July 23, 2025 • 22 mins
Dr. Michael Greger joins Dr. Michael Koren to discuss his life's work spreading nutritional knowledge. Dr. Greger talks about how a change in diet and lifestyle helped add 31 years to his grandmother's prognosis and how this event convinced him to go into medicine. He explains how a healthy diet is more about adding healthy foods than removing unhealthy foods and that eating is a zero-sum game. Dr. Greger shares good, practical advice on what you can do today to help increase lifespan without compromising your favorite foods.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Announcer (00:00):
Welcome to MedEvidence, where we help you
navigate the truth behindmedical research with unbiased,
evidence-proven facts Hosted bycardiologist and top medical
researcher, Dr.
Michael Koren.
Dr. Michael Koren (00:11):
Hello, I'm Dr .
Michael Koren, the executiveeditor of MedEvidence! And I'm
really excited about theconversation I'm about to have
with Dr.
Michael Greger, who is thefounder of NutritionFacts.
org and he and I are going totalk about his path to becoming
(00:31):
a guru on nutrition, a medicalguru with his background as a
physician, and also talk abouthow evidence-based medicine
impacts nutritional research andscience.
So, Dr.
Greger, welcome to MedEvidence!Thank you for coming on.
Dr. Michael Greger (00:45):
Thanks so much.
I'm honored to be here.
Dr. Michael Koren (00:53):
Well, I'm excited about this conversation.
So, as you know, we have a lotof physicians who look into our
podcast and other people in thehealthcare industry, and there's
a lot of interest on the careerpath of physicians.
So tell us a little bit aboutyour background where'd you grow
up, how you got involved inbeing focused on nutritional
issues and, ultimately, how youdeveloped this very important
website.
Dr. Michael Greger (01:11):
You know it all started actually with my
grandmother.
I was just a kid when mygrandma was sent home in a
wheelchair to die, essentially.
She had end-stage heart disease, already had so many bypass
surgeries, basically, you know,get so scarred up inside there's
nothing more they could do,confined in a wheelchair,
crushing chest pain.
Her life was over at age 65.
(01:33):
But then she heard about thisguy, Nathan Pritikin, one of our
early lifestyle medicinepioneers, and what happened next
is actually detailed inPritikin's biography Talks about
Francis Gregor, my grandmother.
Dr. Michael Koren (01:44):
Really, oh wow,
Dr. Michael Greger (01:45):
They wheeled her in and she walked out.
She was given a medical deathsentence at age 65, thanks to a
healthy diet, was able to enjoyanother 31 years on this planet
Dr. Michael Koren (01:56):
Wow
Dr. Michael Greger (01:57):
To age 96, to continue to enjoy her six
grandkids including me
Dr. Michael Koren (02:02):
Wow
Dr. Michael Greger (02:03):
That's why I went into medicine.
That's why I went to lifestylemedicine, why I started
nutritionfacts.
org, why I wrote the book HowNot to Die, why all the proceeds
from all my books are alldonated directly to charity.
I just want to do foreveryone's family what Pritikin
did for my family.
Dr. Michael Koren (02:23):
Wow.
Well, that's a very compellingstory.
Thank you for sharing that.
So tell me about your medicaltraining.
What path did you choose formedical training?
Dr. Michael Greger (02:34):
So I actually started agriculture
undergrad, then went to TuftsMed and just did a transitional
year at the Lemuel ShattuckHospital, which is a public
health hospital Tufts affiliatedin Boston, before starting
general practice and then veryquickly realized I could
(02:55):
actually reach you know how manypeople can you reach in a day?
So started a I was going to sayDVD series, series, but
actually back then it VHS tapes.
Then then, video series andthen, finally started traveling
around the country to kind of toteach the teachers.
(03:18):
My goal was to hit every singlemedical school every two years
to reach all the pre-clinicalstudents.
So spent years on the roadtalking about lifestyle medicine
, um, before realizing that thatwas an unsustainable lifestyle.
I was living on my car, I was,you know, so then, uh, finally,
(03:41):
thanks to the Internet, I wasable to put my work online and
so you know reach, you know,eventually, millions of people
with this life changing, lifesaving information.
Dr. Michael Koren (03:55):
So that's super interesting.
So let me make sure Iunderstand.
Did you do a traditionalresidency or you just skipped
all that residency, or you justskipped all that?
Dr. Michael Greger (04:02):
just a transitional year.
So in 28 states.
You can practice as a generalpractitioner, just with the
transitional year.
I was originally actually goingto do a public health residency
at UMass but realized that Ididn't think that would give me
(04:23):
the skills I needed to spreadthe message that I really wanted
to, which is that we havetremendous power over our health
destiny and longevity, and thatthe vast majority of premature
death and disability ispreventable with a healthy
enough diet and lifestyleInteresting.
Dr. Michael Koren (04:37):
Do you see patients now or are you just
Dr. Michael Greger (04:39):
no, no.
So I give up my clinicalpractice.
Oh God, decades ago now.
So it's all writing, research,speaking, trying to reach as
many people as possible
Dr. Michael Koren (04:50):
Fabulous.
So interesting.
So Pritikin was certainly aninteresting person and certainly
a pioneer on developingprograms to help people really
change their trajectory throughbetter lifestyle.
