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The Melanie Avalon Biohacking Podcast Episode #134 - Dr. Neal Barnard

Dr. Barnard has led numerous research studies investigating the effects of diet on diabetes, body weight, and chronic pain, including a groundbreaking study of dietary interventions in type 2 diabetes, funded by the National Institutes of Health, that paved the way for viewing type 2 diabetes as a potentially reversible condition for many patients. Dr. Barnard has authored more than 90 scientific publications and 20 books for medical and lay readers, and is the editor in chief of the Nutrition Guide for Clinicians, a textbook made available to all U.S. medical students.

As president of the Physicians Committee, Dr. Barnard leads programs advocating for preventive medicine, good nutrition, and higher ethical standards in research. His research contributed to the acceptance of plant-based diets in the Dietary Guidelines for Americans. In 2015, he was named a Fellow of the American College of Cardiology. In 2016, he founded the Barnard Medical Center in Washington, D.C., as a model for making nutrition a routine part of all medical care.

Working with the Medical Society of the District of Columbia and the American Medical Association, Dr. Barnard has authored key resolutions, now part of AMA policy, calling for a new focus on prevention and nutrition in federal policies and in medical practice. In 2018, he received the Medical Society of the District of Columbia’s Distinguished Service Award. He has hosted four PBS television programs on nutrition and health.
Originally from Fargo, North Dakota, Dr. Barnard received his MD degree at the George Washington University School of Medicine and completed his residency at the same institution. He practiced at St. Vincent’s Hospital in New York before returning to Washington to found the Physicians Committee.

Twitter @DrNealBarnard
Facebook @NealBarnardMD


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The Women's Study for the Alleviation of Vasomotor Symptoms (WAVS): a randomized, controlled trial of a plant-based diet and whole soybeans for postmenopausal women

9:05 - Dr. Barnard's Introduction to Plant Based

13:10 - how do opposite diets work on both extremes?

16:20 - Low carb Vs. Low Carb High Fat Diets

18:40 - energy toxicity and fuel competition in the body

20:30 - intracellular muscle fat

22:35 - endurance athletes

24:35 - processed vegan foods and added oils

26:20 - post menopausal weight gain

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30:15 - dr. Barnard's new study

36:45 - Benefits from soy

40:30 - what are isoflavones? 

45:25 - isoflavones effect on cells

47:10 - diets rich in soy; correlation on mortality

49:00 - is soy preventative for breast cancer?

50:15 - what are the implication of isoflavones on a woman's current estrogen load?

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54:35 - Equol

58:15 - Equol in Dairy

1:00:05 - can we get back the gut bacteria that produce equol?

Gut-microbiota-targeted diets modulate human immune status

1:00:50 - fiber and the microbiome

1:03:45 - can everyone thrive as a vegan?

1:06:15 - what is a vegan diet lacking?

1:08:15 - are we omnivores?

1:13:40 - why do we make enzymes to digest dairy?

1:16:45 - melanie's diet


Melanie Avalon: Hi, friends, welcome back to the show. I am so incredibly excited about the conversation that I am about to have. As you guys know, a lot of you guys follow a ketogenic diet or an animal inclusive diet. I do know I have a lot of plant-based listeners as well. But I definitely feel with the history of the episodes, there's been less episodes focusing on primarily plant-based diets when it comes to health. I was super, super excited when honestly a legend in the plant-based sphere, Dr. Neal Barnard, his people came to me because he had published a new study called The Women's Study for the Alleviation of Vasomotor Symptoms: a randomized, controlled trial of a plant-based diet and whole soybeans for postmenopausal women wanting to talk about that study, as well as the rest of his work.  

I was so excited when I got that email, because I've been a follower of Dr. Barnard for years, years, years. I'm sure many of you are very familiar with him. He is all over the place. He's published so many books. The ones I read most recently were Your Body in Balance and The Cheese Trap. He's published numerous studies over 90 scientific publications. He's the president of the Physicians Committee. His research has played a huge role in the acceptance of plant-based diets in the dietary guidelines for America. His resume just goes on and on. So, I'll put more of it in the show notes but I'm really excited. I have so many questions about all of his work and I'm really excited to expose it to more of my audience. So, Dr. Barnard, thank you so much for being here.  

Neal Barnard: Well, thank you for including me.  

Melanie Avalon: To start things off, I have so many questions for you, but what brought you to the plant-based world? Were you following it growing up, did you have an epiphany one day, what led to what you're doing now?  

Neal Barnard: Yeah, I grew up in North Dakota. I don't know if you've ever been to Fargo. But if not, maybe you saw the movie, then that's where I grew up. Fargo is a town in eastern North Dakota, and if you get on the highway, going out of town, you will see agricultural fields all planted with GMO crops that are fed to cattle. All the corn, all the soybeans, everything you see is cattle feed, hog feed, chicken feed. My dad grew up in the cattle business, and his dad grew up in the cattle business, and everybody as far back as I can trace, that was the thing. My uncles and cousins continued long after my father got sick of it and left. My dad didn't like raising cattle and so he actually quit the business, and he went to medical school, and became the diabetes expert for Fargo, North Dakota. So, he took out a very different path but we still ate like we're in the cattle business.  

My first job was at McDonald's. I didn't see anything wrong with any of this, but the year before I went to medical school, I was working in a hospital basement in Minneapolis. When somebody died in the hospital, they would get sent to the morgue, which is where I worked, and I would help the pathologists to examine the bodies. He was the pathologist, I was the guy who weighed things or took notes and cleaned up afterward. He knew that I was going to go to medical school the following year. The pathologist would give me elaborate medical lectures over these bodies, and one day we had a guy, who died in the hospital of a massive heart attack, probably from eating hospital food, but that's another issue. Anyway, that pathologist wanted to expose the heart and you don't do this with great delicacy. You take a what's like a garden clipper, and cut through the ribs on one side, and then you hack through the ribs on the other side, you pull this big wedge of ribs off the chest, and there it is, the heart with effectively a big bruise on it because that's a myocardial infarction. He sliced open the coronary artery giving me a lecture all the way about what we would see, and the coronary arteries were not supple, flexible arteries. I could feel it and it felt like concrete, like a pipe stem in parts. He said that's calcification. We looked the carotid arteries going to the brain, same story.  

Anyway, at the end of the exam, he wrote up all the findings, and he along the way pointed out that it was bacon and eggs contributing to this, and this person had systemic atherosclerosis. He left and I had to clean the body up, and so, I took the organs and put them in the body cavity, and I put the ribs back in the chest, and tried to make them fit with the other ribs and sewed up the skin. When I was done, it was way after lunchtime. So, I went up to the cafeteria and said, "What do you have left?" They had a serving of ribs there. I want to tell you, I didn't become a vegetarian on the spot, but it smelled like the body that I was working on, and it looked like it, and it hit me, that is a body and I just couldn't eat it.  

As time went on, I started to think more about the connections between what we put in our mouth, what we consider food, what we don't consider food, and then of course, you start learning about the effects these have in our bodies and the lies we tell ourselves about the business our family is in, or the things that we need, and so forth. Much, much later, we started doing randomized clinical trials of various kinds of diets, which is certainly enough to seal the deal. But now, I follow exactly the opposite diet of the way I grew up. I don't eat meat or animal products whatsoever and I follow a vegan diet and as clean a vegan diet as I can.  

