This is a rough transcript of a video by Public Health Nutritionist Dr. Radak, RDN, MPH
As a public health nutritionist and Plant-Based researcher, I would like to share a different perspective. I am not looking to debate. I am only providing a science-based critique and view to consider.
Dr. Ede seems to be saying that for most of us have been misled and feeding our brains incorrectly. And that her health symptoms resolved by not following the standard recommendations. Instead she is following an animal protein centric diet replete with cholesterol and saturated fat, low in fiber and plants. She is not convinced we need anything beyond meat. But with a sample size of 1 does research reflect that? Additionally, she says there is almost no science, biology, or logic behind the majority of current recommendations for a healthy diet, mentioning: whole grains, legumes, a wide variety of fruits and vegetables, nuts, and seeds, as examples. She adds that recommendations for increasing plants are also a concern as some plants are not equally nutritious or safe and have more risks than benefits.
Questioning this perspective, with fiber alone there is plenty of research (including randomized trials) demonstrating beneficial effects via the production of anti-inflammatory compounds in the gut or the gut-brain axis. Separately, there are potential harms from animal products (which contain no fiber) that produce either the microbial metabolite, Trimethylamine N Oxide which has been associated with neuro-inflammatory processes or advanced glycation end products (Łuszczki, 2023; Solanki, 2023; Guan 2021; Mitrea, 2021; Czarnik, 2024; Grant, 2023; Kahleova, 2024; Katonova, 2022).
Why when comparing a Plant-Based diet to a high fat and saturated fat Atkins diet for 4 weeks showed large increases in Trimethylamine N Oxide as well as branched-chain amino acids in plasma which are known cardiovascular risk factors (Park, 2019)?
Why is it that omnivores have a worse inflammatory profile than vegetarians (Franco-de-Moraes, 2017)? It is interesting that she mentions we do not need any carbohydrate at all and can make glucose from fats and protein ‘smoothly’ which ignores some of the benefits of carbohydrates and ignores some of the risks from meaty diets rich in protein and fat.
And the glucose spike from exogenous carbs? Yes, refined carbs certainly but complex carbs from nutrient dense plants? A few examples…
Why do trials with Plant-Based diets do better at controlling and improving glycemic control, insulin resistance and reducing risk for (or reversing) type 2 diabetes and cardiometabolic risk factors than non-vegetarian diets as well as reducing inflammatory markers (Eichelmann, 2017; Kelly, 2020; Jardine, 2021; Del Carmen, 2024)?
One reason may be because of protective nutrients like polyphenols or fiber which can may inhibit glucose absorption while enhancing insulin-dependent glucose uptake (Katonova, 2022). This may also be why a recent meta-analysis of studies in over 1.4 million people found a significant increased risk for type 2 diabetes with meat intake (either processed or unprocessed) and further increases with each 20g portion, while plant protein sources did not (Fotouhi Ardakani, 2024).
Why is it that vegan or vegetarian diets in trials or diet interventions have all resulted in improvement in inflammatory autoimmune diseases like rheumatoid arthritis, lupus nephritis, systemic lupus erythematosus and Sjögren’s syndrome patients (Barnard, 2022; McDougall, 2022; Fujita, 1999; Hafström, 2001; Kjeldsen-Kragh, 1991; Hänninen, 1999; Müller, 2001; Goldner, 2019; Goldner, 2024)?
I agree a poorly planned diet that promotes excess insulin is not good. But refined carbs are the concern not whole-food based carbohydrates. Conversely, several studies suggest saturated fat is implicated in reducing insulin sensitivity by incorporation into cell membranes affecting insulin response (Marsh, 2010). We absolutely need to get a handle on the processed food and saturated fat we consume.
No doubt the Standard American Diet is bad for brain health and contributes to just about every chronic disease. And she is correct in relating inflammation to brain health and the benefit from antioxidants. Processed foods addictive nature containing refined sugars incite inflammation and are not nutrient dense. They make up over 50% of total caloric intake and are a relatively recent phenomenon (thank you food industry!). And they have been associated with mental health issues, depression and anxiety, cognitive decline, dementia, and Alzheimer’s disease (Dai, 2024; Li, 2022; Gomes Gonçalves, 2023; Claudino, 2024).