As I recall, he was an engineer.
He wasn't a medical personinitially.
Dr. Michael Greger (05:10):
Exactly.
Dr. Michael Koren (05:11):
and kind of self-taught person but certainly
evangelical in his beliefs ofgetting the word out.
And this gets into a discussionof evidence-based medicine.
And the fact is that there havebeen some conflicting signals
(05:31):
when you actually try to dorandomized trials in diet, but
the epidemiology is so clearthat people and cultures that
eat better live longer.
It's pretty straightforward.
My favorite fact to quote iswhy do Italians live three years
longer than Germans, eventhough Germans make more money
(05:51):
than Italians and have morehealth care resources?
And it's got to be lifestyle,wouldn't you agree?
Dr. Michael Greger (05:58):
Yeah, Well, that's where Pritikin, the
evidence-based Pritikin, workedoff of to come up with his heart
disease reversal program wasbased on studies by Dr.
Dennis Burkitt, one of ourleading luminatries in medicine,
who early in the last centurywas part of a group of
evangelical doctors.
he went to subsaharan Africaand opened up hospitals, kind of
like the Albert Schweitzer's ofthe world.
(06:30):
And what really struck him isthat many of the diseases, the
epidemic diseases we were dyingfrom, in the Western world
practically didn't exist.
So epidemics of heart diseaseand type 2 diabetes and obesity
and colorectal cancer anddiverticulosis.
And so they actually startedthese African medical journals
(06:53):
to kind of compare notes andwhat is going on.
Why is there a hundredfolddifference in some of these
disease rates around the world?
And you can follow that up withmigration studies where you
know it's not just kind ofgenetic differences but when
people migrate to new areas theyacquire the diseases of people
who live and eat in that newarea.
(07:17):
And that's really what ledPritikin to be like well, what
if we put people on the diet,followed by populations that
don't get epidemic heart disease, in hopes of maybe slowing the
disease down, when in fact yourealize that you can even halt
the progression, even perhapsreverse the progression of heart
disease, which laterdemonstrated in a randomized
(07:39):
control trial by Dr.
Dean Ornish in the famousLifestyle Heart Trial published
in 1980 in the Lancet.
Dr. Michael Koren (07:46):
Yeah, yeah, yeah.
The Ornish study is superfascinating Again a randomized
trial that showed actual diseaseregression in coronary disease
patients.
Now it wasn't a huge number itwas like 4% as I remember but
it's really the first time thatanybody was able to show any
regression, so that wascertainly a breakthrough trial,
really really neat.
(08:07):
The other trial I'm reallycurious about your perspective
on this.
So I still practice cardiologyand I like to tell my patients
that the diet is extremelyimportant.
Sometimes it's hard to getsimple, impactful advice to
patients, but one of the thingsI do like to tell them is that
(08:27):
there is pretty strong evidencethat eating fish multiple times
per week has some benefits.
And some of the fish oilstudies have had results that
are at first glance indiscrepancy with one another,
but I think there's an overallagain epidemiological trend that
fish eating is good.
And then there's the DART study, which is a randomized trial of
(08:50):
giving people the advice to eatfish.
That actually showed a 29%reduction in mortality in
patients after a myocardialinfarction.
On the other hand, thefollow-up study that was looking
at-
Dr. Michael Greger (09:00):
-DART 2!
Dr. Michael Koren (09:05):
Yeah, DART 2 didn't show the same thing.
So I was really curious aboutyour comments on that.
And how do you contextualizeall that information?
That can be really reallycomplicated for people.
Dr. Michael Greger (09:13):
Yeah, people seem to forget about DART2, but
certainly DART1 launched thisbillion dollar fish oil industry
.
If you look at the latestCochrane review, we don't have
good evidence that either adviceto eat fish or fish oil
substantially affectscardiovascular disease rates.
So it may be more confounding.
(09:37):
I mean, who eats fish?
Dr. Michael Koren (09:39):
I love it.
Dr. Michael Greger (09:56):
People who are.
You know it's like when you'reon an airplane you want chicken
or fish.
Well what are people not eatinginstead?
And so they may be eating lessred meat, processed meat, if
they are eating more fish.
And may have other confoundinglifestyle factors that they just
may be generally more healthy.
Dr. Michael Koren (10:03):
So you would argue that the eat fish advice
may have been beneficial incertain randomized trials
because you're taking awaythings that are toxic.
Is that what you're saying?
Dr. Michael Greger (10:15):
Well, certainly, yeah.
I mean, the fundamentalquestion in nutrition is really
compared to what?
So if you ask the question, youknow, is fish healthy?
So well, what would you behaving instead?
Right, food is a zero-sum game,right?
Every time we put something inour mouth, there's an
opportunity cost a lostopportunity to put something
(10:35):
even healthier in our mouth.
And so is fish healthy?
Well, I mean, is a tuna fishsandwich healthy?
Well, compared to a bolognasandwich?
Absolutely.
But compared to something likehummus, for example, I would
argue that not necessarily.
So Same thing, look, eggs.
Are eggs healthy compared to abreakfast sausage?
Absolutely.
Compared to oatmeal no.
