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In this episode of Rollback, Rich Roll interviews Dr. Michelle McMacken, a board-certified internist and Executive Director of Nutrition and Lifestyle Medicine for New York City Health and Hospitals, specializing in plant-based nutrition. Dr. McMacken discusses her work at Bellevue Hospital, the oldest continuously operating hospital in the U.S., which serves a diverse patient population, many of whom are uninsured or on government-sponsored insurance. She emphasizes the importance of providing state-of-the-art care to all patients, regardless of their ability to pay. Dr. McMacken shares her journey into medicine, highlighting her background in English literature and her work at the CDC, which inspired her to pursue a medical career. She notes the lack of nutrition education in medical training, stating that many doctors are unprepared to advise patients on dietary changes, particularly for chronic diseases like diabetes and heart disease. This gap in education drives her mission to teach fellow medical professionals about the importance of nutrition in preventing and treating chronic illnesses. She recounts a pivotal moment at a conference on lifestyle medicine, where she connected with like-minded professionals and realized the potential of lifestyle changes in patient care. Dr. McMacken describes her approach to patient interactions, using motivational interviewing to help patients make gradual dietary changes. She emphasizes the importance of crowding out unhealthy foods with nutritious options rather than focusing solely on restrictions. Dr. McMacken advocates for a whole food, plant-based diet, highlighting the consensus around eliminating processed foods and increasing fiber intake. She shares success stories from her practice, illustrating how dietary changes can lead to significant health improvements, such as lowering cholesterol levels without medication. The conversation also touches on the challenges of promoting healthy eating in underprivileged communities, where access to nutritious foods can be limited. Dr. McMacken encourages patients to seek affordable options, such as frozen vegetables and legumes, and emphasizes the need for education about food sources and nutrition labels. In closing, Dr. McMacken expresses her commitment to aligning her medical practice with her values of compassion and sustainability, urging others to educate themselves about their food choices and advocate for systemic changes in food policy.

Dr. Aseem Malhotra discusses the flawed cholesterol hypothesis, stating that lowering LDL cholesterol does not correlate with reduced heart attacks or strokes. He emphasizes that the focus on cholesterol has led to harmful dietary practices, such as the demonization of saturated fats, which has increased the consumption of ultra-processed foods linked to chronic diseases. Malhotra argues that heart disease is primarily driven by lifestyle factors, including diet, exercise, and stress, rather than cholesterol levels alone. He highlights the minimal benefits of statins, noting that they primarily work through anti-inflammatory effects rather than cholesterol reduction. He advocates for a Mediterranean diet rich in whole foods and emphasizes the importance of addressing psychosocial stress as a significant risk factor for heart disease. Malhotra also critiques the pharmaceutical industry's influence on medical guidelines and the over-medication of patients, suggesting that lifestyle changes should be prioritized over drugs. He calls for a shift in focus towards reducing ultra-processed food consumption and improving community relationships to enhance overall health. Malhotra's upcoming documentary, "First Do No Pharm," aims to explore the consequences of an over-medicated society and promote lifestyle interventions for better health outcomes.

Three macronutrient-based rules govern carbohydrate intake: avoid processed carbs, prioritize whole fruits and vegetables, and focus on protein and fat. Insulin resistance is the foundation of type 2 diabetes, which can be reversed through dietary changes rather than medication. A study showed that 11 women with diagnosed type 2 diabetes reversed their condition in 90 days through a dietary intervention aimed at lowering insulin without medication. To reduce insulin levels, fasting is the most effective method, as it allows insulin to drop quickly. When eating, focus on fats and proteins to keep insulin low. The conventional dietary paradigm, which emphasizes carbohydrates, is flawed; humans do not need essential carbohydrates. Instead, prioritize nutrient-dense animal proteins and healthy fats. Insulin resistance develops when fat cells become hypertrophic, leading to the release of free fatty acids and pro-inflammatory molecules that disrupt insulin signaling. To combat this, a low-insulin approach—controlling carbohydrates and prioritizing protein and fat—is recommended. Meal timing is also crucial; eating earlier in the day is more beneficial for metabolic health.