Melanie Avalon: Wow, McDonald's and more, that is quite the background. One of the things I'm really, really fascinated by is, how it seemingly different diets that are polar, opposite extreme, so, like a low carb, keto diet on one side, and then plant-based vegan diet, low fat on the other side seemingly can work for different people as long as they exist potentially within that extreme? For example, you're talking about the stiffening of the arteries and the calcification. Is that something where a person could be on a low carb, high fat diet and have high cholesterol, but not have stiffening and calcification? If so, what are the implications of that or is that a situation where no, if you have this cholesterol situation, there is damage being happening. How important is the context beyond just one marker like cholesterol?  

Neal Barnard: When Atkins became popular, it was an attractive thing, because you could eat gravy and lose weight. Of course, the reason for that isn't that gravy is a slimming food. Meat is not a slimming food. Protein doesn't cause weight loss. The reason people lose weight is that carbohydrate is 50% or 60% of what you eat normally. In many parts of the world, it's much more than that. If you take all that out of your diet, you're going to lose weight. When he became popular, and we were alarmed by some people having cardiovascular problems as a result, I got a phone call from a man named Jody Goran, who said that he had wanted to lose just a little bit of weight. Just a few pounds, but Atkins was a popular way to go. He went on this diet and his cholesterol went way, way up. He was reassured by a keto believer that you can ignore cholesterol, it's all a myth.  

One day, he's walking down the street and the proverbial elephant sat on his chest. He had crushing chest pain, and of course he was having an infarction. Cholesterol is a real thing. He had his favorite habit, he contacted us because he had a totally clean stand before he went on the Atkins diet. He wasn't terribly overweight and he had a clean heart scan so far as anyone could tell, and didn't have plaque, calcifications. If you just take a great ape, a human being, and you start feeding them like a cat, which is you pretend they're carnivore, some people can handle that cholesterol, but many cannot. LDL cholesterol levels, bad cholesterol levels vary widely with low-carbohydrate diets.  

Normally, any kind of weight loss is going to cause cholesterol to fall. That's just what happens. But the exception is ketogenic diets, low-carbohydrate diets. Sometimes, they fall because you lose weight, but sometimes they increase wildly, and that's what happened in his case. We never use ketogenic diets at all. I know I'm upsetting some of your listeners by saying this, but the fact of the matter is, I think it's antithetical to what our bodies really are built for it and it doesn't surprise me that some people do very badly with them. 

Melanie Avalon: Do you think there's a difference between a person on a low-carb diet versus a low-carb high-fat diet? Because in theory, one could practice a low-carb diet without it necessarily being high fat. 

Neal Barnard: Keep in mind, what carbohydrate, it's the fuel for your body. It's not a bad thing. Ever since the 50s, people have imagined rice makes you heavy or something like that. These are people who've never been to Japan, where there're a whole lot of skinny people eating phenomenal amounts of rice. Your body is designed, your muscles are designed to run on carbohydrate. That is your gasoline. Your brain runs on carbohydrate, your whole body, all your cells, they run on glucose, and that's a good thing. You take any runner from the most amateurish runner to the most, the best runner in the world, their muscles really want carbohydrate. Now, you can run on other fields too, but carbohydrate is what you run on.  

Where we run into trouble? Of course, you can see the diabetes work that we do, and blood sugars are going up, and then people become afraid of carbohydrate. The carbohydrate is not the problem. The problem is that their cells are now insulin resistant and they can't take that fuel in anymore. The carbohydrate was never the problem but it's funny. When a person has become an insulin resistant, they could go and eat a little organic apple and all that healthy glucose in there builds up in the blood because it can't go into their muscle cells where it should go. They think, "Gee, I guess, apples are poison." No, there's nothing wrong with the apple, there's something wrong with your cells that they can't take in the glucose, and we now know what that is, and we can remedy that, so, you can enjoy an apple, or two, or a bunch of grapes, or some spaghetti, or these normal healthy foods.  

Melanie Avalon: My listeners are always pretty surprised. I think they think that I probably follow a keto diet, but I actually follow a very high-carb, very low-fat, but it's high-protein diet. I eat lean animal proteins, and tons and tons of fruit, and I tend to practice intermittent fasting. I do that because I personally have found that if I exist in either of those extremes I just mentioned, so, either a low-fat diet or a low-carb diet seems to create a state of insulin sensitivity because there's not that fuel competition between the fats and the carbs, which brings me to my second question about what you were just talking about. What is the difference in a way between-- If a person is following a high-carb, low-fat diet, then presumably if they bring in some fat to that diet, that could very quickly probably create a problem, because they're running on glucose, and now, you know that fat is most likely going to be stored could create some metabolic issues. On the flipside, if a person's following a low-carb, high-fat diet, they could in theory be having a lot of fat because that's the metabolism they're running on, but then if they bring in just a little bit of carbs, then it might create the same types of issues. So, my question is what are your thoughts on that concept? Is it just the carbs, or just the fats, or is it the context of them both together? 

Neal Barnard: Here's how people destroy their bodies. You're born with a pancreas. It's right behind your belly button and it has a really important job. It makes insulin and the insulin is the key that goes through the bloodstream to the surface of each muscle cell. Its job is to help the sugar that is in the various foods you eat to get inside your muscle cells. Your muscles are really particular. They don't just let sugar in willy-nilly. They got to have the insulin to let it in. As time goes on, because we live in a rich country or a country where really fatty stuff is available. People eat cheese, and bacon, and chicken, and other fatty foods, and fryer grease, vegetable fats, too. Those particles of fat, bit by bit will get stored inside your muscle cells. I don't mean fat on your thighs or in your belly. I mean, some of that fat gets inside your muscles, the muscle cells themselves. Different people store them at different rates. But as that builds up, the insulin doesn't work anymore. That's insulin resistance. It's caused by the buildup of fat inside muscle cells, which we call intramyocellular lipid, the same thing happens in the liver. Eat a ham sandwich, so the fat from the ham, fat from the cheese and the mayo gets inside your liver cells, and then the liver cells can't respond to insulin either. It's taking a key and trying to get into your front door when the lock is jammed with chewing gum or something. You don't have chewing gum in your cells, but you got fat.  

Then, you go to the doctor and you say, "Gee, everything I eat makes my blood sugar rise." The doctor says, "I don't know why, but I guess I wouldn't eat sugar if I were you." You read a book that says that sugar is terrible, and you can't eat carbohydrate, and you discover that when you avoid carbohydrate, your blood sugar indeed falls. For the rest of your life, you imagine that carbohydrate is the devil. Nobody ever used the word intramyocellular lipid. If you come into our research center, and I'll say, "There's nothing wrong with an apple, or a piece of toast, or some brown rice. What's wrong is the fact that your cell can't pull the sugar out and use it." I'm going to put you on the vegan diet. There's no animal fat in that. I'm going to keep oils really low and if I stuck you in an MR scanner, and I could track the amount of fat that's inside your muscle cells, it gradually diminishes.  