So yes, a diet approach to brain health is important. But to advocate for the consumption of meat and cholesterol and exclaim hazards of plants is not an accurate determination based on the available research. If plants, fruits and vegetables, spices are so harmful to our health why is it that some of the longest living people (blue zones) on the planet consume mostly plants? Why does the Tsimane and Moseten tribes in Amazon rainforest have some of the lowest incidence of Alzheimer’s Disease and dementia in the world as well as less age-related brain atrophy while eating a predominantly complex carb diet, low in fat and saturated fat (Gatz, 2022; Kraft, 2018; Irimia, 2021)?
Or why have Plant-Based diet interventions been shown to lower blood pressure, angina and even reverse type 2 diabetes? I was lost about the topic of how plants store energy (carbs) and humans do not and store as fat. Why the comparison? No one would argue that but it would be a stretch to say humans need to get exogenous fat rather than carbs simply because we store fat or because the body only has about a day’s worth of glucose stored.
To exclude other well-known disease risks with meat consumption, particularly colorectal cancer is also a concern (Vieira, 2017; Papadimitriou, 2021). It should not be ignored that the World Health Organization classified processed meat as a group 1 carcinogen and red meat as a “group 2A probably carcinogenic”. Additionally, there is significant non-observational research to demonstrate the hazards of animal product intake on our nation’s top killer, cardiovascular disease. Ingestion of a fatty meal can induce post-prandial lipemia and Angina pectoris for 5 hours after ingestion (Kuo, 1955) which can promote inflammation and injure the arterial endothelium. Saturated fat in clinical studies was found to be more harmful than simple sugars and increases insulin resistance (Luukkonen, 2018). Oxidized lipoproteins/cholesterol by consuming cooked meat is absorbed into the bloodstream and injures the endothelial lining inciting atherogenesis by plaque formation (Staprans, 2003). Metabolic studies support saturated fat as adversely affecting coronary heart disease risk (Zaloga, 2006) with meat-based diets increasing blood viscosity compared to vegetarian diets which reduced blood viscosity. The latter likely due to the high levels of antioxidants and low levels of saturated fats in plants (Ernst,1995; Naghedi-Baghdar, 2018; Sloop, 2018). An analysis of studies looking at high protein intake suggested that consumption of high protein diets may affect immune cells leading to arterial plaque formation (Zhang, 2024).
What is the only diet I am aware of that actually can reverses cardiovascular disease? A vegan diet (Esselstyn, 2014) or Plant-Based diet and lifestyle (Ornish, 1998). Several case studies on patients demonstrates improvement in heart failure symptoms, reversal of Angina and one whose Angina returned with the resumption of an animal product rich diet (Massera, 2015; Massera, 2016; Allen, 2019; Choi, 2017).
Will taking patients with CVD and changing their diet to a keto or animal dominant diet yield the same results? LDL cholesterol for example is a known risk factor for CVD and not just from observational studies. A recent meta-analysis of low carb trials suggests an overall increase in LDL cholesterol in normal weight people (Soto-Mota, 2024). And while observational studies did not find low carb diets to increase CVD incidence, that is probably because most are not able to stay on the diet for long periods of time. What is consistent however is the 30% increase in overall mortality from following low carb diets as the Scientific Statement from the National Lipid Association Nutrition and Lifestyle Task Force noted (Kirkpatrick, 2019). A recent clinical trial looking at the keto diet for 12 weeks suggested that in addition to the predictable loss in fat mass, restricting carbohydrates via reducing glucose tolerance negatively impacted the gut microbiome with reduced beneficial gut bacteria, with the authors suggesting that the results did not necessarily produce a cardiometabolic health benefit that would have been expected by the weight loss observed (Hengist, 2024).