In this episode of "Armchair Expert," Dax Shepard and Monica Padman interview Dr. Steven Gundry, a cardiologist and author known for his focus on diet after performing over 10,000 surgeries. Dr. Gundry discusses his background, including growing up in Omaha, Nebraska, and his journey through medical school at Yale and the Medical College of Georgia, where he specialized in cardiothoracic surgery. Dr. Gundry shares his transition from surgery to diet after a patient, referred to as "Big Ed," experienced significant heart health improvements through dietary changes. This prompted him to explore the impact of nutrition on health, leading to his books, including *The Plant Paradox* and *The Longevity Paradox*. He emphasizes the importance of a plant-based diet, particularly highlighting olive oil's benefits and the commonality among "blue zones," regions where people live significantly longer. The conversation touches on the role of lectins, proteins found in many plants that Dr. Gundry believes can cause health issues by disrupting gut health. He explains how lectins can lead to leaky gut syndrome, which he links to various autoimmune diseases. Dr. Gundry argues that modern diets, filled with processed foods and antibiotics, have compromised our microbiomes, making us more susceptible to these issues. He also discusses the microbiome's crucial role in health, stating that a healthy gut can prevent many diseases. Dr. Gundry shares personal anecdotes about his health journey, including weight loss and improved well-being after adopting a diet rich in plant-based foods and supplements. Throughout the episode, Dr. Gundry addresses criticisms of his views, particularly regarding the effects of lectins and the plant-based diet. He maintains that while there are various dietary philosophies, individual responses to food can vary greatly, making personalized nutrition essential. The discussion concludes with a reflection on the evolving understanding of nutrition and health, emphasizing the need for ongoing research and adaptation in dietary practices.

Rich Roll introduces Simon Hill, a nutrition expert and author of "The Proof Is In The Plants," emphasizing the importance of a plant-predominant diet for human and planetary health. They discuss the confusion surrounding nutrition science, the impact of misinformation, and the need for evidence-based dietary choices. Simon shares his background, including his father's health crisis that sparked his interest in nutrition. He highlights the importance of being open to changing one’s views based on scientific evidence and the necessity of a rational approach to nutrition amidst the extremes often seen in social media. Simon explains that while genetics play a role in health, lifestyle choices significantly influence disease risk, with studies showing that lifestyle accounts for about 80% of health outcomes. He recounts how his brother's shift to a plant-based diet influenced him to explore nutrition science, leading to his master's degree in the field. Simon emphasizes that an optimal diet is characterized by low saturated fat, high fiber, and minimal ultra-processed foods, which can lead to better health outcomes. They delve into the hierarchy of scientific evidence, discussing the reliability of different types of studies, from expert opinions to randomized controlled trials and meta-analyses. Simon stresses the importance of understanding this hierarchy to navigate the conflicting narratives in nutrition science. He notes that while some studies may seem to support certain diets, the broader body of evidence often points to the benefits of a plant-predominant diet. The conversation shifts to saturated fat and its link to heart disease, with Simon explaining that the relationship is well-established in scientific literature. He addresses the criticisms of Ancel Keys, a pivotal figure in nutrition science, clarifying that his research supports the idea that high saturated fat intake increases heart disease risk. Simon also discusses the emerging trend of vilifying seed oils, arguing that while ultra-processed foods should be avoided, the evidence does not support the notion that seed oils are inherently harmful. They explore the environmental implications of dietary choices, with Simon highlighting that animal agriculture is a major contributor to greenhouse gas emissions and deforestation. He advocates for a shift towards plant-based diets to mitigate these issues, emphasizing the inefficiency of animal farming in terms of land use and resource allocation. Simon points out that regenerative agriculture practices can improve soil health but cautions against the notion that they can fully offset the environmental impact of livestock farming. The discussion touches on the need for a cultural shift towards stewardship of the land, with Simon referencing successful rewilding projects that demonstrate the benefits of excluding livestock from certain ecosystems. He concludes by emphasizing the importance of reducing meat consumption to free up land for more sustainable agricultural practices and to restore biodiversity. Finally, Simon shares that proceeds from his book will support conservation efforts in the Daintree Rainforest, highlighting the interconnectedness of health, environment, and indigenous stewardship. He encourages listeners to embrace a plant-predominant diet for both personal health and the health of the planet, reinforcing the message that small changes can lead to significant benefits for individuals and the environment.