So we can always kind ofratchet up the healthiness on a
(11:00):
day-to-day basis.
Of course, it doesn't matterwhat you eat on your holidays,
birthdays, special occasions,but on a day-to-day basis, you
really should try to eat healthy, which means centering our
diets around whole foods fromfields, not factories,
unprocessed plant foods reallyprobably are healthiest choices.
Dr. Michael Koren (11:17):
Got it Very interesting perspective.
So patient comes in and they'reready to make some changes in
their diet, but they have atypical American diet, so break
down your approach on how youwould help that person.
Those people, by the way, arelistening as we speak, so talk
to those people out there thatare ready to go to their fast
(11:40):
food joint and get their burgerwith bacon which I get the
willies when I think about that,but that's what people do.
But they're ready.
They're ready to roll, they'reready to do something different.
How do you advise them?
Dr. Michael Greger (11:56):
I think it really depends on the psychology
of the various individuals.
Some people have a very kind ofblack and white thinking all or
nothing and it's actuallyeasier for them to make more
kind of dramatic changes.
But I think for most peopleit's a matter of, you know,
slowly edging out some of theleast healthy choices and kind
of crowding out by addinghealthy foods to your diet.
(12:18):
I mean, I think people, youknow, when I was practicing,
people had the sense that I was,you know, ready to take away
some of their favorite foods andare surprised when I say no, no
, I want you to add healthyfoods to your diet in hopes, by
the end of the day, they justdon't have enough room for some
of the less healthy choices.
So encourage people.
Eat, you know, berries every day, the healthiest fruits, greens
every day, the healthiestvegetables, legumes, beans,
(12:40):
split peas, chickpeas andlentils.
That is the kind of proteincenterpiece of all the blue
zones around the world, theseareas of exceptional longevity.
According to the Global Burdenof Disease Study, the largest
study of risk factors in humanhistory for death and disease,
legumes appear to be associatedwith the greatest life
expectancy gains, and that maybe a combination of what they
(13:02):
would the protein sources theywould be eating instead.
But so if I could just havepeople eat those three things, I
think that would go a long waytowards people eating healthy.
And if there were just threethings I would first remove from
someone's diet.
It'd be trans fats anythingwith partially hydrogenated
vegetable oils removed from theUS food supply but still
contributing to hundreds ofthousands of deaths around the
(13:23):
rest of the world.
Number two processed meat bacon,ham, hot dogs, lunch meat
sausage.
We know these foods causecancer, colorectal cancer, the
number one cancer killer ofnon-smokers.
And number three sugarsweetened beverages.
You know, liquid candy.
We really shouldn't beconsuming our calories in that
way.
Dr. Michael Koren (13:42):
Yeah, and that's super helpful.
Repeat the three things that weshould eat, just to be clear for
the audience.
Dr. Michael Greger (13:48):
Beans, greens and berries.
And removing trans fats,processed meat and soda.
Dr. Michael Koren (13:53):
Perfect.
That's very succinct advice.
It's terrific.
So tell us a little bit aboutyour website and how's it going.
Are you getting the tractionthat you're looking for?
What are the reactions?
How does it help people?
Dr. Michael Greger (14:09):
So Nutrition Facts is a free, nonprofit,
science-based public serviceproviding daily updates on the
latest in nutrition research viabite-sized videos.
Now over 2,000 videos on nearlyevery aspect of healthy eating,
with new videos and articlesuploaded every day.
The latest in evidence-basednutrition what a concept at
Nutrition Facts.
org.
(14:30):
It's interesting.
The traffic's actually down andit's because we're getting less
organic searches thanks to theGoogle AI technology um blurb.
So normally when someone looksyou know what can I eat for
migraines, or how do I cook asweet potato or anything like
(14:50):
that, you know we, um, you knowwe've been around for so long
that you know we often you knowuh, are in that first page of
results.
But now we have this little AIblurb which kind of goes
directly, so no one has to keepclicking and watching videos,
and so I think that's actuallykind of undermined our ability
(15:11):
to reach people.
But having said that, sometimesthe AI blurb actually quotes
something on our website, sothat helps as well.
Dr. Michael Koren (15:18):
Well, that's super interesting.
I think there's a lot ofinsight to that is, with these
kind of AI descriptions, some ofthe work is taken away, but
there may be unintendedconsequences of that, in fact
directing you to certain placesfor whatever reasons, and that
can certainly impact your reachand business model.
(15:40):
So interesting.
So I have a question for youwhat study would you design or
what do you have in mind forlooking at an issue that you're
very passionate about?
If you could design a clinicaltrial and get it funded, what
would that look like?
I'm curious about how you'rethinking and for our audience as
(16:02):
well.
Dr. Michael Greger (16:04):
You know, when it comes to nutrition, I
think the controversy is lessabout science and more about the
compliance I mean people.
Just, you know, too often youknow, we physicians have this
kind of patronizing attitudethat our patients aren't, you
know, willing to make changes indiet and lifestyle.
But I think what can be mostmotivating is are these kind of
(16:29):
disease reversal, you know, whenyou're looking at, you know,
high blood pressure, type 2diabetes the fact that you can
put someone in a healthy enoughdiet and actually, um, reverse
the course of the disease.