Having once eaten as an omnivore, I’ve followed what the preponderance of research has suggested. Following a whole food (minimally processed) Plant-Based diet is the ‘best bet’ for reducing chronic disease risk and maintaining brain health, while also leaving a smaller environmental footprint. I’ve written about the topic of brain health extensively addressing diet and other lifestyles factors primarily to address those who follow vegan diets. But this is still useful for any dietary pattern and addresses meat, cholesterol, and glucose and why some are calling Alzheimer’s Disease “Type 3 Diabetes: https://radaktim.wixsite.com/website/post/omega-3-diet-and-lifestyle-factors-influencing-brain-health
It is important to be careful in advocating something for just one disease state such as brain health without factoring in other diseases or the environment. And to exclude the relation between food choices and the environment is increasingly considered irresponsible (Storz, 2020) and in my opinion selfish. Food systems account for roughly a third of global greenhouse gas emissions. A lot of research is happening in this area.
Shifting from red meat to principally Plant-Based proteins could result in global annual dietary emissions falling 17% (Li, 2024). Even a flexitarian diet approach can considerably reduce greenhouse gas emissions (Humpenöder, 2024). Even compared to a Mediterranean diet, a vegan diet was suggested to incur a 44% less total environmental impact (Filippin, 2023). It is important to care for our health and we have a responsibility to care for our planet too.
A meat diet was suggested to affect greenhouse gas emissions twice as much as vegan diets with the latter using less water, less land, and resulting in less loss of biodiversity (Scarborough, 2024). Just research the loss of precious rainforest land due to animal agriculture in south America. All important things to consider if deciding to follow a carnivore, paleo, or ketogenic diet.
This is what happens when a psychiatrist delves into diet as we’ve seen with others like psychologist Jordan Peterson. And even physicians who are not trained in nutritional science like Dr. Gundry underscore the importance of having a solid background in nutrition or seeking input from those who do. Yes, like many areas of science and medicine, there can be incorrect or biased information. And the federal dietary guidelines as well have a way to go with translating and disseminating the available research. But to say there is almost no science, biology, or logic behind the majority of recommendations for a healthy diet (she mentioned whole grains, legumes, a wide variety of fruits and vegetables, and more plants), and there is no value in epidemiological studies, and advocate meat and exogenous cholesterol in the context of ignoring the other diseases and environmental risks, does not seem wise. She is not looking at all of the available research.
Many of the studies are available freely online. Judge for yourself. Even the Carnivore MD, author of the book The Carnivore Code has reversed his position on the diet and stopped eating the Carnivore diet after 2 years as he saw his testosterone levels drop and it caused sleep disturbances, heart palpitations, and muscle cramps.
References located:
Allen KE, Gumber D, Ostfeld RJ. Heart Failure and a Plant-Based Diet. A Case-Report and Literature Review. Front Nutr. 2019 Jun 11;6:82.
Barnard ND, Levin S, Crosby L, Flores R, Holubkov R, Kahleova H. A randomized, crossover trial of a nutritional intervention for rheumatoid arthritis. Am J Lifestyle Med. 2022;0(0).
Choi EY, Allen K, McDonnough M, Massera D, Ostfeld RJ. A plant-based diet and heart failure: case report and literature review. J Geriatr Cardiol. 2017 May;14(5):375-378.
Claudino PA, Bueno NB, Piloneto S, Halaiko D, Azevedo de Sousa LP, Barroso Jara Maia CH, Netto BDM. Consumption of ultra-processed foods and risk for Alzheimer’s disease: a systematic review. Front Nutr. 2024 Jan 15;10:1288749.
Czarnik W, Fularski P, Gajewska A, Jakubowska P, Uszok Z, Młynarska E, Rysz J, Franczyk B. The Role of Intestinal Microbiota and Diet as Modulating Factors in the Course of Alzheimer’s and Parkinson’s Diseases. Nutrients. 2024 Jan 19;16(2):308.