In this conversation, Rich Roll speaks with Michael Greger, Blake Curtis, and Nathan Pritikin about nutrition, health, and the impact of lifestyle choices on chronic diseases. Greger discusses his extensive travel schedule, giving lectures in over 200 cities, and his commitment to producing educational content on nutrition through books and videos. He emphasizes the importance of evidence-based information and the challenges of navigating conflicting studies in the field of nutrition. Greger highlights the significance of plant-based diets, particularly in reversing heart disease, which he argues should be the default diet given its proven benefits. He shares anecdotes of patients who have dramatically improved their health by adopting a whole food plant-based lifestyle. The discussion touches on the psychological aspects of dietary changes, noting that emotional factors often hinder individuals from making lasting changes, despite having access to information. The conversation also addresses the challenges within the healthcare system, where lifestyle interventions are often not prioritized or reimbursed. Greger advocates for a shift in incentives to promote healthier eating habits and reduce reliance on medications for chronic diseases. He reflects on the legacy of Nathan Pritikin, who pioneered the idea that heart disease could be reversed through diet, and how this inspired Greger's own work. Greger shares practical advice for those looking to improve their health, encouraging them to start with small, manageable changes and to utilize resources like his Daily Dozen app and the 21-day kickstart program from the Physicians Committee for Responsible Medicine. He emphasizes the importance of whole foods, fiber, and the microbiome in achieving optimal health and weight loss. Overall, the discussion underscores the need for a cultural shift towards plant-based eating, the importance of scientific literacy in nutrition, and the potential for individual empowerment through informed dietary choices.

In this conversation, Rich Roll and Dr. Michael Klaper discuss the critical need for nutrition education in medical schools. Dr. Klaper, a physician for 47 years, emphasizes the glaring absence of nutrition in medical training, which often leads to misdiagnoses and ineffective treatments. He has initiated the "Moving Medicine Forward" campaign, collaborating with PlantPure Communities to lecture at medical schools about the impact of diet on health, reaching nearly 20 institutions so far. Dr. Klaper's lectures aim to connect food choices with diseases like obesity, diabetes, and heart conditions, arguing that many chronic diseases are reversible through a whole food, plant-based diet. He highlights the importance of educating future doctors about the consequences of patients' diets, which are often overlooked in traditional medical training. He notes that students are increasingly receptive to these ideas, influenced by documentaries like "Forks Over Knives" and "What the Health." Despite the growing acceptance among students, Dr. Klaper points out that institutional resistance remains, as many professors are entrenched in traditional dietary paradigms. He advocates for a shift in medical education, including the incorporation of nutrition questions into national board exams, to legitimize the importance of dietary knowledge in medical practice. Dr. Klaper also addresses the confusion surrounding various diet trends, such as keto and paleo, asserting that while initial improvements in health may occur, these diets can lead to long-term health issues. He stresses that humans are primarily plant-eating creatures and that a diet rich in whole plant foods is essential for optimal health. The conversation concludes with Dr. Klaper sharing his vision for a healthcare system that rewards preventive care and healthy living, suggesting that financial incentives could encourage healthier choices among patients. He encourages listeners to seek out plant-based doctors and resources to support their health journeys.

Poor diets are responsible for more disease and death than physical inactivity, smoking, and alcohol combined. Cardiovascular disease remains the leading cause of death, yet medications have not effectively addressed this issue. Insulin resistance is identified as the main pathophysiological process behind heart disease, and no pill effectively targets it. Dr. Aseem Malhotra, a board-certified cardiologist, emphasizes the need for dietary and lifestyle changes to combat chronic diseases. Dr. Malhotra's journey into cardiology was influenced by personal tragedy, including the loss of his brother to heart failure and his father's unexpected cardiac arrest. He became an advocate for improving public health, particularly in addressing obesity and the food environment in hospitals. He highlights the disconnect between medical advice and hospital food offerings, questioning how patients can change their lifestyles when unhealthy food is readily available. The podcast discusses the flaws in the medical system, particularly regarding cholesterol and statin medications. Dr. Malhotra argues that lowering LDL cholesterol does not correlate with reduced heart disease risk and that many patients experience adverse effects from statins. He stresses that lifestyle changes, particularly diet, can significantly improve metabolic health and reduce cardiovascular risk. Dr. Malhotra advocates for a low-carb Mediterranean diet, emphasizing the importance of reducing sugar and starch intake. He also highlights the impact of stress on heart disease, equating chronic stress to smoking in terms of health risks. The conversation calls for systemic changes to improve the food environment and public health policies, aiming to make healthy choices more accessible. Ultimately, Dr. Malhotra's mission is to enhance patient outcomes and promote a healthier society through informed lifestyle choices.