Then, you discover that you can eat sugar, and you can eat carbohydrate, and it'll now work for you, and you'll be okay. The problem wasn't some metabolic switch, which people talk. We talk about the problems that your cells got all jammed up with fat and so the rest of your life, you're afraid of carbohydrate. The converse is not true. If a person has been on a very low-fat plant-based diet and they eat some fat, nothing's going to happen. If it's a little bit here or there, they go out and have some guacamole, nothing happens. But on the other hand, if you decide you want to indulge in lots of fatty stuff, which nature didn't have in mind for you, then you can become insulin resistant, too.  

Melanie Avalon: What do you think about endurance trained athletes, who have high amounts of intramuscular triglycerides, but they're still insulin sensitive? What's going on there?  

Neal Barnard: Who knows. It is the paradox that we do see in people who-- It's not me and it's not the people who come into our clinic. But there are people who can accumulate fat inside their muscle cells and still remain insulin sensitive. It has something to do with their body's adaptation to extreme exercise.  

Melanie Avalon: I just ponder that and I wonder how similar that scenario is maybe to people, who seem to be similarly insulin sensitive while having intramuscular triglycerides.  

Neal Barnard: The real key though, I think, is to remember the simple picture and the big picture. We've got most of the population is overweight. These are not vegans. What 60% of population, 70% of the population, these are people who have been eating meat, and cheese, and oily foods, and all kinds of stuff. Then, when they're trying to lose weight, they do things they've heard like, try to eat a smaller portion of the same stuff or leave out carbohydrate. If instead of doing that, we eat the foods that our bodies are designed for and it's simple. Fruits, four groups. Fruits, and vegetables, and whole grains, and legumes, meaning beans and lentils. If they keep the oils out and the animal products out, they're going to slim down, their diabetes will improve, their blood pressure will improve, their digestion will improve, their cancer risk will fall.  

Melanie Avalon: Well, I do want to thank you because the work you're doing is profound, and I think you've mentioned this already, and I've mentioned it. I think there's a massive, massive fear of carbohydrates, especially, people I think they fall into the low-carb keto world, and they think it's the only way, and they get this demonization of carbs. For me, personally, I think the focus on whole foods is just so important that's something that I really get reading all of your work. A random, binary question or comparison question I want to ask you was because a lot of people go vegan, but there are a lot of processed vegan foods now, and you talk about the potential issues of added oils, and fats, and things like that. So, not that it's a comparison we have to make, but if you had to choose between a vegan diet, but that's high in oils and processed vegan compared to a Whole Foods, low fat, animal inclusive diet, like metabolically, do you think one would be better than the other?  

Neal Barnard: Keep in mind. There are sometimes people who try to pick on vegan diets. I don't mean you're doing this, but this is where I usually hear this kind of question raised is, they'll say, there's vegan junk food out there. They're trying to somehow blame the industry that's managed to simulate ice cream with a vegan version made from almonds or something like that. The fact of the matter is junk food is there in everybody's diet. I don't mean you or me, but-- [crosstalk]  

Melanie Avalon: Keto, too. There're keto junk foods.  

Neal Barnard: When I was growing up in North Dakota, I didn't know a vegetarian or vegan. Never heard of any of it. But there were potato chips, and there was ice cream, and there was licorice, and there were all kinds of stuff, and candy, and pork rinds, and Slim Jims, and then when we got convenience stores, which we didn't have when I was a little, convenience stores came in, they had Slim Jims and cheese, string cheese, and all this kind of stuff. When a person becomes vegan, they have eliminated products of animal origin, that's a good step. Then, if they are still eating the potato chips, or Twizzlers, or whatever, they've got some other steps that they might want to take. But meat eaters are eating those things, too.  

In other words, I wouldn't denigrate a vegan diet because there are lots of other things that are wrong with the diet. But I'll tell you a funny story. Years ago, 2005, we published a paper in the American Journal of Medicine. We wanted to help women, who had postmenopausal weight gain. We brought in 64 women, they'd all done Atkins, South Beach, Jenny Craig, Nutrisystem everything. They'd all lost weight, felt great, either couldn't stick with it, or it didn't stick with them. They ended up heavier than ever. We gave them just two rules. The rules were no animal products and keep oils really low. When we do research studies, we do what I encourage everybody to do, which is to get together as a group every week, and compare notes, and see how we're doing. Because you'll have problems with a diet here and there like, "I got invited to a wedding. What do I do?" You want to sort things out.  

Week three of the study, one of the women said, "Dr. Barnard, I found a snack that fits in with your vegan diet." I go, "What is it?" She said, "It's Twizzlers," and she pulled Twizzlers out of her purse, and these are these red twisty things they sell and they're red licorice. She was right. The rules of the study were no animal products and no added oils. If you look at Twizzlers, it's just sugary, starchy, artificially colored junk. She made sure that all of the research participants knew that you can eat unlimited Twizzlers in the research setting, which was not the intention. Nonetheless, our low-fat vegan Twizzlers-fueled research participants still lost about a pound per week and their weight at two years was still below baseline. So, they never came back.  

My point is that this is not health food. But if a person only eliminates animal products, if that's all they do, that's a huge and very good step. If in addition to that, they realize that oily junk doesn't really love you back either. Getting rid of that is an important step, too. Beyond that, then it's good to think about what are the healthy foods. Like you were saying earlier, apples, and oranges, and pears, and bananas, those are really healthy foods that our bodies really are designed for, and candy and junk, really not so good. 

Melanie Avalon: Well, speaking of that study, perhaps, that's a nice segue into your newest study, which, so I already mentioned it, but it's The Women's Study for the Alleviation of Vasomotor Symptoms: a randomized, controlled trial of a plant-based diet and whole soybeans for postmenopausal women. I read it, and I went deep, deep, deep down the rabbit hole researching soy and equol, and so many factors, and I changed my mind on a lot of things because prior to researching all this with your work, I think I was subscribing to the general idea of no soy ever, because there's definitely a vibe about soy in the low carb world that it possibly creates hormonal issues or is related to cancer, things like that. So, I've learned a lot and I have a lot of questions for you. I was wondering if you could tell listeners a little bit about the setup of the study and what you found with it.  

Neal Barnard: Sure. Menopause is a normal phase of life. It happens to everybody. If you had to design the human body, menopause is kind of a good thing. It's nature's way of saying, "You're 52, you don't want to have a toddler on your kitchen floor right now, factory's closed." The problem is that for some women they sail through it really well. But for some women, they have pretty bad hot flashes. We were sitting in the Board of Directors meeting, it's 2:30 In the afternoon and all of a sudden it's 150 degrees, and it's the middle of the night, and the same thing happens, and you're soaked with sweat, and you go to the doctor, and the doctor says, "I've got a treatment for you. It's called HRT, Hormone Replacement Therapy." Great. I go to the drugstore, and I fill my prescription, and they give me a product information sheet that has the word "cancer" on it, and blood clots, and myocardial infarction, and dementia, all these side effects of the drug the doctor just prescribed for me. It puts women in a really tough spot. They get ignored, they get belittle, they're told you're old, you're past your cell by date. This is all complete and utter nonsense and abusive.  