Dai S, Wellens J, Yang N, Li D, Wang J, Wang L, Yuan S, He Y, Song P, Munger R, Kent MP, MacFarlane AJ, Mullie P, Duthie S, Little J, Theodoratou E, Li X. Ultra-processed foods and human health: An umbrella review and updated meta-analyses of observational evidence. Clin Nutr. 2024 Jun;43(6):1386-1394.
Del Carmen Fernández-Fígares Jiménez M. Plant foods, healthy plant-based diets, and type 2 diabetes: a review of the evidence. Nutr Rev. 2024 Jun 10;82(7):929-948.
Eichelmann F, Schwingshackl L, Fedirko V, Aleksandrova K. Effect of plant-based diets on obesity-related inflammatory profiles: a systematic review and meta-analysis of intervention trials. Obes Rev. 2016 Nov;17(11):1067-1079.
Ernst E, Franz A. Blood fluidity score during vegetarian and hypocaloric diets – a pilot study. Complementary Therapies in Medicine. 1995;3(2):70–1.
Esselstyn CB Jr, Gendy G, Doyle J, Golubic M, Roizen MF. A way to reverse CAD? J Fam Pract. 2014 Jul;63(7):356-364b.
Filippin D, Sarni AR, Rizzo G, Baroni L. Environmental Impact of Two Plant-Based, Isocaloric and Isoproteic Diets: The Vegan Diet vs. the Mediterranean Diet. Int J Environ Res Public Health. 2023 Feb 21;20(5):3797.
Fotouhi Ardakani, A., Anjom-Shoae, J., Sadeghi, O., Marathe, C. S., Feinle-Bisset, C., & Horowitz, M. Association between total, animal, and plant protein intake and type 2 diabetes risk in adults: A systematic review and dose-response meta-analysis of prospective cohort studies. Clinical nutrition (Edinburgh, Scotland). 2024, 43(8), 1941–1955.
Franco-de-Moraes AC, de Almeida-Pititto B, da Rocha Fernandes G, Gomes EP, da Costa Pereira A, Ferreira SRG. Worse inflammatory profile in omnivores than in vegetarians associates with the gut microbiota composition. Diabetol Metab Syndr. 2017 Aug 15;9:62.
Fujita A, Hashimoto Y, Nakahara K, Tanaka T, Okuda T, Koda M. [Effects of a low calorie vegan diet on disease activity and general conditions in patients with rheumatoid arthritis]. Rinsho Byori. 1999 Jun;47(6):554-60.
Gatz, M et al. Prevalence of dementia and mild cognitive impairment in indigenous Bolivian forager-horticulturalists. Alzheimers Dement. 2023 Jan;19(1):44-55.
Goldner, MD, B. (2019). Six Week Raw Vegan Nutrition Protocol Rapidly Reverses Lupus Nephritis: A Case Series. International Journal of Disease Reversal and Prevention, 1(1).
Goldner B, Staffier KL. Case series: raw, whole, plant-based nutrition protocol rapidly reverses symptoms in three women with systemic lupus erythematosus and Sjögren’s syndrome. Front Nutr. 2024 Feb 27;11:1208074.
Gomes Gonçalves N, Vidal Ferreira N, Khandpur N, et al. Association Between Consumption of Ultraprocessed Foods and Cognitive Decline. JAMA Neurol. 2023;80(2):142–150.
Grant WB, Blake SM. Diet’s Role in Modifying Risk of Alzheimer’s Disease: History and Present Understanding. J Alzheimers Dis. 2023;96(4):1353-1382.
Guan ZW, Yu EZ, Feng Q. Soluble Dietary Fiber, One of the Most Important Nutrients for the Gut Microbiota. Molecules. 2021 Nov 11;26(22):6802.
Hafström I, Ringertz B, Spångberg A, von Zweigbergk L, Brannemark S,Nylander I, et al. A Vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens. Rheumatology. (2001) 40:1175–9.
Hänninen O, Rauma AL, Kaartinen K, Nenonen M. Vegan diet in physiological health promotion. Acta Physiol Hung. 1999;86(3-4):171-80.