Dr. Joel Kahn discusses heart health assessments, emphasizing that feeling good is not enough to ensure a healthy heart. He recommends a coronary artery calcium CT scan, ideally aiming for a score of zero, which indicates no calcified plaque. If the score is not zero, lifestyle changes are necessary. For a more comprehensive view, a CT angiogram can be performed, though it is not the first test to consider. Kahn highlights the importance of blood tests, particularly hemoglobin A1c for blood sugar levels, fasting insulin, hsCRP for inflammation, and lipoprotein little a (LP(a)), a genetic cholesterol that can be harmful. He also mentions APO lipoprotein B (APO B), which aggregates all bad cholesterol particles into one number, helping to assess cardiovascular risk. He stresses the significance of lifestyle factors such as diet, sleep, and exercise in managing heart health. Kahn advocates for a whole food, plant-based diet, while acknowledging that individuals can have varying dietary needs. He notes that high LDL cholesterol levels can exist alongside good metabolic health, underscoring the need for personalized assessments. Kahn also discusses the role of supplements, particularly aged garlic extract and a product called Arterial Protect, which contains Gotu Kola and Pycnogenol, both shown to reduce plaque. He cautions against high doses of vitamin K2, as recent studies show no significant impact on calcium scores. The conversation touches on the importance of strength training and adequate protein intake for muscle mass and metabolic health. Kahn references Dr. Walter Longo's research advocating for lower protein intake for longevity, suggesting a balanced approach to diet and exercise. Finally, Kahn emphasizes the need for proactive heart disease screening, particularly for high-risk populations like South Asians, and encourages individuals to seek personalized medical advice to ensure optimal heart health.

Plants and animals are in a constant struggle, with plants using biological warfare to deter predators. Humans have developed defenses against plant compounds, such as stomach acid and a diverse gut microbiome. Dr. Steven Gundry, a renowned cardiologist, shares his transformative journey after treating a patient named Big Ed, who reversed severe coronary artery disease through dietary changes and supplements. This experience led Gundry to reevaluate his own health, resulting in significant weight loss and improved health markers. He emphasizes that modern diets often lack essential nutrients, contributing to chronic inflammation and health issues. Gundry discusses the dangers of lectins found in certain plants and the importance of understanding which foods support health. He advocates for a diet rich in fermented foods and supplements to restore gut health. Additionally, he highlights the link between oral health and cardiovascular disease, urging attention to both areas for overall well-being. Gundry's work encourages a shift in focus from medication to nutrition for preventing disease.

Sixty-six percent of heart-related deaths occur without obvious symptoms. Five unusual signs may indicate an unhealthy heart: poor sleep, random anxiety, fatigue after small efforts, shortness of breath, and cold hands and feet. Poor sleep can signal hormonal issues or stress, while random anxiety might indicate underlying health problems. Fatigue after minor activities, like climbing stairs, is a significant red flag. Shortness of breath during normal activities and cold extremities can point to circulatory issues. To improve heart health, diet plays a crucial role. A high-protein diet enhances insulin sensitivity, which is linked to heart health. Eating a high-protein breakfast can help regulate blood sugar throughout the day. Avoiding processed foods is essential, as they contribute to overeating and obesity. Many people can lose significant weight simply by eliminating processed foods from their diet without feeling deprived. Saturated fats have a complex relationship with heart health; some individuals may need to monitor their intake due to genetic factors, while others can consume them without adverse effects if their overall diet is healthy. Fiber is also vital for heart health, aiding digestion and satiety. Increasing fiber intake through fruits and vegetables can alleviate digestive issues. Boosting nitric oxide levels is beneficial for heart health. Nitric oxide dilates blood vessels and improves blood flow, which can be enhanced through diet (e.g., beets) and exercise, particularly strength training and sauna use. Regular sauna sessions can significantly reduce heart-related mortality. Daily movement, such as walking 8,000 steps, is recommended for heart health, alongside avoiding smoking, which is a major risk factor for cardiovascular disease. Personal trainers should focus on building relationships with local businesses and offering free classes to attract clients. Mentorship for new trainers is crucial for retention and success in the fitness industry.