I think that excites peoplemore than prevention,
unfortunately.
I mean prevention the best, butprevention is not sexy.
Prevention works.
Nothing happens.
It's very difficult to motivatepeople.
(16:50):
So I mean the disease reversalstudies I'd love to see there
was just this Plants for Jointstrial on both osteoarthritis and
rheumatoid arthritis in EuropeReally exciting results.
You know these are some of the,you know, osteoarthritis leading
cause of physical disabilityamong older adults and you see
significant improvements in, youknow, number of tender and
(17:13):
swollen joints.
You know quality of life, asignificant improvement in pain,
just by switching someone'sdiet and so-.
Dr. Michael Koren (17:24):
-was that randomized, controlled or?
Dr. Michael Greger (17:26):
Randomized controlled trial.
Dr. Michael Koren (17:31):
Wow
Dr. Michael Greger (17:32):
So I mean.
So those are the most kind ofexciting.
So yeah, RCTs on diseasereversal, I'd love to see so
there's.
There's been such studies on,you know, migraines and PMS,
and-
Dr. Michael Koren (17:51):
-so for migraines that's a common
complaintWhat is the dietary solution for
that?
We talk about caffeine andthings like that as a dietary
solution, but educate us alittle bit more on that.
Dr. Michael Greger (18:04):
Yeah, so certainly there's.
Many people with migraines dohave dietary triggers.
So one can do kind of anexclusion diet and then slowly
add back some of the foods thatare more common triggers to see
if they're indeed are luckyenough that there is indeed some
kind of food sensitivity thatthey can then eliminate.
(18:26):
In terms of treatment, though,ground ginger, 1/4 teaspoon of
ground ginger that you can buyat any store compares well to
some of the abortive migrainetreatments that we would
normally prescribe for reducingpain duration and so something
like that, where it's just likeyou know you never there's no,
(18:50):
there's no, you know big gingerisn't out there, it can't put
ads on TV, but these kind ofsafe, simple, side effect free
solutions can sometimes be quitepotent and compare favorably to
you know, something an NSAID,NSAID um, ibuprofen which is uh
(19:10):
lots uh of- potentially be uhum rare cases.
Dr. Michael Koren (19:21):
That's great.
Well, Michael, this has been afabulous conversation.
Any, any parting words for ouraudience or anything, um
anything you think is importantfor people to hear as a
take-home lesson.
Dr. Michael Greger (19:32):
I think it's important that one need not
make drastic changes.
It's not all or nothing.
Even basic common-senselifestyle behaviors can mean
living a decade longer notsmoking, not being obese,
regular exercise, more fruitsand vegetables.
You know, it's never too lateto stop smoking, never too late
to start moving, never too lateto start eating healthier.
(19:53):
We really do have the power.
Dr. Michael Koren (19:55):
So, Michael, I'm really curious to ask you do
you feel like people need astrict vegetarian diet to get
their maximum health benefits?
Dr. Michael Greger (20:04):
We should try to eat primarily plants, not
necessarily exclusively plants.
A plant-based diet is reallymore just about maximizing the
intake of the healthiest foods.
Right as a physician labelslike vegetarian, vegan, that
just tells us what people don'teat.
I mean, do you actually eatvegetables?
If you look at the Blue Zonesfood guidelines, for example,
(20:26):
which is based on more than 150dietary surveys of the world's
longest living populations.
They recommend eating at least95% plant-based, but that could
include 100 calories of animalproducts a day.
So like a tablespoon of butterevery day, a container of Greek
yogurt, a third of a lamb chopor something.
So really meat seen more as acondiment or flavoring rather
than a big chunk at the centerof the plate.
Dr. Michael Koren (20:47):
That makes sense.
My other question is what areyour views about the use of less
than high levels of alcohol?
There's some controversy aboutwhether or not people who are
light to moderate drinkers areat health risk, balancing cancer
risk versus potentialcardiovascular benefits.
Dr. Michael Greger (21:05):
Yeah well, everyone agrees that heavy
drinking, drinking duringpregnancy and binge drinking bad
ideas.
But there's been thiscontroversy about moderate
drinking, not with regards tocancer, but since cancer is
killer number two, heart diseasekiller number one, and we
thought there might be somebenefit.
That's why there hasn't been astronger public health message
against drinking.
Those who live the longest tendto not be abstainers, but those
(21:28):
who imbibe a few drinks a week.
Unfortunately, this appears tobe an artifact of the so-called
sick-quitter effect arising fromthe systematic
misclassification of formerdrinkers as lifelong abstainers.
It's the same reason.
You can find studies that findhigher mortality rates among
those who quit smoking comparedto those who continue to smoke.
(21:49):
It's not that abstention led topoor health, but rather poor
health led to abstention.
So you know, according to theGlobal Burden of Disease Study
of the World Health Organization, the World Heart Federation,
the safest level of drinking isnone.
You know, grapes, barley andpotatoes best eaten in their
non-distilled form, and JohnnyWalker, no substitute for actual
walking.
Dr. Michael Koren (22:08):
Michael, thank you for your insights.
I truly enjoyed it.
Thank you for educating me andthank you for being a guest on
MedEvidence.
Dr. Michael Greger (22:16):
I'm honored.
Keep up the great work.