Our research team started looking at the research on this. The first thing, if you look at Japan in a post-World War II period, a fairly impoverished country just lost the war, eating huge amounts of rice, some soybeans, some vegetables, and not much in the way of animal products. Some fish, not much meat, no dairy. They had very few hot flashes. Maybe, 15% of women had them, they were quite mild, they didn't even have word from them. But then, when the Japanese diet westernized and the Golden Arches setup in say the 1990s, early 2000s, hot flashes became much more common as did diabetes, and weight problems, and cardiovascular disease. In other countries, you started to see a pattern where plant-based diets were healthy in many ways, but one of the associations was very little hot flashes.  

The first thing is just something about plants helps, but the other thing is the Japanese diet, like Asian diets in general makes abundant use of soy. The soy isoflavones like daidzein and genistein are credited with-- as part of the reason Japanese women have so little breast cancer or did historically, because isoflavones reduce cancer risk. I'm sure we want to talk more about that because that will surprise people to hear. But they also seem to be helpful against hot flashes. In 2016, there was a nice meta-analysis in JAMA, suggesting some kind of modest effect. Anyway, I wrote about this in a book called Your Body in Balance, which you kindly mentioned earlier. It talks about hormones, how you can control all kinds of hormones. Thyroid hormone, and testosterone, and estrogens, and so forth. I mentioned how menopausal hot flashes could be improved by a diet that is both plant-based and rich in soy.  

A woman contacted me and her name was Betty. She said, "Dr. Barnard, I've read Your Body in Balance. I went straight to the menopause chapter, and my hot flashes were gone in just a couple of days, I think five days." That really surprised me because I thought the diet change would help. I thought going vegan and adding soy would help, but I didn't think it would help that quickly. She said, "No, for real." I said, "Tell me exactly how you did this?" She said, "Totally vegan, no added fat, and I went to Amazon, and I bought some soybeans." I said, "What brand?" She said, "Laura Brandt non-GMO soybeans." "How did you cook?" "I bought an instant pot, I put them in, then I portioned them into half cup portions every day." I wrote down all every detail of how she knocked her hot flashes out so fast. After I hung up the phone, I ran into the office of my research director, and I said, "We got to do a trial."  

We brought in women who had hot flashes, and we did exactly Betty's diet. Half the women, I gave them instant pots, I gave them lower brand soybeans, we made them vegan low fat, and we had a control group, and it was true. We knocked out the moderate to severe hot flashes by 84%. Okay, what do we know versus what we say? Because I think we got to be modest about what we're sure about. What we know is that hot flashes improve, improve a lot. If a person has been vegan and on a really clean diet, when they add the soy beans, for some people is like a bazooka against their hot flashes. They just go bang like three, four days, they are gone. What we think is happening is that the soy isoflavones are a good force against hot flashes.  

But one of these isoflavones is called daidzein, D-A-I-D-Z-E-I-N, daidzein. There are others like genistein, but the daidzein, when it's in your digestive tract, if you have been on a plant-based diet, it looks like that causes healthy gut bacteria to be able to convert that daidzein into another compound called equol, E-Q-U-O-L. The equol goes in your bloodstream and this seems to be what is more powerful against hot flashes. What we think but can't get proved is that, you need all these three things together. Vegan, animal fat, and the soybeans, and it's that combination together gives you this healthy gut bacteria that can convert the isoflavones into their most medicinal form. What do you get? You get rid of your hot flashes, you are now on a diet that is going to reduce your risk of cancer, and by the way, the average woman lost about eight pounds. It was absolutely life changing for these women. For anyone, who's wants to see the woman and hear what they have to say, if you go to our website pcrm.org and search the "WAVES study" W-A-V-E-S or hot flashes, you'll see the women describing what they did and how it helped them.  

Melanie Avalon: Question about the setup of the study. Since there wasn't a third arm of people on a vegan diet without the soy, how do you know what you can contribute to the soy compared to just the vegan diet in general? If you did it again with a third arm, do you think you would see more benefits from the soy compared to not having the soy?  

Neal Barnard: We did have some women, who were vegan going into it. They were already avoiding animal products, some for quite a long period of time. When they added the soy, they did better.  

Melanie Avalon: Oh, really?  

Neal Barnard: Yeah, they did. I think you're raising a really cool question. In the Yucatán peninsula of Mexico, you fly down to Cancun, get your Hertz rental car, drive two hours west, you'll be in a town called Valladolid. Researchers went down there and they interviewed more than hundred Mayan women, and they didn't have hot flashes at all. But what do they eat? They don't eat rice. In Japan, the grain is rice, in the Yucatán Peninsula, it is corn. They don't eat soybeans. Their bean is the black bean and they eat la chaya, which is a plant. It's a green vegetable. It's not a soy diet, but it's a plant-based diet. I think your question is a good one. Could people who are on plant-based diets but they don't bother with soy? Could they do better? My guess is probably so. But we had some women in our study, who were already vegan and the addition of soy seemed to help. Who knows?  

It's like Dean Ornish's work. Dean Ornish did brilliant work, where he took people who had pretty advanced cardiovascular disease, I mean, narrowed arteries. He put them on a combination of a plant-based diet, no smoking, physical exercise, reduced stress, and their arteries restarted opening up was miraculous. On angiograms, you see their arteries effectively healing. Somebody would criticize, "Well, was it the stress reduction, was it the diet?" The answer is you don't know. You're testing a combination, and then if you wish to, you can try to teaser apart, which are the pieces that actually work. For now, we don't have that answer.  

Melanie Avalon: I'd be really interested to see that study conducted and that's really good to know about the preexisting vegan patients and how the soy affected it, because you would think, like, just hearing everything that you said and what I read, you would think if there was that third arm that you probably would see a greater benefit with the soy inclusive diet, but it could be a surprise. It could be that you saw the opposite that there's actually a slightly better benefit without the soy. We just don't know.  

Neal Barnard: Well, soybeans are a funny bean. Black beans, and pinto beans, and other beans are really low in fat. They're high fiber. Soybeans have a little bit more fat in them. You'll find traces of isoflavones in other beans, but soybeans are really rich in that. It's a unique bean. The one thing that I would mention is, when Betty called me up and described her diet, when she said, she used organic soybean or non-GMO whole soybeans, a light bulb went off in my head. Because if you go to a Japanese restaurant, they give you the bowl of edamame. Those are baby soybeans. They're in the pod, but they're juvenile. If you leave them on the vine a little longer, the isoflavones are elaborated into a higher degree. You get more isoflavone in a half a cup of mature soybeans than you will in edamame or if you take soymilk, it's got isoflavones too, but very diluted. You'd have to have two quarts of soymilk to get the isoflavones you get in a half a cup of say mature soybeans.  

Melanie Avalon: Yeah, I'd love to dive deeper into isoflavones as well as I'm glad you said it, because I knew I was pronouncing it wrong, equol. Maybe start with isoflavones, what are they? I know that's a very simple question, but what are they, what do they do in the body, how do they interact with our estrogen receptors, what's going on? 

Neal Barnard: First of all, I think we should once again acknowledge what do we know, and what do we not know, and what are we kind of unclear about. What we know is that, this diet really works for women. As time goes on, they can back off. They may decide, "Okay, I've been vegan, and I've been taking the soy, and my hot flashes have been gone now for four years. Maybe, I don't need the soy anymore." You can get away from it if you want. We know it works, but then we're going to speculate as to why and what do these things do.  