Hengist, A., et al. (2024). Ketogenic diet but not free-sugar restriction alters glucose tolerance, lipid metabolism, peripheral tissue phenotype and gut microbiome: RCT. Cell Reports Medicine, 5(8), Article 101667. https://doi.org/10.1016/j.xcrm.2024.101667
Humpenöder F, et al. Food matters: Dietary shifts increase the feasibility of 1.5°C pathways in line with the Paris Agreement. Sci Adv. 2024 Mar 29;10(13):eadj3832.
Irimia A, et al. The Indigenous South American Tsimane Exhibit Relatively Modest Decrease in Brain Volume With Age Despite High Systemic Inflammation. J Gerontol A Biol Sci Med Sci. 2021 Nov 15;76(12):2147-2155
Jardine MA, Kahleova H, Levin SM, Ali Z, Trapp CB, Barnard ND. Perspective: Plant-Based Eating Pattern for Type 2 Diabetes Prevention and Treatment: Efficacy, Mechanisms, and Practical Considerations. Adv Nutr. 2021 Dec 1;12(6):2045-2055.
Kirkpatrick CF, Bolick JP, Kris-Etherton PM, Sikand G, Aspry KE, Soffer DE, Willard KE, Maki KC. Review of current evidence and clinical recommendations on the effects of low-carbohydrate and very-low-carbohydrate (including ketogenic) diets for the management of body weight and other cardiometabolic risk factors: A scientific statement from the National Lipid Association Nutrition and Lifestyle Task Force. J Clin Lipidol. 2019 Sep-Oct;13(5):689-711.e1.
Kjeldsen-Kragh J, Haugen M, Borchgrevink CF, Laerum E, Eek M, Mowinkel P, Hovi K, Førre O. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet. 1991 Oct 12;338(8772):899-902.
Kahleova H, Znayenko-Miller T, Motoa G, et al. Dietary advanced glycation end-products and their associations with body weight on a Mediterranean diet and low-fat vegan diet: a randomized, cross-over trial. Front Nutr. 2024. doi:10.3389/fnut.2024.1426642
Katonova A, Sheardova K, Amlerova J, Angelucci F, Hort J. Effect of a Vegan Diet on Alzheimer’s Disease. Int J Mol Sci. 2022 Nov 29;23(23):14924.
Kelly J, Karlsen M, Steinke G. Type 2 Diabetes Remission and Lifestyle Medicine: A Position Statement From the American College of Lifestyle Medicine. American Journal of Lifestyle Medicine. 2020;14(4):406-419.
Kraft TS, Stieglitz J, Trumble BC, Martin M, Kaplan H, Gurven M. Nutrition transition in 2 lowland Bolivian subsistence populations. Am J Clin Nutr. 2018 Dec 1;108(6):1183-1195
KUO PT, JOYNER CR Jr. Angina pectoris induced by fat ingestion in patients with coronary artery disease; ballistocardiographic and electrocardiographic findings. J Am Med Assoc. 1955 Jul 23;158(12):1008-13.
Li, Y., He, P., Shan, Y. et al. Reducing climate change impacts from the global food system through diet shifts. Nat. Clim. Chang. (2024).
Luukkonen PK, et al. Saturated Fat Is More Metabolically Harmful for the Human Liver Than Unsaturated Fat or Simple Sugars. Diabetes Care. 2018 Aug;41(8):1732-1739
Łuszczki E, Boakye F, Zielińska M, Dereń K, Bartosiewicz A, Oleksy Ł, Stolarczyk A. Vegan diet: nutritional components, implementation, and effects on adults’ health. Front Nutr. 2023 Nov 9;10:1294497
Massera D, Graf L, Barba S, Ostfeld R. Angina rapidly improved with a plant-based diet and returned after resuming a Western diet. J Geriatr Cardiol. 2016 May;13(4):364-6.
