, but our good gut bacteria can. We have trillions of bacteria in our gut. And we used to think that was just gut health, but now we know that our microbiome, our friendly flora down in our colon actually can have effects on our immune system, even our psychological health.

And what do they eat, what do our good bugs eat? They eat prebiotics, which is fiber and resistant starch found in abundance in only one place: whole plant foods, and some of these compounds have anti-inflammatory effects. They’re breakdown products of fiber; they get absorbed into your system and circulated throughout your body. So that’s one of the reasons why plant-based diets are so anti-inflammatory.

Gianna:          Number six: What are your thoughts on vitamins and supplements, vegan based, either taken orally or intravenously like vitamin C drips?

Dr. Greger:    Well, certainly vitamin B12 is critically important for anyone consuming a healthy diet, so I’d recommend 2500 micrograms of what’s called cyanocobalamin, which is the cheapest source. Once a week is all you need. Costs less than $5 a year. You’re going to get all the B12 you need, but critically important from a regular reliable source.

If you’re not getting enough sun… So, now, if you’re light skinned enough and young enough and thin enough and live at a latitude that’s sunny enough, then getting 10, 15 minutes of mid-day sun, you’ll get all the vitamin D you need. But it doesn’t matter how sunny it is if you’re stuck at a desk job all day, not getting outside, in which case you’d need to supplement your diet with vitamin D, the sunshine vitamin. I recommend 2,000 international units of vitamin D3 a day.

So, I mean intravenous vitamin C has been used as a cancer treatment, going back to the 1970s with Linus Pauling’s work. It was since—interesting—kind of debunked by Mayo Clinic, where they gave people a whole bunch of vitamin C; didn’t see the kind of miraculous results that were originally seen, but they were using oral vitamin C. We used to think, well, oral vitamin C is the same as intravenous vitamin C, but no, our body actually clamps down on vitamin C absorption. At very small doses it doesn’t matter either way, you’ll absorb it all. But once your body gets over about 200, 250 milligrams of vitamin C—which is about five servings of fruits and vegetables worth—your body starts clamping “that’s a little too much.” Your body starts clamping down on absorption, so they actually weren’t exposed to the same amount. And so I have a whole series of videos on intravenous vitamin C for cancer if you’re interested in that; I encourage people to check it out. 

Gianna:          Should we be cooking cru—your favorite—should we be cooking cruciferous vegetables, like steaming broccoli, or is blending raw kale in a smoothie effective enough, and is it bad for the thyroid to eat them raw?

Dr. Greger:    Oh, my God. We should eat cruciferous vegetables in whichever way gets us to eat the most of them. You like raw broccoli? Eat raw broccoli. You like steamed broccoli? Eat steamed. Whichever way will get you to eat the most. In fact cruciferous vegetables are one of my Daily Dozen. It’s a free app on iPhone, Android: “Dr. Greger’s Daily Dozen.” I talk about all the foods I encourage people to get and fit into their daily routine.

So, you know, greens every day are the healthiest vegetables, beans every day, berries every day are the healthiest fruits. A tablespoon of ground flaxseeds, a quarter teaspoon of ground turmeric. You know, the best beverage, the best sweeteners, how much exercise to get—just to kind of inspire people to try to fit some of the healthiest of healthy foods into the diet. And one of those boxes I encourage people to tick off every day, you’re not going to fit—you’re not going to check off the day unless you get some form of cruciferous vegetables, which is about a half cup of cooked cruciferous vegetables, about a cup of uncooked. And so that’s like kale, collards, bok choy, and Brussels sprouts, and collard greens, all these wonderful greens. And so basically however you get them in your diet, the better. During the summertime, green smoothies are a great go-to way to get greens in your breakfast. And I kind of smash some white beans in my oatmeal just to get my legumes, got to check those off. But, yeah, put them in a smoothie, put them anywhere; as long as you’re getting greens, that’s the most important thing.

Now you can overdo, I mean you can overdo raw cruciferous vegetables that have this so called goitrogenic compounds which are found in lots of healthy foods, not only broccoli, but also flaxseeds and a number of other healthy things. But the answer is not to avoid these really healthy foods; it’s just to get enough iodine because these goitrogenic compounds just interfere with the uptake of iodine, which is the thyroid gland. So if you’re actually marginally not getting enough iodine, then eating a lot of broccoli and cruciferous can actually affect your levels. So the answer, you just make sure you’re getting a source of iodine; the healthiest one is sea vegetables, so you like munch on those seaweed snacks, and then just like dark green leafies as a snack. Ah! I mean the more ways you can get them into your diet, the better.

There was this famous case in the New England Journal of Medicine, a woman who—I forget, it was like literally thousands of pounds of raw bok choy, she was on some crazy diet, and actually did run into thyroid problems, so 1000 pounds… OK, but…

Gianna:          It’s like the soy.

Dr. Greger:    I encourage people, right. And look, we’re talking about foods with medicinal effects. I mean we should assume like if you can eat as much—I mean if there’s an unlimited amount of something that you can be exposed to, probably doesn’t have much “uumph” to it, right? But the fact that, look, no, some of these foods can have powerful effects on our biology, so no surprise that there’s a certain level which you want to stay within, but thankfully they’re all easily within any kind of typical culinary dose.

Gianna:          Number eight: is sprouting nuts, seeds, grains and beans better for digestion? If so, why?