Dr. Michael Koren (22:18):
Thank you.
MedEvidence.
Announcer (22:18):
Thanks for joining the MedEvidence podcast.
To learn more, head over toMedEvidencecom or subscribe to
our podcast on your favoritepodcast platform.
Welcome to MedEvidence, where we help you
navigate the truth behindmedical research with unbiased,
evidence-proven facts Hosted bycardiologist and top medical
researcher, Dr.
Michael Koren.
Dr. Michael Koren (00:11):
Hello, I'm Dr .
Michael Koren, the executiveeditor of MedEvidence! And I'm
really excited about theconversation I'm about to have
with Dr.
Michael Greger, who is thefounder of NutritionFacts.
org and he and I are going totalk about his path to becoming
(00:31):
a guru on nutrition, a medicalguru with his background as a
physician, and also talk abouthow evidence-based medicine
impacts nutritional research andscience.
So, Dr.
Greger, welcome to MedEvidence!Thank you for coming on.
Dr. Michael Greger (00:45):
Thanks so much.
I'm honored to be here.
Dr. Michael Koren (00:53):
Well, I'm excited about this conversation.
So, as you know, we have a lotof physicians who look into our
podcast and other people in thehealthcare industry, and there's
a lot of interest on the careerpath of physicians.
So tell us a little bit aboutyour background where'd you grow
up, how you got involved inbeing focused on nutritional
issues and, ultimately, how youdeveloped this very important
website.
Dr. Michael Greger (01:11):
You know it all started actually with my
grandmother.
I was just a kid when mygrandma was sent home in a
wheelchair to die, essentially.
She had end-stage heart disease, already had so many bypass
surgeries, basically, you know,get so scarred up inside there's
nothing more they could do,confined in a wheelchair,
crushing chest pain.
Her life was over at age 65.
(01:33):
But then she heard about thisguy, Nathan Pritikin, one of our
early lifestyle medicinepioneers, and what happened next
is actually detailed inPritikin's biography Talks about
Francis Gregor, my grandmother.
Dr. Michael Koren (01:44):
Really, oh wow,
Dr. Michael Greger (01:45):
They wheeled her in and she walked out.
She was given a medical deathsentence at age 65, thanks to a
healthy diet, was able to enjoyanother 31 years on this planet
Dr. Michael Koren (01:56):
Wow
Dr. Michael Greger (01:57):
To age 96, to continue to enjoy her six
grandkids including me
Dr. Michael Koren (02:02):
Wow
Dr. Michael Greger (02:03):
That's why I went into medicine.
That's why I went to lifestylemedicine, why I started
nutritionfacts.
org, why I wrote the book HowNot to Die, why all the proceeds
from all my books are alldonated directly to charity.
I just want to do foreveryone's family what Pritikin
did for my family.
Dr. Michael Koren (02:23):
Wow.
Well, that's a very compellingstory.
Thank you for sharing that.
So tell me about your medicaltraining.
What path did you choose formedical training?
Dr. Michael Greger (02:34):
So I actually started agriculture
undergrad, then went to TuftsMed and just did a transitional
year at the Lemuel ShattuckHospital, which is a public
health hospital Tufts affiliatedin Boston, before starting
general practice and then veryquickly realized I could
(02:55):
actually reach you know how manypeople can you reach in a day?
So started a I was going to sayDVD series, series, but
actually back then it VHS tapes.
Then then, video series andthen, finally started traveling
around the country to kind of toteach the teachers.
(03:18):
My goal was to hit every singlemedical school every two years
to reach all the pre-clinicalstudents.
So spent years on the roadtalking about lifestyle medicine
, um, before realizing that thatwas an unsustainable lifestyle.
I was living on my car, I was,you know, so then, uh, finally,
(03:41):
thanks to the Internet, I wasable to put my work online and
so you know reach, you know,eventually, millions of people
with this life changing, lifesaving information.
Dr. Michael Koren (03:55):
So that's super interesting.
So let me make sure Iunderstand.
Did you do a traditionalresidency or you just skipped
all that residency, or you justskipped all that?
Dr. Michael Greger (04:02):
just a transitional year.
So in 28 states.
You can practice as a generalpractitioner, just with the
transitional year.
I was originally actually goingto do a public health residency
at UMass but realized that Ididn't think that would give me
(04:23):
the skills I needed to spreadthe message that I really wanted
to, which is that we havetremendous power over our health
destiny and longevity, and thatthe vast majority of premature
death and disability ispreventable with a healthy
enough diet and lifestyleInteresting.
Dr. Michael Koren (04:37):
Do you see patients now or are you just
Dr. Michael Greger (04:39):
no, no.
So I give up my clinicalpractice.
Oh God, decades ago now.
So it's all writing, research,speaking, trying to reach as
many people as possible
Dr. Michael Koren (04:50):
Fabulous.
So interesting.
So Pritikin was certainly aninteresting person and certainly
a pioneer on developingprograms to help people really
change their trajectory throughbetter lifestyle.
As I recall, he was an engineer.
He wasn't a medical personinitially.
Dr. Michael Greger (05:10):
Exactly.
Dr. Michael Koren (05:11):
and kind of self-taught person but certainly
evangelical in his beliefs ofgetting the word out.