Massera D, Zaman T, Farren GE, Ostfeld RJ. A Whole-Food Plant-Based Diet Reversed Angina without Medications or Procedures. Case Rep Cardiol. 2015;2015:978906.
Marsh K, Brand-Miller J. Vegetarian Diets and Diabetes. American Journal of Lifestyle Medicine. 2011;5(2):135-143. doi:10.1177/1559827610387393
McDougall J, Bruce B, Spiller G, Westerdahl J, McDougall M. Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis. J Altern Complement Med. 2002 Feb;8(1):71-5.
Mitrea L, Nemeş SA, Szabo K, Teleky BE, Vodnar DC. Guts Imbalance Imbalances the Brain: A Review of Gut Microbiota Association With Neurological and Psychiatric Disorders. Front Med (Lausanne). 2022 Mar 31;9:813204
Müller H, de Toledo FW, Resch KL. Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review. Scand J Rheumatol. 2001;30(1):1-10
Naghedi-Baghdar H, Nazari SM, Taghipour A, Nematy M, Shokri S, Mehri MR, Molkara T, Javan R. Effect of diet on blood viscosity in healthy humans: a systematic review. Electron Physician. 2018 Mar 25;10(3):6563-6570.
Ornish D., Scherwitz L.W., Billings J.H., Brown S.E., Gould K.L., Merritt T.A., Sparler S., Armstrong W.T., Ports T.A., Kirkeeide R.L., et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280:2001–2007.
Papadimitriou N, et al. An umbrella review of the evidence associating diet and cancer risk at 11 anatomical sites. Nat Commun. 2021 Jul 28;12(1):4579.
Park JE, Miller M, Rhyne J, Wang Z, Hazen SL. Differential effect of short-term popular diets on TMAO and other cardio-metabolic risk markers. Nutr Metab Cardiovasc Dis. 2019 May;29(5):513-517.
Scarborough P, Appleby PN, Mizdrak A, Briggs AD, Travis RC, Bradbury KE, Key TJ. Dietary greenhouse gas emissions of meat-eaters, fish-eaters, vegetarians and vegans in the UK. Clim Change. 2014;125(2):179-192.
Sloop GD, Weidman JJ, St Cyr JA. Perspective: interesterified triglycerides, the recent increase in deaths from heart disease, and elevated blood viscosity. Ther Adv Cardiovasc Dis. 2018 Jan;12(1):23-28.
Solanki R, Karande A, Ranganathan P. Emerging role of gut microbiota dysbiosis in neuroinflammation and neurodegeneration. Front Neurol. 2023 May 15;14:1149618.
Soto-Mota A, Flores-Jurado Y, Norwitz NG, Feldman D, Pereira MA, Danaei G, Ludwig DS. Increased low-density lipoprotein cholesterol on a low-carbohydrate diet in adults with normal but not high body weight: A meta-analysis. Am J Clin Nutr. 2024 Mar;119(3):740-747.
Staprans I, Pan XM, Rapp JH, Feingold KR. Oxidized cholesterol in the diet is a source of oxidized lipoproteins in human serum. J Lipid Res. 2003 Apr;44(4):705-15.
Storz MA. Will the plant-based movement redefine physicians’ understanding of chronic disease? New Bioeth. 2020 Jun;26(2):141-157
Vieira AR, Abar L, Chan DSM, Vingeliene S, Polemiti E, Stevens C, Greenwood D, Norat T. Foods and beverages and colorectal cancer risk: a systematic review and meta-analysis of cohort studies, an update of the evidence of the WCRF-AICR Continuous Update Project. Ann Oncol. 2017 Aug 1;28(8):1788-1802.
Zaloga GP, Harvey KA, Stillwell W, Siddiqui R. Trans fatty acids and coronary heart disease. Nutr Clin Pract. 2006 Oct;21(5):505-12.
Zhang, X., Kapoor, D., Jeong, SJ. et al. Identification of a leucine-mediated threshold effect governing macrophage mTOR signalling and cardiovascular risk. Nat Metab 6, 359–377 (2024).
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