Many, many years ago, when isoflavones were discovered, these are compounds that are natural to the soy. They're not sprayed on by the farmer. It's a natural part of the soybean. They will attach to estrogen receptors and that frightened people or led some people to write frightening headlines, suggesting that if something can attach to an estrogen receptor and can then be called estrogenic, that it's going to somehow make you effeminate or might make a woman have cancer, or might make a woman who had cancer make that cancer progress. That's about as far as the thinking has then gone. People would say things that have turned out to be 180 degrees wrong, a guy at the beach has got breast enhancement, maybe it's because of isoflavones. You know I'm talking about? What's the locker room word? Man boobs, man boobs.  

By the way, you will hear people say that man boobs are caused by soybeans. You can rapidly just prove that by going to a beach on a hot August day. If you see a guy peel off his t-shirt, and he's been heavyset, and he's got some breast enhancement, you can go right up to him and ask him, how much tofu he's eaten this past week? I guarantee you, he will look you in the eye and go, "What are you talking about? I don't eat tofu. I eat burgers, and fries, and pizza, and chicken, and stuff like that. I never had any tofu. What is it?" The reason he has breast enhancement is because as he has gained weight, fat cells convert testosterone to estradiol. 

He will then go to his doctor after 15 or 20 years of this, and the doctor will use a wonderful invented term of "andropause" and say like menopause, but you're a guy. So, you've got andropause, and I've got something I can sell you, because I think you've got a low T. He may in fact have low testosterone. Nowhere in reading men's health, or searching on the internet, or in this doctor's office will anyone explain to him that his own adipose tissue has enzymes that convert his own testosterone into estrogen. The way it goes his testosterone is gone. The second contributor is that he is this man, like your average American adult, he is eating 37 pounds of cheese every year, and milk, and milkshakes, and ice cream, and yogurt. All of these are milk products that came out of a cow.  

Every single cow that ever gave any milk to you at some point had a farmhand's left hand up her rectum. That farmhand was busily grabbing her uterus which he could feel through the rectal wall. At the moment that he did that, he took his right hand and took what looks like a knitting needle, and jammed through the cow's cervix, and inserted semen that he took from a bull. At that moment, that cow is now impregnated. Nobody wants to talk about that, of course, but biologically, you've just set in motion something really important. You're going to continue to milk this cow while her body is responding to what you just did. Her body responds by creating estrogen. She was making it before, she's now pregnant. She's going to make more and more and more estrogen, and they keep milking her for most of her pregnancy, and you turn that milk into cheese, and Hank thinks cheese is a great thing. It's got calcium, it's got protein, and he is consuming estradiol in dairy products. Nobody told him that there's no estradiol in the soybean. There's genistein and daidzein, but there's no estradiol. But there is estradiol in every dairy product you ever eat.  

That's the first thing that has to be said, is for some reason, I think it might be American xenophobia, where we pick on countries that have soy as their traditional staple food, and we ignore the actual estrogens that are in our own diet. But the fact of the matter is soy isoflavones do attach to estrogen receptors, but then the research didn't turn out to show a higher risk of breast cancer. It showed a substantially lower risk of breast cancer with soy consumers.  

Melanie Avalon: When the isoflavones are attaching to those receptors, are they activating it, are they blocking it? What are they telling the cell? 

Neal Barnard: Yeah, great, great question. We're still groping around with a flashlight in the dark. The old-fashioned idea was that a hormone would stimulate the receptor. But then we started to learn that they have estrogenic and anti-estrogenic effects, they do both. But then what really, I think, changed the discussion was the discovery that there are two different categories of estrogen receptors. There are alpha receptors, and then there are beta receptors. In estradiol that a woman's body makes or the man's body makes particularly if he's overweight, estradiol attaches to both the alpha and the beta receptors. But the isoflavones attached preferentially to the beta receptors. To put it in a simple-minded way, on the floor of your car, if you put your foot down, you're behind the wheel. You put your foot down really hard, does your car go? Well, yeah, if you put your foot down on the gas. 

Melanie Avalon: It depends what you hit.  

Neal Barnard: Yeah, if you hit the brake, it stops. If you have a natural compound that attaches to the alpha receptor as estradiol will, that probably will cause cancer progression. But if it goes to the beta receptor, probably not. This is a little bit of a simple-minded way of putting it. But soy should be viewed as the brake on cancer. We have many, many studies now with a very consistent result showing that women who avoid soy have the highest breast cancer rates. Women who eat abundant soy have the lowest breast cancer rates. 

A few years ago, a study came up combining five prior trials with more than 11,000 women, all had had breast cancer in the past and then their diets were tracked. The soy avoiders had the highest mortality. The women consuming the most soy had about 25% maybe 30% reduced mortality. But I want to be a little humble about what we know, because we saw reduced mortality in women who had previously had estrogen receptor negative cancers and estrogen receptor positive cancers. Both ways, the soy seemed to help them. It may be that soy is working its magic through the beta receptor, but it might be something completely different. But the thing that we do know pretty clearly is that the well-meaning, but ill-informed doctor, who says to the patient, "You've been diagnosed with breast cancer. I would not touch soy if I were you." You just put that woman in the category to be at risk for 25% to 30% high risk of cancer mortality, which coming back to our 'WAVES study.'  

Here are women, they're going through menopause, you can put them on HRT. Out of every 25 women that go through a clinic and get a prescription for HRT. Out of every 25 women who continue on that for 10 years or more, one of those 25 will get breast cancer that the doctor caused. If I say to her, "Let's go vegan, keep oils low, let's have soybeans every day." It's the opposite. You've reduced the risk of breast cancers and you've also helped her to lose weight, which is going to further reduce her risk of breast cancer. These are also the very foods that are associated with reduced risk of Alzheimer's disease. I'm talking about plant-based low-fat foods.  

Melanie Avalon: A question about those stats on breast cancer and soy intake. Was that looking back at people who had cancer and looking at their pre-cancer soy consumption? Is there a difference between having a high soy diet preventatively for cancer compared to never having had soy getting cancer, and then adding in soy?  

Neal Barnard: The best guess, keep in mind, none of these are done as randomized clinical trials. It's always observational trials. You have to be really cautious in what you're doing. Well, I shouldn't say there aren't any. There are studies that are randomized clinical trials. But this literature is really mostly observational. There are studies showing that more plant-based diets will reduce mortality in people who have had cancer in the past. But my best interpretation is that, the earlier women have soy in their diet, the better the effect. Some have suggested that it might matter most when the breast cells are really maturing. I'm talking about when she's 12, 13, 14, 15, 16, something like that. But there's also evidence that diet changes even after cancer diagnosis do matter a lot. So, I think we need to withhold judgment on that. 

Melanie Avalon: Okay, gotcha. This is a granular question, but would there be implications about a person's current estrogen burden, and then, when they have isoflavones, and what I mean by that is, so when the isoflavones attached the receptors, are they blocking a docking station that the estrogens in their body would have been docking to? If so, now, where do those estrogens go? Do they get excreted, do they redistribute to other estrogen receptors, like, just the estrogen body burden playing effect and what happens when you have soy?  