And this gets into a discussionof evidence-based medicine.
And the fact is that there havebeen some conflicting signals
(05:31):
when you actually try to dorandomized trials in diet, but
the epidemiology is so clearthat people and cultures that
eat better live longer.
It's pretty straightforward.
My favorite fact to quote iswhy do Italians live three years
longer than Germans, eventhough Germans make more money
(05:51):
than Italians and have morehealth care resources?
And it's got to be lifestyle,wouldn't you agree?
Dr. Michael Greger (05:58):
Yeah, Well, that's where Pritikin, the
evidence-based Pritikin, workedoff of to come up with his heart
disease reversal program wasbased on studies by Dr.
Dennis Burkitt, one of ourleading luminatries in medicine,
who early in the last centurywas part of a group of
evangelical doctors.
he went to subsaharan Africaand opened up hospitals, kind of
like the Albert Schweitzer's ofthe world.
(06:30):
And what really struck him isthat many of the diseases, the
epidemic diseases we were dyingfrom, in the Western world
practically didn't exist.
So epidemics of heart diseaseand type 2 diabetes and obesity
and colorectal cancer anddiverticulosis.
And so they actually startedthese African medical journals
(06:53):
to kind of compare notes andwhat is going on.
Why is there a hundredfolddifference in some of these
disease rates around the world?
And you can follow that up withmigration studies where you
know it's not just kind ofgenetic differences but when
people migrate to new areas theyacquire the diseases of people
who live and eat in that newarea.
(07:17):
And that's really what ledPritikin to be like well, what
if we put people on the diet,followed by populations that
don't get epidemic heart disease, in hopes of maybe slowing the
disease down, when in fact yourealize that you can even halt
the progression, even perhapsreverse the progression of heart
disease, which laterdemonstrated in a randomized
(07:39):
control trial by Dr.
Dean Ornish in the famousLifestyle Heart Trial published
in 1980 in the Lancet.
Dr. Michael Koren (07:46):
Yeah, yeah, yeah.
The Ornish study is superfascinating Again a randomized
trial that showed actual diseaseregression in coronary disease
patients.
Now it wasn't a huge number itwas like 4% as I remember but
it's really the first time thatanybody was able to show any
regression, so that wascertainly a breakthrough trial,
really really neat.
(08:07):
The other trial I'm reallycurious about your perspective
on this.
So I still practice cardiologyand I like to tell my patients
that the diet is extremelyimportant.
Sometimes it's hard to getsimple, impactful advice to
patients, but one of the thingsI do like to tell them is that
(08:27):
there is pretty strong evidencethat eating fish multiple times
per week has some benefits.
And some of the fish oilstudies have had results that
are at first glance indiscrepancy with one another,
but I think there's an overallagain epidemiological trend that
fish eating is good.
And then there's the DART study, which is a randomized trial of
(08:50):
giving people the advice to eatfish.
That actually showed a 29%reduction in mortality in
patients after a myocardialinfarction.
On the other hand, thefollow-up study that was looking
at-
Dr. Michael Greger (09:00):
-DART 2!
Dr. Michael Koren (09:05):
Yeah, DART 2 didn't show the same thing.
So I was really curious aboutyour comments on that.
And how do you contextualizeall that information?
That can be really reallycomplicated for people.
Dr. Michael Greger (09:13):
Yeah, people seem to forget about DART2, but
certainly DART1 launched thisbillion dollar fish oil industry
.
If you look at the latestCochrane review, we don't have
good evidence that either adviceto eat fish or fish oil
substantially affectscardiovascular disease rates.
So it may be more confounding.
(09:37):
I mean, who eats fish?
Dr. Michael Koren (09:39):
I love it.
Dr. Michael Greger (09:56):
People who are.
You know it's like when you'reon an airplane you want chicken
or fish.
Well what are people not eatinginstead?
And so they may be eating lessred meat, processed meat, if
they are eating more fish.
And may have other confoundinglifestyle factors that they just
may be generally more healthy.
Dr. Michael Koren (10:03):
So you would argue that the eat fish advice
may have been beneficial incertain randomized trials
because you're taking awaythings that are toxic.
Is that what you're saying?
Dr. Michael Greger (10:15):
Well, certainly, yeah.
I mean, the fundamentalquestion in nutrition is really
compared to what?
So if you ask the question, youknow, is fish healthy?
So well, what would you behaving instead?
Right, food is a zero-sum game,right?
Every time we put something inour mouth, there's an
opportunity cost a lostopportunity to put something
(10:35):
even healthier in our mouth.
And so is fish healthy?
Well, I mean, is a tuna fishsandwich healthy?
Well, compared to a bolognasandwich?
Absolutely.
But compared to something likehummus, for example, I would
argue that not necessarily.
So Same thing, look, eggs.
Are eggs healthy compared to abreakfast sausage?
Absolutely.
Compared to oatmeal no.
So we can always kind ofratchet up the healthiness on a
(11:00):
day-to-day basis.
Of course, it doesn't matterwhat you eat on your holidays,
birthdays, special occasions,but on a day-to-day basis, you
really should try to eat healthy, which means centering our
diets around whole foods fromfields, not factories,
unprocessed plant foods reallyprobably are healthiest choices.