Dr. Greger:    Oh, well, see, part of the reason that people soak or sprout nuts is to get rid of the phytates. So there was this thought, based on studies on puppies back in the ‘50s, that phytates were mineral inhibitors. And so the way you can get rid of the phytates, you soak nuts or you sprout nuts to get rid of the phytates, and then you’d maximize your calcium absorption and other important minerals. But we now know not only is that not the case, but phytates are actually healthy for you, actually beneficial effects of phytates, so we should really try to get as much phytates in our diet as possible, and the way we do that is by eating our nuts un-sprouted, eating our nuts un-soaked. And so, yeah, I encourage people to eat raw nuts, seeds, and seed butters.

The reason we’d rather not roast them is because of the formation of AGE’s, Advanced Glycation End products, which are these glycotoxins associated with increased risk of kidney disease and Alzheimer’s and accelerated aging and all sorts of really bad things. And it’s formed when high fat, high protein foods are exposed to extremely high heat, dry heat. And so almost all AGE exposure is meat—so like barbequed hot dogs, so barbequed, grilling, grilled chicken, that kind of thing—extremely high. So if you look at it, whereas plant foods have almost nothing no matter what you do—I mean you can grill a bell pepper and you’re not going to produce a problem, but there are rare plant foods that are high in protein effects, such as nuts, such as soy. So we should really, ideally should not—like Cajun blackened tofu, not a good idea on a regular basis because of these AGEs. So that’s why we really shouldn’t roast our nuts.

Gianna:          And why do you recommend nut butters as opposed to just the whole nut?

Dr. Greger:    Oh, actually whole nuts are better because you actually chew down to little particles—no matter how well you chew, you typically only fracture down to about 2 mm, which is a thousand times larger than the particles found in nut butters. And the reason that’s important is because those cell walls and those little cubes, which contain hundreds of thousands of intact walls, actually protect all the nutrients inside from absorption in your small intestine, and that creates a bounty for our gut flora.

So when we eat just acellular foods, powders like flour products, even if it’s 100% whole wheat flour—so if we eat 100% whole wheat flour bread or pasta or something, we’re getting all the nutrients; they didn’t take away the fiber, but all the nutrients are out, exposed to be absorbed. They get absorbed in the small intestine, leaving very little for our gut flora at the end. Whereas if you eat whole intact grains or whole beans, then there is actually these little clumps of food that’s leftover for our good bacteria, and that improves our gut health and improves our microbiome.

Gianna:          I love it. Since so much of our soil is depleted of minerals, where can we get great sources of minerals?

Dr. Greger:    So that’s some scammy trace mineral seller talk. Somebody should look at crop nutrient decline over the last half century, maybe 15%. So people trying to sell you mineral supplements will make this, will say, oh, our crops are depleted, just because they’re trying to sell you something. We can actually look at the data; the USDA tracks nutrients in the soil going back for a century: 15% decrement. So that means, OK, instead of five florets of broccoli, now you have to eat six florets of broccoli instead of a half century ago. Fine, eat six florets of broccoli. There’s no need to take mineral supplements.

Gianna:          OK. Number ten:  For people who say everyone’s different, so we all require different diets.

Dr. Greger:    Yeah.

Gianna:          What is your advice on this, and does a whole food, plant-based diet help us live longer, healthier lives, all of us?

Dr. Greger:    So, it’s not like—like at a zoo, there’s a gorilla diet and there’s a lemur diet. It’s not like, oh, you’re lemur #12, so you get some crazy diet. No, there’s a diet that’s naturally tuned to our biology. We evolved for millions of years. So we broke from our last great ape ancestors about 20 million years ago. So for the first 90% of our evolution until about 2 million years ago we ate what our fellow great apes ate, which is basically greens and fruit. We were a plant-based diet, almost exclusively plant-based diet, and only in the last 10% of our evolution did we start knowing how to make tools and hunting, etc.

And so our biology is tuned to eating whole food, plant based—so no wonder that the same kind of diet that reverses heart disease, the number one killer of men and women, is the same diet that also reverses diabetes, and the same diet that reverses high blood pressure. And so a kidney healthy diet, is a liver healthy diet, is a brain healthy diet, right? And it all makes sense because, look, the anti-inflammatory diet is a diet that helps your arteries everywhere throughout your body. I mean, look, if that’s all a plant-based diet could do, reverse the number one killer of men and women, shouldn’t that be kind of the default diet until proven otherwise? In fact that it can also prevent or reverse other leading killers would seem to make the case for plant-based eating simply overwhelming.

Gianna:          We have one bonus question.

Dr. Greger:    Bonus! What do ya’ got?        

Gianna:          What is the most effective way to help people convert to being plant based?

Dr. Greger:    So I think sharing resources with them. So sometimes it’s hard; people put up their defenses when someone tries—when anyone comes to us with some new idea that conflicts with what we believe, there’s just this kind of natural reaction to kind of want to hold on. That’s why sharing kind of third-party sources: “Here’s a great documentary, here’s a great website, here’s a great book,” and then they can kind of take it in on themselves, and then kind of the motivation comes from within rather than feeling someone’s trying to tell them to do something. So that’s one of my favorite ways. And share great food! They have this sense that, oh, yeah, it doesn’t matter how—will I live that long or just feel like I lived that long? But no, it’s really the best of both worlds. Some of the yummiest, like berries, right? Wait a second. Tastes great and you get to live longer? That’s what plant-based eating is all about

Gianna:          Thanks for tuning in, Love, Giana.

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