Neal Barnard: Fascinating question. I don't think we know the answer. But the way you described is exactly what I would have said. Way back when I thought of it as 747 is gawking at O'Hare Airport. There's a little jet bridge is coming out and that big 747, that's estradiol, that's big, ugly looking estrogenic molecule that's going to cause cancer. If instead the isoflavone lands, it's a little private plane. It just arrives but it occupies the same jetway. The 747 can't approach anymore. We thought of it that way that the isoflavones are taking the place so that estradiol can't attach. I'm no longer sure that that's the mechanism. I really am not sure what the actual mechanism is but it's reasonable to speculate. What we do know now and what we're going to know for the foreseeable future is that, there is no reason to avoid soy, and probably every reason to take advantage of it.  

Now, that said, I'm not pushing it necessarily. It's an optional food, it's very versatile, it's always healthier than what it replaces. If you have soy bacon versus bacon that came out of the backside of a pig, there is no contest. But people don't have to have soy if they are allergic or wish not to. 

Melanie Avalon: Going back to that equol and that metabolite of soy produced by our gut bacteria, we're talking about how people on plant-based diets seem to be able to produce more of that. Have there been studies on that or is it a situation, like, do some people just naturally not have the gut bacteria that they need to produce equol, and they're never going to have it, and might mean that they're just not suited to the benefits of soy? 

Neal Barnard: The funny story really, the original observation was that Asians could produce equol and Americans couldn't. In other words, a woman in Tokyo, she's eating tofu, or miso, or whatever, and if you do a urine test, you find equol in her urine, which means that the soy, the daidzein in the soy was converted by her gut bacteria into equol. It got into her blood and then she's excreting in the urine you can measure. You go to Cincinnati and you notice that none of the women are making equol. What searchers then did, it sounds a little ridiculous today, but they would take a woman, American woman, or a woman who's not making equol, feed her heroic amounts of soybeans, and do it for day after day after day. I'm going to make you an equol producer. It just doesn't happen, just doesn't happen.  

The question was, well, it's got to be genetic. What they missed was, what is it that causes your gut bacteria to change? What causes your gut bacteria to changes is the soil that they're growing in. If you're eating a high-fiber diet of vegetables, and fruits, and whole grains, and beans that selects for healthy gut bacteria that can then produce equol. If you're eating chicken wings, and fish, and animal muscle tissue that cell selects for a very different kind of gut bacteria. It's a little bit like, you go to the garden store, these roses will not grow, just won't grow, doesn't happen. The person behind the desk says, "Well, show me the soil that you're using." I show him. He says, "This is cactus soil. Who sold this to you?" You need a whole different flowerbed to grow roses than to grow cactus and you can change your flowerbed very rapidly.  

At the University of Pittsburgh, Steve O'Keefe's crew did an amazing study. They took American men eating, let's face it, American diet, and chicken wings, and roast beef, and the things that we eat and they took a group of men from rural South Africa, eating what men in rural South Africa eat. Root vegetables, and beans, and a very high fiber, mostly plant-based diet. They switched diets. The man in Pittsburgh started eating a South African diet and within two weeks' time, you could see their gut bacteria changing to the kinds of gut bacteria that you could see in Africa. The men in rural South Africa now eating Velveeta, chicken wings, and these kinds of things. Their gut bacteria are changing too in exactly the wrong direction.  

One of the most frightening things that I have seen is historically, Japanese women maybe 60% produce equol. In the United States, maybe 20% of Westerners produce equol. Japan is changing now. Japan is becoming more like Pittsburgh. They've got Burger King, they got KFC, they got all this stuff, they got dairy. They didn't have dairy. It was not a cheesecake culture in 1940. They got it now. If you look at women athletes now in Japan, maybe 30% of them are making equpl. They're on a less healthy diet, they're less healthy people, there's a lot more obesity and all these kinds of problems.  

Melanie Avalon: What do you feel about the high equol content of dairy food?  

Neal Barnard: Who knows? We've got to see.  

Melanie Avalon: Do you think there'll be potentially some benefit there or--? 

Neal Barnard: Well, keep in mind. What is dairy? The number one nutrient in a glass of milk is sugar, number two is fat. If it's low fat, then it's sugar, and there's some protein in there and so forth. Cows do make all kinds of foods, all kinds of products. They've got gut bacteria, too. But keep in mind, dairy is a cocktail that's designed to overfeed an infant, because you don't want that in infant's body. A cow's body is not supposed to stay the same size. Your body's supposed to say the same size, and mine is, but not a calf. Dairy is designed to create rapid increase in body weight. Number one, sugar, number two fat, number three, protein. When you eat those things, it causes in your body IGF-1 levels to increase, not the IGF-1 in the milk. That's there but that's not the big thing. It just stimulates your body to make IGF-1, so your body grows. To say that there could be some health benefit to this cocktail, milk, I think is a wildly, overly promoted and completely inappropriate food for humans. 

Melanie Avalon: Yeah. Whenever listeners ask me about foods to cut out for weight loss, I say, "Well, the one food that's a hormonal food made to grow something and it's also a cocktail of both sugar and fat together is dairy." I think a similar case, I don't know. Well, nuts would be the other food where its carbs and fats with the "intention of growing something in high calorie," but I definitely think dairy is, it doesn't have that hormonal aspect of dairy. We were just talking about can we get back these bacteria that produce equol?  

Neal Barnard: Oh, yeah. More research needs to be done. But researchers have looked at adults in Western countries, and you take your average Western, maybe one in five will produce an equol or something like that. Wait a minute, here I'm in Australia, researchers brought together 41 adults. If you look at the non-vegetarians maybe a quarter of them produced equol, but if you look at the vegetarians, about 60% produced equol. No, they weren't born that way. It's just a question of the gut bacteria that predominate at the time. So equol has nothing to-- The issue isn't whether you're eating soy or not. The issue is, are you eating foods that have helped you to have a healthy gut microbiome? Once you do, then if you consume soy, your body will take the daidzein and convert it to equol.  

Melanie Avalon: Have you seen the Cell 2021 study, gut-microbiota-targeted diets modulate human immune status for people on either a high-fiber diet or a high-fermented foods diet to see how it affected their gut microbiome? Did you see that one?  

Neal Barnard: No, I don't think so. I don't think I have.  

Melanie Avalon: Okay, I will send it to you. I am so curious about your thoughts on it. They had two groups and they put them on either a high-fiber diet or like I just said, a high-fermented foods diet. The high fiber diet, they did not add fermented foods and the high-fermented foods diet did not add in fiber. As far as like how did macronutrients and stuff like that change, interestingly, the high-fiber diet had higher plant-based foods, higher carbs, less animal protein, the high-fermented foods diet, because of just the nature of it, they ended up having more animal protein or sodium. But what was really interesting was they were looking at microbiome diversity and it was only increased in the fermented foods diet, not in the fiber diet. Inflammatory markers were modulated in the fermented foods diet and not the fiber diet. They were talking about how it seemed to also be, I think, case specific.  