Dr. Michael Koren (11:17):
Got it Very interesting perspective.
So patient comes in and they'reready to make some changes in
their diet, but they have atypical American diet, so break
down your approach on how youwould help that person.
Those people, by the way, arelistening as we speak, so talk
to those people out there thatare ready to go to their fast
(11:40):
food joint and get their burgerwith bacon which I get the
willies when I think about that,but that's what people do.
But they're ready.
They're ready to roll, they'reready to do something different.
How do you advise them?
Dr. Michael Greger (11:56):
I think it really depends on the psychology
of the various individuals.
Some people have a very kind ofblack and white thinking all or
nothing and it's actuallyeasier for them to make more
kind of dramatic changes.
But I think for most peopleit's a matter of, you know,
slowly edging out some of theleast healthy choices and kind
of crowding out by addinghealthy foods to your diet.
(12:18):
I mean, I think people, youknow, when I was practicing,
people had the sense that I was,you know, ready to take away
some of their favorite foods andare surprised when I say no, no
, I want you to add healthyfoods to your diet in hopes, by
the end of the day, they justdon't have enough room for some
of the less healthy choices.
So encourage people.
Eat, you know, berries every day, the healthiest fruits, greens
every day, the healthiestvegetables, legumes, beans,
(12:40):
split peas, chickpeas andlentils.
That is the kind of proteincenterpiece of all the blue
zones around the world, theseareas of exceptional longevity.
According to the Global Burdenof Disease Study, the largest
study of risk factors in humanhistory for death and disease,
legumes appear to be associatedwith the greatest life
expectancy gains, and that maybe a combination of what they
(13:02):
would the protein sources theywould be eating instead.
But so if I could just havepeople eat those three things, I
think that would go a long waytowards people eating healthy.
And if there were just threethings I would first remove from
someone's diet.
It'd be trans fats anythingwith partially hydrogenated
vegetable oils removed from theUS food supply but still
contributing to hundreds ofthousands of deaths around the
(13:23):
rest of the world.
Number two processed meat bacon,ham, hot dogs, lunch meat
sausage.
We know these foods causecancer, colorectal cancer, the
number one cancer killer ofnon-smokers.
And number three sugarsweetened beverages.
You know, liquid candy.
We really shouldn't beconsuming our calories in that
way.
Dr. Michael Koren (13:42):
Yeah, and that's super helpful.
Repeat the three things that weshould eat, just to be clear for
the audience.
Dr. Michael Greger (13:48):
Beans, greens and berries.
And removing trans fats,processed meat and soda.
Dr. Michael Koren (13:53):
Perfect.
That's very succinct advice.
It's terrific.
So tell us a little bit aboutyour website and how's it going.
Are you getting the tractionthat you're looking for?
What are the reactions?
How does it help people?
Dr. Michael Greger (14:09):
So Nutrition Facts is a free, nonprofit,
science-based public serviceproviding daily updates on the
latest in nutrition research viabite-sized videos.
Now over 2,000 videos on nearlyevery aspect of healthy eating,
with new videos and articlesuploaded every day.
The latest in evidence-basednutrition what a concept at
Nutrition Facts.
org.
(14:30):
It's interesting.
The traffic's actually down andit's because we're getting less
organic searches thanks to theGoogle AI technology um blurb.
So normally when someone looksyou know what can I eat for
migraines, or how do I cook asweet potato or anything like
(14:50):
that, you know we, um, you knowwe've been around for so long
that you know we often you knowuh, are in that first page of
results.
But now we have this little AIblurb which kind of goes
directly, so no one has to keepclicking and watching videos,
and so I think that's actuallykind of undermined our ability
(15:11):
to reach people.
But having said that, sometimesthe AI blurb actually quotes
something on our website, sothat helps as well.
Dr. Michael Koren (15:18):
Well, that's super interesting.
I think there's a lot ofinsight to that is, with these
kind of AI descriptions, some ofthe work is taken away, but
there may be unintendedconsequences of that, in fact
directing you to certain placesfor whatever reasons, and that
can certainly impact your reachand business model.
(15:40):
So interesting.
So I have a question for youwhat study would you design or
what do you have in mind forlooking at an issue that you're
very passionate about?
If you could design a clinicaltrial and get it funded, what
would that look like?
I'm curious about how you'rethinking and for our audience as
(16:02):
well.
Dr. Michael Greger (16:04):
You know, when it comes to nutrition, I
think the controversy is lessabout science and more about the
compliance I mean people.
Just, you know, too often youknow, we physicians have this
kind of patronizing attitudethat our patients aren't, you
know, willing to make changes indiet and lifestyle.
But I think what can be mostmotivating is are these kind of
(16:29):
disease reversal, you know, whenyou're looking at, you know,
high blood pressure, type 2diabetes the fact that you can
put someone in a healthy enoughdiet and actually, um, reverse
the course of the disease.
I think that excites peoplemore than prevention,
unfortunately.
I mean prevention the best, butprevention is not sexy.
Prevention works.
Nothing happens.
It's very difficult to motivatepeople.
(16:50):
So I mean the disease reversalstudies I'd love to see there
was just this Plants for Jointstrial on both osteoarthritis and
rheumatoid arthritis in EuropeReally exciting results.