Food is a fundamental aspect of human life, providing essential nutrients and energy while fostering cultural connections. Sixteen years ago, the host experienced a health scare that prompted a shift to a 100% plant-based diet, leading to improved health and performance. This episode focuses on plant-based nutrition, starting with Dr. Gemma Newman, who addresses social challenges faced by those adopting a plant-based lifestyle. She emphasizes the importance of aligning food choices with personal values, such as health, animal compassion, or environmental concerns, to navigate social situations effectively. Dr. Newman also discusses the complexities of relationships when one partner chooses a plant-based diet. She advises patience and encourages individuals to focus on their own happiness rather than imposing expectations on their partners. The conversation highlights the need for gradual changes in dietary habits, suggesting starting with one plant-based meal per week. Simon Hill, a nutrition expert, identifies common pitfalls for those transitioning to a plant-based diet, including calorie density and nutrient awareness. He stresses the importance of planning to ensure adequate nutrient intake, particularly for vitamin B12, vitamin D, omega-3 fatty acids, and others. Dr. Dean Ornish discusses the holistic benefits of a whole foods plant-based diet, emphasizing its role in reversing chronic diseases and improving overall health. He highlights the impact of diet on gene expression and aging, noting that lifestyle changes can enhance brain health and cognitive function. Dr. T Colin Campbell shares insights from his research, revealing that animal protein can increase cancer risk and that plant-based diets offer protective benefits. Dr. Michael Greger discusses practical strategies for maintaining a healthy plant-based diet, including meal preparation and the importance of fiber. Dr. Ayesha Sherzai and Dr. Dean Sherzai emphasize the connection between diet and brain health, advocating for foods rich in antioxidants and anti-inflammatory properties to reduce the risk of neurodegenerative diseases. They highlight the significance of lifestyle choices in managing Alzheimer's risk. Overall, the episode underscores the transformative potential of a plant-based diet for health, longevity, and disease prevention, while addressing the social and psychological challenges individuals may face in adopting this lifestyle.

Rich Roll hosts a conversation with Dean and Anne Ornish, pioneers in lifestyle medicine and plant-based diets. They discuss the decline of the low-fat diet craze, emphasizing that the issue was not the diet itself but people's failure to adhere to it. Dean Ornish explains that their approach focuses on a Whole Foods plant-based diet, which is low in fat and sugar, combined with stress management, exercise, and social support. He highlights that over the decades, despite being labeled as the "low-fat guy," his work has consistently shown that lifestyle changes can reverse chronic diseases, including heart disease, type-2 diabetes, and even Alzheimer's. The Ornishes address the confusion surrounding saturated fat and cholesterol, noting that while some recent studies have suggested a shift in perspective, their research indicates that saturated fat increases the risk of various health issues. They argue that animal protein is inflammatory and contributes to chronic diseases, while plant-based proteins offer protective benefits. Dean Ornish critiques the media's role in perpetuating diet myths, emphasizing the need for accurate information and the importance of lifestyle changes over quick fixes. They discuss the significance of community and support in making lasting lifestyle changes, stressing that emotional well-being is crucial for health. The Ornishes advocate for a holistic approach, integrating diet, exercise, stress management, and love into healthcare. They share personal stories of transformation and the importance of finding meaning and purpose in life, which can motivate individuals to adopt healthier habits. The conversation touches on the systemic challenges in healthcare, including the need for lifestyle medicine to be recognized and reimbursed by insurance. Dean Ornish recounts his efforts to get Medicare to cover lifestyle interventions, highlighting the positive outcomes of their programs. They express optimism about the growing movement towards lifestyle medicine and the potential for significant change in public health. The Ornishes encourage listeners to reflect on their motivations for wanting to live longer and better, emphasizing that personal agency and self-awareness are key to making meaningful changes. They conclude by inviting people to explore their new book, "Undo It," which encapsulates their philosophy and provides practical guidance for adopting a healthier lifestyle.

In this episode of Rich Roll's podcast, Dr. Kim Williams, former president of the American College of Cardiology, discusses the critical issue of cardiovascular health, highlighting that one in three Americans will die from heart disease, a largely preventable condition. Dr. Williams emphasizes the role of diet and lifestyle changes in preventing and reversing heart disease, particularly focusing on the dangers of sugar and processed foods. He critiques the sugar industry's influence on research, revealing how funding has historically shifted attention away from sugar's harmful effects towards saturated fat. Dr. Williams also addresses the socioeconomic disparities in health, noting that unhealthy food options disproportionately affect lower-income communities. He advocates for changes in programs like SNAP to promote healthier food choices and reduce healthcare costs. He shares insights from his own transition to a plant-based diet in 2003, motivated by both personal health concerns and the desire to set an example for his patients and colleagues. The conversation touches on the complexities of nutrition research, the importance of independent studies free from industry bias, and the need for better public health messaging. Dr. Williams stresses that while exercise is beneficial, it cannot compensate for a poor diet. He encourages a holistic approach to health, advocating for community engagement and education to address health disparities. Ultimately, he calls for a shift in focus towards prevention and healthier lifestyle choices to combat the rising rates of heart disease in America.