Basically, the people in the fiber diet, they experienced an increase in density of the gut bacteria, but not increased in biodiversity compared to the fermented foods diet, where they did experience increase in biodiversity, but not increase in density. They were talking about what we were just talking about now, which was maybe fiber alone wasn't enough to add in those species compared to the fermented foods diet. But they did say that maybe it just needed to be longer. I think it was a six-week study. It makes me wonder a lot about how much can you change your diet with adding in plants compared to if those species are just not there.  

Neal Barnard: Yeah, I think it's a really good question and you got to find the species somewhere and that's the presumption. On the other hand, it's amazing how easily things can get introduced into your digestive tract. You're on an antibiotic, it wiped out your gut bacteria and you think, "Oh, I got to go to the store and get probiotics." Your gut is going to repopulate whether you take probiotics or not just from inhaling and eating and things like that. I no longer bother with probiotics at all. I think your point is a good one. I do think that fiber is important. But what is fiber? Fiber is just a carbohydrate food that you couldn't digest but the bacteria can. There are other carbohydrates as well, and sugars, and then there are fats, and proteins, and all of these things, kind of their own ideas about what bacteria should survive. 

Melanie Avalon: Is there the possibility that some of the health benefits that we see from people on vegan diets is because, it self-selects for people who are suited to that diet? Basically, the type of people who can thrive on a vegan diet is because they have the gut microbiome to thrive on that diet. Maybe it's not even the foods as much as its they have a gut microbiome that can be adapted to that. The reason I bring that up is some people seem just have such GI distress, and they seem they can't handle high plant-based diets, and so, they go on a ketogenic diet, lower fiber, and then finally that seems to really work for them. I just wonder about the role of, I don't know, if it's a chicken or egg question. I guess, it does go back to what are your thoughts on you know is a person innately suited to a certain diet?  

Neal Barnard: No. I think it's Paris. You get on a plane, you fly overnight, you touch down in Paris. You go to your hotel and you say, "Is there a restaurant around here?" The next day you're having lunch and you are having dinner, and you discover that your digestion may not be exactly quite right, because you're eating foods that are just different from what you eat. Eventually, if you stay there about a week or two, you'll find the foods that agree with you but when you're eating something new, your digestive tract reacts a little bit funny.  

Getting out of Paris and going back to Washington, D.C., when a person goes vegan, they're eating foods that are strange for them. They may have said, "Well, I normally eat about an eight-ounce steak every day. I need eight ounces of beans," and they get gassy from it. They think "I guess I can't ever have beans." They didn't know how maybe to prepare them. They thought they should be al dente, like crunchy. Anyway, these are really common issues. I've never seen anybody unable to adapt. But unfortunately, we don't have a culture that guides us to healthy plant-based foods. We all grew up in places like Fargo. So, we learned how to grow a burger, but we never really learned how to make healthy food. No, I don't think there's anybody who can't do it. The gut microbiome that you have, that's like the shirt you're wearing. It changes. It changes really rapidly. Whatever it is that you have, now, you can change it.  

Melanie Avalon: I know. You get this question all the time. So, I'm hesitant to even ask it, but what are your thoughts on the fact that vegans might be lacking in something like B12, for example, and what does that say about, is it our natural human diet if it's lacking something that we can't get from food? I know you get this question all the time. So, I'm apologizing, [laughs]  

Neal Barnard: No, it's a very, very good question. Vitamin B12 is not made by animals. If you eat a goat, the goat didn't make B12, it's made by bacteria. Historically, people speculate that the traces of bacteria in the soil, on plants, on our fingers, in our mouths, we give you that tiny bit of B12 that you need, it's may even conceivable that the gut bacteria that you'd make would have made some B12 that you might have even been able to absorb depending on how you look at these things. Whether that was ever true, those days are definitely gone in our modern hygienic world. Everybody, who's on a vegan diet should be supplementing vitamin B12. That doesn't mean that you're not suited to a plant-based diet.  

If you let's say, you eat meat all the time, and you happen to be on a ship back a couple of centuries ago from England, and everybody's dying of scurvy. Fast forward, somebody says, "Meat doesn't have any vitamin C at all. It just doesn't have it." If you're a dog or cat, you could have made vitamin C, but you're not. You're a great ape. You get vitamin C from plants. You're obviously not made to eat meat. In your digestive tract, you don't have fiber in your digestive tract, I wish you all the best, because you're going to be miserable. We would like to pretend that we're cats or dogs, because being a carnivore is kind of more macho than being a chimpanzee, but we are great apes. Like orangutans and gorillas, chimpanzees, and bonobos, our diets are plant-based either exclusively or largely but that's the diet that we do best with. 

Melanie Avalon: What are the implications of the intense acidity of our stomach and our small intestine compared to the large intestine? I just feel when I look at the human, it says omnivore to me rather than herbivore. 

Neal Barnard: Sure. Well, let's look at what we know versus what we wish were true. Researchers have parsed this out a little bit, one of the really cool studies is the Adventist Health Study, and the reason I like this is that they put Seventh Day Adventists under the microscope. It took me a while to figure out why they would pick on Seventh Day Adventists. The reason is, there's a lot of them, they volunteer for research studies, and they are extremely health-conscious people. They are nonsmoking, teetotaling people, but they vary in diet. Let's say, well, you can find some-- Their teachings will say, you've got to be health conscious. You'll find vegans, you'll find ovo-lacto, you'll find pescatarians, who don't eat any animal products except for fish, you'll find heavy meat eaters too in that population. You see this remarkable gradation. 

Serena Tong stat in diabetes care in 2009 looked at body mass index. The body mass index, if I remember correctly in the meat eaters, these are health-conscious modest meat eaters, but as something like 28.8. In other words, they were in the overweight range. Then if you went to the people who were rare meat eaters less than once a week, they were still overweight, but lower BMI. Then if you looked at people who didn't eat meat at all, except for fish, they were slightly skinnier, and then the lacto-ovo vegetarian skinnier too, but the only group whose BMI on average was smack in the middle of the healthy BMI range was the people on a completely vegan diet. The more you get the animal products out of your diet, the better.  

But the reason that the American Diabetes Association published it was that the diabetes gradient was exactly identical. The people on the meaty diet, who were letting meat, and gravy, and cheese take the place of beans, vegetables, and things to a degree, they had by far the highest diabetes prevalence. The people who were vegans, who apparently never read the Atkins books and stuff, because they didn't realize they shouldn't be eating all these carbohydrates, I'm kidding. The vegans have, I think it was maybe a 2.9% some of that percent prevalence of diabetes in the vegan population. The more people get away from animal products, the better they do.  

Now, that said, we're no longer in charge of our diets. You buy things at the store, we're not really taught how to do it. It's good to have some rules of thumb, and that the rule of thumb is have fruits, and vegetables, and legumes, and whole grains, and build your diet from however much of those you want. Don't limit carbohydrates, don't limit calories, eat what you want of those, but keep oils really low and have some B12 every day. If you live in North Dakota and its wintertime, you're probably going to need some vitamin D, too, because no matter what your diet is like, you're going to probably run low in D. That's about it. That's really all you need.  

Melanie Avalon: One more question about the evolution of the species. We have amylase gene, which suggests that we digest starch, but then we also have lactase gene, which-- or some people or gene, I don't know if is it a gene?  

Neal Barnard: Yeah, it is. Yeah. It's a gene.  