You know these are some of the,you know, osteoarthritis leading
cause of physical disabilityamong older adults and you see
significant improvements in, youknow, number of tender and
(17:13):
swollen joints.
You know quality of life, asignificant improvement in pain,
just by switching someone'sdiet and so-.
Dr. Michael Koren (17:24):
-was that randomized, controlled or?
Dr. Michael Greger (17:26):
Randomized controlled trial.
Dr. Michael Koren (17:31):
Wow
Dr. Michael Greger (17:32):
So I mean.
So those are the most kind ofexciting.
So yeah, RCTs on diseasereversal, I'd love to see so
there's.
There's been such studies on,you know, migraines and PMS,
and-
Dr. Michael Koren (17:51):
-so for migraines that's a common
complaintWhat is the dietary solution for
that?
We talk about caffeine andthings like that as a dietary
solution, but educate us alittle bit more on that.
Dr. Michael Greger (18:04):
Yeah, so certainly there's.
Many people with migraines dohave dietary triggers.
So one can do kind of anexclusion diet and then slowly
add back some of the foods thatare more common triggers to see
if they're indeed are luckyenough that there is indeed some
kind of food sensitivity thatthey can then eliminate.
(18:26):
In terms of treatment, though,ground ginger, 1/4 teaspoon of
ground ginger that you can buyat any store compares well to
some of the abortive migrainetreatments that we would
normally prescribe for reducingpain duration and so something
like that, where it's just likeyou know you never there's no,
(18:50):
there's no, you know big gingerisn't out there, it can't put
ads on TV, but these kind ofsafe, simple, side effect free
solutions can sometimes be quitepotent and compare favorably to
you know, something an NSAID,NSAID um, ibuprofen which is uh
(19:10):
lots uh of- potentially be uhum rare cases.
Dr. Michael Koren (19:21):
That's great.
Well, Michael, this has been afabulous conversation.
Any, any parting words for ouraudience or anything, um
anything you think is importantfor people to hear as a
take-home lesson.
Dr. Michael Greger (19:32):
I think it's important that one need not
make drastic changes.
It's not all or nothing.
Even basic common-senselifestyle behaviors can mean
living a decade longer notsmoking, not being obese,
regular exercise, more fruitsand vegetables.
You know, it's never too lateto stop smoking, never too late
to start moving, never too lateto start eating healthier.
(19:53):
We really do have the power.
Dr. Michael Koren (19:55):
So, Michael, I'm really curious to ask you do
you feel like people need astrict vegetarian diet to get
their maximum health benefits?
Dr. Michael Greger (20:04):
We should try to eat primarily plants, not
necessarily exclusively plants.
A plant-based diet is reallymore just about maximizing the
intake of the healthiest foods.
Right as a physician labelslike vegetarian, vegan, that
just tells us what people don'teat.
I mean, do you actually eatvegetables?
If you look at the Blue Zonesfood guidelines, for example,
(20:26):
which is based on more than 150dietary surveys of the world's
longest living populations.
They recommend eating at least95% plant-based, but that could
include 100 calories of animalproducts a day.
So like a tablespoon of butterevery day, a container of Greek
yogurt, a third of a lamb chopor something.
So really meat seen more as acondiment or flavoring rather
than a big chunk at the centerof the plate.
Dr. Michael Koren (20:47):
That makes sense.
My other question is what areyour views about the use of less
than high levels of alcohol?
There's some controversy aboutwhether or not people who are
light to moderate drinkers areat health risk, balancing cancer
risk versus potentialcardiovascular benefits.
Dr. Michael Greger (21:05):
Yeah well, everyone agrees that heavy
drinking, drinking duringpregnancy and binge drinking bad
ideas.
But there's been thiscontroversy about moderate
drinking, not with regards tocancer, but since cancer is
killer number two, heart diseasekiller number one, and we
thought there might be somebenefit.
That's why there hasn't been astronger public health message
against drinking.
Those who live the longest tendto not be abstainers, but those
(21:28):
who imbibe a few drinks a week.
Unfortunately, this appears tobe an artifact of the so-called
sick-quitter effect arising fromthe systematic
misclassification of formerdrinkers as lifelong abstainers.
It's the same reason.
You can find studies that findhigher mortality rates among
those who quit smoking comparedto those who continue to smoke.
(21:49):
It's not that abstention led topoor health, but rather poor
health led to abstention.
So you know, according to theGlobal Burden of Disease Study
of the World Health Organization, the World Heart Federation,
the safest level of drinking isnone.
You know, grapes, barley andpotatoes best eaten in their
non-distilled form, and JohnnyWalker, no substitute for actual
walking.
Dr. Michael Koren (22:08):
Michael, thank you for your insights.
I truly enjoyed it.
Thank you for educating me andthank you for being a guest on
MedEvidence.
Dr. Michael Greger (22:16):
I'm honored.
Keep up the great work.
Dr. Michael Koren (22:18):
Thank you.
MedEvidence.
Announcer (22:18):
Thanks for joining the MedEvidence podcast.
To learn more, head over toMedEvidencecom or subscribe to
our podcast on your favoritepodcast platform.
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