Melanie Avalon: To digest dairy, would that insinuate that we're supposed to be eating dairy?  

Neal Barnard: It insinuates that you had a mother, and your mother was a mammal, and her breasts were hopefully there to nourish you. Now in the 1950s and to some extent today, it was unfashionable to breastfeed your child. But I have to say as a doctor, I believe that breastfeeding is an integral part of reproduction. When you're going to create a baby, give the baby the nutrition that they need. But for all mammals, there is in fact a gene that creates this enzyme called lactase. A lot of genes, after the age of weaning, it says, "Son, you got to make your own way. I'm not going to make any more lactase for you and you're not going to drink any milk anymore."  

For all mammals including the human mammal, that lactase goes away, and so you're then lactose intolerant. Then if you drink milk later, the milk sugar lactose doesn't break apart, and bacteria will break it apart, they ferment it, you get a bubbly stomach, and diarrhea, and pain, and all this kind of stuff. Unless you happen to be in a culture that started raising cows in Europe or the Middle East, and there was a huge genetic selection for people who could have the lactase enzyme persist for a longer period of time. Those people thought of themselves as normal and everybody else is abnormal, because everyone else got sick when they would drink milk. Only in the mid-60s was it clear that lactase persistence is due to a peculiar genetic mutation. But that doesn't mean that it's good idea to drink milk, because those people are then free of the digestive symptoms that milk causes. But they get all the other problems that milk causes like acne, and hormonal problems, and weight gain, and everything else.  

Melanie Avalon: Yeah, that was a mind-blowing moment for me. And listeners, I really recommend reading The Cheese Trap, because it will just blow your mind on cheese. But this idea that maybe not having that lactase gene later could actually be protective, because you're not getting some of the problematic problems of actually digesting and breaking down cheese. Specifically, was it galactose, was that the sugar that's created?  

Neal Barnard: Yeah, well, lactose is in milk.  

Melanie Avalon: Or galactose, the one starts with the G. 

Neal Barnard: Yeah, exactly. Lactose is a double sugar. If you can look at it under a super powerful microscope. It's a mixture of galactose and glucose, and they're hooked together, and that's what gives you an upset stomach, because bacteria can digest that and they make gas. But the lactase enzyme when your little baby will break that apart, and so you can then absorb the galactose and the glucose both. But that becomes a problem later on for you. Anyway, there you are.  

Melanie Avalon: Looking at, so my diet, for example, all Whole Foods, very low fat, very high carb, but I do have a lot of animal protein, lean animal protein, and I do intermittent fasting. In that type of diet, and I think a lot of my listeners actually follow similar diet. What problems do you see there? I guess, from the animal protein, is it the IGF-1? 

Neal Barnard: Well, I guess, there are four sets of problems and maybe we don't talk about you for the moment. But when I was a child, I drove a load of cattle to East St. Louis. Before I started worrying about my grandpa's coronary arteries, the cattle themselves might have been a clue to an intelligent human being that there might be something amiss. Now, doctors are not supposed to talk too much about ethics, but the idea of taking, there's no animal more placid and nice than a cow. They don't borrow money, they don't smoke in your living room, they're perfect, they won't say anything bad about you while they're gone.  

But all the ones that I drove to East St. Louis were hung out by their leg and their throat was slit by underpaid person, their life was sacrificed just to cause coronary artery disease in other people. In some cultures, people take animal suffering seriously, in North Dakota we didn't. But when my grandpa died at 62, I found myself thinking maybe if we had thought a little bit more about what we were doing and not just them, I had a shotgun and I killed anybody who would fly overhead. I do think that if we have the guts to bring a recognition of the other animals we share this planet with and think about their interest a little bit, we might leave them alone a little bit, and we would probably do a whole lot better.  

The second piece of this apart from the animals is, if anybody believes climate change is not real, I would encourage you to maybe think more about that. You can't be having animal products as part of your diet without having a pretty heavy impact on the environment and I will raise my hand with a big mea culpa because my family has been busily destroying the environment for many generations, but it's good to take that seriously. Then, the third thing that we haven't talked about is apart from your health is what is our message to the next generation. Kids growing up in schools today are very often overweight. In some cases, insulin resistant before they get their high school diploma. They have learned from the TV a lie that a potato caused that, or an apple, or a pear. They grew up with so much unfortunate nonsense. Then, when they get cancer or heart disease, they're told it's genetic or they get dragged into all kinds of absurd other directions.  

My point is, where they think about animals of the Earth or the next generation that we have some responsibility toward, the more we understand that healthy, simple plant-based foods really are an important thing to consider. That's really good. That's it. Back to your body. If we're on a plant-based diet, many things get better at the same time. Our waistline trims, our heart gets healthier, our insulin resistance diminishes, our cancer rates drop, the likelihood of Alzheimer's diminishes. We're still vulnerable. Things go wrong no matter what. The body is not perfectly designed, but that gives us the best shot. 

Melanie Avalon: No, I'm super glad that you brought all that up, because I know, we probably diverge a little bit on the best route to it, but one of the most important things to me is the sustainability of the planet, and the environment, and ethics, and I just think it's so important. I think there's so much confusion, too, out there about the best method to that, and I'm constantly researching, and trying to learn about what that may be. I'm really, really interested in regenerative agriculture for example. I'm good friends with Robb Wolf, who wrote a book called Sacred Cow and I really like his perspective on everything. But I think it's really confusing and I think in the end, what we can say is, everything that you just said, it's a mission to change people's lives, change people's health, support the environment, support the planet. I can't thank you enough for what you're doing. You're changing so many lives, so many. So, the last question I actually asked every guest on this show and it's because I realized more and more each day how important mindset is. So, what is something that you're grateful for?  

Neal Barnard: Well, today, I'm grateful for the opportunity to speak to you, and to speak to your listeners, and I'm grateful for what you do because you reach a lot of people. You may not see them, and you'll never really know who you touch, but you touch many, and some people are going to make some changes based on what you've helped them to understand. You save far more lives than you know.  

Melanie Avalon: Well, thank you. Thank you for coming on my show, because I know it can be, I mean, you're all over the place, so, you're probably not nervous. But I know my audience is a little bit different than the audiences that you speak to, so I really, really appreciate it and I really appreciate your work. How can listeners best follow everything that you're doing?  

Neal Barnard: Well, our website is pcrm.org. This stands for Physicians Committee for Responsible Medicine. Go to pcrm.org, you'll see recipes, you'll see our menopause studies there, my books, Your Body in Balance and the others are there on Amazon and online and everything else. But if there's somewhere a library or a bookstore that's still opening its doors these days, I'm sure they'd like to have your patronage.  

Melanie Avalon: Awesome. Are you currently writing a new book?  

Neal Barnard: No, not at the moment but we are doing quite a number of research studies on the implications of these kinds of diets and also studying on ways to make them really as easy as possible for people to adopt and then that kind of thing. So, that's a bit of a preoccupation right now.  

Melanie Avalon: Awesome. Well, that's wonderful and open door, whoever would like to come back on the show again with your future work. I really appreciate all of it.  

Neal Barnard: Great. Well, thank you.  

Melanie Avalon: Thanks. Have a good day.  

Neal Barnard: You too.  

Melanie Avalon: Bye. 

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